NHS bowel screening programme

Patients living in Warwickshire will be receiving invites in the near future to have bowel cancer screening. The simple home test will detect many bowel cancers and will certainly save many lives. Our patients in Leicestershire should see the screening beginning in December . All patients between the ages of 60 and 69 years will automatically be sent an invitation and those older than 69 can phone to receive an appointment:

http://www.cancerscreening.nhs.uk/bowel/

* as of end December 2007 there were still not announcements about screening launch in Leicestershire = watch this space

Exercise and health (BMJ 9th June 2007)

We all know that physical activity improves health. In this weeks editorial in the British Medical Journal there is a discussion on how to achieve this. The idea being that few people will take up sports after leaving school but many could be persuaded to walk  about 30 to 60 minutes extra per week. Meanwhile people with chronic medical conditions can be referred by one of the practice doctors to the Lutterworth Sports Centre to go to the gym for half the usual price.

There have been studies that suggest caffeine should be avoided all together. The problem is that women who drink more coffee than most nearly always differ from other pregnant women in other ways too. They are more likely to smoke, for one thing, which makes it difficult to decide what is causing what.

HRT and ovarian cancer Just as one reads in the news paper that HRT does not increase the risk of heart attacks and more women should  be taking HRT another study comes out and suggests that HRT might increase slightly the risk of ovarian cancer. This conclusion is from the million women study that Dr Masharani reported on these pages in 2003. The risk from ovarian cancer seems relatively small but warrants consideration before embarking on HRT. These issues will be fully discussed when patients start HRT or at the time of the medication review. Meanwhile click the link for further information:

http://info.cancerresearchuk.org/news/pressreleases/2007/april/313826

Regular readers will be aware that Dr M is rather keen on computers and information technology. As such he is a fan of BBC's technology program "click". A feature that caught his eye was a plug for a website that gives recipes for home made food for babies...click here. In addition to good advice about feeding the little ones there is plenty of parenting advice on this site.

Membership to the Royal College of General Practitioners has become a bit of a gold standard for General Practitioners showing that the particular doctor has demonstrated skills for being a good GP. Dr Taylor and Dr Masharani took and passed the exam many moons ago!

It has taken some while to find the right candidate to replace Zoë Hughes who finished at the beginning of the summer but we believe that Jane is the right one. She has a lot to offer the patients and the practice.  Jane hopes to expand her role in minor operations and joint injections She also has an interest in mental health. Jane has a great personality and lots of talent. Outside medicine her interests include painting  and arts and crafts, she also enjoys attending concerts and festivals. Jane is married and has 2 cats.

Liquid based cervical cytology testing  9th August 2006

The next time ladies come for their " smear" test, they will notice something different about the way the test is carried out. The new test involves using a tiny brush to take a sample from the neck of the womb and the sample is then put in bottle of preservative for transportation to the laboratory at the Leicester Royal Infirmary. The advantage of the test is that it is more accurate and patients are less likely to be recalled unnecessarily.  We still have a few women who refuse to participate in the screening program but with this change, hopefully , some will be encouraged to come forward for a check-up.

Teenagers 'in different time zone' (www.ananova.com)

Scientists have confirmed that teenagers live in a different time zone to the rest of us.And they say waking them too early could damage their health, reports New Scientist.

From the age of 14 to 20 youngsters body clocks change making them go to bed and get up later.

Sleep deprived teens are more likely to smoke, are more prone to disease and more likely to have accidents.

...Dr M cant understand why his teenager can get up fine at weekends but is useless during the school week...

Colorectal cancer in primary care BMJ 8th July 2006

About one in 20 people in the UK will develop bowel cancer during their lifetime. It is the third most common cancer in the UK, and the second leading cause of cancer deaths, with over 16,000 people dying from it each year.

An editorial in the British Medical Journal suggests, on the basis of a study published in the journal, that any one over the age of 45 years presenting with new onset rectal bleeding should be investigated for bowel cancer. One in ten of this group will prove to have bowel cancer. The NHS bowel cancer screening program, which is being rolled out over the next 3 years is aimed at 60 to 69 year olds rather than this younger population.

The main take home message is that if you have rectal bleeding, make an appointment to see one of the doctors in the practice.

Adolescent obesity is established in childhood (BMJ)

A study involving 5800 pupils from 36 London schools has shown that obesity may well be established before the age of 11. The authors suggest that efforts to prevent obesity should therefore be targeted in the early years

We say goodbye to Dr Zoë Hughes...

