Author Archives: Dr M 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
    7. Highly refined carbs i.e. lots of sugar and non-foods, cakes, sweets etc. If you get a lot of your energy from highly refined carbs this can also increase your cholesterol.
  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

 

How Much Physical Activity Is Good?

What Public Health England advises regarding physical activity.

We know from research that from all medical interventions we pay for to improve the health of the population and reduce hospital admissions exercise based interventions give some of the best investment returns. That’s for example why we paid for additional pulmonary rehabilitation interventions in Bracknell & Ascot in order to improve the life of patients with respiratory conditions. That is also why we have sponsored a lot of other activity based schemes.

And lets be fair: While most of us find it hard to stick to a daily fitness routine we all know how good it feels when we have been active. So, ask yourself the question.

  • When have you had your last muscle ache due to exercise?
  • When have you last been out of breath so you couldn’t talk because of exercise?

Find below information on how much activity is good for us. You may be surprised, but the body is made to sweat and be active!  If you are looking for a way to go from nothing to be able to run 5K, why not try the BBC “Couch to 5K challenge”.

However, a word of warning: Patients with chronic conditions, on permanent medication or otherwise disabled may have to start slowly when taking up exercise or may need support by a health coach or physiotherapist.

Adults and Older Adults

Children 0-5

Children 5-18

Pregnant Women

For more information please go to Public Health England https://www.gov.uk/government/publications/health-matters-getting-every-adult-active-every-day/health-matters-getting-every-adult-active-every-day

 

NEW – Healthmakers Spring 2018

Suffer of a bit of springtime tiredness? Want to manage your Blood Pressure, Diabetes, Chronic Bronchitis, Arthritis or any other condition you suffer of better? Want to get out and meet likeminded people?

Free NHS supported HealthMaker Course for patients with chronic conditions

Find below the new spring Healthmaker courses.

If the leaflet below does not display, please click here for further information. If you want further information about free NHS courses, events and resources, please sign up in the newsletter box on the right (below on mobiles).

 

New Years Resolution 2018 – Join Healthmakers!

Free NHS supported HealthMaker Course for patients with chronic conditions

If you suffer a chronic condition like Diabetes, Chronic Bronchitis, Heart Disease, Arthritis or many more this course will help you to improve your self care a dramatically. While patients within Bracknell & Ascot CCG have benefitted from these courses for years they are now also being rolled to other areas of East Berkshire including patients from Windsor, Ascot, Maidenhead and Slough.

If the leaflet below does not display, please click here for further information. If you want further information about free NHS courses, events and resources, please sign up in the newsletter box on the right (below on mobiles).

 

Toenail Cutting Service from Age UK

Letter to our surgery with the promotion of a new service

This letter was faxed to us, recently. Toenail cutting was not available locally for some time. I hope perhaps this new service may help some of the members of this website, their relatives or friends. I have not been able to confirm it is a free service, but would assume so with age UK being a charity.

 

Get Your Flu Jab early, this year

Why to get your Flu Jab early this year

Summary

Australia experienced the worst flu outbreak on record this summer (which is the Australian Winter). The observation was that flu hit them very hard and very early. Public Health England is now warning hospitals to clear wards for high levels of admissions with flu this winter.

Who is affected?

The main strain is H2N3 and children and old people are particularly vulnerable, but there are still significant amounts of H1N1 (Swine Flu) around and that affects young adults, particularly with chronic conditions like Asthma.

How can I protect myself?

  1. Get the flu jab early
  2. Isolation of patients with flu / keeping away from patients with flu (don’t see the doctor unless you are seriously ill)
  3. Wash your hands
 

Free NHS supported HealthMakers Course

Free NHS supported HealthMaker Course for patients with chronic conditions

If you suffer a chronic condition like Diabetes, Chronic Bronchitis, Heart Disease, Arthritis or many more this course will help you to improve your self care a dramatically. While patients within Bracknell & Ascot CCG have benefitted from these courses for years they are now also being rolled to other areas of East Berkshire including patients from Windsor, Ascot, Maidenhead and Slough.

If the leaflet below does not display, please click here for further information. If you want further information about free NHS courses, events and resources, please sign up in the newsletter box on the right (below on mobiles).

 

 

Why finishing your Antibiotics is still important

Please dont stop using Antibiotics because of todays news

 

Today the Telegraph and many other newspapers published a top of the frontpage article in which the headline suggested patients shouldn’t complete their courses of Antibiotics, but stop Antibiotics when they feel better. I believe this is irresponsible journalism considered the public health implications such a message carries.

The initial statement was based on a professional publication in the BMJ. This publication was intended to inform a debate between professionals, not intended for public education. I also believe 2 of the 4 key messages in the BMJ are not evidence supported and will write to the BMJ about this.

The BMJ argues the basic argument why we complete our Antibiotics is, apparently, not based on sound research, but on a statement of Sir Alexander Fleming, the inventor of Penicillin, at his Nobel Price speach in 1945 (he recommended to finish courses of Antibiotics to reduce resistance). The Telegraph unfortunately created a rather dramatic headline, taking the message out of context.

And of course Fleming had a strong argument. He had seen what had happened to one of his colleagues that had not enough Penicillin available and died. The BMJ writes: “When Howard Florey’s team treated Albert Alexander’s staphylococcal sepsis with penicillin in 1941 they eked out all the penicillin they had (around 4 g, less than one day’s worth with modern dosing) over four days by repeatedly recovering the drug from his urine. When the drug ran out, the clinical improvement they had noted reversed and he subsequently succumbed to his infection”. Only as recently as 2014 the prescribing guidelines for children for Penicillin and Amoxicillin, 2 of the most commonly prescribed Antibiotics, were doubled in all doses.

