Don’t Be A Winter Ostrich

There is something about winter that makes ostriches of so many people (except that at present they have to stick their heads in the snow rather than sand). Even after twenty years in general practice, it is something that never ceases to amaze me. What is it that I am speaking of? It is the simple issue of people not wishing to protect themselves against a potentially serious infection, and the infection I refer to is influenza.

As a doctor, it concerns me that less than 50% of the eligible population of North Lincolnshire have had the influenza vaccine this year. Put bluntly, being 'eligible' basically means that you have a significant risk of dying from influenza and its side-effects. So, if that is the case, why do people choose not to protect themselves? Simply assuming that you are super-immune to influenza simply because you have not caught it for so many years doesn't guarantee your survival. I have never had the misfortune to be knocked down by a car; but I still take the precaution of looking both ways before I step into the road; if I do not then one day my folly will catch me out, at which point it will be too late.

In an average winter, there are 25,400 more deaths in England and Wales than at other times of the year. The precise death rate depends on various factors, including the temperature. However, influenza is implicated in many of these deaths. The peak period is between December and March, so we are now entering that time; and as you are aware, it is very, very cold.

Everyone who has not been immunised has the chance of catching influenza. However, amongst those most at risk are children and adults with asthma or diabetes, those with heart disease, anyone whose immunity is reduced (e.g. because of treatment for cancer) people over the age of 65 years, and pregnant women. Anyone within those categories should seriously consider having the influenza vaccine as soon as possible. Carers and health professionals should also be setting the standard by getting themselves vaccinated; by not doing so, they are putting other people at added risk.

The serious side effects of influenza include bronchitis, pneumonia, exacerbation of asthma, convulsions, heart failure, and encephalitis (inflammation of the brain). I am sure that you would agree that none of these sound particularly trivial, and they are not. They are very distressing to the sufferer and the observer, and often cannot be cured. On the other hand, the side effects of the vaccine are usually very mild or non-existent despite all the myth surrounding it.

So, let us not think of the risk of death from influenza in terms of statistics. Consider instead individual human beings known to you. If you are not personally in the high risk categories, do you have a relative or friend who is? Have they been vaccinated against influenza this year? If not, start nagging them to go and get vaccinated. Let us face it, none of us would wish our elderly parents, our children with asthma or diabetes, our husband with heart disease, or our pregnant wife to be one of those 25,000 extra deaths this year. However, without the influenza vaccine, they are at significant risk of becoming one of them. I know I would not want that on my own conscience.

(This article was first published in the Scunthorpe Telegraph on Wednesday 8^th December 2010.)

Something for After School, Young Man?

One month ago, Pope Benedict XVI announced that the use of condoms may be morally justified 'when the sole intention' is to combat the spread of AIDS. My immediate response was to ask 'so what?'

As I am writing this column in my capacity as a physician, this is not the place for me to start a religious debate, and I certainly have no wish to upset anyone. However, whilst the Pope's edict may influence the use of condoms in parts of the world, I feel sure that it will do very little to improve condom usage in this country; especially amongst our younger members of society where such improvement is desperately needed.

Two months ago it was announced that the teenage pregnancy rate in the United Kingdom has fallen from 46.6 per 1,000 in 1998, to 40 per 1,000 in 2010. Whilst we should be pleased to make any improvement on this front, it remains deplorable that, in this country, there are 40,000 pregnancies per year in people under the age of 18 years. Although I am all for the United Kingdom taking the lead in respect to many issues the world's stage, having the highest teenage pregnancy rate in Europe is not an achievement to be particularly proud of.

Unfortunately (in respect to condoms), the majority of our young people are not influenced by the traditional teachings of the Roman Catholic Church. Neither (speaking from a Northern Lincolnshire perspective) are they greatly influenced by the risk of contracting AIDS, as the incidence of the latter is mercifully low in this region compared to some of our cities, and very low compared to certain countries in Africa. Nor do our teenagers particularly concern themselves with preventing other forms of venereal disease; except that is, in respect to Chlamydia infections. Though, with the latter, my perspective is that we also seem to have got the message over in the wrong way. Anecdotally, I come across teenagers informing me that they have responsibly taken another Chlamydia test (note the word 'another') as they have recently changed partners. Yes, that is good news to a point. However, if they were to use condoms in the first place then there would not be the same need for the Chlamydia tests. We are not doing very well in communicating the real messages.

The truth is, our sex education program is not working. Yes, there is a place for moralistic debate and reasoning, greater parental responsibility and informing youngsters of the health risks. However, there is also the pressing need to make condoms 'cool' in the eyes of those most influenced by fashion. Regardless of society's laws, or the best of moralistic and religious teaching, sex happens and will continue to happen within an hormonally fuelled younger generation.

