Tag Archives: health

Health Matters

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Our babies are precious to us. We pile them with presents. We worry about all the harmful chemicals that the world has manufactured. We fill them with finest foods. But we’ve forgotten the most important ingredient. And it’s all round us, free and just waiting to be used: words. Meet the newest trend: ‘language nutrition’.

And words are going out of business. We used to live in big, extended families in big, extended streets or villages. We used to – listen to this, kids! – talk to each other round the fire, over the washing or at the peat bank. We didn’t used to have – our grannies tell us – radios, tellies, videos, iPads or even smart phones. I remember thirty years ago sitting in Australia’s Western Desert with a bunch of Pintupi Aboriginal guys, trying to convince them that the TV was only invented recently and that when I was born our family hadn’t had one!

There are now huge – and I mean really huge – differences in the amount of language we speak to our kids. Twenty years ago researchers in America followed 42 families with young children every month from the age of 7 months to 3 years. Every month the scientists sat in a corner of the room and recorded all the conversations for an hour. The results amazed everybody. After 3 years, up to 98% of the words used by the children had been used by their parents during that period. But as well as that, the kids were mimicking the way and the amount their parents talked. Some families talked much more than others. The least-talking households used 616 words an hour, while the most-talking children were hearing 2,153 words an hour. That meant that the children in the most-talking families had heard 30 million more words than those in the least-talking houses by the age of four.

Not only that, but some families ‘scolded’ their children much more than others. Some parents gave out two discouragements for every encouragement – by the age of four they were on the receiving end of 125,000 more words of discouragement than encouragement; others praised six times more than they scolded. All the families were equally loving and the kids as well-looked after as each other.

And what about ‘screen language’? Is the old parental standby of CBBC, DVD and now the kid’s own iPad just as good? Probably not. Another study from America looked at 9-month-old babies from Englishspeaking families, who were talked to in Mandarin Chinese for half an hour, three times a week for a month. At the end of this they tested the babies to see if they could tell the difference between two sounds common in Chinese – ‘chee’ and ‘shee’. The babies could do this, as well as babies brought up in Taiwan. But babies given exactly the same exposure to Mandarin on a TV or a radio hadn’t learned anything. You need the words, but you also have to have a human being in front of you.

Babies learn more if you talk to them about what’s interesting them at the time. In other words, if they’re looking at a bright red car, talk about that, not a book about hippopotamuses you’ve just got from the library. And two languages are even better. Children exposed to two languages concentrated better, and were better at solving problems, than English-only kids.

So how should we talk to babies and young children – apart from ‘a lot’? Well, you might think that being sophisticated is better. But speaking in baby talk, or what the experts call ‘child directed speech’, is the best. Sometimes called ‘parentese’, this involves a higher pitched voice, a sing-song style, stretching the words out (“Whoooose a prettyy bayyybeeee. Yes, yoooo are!”), and exaggerated facial expressions. Studies show that babies like it and they remember more from the ‘conversation’. Importantly, adults who speak baby talk actually like babies more, and infants are good at working this out – and smile at them more. They’ve got us wrapped around their tiny fingers! A baby’s first 1,000 days are the most important; words are as important to the growing brain as food is to the growing body. Scans show that babies exposed to more talking have physically bigger language centres in their brains.

As one expert said, “Brains aren’t born, they’re made.” Words are free. Fill the air with them!

SLÀINTE – health matters

Yes or no? Why do (don’t) we take the flu jag?

injectionIt’s sore. It doesn’t work. Or I never give it a second thought – I have it every year.

It’s flu jag time again. We’ve known about vaccination for a very long time. We’ve all heard of our man, Edward Jenner. In 1796 Jenner inoculated eight year old James Phipps, the son of his gardener, with pus from the blisters on the hands of a local milkmaid. The milkmaid had caught cowpox, a less extreme disease, and the boy became immune to smallpox.

In case you’ve got a pub quiz coming up, the hide of the cow that gave the cowpox to the milkmaid (are you following me?) now hangs in the library of the medical school in St George’s Hospital in London – there’s fame for you!

In fact vaccination against smallpox, an infection that used to kill about a fifth of sufferers, had been developed hundreds of years before in India and China. In a technique known as variolation, dried smallpox scabs were blown up the nose and causing a milder form of the disease – in other words, your chance of dying was only 1-2% rather than 20%.

Lady Montagu was the wife of the English ambassador to Turkey, and she had been badly infected and scarred by smallpox herself as a girl. She learned about variolation and in 1717 had her son inoculated against smallpox (having tried it out on a few prisoners first) and persuaded the rest of her family to get it done too when she came back to London. Smallpox was declared extinct in 1979, although I’m old enough to remember giving one of my patients a smallpox vaccination in my first year on the job.

