Tuesday, April 24, 2012

To Supplement or not to Supplement?

I was reading an otherwise very informative blog about how to maintain "healthy skin" but my thought processes jammed on the phrase "A multivitamin helps insure you receive all the vitamins and minerals your body requires. This, in turn, helps maintain healthier-looking skin and a vivacious energy level".

I was "aroused" enough to send a tweet to the writer to ask why the need for vitamin supplementation if someone was already on a healthy balanced diet. Apparently even those who think they are on a healthy balanced diet might might benefit from a multivitamin supplement because ..... their diet might not provide all the necessary vitamins they need!

I would be the first to hold up my hand and say that we are still discovering new "truths" each and every day and my knowledge definitely has limits, but I've always baulked at the idea that taking vitamins and minerals is essential to live a full and healthy life - especially one full with vivacious energy! I am a great believer that if you have a varied diet, you'll get all the good stuff your body needs.

Vitamin supplements, which are expensive, contain Vitamins A, B, C and E - some will have D too.

Here's some interesting facts:

Review of the benefits of vitamins has shown that high dose supplementation with Vitamin A - or beta carotene - actually increases the rate of cancer of the lung by 18%, so the "era" of vitamin A finished back in the '80s. Next came Vit B which is a complex of several substances the most well known being Folic acid. There is no doubt that pregnant women should take Folic acid as a supplement to reduce the risk of "Neural Tube Defects" - spinal bifida et al. Also, those with an alcohol related problem are often deficient in Folic acid and at risk of developing mental disorders that can be improved by Folic acid supplementation. So in specific instances, Folic acid is excellent, but the downside is that high dose Folic acid supplementation is actually associated with an increase in Colonic adenoma - the precursors to bowel cancer: the moral to Folic acid is to "pick your target"!

Vitamin C is probably known to every school child as the thing that you need to take to prevent scurvy - a nasty affliction of the skin that long distant sailors suffered from back in the times when tall masted ships sailed the seven seas. But it's promised glory as a wonder medication to reduce risks of cancer have never materialized despite many very large scientific trials.

Vitamin E was the big hope as early reports found that it may help heart patients. Alas, it didn't help heart patients - it actually increased mortality;  and it's hoped for help with prostate cancer also has proved illusory as it actually increases the risk for prostate cancer!

Now we are in the era of vitamin D which is essential for maintaining healthy bones and reducing fractures in older people. Recent reports are suggesting a benefit with cancer rates and depression which may prove to be real: but so did the others.

My conclusion is that there are those who have a genuine deficit of these vitamins and they may need supplementation, but the only way you can KNOW you have a deficit is to get it measured: in other words go to your Doc and have a check. If you are deficient, get a supplement and then get it checked again later to see if you've corrected it. But for most of us there may be a danger in over-supplementing an otherwise healthy diet with unnecessary vitamins. In fact, a healthy balanced diet is far safer and far "Healthier" than taking supplements.

If you want to be reassured about your diet, then check with a registered Dietician: in the long run it will prove far more cost effective and a far more healthy option.
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Friday, April 20, 2012

Living life to the Full

First an apology is in order: I've been away visiting my brother in the southern part of France and have not been able to "post" a blog for the past week, so if you've missed me, then please accept my apologies.

My brother lives in a part of France which is called the Ger and seems to be populated exclusively by English people who went to Eton and now own Chateaus! For the past week I haven't spoken a word of French, which was one of the reasons for coming to France in the first place. My "excuse" for learning French has been that the researchers tell us that as we age, if we exercise and use our brain - dancing, learning a new language - then we can stave off the chances of declining into dementia! Thus it seemed to me a very reasonable idea to come to France, jog/cycle/walk/dance my way through the countryside shouting greetings in French to passing locals and all in the great cause of holding onto my "marbles"! If you can give me some other suggestions that are better, then I will be delighted to receive them and try them out!

All of which leads me onto the subject behind this blog.