Thus far, we health and social educationalists have got it wrong. Perhaps our sporting and celebrity heroes are the people to recruit in a renewed drive to relegate us from the top of this particular league table.

(This article was first published in the Scunthorpe Telegraph, Friday 3^rd December 2010)

Do You Have a Mo?

For one brief moment this month I thought I was a trendsetter; a man of the moment; a fifty-year-old icon of fashion.

What was the cause of the delusion that I had become a leading light in the world of masculine style? It was the realisation that upper lips were becoming hirsute; or at least some male ones were. As someone who has sported lip foliage ever since my teenage days (apart from when fellow students shaved it off during a university Rag Week in 1980), I was happy to form the advance party of 21^st century masculine chic.

Then I read about 'Movember'; the Canadian-based movement to raise awareness of prostate cancer. Now, for older readers of this column, the name Little Mo may bring back memories of the 1950s tennis star, Maureen Connolly. However, younger readers may be more familiar with the character from the soap opera, EastEnders. Nonetheless, I suspect that neither group will immediately guess that 'mo' is slang for moustache, and that these chaps are therefore in the process of sprouting a 'little mo'; hence the renaming of last month as Movember; witty people those Canadians.

So, you may well be asking what all the fuss (or fuzz?) is about. It involves the recognition that 35,000 men per year develop prostate cancer. It is the second most common cancer in men, with a 1-in-13 lifetime chance of developing it. 90% of cases occur in men over the age of 60, and there is a 2.5 times greater chance of developing it if there is a family history of prostate cancer.

That makes for some cheerful reading, doesn't it? However, before you decide all is lost, there are certain things you can do to help reduce your individual risk or improve your chance of responding successfully to treatment. Preventative measures include adopting the healthy lifestyle we keep hearing about, which means eating less saturated fat, meat and dairy products; all of which adversely influence the risk of prostate cancer.

The next action is not to ignore any urinary symptoms. Whilst problems with urinary flow and middle-of-the-night 'calls of nature' are familiar to many older men, do not ignore such issues, and certainly do not ignore the presence of blood in the urine: go and have a chat with your GP. Not all of these symptoms suggest prostate cancer, and (except for bleeding) may be caused by age-related growth of the prostate. However, your GP may recommend a blood test and possibly a scan; neither test being unpleasant to have.

Oh, and how is your sex life, chaps? According to Italian scientists, a healthy sex life makes men live longer. Apparently, sexual activity reduces the risk of heart disease and diabetes, and helps to avoid prostate problems.

So, gentlemen, although the month of Movember is now over, still give consideration to your prostate and go to it! I will leave you to decide whether that means growing a winter moustache; you may find some of the alternative activities are more enticing...

(This article was first published in the Scunthorpe Telegraph on Thursday 25th November 2010)

Literary GP Wins Poetry Award

The Scunthorpe Telegraph coverage of the Fathom Prize can be found at:

http://www.thisisscunthorpe.co.uk/whereyoulive/barton/tonic-win-poetry-prize/article-2936608-detail/article.html

Living Means Moving

'RUN FOR YOUR LIVES!

Well, perhaps you can afford to relax for a few moments more and read on before carrying out my first instruction. However, before explaining, I would like to carry out a small experiment, for which I need your assistance.

I want you to turn to the person next to you and check that the person is your 'nearest and dearest', for if they are not I cannot be held responsible the consequences of your next actions.

Now I want you to grasp that person's tummy just above the waistline and tell me how much you can pinch. If it is less than an inch, then you possibly have a 'lean mean fighting machine' as a partner. However, if there is a roll of fat several inches thick, then we might have a problem; if you need more than one hand to do the squeezing then, without question, we have a really big problem. Do not be fooled by his or her claims that it is 'muscle'; if you can squeeze it, it is not muscle, it is fat, and it is making your nearest and dearest very unhealthy, and will probably shorten their life expectancy.

Right, having established the reality of the situation, let me give you a few facts, and then I will explain how you can help me save a few lives, make our population healthier, reduce the cost of the NHS, and allow me to retire early for the want of any patients to see.

Inactivity increases the risk of developing more than six major diseases and, according to the Department of Heath, affects 60-70% of the adult population at a cost to the tax payer of £8.3 billion. Add in some other figures: 24% of adults are affected by obesity (£16 billion), 9% affected through misuse of alcohol (£20 billion) and the 20% who suffer through smoking (£5 billion), and the cost to our economy is astonishing: lifestyle issues cost us £50 billion per year.

