MERS ALERT RETURNS! – Traveller from the Middle East to South Korea.

12 months ago I blogged an alert about MERS (Middle East Respiratory Syndrome Coronavirus (MERS- CoV)


The BBC have broadcast that there is a further outbreak In South Korea following a businessman travelling from the Middle East to South Korea and a further traveller has been diagnosed following travel to Hong Kong and China. Although there seem to be greater concerns about how this is affecting the economy in South Korea!

The WHO suggest  countries, whether or not MERS cases have been reported in them, should maintain a high level of vigilance, especially those with large numbers of travellers or migrant workers returning from the Middle East.


Since May 2015, an outbreak of the Middle East respiratory syndrome coronavirus has affected South Korea. The virus, which causes Middle East Respiratory Syndrome (MERS), is a newly emerged betacoronavirus that was first identified in a patient from Saudi Arabia in April 2012.

As of 12 June 2015, there were 126 known infections in/from the country and 11 people have died from this outbreak. 2,208 schools have been temporarily closed, including 20 universities.3,800 people have been placed in isolation at home or at government designated facilities.image

Here are  things you should know about MERS:

as published by World Health Organisation – fact sheet 401 – to get any further updates

  • Middle East respiratory syndrome (MERS) is a viral respiratory disease caused by a novel coronavirus (MERS‐CoV) that was first identified in Saudi Arabia in 2012.
  • Coronaviruses are a large family of viruses that can cause diseases ranging from the common cold to Severe Acute Respiratory Syndrome (SARS).
  • Typical MERS symptoms include fever, cough and shortness of breath. Pneumonia is common, but not always present. Gastrointestinal symptoms, including diarrhoea, have also been reported.
  • Approximately 36% of reported patients with MERS have died.
  • Although the majority of human cases of MERS have been attributed to human-to-human infections, camels are likely to be a major reservoir host for MERS-CoV and an animal source of MERS infection in humans. However, the exact role of camels in transmission of the virus and the exact route(s) of transmission are unknown.
  • The virus does not seem to pass easily from person to person unless there is close contact, such as occurs when providing unprotected care to a patient.
  • There are no treatments and no vaccine.


Last year I blogged about mindfulness and recommending this has become an integral part of our practice as we constantly see patients faced with the stress of modern living. For those that are not aware of mindfulness, which involves meditation, is defined as:-

 “the intentional, accepting and non-judgemental focus of one’s attention on the emotions, thoughts and sensations occurring in the present moment”.


I was asked to proofread an  article written by Charlie Morgan, yogi and yoga teacher who promotes the slogan:-

                               ‘ Your health is your wealth, the rest is a bonus’

The article was to be published in the section on health and happiness on the blog of deliciouslyella the blogger, foodie, yogi, best-selling author, nut butter addict, Telegraph columnist, app creator & avocado enthusiast.

I was delighted to see it appear on her blog for many  people to view and subsequently read the positive comments.

Click on the link below to read the article:-

image                                     Mindfulness

Thank you Ella and Charlie for collaborating to promote mindfulness and help many people understand it’s value in today’s world.



Posted by on June 12, 2015 in Training and Advice


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One of the most distressing things I had to do as a junior obstretric doctor was to attend the monthly meetings to discuss neonatal and maternity deaths. At that time many of the causes were unavoidable due to lack of medical progress and expertise in monitoring and managing complications of labour. Also, caring for the neonate was limited and often carried out by junior paediatricians without specialist training.  I was one of those junior paediatricians and was often left to resuscitate  and care for a neonate with virtually no training. Some of these precious babies miraculously survived but a significant number died with complications of prematurity and foetal distress which are now treated with success by staff, who are highly trained.

However, we still aware that their are  inconsistencies with regards to facilities and availability of trained staff and although deaths are significantly fewer every neonatal or maternal death is a tradegy for the families expecting to take home a healthy normal baby and every woman having a baby expects to survive. Hence, the overall opinion from the commissioning groups is that each maternity unit should have the most up to date facilities and highly trained staff to be available every minute of the day and night to address and problems should they arise.

