Welcome to Katy Gordon’s blog, where you will find all your health care questions answered sensibly, straightforwardly and reliably. Whether your question is about how to look after your health, how to deal with a specific condition, or simply how to negotiate the UK health care system, Katy can help – and if she can’t answer your question herself, she’ll ask someone who can. Katy Gordon – expert, reliable, sensible health care advice
Do you know that the more I think about the statistics on raised blood pressure, obesity and diabetes in the WHO annual health report last week the more concerned I become that we’re not all doing more about our own health, and that the NHS and our health services are not doing more with people during consultations with their doctors and nurses. Every consultation should be seen as an opportunity to help that person help themselves to good health and I think many of these opportunities are being missed completely.
I also feel that the Western world is very complacent about their own health care, and I think there are huge pitfalls for developing countries who want to aspire to health care as ours is in the UK etc. There is much that these countries could learn from what we have done, but more importantly what they should not follow us in doing. This would help them develop far better health policies in years to come than we have got.
I feel very passionately that we should be trying to stop the ‘global heart attack’ from happening. And much of our Western way of life actively contributes towards the global heart attack. So what should developing countries be learning in order to prevent them from also contributing to the global heart attack? They should be thinking about developing strategies to prevent endless fast food outlets from opening. They should ensure that PE and games is very much a part of the school Curriculum. They should ban tobacco advertising and smoking in public places. They should actively encourage healthy home cooking especially without adding salt to food, and with lots of fibre in what you eat, especially vegetables.
I could go on and on about what they should be doing and then I just sound like I’m preaching at people, which is not what I want to do. I think one of the most important things that should be thought about at governmental level is that health and social policies should be integrated so that they actively link and support each other. there are some policies that have been overlooked in the UK which seem to be diametrically opposed to each other which really makes you wonder if the left hand knows what the right hand is doing within the government itself. It appears that different government departments do not communicate or speak with each other at all which makes a mockery of some of these strategies and policies. I think that is one of the single biggest things that developing countries could insure doesn’t happen within their governments.
I used to work with Alan Maryon-Davis who was saying all these things in the mid to late-90s and at the time seemed rather like a lone voice. These statistics published last week by the WHO completely bear out what Alan was saying. More’s the pity that we didn’t take more notice then, and also that Prof Sir Roger Boyle had not had to choose between secondary prevention and primary prevention under the last government. He did a marvellous job by dramatically improving the care given to people after they had had a heart attack and other related cardiac conditions. However what should also been taking place at the same time was primary prevention and more specifically earlier diagnosing and managing people with high blood pressure, working with people who are overweight or obese especially young people and working with the food industry to reduce drastically the amount of hidden salt and sugar in a lot of our foods.
Is it too late to change our policies and try and do something about this in the UK? No, it is never too late but will this government actually do something about it. Sadly I have little faith in Andrew Lansley and the Department of Health to put appropriate policies in place within the healthcare system or to work with other government departments to develop healthier population approach policies on healthy eating and physical activity or exercise. However I would love to be be proved wrong!
The first time that I had ABPM was an interesting experience! My GP was concerned about my blood pressure as my levels were starting to become consistently raised. I duly had an appointment at my local hospital to go in and have one of these devices fitted. It was really quite quick. I turned up at the relevant department shortly after eight o’clock in the morning and was told what would happen, how often it would take it, and what would happen at night. They then put a cuff on my arm and attached it with a long tube to the machine itself. This they put in a long carrying holster which I wore over my shoulder. Every half-hour it took my blood pressure. They told me that I was to be as relaxed as possible when the machine took my blood pressure. It was supposed to be a typical day for me. I was doing a lot of computer work at the time and it meant that every half an hour I had to relax my arm and stop doing what I was doing.
This wasn’t particularly a problem until I received a phone call from my brother’s cleaner who had gone to his house as per usual but found that somebody had broken in. She had called me because my brother was away at the time. I asked her to call the police, dashed out of my office and jumped in my car to drive over there. All thoughts about my blood pressure monitoring went out of my head. I was brought up with a sudden jolt as I was trying to change gear was in the middle of a large road junction in the middle of the city. What stopped me short was the machine trying to take my blood pressure while I was changing gear. It was patently obvious that I could not stop driving for the machine to do its job. It kept trying to take my blood pressure but I was still changing gear and driving. It eventually gave up and I thought no more about it.
