Author Archives: Dr M Kittel

Warts and Verrucas

Topical treatment for warts and verrucas

Topical treatment includes wart paints containing salicylic acid or similar compounds, which work by removing the dead surface skin cells. I recommend Salactol Paint.
The paint is applied once daily. Treatment with wart paint usually makes the wart smaller and less uncomfortable; 70% of warts resolve within twelve weeks of daily applications.
• Soften the wart by soaking in a bath or bowl of hot soapy water.
• Rub the wart surface with a piece of pumice stone or emery board.
• Apply wart paint or gel accurately, allowing it to dry.
• Cover with plaster or duct tape.
If the wart paint makes the skin sore, stop treatment until the discomfort has settled, then recommence as above. Take care to keep the chemical off normal skin.

How about other methods?

Other methods have scientifically not proven more successful and are often not available on the NHS

Pitfalls

  • Not trying for long enough
  • Not being persistent with the treatment

 

Dr Kittel’s Mental Health Resources – Bracknell

Image result for mental health

Find below a list of Mental Health Resources that you may find useful for your own Mental Health journey. You may also wish to register on this website (see registration section on the right hand side) for occasional non-promotional local NHS information emails by Dr Kittel and Forest Health PPG.

  1. A list of Mental Health Self Support Messages by Dr M Kittel
  2. A list of counselling and other support organisations in and around Bracknell
  3. The excellent “Books on Prescription” service by Bracknell Library
    1. A prescription form
    2. A synopsis for every book
  4. A PHQ 9 and GAD 7 form for self assessment of Anxiety and Depression. Please take a completed form to your GP

 

Back Pain – Tips and tricks

Introduction

Low back pain and Sciatica are incredibly common conditions in highly developed, civilised societies. According to some reports, more indiginous societies (i.e. tribes in the Amazon etc.) rarely suffer back pain. This is probably due to better core strength in less civilised peoples.

Summary

What should I do with acute back pain in a nutshell: 5-point plan:

  1. Take painkillers that you are not allergic to i.e Ibuprofen (beware indigestion) and / or Co-codamol (beware constipation) over the counter and take them regularly for a few days. Always read the drug information sheet in the pack.
  2. Read the NHS write up on back pain, it contains lots of good information.
  3. Buy Robin McKenzie “Treat your own back” (see below)
  4. Ask your doctor  to refer you for physio if your backpain hasnt improved after 2 weeks or see your practice physiotherapist.
  5. Contact your doctor, should you have any “red flag symptoms” described in the NHS leaflet.

More on Low back pain and Sciatica

These 2 conditions are the most common ones causing patients pain and disability. There is a really good overview on the NHS website . However, there are a few additional resources that I  would like to share.

  1. The Book: Robin McKenzie, “Treat Your Own Back” for a quick fix.
    • This is a 30 year old book based on a 60 year old method that my own doctor recommended to me and truly, with a few stretches, a lot of people are able to improve their back pain quite significantly. Thus, I believe it is the best £10 I ever spent on my own back.
  2. StartBack Tool
    • The StartBack Tool is a good tool to assess the chance of Chronification in Low Back Pain. Click here to download and complete it. The scoring method is explained on the second page. If you score highly, seek help early, as you are much more likely to suffer this condition for a long time.
  3. The Back Pain Booklet
    • Almost 20 years old, this booklet is still very relevant and helpful. Click here to download this file. It is double sided A5 and a bit tricky to print, but the content is very good

Why an MRI scan is commonly a useless investigation

An MRI scan is a tool to get a good 3D photograph of our spine. It is very sensitive to abnormalities like disc bulges, slippage etc. However, many people with disc bulges lead completely normal lives without any symptoms. Equally, people with entirely normal MRI scans suffer severe back pain. Click here for MRI scan results of the spine for normal people without back pain.

Should I see my GP with Low Back Pain?

Most GPs are not well placed to treat Low Back Pain. Apart from painkillers, with a various degree of side effects and health hazards attached to them, they often can do little to help back pain. However, many practices now employ senior physiotherapists (First Contact Physiotherapists), who can be helpful in the assessment and treatment co-ordination of Back Pain.

Of course there are exceptions where Low Back Pain has more serious causes and there is a good summary on the NHS website quoted above. If you think your symptoms may be more serious, you should see a health professional quickly.

Dr M Kittel, March 2019

 

Extended Hours GP Services in Bracknell – Phone Number Change

Phone number changes for cancelling ‘Extended Hours Clinics’ appointments- Bracknell and Ascot

A telephone number for residents to call when cancelling evening or weekend GP appointments, as part of Bracknell and Ascot’s ‘Extended Hours Clinics’ service, has changed.

The new number is 01344 233 300 and is available Monday to Friday 8.30am -6.30pm and during clinic opening times, Monday – Sunday inclusive of Bank Holidays.  Please note that the old number – 01344 637 808 – is no longer in use.

