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SING – A – LONG TO IMPROVE YOUR LUNG CAPACITY AND PARKINSON’S DISEASE

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We have all been introduced to singing since we were born and most parents we will be delighted when they hear their child sing a familiar song for the first time and leap to record the moment. It is just as delightful when you hear your grandchild sing and singing to your grandchild even if your singing voice is limited is always appreciated and met with the  words ‘again, again’ !

As a schoolgirl  I associated  singing with warbling, middle aged women with blue rinses and clearly remember having learn to sing ‘Blow the wind Southerly’ by Kathleen Ferrier as an 8 year old !  I was in the school choir because I liked singing not because I had any musical talent!  Then there was the evolution of pop music And musical shows and then the doors opened wide and  singing for pleasure in the home took on a new light. After all I followed the generation where families used to sing around the piano at home but now it was singing with the radio or TV.

My children have known pop music since an early age and sing-a-longs with the radio on the school run were an important start to the day,  amusing many a commuter as they sidled up alongside us on the Great West Road. Now there are an overwhelming number of genres of music,  which has led to a wider range of choirs than ever before – gospel, rock, church, barbershop, beatbox  to name a few. You can find choirs who do popular chart hits arranged for choir, songs from the shows, or traditional folk music so that singing in choirs has become more popular.

In previous blogs I have alluded to the benefits of singing for patients with dementia and  the feel-good effects of singing in helping in depression. However, experts now believe that joining a choir could improve the symptoms of a range of health problems including Parkinson’s, depression and lung disease.

At a conference of the Royal Society for Public Health, Grenville Hancox, professor of music at The Sidney De Haan Research Centre for Arts and Health, Canterbury, described the changes that can take place through singing together as “extraordinary”.
He told how he and colleagues have witnessed people with respiratory problems learning to breathe more easily, those with depression beating the blues and patients with Parkinson’s disease standing tall and singing loudly.
Prof Hancox is the founder of Skylarks, a new choir for people with Parkinson’s. This disorder of the central nervous system makes normal movements difficult and weakens the voice as the muscles in the face and vocal chords deteriorate. Prof Hancox and his colleague Stephen Clift, the centre’s professor of health education, are undertaking research to find out if choral singing can help with Parkinson’s symptoms, especially those affecting the voice, with choir members undergoing computer-assisted acoustical voice analysis at the start and finish of the study.

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Ian MacDonald, voice specialist with the British Association for Performing Arts Medicine, reported to have said that it is logical that singing can help in this way. “The vocal cords are muscles,” he says. “By exercising them, you increase tone and restrict tremor, and the voice is less jittery. Singing warms the muscles up – just as athletes warm up theirs.” Being required to stand tall when performing may also improve core strength and benefit these patients.

As Professor Hancox and his colleagues have claimed they have witnessed people with COPD , a debilitating respiratory disease  learn to breathe more easily.  Around the world an estimated 64 million people are struggling to breathe on a daily basis.  The World Health Organization expects COPD to be the third leading cause  could potentially help so many people 

Sonia Page, the specialist respiratory nurse who is leading the current Singing for Breathing choir at the Royal Brompton Hospital, London says it has helped people with COPD “gain greater control of their breathlessness instead of being at the mercy of it.”

Patients have also reported improved respiratory stamina, reduced impact of chest infections and improvements in sleep apnoea (a condition that causes interrupted breathing during sleep). Dr Nicholas Hopkinson, a consultant chest physician at the Royal Brompton Hospital in London, notes that singing cannot reverse the lung damage caused by COPD, but it can still be of benefit.
COPD patients have difficulty emptying the air from their lungs (known as gas trapping), he says, which is why they suffer from shortness of breath – a problem made worse if they panic and start to hyperventilate.
“Singing may help these patients to improve their posture and learn techniques to help control their breathing. In particular, by breathing out more slowly they give their lungs more time to empty, reducing gas trapping,” says Dr Hopkinson.

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The free weekly singing classes held at both Royal Brompton and Harefield hospitals are open to all respiratory  at Royal Brompton & Harefield NHS Foundation Trust to help them relax and learn new breathing techniques.

