Monthly Archives: March 2015
Also, there is a list of legitimately prescribed drugs on the list shown later in this article. For those people who use prescription drugs “the onus is on the individual to assure themselves that their driving ability is not impaired”.
* You should not drive if you feel dizzy, clumsy or sleepy
Drugs and driving: the law
* you’ve been prescribed them and followed advice on how to take them by a healthcare professional
Penalties for drug driving
a minimum 1 year driving ban
your car insurance costs will increase significantly
One of the things I most enjoy in life is chatting with young people especially my children and their friends and relatives. I love to listen to their zest for life, their enthusiasm to explore the world around them, their hopes and thoughts of the future and most of all their wit and humour, albeit honest and direct. It is good to laugh out loud one minute and then be in serous conversation about where our world is going and what they think ought to be done. I cope with being teased, infact I secretly enjoy it but at the same time they usually show respect for my views. It makes me feel refreshed and inspired to look out for opportunities in my life.
Hence, when I went with my youngest daughter to see The second Marigold hotel, starring actresses such as Judi Dench and Maggie Smith, who I have followed since my late teens, the poignant words at the end said by Maggie Smith ” There is no present like the time” stayed with me and made me write this blog which I published whilst still writing! It was an amusing film, not necessarily outstanding in anyway but not a bad way to spend a late dreary Sunday afternoon. For those that haven’t seen it, it is the story of a group of retired, typically English people (almost cringeworthy) who decide to go to an Indian retirement home rather than face the alternative in England. Before long amidst the chaos they find themselves finding employment of varying sorts and subsequently feeling rejuvenated and stirred into embarking on new intimate liaisons or just simply falling in love’ and generally rekindling a youthful lifestyle. Hence, Maggie Smith’s reflection at the end.
One of the things that prevent us making the most out of time is fear. fear of commitment, fear of the unknown, fear of being hurt or simply fear of being left alone. It doesn’t matter what age we are these feelings loom large. Many people find themselves in a rut, unfulfilled, or suffering a job which they don’t enjoy, being underpaid, putting up with working with a bully or someone who is not pulling their weight. I hear this again and again in surgery and I know the impact it has on their lives and those close to them. Inevitably, if they don’t move on it effects their mental or physical health or both and that’s when they appear in the surgery for help. It is interesting in Chinese medicine that ‘fear’ is the emotion related to the kidney and by weakening the kidneys this impacts on the other major organs. Also, they hold the view that the kidneys are related to fertility and because of this it is important to maintain a balance by avoiding fear and preserving kidney function to become fertile. An interesting idea and over the years I have been aware of several infertile couples becoming pregnant very quickly when they have cast cares and fears aside!
At our CQC inspection the staff were asked if they were happy and whether there was much sick leave and if they were able to talk openly and whistle blow if appropriate. Fortunately, it was remarked by the inspectors that they felt there was a positive atmosphere in the surgery and we fulfilled these criteria. I think on a day to day basis I believe for the most part we do. I also hope that if we don’t that patients and staff alike will be able to complain so that it can be redressed.
I feel very sad when I talk with young people who are trapped and can’t move on, they are lost and without direction. They fear getting a job that doesn’t sound good enough or is not paid well enough, but often taking up the most unlikely job can lead to job of your dreams. General Practice was always furthest from my thoughts, I only went the interview for the training scheme because the scheme was new and they wanted as many applicants as possible to attend in order to promote the new scheme. I was doing nothing on that afternoon and many of my friends were going so I thought I would go along . When I was offered a place I thought the jobs would be useful for my paediatric career. But at this time General Practice was under great change and before long I became drawn to it and I certainly have no regrets.
As we get older the fear can increase so that often people fear leaving the comfort of their homes. However, with the advent of easier travel and better health care I never fail to be astounded at the corners of the Earth our elderly patients venture – from jungles to Antartica. I have often thought it would save the country a lot of money if retired people could have subsidised consecutive cruises to combat loneliness and they would receive excellent day care. I have learnt how oxygen can be arranged from country to country overcoming who is responsible from the aeroplane to the other side of passport control. This was to arrange various ambitious holidays for a patient dependent on constant oxygen, but it was a rewarding challenge! This demonstrated how determination and drive can overcome a disability. Travel is not everyone’s ‘cup of tea’ but it is important to make the best of life while we can and with modern technology there are ways in which the World can be brought to the home. I remember a 90 year old came into the surgery with neck pain. I asked her if she had been polishing or gardening but the she said” I have a confession to make, I bought myself a laptop for my 90th birthday and I think I have been spending too long on it!” She is by no means the only nonagenarian ‘techy’.
My message to young and old seize those opportunities whilst you can as time is precious and not only will you enjoy life and be more fulfilled but it will preserve both your mental and physical health.