I had three births under the care of the  Old  Queen Charlotte Hospital, Goldhawk Road. The first birth was after a difficult, long labour and delivery was using antiquated Keilland’s high rotating forceps and both my condition and the baby’s was ‘touch and go’ but thankfully we both survived. My second birth was a precipitant delivery in the antique bath on the ante-natal ward with late assistance from a passing junior midwife – my idea of having a delivery in a birthing pool which hadn’t been invented at that time – but much more cumbersome to get out of!  My third delivery was in the front seat of the car ( my husband was driving) ‘on the way to Queen Charlotte’s’  as stated on her birth certificate – a natural delivery with no complications even not needing stitches just so hungry afterwards that I ate my breakfast and my husband’s whilst he went home to clean the car! That was the nearest I could have to  a home delivery which were not available at that time!  She now uses the car registration number as her email address and is 29 yrs of age tomorrow! That is the reason why I feel pleased to see a much more consistent approach……


Moreover, as Ealing Hospital was unable to meet these requirements the maternity unit will be closing on June 25th and expectant mothers will be directed to another unit in Northwest London.

Uncomplicated pregnancies can be managed in the communitiy with improved support for home deliveries.

All our maternity units offer both consultant-led and midwifery-led care depending on the level of support you need. They all have birthing pools accomadati g families to be part of the event at the same time the most up to date facilities and staff are available if necessary. You can  also choose to give birth at home, where you will be supported by our home birth team.


Antenatal care is carried out in our hospitals, in children’s centres and in health centres close to where you live. Most women can choose where they receive antenatal care, although some women with particular medical needs may be advised to attend hospital for appointments. Women can also choose to have their postnatal care either at home, in hospital, or in health and children’s centres near where they live. Recently we have concentrated our staff and resources into six maternity units.

This has enabled us to have more midwives and senior consultants in our units to provide care for women, upgrade our facilities, provide more antenatal (before birth) and postnatal (after birth) care locally and offer greater home birth choice.

Your choices In North West London there are six hospitals where you can give birth:


– Chelsea and Westminster

– Hillingdon

– Northwick Park

– Queen Charlotte’s and Chelsea

– St Mary’s

– West Middlesex

further details can be accessed using the following link:-


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Last month I had my usual trip to the Friday market at Brantôme, a small picturesque town in the Perigord , a chance to pick up on the local gossip and see what’s in season.


The gossip first; Olivier from Café Co’Thé on ‘Rue Victor Hugo’ was on the French version of Mastermind and he did very well but didn’t get through to the third round. Needless to say his questions were on coffee! There have been a few major changes in that the pharmacist has moved over the bridge and their old shop has been taken over by the cafe owners next to the newsagent on Puy Joli and as they have createneated a large terrace( and who gave permission for that!)  the stall selling greengrocerie has had to move opposite the new cafe as the pitch has been taken over by the terrace. Moreover, the fishmonger’s van has had to relocate up the road on the main bridge! Then a few progress reports of new illnesses and deaths in the past month, what events are coming up such as ‘ the Charente Weavers festival’ in Varaignes, the home of the slipper ( Pantoufle) and what concerts or Art exhibitions are coming up at the Abbey or nearby and not forgetting the progress of the garden and the weather almost all in the same breath! This is what markets are about and happen the World over – it could even  be Saturday morning in West Ealing or chatting on Pitshanger Lane.

Before meeting up for coffee a view around the many stalls containing foodstuffs, mostly locally resourced, homemade wooden items, soaps and jewellry aswell as random Morrocan , Peruvian stalls that find their way to Brantôme. The seasonal item that is most noticeable are  local strawberries including ‘Fraises de Bois’,  strawberries diligently gathered in the wild. Also, as always is the Asparagus which always appears at this time and has a very short season. Their are the familiar green asparagus but more popular in this region is the white or purple Charentais asparagus. Fresh asparagus is usually only available in French markets in May and June and stalls sell out very quickly.  White asparagus is derived from the same varieties as green asparagus, however its growing method separates it from other varieties; while being cultivated, it has never seen the light of day: soil is mounded over the asparagus plants to prevent the sun’s rays from producing chlorophyll as they grow. Hence,it matures without colour, making it the albino version of asparagus. When the slightest sight of a tip protrudes from the earth, the plant is picked.
Ideal White asparagus spears are pearly white, thick and rounded, about 6 to 8 inches in length with Christmas tree shaped crowns. Their flavor is mild, slightly herbaceous, earthy and nutty with notes of artichoke and fresh White corn. I have to say I prefer the green variety.
As it hasn’t received the nutritional elements of light, white asparagus is more brittle than green asparagus and must be used soon after harvest or the spears quickly turn fibrous and bitter, rendering them inedible. White salad asparagus are tender and sweet, and can be eaten raw or cooked. Sauté chopped white asparagus with shrimp or scallops, or cook quickly in brown butter and serve as a side.