The sessions are organised by the arts team at the hospital and are funded by charitable donations. The course leaders hope to enhance existing support for respiratory patients with an enjoyable, informal exercise, that teaches a better understanding of breath control through the use of the voice.
Two of the longest-standing members of the singing groups are Harold Dearing, who has asthma and has had several operations on his heart, and John Turner who has COPD. John has been coming once a week to the Brompton Hospital since 2010 and is passionate about the benefits of singing.
“It helps us feel much, much better. Although singing therapy can’t cure the lung damage caused by acute respiratory conditions such as COPD, the combination of breathing exercises and song can help people with breathing difficulties cope better with their disability.”
“Doing everyday ordinary activities becomes increasingly difficult for people with lung problems,” says John. “I find singing gets your lungs working better, you get out of the house, you meet people and you become a social animal again.”
“Way back in 2002 when I was diagnosed with emphysema, it was suggested I would soon need oxygen. Well I haven’t yet needed it and I think this is very largely due to singing.”
Singing to build confidence
Harold Dearing has been with a singing group for three years. As a teenager, he’d sung in a choir, so when he saw the Harefield course advertised he decided to give it a go.
“Every time I go it’s beneficial. I enjoy the exercises, but it’s especially nice to be together singing. It’s confidence-building. The teachers make it fun and make sure you’re in your comfort zone.”

Angela Reith, a music therapist who runs the sessions at the Harefield hospital says she sees several benefits.
“Some find that by the end of the session they breathe more easily. Others benefit especially on a social level. They have a good time and if you’re happy with yourself you can cope better with your condition,” says Angela.
Singing’s feel-good factor
Joanna Foster who runs the sessions at Royal Brompton agrees about the feel-good factor of singing in a group. “Singing together is not just exercises. It’s fun and it releases endorphins.”
Each of the sessions involves breathing exercises and singing. Starting with gentle upper body stretches, the group then practice making different sounds as they exhale such as sighs and fake laughter.
“It’s the same techniques that actors and professional singers use to warm up their voices and overcome nerves,” says Joanna.
This then leads into singing whole songs, learning them in chunks and eventually – depending on the size of the group – singing rounds and harmonies.
A survey of 500 patients taking part in the singing workshops at Royal Brompton and Harefield found that 70% felt markedly physically better after the workshops.

Joining a choir is by no means a conventional solution for such a serious illness.

The research team from Canterbury Christ Church University in Kent felt they had good reason to investigate the effects  on COPD and singing and showed that the benefits are real. Dr Ian Morrison, a senior research fellow and one of the project’s authors, said: “Lung function improved dramatically, particularly after about five months, once people had got used to what they were doing and changed their breathing habits.

It has been observed that people with breathing problems tend to develop a lot of anxiety about the very process of inhaling.  The tendency is to do ‘gaspy’ breathing so they’re taking short little breaths. This actually fills up the lungs without clearing them, making it even more difficult to breathe. Due to their obstructed airways, many people with COPD already find emptying their lungs a challenge.Gasping makes the problem worse and can, in the most serious cases, lead to a build-up of carbon dioxide in the blood, which can result in respiratory failure.

In contrast, the techniques used in singing encourage people to breathe in a much deeper, more controlled manner.The whole musculature around the lungs, throat and the upper chest improve with time,” says Dr Morrison. They use what they have much better and you really see a difference in the skill of actually breathing.”

To test its effects, Morrison and his colleagues asked over 100 COPD patients – ranging from mild to severely affected – to attend weekly singing sessions over a 12-month period.They measured their lung capacity with a device known as a spirometer – which looks a bit like a giant breathalyser – and asked participants to fill in a questionnaire to find out on a qualitative level how they were feeling. One of the tests involved measuring how much air a person could force out in a rapid puff. ( Peak Flow Meter)

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On average the people in our study had 50% of expected lung function,” said Prof Stephen Clift, the study’s lead author. “That means about 1.5 litres of air in a one second puff. For healthy lungs, we would expect something more like 3 litres.” Without treatment, people with COPD can expect to see the size of their puff decrease by around 40ml a year.The very best the team had hoped for was that after singing regularly for one year, the size of that puff would stay the same.

Instead we got an increase of 30ml,” says Prof Clift.

“Although the changes are small, the progressive nature of COPD means that any loss of function year-on-year is going to be more significant for them.

“In our study, we not only appeared to halt the decline but people showed a small improvement.”

Dr Morrison added: “There’s also the social and psychological side, because any long term condition is isolating.

A recent Swedish study published in the journal Integrative Physiological and Behavioural Science suggested that it not only increases oxygen levels in the blood but triggers the release of “happy” hormones such as oxytocin, which is thought to help lower stress levels and blood pressure.

Singing has all the benefits mentioned so far and can also be very helpful in improving speech which has become slurred and unclear as a result of Parkinson’s. These same breathing exercises can prevent decline and marginally improve lung function in serious lung disease.

Breathing exercises and vocal techniques used when singing can help with:

  • sustaining the voice
  • increasing and controlling volume
  • varying pitch and expression
  • improving diction
  • controlling vocal speed
  • increasing the fluidity of diction
  • improving Posture

Not surprisingly there are a growing number of informal singing groups for people with Parkinson’s or other illnesses, such as Alzheimer’s. The opportunity to work on vocal and breathing techniques in an informal setting with people who share similar difficulties can be a valuable social activity and can help with self-confidence and overcoming Depression. And you don’t generally need to be able to sing to participate because such groups are not usually choirs and most do not give performances.

