Eating Disorders-some surprising figures

 Eating disorders are increasing in our society. Current statistics are hard to come by but one study shows 37/100000 people in 2009 met criteria to be diagnosed with an eating disorder and hospital admissions for eating disorders have increased by 8%.

 This week is national eating disorder awareness week and this year its aim is to increase awareness of early signs and of the importance of early intervention.

I was amazed to discover that Anorexia Nervosa has the highest mortality rate of any psychiatric illness, and suicide rates in anorexia are 1.5 times higher than in major depression. Yet often we treat this illness as a teenage fad, support is sparse unless the sufferer reaches a critical weight loss despite repeated evidence showing that intervention in the early stages of the illness can hugely improve outcomes.

 Eating disorders are found equally in all cultural groups and yet is rarely treated or talked about in minority groups. It is increasing in older age groups and in young children.

While eating disorders can be categorised into anorexia, bulimia and binge eating disorder there is often a degree of overlap. Orthorexia, the extreme adherence to a 'healthy' diet, while not formally recognised, is becoming increasingly common.

 So what signs can you look out for in a friend or patient? The American Medical Association recommend the SCOFF questionnaire for screening, the questions are:

Do you make yourself Sick because you feel uncomfortably full?

Do you worry that you have lost Control over how much you eat?

Have you recently lost more than One stone (14 lb) in a 3-month period?

Do you believe yourself to be Fat when others say you are too thin?

Would you say that Food dominates your life?

 Obviously these are easier to ask as a GP than as a friend. Consider broaching the subject in any friend who has lost a severe amount of weight recently, if they appear secretive about their eating habits or complain of feeling fatigued and cold all the time.

It's also worth if you have a friend who exercises obsessively, or who cuts out all gluten, lactose, processed foods to extremes.

. Under 18 year olds can be referred to their local child and adolescent mental health services and adults to psychology services. If there are signs of severe illness (BMI less than 15 or abnormal blood results due to starvation) they can be referred to specialist eating disorder units.

Remember early intervention saves lives.

How to get the best from your GP

A few days ago an old school friend contacted me on Facebook. At first I thought I should write about the medical condition they were thinking of, but really the gist of the message was, 'How do I get my GP to take me seriously?'
 And this can be an issue; my trainer once told me ninety percent of what we see in general practice will resolve by itself, and other GPs describe our job as searching for a needle in an ever enlarging haystack. After seeing 40 patients it's all too easy for us to dismiss concerns in the patient or parent when they may have a valid presentation.
 So what did I advise my friend, and what points will help you get the most from your GP?

Before your appointment.

Allow enough time.

 If you are going to ask about a couple of things, or have a complex cluster of symptoms, ask to book a double appointment, you may have to wait a bit longer but you shouldn't feel as rushed and we appreciate the consideration.
 Receptionists can also be helpful about letting you know the best person to see or the best time to come. In my old surgery I was the only GP who did minor surgery and contraceptive coils and implants, so asking reception the best doctor to see can save you having to come back.
 It's also worth asking when samples are sent to the lab. It is rare that a GP has time to take a blood sample in an appointment, but I often had to rebook patients from a friday afternoon who needed swabs taking as the courier had already been and gone.

Plan.

 Plan what you want to say beforehand. Even I can get flustered in an appointment and come out realising I have forgotten to say what I wanted to bring up. Going to see a doctor can be daunting, no matter how friendly they seem, so plan what symptoms you want to describe, make a list if needed and try to be clear. Ninety percent of diagnosis comes from what you tell us, so it's important.

Be accurate.

 Try to think of how long you've had the symptoms for. Answering 'a while, ages or a bit' is not helpful.
 If you have a pain, think of words to describe the nature beforehand. Is it sharp? Burning? Aching? Does anything seem to bring it on?

 Let us know your concerns.

 Let us know what you are worried about and why. If you tell us your brother had a brain tumour, we'd understand why you are seeing us with a headache. A lot of illnesses have a genetic basis so tell us about them, it may make us more likely to test for that condition.


On the day.

