Author Archives: Dr M Kittel

Feeling safe in a restaurant / pub during COVID-19

Its not difficult to be COVID safe, but it takes thought, training and some investment

Last night (7/7/2020) I went to a local restaurant with my wife, who is a nurse. The food was excellent, the service impeccable, the staff wore face masks or visors. But the whole experience did not feel very COVID safe. And their website says nothing about what changes they have implemented. There is a lot of advice out in the open how to run a COVID safe service for staff and clients, for example here https://www.food.gov.uk/business-guidance/reopening-and-adapting-your-food-business-during-covid-19. However, while I am no expert in how to run a good kitchen, we certainly run a COVID safe surgery and below some ideas on what I will look for for my next restaurant / pub visit:

  1. The restaurant / pub states on their website what COVID safe changes they have made (if this is not the case, it may indicate management hasnt’ thought this through or doesn’t care. Restaurant / pub owners had 3 months to think this through and inform themselves).
  2. Staggered bookings are made so clients dont have to wait in a crowded space
  3. Handgel station at the entrance and both sides of toilets. Paper towels. Signs, like on cruise ships, to use paper towels to open toilet doors. Paper towel bins on both sides.
  4. Check regularly soap and handgel isn’t empty, nothing worse than 40 people pressing the lid of an empty dispenser.
  5. Social distancing signs on  floors.
  6. Printed single use menus on normal paper inspire more confidence than laminated menus that dont get wiped when the heat is on and distributed to different tables…
  7. Single use condiments (sachets) rather than salt and pepper in glass containers
  8. Staff wear face masks / visors
  9. Staff have the opportunity to gel their hands frequently with dispensers on the walls
  10. Tables get wiped after every visit with soapy water or use single use paper table cloth
  11. Paper sheets under plates and where cutlery lies.
  12. Staff wear some form of ID saying they have been COVID trained and are COVID aware.

All the above would inspire confidence. In terms of the restaurant we went to yesterday I will keep monitoring their website and see what management and the owners do and once they have implemented a COVID safe way of working we will definitely return.

In the meanwhile I would suggest that as many of us as possible ask COVID questions to pubs and restaurants when we are booking, so they understand the general public wants to be protected and it is good for business to be COVID aware, COVID equipped and COVID trained.

Dr M Kittel, July 2020

 

Viral Gastroenteritis Diet

Self-care for adults:

BRAT diet

For vomiting, follow these instructions in order:

  1. Do not eat or drink anything for several hours after vomiting.
  2. Sip small amounts of water or suck ice chips every 15 minutes for 3-4 hours.
  3. Next, sip clear liquids every 15 minutes for 3-4 hours. Examples include water, sports drinks, flat soda, clear broth, gelatin, flavored ice, popsicles or apple juice. Do not drink citrus juices or milk. Increase fluids as tolerated.
  4. When you can tolerate clear liquids or diluted apple juice for several hours without vomiting and if you’re hungry, try eating small amounts of bland foods. Try foods such as bananas, rice, applesauce, dry toast, soda crackers (these foods are called BRAT diet). For 24-48 hours after the last episode of vomiting, avoid foods that can irritate or may be difficult to digest such alcohol, caffeine, fats/oils, spicy food, milk or cheese.
  5. When you can tolerate bland food, you can resume your normal diet.

Retake medications if vomiting occurs within 30 minutes of taking usual medication. If you vomited after taking oral contraceptive pills, use a back-up contraception method for the rest of the month.

If diarrhea is the only symptom, try Imodium, a non-prescription (over-the-counter) medication available at any pharmacy according to package directions. Follow a bland diet (see 4 above). After the passage of a soft, formed stool, you can resume a normal diet. Call for medical advice if you have no improvement within 48 hours after starting Imodium.

 

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

Adult Mental Health

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. For direct access to IAPT during COVID-19 click here
  3. The excellent “Books on Prescription” service by Bracknell Library
    1. A prescription form
    2. A synopsis for every book
  4. PHQ9 and GAD7 are good markers of Depression and Anxiety, respectively. You can self score for depression here: https://www.mdcalc.com/phq-9-patient-health-questionnaire-9 and for anxiety here https://www.mdcalc.com/gad-7-general-anxiety-disorder-7. Please send the results of the completed forms to me / the GP who has pointed you to this website.

Child Mental Health

Click here for a self help leaflet on Child Anxiety

 

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. Initially, 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. Don’t take them long term.
  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.
  6. If you suffer chronic back pain, improve your core strength with Pilates. There are many free courses, I am using “Trifecta Pilates” for my own back pain successfully. There are many sessions online.

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.

What about painkillers?

Taking Painkillers short term is fine, but they suppress the pain, dont cure the problem. They also have lots of bad long term side effects (the affect your kidneys and increase your blood pressure, cause bowel spasticity and more_)

And very quickly, they become less effective. We call this “Tachyphylaxis” and furthermore, in patients taking long term painkillers there is a phenomenon called “Hyperalgesia”. I have seen it many times: Patients on long term painkillers have awful amounts of pain, some patients ended in suicide. And on top of this, a lot of painkillers are controlled drugs (CD4). So, if you are involved in an accident and driving with them you could end up in prison. You may have heard that half of the US is addicted to Morphine based painkillers.

So remember, grabbing painkillers is an easy short term solution, but pain is there for a reason. Back pain usually tells something i.e. that more needs to be done to strengthen your back and that you may sit too much. So, dont allow long term painkillers to rule your life, take action now. Take a fitness and lifestyle changing approach. Think “what can I do to make myself better” rather than medicalising what is essentially a social problem and often caused by too much sitting and too little activity / too little core strength.

Dr M Kittel, March 2020

 

 

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)

Related image

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 Musli-type Cereal for good bowel health

Cereal against Constipation, Abdominal Pain and / or nausea caused by a slow bowel passage

Woman with Menstrual Cycle Pain

Start the day with a mix of fibre and seed containing foods with plenty of fluids can relieve constipation in 80-90% of patients. It reduces the transit time of your food and relaxes your bowels by adding bulk. Fibrous foods like the ones outlined below consumed regularly are thought to reduce the risk of bowel cancer in the long term. A slow bowel passage can be the cause of a large variety of symptoms of which abdominal pains and nausea are the most common.

Recipe of the Musli type cereal

Ingredients

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

What to do

  • 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, reduce bowel transit times for food, reduce bowel spasm through prolonged bowel transit and “relax” your bowels by adding bulk.
  • 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?

  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