An easy way to cook green asparagus is first break the stems where it breaks naturally to get rid of the less tender part then lie them in a pan or tray covered with water, bring the water to the boil and then turn the heat off and leave for 5 mins. Serve with butter or Hollandaise sauce on their own or an accompaniment with poached salmon.


The same evening we went to the local restaurant for supper and we were interested to note that our amuse-bouche ( pre-meal taster) was garnished with wild asparagus which was foraged in the local vicinity. I managed to discover the source in the next village and imagined Primitive Man ( a known resident of the Dronne valley) probably fed on this delicacy.


The Egyptians, Greeks and Romans valued asparagus for its medicinal value in addition to enjoying it as a food. The second century physician Galen attributed cleansing and healing properties to asparagus.

Asparagus can neutralize ammonia, protect small blood vessels, act as a diuretic… plus its fiber is a natural laxative.

Modern studies show the ancients were right to place high value on asparagus. By eating only a few calories you benefit from many nutrients.

It’s loaded with nutrients: Asparagus is a very good source of  fibre, folate, vitamins A, C, E and K, as well as chromium, a trace mineral that enhances the ability of insulin to transport glucose from the bloodstream into cells.
This herbaceous plant—along with avocado, kale and Brussels sprouts is a particularly rich source of glutathione, a detoxifying compound that helps break down carcinogens and other harmful compounds like free radicals.

This is why eating asparagus may help protect against and fight certain forms of cancer, such as bone, breast, colon, larynx and lung cancers.
Asparagus is packed with antioxidants, ranking among the top fruits and vegetables for its ability to neutralize cell-damaging free radicals. This, according to preliminary research, may help slow the aging process.

The asparagus tuber is used in Chinese medicine, known as Tian Men Dong and tonifies the Yin especially the lung and kidney Yin which are affected in debilitating illnesses such as cancer.

This is an an important ingredient of the formula Káng Ái Fāng (C82) which when I have noticed when  administered with Western medicine: the patients seem to respond better and become less debilitated and recover from the ill effects quicker. Most oncologists are not averse to supporting the use of this medication.

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Lung Yin deficiency manifests itself by  a dry cough, loss of voice, thirst, dry throat, dry skin, sometimes spitting up thick sputum.  When advanced, can become Lung Consumption: chronic cough, low-grade afternoon fever, nightsweat, hemoptysis, thin, rapid pulse.

The kidney Yin deficiency occurs in most debilitating chronic illnesses and in Chinese medicine is considered part of the ageing process. It is manifest by symptoms such as dizziness, tinnitus, weak lower back and legs, warm palms and soles, afternoon low-grade fever, diminished sexual function, scanty and dark urine, red-dry tongue, thin pulse without strength.  Kidney yin fails to nourish Liver yin, which can lead to Kidney+Liver yin Deficiency.

In Chinese Medicine the relationship between the Liver and the Kidneys is of considerable clinical significance as it is based on the mutual exchange between blood and essence and is particularly important in gynaecology. Essence ( oversimplified) is a term in Chinese medicine to describe vital substances which are inherited and acquired and determines our basic constitutional strength and resistance to exterior pathogens. When the Essence is deficient it affects growth, development,  fertility and our ability to fight disease of body and mind.

I find that TCM for me gives some explanation to the mysteries of medicine, chronic illnesses and ageing and why we eat certain foods and understanding more about asparagus is a good example of that!


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Since I started this blog each year I have had the chance to make and record some fascinating observations. The first year it was a family of ducklings that hatched and were led by their mother to the river and the challenges of surviving nature and its dangers Alas this year the mother reappeared but she didn’t  establish a nest and I have not spotted any ducklings.

Last year I obseved a family of bluetits which nested in a jug and all fledglings hatched and happily flew into the outside World. This year the tits have nested in the nesting box fixed to a tree and the parents have been happily flitting back and forth and seem very contented  with their new home.