Arrive on time. I know, I know, we often run late. But that's usually because someone has taken more than ten minutes to sort out, not because we've idled and turned up late. If you have other things to sort out at reception, arrive early.

 Bring a friend.

 If you think you need moral support then feel free to bring a friend or relative, especially if they have witnessed an episode of illness, they may have helpful information to share.

Put your phone on silent.

 Mobiles don't interfere with much medical equipment, but a phone ringing, and especially if you answer it and proceed to have a conversation, is practically guaranteed to put your doctor in a bad mood!

Be prepared to be examined.

 If you have a problem with your shoulder, wear a vest top under your clothes. If it's your leg think about wearing a skirt (definitely not tights under trousers!) If it's a gynaecological problem try not to schedule an appointment during your period.

Feel free to return.

 Most illness don't start with text book symptoms, they evolve gradually. Watching and waiting can be a valuable diagnostic tool. If your symptoms are changing, or not resolving in the advised time, we want you to come back and let us know.

Valentine's is over, now what?

The endless pictures of flowers and chocolates are rapidly dropping down my newsfeed, the satirical anti-valentines posts are fading too, the dramatic sweep of red and pink around our shopping centres is rapidly changing to the baby yellows, greens and blues of Easter.
 Did you take a moment this Valentine's to appreciate your partner or loved ones?
 Not all of us are so lucky. One in 4 women and 1 in 6 men experience an incident of domestic abuse in the UK.

 So now the flowers and hearts are finished with for another year, what are the signs that you are in an abusive relationship?

 We've all seen the soap-land iconic battered wife scenarios, but physical violence is only one part of domestic abuse. Emotional, sexual and verbal abuse are all damaging.
 Does your partner constantly put you down, chipping away at your self esteem and making you feel that you are incapable of the simplest activity?
 Do they control where you go and who you see? Are they constantly checking up on where you are and accusing you of cheating?
 Do you find yourself avoiding certain topics or activities for fear they will cause an outburst?
 Do you feel threatened or trapped?
 Have they threatened to hurt you or your children if you leave?
 Do they withhold money or prevent you from working?
 Do they blame you? Tell you they wouldn't do it if you didn't stress them, blame it on alcohol or tiredness?
 Are you forced into having degrading or unwanted sex? Are you treated as a sexual object or belonging?

 Contrary to popular belief most people who suffer abuse are not weak, but constantly being told they deserve this treatment or have brought it upon themselves has a huge psychological effect.

 The first step to escaping an abusive relationship is recognising it, then you need to shake off the guilt and shame and get help. Women's Aid and Refuge both offer excellent advice on financial rights and ways of escaping legally and safely.

 If you suspect a friend is subject to abuse, try to find a way you can gently offer help when they are alone. You may find you are greeted with denial, or even anger, but simply letting them know you are there for them if they ever need it may help give them the reassurance that they are okay to leave.

www.womensaid.org.uk
www.refuge.org.uk

Sexual Health Awareness Day

February 12th is the Sexual Health Awareness Day. As a GP who specialised in family planning this is a subject I deem to be hugely important.
 It doesn't feel like such a long time ago that I was a teenager, trying to make sense of the world of relationships, sex and society. Even now as 40 rapidly approaches I'm still trying to figure out some things.
 On this day of highlighting the importance of sexual health, I decided to write down what I would like my children to be aware of as they enter the age of sexual relationships.

1. As long as everyone is consenting and comfortable, no sexual activity is 'wrong'.

 We often follow a vicious cycle of shaming and low esteem. It's okay to have sex with someone, it's okay if that is in a long term relationship, it's okay to have a one night stand, it's okay to want to wait until marriage, it's okay to fancy someone of the same gender, it's okay to try anal, it's okay to have group sex. Whatever you want to do, if both you and your partner are of an age and ability to consent and you're not coercing or deceiving anyone, then go for it.

2. Women are not sexual objects.

 I have 4 boys, one of my hopes for them is not to treat women as objects. They are people with hopes, desires, and dreams just like you. She is not a slut for having sex, or frigid if she chooses not to. She can wear what she wants, when she wants and it is not an indicator of her willingness to have sex. Choose a life partner based on personality, not just looks, chose someone who will support you when you are down, cheer for you when things go well, care for you when life is risky, who makes you smile and laugh. And if that person is male or female, it doesn't matter, you are my sons and you have my heart forever.