Polio is tantalisingly close to going the same way, saved for the time being by humans arguing with each other. Bill Gates gives billions of dollars to vaccination campaigns in poor countries. Virtually everybody agrees that immunisation is a Good Thing – for other people anyway, especially other people in developing countries. Flu immunisation is not a new thing either. It’s been around since the American Army started using it in 1945.

The question I want to think about this week is why we agree, or refuse, to have our winter influenza shot – the flu jag. What are the pros and cons? And how good are we at weighing up the risks? (I’ll give you the answer now: not very good). What risk is there you will catch influenza?

5-10% of the population will catch flu in a normal year, rising to 20% in epidemic years, the last one of which was 1989/90 in the uk. So, on average, you will get flu once in every twenty years. How unpleasant or dangerous would that be? Anybody who has had ‘real’ flu will tell you it’s pretty miserable. More than pretty miserable. “The worst illness I’ve ever had,” and “If there was a £50 note on the floor by the bed, I wouldn’t be able to pick it up” are common remarks from fit young people afterwards.

As to how dangerous it is, we can’t put an exact figure on this. 12 people were recorded in Scotland as having died from influenza in 2010, 131 in 2000. This low figure is because doctors often don’t think of influenza when writing out death certificates, but tend to use diseases like ‘pneumonia’ or ‘heart failure’ that were brought on by the flu. But last winter (a ‘good’ winter as it happens) 1420 more Scots died in the four winter months than in the four summer months. This ‘excess winter mortality’ tends to be worse when there is a lot of flu about, and it is likely that flu is responsible for lots of severe winter illness and a couple of hundred deaths in Scotland every year. Even so, an average person’s chance of dying from flu is small, around 0.004% each winter.

But how risky is it for me?

That depends. The flu virus really goes to town and licks its lips (or would if it had them) when it finds a victim who is old or worn out, particularly if the victim has got a nice rattly chest, a dicky heart or blood with loads of delicious sugar. Or a baby.

Is it as risky every year?

This is where a good head for gambling comes in handy (if you see what I mean). The odds are different every winter. We’ve had a good run in the last decade, but every few years there’s a spike in the figures.

How effective is the vaccine?

Again it’s frustratingly hard to be accurate, but the best estimate is 60% effective. It is actually works less well (50%) in older and sicker people. And because the flu virus changes its spots every year, scientists have to race against time to guess what it’s going to look like every winter. They do this by checking out the strains doing the rounds in the previous southern hemisphere winter. If they guess wrong the flu vaccine still works, but not as well.

A common reason for not taking the flu jag is that you, or a friend, took it one year and got a bad cold a week or two later. To look into this, some researchers in Brazil followed up hospital workers who had taken the flu vaccine very carefully. Almost all the ‘flu’ they got later that winter was caused by other viruses.

What are the side effects?

About one in three people who take the vaccine will get a sore arm, or a brief headache, runny nose, sore muscles or tiredness.

And how dangerous is the vaccine?

Very not dangerous. The worst problem could be a one in a million chance of getting muscle weakness called Guillain-Barre syndrome. And there is a lot of argument about whether this really happens or not.

So how good are you at weighing up all these figures and working out whether you should take the flu immunisation?

Let’s go back to smallpox and put ourselves in the shoes of Lady Montagu. She had to weigh up the risks for her son three hundred years ago. The disease was common in Turkey and London, causing one in ten of all deaths at the time. She had had smallpox herself, had survived but bore the scars on her face. She learned about a technique that had been used for hundreds of years in a foreign country she admired. There were no huge vaccine trials to read, but she decided to let a doctor deliberately infect her son with smallpox – and it worked.

We all have to make the same calculations and our skill at working out this risk is called our ‘risk intelligence’. Like all forms of intelligence, some people are much better at this than others. Some of us have the make-up of daredevils, some of us are ‘risk averse’. As you can see, the figures are pretty complicated and many of us leave it to the experts. That’s what I do, and I’ve had the flu jag for 30 years.

There’s still plenty left in the surgery and now’s the time to get it!

Health Matters – To Run Or Not

stethoscopeExercise is bad for you. It’s something I’ve heard a lot on the island recently, and I can see why. However, not exercising is worse!