That shows the size of the cost to our pockets. However, what about the cost to our health? Well, by taking a little more exercise (and I am not talking about a lot), we can reduce our risk of heart disease by 10%, stroke by 20%, diabetes, bowel cancer and osteoporosis (fragile bones) by 50% each, and the risk of breast cancer declines by 30%.

The official recommendations are to exercise for 60 minutes each day if you are a child, and 30 minutes five times a week if you are an adult; and it doesn't take very much – a good brisk walk is a good starting point, and for those less capable, how about discovering what tai chi is all about?

If your intention is to accept my invitation of a few weeks ago and attend my 120^th birthday party, you have got to slim those waistlines. Now is the time to get going. At the very least start walking for your lives – and start today!

(This is article was first published in the Scunthorpe Telegraph on Monday 15^th November 2010)

Who Cares, Wins

'You're not from round here, are you doctor?'

Those words were frequently heard during my early days in practice in North Lincolnshire. Considering that I am a Kentish Man, I happily accept that the enquiry was pertinent and showed a considerable degree of perspicacity on the part of my Lincolnshire patients (unless it was my accent that gave the game away?). Some people would put the question down to nothing more than an innate sense of curiosity. However, for me, it was an indication that I was being welcomed into my new community, and that my interlocutors were simply showing that they cared. After all, the Oxford English Dictionary does define the verb 'to care' as 'to feel concern, interest, affection or liking'.

That the inhabitants of North Lincolnshire are caring people came home to me in another way one dark winter's evening whilst I was visiting a patient in a rougher part of town. On my way to the house, I was vaguely aware of some young men lurking in the shadows and felt a little uneasy about their possible intent. Upon departing the house, I was suddenly joined by another, rather scruffy, young man who was also a patient of mine. Sensing that I might indeed be in some degree of danger, he said 'looks like you've got a problem sir; stay with me and you'll be alright'. With that he safely escorted me the fifty or so yards back to my car. That young man was caring for me.

Such thoughts led me to think about the Prime Minister's concept of the 'Big Society', and how that fits in with the idea of caring. For a 'Big Society' to work, local people must care about the people and communities where they live. If they do not care, then the Big Society cannot work.

Of course, we already have a familiar group of carers within our society. They are the armies of family members and paid carers who look after people, young and old, who through frailty or disability are unable to look after themselves. However, I would like to suggest that we are actually all carers; each and every one of us, whether we realise it or not. For example, when was the last time you put an elderly neighbour's dustbins out, assisted with someone's shopping, offered up your seat, held a door open to let another pass, gave someone a lift in your car, or simply smiled at a stranger in the street? I am sure that you can think of many other examples. Each of these individual acts shows that we care.

Now that winter is approaching, many people will have difficulty with basic daily chores. Who, therefore, will you seek to help? By performing at least one act of caring every day we can together make 'care' the foundation of the Big Society in England; that way everyone wins.

After all, as my story shows, we all sometimes need care.

(This article was first published in the Scunthorpe Telegraph, Wednesday 10th September 2010)

Fathom Prize

This morning finds me still delighted and surprised at having won the Fathom Prize for poetry last evening, with my poem 'My Neighbour's Lawn'.

Th competition, billed as Northern Lincolnshire, Hull and the East Riding of Yorkshire's 'foremost literary competition', was judged by the poet Frances Leviston MA (whose anthology, Public Dream, was shortlisted for the T.S. Eliot Prize, the Forward Prize and the Jerwood-Aldeburgh Prize).

An anthology, Fathom 10, is available from The Ropewalk, Barton upon Humber, North Lincolnshire (www.the-ropewalk.co.uk), price £5.

A Poem For Remembrance Sunday

The Remembrance Day Parade

As he walked up to the rostrum,

silence round him fell;

and whilst he gazed upon the steadfast ranks,

emotive lines began to tell.

Too many lives were lost before today:

young men and women – yesterday's youth.

They were the cheques we drew to pay

for the blinded search for fallacious truth.

You are the inspired; the fortunate few

who have lived through to this day;

the ones who now must tell the world

to find a better way.

It is the charge of those who live

beyond vanquished dreams of many men,

to find the strength to forgive;

to learn and love as best you can.

And in so doing, let us ensure

a sense of remembrance, not of rage -

may this quietude beyond the war

turn pugnacious soldier to reflective sage.

Thus, he stood upon the rostrum as

the silence round him fell,

and gazed upon the steadfast ranks

of those returned from hell.

© Copyright Dr Robert M Jaggs-Fowler 2008

Gold Dust, Hens Teeth and Audiences with the Pope

Have you had difficulty getting an appointment with your GP recently?