There is no present like the time
The letter reprinted:
Mrs Diane Mellitus
6, Sweetwater Drive,
Andover B4 1LL
Dear Dr Down
Thank you for your letter and concern. I am so sorry that I have not been to see you but I have been so busy with decorating and doing jobs around the house and my sister has been ill and my mother was taken into hospital. Also, I couldn’t get an appointment for two weeks to see you and when I go to the surgery I have to wait so long and I just haven’t got the time to wait around. As much as anything I was worried I might pick up something whilst I was waiting that I might pass on to my mother or sister.
Anyway, I have made an appointment next week to have my bloods taken and the following week I have made an appointment to see the nurse and one to see you.
Thank you once again for your concern.
Today someone came into the surgery handed me a copy of an article on Chikungunya virus found on the Internet and said, ” My mother and I are going to Jamaica and should we be worried?” Strangely enough I had just read about Chikunyunya Virus and remembered probably because the name fascinated me.
Chikungunya is a mosquito-borne viral disease first described during an outb
reak in southern
Tanzania in 1952. It is an RNA virus that belongs to the alphavirus genus of the family Togaviridae.
The virus is passed to humans by two species of mosquito of the genus Aedes: A. albopictus and A. aegypti.
Animal reservoirs of the virus include monkeys, birds, cattle, and rodents.
This is in contrast to dengue, for which only humans are hosts.
The name ‘chikungunya’ derives from a word in the Kimakonde language, meaning “to become contorted” and describes the stooped appearance of sufferers with joint pain (arthralgia).
Yes it does exist and is found globally as illustrated below :-
Where Has Chikungunya Virus Been Found?
Countries and territories where chikungunya cases have been reported* (as of March 10, 2015)
* Prior to 2013, chikungunya virus outbreaks had been identified in countries in Africa, Asia, Europe, and the Indian and Pacific Oceans. In fact last year there Were 4 reported cases in Montpelier,France
* In late 2013, the first local transmission of chikungunya virus in the Americas was identified in Caribbean countries and territories. Local transmission means that mosquitoes in the area have been infected with the virus and are spreading it to people.
* Since then, local transmission has been identified in 44 countries or territories throughout the Americas with more than 1.2 million suspected cases reported to the Pan American Health Organization from affected areas.
To verify exactly which countries go to the following link: http://www.cdc.gov/chikungunya/geo/
* Symptoms are generally self-limiting and last for 2–3 days. The virus remains in the human system for 5-7 days
* Most patients recover fully and the illness is mild and it is rarely fatal and then usually in vulnerable people.
* It causes fever and severe joint pain. Other symptoms include muscle pain, headache, nausea, fatigue and rash.
* Joint pain can be debilitating and can vary in duration and may last months or even years.
* Occasional cases of eye, neurological and heart complications have been reported, as well as gastrointestinal complaints. Serious complications are not common, but in older people, the disease can contribute to the cause of death.
* The disease shares some clinical signs with dengue, and can be misdiagnosed in areas where dengue is common.
* There is no treatment or cure for the disease. Treatment is focused on relieving the symptoms using painkillers and anti- inflammatory drugs. It is diagnosed by a simple blood test which can differentiate it from Dengue Fever. There is no vaccine available at present.
The most effective means of prevention are protection against contact with the disease-carrying mosquitoes and mosquito control.
* These include using insect repellents with substances such as DEET (N,N-diethyl-meta-toluamide; also known as N,N’-diethyl-3-methylbenzamide or NNDB), icaridin (also known as picaridin and KBR3023), PMD (p-menthane-3,8-diol, a substance derived from the lemon eucalyptus tree), or IR3535.
* Wearing bite-proof long sleeves and trousers also offers protection.
* In addition, garments can be treated with pyrethroids, a class of insecticides that often has repellent properties. Vaporized pyrethroids (for example in mosquito coils) are also insect repellents.
* Securing screens on windows and doors will help to keep mosquitoes out of the house. In the case of the day-active A. aegypti and A. albopictus, however, this will have only a limited effect, since many contacts between the mosquitoes and humans occur outside.
Something I feel passionate about is the importance of vaccination especially childhood vaccine s which provide vital immunisation against major threatening diseases.
I have during my medical career witnessed the suffering and in many cases deaths relating to these infectious diseases.
I have seen the terror in the eyes of people dying with tetanus, the demise of children with measles the congenital abnormality ( heart defects and delayed development) acquired as an effect of German Measles(Rubella) in the unborn child, infertility as are a result of mumps, the longstanding mobility handicaps following polio aswell as the agonising death from meningitis. I remember one of our patients, a fit healthy lady in early pregnancy contracting pneumococcal pneumonia and was on life- support machine for 5 weeks, fortunately with excellent medical care at Ealing Hospital she survived but sadly had a miscarriage.
We now provide immunisation for these infections.