Typical singing activities which can help with improving posture, breath work and diction include:

  • taking your voice ‘for a walk’ up and down in pitch
  • lifting the tongue to the roof of the mouth
  • practicing trills (rapid alternation between two adjacent notes of a scale) with lip and tongue
  • making different types of sighs
  • humming
  • echoing tunes
  • singing in rounds (one voice starts and others join in one after another until all are singing different parts of the same song at the same time)
  • experimenting with a variety of pitch, pace and mood in songs.

Singing techniques have also been used to aid fluidity of speech and combat stuttering: Melodic Intonation Therapy (MIT) uses song phrases to retrieve speech when this has been lost or weakened. Group singing can give a social outlet and boost self-confidence in people who tend to withdraw socially due to slurred speech and weakening articulation

Prof Clift and Prof Hancox believe the health benefits of belonging to a choir, for some chronic conditions will become indisputable. “There are examples of arts on prescription and gym on prescription,” argues Prof Hancox. “How about singing on prescription, too?”

If after reading this you want to have singing lessons or join a choir try your local church, community centre or school. I have listed some ideas below of various choirs in and around Ealing.

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Ealing Choral Society,

This is one of London’s best choirs: they are an amateur choir, performing with world-class orchestras and soloists in Ealing, as well as Central London and occasionally abroad.

http://ealingchoralsociety.org

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Questors Theatre Choir

imageAnd for more information about joining, read the Why not sing with us? section.

Contact us here or phone 020 8816 7734 / 07802 720333

We are a 60-strong mixed voice choir based in West London, England, and affiliated to Questors Theatre.

http://www.questorschoir.org.uk

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Ealing Common Choir

imageThis was formerly Ealing Common Choir. Singers are welcome and ideally  can read music and sight-read a simple line. You’ve probably sung on and off all your life. Contact us or just come along to a rehearsal on a Thursdays at St Matthews Church, Ealing Common. Further details:-

http://www.smce.org.uk

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Gospel choir/Singology

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Singology is a vocal coaching company setup by Mark De-Lisser in 2000 to provide singing opportunities and tuition to people of all ages. With a strong tradition of choral singing, Singology has now launched ‘Singology Choirs’ to encourage more and more people to get involved in community singing, which has been proven to increase confidence, social cohesion and can also be used as a diversionary activity for young people in the community.

Monday Ealing 7:30pm – 9:30pm Ealing Town Hall, W5 2BY 12th Jan – 23rd Mar

http://www.gumtree.com/p/classes/new-intake-of-singers-for-singology-pop-gospel-choir-in-ealing/1007900384

http://www.singology.com

Singology choirs throughout London are joining together to sing at the Royal Festival Hall.

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The Ealing Rock Choir

image             Grange Primary School,
Church Gardens, Ealing, London, W5 4HN

The Ealing Rock Choir is led by singer/pianist Christina Clark. We have a great year lined up and we would like to invite you to join our choir and take part in the local Ealing and wider London community. We are the Ealing rehearsal of the trailblazing Rock Choir. We often team up with the other local London choirs to perform in much bigger choral groups. These inspirational moments are unique to the Rock Choir experience. It’s unbelievable and you can still join the choir. Just like a gym class or amateur dramatic society, your Rock Choir rehearsal provides an escape from everyday life. One evening a week during term time, your time is completely your own, to do nothing but sing your heart out with friends whilst enjoying our trailblazing formula of fun, friendship and feel-good music. Book a FREE singing taster session at the Ealing Rock Choir and see for yourself!

There’s no pressure to perform if you don’t want to – it’s all about having fun and enjoying some well-deserved ‘me time’. – See more at: http://www.rockchoir.com

The Ealing Rock Choir singing at the Minack theatre, Cornwall. This is a fascinating outdoor theatre with an intriguing story.

http://www.minack.mobi

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Addison Singers

imageThe Addison Singers comprises two classical choirs – an auditioned Chamber Choir and larger non-auditioned Oratorio Choir; and two jazz choirs – an auditioned Jazz Ensemble and a larger non-auditioned all-female Jazz Choir. It also offers three different singing classes to meet the needs of beginners, intermediate and the more competent, experienced singer.

http://www.addison-singers.org.uk/about-us/who-are-the-addison-singers

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Or if or if all else fails try some Kareoke or sing- a – long with the TV or radio

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Posted by on February 8, 2015 in Training and Advice

 

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Don’t Believe In Vaccinations?