Having sorted out what was happening in my brother’s house I took myself back to work and carried on with the day, relaxing my arm every time the machine wanted to take my blood pressure. I had been told that from 10 o’clock in the evening until six o’clock, I think, the following morning the machine would only take my blood pressure every hour. I have to say that I did find my sleep was somewhat disrupted by what I was rapidly coming to regard as ‘that flaming machine’!
When I looked back though, all in all, it was actually a very okay experience. It was very interesting when I went in just after eight o’clock the next morning and they took the machine off. They said if I waited they would tell me what the readings had shown. They were very prompt in coming back to me and asking me what on earth had happened about midday the previous day. I thought carefully about what had happened and realised that it was about that time that I had been changing gear in the middle of a very big road junction. I told them what had happened and they told me that because the machine had not been able to take a reading for a little while this had quite affected their, or should I say my, results. They were able, however, to discount that period of 24 hours and come up with a sensible report. Needless to say I was diagnosed as having high blood pressure but am also very happy to say that I went on treatment, which after some initial juggling, now works very effectively and my blood pressure is within normal limits.
So if any of you are asked by your GP to have this done it is a relatively painless experience in that it was only during the night that it was a bit of a nuisance but otherwise was absolutely fine. It is a lot easier to find out this way if you do have high blood pressure than going along several times in a three-month period to your GP. I would happily have it done again if my GP wanted to reassess my blood pressure.
Yesterday the WHO released their latest health statistics report [http://www.who.int/mediacentre/news/releases/2012/world_health_statistics_20120516/en/index.html] highlighting the growing problem of noncommunicable diseases with some pretty stark facts:
“One in three adults worldwide have raised blood pressure [also known as hypertension] – a condition that causes around half of all deaths from stroke and heart disease. One in ten adults has diabetes….. Left untreated, diabetes can lead to cardiovascular disease, blindness and kidney failure. …. In every region of the world, obesity doubled between 1980 and 2009. Today, half a billion people [12% of the world’s population] are considered obese.”
For quite some while now I have been banging the drum to raise awareness of the implications of having high blood pressure and that so much can be done by the individual to reduce their likelihood of getting complications such as heart attack, stroke and kidney disease. In the UK and the Western world high blood pressure has historically been under diagnosed for a variety of reasons, not least that the person does not have any signs or symptoms of the condition. Having said that if a raised blood pressure is recorded in general practice this is not always followed through to see if the patient actually has high blood pressure or not. And then if they actually do have high blood pressure and a diagnosis is made they are not necessarily treated to get their blood pressure down to the right target levels. In the early 90s this was termed the rule of halves: half of people with high blood pressure were not identified, of those identified half of those were not on treatment, and of those on treatment half of those were not treated to the target levels identified by research. This has improved somewhat over the last couple of decades but there is still an awful lot more that could be done. Reports such as this one from the WHO highlight this.
I think it is incredible to realise that one out of every three people worldwide have high blood pressure. There is so much that we can do to keep our blood pressure within normal limits. In the Western world we add salt to our food, we find it in processed foods along with hidden sugar, we are increasingly taking less exercise and becoming more overweight, we drink an awful lot more alcohol than is good for us, and still quite a lot of people smoke. Obesity, particularly, affects your blood pressure adversely. It isn’t any wonder then that we, collectively, are headed towards the global heart attack or stroke. More importantly to me is that developing countries who might aspire to become like those of us in the Western world do not fall into the same trap and also sign up to the global heart attack or stroke. For those responsible for health and social policies in developing countries it is imperative that they take on board the messages that this WHO report gives to ensure that they don’t follow in our footsteps but rather learn from where our policies went wrong and do not fall into the same trap.