This year after watching a pair of busy redstarts it became apparent that they had decided to build a nest in the eaves of the covered terrace. Redstarts are immediately identifiable by their bright orange-red tails, which they often quiver. Breeding males look smart, with slate grey upper parts, black faces and wings, and an orange rump and chest. Females, like the one I photographed on her nest and young are duller. Redstarts ‘bob’ in a very robin-like manner, but spend little time at ground level. They are commonly seen in Wales, but usually around London but if you are in Europe or travelling outside London  look out for them  as they are charming little birds with a sweet song. They were thought to be in the thrush family but are now thought to be part of the old world flycatcher family and are cousins to robins and nightingales. Infact  name start comes from the Old English word fot tail, steort. According to the RSPB  The redstart is included on the Amber List as a species with unfavourable conservation status in Europe where it is declining, which made me feel happy to be providing a home for this family.


Then to my delight while the the mother had briefly left the nest I took a sneaky peep in the nest and discovered that the fledglings were beginning to hatch and I was able to take a short video to share:-


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As a follow up of the blog posted recently which explains this scheme we can now give more details:-

Long Term Conditions – Self Management Programme for Ealing!
This programme is available to Ealing residents living with a long-­term condition such as:
Heart Disease
Pain conditions
Neurological condition
Pulmonary Rehab
High blood pressure


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I have made it quite apparent that not only do I enjoy gardening but I am advocating it as an important health benefit both physically and mentally. Many people are not fortunate to have a garden and don’t even have a balcony or chance to grow plants. However, during these summer months there is a chance to be able to not only visit public gardens but also private gardens which open for public viewing and at the same time raise money for a selection of important charities.

I have been aware of The National Gardens Scheme in Britain for many years and enjoyed visiting many private gardens with the  help of ‘The Yellow Book’ which has made its appearance in my home from time to time and contains when and where these gardens are open and is available to purchase from ‘Smiths’ bookshop of you can refer to the website


You may be wondering what this all has to do with District nurses now often named community nurses. Before I reveal that, I must digress to declare my admiration for these nurses who have to be resourceful, broadminded, diplomatic and adaptable to any situation.  They have certainly made a significant  impact on my career as a GP.  It was district nurses in my early career as a GP who enlightened me into the necessity  of holistic care of an ill person at home.

To give just one example, I remember not long after I started at the practice in Ealing being called to see a patient, Tom who was a middle aged man, formerly a ballet dancer. When I arrived the door was ajar and as I tentatively opened the door I was greeted by a swarm of flies and an intense stench of faeces. I called out to give me an idea of where I was to go and Tom summoned me to a large room at the end of the hallway. He was lying semi-naked propped up in a bed covered in newspapers  to absorb his double incontinence and was struggling to eat his meals on wheels accompanied by a can of Lager and joined by a couple of friends . He was in good spirits, somewhat confused as he was suffering Korsakov Syndrome an infliction secondary to long term alcohol abuse and although he did not warrant an acute hospital  admission, clearly he needed sorting out. Following my visit I contacted the district nurses and within 24hrs when I revisited Tom, I arrived at a flat now smelling sweet and a clean,tidy, almost unrecognisable patient sitting in a chair by the bed eating his dinner, listening to some music. The ‘fairies’ had visited and had transformed the scene in a most remarkable way – the district nurses had managed the situation.

It was the National Garden Scheme, which was founded  in 1927 in order to raise money for a national voluntary organisation which would recruit, train, and support  ‘District’ nurses, who would nurse patients in their  homes in deprived areas throughout the country.

The idea of District  nurses had originated in 1859 when William Rathbone, a Liverpool merchant, employed a nurse to care for his wife at home. After his wife’s death, Rathbone kept the nurse on to help poor people in the neighbourhood. Later, Rathbone raised funds for the recruitment, training and employment of nurses to go into the deprived areas of the city. Based on this idea in the latter half of the 19th century ‘District’ nursing spread throughout the country and became  a national voluntary organisation supported by Queen Victoria and Florence Nightingale.