The change coincides with Berkshire Primary Care Ltd, who is commissioned by East Berkshire Clinical Commissioning Group (CCG) to provide the service, moving offices.

The clinics continue to run from Boundary House Surgery as usual.

The ‘Extended Hours Clinics’ are available for people who find it difficult to take time off work or have other commitments during daytime hours. The service offers a range of appointments with GPs, nurses, healthcare assistants and phlebotomists (blood tests).

People must be registered with a GP surgery locally to access the ‘Extended Hours Clinics’ and appointments can only be made in advance through their own GP practice, as the service cannot accept walk-in patients.

Appointments are for routine general practice issues only and not for urgent care. If urgent care is required, please call NHS 111 for advice.

Although residents need to book appointments through their individual GP practices, they are urged to call the cancellations line if they are no longer able to make the appointment.

The ‘Extended Hours Clinics’ in Bracknell and Ascot are part of a national initiative to improve access to general practice.

 

A Kidney Friendly Lifestyle

Key Messages for good Kidney Health

  • Increase your vegetable intake massively (at least 5-a-day, better 9-a-day!)
  • Reduce salt in your diet (kidneys have to get rid of all salt from the body)
  • Reduce your protein intake significantly (protein clogs up kidneys).
  • Reduce fats and sugar in your diet (general drivers of obesity)
  • Reduce pesticides and environmental contaminants in your diet (again a lot of what both kidneys and liver do is getting rid of those)
  • Eat fresh food, cook yourself (avoid additives and bad fats, know what goes into your dinner!)
  • Avoid food additives, the list is endless.
  • Drink Plenty (unless you have very advanced kidney disease, here you need fluid restriction)
  • Be active, do plenty of exercise (general fitness helps your kidneys, too)
  • Stop smoking (always toxic, vaping is less toxic overall)
  • Alcohol in moderation.
  • Loose weight (obese people have a higher risk of kidney problems)
  • Be very careful with painkillers (i.e. Ibuprofen is a real enemy of good kidney health)
  • Research your kidney friendly diet, CKD etc online, start here

Background

Kidneys and CKD (Chronic Kidney Disease)

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Kidneys are amazing organs. They detoxify our bodies on a daily basis and get rid of most things the liver and bowels cannot get rid off. And many people have healthy kidneys until their old ages. However, an increasing number or people in the UK have Chronic Kidney Disease. (CKD), similar to blood pressure is actually a condition rather than a disease as most people dont really suffer with it. Many people do not have any symptoms or only have minor symptoms until the condition is relatively advanced.

Doctors in the UK tend to warn patients when their eGFR (Glomerular Filtration Rate = the rate at which your kidneys work) drops below 60, which is an arbitrary, yet probably sensible line according to todays knowledge. NICE classifies most people with a

For a more complicated NICE classification of CKD click here

Diagnosis of CKD 3

Usually, patients need 2 readings of an eGFR (the rate at which your kidney works) below 60, 3 months apart, to be diagnosed with CKD stage 3. A single reading is not enough. Stage 3 means that you have now moderate disease (stage 2 is mild and stage 1 is normal and these stages are medically only important for people with pre-existing kidney damage).

Prevention of CKD3

However, I would encourage everybody with CKD 2 to already take measures to avoid their kidney function to drop. Aging drops kidney function anyway, but it is the acceleration of this drop we need to avoid. Simply go to the top of this page for the key messages.

I have got CKD 2 or 3 – What next?

  1. Dont panic – most people with CKD 3 will NEVER end up on dialysis or need a kidney transplant
  2. Get informed – the internet is your oyster. There is so much written about a kidney friendly lifestyle.
  3. Prepare – Change your diet, get fitter, try to be positive and happy if you can, drink plenty of water, implement the key changes listed above.
  4. Be critical – Protein clogs kidneys up, yet a lot of recipes even on really good websites contain too much protein and too little vegetables. Also, remember, replacing animal protein such as meat and dairy products with plant proteins such as beans, lentils and tofu is better for your kidneys.  Learn about kidneys. Make up your own mind. And do what you think is right.
 

Dr Kittel’s Anti-Constipation Cereal

Image result for constipationStart the day with a mix of fibre and seed containing foods with plenty of fluids can relieve constipation in 80-90% of patients.

  • Rye Flakes
  • Oat Flakes
  • Dried Fruit
  • Linseed
  • Pumpkin seeds
  • Sunflower seeds

 

  • All these incredients can be obtained at health food stores i.e. Holland & Barretts and mixed according to taste in a big cereal container.
  • Eating a bowl of this cereal every day will after a few days relieve most peoples constipation.
  • Patients suffering irritable bowel syndrome are advised to avoid dairy and eat the cereal using a variety of fruit juices.
  • Should you still suffer symptoms after starting your dietary changes, please see your doctor again.
  • For very young children that cannot yet have the above cereal I usually recommend to give Porridge with some Linseed and a mashed up banana for breakfast (mash and mix banana into hot porridge to cool down and add linseed). You can also put linseed into yoghurts etc.