After a 3 year spell we are sorry to say goodbye to Zoë, who is going back to becoming a full time mum. She has made a major contribution towards the care of patients within the practice and has been a popular member of staff so I am sure everyone will miss her. Hopefully she will return to working in general practice at some future date.. meanwhile Dr Taylor and I will both be increasing our clinical commitments until a replacement doctor has been appointed. Zoë did her last clinic on 28th April.

Aspirin for all over the age of 50 years?

Several patients have recently turned up with newspaper articles extolling the virtues of taking aspirin. Unfortunately life is not that simple and there are plenty of doctors who feel that universal aspirin use may do more harm than good. Here is a link to an article published in the British Medical Journal in June of this year- click here. The article has led to a heated debate in the letters section of this journal... with no consensus developing to date. Wait and watch this space is the best advice that I can give at the moment.

Ibuprofen, diclofenac (Voltarol) and heart attacks BMJ  2005;330:1366 (11 June)

There has been a lot of news coverage about this study which looked 9218 patients with a new heart attack during the four year study period to see if there was anything unusual about these patients compared with those who did not have a heart attack.

"For Ibuprofen, one additional myocardial infarction would happen for every 1005 patients aged 65 and over, and for Diclofenac the figure would be one additional myocardial infarction for every 521 treated patients. Given the high prevalence of the use of these drugs in elderly people and the increased risk of myocardial infarction with age, even the relatively large number of patients needed to harm could have considerable implications for public health"

Does this mean that people should avoid these commonly used drugs? Probably not - particularly in those who do not have a  heart condition. The authors themselves express caution about the results. The present advice seems to be not to stop them.. but watch this space for further information. Meanwhile click  on the 2 links below for statement from the Committee on Safety of Medicines

Who is entitled to NHS eye test ?

Popular diets are equally effective for losing weight (BMJ 16th April 2005)

A recent study found that the Atkins, Zone, Weight watchers and Ornish diets were equally effective in helping adults lose weight and reduce cardiac risk factors. I note that the drop-out rate was from 21% to 50 % with the Adkins and Orish faring the worse because it was too hard to follow. The take home message is to go for the diet that you can stick to.

Dr Masharani and all his staff celebrate an excellent Patient Survey Report!

An independent survey was carried out on behalf of Dr Masharani’s practice during the first two weeks of July 2004. The survey report showed that the practice is well above the national average in terms of patient satisfaction. For further information click here.

depression BMJ 2nd April 2005

A study published in an American journal looked at 80 adults with depression found that taking exercise three times a week was helping in lifting their depressive symptoms. There did not seem to be an additional benefit from taking exercise more often than three times a week.

Angela Bell joins the practice

Angela Bell is a shared care counsellor in substance abuse. She will be starting holding clinics from next week to help people with drug addiction to come of their habit.  The British Crime Survey of 2001/2002 indicates that 15% of men and 9% of women aged 16 - 24 in England and Wales had taken an illicit drug in the previous year, so the problem is not minor.

Unfortunately no photo of Angela this week because of technical problems but watch this space.

Antibiotics not needed for children with earache

American paediatricians and family doctors are being encouraged not to prescribe antibiotics for children with ear infections, and to recommend painkillers only. The aim is to stop the rise in antibiotic resistant bugs. A spokesman for the Centre of Communicable Diseases said " some kids may have a little bit longer course of their infection, but for society as a whole, we will be better served if we don't give them".

This sentiment is very much in line with the guidance from specialists in this country and Europe because all the evidence suggests that ear infections settle down by themselves.

Restless legs and other things

Last week one of my patients asked about restless legs at night and what can be done about them. It has taken me some time to find good information about it and along the way I came across 'Treatment notes'. These are a series of information sheets produced by the same people who do the Which? magazine. They also publish the highly regarded doctors newsletter about new medications called the 'Drug and Therapeutics Bulletin' .

I have placed the list of treatment notes in the frame below.

Click  Treatment notes link here.  to access the leaflets in .pdf form. You will need Adobe reader to view these leaflets. A free version can be downloaded via the Adobe site -  a link to Adobe is provided on the index page of this website.

If you look there is a leaflet about Coping with restless legs. The main message is that if it is bad there are drug treatments for it...come and talk to us about it.

More bad news for women.... Research on 1000 French women suggested that they are more likely to suffer from ear, nose and throat complaints if they worked in an air conditioned building. I can't quite understand why the study only seem to focus on women though

Does live yogurt prevent vaginal thrush? (BMJ 4thSeptember 2004)

A study from Australia suggests not. They took 55 women with post antibiotic thrush and gave half either oral capsules full of bacteria found in yogurt or vaginal pessaries of it. Neither method seemed to do much good. Although one could argue that using a creamy preparation would me more like the consistency of yogurt than using capsules and pessaries.