We have worried about exercising too vigorously since the time of the Ancient Greeks. The messenger Pheidippides ran 150 miles in two days when the Persians invaded at Marathon in 490 BC. When he reached the finishing line he gasped, “We have won” – and died on the spot. In 1909 a group of eminent doctors wrote to The Times saying that, “school and cross-country races exceeding one mile in distance were wholly unsuitable for boys under the age of nineteen, as the continued strain involved is apt to cause permanent injury to the heart and other organs.” And when the 52 year old running guru Jim Fixx died of a heart attack in 1984 while out for his morning jog – well, that proved it. (except that he lived nine years longer than his dad). And yet, doctors still want you to work up a sweat five times a week! What’s going on? The short answer to the so-called ‘exercise paradox’ is that pushing yourself  is slightly dangerous – while you’re doing it. While you’re exercising your risk of dying from a heart attack just about doubles. That’s still a small number if you’re young or female; a slightly larger number if you’re older or male. But, when you stop, the body’s metabolism and hormone levels change for the next two days in a profoundly healthy way. So you end up much better off. Sudden death during exercise happens, even in young people who reckon they’re healthy. Let’s not pretend it doesn’t exist. But it’s incredibly rare – one study on American nurses put the risk at one death for every 36 million hours of exercise. And almost all of those who collapse have something wrong with their hearts. This is why there has recently been such a lot of talk about screening young players as they do in Italy. Since 1982 it has been compulsory there for all kids taking part in sport to have a medical examination and an ECG, an electrical test on the heart. About 2% need further tests, and some of these are no doubt disappointed to be told to stop playing completely. But there has been a 90% fall in the number of sudden deaths during exercise in Italy and the pressure is building to introduce it here.

Here’s the trick. Don’t push yourself. Build it up slowly. Be careful when you get over 50. And listen to your body – stop if it hurts. It is important to be aware of what your body is telling you. One study found that almost half of all athletes who died during exercise had had symptoms, like chest pain, in the previous weeks. And you don’t have to push yourself to the limit to get huge health benefits. The chances of sudden cardiac death for a middle aged man like me during a 30 minute brisk walk is tiny, compared to my haring after a fit teenager during an all-ages shinty game. Despite all these warnings, exercise is great for your health. Researchers in Seattle looked at the 145 people who had died suddenly in one year in the city. Those who exercised vigorously were two thirds less likely to die than those who were couch potatoes. And doesn’t all that running knacker your knees? Well, no actually. A study in California followed middle aged runners for 20 years. At the end 32% of the non runners had knee arthritis and only 20% of the runners. But different sports do mean different risks. There were 14 injuries reported by 1000 runners in one study over a year, 64 by football players and 96 by rugby players. 1 in 600 horse riders are injured every year, particularly novice riders. Horse riding in Australia was found to be the third most dangerous sport after motor racing and power boating.

So, exercising is much better for you than not exercising. Some pastimes are safer than others. And if you’re a middle aged man like me – be sensible!

Health Matters – Walking and Talking

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I felt an icy trickle down my back when I heard the news. If you can remember back that far, last month’s report that our memory starts to get worse in our forties was a bit of a wakeup call. Five out of six people who get to 80 won’t get dementia. But one in six people will. It is set to become one of the most important features of care on Tiree as the rate is going to double in the next 40 years. Indeed, it is very much in our thinking at Cùram as we plan how we could look after the next generation.

Two thirds of people with dementia have Alzheimer’s disease. This is when the brain cells get clogged up with protein sludge. Another one in five have what is called vascular dementia – lots of tiny strokes, one after the other. There are other sorts of dementia too, and it is becoming increasingly important to try and find out which sort people have. The treatment is slightly different and the dementias progress in different ways.

But can we do anything about the wearing out of what has been called the most complex thing in the universe – the human brain? We’re not sure, to be honest. Dementia is such a slow process: you would have to take a thousand people, do something to one group, nothing to another –
and wait twenty years to see what works best. But exercising mind and body seems to be the key. A lot of the evidence about this comes from the poor old laboratory mouse (look away now if you find this distasteful). There is a strain of mice now which has been bred to get dementia – at 7 months of age they are showing advanced signs. But if they are given free access to a running wheel from their first weeks they are less likely to develop dementia changes, in their behaviour and in their brains. And if you allow the same strain of pregnant mice to run as much as they want on a treadmill, their offspring have less dementia changes in their brains when they grow up too. The brain needs a lot of energy, and a lot of blood. Keeping your circulation healthy is important. On the medical side this means good blood pressure, good cholesterol and good sugar. I’m sorry to say – if you have diabetes you’re a bit more likely to get dementia in old age.

And a big study in humans this year in Texas gives a useful pointer. 17 years ago they put 60 000 people (yes, 60 000 – they don’t do things by halves in Texas!) on a treadmill and measured how fit they were. Then they looked at how many of them died from dementia over the years. The fittest two thirds in the study were half as likely to die from dementia as the least fit. Of course, that doesn’t prove it was the exercise that did it. People who keep physically fit are more likely to be healthy in other ways too. But another study found that the more muscle people have, the less likely they are to get dementia.

On the mental front, another smaller study recently found that older people who used their brains a lot when they were younger had healthier looking brain scans. And we’re not talking Einsteins here. The best way to use your brain? Talk to people – and be interested in what they say. We use huge amounts of brain power remembering who has said what, to whom. Sitting and watching television look like the worst things to be doing if you want to keep your brain active.