Two years ago I wrote a blog about the Measles epidemic in Swansea brought about because parents had declined to vaccinate their children. In USA there has been an outbreak of measles in 14 states and President Obama is urging parents to get their children vaccinated. At least 58 of those cases began in Disneyland in Dec. 2014, where large numbers of unvaccinated people made it easy for the virus to spread. Unvaccinated people are now being encouraged to avoid Disneyland parks altogether, lest the virus continues to spread. Last year alone the U.S. saw 644 confirmed cases of the measles, more than triple the number of cases in 2013.

   WHO            According to the WHO in November 2014

 * Measles is one of the leading causes of death among young children even though a safe and cost-effective vaccine is available.

* In 2013, there were 145 700 measles deaths globally – about 400 deaths every day or 16 deaths every hour.

* Measles vaccination resulted in a 75% drop in measles deaths between 2000 and 2013 worldwide.

* In 2013, about 84% of the world’s children received one dose of measles vaccine by their first birthday through routine health services – up from 73% in 2000.

* During 2000-2013, measles vaccination prevented an estimated 15.6 million deaths making measles vaccine one of the best buys in public health.m

27 years  ago Roald Dald wrote this moving letter to encourage parents to make sure they immunise their children: the message is still pertinent today.

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Olivia, my eldest daughter, caught measles when she was seven years old. As the illness took its usual course I can remember reading to her often in bed and not feeling particularly alarmed about it.
Then one morning, when she was well on the road to recovery, I was sitting on her bed showing her how to fashion little animals out of coloured pipe-cleaners, and when it came to her turn to make one herself, I noticed that her fingers and her mind were not working together and she couldn’t do anything.
“Are you feeling all right?” I asked her.
“I feel all sleepy,” she said.
In an hour, she was unconscious. In 12 hours she was dead.
The measles had turned into a terrible thing called measles encephalitis and there was nothing the doctors could do to save her.
That was 24 years ago in 1962, but even now, if a child with measles happens to develop the same deadly reaction from measles as Olivia did, there would still be nothing the doctors could do to help her.
On the other hand, there is today something that parents can do to make sure that this sort of tragedy does not happen to a child of theirs. They can insist that their child is immunised against measles.
I was unable to do that for Olivia in 1962 because in those days a reliable measles vaccine had not been discovered. Today a good and safe vaccine is available to every family and all you have to do is to ask your doctor to administer it.
It is not yet generally accepted that measles can be a dangerous illness. Believe me, it is. In my opinion parents who now refuse to have their children immunised are putting the lives of those children at risk.
In America, where measles immunisation is compulsory, measles like smallpox, has been virtually wiped out.

Here in Britain, because so many parents refuse, either out of obstinacy or ignorance or fear, to allow their children to be immunised, we still have a hundred thousand cases of measles every year.
Out of those, more than 10,000 will suffer side effects of one kind or another. At least 10,000 will develop ear or chest infections. About 20 will die.
LET THAT SINK IN.
Every year around 20 children will die in Britain from measles.
So what about the risks that your children will run from being immunised?
They are almost non-existent. Listen to this. In a district of aroundu 300,000 people, there will be only one child every 250 years who will develop serious side effects from measles immunisation! That is about a million to one chance.
I should think there would be more chance of your child choking to death on a chocolate bar than of becoming seriously ill from a measles immunisation.
So what on earth are you worrying about? It really is almost a crime to allow your child to go unimmunised.
The ideal time to have it done is at 13 months, but it is never too late. All school-children who have not yet had a measles immunisation should beg their parents to arrange for them to have one as soon as possible.
Incidentally, I dedicated two of my books to Olivia, the first was ‘James and the Giant Peach’. That was when she was still alive. The second was ‘The BFG’, dedicated to her memory after she had died from measles.
You will see her name at the beginning of each of these books. And I know how happy she would be if only she could know that her death had helped to save a good deal of illness and death among other children.

***If your child has not been immunised contact your surgery to make an appointment withe practice nurse.

 
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Posted by on February 3, 2015 in Training and Advice

 

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MYTHS TO DISPEL

Last year a pair of 4th year medical students from Kings College, London carried out a study in the practice looking at myths  that women have concerning  cervical smears. They distributed this to patients: it was revealing how many misconceptions women had. Read this and see what you may learn. 

 Smear

Did you know that the statements below are ALL TRUE  

1) The main cause of cervical cancer is the Human Papilloma Virus (HPV)

2) All women, regardless of their sexual preference (heterosexual, bisexual, lesbian) are at risk of developing cervical cancer.

3) Every women should have a regular smear test, including women who have never had a sexual experience (virgins).

4) The more sexual partners you have , the greater risk your risk of cervical cancer.

5) You should still have your smear test even if you are no longer sexually active, as the cancer can develop long after sexual activity.