Yes, I thought that might be your answer. I won't tell you how many of my own patients tell me that it is easier to find gold dust, spot hens teeth or see the Pope than to get an appointment with me. Indeed, one enterprising patient threatened to book an appointment for every Monday morning and then put them for auction on E-bay. I suspect there are many similarly accused doctors harangued by politely disgruntled patients, so you are in good company. However, having established that fact let me ask another question:

Do you fancy hearing about a local scandal?

I knew the answer to that one as well; so here goes. Do you know that last month in North Lincolnshire one GP was paid to do nothing for the entire month? I hope you are astonished as I was when I found out. Just think of all that wasted tax-payers' money. Does that incense you? Good; I am pleased. Now, before you start to harangue your local MP over this flagrant wastage of NHS money, let me explain.

In my practice we waste two hours per doctor per month because some patients do not keep their appointments. If the same applies to all 110 GPs in North Lincolnshire, the wastage amounts to 1,320 lost appointments per month, or the equivalent of one doctor in the county not working for almost six weeks.

Now, if that isn't bad enough, think of another fascinating statistic. In England, every month one lucky GP wins the NHS Lottery and is given the next 36 years off; yes, that's right: full pay for no work. Honestly, it's true! It happens every month; twelve doctors per year are paid by the tax payer for a full working career to do nothing. I told you it was scandalous gossip I was about to impart.

Actually, I am not really telling you the truth; but the reality is almost the same. If you extrapolate the earlier figures for time wastage in North Lincolnshire to the 30,000 (full-time equivalent) GPs in England, then each month 60,000 hours of GP time are wasted by missed appointments; that's 360,000 appointments. If all those hours were allocated to one GP, it would be the equivalent of that GP not having to work for just over 36 years; and that happens every month, hence 12 lucky GPs per year, at a cost to the tax-payer of some £1.2million per year.

So, next time you cannot get an appointment with your GP, or the NHS cannot afford some part of your treatment, don't start by blaming the doctors, the managers or even the MPs; first ask yourself when it was that you, or a friend of yours, last missed an appointment with your GP.

As for me, I need to get my blood pressure checked. I think I'll go and register with that GP who has nothing to do this month.

(This article was first published in the Scunthorpe Telegraph, Friday 5^th November 2010)

All Change Please

'All changed; changed utterly: A terrible beauty is born.'

You might recognise the lines, taken from the poem 'Easter 1916' by the Irish poet, W. B. Yeats. It was written in response to the Easter Rising in Ireland in 1916. Whilst the poem bears only a metaphorical relevance to my topic today, I find that as I grow older those two lines increasingly resonate for me; especially in a time when change seems to be occurring on a daily basis.

Change is something which our human nature tends to avoid if possible. We feel comforted by familiarity and repetition. Normality is a state of equilibrium, where everything is just as it ought to be and nothing happens to offend that sense of well-being. However, the modern world is not like that, and perhaps it is idealistic to think that life ever was. I am sure that the Romans, Tudors, Victorians, Edwardians and so forth, all saw changes happening which caused unrest. Utopia is, after all, a mythical land.

So change happens, and somehow we have to deal with it. For some people, the rate of change is too fast for them to easily adjust to the new circumstances. Life changing events are the worse culprits: separation, divorce, redundancy, bankruptcy, house repossession, or the death of someone close. Such experiences are stressful, causing anxiety, loss of sleep, irritability, palpitations, mood changes, loss of concentration, hopelessness and depression.

Sometimes, the changes are positive in their nature, but no less unsettling. For example, I started studying medicine thirty years ago. However, the medical world I now inhabit is nothing like the one I entered in 1980; is certainly different from the one attending my birth in 1960; and the latest NHS reorganisation will ensure that it will be a very different organisation I retire from. Apart from structural changes, each week brings news of medical advances, making it harder to keep on top of my professional knowledge. This week alone informed us of a genetic cause for depression, a new screening test for prostate cancer, a 'breakthrough' screening test for bowel cancer, and new drugs for breast and ovarian cancer; all encouraging news, but no less unsettling for a professional trying to make sense of it all for his patients.

So, somehow, we need to turn change round to be positive and life-enhancing; to make it a time for new opportunities; a time to take a fresh look at how we do things and how we lead our lives. 'Who Moved My Cheese' (by Spencer Johnson, published by Vermilion) is a small and very readable book about dealing with change. It is a simple parable for modern times and I would recommend it to everyone who is affected by change of any sort. Change brings the need to adapt; this book reminds us that we are significantly empowered with the strength and ability to do so.

After all, somewhere out there, life is still beautiful.

(This article was first published in the Scunthorpe Telegraph, Thursday 28^th October 2010)

St John Ambulance - The Difference

For an important video, which may save the life of a family member or friend, go to:

http://www.youtube.com/stjohnambulance

You need to know...a life could depend on it.