In 1926 the organisation decided to raise a special fund in memory of their patron, Queen Alexandra, who had recently died. For much of the 20th Century, district nurses were usually unmarried women who lived in nurses’ homes provided by local nursing associations all over the country.The fund would pay for training and would also support nurses who were retiring. The Institute became known as ‘The Queen’s Institute of District Nursing and  trained district nurses until the 1960s, in a model that was copied across the world. This model of care was instrumental in developing a comprehensive, highly-skilled service in the UK that meets the needs of millions of people every year.


In 1926 a council member, Miss Elsie Wagg, came up with the idea of raising money for charity through the nation’s obsession with gardening, by asking people to open their gardens to visitors and charging a modest entry fee that would be donated. The following year The National Gardens Scheme was founded. Individuals were asked to open up their gardens for ‘a shilling a head’. In the first year 609 gardens raised over £8,000. A year later, the district nursing organisation became officially named  The Queen’s Nursing Institute.

Subsequently, a few years later Countrylife produced the ‘ Yellow Book’ and there were 1,000 gardens listed.

After the Second World War, the National Health Service took on the District Nursing Service, but money was still needed to care for retired nurses and invest in training. The National Gardens Scheme offered to donate funding to the National Trust to restore and preserve important gardens. In return, the National Trust opened many of its most prestigious gardens for the NGS.

The NGS , although it no longer funds District Nurses per se it now acts as a beneficiary for Macmillan Cancer Support, Marie Curie Cancer Care, Help the Hospices and (now Carers Trust) and also benefits a different annual ‘guest’ charity chosen from recommendations from NGS volunteers.

Since its foundation, the National Gardens Scheme has donated over £45 million to its beneficiary charities, of which nearly £23 million has been donated within the last ten years. The National Gardens Scheme’s commitment to nursing and caring remains constant, and the charity continues to grow and flourish.

Jardins Ouverts 

When I arrived this year in France I was intrigued to hear that the scheme had arrived in this Country starting with 4 gardens in one Departement 3 years ago and is expanding fast by 100 gardens each year. Some enterprising English migrants had decided to start the Jardins Ouverts scheme along similar lines to the NGS. An ex-nurse friend and another friend as well as other people in the area had decided to open their gardens this year and introduce the French in the Perigord to the idea of opening your own garden to raise money for charity.

The chosen charity for Jardins Ouverts for 2015 is:-

À Chacun son Everest is a French charity, founded by Dr Christine Janin, the first French woman to summit Everest.


  • It recognises the similarity between the supreme test of climbing the world’s highest mountain and the challenge facing young people with cancer or leukaemia:
  • the sense of achievement when the goal has been reached;
  • the confidence that this brings;
  • the opportunity to share their hopes and fears with children in a similar situation
  • the realisation of innate personal qualities such as courage, will-power, hope and determination.

They decided to support A Chacun son Everest for several reasons: there can be few things worse for a child and his/her family than to be told that s/he has cancer or leukaemia. They were also impressed by their very personal responses to their enquiries and ware now building a very positive relationship with this organisation.

We set off on one of those days which looked totally unpredictable – the sort of day that you wear a sun hat with a raincoat . I used to be amused by one of my patients who would come to surgery dressed like this – I now understand why. The blue sky made a  perfect back cloth  to the  soft white fluffy cotton wool clouds creeping high above with the occasional ones showing a tinge grey potentially threatening to open up to rain. In good determined British style,  whatever the weather we were to proceed not to let our friends down and with grim resolve to enjoy the day. We drove through the beautiful Dordogne countryside past woodland glades causing  the sunlight to dazzle and dance and fields bursting with seedlings teasing the eye  by not revealing whether they would become sunflowers or maize; the fields frequently punctuated with majestic walnut trees either in rows or alone registering their supremecy in this countryside. Moreover, along the roadside there was a plethora of wild flowers, Queen Ann’s lace, wild sage, Ox-eye daisies,  greater and lesser stitch work, campions and  outcrops of wild orchids just to name a few. We didn’t need to go to a Jardins Ouverts we were admiring the country garden just by venturing into this wide open space.

We arrived at the entrance of the first garden labelled accordingly by a sign showing the way and drove up a track for almost 1 km through a wooded area until the house and garden were revealed. The man at the desk took our money 5€ for both gardens  and a plant stall selling donated plants and then pointed us in the right direction. By now the sun was shining brilliantly enough to make us feel happy enough to leave our wet weather attire in the car. We strolled around the garden admiring the clematis concealing old sheds and aged trees, hostas, roses, foxgloves, violas, budding peonies and countless familiar shrubs and perennials all had been tended carefully and prepared for this event.