6) HPV is transmitted through vaginal sex, but also oral sex, and skin-to-skin contact ( of the genital area) with an infected person.

7) You should still attend your smear tests despite having your HPV vaccine, as the vaccine protects against the commonest type of virus, but not all types.

8) Early stages of cervical cancer may present without symptoms, screening enables detection before symptoms.

9) An abnormal smear test does not mean cancer – it indicates early changes, which if left untreated, could become cancer.

10) You should not feel any pain on having a cervical smear.

11) There is always an option for a female member of staff performing your smear test.

12) Though cervical cancer is uncommon in young women, they may develop changes in the cervix  that may develop changes in the cervix that may become cancer if not detected early.

13) The risk of cancer does not decrease with age – even after menopause it is important to attend your smear tests.

14) Smoking increases your risk of cervical cancer.

15) Cervical cancer is one of the most preventable cancers. The best preventions is attending smear tests.

Smear

All women aged between 25 and 64 are invited for cervical screening every three to five years.

The procedure is used to detect abnormal cells which, if left untreated, could lead to cancer in the cervix.

Screening coverage – the percentage of eligible women recorded as having been properly tested at least once in the last five years – has been falling.

On March 31 2014, the figure stood at 77.8%, down from 78.3% a year earlier and 80.6% a decade ago.

Across the UK, more than one in five invited to be screened don’t attend – one million women a year

Among 25 to 29-year-olds that figure rises to one in three.

Currently 33.7 per cent of 25 to 29 year-olds in and 22.3 per cent of 30 to 34 year-olds in the UK aren’t being screened.

The simple test can be carried out by practice nurses in local GP surgeries.

Every year in the UK, 300,000 women are diagnosed with cervical abnormalities.

Nine women are diagnosed with cervical cancer and three lose their lives, every single day.
Cervical screening saves around 5,000 lives a year.

But the Jo’s Trust research found that 20 per cent of young women see smear tests as unnecessary.

Other reasons given for not attending were concerns about pain (26.2 per cent) and embarrassment (26.6 per cent)

HAVE YOU BOOKED YOUR TEST OR ENCOURAGED YOUR

PARTNER / FRIEND / MOTHER / SISTER / DAUGHTERS / FEMALE RELATIVES TO BOOK THEIR TEST?

 
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Posted by on January 27, 2015 in Training and Advice

 

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IS BLOATING A PROBLEM?

This week I had an email reminding me it is Ovarian Cancer Awareness Week in March and to prepare for fundraising events and this brought to mind the tale of a dear aunt.

It was Easter 1969 when my aunt who was diagnosed with carcinoma of the ovary. She was the head teacher of a challenging junior school in Dagenham and aware of the surplus energy many of her pupils had and as no-one had volunteered to teach imagefootball she had decided to take on the task. However, that did create some problems as she was a Roman Catholic nun Sister Mary Ursula, who wore a full length habit and a stiffly starched headdress as seen in the comedy Sister Act!

I had only seen her when we as a family visited London as she was not allowed to stay anywhere other than a convent. We always had great fun as children when we visited as she always managed to produce a special meal usually afternoon tea and we were allowed to explore the convent grounds play with the animals they kept as well as have a singsong or dance to popular songs around the piano. We also helped to serve soup to the unusual people who came to the back door. I was always puzzled by these visitors but despite being as inquisitive as usual I never got any satisfactory answers to why these people came.

She had been to see her team play in the schools cup final and was overjoyed that they had won. She had run up and down the pitch cheering them on like any other football coach but in full nuns habit!
Unfortunately, shortly after this she was admitted to hospital with pneumonia and incidentally found to have advanced Ovarian Carcinoma. She like many others showed very little in the way of symptoms.

Coincidentally, I had applied to do voluntary work in Dr. Barnado’s children’s home in Barkingside, Essex, helping with spins bifida children who had been taken into care and was accepted. They provided free accommodation and meals and this gave a country girl a chance to be able to explore London. What’s more I would be near Upton Park Hospital where she was having frequent admissions for treatment.

It wasn’t long before she made her mark there with frequent colourful visitors ranging from high ranking priests to ex-pupils. There was never a dull moment especially as she took it upon herself to visit the male wards (bearing in mind that in those days many patients were in hospital for weeks on end) equipped with mouth organ to orchestrate singalongs usually the old cockney pub songs or football songs especially as she was a keen West Ham supporter!

Needless to say it was appropriate that she was the first person I told when I received my A level results and full acceptance to Medical school. Sadly she died the day I left to go home to prepare to start my career in medicine. This was my first experience of being with someone so ill and eventually dying. She was only 41yrs of age and died within months of being diagnosed. She was so open about how she felt and what gave her the most comfort. Her insights, her humour and her fears along with her many words of wisdom formed a good base as I embarked on my medical training.