So what should we be doing about this? Fast food outlets such as McDonald’s should be regulated to ensure that their food is healthier. In this day and age where life is frequently lived at full stretch people look to fast food outlets for many of their meals. However the food that they are buying is not necessarily very nutritious, contains high levels of salt and possibly sugar, and is not very balanced in terms of fibre and vitamins etc. People frequently buy ready meals as well, and these, too, often contain high levels of sugar and salt which, as we know, are not good for us. What are the big supermarket chains doing to sell much healthier meals? Should we be lobbying for better regulation of foods sold by supermarkets? Well, if the supermarkets themselves are not going to do it then may be it is time for governments to step and force them to ‘clean up their act’.
In the UK over many years school playing fields have been severely reduced in number as have the amount of sessions of PE or games in the school curriculum. As we move much more towards using electronic, in the moment communication and working this also reduces the amount of exercise many people take as they lead an increasingly sedentary lifestyle. TV also contributes to this as many people spend quite a lot of their leisure time in front of ‘the box’. Alcohol has become cheaper and more readily available, especially in the UK, with the move towards pubs and clubs being open 24 hours a day. Only recently has having tobacco on display in supermarkets been stopped, and there are still a significant amount of the population who smoke.
Is it any wonder, then, that we see that high blood pressure, obesity, and diabetes increasingly prevalent in the population? However so much of this can be prevented and this is where we all need to take much more responsibility for our own health, and look at the changes that we can make in our lifestyle that bring us good health rather than ill health. These changes do not need to be far reaching, in the main, but just looking sensibly at how we live our lives: taking more exercise, cooking healthy meals at home more for ourselves, cutting down, or even out, the amount of salt we add to our food and in cooking, drinking sensible amounts of alcohol, and stopping smoking are just some of things that we can quite easily change which will make a huge impact on our health in years to come. For me this is even more important when it is children’s health which is at stake.
So, are you signing up to be part of the global heart attack? Or are you going to decide to do something positive about your own health and make whatever lifestyle changes will bring you much better health over the coming years? Don’t be a sheep but think positively and carve your own way to better health!
‘Diabetes blood pressure control warning’: half of people with diabetes are failing to keep control of their blood pressure, risking ‘damaging’ complications, figures suggest. www.bbc.co.uk/news/health-17626129
A friend of mine drew my attention to an article on the BBC Health News yesterday about how 50% of people with diabetes are not reaching target blood pressures and as a result are getting more serious complications than if their blood pressures were controlled. It is with great sadness that I read the article as diabetes is not a diagnosis I would want to cope with at the best of times, and it is something of an indictment of the NHS.
High blood pressure is more common than any other medical condition but we have known for years that the evidence shows that if we are going to treat someone we need to treat to the target blood pressure or else they will get more complications. People with diabetes need to be aware of this as it can have a ‘hugely damaging effect on their health’ as Barbara Young, chief executive of DiabetesUKsays.
Record numbers of people with diabetes are being admitted with strokes and kidney failure, and are dying prematurely. As a healthcare professional I know that we need to get people’s blood pressures to within normal limits or they run a real risk of developing heart disease, stroke or kidney disease. However we can only do this in partnership with patients. The patient is the one who has to decide to take their blood pressure seriously and want to get it under control. We cannot do it for them, but rather, with them.
I am very passionate about raising awareness of this as high blood pressure is a growing national problem. There are over 16 million people in the UKwho have high blood pressure, and I in 3 people don’t even know they have got it. Bearing in mind that there are approximately 2.9 million people who have diabetes, and we know about them, there is a lot that we all can do to make sure we don’t become one of these unpalatable statistics.
Both stroke and kidney failure have a major impact on our lives, and all too frequently leave people requiring long term care and support for possibly another 20-30+ years. The impact of a severe stroke can result in permanent disability and leave the person needing 24 hour care for the rest of their lives. This is, in the main, avoidable and that is why I believe that if we all ‘knew our numbers’ we would effectively be able to reduce the number of strokes, heart attacks and kidney disease that currently afflict the UK population.
There is so much that we as individuals can do to keep our blood pressures normal. Simple things like stopping smoking, eating more healthily, taking regular exercise, cutting right down the amount of salt we eat, and similarly reducing the amount of alcohol we drink are very simple measures that can make a huge difference, and what’s more they don’t cost anything to do either, and may actually save us some money!