Leisure centre fully open

A leisure centre for Lutterworth has been promised for over a decade. Now it is finally fully open. You may be aware that until 1st August, the swimming pool has been closed but now there are no excuses about not exercising.

Having become a member my self ( together with several of the practice staff - lest we are accused of being couch potatoes!) I took some time to look at the physiology of exercise.

One website which was particularly lucid is hosted by a senior athletics coach called Brian. Click here to a link to his site that discusses what your ideal heart rate should be for optimum training. The little training zone calculator based on an Excel is particularly neat. Note the disclaimer on this site.

Do detox diets work?

The issue of so called detox diets bugs Dr Masharani. The whole subject is veiled in pseudo-scientific mumbo jumbo when it is written about in the press. There is a good article on the BBC health website about this subject which I have saved as a .pdf document( click the link below). The author quite rightly points out that we are constantly absorbing toxins from plant and animal based foods and the liver does a brilliant job in getting rid of any toxins. Anatomically this is done because all of the blood carrying absorbed material from the bowel is taken directly to the liver first rather than entering the general circulation.

Detox diets by Alyson Greenhalgh

Fat or thin?

There has been a lot written about obesity in the last few weeks. The problem with specific diets such as Atkin's and Slimfast diets is that even if they work there are very few people that can stomach sticking to a 'diet' for ever so you just yo-yo up and down.

Modifying what you eat so that you cut out some of the junk, high fat food and reducing the total amount of food is something you can do for good.In addition it helps to take exercise...

First of all the thing to work out is your ideal weight. A body mass indicator is posted on the 'kidzone' page of this website or else you can download this neat little shareware program onto you hard disk. Click here.

Ginseng interaction with warfarin

It was reported in 'Annals of Internal Medicine' that in a 4 week study of 20 patients found that the effectiveness of warfarin was reduced by taking Ginseng. Patients taking warfarin should be aware that taking any medication or herbal treatment may affect their anticoagulant control.

Mumps cases rise among teenagers and young adults

Cases of mumps are running at the highest level for a decade in England and Wales. The latest figures show that most cases of mumps are now among young adults who  missed out on having the MMR vaccinations in the 1980's. This may mean that young adults may have to be given the MMR vaccination if things get worse.

On the subject of heart trouble...[ & high blood pressure]

One of the conditions that takes up a lot of the doctor's and nurse's time at the surgery is dealing with raised blood pressure (hypertension). Quite often we are spotting rising blood pressure in people in the late 30's and onwards and it becomes more common the older you get. There is plenty of evidence that high blood pressure increases the risk of getting heart attacks and strokes. And some groups such as smokers and diabetics are at even higher risk of something horrible happening to them. We would recommend adults to have a blood pressure check done about every 3 years. These days many chemists provide this service so you don't even have to come to the surgery. Although our nurses would be happy to provide this service should you wish to book and appointment.

Rather than write a long article about blood pressure, Dr Masharani has provided a few links for those wanting to know more about hypertension.

http://www.bpassoc.org.uk/information/what_is/what_is.htm

Patient information sheet as .pdf document

for budding doctors the British Hypertension Society website contains the definitive guidelines for hypertension management. The language is a bit technical though.

Is chocolate good for your arteries?

A small United States study recently suggested that antioxidants found in chocolate may be beneficial to health. The study which only lasted 2 weeks measured the blood flow through an artery in the arm. Despite what was reported in the Daily Mail and other papers, it did not demonstrate that those taking chocolate lived longer or anything else. It just goes to show that you can't believe everything you read in newspapers.

The head of medical information at the British Heart Foundation commented on the very high calorific content of chocolate and advised eating at least five portions of fruit and veg' each day as a better way of improving vascular health.

Intermediate care

 This week saw the launch of the Intermediate care scheme, a joint scheme funded by the South Leicestershire PCT and Leicestershire County Council, which will no doubt prove to be a fantastic way of improving the care that is provided to the community in South Leicestershire. For more information click here

Men's Health Week

I wonder how many noticed that the third National Men's Health Week ran from 14-20th June 2004. The Men's Health Forum (MHF) are the charity behind the campaign and they have the aim to raise awareness of men's health among men, health policymakers and service providers - and also to encourage men to be more symptom aware with the hope of driving them to seek medical advice sooner.