One morning the young bride and I got up early and braved the freezing breeze to jog a couple of miles into the local village and back. Going through the countryside, the fields were greening up beautifully, in the distance wild deer ran across a ploughed field and storks circled lazily overhead: all in all a blissful scene and one which filled me with pure delight. But then I had a thought: if the young bride were not there to share it with me, if she were sick or disaster of disasters - dead, then all that beauty would have turned to ashes and the experience would be as nothing.

We who are in the medical profession talk all the time about "healthy lifestyles", and "reducing the risks" of developing chronic diseases, but is that the complete story? Is "good health" the ultimate goal? Being healthy is great and makes living so much more "cope-able" with, but there's not much fun being amazingly healthy and living in isolation. For me, being able to share life with the person I love makes life the wonder that it can be, and leads me to think that the more important goal we should be aiming for is to Live to your maximal potential and to be able to share it with those who are precious to you.

So after I've been for a jog with the young bride (heart, brain and lower cancer risk) and eaten some walnuts (heart) grown from my brothers tree, and then sit and read the French newspaper (reduce dementia)  in the shade of a tree (some vit D but low UVB to protect from skin cancer) with sister-in -law whilst she sews curtains (because she can and I can't) I'm using the benefits of living a healthy life to achieve my real goal in life which is to live it to the max, and to share it with the ones I love.

What do you do?
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Thursday, April 12, 2012

Asthma - refine your technique

   I was reading the Australian Prescriber catching up with the latest advice for Doctors on controlling asthma, and was disturbed by some of the information I found there. Thankfully the number of deaths has fallen over the years and yet asthma still causes considerable health problems and impacts on the lives of many millions around the world.

Although medications haven't changed fundamentally over the years, the way they are used and the way patients should be reviewed has. But we are falling dramatically short of good and effective care partly due to poor education and partly due to poor compliance by the asthmatics themselves: " more than half of the people aged 15–34 years (who have asthma) .. (pick up their) medications only once in a year. Most patients use their inhalers incorrectly, and only 22% of patients have a written asthma action plan". These are not encouraging findings!

Picking up on the poor technique of most asthmatics, I've cut and pasted the suggestions from the Oz Prescriber so that those of you with asthma, or who have children/adolescents with asthma, can review what you are/they are doing and see if you can do it better.

                                                     Common problems with inhaler devices

  • breathing out through the inhaler mouthpiece leads to condensation and clogging of the nozzle
  • difficulty actuating inhaler (for patients with arthritis, an aid may be available and fitted around the inhaler to ensure easier use)
  • failure to coordinate actuation with inhalation. At its worst, medication will be seen to escape from the top of the inhaler.
  • too fast an inhalation
  • failure to hold breath after inhalation
  • multiple actuations without shaking between doses, or on the same breath
  • failure to replace cap on inhaler (leaves patient at risk of inhaling foreign bodies from pocket or handbag)
  • failure to use a spacer with an inhaled corticosteroid-containing medication (the spacer increases lung deposition and hence efficacy, and reduces the risk of local adverse effects)

                                              Pressurized metered dose inhaler with spacer

  • failure to prepare spacer before first use, to reduce the static charge which will otherwise prevent medication reaching the airways (wash in warm detergent water, do not rinse, allow to air dry,
  • reassemble; there is no need to prime with puffs of a salbutamol inhaler)
  • too-frequent washing without detergent priming (regenerates the static charge)
  • sticky valve (the spacer should be washed once a month as above, or if the valve sticks)
  • multiple actuations of preventer inhaler into the spacer at one time
  • delay between actuation and inhalation
  • too-fast inhalation, without a breath-hold at the end


  • failing to lift the lever before inhaling
  • stopping breathing in when the click is heard
  • failure to hold breath
  • breathing out into inhaler
  • not loading dose (by pushing lever) before inhaling
  • not holding breath after inhalation
  • not closing inhaler cover after use


  • not holding Turbuhaler upright during priming (loading) of dose
  • not twisting base both around and back (note: it does not matter whether the click is heard at the end of rotation around, or at the end of the rotation back, as long as the base is rotated in
  • both directions)
  • not breathing in strongly enough
  • not holding breath after inhaling dose
  • breathing out into inhaler
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Friday, April 6, 2012

Instead of a bunny this Easter, try a Tiger instead!