About a week ago the BBC Health News had an article about the English diet. Apparently we are becoming a little bit of a paragon when it comes to our diet!!! News indeed! Research studies have shown that we in England eat more fruit and vegetables and less salt and fat so it appears that as a whole the English population has taken note of healthy food messages to a greater degree than those in Scotland, Wales and Northern Ireland. Death rates from heart disease and cancer are now lower in England than the other 3 countries which is good news.
However we should not be complacent and sit on our laurels as the research goes on to say that our diet in England is still far from perfect. So well done to all of you who have listened to chefs like Jamie Oliver et al and adopted healthier eating habits BUT there is still more to do if you want to reduce further your risk of heart diasease and cancer. Some people have suggested that a ‘hamburger’ tax should be applied to help us come to the realisation that fruit and veg is cheaper and therefore we would eat more of it. Not a bad idea but in reality that means more of the nanny state, and I’m not an advocate of that if other means can produce results.
Last night I watched the second and third episodes of The Food Hospital on Channel 4 – what an excellent programme is that!!! This should be compulsory viewing in schools and advertised much more widely on the TV as it has very valuable health messages. The case studies they present show fantastic results in health by just adjusting your diet and the amount of exercise you take. I’m sure as the series goes on we will see how to modify our diets and improve our health in many different ways. The lovely thing about this programme is that it doesn’t put forward faddy diets which are difficult to follow, or recommend you take lots and lots of expensive health supplements and vitamins, but has practical easy to follow advice that is producing really good results. If you eat a healthy diet you shouldn’t need to take many supplements or vitamins as you should get them as part and parcel of your diet. The one thing that irritated me about this series is that I tried to download the App onto my iPhone, and I can’t get it because I don’t have the latest model. If they are really serious about getting the health messages out to everyone they need to make sure the App is downloadable on 18 month old phones! This is the one grizzle I have about the programme, but otherwise this is a great programme which everyone should watch. I am about to sign up on their website since I can’t get the App.
This programme gives hope to people who are obese, have psoriasis, diabetes, high blood pressure and many more conditions. I am now a huge fan and follow them on Twitter – although I note that they don’t seem to be tweeting at all yet!!!
I’m sure you will be hearing more from me about this programme in the weeks to come….. In the meantime, get watching it – Channel 4 at 8pm – I can’t think of many things that would make better use of this time!!!
Well, the last month or so have seen quite a lot in the health news, and no I am not talking about Hallowe’en and Bonfire Night related issues, although that might not be a bad place to start. Personally I don’t hold with the practice of trick or treating as I think it is an American idea that has taken off over here and become very commercial, not to mention the old folk who get scared witless and feel held to ransom to provide ‘good’ treats in order to avoid any nasty tricks being played on them. And then once they have got over the traumas of Hallowe’en they have to start all over again with the pitfalls of Bonfire Night, and avoiding firecrackers and bangers being thrown on the ground next to them to make them jump out of their skins. Surprising really that Coronary Care Units don’t see a massive increase in admissions of patients with heart attacks! Or is it that the ‘great British constitution’ stands up to these rigours better than we think?
So on to other matters medical: what has got my goat over the last few weeks that makes me want to take pen to paper?
In early October I read a storyabout alcohol advice limits being confusing. How true is this??? The last government changed the amount of units it was deemed safe to drink upwards. So for women it became 2-3 units per day taking the weekly total to a potential maximum of 21 units, and for men it was increased to 3-4 units/day equalling up too 28 units. Now was this really sensible advice to give? No, of course not! All this was bound to do was to enable the general public to take what they wanted to take from this and a lot of them have quite obviously decided that it meant that it was ok to drink 3 units in an evening if you were a woman and 4 for men, and that this would mean you were safe to drive. You only have to watch programmes like Road Cops, or Cops with Cameras on the TV to see that this has really taken hold. This frequently leaves charities who give support to people addicted to alcohol to pick up the pieces.