Click here to download the recipy below in a printable .pdf.

Good Luck! – Dr Martin Kittel

 

High Cholesterol – 8 Point Plan – What to do?

Image result for high cholesterol

  1. Take it seriously. Cholsterol clogs up your blood vessels. It is a major cause of heart attacks, strokes and cancers including bowel cancer. And remember, having your Cholesterol tested every year and doing nothing about it is like weighing yourself every week. Absolutely no point.
  2. Adjust your diet: What is bad?
    1. Butter, Ghee
    2. Hard margarines
    3. Lard, dripping and goose fat
    4. Fatty meat and meat products such as sausages
    5. Full fat cheese, milk, cream and yogurt
    6. Coconut and palm oils and coconut cream
  3. Adjust your diet. What is good?
    1. Porridge, Oatbran, Oat breakfast cereals, Oatcakes, Bread made with 50% oat flour or oat bran
    2. Pearl barley, Adzuki beans, black beans, black-eyed peas, butter beans, cannellini beans, chickpeas, edamame beans, kidney beans, lima beans, mung beans, navy beans, pinto beans, split peas, white beans
    3. Red lentils, green lentils
    4. Vegetables rich in soluble fibre such as okra, aubergine, citrus fruits, turnip, sweet potato and mango
    5. Unsalted soya nuts (also called roasted edamame beans)
    6. Soya alternative to milk, yoghurt, Soya mince/chunks, Tofu
  4. Start exercising. Cardiovascular = sweat producing exercise. Three times a week for 45 minutes or 5 times a week for 30 minutes.
  5. Try to loose weight. Slimming reduces cholesterol.
  6. Cook from fresh. Don’t buy ready made products.
  7. Stop smoking and drink sensibly. Help is available for both.
  8. Inform yourself, be Cholesterol wise:
    1. Know your numbers! https://heartuk.org.uk/health-and-high-cholesterol/cholesterol-tests—know-your-number
    2. Ask your doctor for your Cholesterol Results
    3. Read more, inform yourself i.e. https://www.nhs.uk/conditions/high-cholesterol/
    4. And read even more about what to do https://heartuk.org.uk/cholesterol-and-diet
    5. Calculate your risk on https://qrisk.org/three/index.php

Dr M Kittel, 2018

 

On-line discussion forum for residents following change in prescribing policy

Would you like to discuss the recent change in GPs prescribing over the counter (OTC) medicines for short term conditions or minor aliments with your local NHS?

If so, commissioners from NHS East Berkshire Clinical Commissioning Group (CCG) are holding two on-line discussion forums on Wednesday 26 September between 12-1pm and 7pm-8pm. The forums are an opportunity for residents across Slough, Windsor, Ascot, Bracknell and Maidenhead to ask questions and discuss their views with a lead clinician. Click here to register and take part.

The start of this month (1/9) saw a change to the CCG’s prescribing policy with GP surgeries across East Berkshire no longer prescribing a range of OTC medicines, vitamins and minerals associated with short term conditions and minor ailments.

The change follows a national consultation and subsequent NHS England guidance which recommends that OTC medicines associated with minor, short-term conditions, which can either get better by themselves, or can be self-treated by an individual, should no longer be made available on NHS prescription.

During June 2016 and June 2017, the NHS spent approximately £569 million on prescriptions for medicines which could have been purchased OTC from a pharmacy or other outlets such as supermarkets. Between April 2017 and March 2018, GP practices in East Berkshire spent over £3.7 million.

Medicines which are no longer being routinely prescribed include treatments for coughs, colds, dandruff, mild acne, nappy rash, warts and verrucae, ear wax, head lice and mild dry skin.

However, in line with national guidance, the CCG has agreed exceptions, which include:

  • Patients prescribed an over the counter medicine for a long term or more complex condition or
  • Where a clinician considers that a patient’s wellbeing could be affected due to health, mental health or significant social vulnerability

Tim Langran, the CCG’s Lead Prescribing Support Pharmacist, said: “We have amended our prescribing policy to reflect the recommended changes nationally.

“While we do not envisage the change to affect the vast majority, there will be some patients who are currently able to get these medicines on NHS prescription from their GP surgery, who will no longer be able to. Instead, they will need to buy the medicines themselves. Community Pharmacies are an accessible source of excellent advice regarding health and medications.

He added: “We acknowledge that some people may have some questions and concerns surrounding this change which is why we would like to invite people to join our on-line discussion forums next week. People can log on from the comfort of their home or join us during their lunch break next Wednesday.”

A set of FAQs have been prepared following the change in prescribing policy.

This article is being distributed on behalf of your NHS commissioners, East Berks CCG. (note: A commissioner purchases health care provision for a local population).