It is sad that even after 45yrs only 3% of women can very confidently pick out a symptom 

Carcinoma ovaryIf ovarian cancer but if diagnosed the prognosis has improved considerably. 

The disease is the fifth most common cause of cancer deaths in women and experts fear the lack of awareness may contribute to low survival rates in the UK compared with elsewhere.

Ovarian cancer

We as doctors are increasing our awareness and  vigilance  about investigating women when presenting with suspicious symptoms. We need you to come to us if you have suspicious symptoms.

    image          It  may simply be persistent bloating don’t assume it is Irritable Bowel Syndrome –  GET CHECKED

http://www.targetovariancancer.org.uk

 
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Posted by on January 25, 2015 in Training and Advice

 

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FREE NHS HEALTH CHECKS

Ealing Borough has one of the highest uptakes of free NHS Health Checks in the country. That means residents are reducing their risk of developing heart disease, stroke, diabetes and kidney disease.

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If you are aged between 40 – 74years old , have not had a health check in the last five years and have not already been diagnosed with certain conditions you will  be invited for a Free NHS  Health Check. The checks only take 20 minutes and hopefully will give  you peace of mind and good advice on staying well.

Even if you feel perfectly well and lead a healthy life style it is worth having it. Some conditions do not have early symptoms. It is estimated that 850,000 people are unaware that they have type 2 diabetes. I remember when I first joined the practise on simple urine screening I picked up 19 asymptomatic diabetics in 6 months including a 19 year old young man.

We as GP’s are increasingly aware that people need to be educated as to what is a healthy weight, the safe levels of alcohol aswell as the importance or regular exercise. If after discussing your results you are found to be at risk of getting one of these diseases your healthcare professional can offer support to help lower the risks.

For more information visit   www.nhs.uk/nhshealthcheck

 

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100 days of coughing after a 100 years

Eight months ago I wrote my 100th blog about a lady who had become a centenarian and how we had celebrated her birthday and since then she has followed my blogs and I have even introduced her to TED talks which she finds most interesting!

The telephone went yesterday to inform me that she was in hospital with what in some countries is known as
the 100 days’ cough or cough of 100 days.

The red dots are Bordatella pertussis bacteria, the cause of whooping cough.

We know it as whooping cough, or Pertussis..It is a highly contagious bacterial disease caused by Bordetella pertussis.

Although, in isolation and distressed by the severe coughing fits, which often produce the namesake high-pitched “whoop” sound when air is inhaled after coughing she has been in good spirits and no doubt full of questions due to her interminable curiosity.

What causes whooping cough

The bacterium infects the lining of the airways, mainly the windpipe (trachea) and the two airways that branch off from it to the lungs (the bronchi).
When the Bordetella pertussis bacterium comes into contact with the lining of these airways, it multiplies and causes a build-up of thick mucus. It is the mucus that causes the intense bouts of coughing as your body tries to expel it.
The bacterium also causes the airways to swell up, making them narrower than usual. As a result, breathing is made difficult, which causes the ‘whoop’ sound as you gasp for breath after a bout of coughing.

How whooping cough spreads

People with whooping cough are infectious from six days after exposure to the bacterium to three weeks after the ‘whooping’ cough begins.
The Bordetella pertussis bacterium is carried in droplets of moisture in the air. When someone with whooping cough sneezes or coughs, they propel hundreds of infected droplets into the air. If the droplets are breathed in by someone else, the bacterium will infect their airways.
This is why it is highly contagious. I remember in 1979 I was working as a paediatric doctor and there had been a whooping cough vaccination scare resulting in a sharp increase in cases. It was pitiful to see the numerous admissions of babies and young children with distressing bouts of coughing. It is clear how when a vaccination is introduced how the incidence of the disease falls so rapidly but rises again if vaccination uptake declines.
Whooping cough.

Treatment
If whooping cough is diagnosed during the first three weeks (21 days) of infection, a course of antibiotics may be prescribed. This is to prevent the infection being passed on to others.
It is important to take steps to avoid spreading the infection to others, particularly babies under six months of age.
Children with whooping cough should be kept away from school or nursery for five days from the time they start taking a prescribed course of antibiotics. The same advice applies to adults returning to work.
As a precaution, household members of someone with whooping cough may also be given antibiotics and a booster shot of the vaccine.
Antibiotics will not usually be prescribed in cases where whooping cough is not diagnosed until the later stages of infection (2-3 weeks after the onset of symptoms).
By this time, the Bordetella pertussis bacterium will have gone so you will no longer be infectious. It is also very unlikely that antibiotics will improve your symptoms at this stage.
Immunisation

Children are vaccinated against whooping cough with the 5-in-1 vaccine at two, three and four months of age, and again with the 4-in-1 pre-school booster before starting school at the age of about three years and four months.