It would not be complete without the inevitable chat with fellow visitors over a cup of tea and cake served by the fascinated French children, who had come along to witness this interesting event.

We then left and after a short drive appeared at our next destination, an old presbytery where the garden had been revived including the nurturing of a herb garden,


There was an aged Medlar tree, which bears the fruit that is eaten just before it  becomes rotten, bletted and is frequently mentioned by Shakespeare and Chaucer when they write about unfaithful women.
The house was in the shadow of the Church and there was an ancient well which was adorned by roses and irises in full bloom.


Moreover,  hidden away an array of various chickens and bantams all individually named strutting around there territory clearly dominated by the new arrival ‘Lady Gaga’

In the ponds, more recently created goldfish  darted” under the Lily pads and the perfect water lily flowers were resplendent as the water sparkled  in the sun as the water glistened as the surrounding shrubs and flowers swayed gently in the soft warm breeze.



My friend had jested the night before that she had sent her husband around with a pair of scissors to deadhead some of the flowers and trim any unwanted buttercups which were found peeping amongst the perennials – he had certainly done a good job. Chelsea Flower Show had arrived in the Dordogne! After another chat with visitors French and English, a cup of tea  under the lime tree and a purchase at the pop up jams and chutney stall  we drove back with a clearer blue sky along twisting country roads past the tapestry of the glorious Dordogne countryside.

We arrived home refreshed, inspired with fresh eggs and homemade spicy mango chutney and having had a delightful day out . These gardens had been revived and  nurtured by people who had seen adversity in their lives but had pluckily exercised their energies into something,  which not only can they be proud of but have shown the generosity of spirit to share with others and raise money for a worthy cause.

I wanted to share this experience  As may be someone reading this might be inspired to share their garden and raise money for these worthwhile caring charities  as well as share their garden or allotment  with others who don’t have one of their own.

If you are in France this summer there may be a ‘Jardins Ouverts’ near where you are going : to find out view

The website

When I referred to the NGS website( there is a garden open in Hanwell this weekend so perhaps you can visit this newly joined garden to be inspired and support Tony and Eddy. Details below:-



Posted by on May 18, 2015 in Training and Advice


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Every year a group of 4th phase medical students are attached to the practice to follow a pregnant lady through the last few weeks of her ptregnancy and see her after the birth. This is always a valuable experience for the students as many of these young people have not had the experience of talking to a pregnant woman and understanding the process and what is entailed in ante-natal care, the delivery and post-natal care. Also, just as importantly how it affects the life of the pregnant woman and her life. I am always grateful to the pregnant women who kindly partipate in this project.

Alongside this assignment they are required to carry out a Health Promotion study. This involves looking at an aspect of medicine which they research and often find a way of producing data eg by written questionnaire or patient and/or health professional interviews. This is a compulsory part of their studies and they are then required to formally present their findings and usually produce a result in the form of an education leaflet or a recommendation for increased patient awareness.

This year all the studies were of a high standard and gave us important insights into particular aspects of health care. I am publishing one example by permission of the students involved. One student was concerned that her younger 15 year old brother had not been vaccinated with the MMR vaccine. With her colleagues she researched the topic and then was able to send out a questionnaire out to parents of that age group to find out how many of these teenagers were affected. Following this they devised a leaflet explaining the importance of the MMR vaccine and distributed it to the relevant parents. We will be distributing their leaflet to our teenagers in the practice where there is no record of vaccination so that they can be seen to receive the appropriate vaccine.

They created the poster below to illustrate their study



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Cough is the commonest reason for preschool children to see a GP. Isolated coughing has been reported by parents in almost a third of children at any one time; the symptom can have an impact on sleep, school and activities for the child and can be anxiety provoking for parents.


An average preschool and primary school child has 3-8 coughs or colds per year. Sometimes several coughs or colds occur one after the other. A child who lives with smokers has an increased risk of developing coughs and colds.

A cough is a reflex action to clear your airways of mucus and irritants such as dust or smoke.
Coughs may be dry or chesty and most coughs clear up within three weeks.