3. Condoms, condoms, condoms.

 Carry them in your purse, pocket, car, have them in your room. When my boys are older I'm planning on having a big jar of them in the bathroom cupboard.
 It's not a sign of being a slut, it's a sign of being mature and aware of safety. Correct use of condoms will prevent most STIs and pregnancy.
 If you're not sure about correct use your local family planning clinic will happily show you. My key three points; remember to use it right from the start-don't think you can just put it on to orgasm, don't forget to pinch the air out of the tip before putting it on, and don't use any oil based lubricants with it.

4. Back up plans.

 Condoms are 96-97% effective at preventing pregnancy. If you really don't want to risk pregnancy then it's worth thinking about using the contraceptive pill, patch, ring. injection, implant or coil. All of these can be had from the family planning clinic and most GP practices do them as well. There are plenty to chose from to find the one which suits you best.
 If you think a condom has split, or you didn't use one in the heat of the moment (and we've all been there-believe me) then you can get the morning after pill from your GP, family planning clinic and also free of charge from many large pharmacy chains. The sooner you take it the more effective it is.

5. Get tested.

 The sexual health clinic at Charing Cross used to be accessed via a long glass corridor, jokingly referred to as the walk of shame by many.
 Now I feel more ashamed to have called it that.
 In a new relationship? Go together. Want peace of mind-go get tested. You don't have to have symptoms, and a lot of STIs don't have any symptoms at all.
 You can also do a self swab for chlamydia from the family planning or some GP surgeries.
 STIs show no judgement when they infect, it doesn't matter how nice someone is, what social class they are from, what the colour of their skin is, anyone can be infected without knowing.

5. Think about those less fortunate.

 In the UK we take our sexual health services for granted. Condoms are available easily and cheaply-you can get them free from clinics too. I hope this isn't a service we will lose in the destruction of the NHS services our government has pushed through.
 Now imagine being in a less aware country, where sexual taboo is rife, condoms are hard to get hold of and many refuse to use them.
 Support AIDS charities and sexual health charities. Support getting rid of the taboo of menstruation in India, support girls being educated and not married off in their early teens. If you watch porn make sure it is from a licensed, regulated company.

 And after all this? Enjoy your selves and have a happy and healthy sex life.

Hernias

Today my dad went in for a routine hernia repair. I didn't realise I had been worrying until after I got the message from my mum to say he was home and well. Being 5000 miles away is hard when you want to be around to help and support.

 Hernias come in many shapes and sizes, up to 10% of us will experience one at some point. They occur more commonly in men and are associated with being overweight, heavy lifting, and chronic cough.

 A hernia occurs when there is a weakness is the muscular wall of the abdomen which allows the contents (sometimes bowel, often just the fatty tissue that surrounds the bowel) to bulge out under pressure. They can range in severity from a painless small swelling to causing complete obstruction or strangulation of the bowel.

 The commonest hernias occur in the groin, with a swelling in the crease between the abdomen and thigh, or swelling into the scrotum.

 Other hernias can occur in the upper thigh, in or around the belly button, around the edges of the abdominal muscles and in old surgical scars.

 It's worth seeing your GP if you develop any of these to discuss the pros and cons of surgery, and if ever a swelling was to get stuck, become inflamed or you developed abdominal pain, swelling or vomiting with it you should seek emergency advice.

 Some hernias have very little risk of becoming stuck or cutting off the blood supply to the bowel and can be left alone if they are not causing symptoms. However some have a higher risk of complications and surgery is recommended.

 The surgery can be keyhole or open, and usually involves applying a mesh to the weakened area, reinforcing the abdominal wall.