Vaccination in pregnancy
In the UK, all pregnant women are offered vaccination against whooping cough when they are 28-38 weeks pregnant. Getting vaccinated while you’re pregnant could help to protect your baby from developing whooping cough in its first few weeks of life.

The immunity you get from the vaccine will pass to your baby through the placenta and provide passive protection for them until they are old enough to be routinely vaccinated against whooping cough at two months old.

Is the whooping cough vaccine safe in pregnancy?
It’s understandable that you might have concerns about the safety of having a vaccine during pregnancy, but there’s no evidence to suggest that the whooping cough vaccine is unsafe for you or your unborn baby.

Pertussis-containing vaccine has been used routinely in pregnant women since October 2012 and its safety has been carefully monitored by the Medicines and Healthcare Products Regulatory Agency (MHRA). The MHRA’s study of nearly 20,000 vaccinated women found no evidence of risks to pregnancy or babies.
To date, 50-60% of eligible pregnant women (over half a million) have received the whooping cough vaccine with no safety concerns being identified in the baby or mother.
Vaccination against whooping cough in pregnancy is also routinely recommended in the US and New Zealand.
The pregnancy vaccination programme has been very effective in protecting babies until they can have their first vaccine when they are two months old.
During 2012, 14 babies died from whooping cough, all of whom were born before the vaccination in pregnancy programme was introduced, and developed whooping cough before they could be vaccinated themselves. The number of infant deaths from whooping cough fell to three in 2013 – all three babies were too young to have been vaccinated themselves and none of their mothers had been vaccinated in pregnancy.

Further questions can be answered using the following link:-

http://www.nhs.uk/Conditions/Whooping-cough/Pages/Prevention.aspx

 
 

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CAN YOU LIVE A NORMAL LIFE WITH DIABETES ?

imageWhen I first stated at 102 The Avenue I tested every single person’s urine for glucose and after 6 months I had picked up 19 new diabetics.

Those of you who have read one of my previous blogs may remember Sam, an 18yr old boy who came in nervously with his sister as he had been complaining of genital irritation which turned out to be thrush, which is a known presentation of diabetes especially in men.
https://102theavenue.wordpress.com/2013/08/13/how-to-prevent-or-delay-the-onset-of-diabetes/

He had no other symptoms but his urine contained glucose. When I told Sam he had diabetes his reply was, ” Am I going to die?” My reply was “I hope not as that means I am not a very good doctor. However, I suggest that you must not smoke and night’s out with the lads heavy drinking is not for you!” He replied,”Oh that’s good I don’t smoke and I am not fond of drinking I only drink an occasional lager”

I arranged for him to attend the diabetic clinic to be initiated on insulin as he was clearly a Type 1 diabetic.
Sam remains well still in the same job, although thinking of joining the fire service, married with 2 children, fit as a fiddle. Diabetes does not dominate his life, he has never been in hospital,continues taking insulin and sees his doctor every 6 months for regular check ups. That how the majority of diabetics live – they can have a lager or a bar of chocolate occasionally and can become organ donors and he will be assessed on his ability to be a firefighter and will not be turned down because he has diabetes.
Type 1 diabetes develops when the insulin-producing cells in the body have been destroyed and the body is unable to produce any insulin.

Who typically gets Type 1 diabetes?
Type 1 diabetes accounts for about 10 per cent of all adults with diabetes and is treated by daily insulin injections, a healthy diet and regular physical activity. Type 1 diabetes can develop at any age but usually appears before the age of 40, and especially y in childhood. It is the most common type of diabetes found in childhood. Type 1 diabetes can’t be prevented. The body’s immune system destroys the insulin-producing cells, and nobody quite understands why.
The vast majority of children with diabetes have Type 1 diabetes, but an increasing number are now developing Type 2 diabetes.

Notwithstanding, there are those for one reason or another develop complications but for the most part the majority of people like Sam lead a normal life.

 