Men out there who want to improve their knowledge about health click here to the MFH website

Breast augmentation is unlikely to affect cancer identification (BMJ 12thJune 2004)

Does breast augmentation interfere with the detection of breast cancer?

This article in the British Medical Journal  suggests that Breast implants decreases the sensitivity of screening mammography in  women without symptoms but does not increase affect the accuracy of mammography in patients with symptoms. Women with breast augmentation are encouraged, like other women, to undergo routine screening mammography at recommended intervals.

Childcare Provision

A new document has been published by Leicestershire County Council outlining childcare provision in this county. Copies can be obtained by telephoning the Education Dept. of county hall (0116) 265 6545. I have converted it into a .pdf black&white copy. Is a bit blurry but keeps the file size small for downloading. Click here

 A sad farewell to our health visitor, Karen Ford...

Patients and colleagues alike were saddened by the departure to Karen Ford. She has been the health visitor attached to the practice for 7 years. Karen has worked very hard to improve services for parents and their off spring. She is now moving to Market Harborough. Here is a photograph of her (centre) with some work colleagues at her leaving do.

HRT and Breast cancer risks

We are slowly seeing our way through patients on HRT in order to discuss the implications of recent research about breast cancer and other risks of taking the medication. It is worthwhile downloading and reading the resources prior to going to see the doctor for the next medication review. This week saw the publication of more guidelines as to who should have HRT and who should consider coming off it. The first three links below are what were published on this site previously and the last link to a pdf document is new.

1. Patient leaflet
2. Health professional's leaflet
3. Cancer UK Press release
4. New dept of Health circular ( 3rd December 2003)

Disabled badge scheme

The Blue Badge Scheme provides a national arrangement of parking concessions for people with severe walking difficulties, who travel either as drivers or passengers. The object of the concessions is to assist those qualifying for badges to lead a normal life by making it easier for them to visit shops, restaurants and other local amenities by parking closer to their destination. The scheme only applies to on-street car parking.

For further information about the scheme, please see a .pdf version of the DTLR’s information leaflet

Who is entitled to a blue badge?

You can obtain a badge automatically if:

The County Council is also able to apply discretionary criteria if you...

Forms can be obtained form the service shop on Market Street, Lutterworth. Or you can email social services on social-services@leics.gov.uk  or write to them at: Social Services Department, County Hall,
Glenfield,Leicester, LE3 8RL

A pdf. version of the form can also be downloaded click here

When returning your completed application form, you will need to include a passport-sized photograph and a cheque/postal order for £2.00 (made payable to ‘Leicestershire County Council’). Please remember to put a postage stamp on the envelope before handing the form to the surgery.

Our Warwickshire residents need to fill in a different form which can be obtained from Warwickshire County council by phoning  01926 410410 or writing to them at: Warwickshire County Council, Customer Services Dept, Shire Hall, Market Square, Warwick, CV34 4TH. It can also be downloaded by clicking here.

The Warwickshire form does not have to be countersigned by the doctor and of course the £2 cheque/postal order is made out to 'Warwickshire County Council'

FDA warns against commercial prenatal ultrasound videos 

Prenatal ultrasound videos called "keepsake videos" and taken by commercial studios may affect the fetus, warns the US Food and Drug Administration. The administration shut down such studios 10 years ago and is again considering regulatory action. Ultrasound is a form of energy and can't be considered harmless, even at low levels, it says. The reason that these videos are so popular is that they give a 3 dimensional image of the baby in the womb but on the other hand it is not known how dangerous prolonged exposure to ultrasound is to the baby. There is no evidence that the short exposure to ultrasound on a regular antenatal examination at the hospital is dangerous.

I suppose it will only be some time before private clinics in this country will offer the service but you have been warned!

Sun and skin cancer

With the clocks changing to British summer time we are all looking forwards to a hot and sunny summer. So here is a timely reminder about skin cancer how to stop getting it.

There are around 65,000 new cases of skin cancer reported in the UK every year and the numbers are rising and they result in about 2,000 deaths each year in the UK. The important message is that skin cancer is almost totally preventable through simple and inexpensive sun protection methods.

Click here for a summary article adapted from information on the Cancer UK web site.

Repetitive Strain Injury (RSI) and all that

One of my patients came in today with RSI affecting her wrist . It made me think that the issue of work related health issues needed another airing.

Different problems occur with different jobs but the common theme is that prevention is better than cure.

With regard to hand RSI ; this can be caused by sitting too long typing without taking adequate breaks. I have pasted a couple of pdf documents which may be helpful to those who have the problem or want to prevent getting the problem.