A dear friend of mine, a clinical psychologist once told me a story about himself. Although he was a great listener and was a fount of wisdom, he had always found it difficult to assert himself. He confided this to a colleague who gave him the following advice: he told him that the next time he went out for a coffee, he was to ask the waiter to take it back as it wasn't the right temperature - even if it was. As he tells it, he found it so hard on the first few occasions, but after that her "got over it" and from then on it never troubled him about confronting those sorts of situations. After all, how many times have we drunk a cup of really bad coffee and never thought/dared to send it back?

I was reminded of this when reading a reflection by Patricia Raymond MD entitled "Embrace your Tiger". Pat is a Doc who is also a motivational speaker whose goal is to "resuscitate the joy in medicine" - which can be sadly missing in these technologically driven times. It's all about facing up to confrontation and finding out that you can be more of a tiger than you really thought you could. Here are some of Pat's suggestions:

  1. Sit down with your “oppo­nent” in a quiet space.
  1. Tell them what you perceive.
  1. List the facts that led to this conclusion.
  1. Hon­estly ask to be shown where you are wrong.
  1. Lis­ten.
Often we burden ourselves with the "feelings" of others and don't like to "upset them". What we need to remember is that everyone is entitled to their feelings, but we are not responsible for them! Most of us have enough trouble coping with our own feelings, so why add others to the list? Yes we can "press the buttons" on our nearest and dearest and "upset" them - just as they can do it to us - but in the end, it's their/my feelings that they/I need to listen to.

Our feelings are the "signposts" that help us to identify the path we should follow. But although we should always take our feelings into account, in the end we should be making conscious, informed decisions on how we should act and not rely on just feelings.

Taking the emotion out of confrontation makes it into a discussion where both sides are winners - and if someone gets "upset" that really isn't your problem!

So with Easter now here and change happening, as Pat suggests, it might be your time to let your Tiger out of the cage! Happy Easter.

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Wednesday, April 4, 2012

Sniffing out Urinary Tracts Infections -UTIs

The Olfactory, or "smell" are of the brain, is thought to be one of the oldest parts of our brain from an evolutionary point of view; hence an unexpected smell can take you back decades to an event long forgotten, but stored away in that mysterious part of your thinking apparatus! I was reminded of this when reading about "stinky urine" and how it can raise the suspicion that an infant may have a urinary tract infection.

One of the lesser delights of being a parent is changing diapers/nappies, and most of us developed the skill of knowing "what was in there" often reflected on how your baby was health-wise. You can all probably remember that if your baby was breast fed that the day after you introduced cows milk or some solid foods, then when you came to change their diaper the next time, it was a "whole new experience"!

As a GP I learned that the sense of smell was always a quite useful tool - the smell of stale alcohol was always a dead giveaway, as was that of tobacco smoke in teenagers hair/clothes! But it was also helpful for diabetics who weren't looking after themselves and for wounds that were becoming infected.

And if an infant was unwell, I always listened to "Mum", because in the great majority of cases, "Mum" was always right, and if she said her infants urine smelt a bit strong, then it was time to get a sample to send off to the lab for investigation. Now the scientists and researchers have confirmed this thanks to Marie Gauthier, MD, from the Department of Pediatrics, Sainte-Justine University Hospital Center, Montreal, Quebec, Canada. Although their findings cannot to be said to be certain proof, the presence of "malodorous urine" should raise the suspicion of a UTI, and further investigation should be undertaken.

With the increasing aged population, the incidence of incontinence is also on the rise, and many of these older people rely on the use of incontinence pads/pants every day, and they too are at increased risk of UTIs. For them, we need to use our noses and our brains to make sure that they are diagnosed and treated appropriately too, because a urinary infection can become a life-threatening event.

Hopefully this is some information that you wont sniff at! 

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