Diabetes

The rest of those patients who I picked up with glucose in the urine were older.
I particularly remember Diane, who was a 55yr old teacher very overweight, and admitted she did very little exercise. She had come to surgery feeling tired and stressed but a routine urine showed glucose. I tried to suggest that she lost weight and even suggested Bariatric surgery but she was very negative, claiming she had tried every diet and didn’t have time for exercise. As time went by she was treated for hypertension and needed to have several types of diabetic medication and the diabetes was still not satisfactorily controlled and she was not only was her weight increasing but she was developing angina. Probably dreading hearing the same old advice – diet and exercise and the suggestion of insulin she started not turning up for her appointments. At the beginning or each year we audit our patients to review those that have not been checked and her name appeared and we then ask the receptionists or nurse to phone them to make an appointment. She did make an appointment and her blood tests showed her blood glucose was running very high. When I saw her she said that her job was now becoming so stressful that she was considering early retirement and that she was now prepared to have Bariatric surgery and look seriously at her health. I was thrilled it was worth waiting for that moment. She went on to have surgery and with the support of the multidisciplinary team of dietitian, psychologist and surgeon she became motivated to eat a healthier diet, exercise and gradually as the weeks went by she stopped one medication after another. She was transformed she looked more attractive, she was happier, free from both her diabetic and blood pressure medication and the angina settled. She was now retired and set to enjoy life outside London and as she came to say goodbye she said, “Why hadn’t I done this earlier?”
Diabetes
Who typically gets Type 2 diabetes?
Type 2 diabetes usually appears in people over the age of 40, though in South Asian people, who are at greater risk, it often appears from the age of 25. It is also increasingly becoming more common in children, adolescents and young people of all ethnicities. Type 2 diabetes accounts for between 85 and 95 per cent of all people with diabetes and is treated with a healthy diet and increased physical activity. In addition to this, medication and/or insulin are often required.
In Type 2 diabetes there is not enough insulin (or the insulin isn’t working properly), so the cells are only partially unlocked and glucose builds up in the blood.
In today’s press:-
More than one in three adults in England are on the cusp of developing type-2 diabetes, new research suggests.
If nothing is done to stop the trend, there will be a steep surge in this form of diabetes within the next few years, the authors of a report published in the British Medical Journal Open said.
People are classed as having borderline diabetes, also known as pre-diabetes, when they have blood glucose levels at the very high end of the ‘normal’ range. Those with the condition are at high risk of developing diabetes and its associated complications.
Their study found that in 2011, the number of people diagnosed with pre-diabetes tripled from 11.6 per cent in 2003 to 35.3 per cent.
We now regularly screen patients not just for urine glucose but for blood glucose in an attempt to prevent the onset of diabetes.

It is now reported that 80% of Type 2 diabetes can be prevented by diet and exercise alone

As I reflected it made me realise the enormous strides that have been made in medicine since I have been qualified regarding diabetes, firstly being able to diagnose it so easily with a simple dipstick and more accurate blood tests to recognise pre-diabetes as well as having the proven knowledge that leading a healthy lifestyle can prevent the onset. However, sadly many people don’t take heed of this and don’t eat healthily and live a life of a couch potato running a great risk of developing Type 2 diabetes.

 

I remember my first job as a surgical house officer there were always some patients on the ward with chronic leg ulcers, and those who had poor lower limb circulation both as a result of diabetes and who were on the surgical ward and inevitably ended up having an amputation. Many of these patients also had poor eyesight due to cataracts or diabetic retinal damage, others had had heart attacks or strokes and it was a concern whether they would able to cope with anaesthetic and had to have the surgery with a spinal block. Most of these diabetics went on to develop kidney failure but were considered unsuitable candidates for renal dialysis because of there array of other complications. They had to have peritoneal dialysis – a cumbersome way of ridding the body of liquid waste. It involved pouring large volumes of fluid into the abdomen and then flushing the fluid out. When I was a GP visiting these patients, who were discharged home for it to be carried out by the District nurse on a regular basis, sometimes daily, I remember having to squeeze past these piled up boxes in the hallway. There prognosis was poor and they often developed severe infections or went into end-stage kidney failure and died at in there 50’s. Hence, it is not surprising that many people fear this condition and feel it will alter their life.
Diets at that time consisted of large amounts of fat and sugar: the day started with a greasy cooked breakfast, puddings were a must and afternoon tea was accompanied by a selection of home-made cakes. Although exercise was part of a daily routine the television began to limit how much people did and more people bought cars, public transport improved but everyone continued with the same diet.
Diet and exercise
In 2001 Diabetes Prevention Program (DPP),a large trial was carried which was scheduled to last 4years comparing a group of people who were supervised strictly to adhere to exercise and a healthy diet and a group who were not educated but the trial had to be abandoned after 3 years because it was so clear that a highly significant number were developing diabetes in the non-educated group and it was considered non-ethical not to educate everybody.
Participants randomly assigned to intensive lifestyle intervention reduced their risk of getting type 2 diabetes by 58 percent. On average, this group maintained their physical activity at 30 minutes per day, usually with walking or other moderate intensity exercise, and lost 5-7 percent of their body weight.

It is reported that 80% of Type 2 diabetes can be prevented by diet and exercise alone

You can check your risk of developing diabetes by clicking on the link below:-
http://riskscore.diabetes.org.uk/type2risk/

It is possible to delay the onset of Type 2 diabetes by lifestyle intervention.
Before you develop symptoms:-
Diabetes

 
 

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