During the ‘swine flu’ epidemic the intensive care units of all the local hospitals each had several pregnant women fighting for their lives because they had contracted swine flu. This is why we which now offer vaccination to all pregnant women after
However, there will always be those around us who for one reason or another, they may be taking steroids or receiving chemotherapy or for some reason have poor immunity and need as many people around them to be vaccinated and become immunised against a specific infectious disease so that they can be protected from the disease – herd immunity.
The TED talk above given by Romina Libster albeit in Spanish with English subtitles is delivered with the same sentiment and echoes how I feel about the importance of vaccination.
Last year I attended an interesting lecture from a doctor that had recently been diagnosed with dementia. What impressed me was not only her courage at being able to talk about the subject but the fact that having been diagnosed in the early stages she was able to get her affairs in order and have some say in how she wanted to spend the rest of her life as well as share with others what her thoughts were about her future.
She was taking medication which can slow the disease down considerably. Moreover, the understanding and care of patients with Dementia has improved remarkably in the past 5 years. When I wrote about my mother 2 years ago it had only just been recognised the importance of Advanced Care Planning and my sister and I were able to have similar conversations with her so that she was able to have some say in where she was to live for the rest of her days, have a say in who should have her treasured possessions and even make personal similar requests such as ‘you will pluck out any facial hair, keep my hair tidy, my nails manicured, and make sure I wear my favourite make up’ She wanted to remain smartly dressed and maintain a neat appearance this was important to her. We fulfilled her wishes as far as possible and she died wearing her usual make up, her favourite perfume, hair set and permed and wearing a clean, new nightdress. She had pictures of her family around her and playing the music she loved most.
When I recently went to see ‘Still Alice’ at the cinema not only was the acting of Julianne Moore worthy of an Oscar Award but it demonstrated how a family can be involved in the care of a relative with progressive dementia. In the case of Alice it was a rare form of dementia which particularly strikes those of a young age, but nevertheless the message was the same. It was a compelling and emotional account of a family overwhelmed with a disease which affects all family members in many different ways, sometimes dividing but also drawing everyone together with the common desire to help fulfil the individual’s life to the end as the person that everyone knows slowly disappears but somehow remains present.
If someone you know is becoming increasingly forgetful, you should encourage them to see their GP to talk about the early signs of dementia. If it is a relative may be accompany them . We usually screen them first by an array of blood tests to exclude simple causes which are easily treatable. If we are concerned about their cognitive function following a mini- mental health test we then refer to a older persons consultant who performs more mental tests s well as a MRI brain scan before coming to a definitive diagnosis.
Dementia is a syndrome (group of related symptoms) that indicate problems with the brain. There are several types of dementia.
One of the most common symptoms is memory loss. While there are other reasons someone might be experiencing memory loss, if dementia is detected early, in some cases its development can be slowed and the person affected may maintain their mental function. The typical features of memory loss are :-
Struggling to remember recent events
Problems following conversations
Forgetting the names of friends or objects
Problems with thinking or reasoning
Confusion in familiar places
In Ealing we have a very supportive group ‘Dementia Concern ‘ which is a group of people who support and help in the many aspects of caring for a person with dementia. Carers as we all know are amazing people who day by day and of often night after night perform the vital job of caring for someone who would fail to manage in their own home without them. They help maintain their dignity, their personal hygiene and those individual demands and requests we all have.
refer to their website to find out how they help and when the Dementia Cafe is open.
Dr Brenda Patricia Down,
Andover, B4 UD1
March 20th 2015
Mrs Diane Mellitus
6, Sweetwater Drive,
Andover B4 1LL
I am writing to you as I am very worried that I have not seen you in surgery for sometime and your last blood tests were not good and showed that your diabetes is poorly controlled. I know that if you come to see me, together we can improve the situation considerably.
The problem is that, although you may not feel too bad, if your blood sugar is high for a long time your body is slowly becoming damaged. Gradually, the large blood vessels in your body will become clogged. As a result, you are more likely to have a heart attack, stroke or have difficulty walking without severe leg pain. It also effects the small blood vessels and this effects your eyes causing cataracts or damage to the back of your eyes and it may effect your kidneys. The high sugar effects the nerves, especially in your feet and hands, so that you can’t feel things properly.
I know you love sewing gifts for your family, but if your eyesight gets worse and you can’t do much with your fingers you will really miss making all those lovely gifts. They so rely on you to do repairs and it won’t be that long before the grandchildren will be on the way! I also know how independent you are and how you like to get out and about.
Do you know that I saw a diabetic patient last week who has lost such a lot of weight and has been walking the new dog each day. I could not believe how his blood sugars have improved, his blood pressure has come down and his cholesterol is normal, which means I have been able to stop nearly all of his tablets. He is so happy that he will look better in his swimming trunks and with the money he has saved on quitting smoking he has decided to take his wife on a Caribbean cruise!