Cough may be broadly split in to three categories:

Acute cough = < 3 weeks

Prolonged acute cough = 3-8 weeks, slowly resolving, e.g. post-viral pertussis

Chronic cough   = Variably defined from 3-12+ weeks

Needless to say that constantly hearing your child cough especially at night is bound to cause concern. Even if the mother is happy her child is otherwise well someone else will make a comment. It may be a well meaning grandparent, a dad returning from work or a teacher who will ask whether the child has seen a doctor. I have to say when I see a child  with a cough I examine the child step by step explaining as I go along what symptoms and signs which would cause me as a doctor to be concerned. This not only makes me rule out significant causes of cough but it also reassures and educates the mother as to what important signs she should be looking for.

  • has the child lost their appetite?

  • are they playing or responding as normal?

These symptoms are most important when you are deciding if your child is unwell in that if the child is showing both of the above symptoms you must  keep a closer eye on your child so that if they go on to develop any signs listed below you can visit your GP  On many occasions I have seen a child in surgery racing around, playing happily and having eaten a good breakfast.  Be reassured a child with a cough in this situation is not needing to see a doctor.

However, If you notice any of the following associated with a cough you must bring the child to the doctor

  • has trouble breathing or is working hard to breathe

  • is breathing faster than usual

  • has a blue or dusky colour to the lips, face, or tongue

  • has a high fever (especially if your child is coughing but does NOT have a runny or stuffy nose)

  • has any fever and is younger than 3 months old

  • is an infant (3 months old or younger) who has been coughing for more than a few hours

  • makes a “whooping” sound when breathing in after coughing

  • is coughing up blood

  • has stridor (a noisy or musical sound) when breathing in

  • has wheezing when breathing out (unless your doctor already gave you an asthma action plan)

  • is weak, wingy, or irritable

  • is dehydrated; signs include dizziness, drowsiness, a dry or sticky mouth, sunken eyes, crying with little or no tears, or passing urine less often (or having fewer wet nappies)

Because most coughs are caused by viruses, doctors usually do not give antibiotics for a cough. A cough caused by a virus just needs to run its course. A viral infection can last for as long as 2 weeks. We very rarely send a child for a chest X-ray. 

Unless a cough won’t let your child sleep, cough medicines are not needed. They might help a child stop coughing, but do not treat the cause of the cough. If you do choose to use an over-the-counter (OTC) cough medicine, discuss with the pharmacist to be sure of the correct dose and to make sure it’s safe for your child.

Do not use OTC combination medicines  they have more than one medicine in them, and children can have more side effects than adults and are more likely to get an overdose of the medicine. Some cough medicines have the effect of making a child hyperactive which most parents would agree is not a desired side effect!

Cough medicines are not recommended for children under 6 years old. Meanwhile, you may want to try this homemade remedy my mother gave to us as children and remains a good remedy.



Honey, lemon and glycerine (a liquid I use in Christmas cake Royal icing to make the icing softer) is a homemade remedy for coughs provided the person  is not allergic to any of the ingredients. It is not adviseable to give to a child < 12 months. Honey is a natural antibiotic and lemon is full of cold-fighting vitamin C and glycerine is good for soothing sore throats.

It can also be bought ready mixed over the counter.

Store in the refrigerator for up to a year. For sore throats and chest congestion take one teaspoonful every few hours. (If it starts to taste so good you want to pour it over ice cream – you are probably getting better and don’t need it any more.)

¼ cup (60ml) freshly squeezed lemon juice
¼ cup (60ml) liquid honey
¼ cup (60ml) food grade glycerine

Strain the lemon juice through a fine meshed strainer. Whisk together with the honey and glycerine and pour into a glass bottle with a tight-fitting lid.

Store in the refrigerator for up to a year. For sore throats and chest congestion take one teaspoonful every few hours.

Remember to train your child to cover their cough in order to help protect  those who are vulnerable from catching an infection. 



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Are re you a carer?

If you look after your partner, or a relative or friend who is ill or disabled, you are a carer, even if you don’t think of yourself that way.

There are many ways that you might care for someone.

For instance you might:

  • be on hand 24 hours a day to provide care
  • arrange hospital appointments for someone
  • drop round each day to keep someone company or cook their dinner
  • visit a relative who lives far away once a month to see how they’re doing.
  • Whether you’ve cared for the person for a long time, are temporarily helping them (for example, while they recuperate from an operation), or have just become a carer, take time to review your options and find out what support is available to you.