    HSEUpperLimbProblems.pdf        HSEWorkingWithVDUs.pdf

I have a copy of Kaz guardian installed on my computer which comes bundled with the excellent Kaz typing tutor program and it monitors how much typing I do and advises me to take breaks. There are other programs that do similar things but I have not come across any independent assessments as to which of these programs is the most effective (see link below). Alternatively the common sense approach to the problem comes free of charge.

If you want a deeper understanding of the issues and possible solutions to avoiding RSI then have a look at the following site by Arkum Associates   http://www.office-ergo.com/pros&.htm

Black Cohosh and treatment of menopausal flushing in Breast cancer patients

A query from one of the local pharmacists [ thanks Dee!] made me look in to the issue of the use of Black Cohosh in the treatment of the quite debilitating menopausal flushing patients with breast cancer can get, especially those on Tamoxifen. 

For my article an links about this subject click here

"Study finds no connection between MMR vaccine and autism" BMJ2004;328:421 (21 Feb 2004)

The debate about the risks of the MMR jab continues to rumble on. The BMJ headline this week, I feel, does not quite reflect the findings of this study, but on the other hand it is more research to support the idea of a lack of association between the jab and development of Autism.

The hypothesis behind this study is that giving the MMR vaccine before the critical time for autism development might be associated with a greater chance of developing autism if the MMR jab is really causing autism.

Instead, Frank DeStafano and his colleagues found, from examination of the records of 624 children with autism in Atlanta (USA),  that there was no difference between this group of children and children who did not develop autism in terms of timing of their jabs.  They also state that the majority of children who had the vaccine later than 36 months of age were already showing signs of autism before they had the jab. Click here for a copy of the research paper.

Domestic Violence

Domestic violence takes many different forms... physical, sexual, emotional or financial abuse of a person by a family member, partner or ex-partner. It can affect men as well as women and children.

It can be difficult to accept that you are being abused by someone you love or once felt close to and it is frightening living with the unpredictability of a partner's. People sometimes blame themselves but there are never any excuses for some one being violent.

The first step towards dealing with domestic violence is by talking to someone. You can approach any member of staff at the surgery or alternatively telephone any of the help lines below.

British Cancer death rates fell by 12% between 1972 and 2002.BMJ 7th February 2004.

Although more people are getting cancer, things are looking up for cancer suffers of all the common cancer sufferers including breast, lung and bowel. But although lung cancer has fallen in men it has risen in women. This is because men are quitting cigarettes whereas more and more women are taking up the harmful habit. Smokers can expect a bit of nagging from Dr V when they come to the surgery!

Cannabis facts revisited (this article was first posted September 2003 but is topical again)

The issue of Cannabis has hit the headlines again because it is set to be reclassified as a class C drug rather than a class B drug in the coming week. In most cases it means that if you are caught in possession of small quantities, the police are likely to caution you rather than arrest you unless there are aggravating factors such as smoking in public, repeat offending and if you are under the age of 17 or hanging about schools. You will still get done for growing the stuff.

The British Medical Association has pointed out this week that  reclassification does not mean that cannabis is safe to use, it is merely a recognition that David Blunkett, the home secretary, is asking the police to concentrate their energies on heroin , cocaine and crack cocaine related criminal behaviour.

The risks of cannabis use are:

·         Smoking cannabis may be more harmful than smoking tobacco. Cannabis has a higher concentration of chemical 'nasties' that cause cancer.

·         Smoking anything can give you heart problems, bronchitis and cancer. Smoking it with tobacco can get you hooked on tobacco.

·         Cannabis can make asthma worse. it's not a good idea with heart disease, high blood pressure or at risk from strokes.

·         Regular, heavy use makes it harder to learn and concentrate.

·         Frequent use of cannabis can cut a man's sperm count and suppress ovulation in women.

·         Some people begin to feel tired all the time and can't seem to get motivated.

·          Some research has made a link between cannabis and mental illnesses like schizophrenia. If you've got a history of mental illness in the family you should think very carefully about getting stoned.