Please make an appointment soon so that we can get to grips with controlling your diabetes as it is not only me who is worried about you, but your family must also be concerned and I know you are so important to them.
Dr B.P. Down
PS Did you manage to get to that meeting with Right Start to learn more about diabetes? If you want to look up to find out more about Diabetes try http://www.diabetes.org.uk it is a really good website.
What is Rheumatoid Arthritis?
Rheumatoid arthritis is an autoimmune disease that causes inflammation in your joints. The main symptoms are joint pain and swelling. It’s the second most common form of arthritis in the UK. To understand how rheumatoid arthritis develops.
How does a normal joint work?
A joint is where two or more bones meet. Your joints let your bones move freely but within limits.
The ends of your bones are covered with cartilage, which has a very smooth, slippery surface. The cartilage allows the ends of your bones to move against each other almost without friction. The joint is surrounded by the synovium, which produces a small amount of synovial fluid that nourishes the cartilage and lubricates the joint. The synovium has a tough outer layer called the capsule that, together with the ligaments, holds your joint in place and stops the bones moving too much. Strong fibrous bands called tendons anchor the muscles to the bones.
What happens in a joint affected by rheumatoid arthritis?
Rheumatoid arthritis causes inflammation in the synovium. The result is very similar to inflammation that you may have seen if you’ve had an infected cut or wound – it goes red, swells, produces extra fluid and hurts. The redness is caused by the flow of blood increasing. As a result, the inflamed joint may feel warmer than usual. The inflammation is caused by a build-up of fluid and cells in the synovium. Your joint hurts for two reasons:
*Your nerve endings are irritated by the chemicals produced by the inflammation.
*The capsule is stretched by the swelling in your joint.
When the inflammation goes down, the capsule remains stretched and can’t hold your joint in its proper position. This can make your joint unstable, and it can move into unusual or deformed position.
Do you know anyone or do you suffer Rheumatoid Arthritis and live near Harrow as this meeting would give you an opportunity to learn more about this condition and how life can be improved.
This weekend lured by the beautiful Spring weather I decided to take a trip out to the country with my husband. We found ourselves in Oxfordshire visiting my husband’s old College at Cuddesdon. . Needless to say during the course of the visit it was necessary to use the toilet or as my mother would say ‘the lavatory’ it was a new up to date clean toilet. As I was washing my hands I noticed a framed picture of a toilet in Nepal and reading he caption I realised that this toilet was ‘twinned’ with a new toilet in Nepal.
My words to many medical students over the years has been, ” Do not be under any illusion that being a doctor you will not save as many lives as the sewage and civil water engineers.”
Many people are surprised by the fact that the two biggest killers of children between 1 month and five years are pneumonia and diarrhea. It’s estimated that these alone account for up to 2 million deaths annually worldwide (Lancet 2012, GBD 2010).
Severe pneumonia and diarrhea in children are complex diseases of poverty, when children are exposed to germs in the air or contamination in their water or food. Diarrhea and pneumonia can be caused by one or a lethal mix of germs the gut and respiratory system. It’s made more complex due to harsh living conditions that impact children’s ability to cope – like poor air quality, a lack of access to sanitation, malnutrition and limited or no access to primary health care.
It’s out of order!
1 in 3 people across the world don’t have somewhere safe to go to the toilet. Bad sanitation is one of the world’s biggest killers: it hits women, children, old and sick people hardest. Every minute, three children under the age of five die because of dirty water and poor sanitation. And, right this minute, around half the people in the world have an illness caused by bad sanitation.
Every day, about 1,400 children under the age of five die of illnesses linked to unclean water and poor sanitation. That’s more than half a million a year – or about one a minute (Unicef)
Right now, more than 50 per cent of hospital beds in developing countries are filled with people who have an illness caused by poor sanitation or dirty water.
Women and girls suffer most
In Africa, half of young girls who drop out of school do so because they need to collect water – often from many miles away – or because the school hasn’t got separate toilets for boys and girls. Not having a loo puts people at risk of being bitten by snakes as they squat in the grass and makes women and girls a target for sexual assault as they go to the toilet in the open.
Toilet Twinning is raising funds to enable people living in poor communities to have clean water, a decent toilet, and to learn about hygiene – a vital combination that prevents the spread of disease, reduces the number of deaths among children, and brings hope for the future.
For a £60 donation, you can twin your toilet at home, work, school or church with a latrine in many countries throughout the World where there is poor sanitation. To read more about it click into the following link:-
We have a newly refurbished toilet in the surgery look out for with whom we will be twinning!
LET ME KNOW BY POSTING A COMMENT IF YOU HAVE DECIDED TO TWIN A LOO OR YOU CAN MAKE A CONTRIBUTION AT THE SURGERY.
Most of all be aware of your own personal hygiene especially handwashing see a previous blog