Dementia is not a welcoming thought and there are no guarantees. The fittest granny in the world can get dementia if that’s in her nature. But, if walking and talking can keep it at bay for a bit, I’m up for having a go!

Health Matters – Let there be light (and dark!)

health matters

There’s a new medicine on Tiree. It’s free. It’s all around us (during the day, anyway). It makes us sleep like babies and wake up full of energy. It stops us feeling depressed. But, like all medicines, there’s a downside, if we don’t use it properly. It can keep us awake at night, and even encourage the growth of cancer. And some of our new gadgets are messing up our brains. Tiree is famous for it. Light.

As well as affecting our skin, light has extraordinary powers over the inside working of the body. It was only in 1995 that scientists found that the eye sends a signal to the control centre of the brain which tells us what time of day it is. This control centre (the pineal gland) pumps out a hormone called melatonin at night, making us sleepy.

Light, especially blue light, cuts production down, so we wake up and feel lively. Our sex drive is also higher (one reason why sunshine holidays are so popular!). Researchers found that if you put residents of an old peoples’ home into bright light (equivalent to outdoors on a cloudy day) for an hour in the morning, they cheer up. Students shown bright blue light did better in their tests than those exposed to green light.

On Tiree we sleep less in the summer and more in the winter. But as we age, the eye becomes less transparent (think cataracts) and we need more light to have the same effect. But this control centre, which tells us when to go to sleep and when to wake up, can also be upset by quite dim light – from a computer screen, iPad or television. Even normal room lighting in the evening (200 lux) has a big effect on melatonin production and the brain can detect levels down to 1 lux (full moonlight). And new energy saving bulbs produce more blue light than the old bulbs.

So, dimming the lights well before bedtime and using red lights if we have to get up, will help you sleep. Some people have even recommended using amber goggles in the evening to calm the brain. Shift workers (like doctors!) are exposed to light at night, messing up their sleep-wake rhythm and this makes them (us) more likely to have heart attacks, diabetes and strokes. Breast cancer in particular is more common in shift workers.

In a nutshell, I think that means– sit out in the sun every morning and turn off your screens at 9pm. Sounds like good advice to me!

Swine Flu – Is the Health Service on Tiree prepared?

docs_surgery_signWith daily newspaper reports of this new flu virus, An Tirisdeach wondered just how prepared our own medical service was if a much feared flu pandemic was to occur here on Tiree.
What is a pandemic? A pandemic occurs when a new flu virus which people have no immunity to occurs and spreads as easily as normal flu with simultaneous epidemics worldwide. Last century three occurred; in 1918, 1957 and 1968. The pandemic of 1918, took 18 million lives compared with WWI which also ended in 1918 and claimed 8.5 million lives. The pandemic of 1957 took 1.4 million lives and the 1968 outbreak took one million lives. We now find ourselves at the beginning of the 21st Century contemplating such a possibility again. But is our medical team prepared ? Are we prepared ?

“the commentary has become less measured”

In the winter of 2008, we suffered, according to our G.P. Dr. Holliday “a two month flu epidemic” which decimated, in Tiree School alone, staff and pupil levels. Dr. Holliday informs An Tirisdeach that the surgery has had a Flu Disaster Plan for the last two years and has received a small amount of Tamiflu from the government. Discussing the current media coverage of swine flu and the concerns that people had he felt that the commentary has become less measured. .
Dr. Holliday explained that the first phase would be mild due to the time of year. Autumn and winter would be the critical months and that Tamiflu was no panacea as it only shortens the disease by a day. Dr Holliday was frank and to the point. “ By far the most important measure that everyone could take responsibility for is hygiene, this is crucial “ he said.

“Sing Happy Birthday twice”

“Washing hands with soap and water while singing Happy Birthday to yourself twice then drying hands on clean towel or paper towel would go a long way to protecting yourself against the virus”. A sanitiser gel would also do the same job as soap and water. Dr. Holliday is under no illusions as to how difficult it is to wash our hands conscientiously and constantly to wash away the germs one comes into contact with. He is also aware that children will say they have washed their hands when in fact they have only ran them under a tap. Singing Happy Birthday to yourself while hand washing actually takes quite a time. Longer than one would normally spend on such a task, but it is a critical element. All households have been given a Swine Flu leaflet by the government. The guidelines on sneezing and nose blowing should also be strictly adhered to with hand washing following. Not always easy, and this is when a Sanitiser gel would be useful to have on hand at all times.

“I would hope and expect the strength of Community to rally round”

If the Tiree Community found itself in the throes of a pandemic Dr. Holliday felt that a close knit community such as ours would cope well with it. “I would hope and expect the strength of Community to rally round”. This virus is virulent. Normally a flu would infect one in ten , this virus is expected to infect one in three. Dr. Holliday has been informed that there will be a flu hotline in the Autumn with increased stockpiling of drugs. We can be sure that Dr. Holliday and his team will be keeping a close eye on developments.