Smoking cannabis when pregnant may harm the baby. Babies tend to be lower in birth weight and to have developmental problems.   PDF doc

Lower tar makes no difference BMJ  2004;328 (10 January), doi:10.1136/bmj.328.7431.0

More bad news for smoker turned up in the Britsh Medical Journal last week:-

Smoking low tar cigarettes does not reduce the risk of lung cancer, and smokers are at higher risk than non-smokers. In a study from the United States more than 940 000 people were followed up for six years; 25% of them were smokers. They found that the risk of dying from lung cancer was the same for smokers of very low tar ( less than 7 mg tar/cigarette), low tar (8-14 mg), and medium tar (15-21 mg) filter cigarettes. People smoking high tar non-filter cigarettes were at an even greater risk, and only those who quit smoking or never smoked had a significantly lower risk of lung cancer.

Some herbal eczema creams contain high doses of strong steroids

Research by doctors in Birmingham published in the Archives of Diseases in Childhood  showed  that 20 out of 24  herbal creams that were used by 19 children contained steroids. Those labelled “ Wau Wa” and  Muijiza” were found  to contain a very potent steroid indeed which would not normally be prescribed to children.

The conclusion from this study is that parents are often worried about using steroid creams on their children but are then inadvertently using them by buying very expensive herbal creams that have been illegally contaminated with strong  steroids.

The author's comment:

“We continue to find examples of illegal herbal creams being used by our patients and have even witnessed recommendations being made in our hospital waiting room. There is an urgent need for tighter regulation and improved legislative mechanisms relating to the herbal and ethnic medicines industries and for increased public education about the potential dangers of alternative therapies. Until then, a high level of suspicion is needed regarding herbal creams that produce "miracle results".” 

Glucosamine improves joint mobility for 1 in 5 patients with osteoarthritis BMJ  6th December 2003

Dr V has been watching the story of Glucosamine in osteoarthritis for some while. At present there are no effective treatments for the prevention of osteoarthritis, which is commonly regarded as age related wear and tear disease of the joints. We have yet to gain understanding why some people's joints seem to last longer than others  and why, when we are younger, joints seem to repair themselves to a great extent. This is one of several studies that Glucosamine ( available from health food shops ) helps symptom control. This does not mean that it prevents progression of the disease process. There has, however, been a review of studies in a medical magazine called Bandolier [ in 2001] that suggest that it may slow the progression of the disease but their main conclusion was that more research needs to be done on the subject. Most studies involve patients taking oral doses of 1 to 1.5 grams a day of Glucosamine.

Baby walkers delay development and cause injuries  BMJ 21september 2002

Wow!  you are saying Dr V is really digging up the archives for newsworthy items. Well the problem about bring up children is that by the time you have had two or three you finally develop some expertise in the subject and then you stop so the messages need repeating from time to time. So here is some helpful advice for first timers.

This time of year people are thinking what to buy infants for Christmas. Baby walkers - those contraptions with wheels that you sit them in should be off the list according to many experts because they are dangerous and delay development according to the BMJ. In fact these walkers have been banned in Canada.

Click here for a pdf version of the article

Impermeable bed covers don't help allergic rhinitis (BMJ 18th October 2003)

Various shops sell impermeable bed covers by claiming that they reduce dust mite allergens and so must be good for allergy sufferers. This study originally published in the New England Journal of Medicine took 279 allergy sufferers and gave half of them normal bed covers and half impermeable covers. It was found that although there were less dust mites if you used the impermeable covers the improvement of symptoms were from using sheets of any type were about the same. This would suggest that there is no benefit from spending the extra cash on the impermeable bed covers.

Changing minds

   click here for more information about changing minds

Paroxetine may help with hot flushes BMJ 4th October 2003  

This article in the British Medical Journal summarises the findings of a study published in an American Journal and concludes that Paroxetine [Seroxat] may be a useful alternative to hormonal replacement therapy for menopausal women with significant hot flushes. Paroxetine is a member of a group of antidepressant drugs called SSRI's.

Another non-hormonal drug that seems to help with hot flushes is Clonidine [Dixarit] and some people recommend herbal treatments such as Black coash but I have not come across clinical trials that prove these herbal treatments work.

Hot flushes can be extremely debilitating so doctors take this subject very seriously. Readers of this page will be aware of recent published data about breast cancer risks associated with taking HRT  and some people are not allowed to take HRT anyway because they have a history of breast  or ovarian cancer or thrombosis. Some patients simply don't tolerate HRT. So here is another possible option to consider but I am not aware of any drug companies that make SSRI's having a licence covering the treatment of hot flushes so it's use is not likely to become widespread in the near future.