However, alcohol has an effect on your blood pressure. A small amount of it [1-2 units per day] is good for you and is beneficial for your heart, although you should not drink every day. More than that and it can do the opposite, especially if you binge drink. When I was an Intensive Care Sister we had a few patients who were admitted a few ties each year because of the effects of drinking too much for too long. Cirrhosis of the liver, and in particular the development of something called oesophageal varices, is very unpleasant. Oesophageal varices are basically varicose veins in the veins that run alongside your oesophagus or gullet. The veins can become swollen and distended, and eventually they rupture and cause massive bleeding. They are not pleasant to treat and if the person continues to drink can eventually cause them to die. Trust me, you really don’t want to have oesophageal varices. So, a little bit of alcohol a few times a week is fine for you but more than that, or binge drinking is definitely NOT a good idea, especially if you do this on a regular basis. If you want to find out more about alcohol and the effects on your blood pressure read some of my other blogs, look at my videos on YouTube, or get a copy of my book.
As I write this I am sitting next to a young woman who looks into this sort of thing as part of her job. She has the additional hurdle to jump in that she has to take a signing interpreter with her to understand the problems encountered by service users. I wonder how AA deals with deaf people with alcohol problems??? Also what are the links with Mental Health?? Whether it be primary, secondary or specialist users there SHOULD be access to deaf counsellors. However apparently NOTHING is available in secondary care!! Or is it??? It may be available if you travel 100 miles to get the appropriate support but how many of us can either afford to do this or have the time to do this?
What kind of society do we live in that allows this distinct gap in vitally needed services to still exist? Travelling by public transport allows me to meet interesting people such as this woman and to pose questions to you, my readers, in your own lives who might have no exposure to this kind of issue, but now that you are aware what might you do differently in your day to day working lives that might make a difference? And I have written before about the affects of alcohol on your blood pressure. Binge drinking is definitely something to avoid if you have raised blood pressure, or you could unwittingly be setting the scene for having a stroke. Could this be an opportunity to review how much you drink? Chilling words indeed so on to other matters of health that have caught my interest……
Last week I became aware that a doctor I had worked alongside many moons ago was firmly in the press. What’s more it turns out he isn’t actually a doctor but has been posing as one for the last 20 or so years. Hmmm, there must be many people along the way who are red in the face as they realise now they were involved in recruiting him to one of several jobs he has held in this time. For those who are curious about his name? Conrad de Souza, and he has worked in and around the Lewisham area ofLondonsince I first came across him some 10 and more years ago.
I must finish now but more next time on the various things that I have been reading that you might want to know about…..
New way of delivering treatment for acute stroke victims???
BBC Health News: Ambulance staff ‘can speed up stroke treatment’ www.bbc.co.uk/news/health-17664024
Germany have done a very small trial of 100 patients and shown that they can speed up treatment time for stroke patients for whom clot-busting treatment is the right management. However they don’t seem to have shown improved outcomes over and above current treatment, and the article infers that the specialised ambulances carry CT scanners which seems a little far-fetched, but then maybe I am not up to date with the latest technology.
Bearing in mind that we have effectively changed management of acute heart attacks over the last 6-7 years from clot-busting treatment to a procedure known in the trade as primary PCI [opening up the blocked artery by scooping the patient up and taking them direct to a centre that specialises in primary PCI] and now have hugely improved outcomes by doing this, why on earth are we not looking to do the same for stroke patients???
These cardiac centres exist up and down the country and the ambulance service take patients with severe chest pain straight to these centres for treatment. Why, then, do we not use these centres to treat stroke patients who have clots in their brains, rather than their hearts, in the same vein – excuse the pun! Interventional radiologists could carry out the procedure once an urgent CT scan had shown that the patient was eligible to have it done. It would also mean that the NHS was using current resources more efficiently which must certainly fit in with the government’s cost saving dictats. It would seem to me that this would be the most obvious course of action for developing care, and Andrew Lansley and the Department of Health need to set the scene for trials to be done to compare the two approaches for stroke treatment which would then give them the evidence to decide where investment and funding would be best spent. Well done Germany for doing this small trial but why aren’t we being more visionary and looking at the lessons learnt for developing acute heart attack care to inform future acute stroke management?? There would also be a knock-on effect of saving brain cells that mean that the person would make a much fuller recovery, much more quickly, which in turn would mean less days off sick and more importantly less severe disability requiring 24 hour care in the future for these patients. It’s a no-brainer, surely!