In fact, some of the BMJ article contains indeed very good and important information. It may be that the argument to stop Antibiotics earlier proves correct in time to come and after (a lot) more research. However, I dont think this can be generalised, I just believe that we need to get more specific advice for different conditions and patient groups.

And it may actually be correct that in some illnesses we could recommend to treat only until patients feel well. This may be the case for example in simple urine infections. It is also true in a lot of the viral illnesses that we take Antibiotics for without any good reason (in fact we should not have them in the first place).

Another argument sometimes quoted for stopping antibiotics early is that Antibiotics do not have to kill every last pathogen (=bacteria, bugs), but only enough for the immune system to get rid of it and therefore they do not need to be finished. This may be true in some infections in healthy individuals, but not in patients with co-morbidities (different chronic diseases) and reduced function of the immune system i.e. patients with diabetes, Rheumatoid Arthritis or older patients.

However, a good example where Antibiotics should not be stopped is an abscess. Particularly in dental abscesses the only thing that usually cures the abscess is removing the pus by removing the tooth or draining it through a root canal treatment. All antibiotics usually do is stop the spreading of the pus into the blood stream and therefore stopping blood poisoning. If you stopped the Antibiotics after you feel better you would usually soon feel worse again, the fevers and shivers and the pain would start again.

Another example may be tonsillitis. Pus can get stuck in crypts (little holes) in the tonsils and it is actually still recommended to take a 10 day rather than a 7 day course. Many patients that finish a course early or have been given too short a course are coming back with a recurrence of symptoms.

A lot of patients have to have very long courses of Antibiotics. Conditions that spring to mind are TB, HIV and even a condition as simple as acne. Also, other patients are on Antibiotics preventatively i.e. for the prevention of urine infection or after a splenectomy (removal of their spleen).

My plea is therefore to wait until new research and guidelines are released that support some of the scientifically scantily supported assumptions made in the press today and still to continue Antibiotics as prescribed by health professionals. For the moment the simple message ingrained into the mind of the public and health professionals remains: Do finish your course of Antibiotics unless advised to the contrary.

Please share or re-publish this article at liberty.

Dr M Kittel, 27/7/2017

PS: For the people interested in the academic part of the BMJ article: The 4 key messages of the BMJ and my first thoughts.

Key messages

  • Patients are put at unnecessary risk from antibiotic resistance when treatment is given for longer than necessary, not when it is stopped early
    My response: The first part of the sentence is likely to be correct although the evidence is based on relatively small trials and lots of assumptions. But the second part of the sentence “not when stopped early” only considers risk from Antibiotic resistance to patients. It doesn’t consider the benefits antibiotic treatment gives patients when taken correctly and for right amount of time not the risk of re-infection and an even bigger course of Antibiotics if they have to be restarted. It also puts generally healthy individuals into the same category as sick and immunosuppressed patients.

  • For common bacterial infections no evidence exists that stopping antibiotic treatment early increases a patient’s risk of resistant infection.
    My response: No evidence exists to the contrary neither. The absence of evidence is not evidence of absence. Simply identifying a lack of direct evidence, or randomized controlled trials, is not sufficient to overturn decades of clinical practice. And why change the guidelines and put vulnerable individuals at risk before we don’t have such evidence? Finally, potential antibiotic resistance in the future may be less of concern in an individual that is very sick at present?

  • Antibiotics are a precious and finite natural resource which should be conserved by tailoring treatment duration for individual patients. My response: This is 100% correct.

  • Clinical trials are required to determine the most effective strategies for optimising duration of antibiotic treatment. My response: I believe this is correct, therefore the strong recommendations within the BMJ article should be withdrawn and science should be supported to do the research needed to get us the answers to the questions that have been raised.

 

Planning to travel this summer? A well controlled blood pressure could reduce your insurance premium.

If you are planning to travel abroad this summer you should ensure now that your Blood Pressure (BP) is well controlled. An undeclared elevated BP reading in your medical records could invalidate an insurance claim, particularly if the problem is a stroke / heart attack or a blood clot during travelling. Thus, if you have had BP readings higher than 140/90 you need to see a doctor or nurse to ensure your BP is reduced.  If you have online access to your records, check it now. If not, get online access today.

Like any other medical condition even a normal blood pressure, if controlled with medication, has to be declared.

If you think you may have a note entry of a high BP, but your actual pressure is lower you can submit home readings performed to NICE guidelines (average of 2 readings twice a day for a week) . Your surgery can put those into your records. Please read this page and download the BP control sheet.

If you are on blood pressure medication and your BP is well controlled it could reduce your Travel Insurance Premiums. The entry of a normal BP in your records is very re-assuring.

And finally remember: Reducing Salt, Fat, Sugar, Alcohol, increasing exercise, vegetable intake and being happy and de-stressed all reduce your Blood Pressure. Happy Holidays.

Dr M Kittel, July 2017

p.s.: If you click on the picture you can see the poster bigger)

 

New HealthMakers Self Managment Courses 2017

Courses currently available are :

  • Bracknell Wednesdays 1pm – 4pm Starts 7th June
  • Bracknell Thursdays 6pm – 9pm Starts 8th June
  • Maidenhead Tuesdays 1pm – 4pm Starts 20th June
  • Slough Monday 6pm – 9pm Starts 26th June

Contact HealthMakers@berkshire.nhs.uk or call 01344 415947

More information can be found at www.Facebook.com/HealthMakersUK or www.berkshirehealthcare.nhs.uk/HealthMakers/