Snorers should not take their problem lightly 24th September 2003

The sleep apnoea trust sent the surgery a mail shot this week pointing out:
1. only 1 in 20 sufferers are so far diagnosed. Most are over weight middle-aged men.
2. each GP will have around 2 or 3 patients with the condition
3. the main symptoms are loud irregular snoring and overwhelming daytime sleepiness
4. this overwhelming sleepiness causes up to a tenfold increase in car accidents
5. sleep apnoea is treatable
6. web site for more information: www.sleep-apnoea-trust.org

Prevention of Group B streptococcal infection of the newborn

26th September 2003

Dr V was approached about screening for group B streptococcal infection screening this week. This bug can be picked up from the mother when a baby is born and can cause a life threatening infection in the child. The problem about dealing with the issue is that the way it is presently managed in this country on the NHS is different than in countries such as the United States of America, Canada and Australia. Click here for more information.

Fear of flying

Like a lot of phobias, the fear of flying causes a lot of distress partly because sufferers themselves recognise that the fear is irrational. Unfortunately patients quite often come to the surgery requesting Valium on the day before they travel rather than coming to see us for advice in good time. One of the best ways of dealing with this phobia is not through taking drugs but by going on a fear of flying course. There is a very good one run at the East Midlands airport.

A couple of links dealing with the subject with some very helpful information and contact numbers are provided here.

travellershealth.co.uk

airfraid

Sick of sick notes!    8th August 2003  

Yep all the doctors in the practice are fed up of giving out sick notes ( medical certificates) when patients don't need one until they are off for more than 7 days. It uses up lots of our and out patient's time. According to our patients a lot of this trouble appears to be generated by employers insisting for notes when they should be dealing with the issue. We do state in our practice leaflet and on this site that we may charge for this service.

If your employer asks for a sick note in this situation then perhaps you can give him/her a copy of the leaflet "Managing short-term sickness" available as a pdf format document here

Eating fish reduces the risk of Alzheimer's disease  

For the full article in the nelh click here

"Eating fish once a week can slash the risk of Alzheimer's disease by more than half, reported the Daily Express (22 July 2003). The newspaper accurately reported the research findings, but confirmation is required from longer-term studies before the association between fish consumption and Alzheimer's disease can be anything more than tentative.

* The Daily Express correctly reported the research findings that eating fish once a week can reduce the risk of developing Alzheimer's disease by 60% . However, the newspaper article also reports that these findings come from a seven-year study of nursing home residents. Participants were actually followed-up for an average of four years and were drawn from the general population.
* Findings from the study, on which the newspaper article was based, showed that weekly consumption of fish and intake of n-3 fatty acids may reduce the risk of Alzheimer's disease.
* Although the newspaper article accurately reported the findings of the study, the headline 'Alzheimer diet cure' is not supported by the evidence presented. Further investigation in the form of longer-term prospective studies and clinical trials is warranted before any definitive conclusions can be drawn."

Thiomersal and vaccines - yet more controversy about kids jabs!    12th July 2003

The issue of thiomersal, a mercury-based preservative in vaccines, has reared its ugly head in terms of its implied risk between having jabs containing the compound and Autism. The mater revolves around an article by Geier and Geier looking at adverse reaction feedback data (click here for a pdf  summary article by the two authors). Not many people in this field are convinced by their assertion because thiomersal has been used for about 70 years without blemish and the authors do not distinguish between different types of mercury compounds. The stuff that is in these vaccines is safer in the body and easier to excrete than the minute amounts that are naturally absorbed through food.

Rebuttal of the evidence  in the American Academy of Paediatrics is posted here and there is also a link to Department of Health's web site about this issue.

The only jab that we give in the practice that contains thiomersal is the ACT-Hib primary injection given to babies. All the other jabs including Meningitis C, polio and MMR are thiomersal free. The overwhelming evidence is that the jabs are safe but if parents are still not convinced there may be other ways round this problem. Please discuss the issue with the health visitor, Karen or come and see the doctor to discuss the matter further if you want.

Don't sneeze on me   

25th June 2003

If you are one of the people suffering with hay fever at this time you are not alone. Here are some statistics from the BBC health web site:

the common presentations are:

Diagnosis is usually made from the history taking. Although allergy testing is widely advocated in the media quite often the cause is obvious and the treatment would not be altered by allergy testing. In addition NHS allergy testing clinics are very thin on the ground. Some allergies such as peanut allergy can be life threatening whereas hay fever will only make you miserable. So avoidance measures are again more important in some allergic conditions than others

This is a bit technical in its language but it is one of the best articles for people who get the sneezing drippy nose or blockage type allergy e.g. hay fever ("allergic rhinitis") is through the link below.

http://www.prodigy.nhs.uk/guidance.asp?gt=allergic%20rhinitis

It is difficult to know why allergies are becoming so prevalent. It has been suggested that there are ways to avoid children having it by taking some avoidance measures whilst the mother is pregnant, but a lot of this advice is not grounded on hard research data:

http://www.anaphylaxis.org.uk/

Lets talk dirty - Nappy recycling   

20th June 2003

You don't have to be a member of the Green party to realise that Society is in real trouble with the amount of dirt and waste it produces. There simply aren't enough deep holes in the ground to put it all into. Here are some statistics -  another topic for children's  school projects I suspect.