To establish your rights as a carer refer to  Age UK on the following link

The Care Act comes into force in May 2015. It changes the way the social care system will work in the future.

You’ve probably heard about the biggest change: a care cap that means no-one will spend more than £72,000 of their own money on their care needs.

If you need care, or look after someone who does, you’ll need to know how care is changing.


Ways it may affect you from April 2015:

  • You will have a right to a free needs assessment from your council, even if it thinks your finances are too high or your needs are too low to qualify for help.
  • All councils will use a new national eligibility criteria to decide whether someone can get help from them.
  • If you get social care support, you will now have a right to request a personal budget if you’re not offered one. This is a summary of how much the council thinks your care should cost. This might be useful if you want to pay for your own care. This will become more important when you have a care account from April 2016 (see below).
  • If your needs assessment shows you don’t qualify for help from the council, they must advise you how the care system works and how to pay for your own care. So if you just need a hand with housework, for example, the council should assist you in finding this.
  • You can defer selling your home to pay your care fees until after your death.
  • If you’re paying for your own care, you can ask the council to arrange your services for you. It can only charge you as much as someone whose care they are funding.
  • If you’re a carer, you have a legal right to a care assessment from the local council. You can also get support services if you qualify for them.
  • If you find it difficult to communicate or to understand the issues being discussed, the council must provide an advocate to help you when discussing your care. They will represent your interests if you don’t have a friend or relative who can help
  • The council must provide preventative services that could reduce or delay your need for care. For example, intermediate care at home after a hospital stay could help keep you independent for longer.

Ways it may affect you from April 2016:

  • It becomes even more important to get a needs assessment, as the council will then set you up with a care account. This tracks the amount of money spent on your eligible care needs. The word ‘eligible’ is important as it only includes the needs covered by your assessment. So if you decide to hire a cleaner but the needs assessment doesn’t say you need this help, the cost of that won’t be included.
  • There will be a cap on how much you have to spend on your care needs. Anything you or the council spend on your eligible needs will be added up in your care account. Once it reaches £72,000, the council will pay for all your eligible needs. This excludes your daily living costs, which include things like your food and accommodation in a care home.
  • The council can reassess your care needs, even if you pay for your own care. This is because the council works out how much your care should cost to meet your eligible needs, and adds this up in your care account. It needs to check every so often that the amount it thinks you should be spending is still right.
  • New rules about top-up fees in care homes mean you may be able to pay them yourself. Top-up fees may apply if you move into a care home that costs more than the council can pay.
  • If you’re not happy about a decision, you have a new right to complain and appeal it, and for this to be independently investigated.


                         For more information:
Call Age UK Advice: 0800 169 6565

To all carers

You  can obtain local support at the Ealing Carers – details on a previous blog

When you’re caring for someone it’s easy to overlook your own needs. But looking after your health and making time for yourself can help you feel better and manage better with your caring role.

Your health

Tell your GP you’re a carer, and discuss the impact this is having on your own health. They will be able to offer you advice and support, and you may be entitled to additional health services such as a free annual flu jab if the person you care for has a serious or ongoing health problem.
Although it can be difficult, try to make sure that you eat healthily, stay active and get enough sleep.

Don’t feel like you need to do everything yourself. If you have relatives who live nearby, try to be honest with them if you need a hand or want to share the responsibility.

I’m Emotional health

Don’t overlook your emotional health. Family and friends, carers’ groups , your GP or counsellor, or organisations like Samaritans can all provide you with space to talk about how you’re feeling.


If you care for someone with dementia, it can be hard to share any feelings of guilt, sadness, confusion or anger with them, leaving you feeling isolated. It’s important to acknowledge your feelings, and remember there’s no right or wrong way to feel.


Your social life

It’s a good idea to take up a hobby or activity, such as going to an exercise group or an evening class, if you can. Taking part in an activity you enjoy will give you the opportunity to do something for yourself – it’s important that you have your own interests and make time to pursue them where you can.

Your local library can provide information about social activities, events, education and courses. The University of the Third Age (U3A) can also tell you about courses in your area.

Please refer to a previous blog


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