The sources of this information are from various articles which are authoritative and properly referenced and can be accessed by links at the end of this piece.

▪The quantity of waste produced is rising by 3% per year and the waste mountain will double by 2020.

In England we recycle 12% of household waste compared with over 40% in some EU countries.

▪About 3 billion nappies are thrown away in the UK every year ( about 4 % of total household waste).

▪About90% of these end up in land fill sites.

▪We don't know how long they will take to decompose. Nappies break down to a varying degree. About 25% of the waste is plastic and paper. The rest is urine and faeces. The plastic will probably never decompose.

▪In 1991 two Proctor and Gamble funded studies by Lentz and Little suggested that there was very little difference in the overall environmental impact between disposable and reusable nappies. The findings have been disputed by many authorities.

So what has this to do with the health centre? Well visitors to the surgery will see a display showing how one can swap disposable nappies for reusable ones without suffering a great deal of extra inconvenience. There are a lot of different types to choose and some companies do a simple pick up and delivery system to take used nappies and leave you clean ones so the washing machine is not on all day. If you miss the display in the next few weeks contact the health visitor who will be happy to advise you or alternatively look at he Leicester City Councils web page on the subject which covers the choices on offer:-

http://www.leicester.gov.uk/departments/page.asp?pgid=5853

Links to articles about the problem of waste and environmental damage:-

http://www.number10.gov.uk/output/page3907.asp

http://www.greenparty.org.uk/reports/2002/1zerowaste.htm

Now you know why Dr V is grumpy on Monday mornings

28th May 2003

Have a look at the hse web site if you ever have a few minutes. It makes fascinating reading. One issue that we are seeing a lot of is stress. Here are some facts from the health and safety executive.

"The 2001/2 survey of Self-reported Work-related Illness (SWI01/02) prevalence estimate indicated that over half a million individuals in Britain believed in 2001/2 they were experiencing work-related stress at a level that was making them ill. The Stress and Health at Work Study (SHAW) indicated that nearly 1 in 5 of all working individuals thought their job was very or extremely stressful.

Estimates from SWI01/02 indicate that self-reported work-related stress, depression or anxiety account for an estimated thirteen and a half million reported lost working days per year in Britain.

Both survey data and surveillance data suggest that work-related stress and related disorders are increasing in the British population. However, these data are difficult to interpret.

Occupation and industry groups containing teachers and nurses along with police officers, social workers, probation officers, UK armed forces personnel and medical practitioners have the highest prevalence rates of work-related stress."

If you are suffering from stress come and talk about it. We can help you.

We keep copies of the BMA book on stress in our patient library and the doctor patient partnership has good advice on their web site - click here

"Media misled the public over the MMR vaccine" BMJ 2003;326:1107

27th May 2003.

In last weeks BMJ Roger Dobson reports on a study from Cardiff. At the height of the media coverage the impression was created that medical scientists were split down the middle over the vaccine's safety but the authors say " Although almost all scientific experts rejected the claim of a link between MMR and autism, 53% of those [the people] surveyed at the height of the media coverage of the issues assumed that because both sides of the debate received equal media coverage, there must be equal evidence for each. Only 23% of the population were aware that the bulk of evidence favoured supporters of the vaccine."

I can't see this topic lying down just yet says Dr V.

Claiming benefits

22nd May 2003

A patient asked this week about maternity grants and how to apply for them. The problem for us is that the rules for claiming different types of benefit change all the time. The Department of Work and Pensions ( formally the DSS) site is a good source of current information. Click here  for the link. Thankfully a lot of the forms are downloadable from the site so you won't have to go telephoning people about them. Filling them up is a different matter. Some of them end up as rather big booklets. The attendance allowance form with the instructions is 42 pages long so the pdf file takes ages to download and even longer to complete. You can complete the from on the screen if you feel brave, and then print it off to send. If you need help and advice filling in benefit forms then the citizens advise bureau is a good source of help. The number is in the phonebook section of the site and their office is at the ' one stop shop'.