FGM case doctor cleared

I read the news today of Dr Dhanuson Dharnasena, a training obstetrician who had been brought before the courts on a charge of Female Genital Mutilation.
 Dr Dharnasena had been on duty when a lady, who had FGM performed on her at the age of 6, attended the hospital in labour.
 This lady's FGM had not been picked up by any of the antenatal team looking after her, as usually such patients are referred to a specialist FGM team to plan the delivery of the baby.
 Faced with a woman in labour unable to deliver due to the mutiliation, putting the lives of the mother and baby at risk, Dr Dharnasena cut the lady to allow room for the baby to descend.
 After delivery the lady needed to be sutured to stop blood loss from the cut, Dr Dharnasena rang and discussed this with his consultant and following advice sewed up the cut he had made.
 It took the jury only 30 minutes to decide this doctor was not guilty of performing FGM and only acting in the patients best interest.
 Sadly the General Medical Council felt the need to suspend this doctor from the register.

We need a system where failing or criminal doctors can be picked up and dealt with, but cases like this go to show that the system is very much weighted against the medical profession.

Facing even a trivial complaint is hugely stressful and can destroy doctors careers, health and  lives. Suicide rates are higher in doctors facing GMC inquiries (and high in doctors in general).

I hope that Dr Dharnasena has had good support throughout this and is able to continue in a fulfilling career.

Wear It, Beat It.

The British Heart Foundation's fundraising and awareness campaign 'Wear It, Beat It' is tomorrow 6th February.

The BHF offers excellent information and advice to patients, their families and medical professionals and I am a big fan of the educational letters they send out to UK GPs. They fund a significant portion of research into preventing and treating heart disease.

 You can join in by wearing red tomorrow, or joining any of the events which can be found on their website https://www.bhf.org.uk/get-involved

Heart disease is the biggest cause of death in the UK, causing 80,000 deaths last year and being the cause of death of 1 in 5 men and 1 in 7 women.

Simple lifestyle changes can reduce your risk of developing ischaemic heart disease; regular exercise, stopping smoking, a healthy diet and checking and managing your blood pressure and cholesterol levels. 

Why I vaccinate my Children

The news headlines on the Disney measles outbreak have waned but the need to keep measles and other preventable diseases in the forefront of peoples' minds remains as important as ever.
 As a mother of four boys and a GP I am fiercely pro-vaccination. My older two boys have had both their MMR jabs, and my younger two will have theirs as soon as they are eligible. I personally ended up having an MMR booster after my second son as my rubella immunity had dropped.
 Why has the recent outbreak been so worrying? I suspect the headlines were so numerous in part due to the Disney association. Last years' outbreak in the Amish community felt distant to most of us, we could write it off as an isolated event, ascribe it to other lifestyle choices of the community, pretend it wouldn't happen to someone we knew.
 But just about everyone knows someone who has visited, or plans to visit a Disney resort. Suddenly this is getting real and although I feel for those affected, I hope this is a good thing overall and encourages an increased uptake in the MMR vaccination.
Last year in the USA there were 644 confirmed cases of measles. This year in the month of January alone there have been 102 confirmed cases, and this outbreak is still ongoing.
 In 2000 measles had been considered eradicated in the USA, but a drastic drop in vaccination uptake following the now discredited Andrew Wakefield's publication has led to a resurgence.

The vast majority of those affected by this outbreak were unvaccinated. Either those who had refused it, those who were unable to have it, or those too young to have it.
 Measles has a 90% transmission rate, and a 30% complication rate. So if either of my two younger children were exposed to a case, they have a 27% chance of ending up in hospital. In 2013 globally there were 145,700 deaths from measles.
 Compare this to the Vaccine Safety Datalink rates of mortality after vaccination which show no difference in mortality rates after vaccination compared to expected US mortality rates.
 It really is a no-brainer-vaccinate your children people.

Raynaud's Awareness

As we welcome the start of February my medical awareness days calendar reminds me that this month is Raynaud's awareness month.

 So what is Raynaud's and why should we be aware of it?

 Many of us suffer from Raynaud's phenomenon, a condition where the sufferer's fingers and toes go white then blue, followed by turning red, itchy and painful. It is commonly triggered by cold conditions.

 The underlying cause is spasm of the blood vessels causing lack of blood supply to the area, followed by increased blood supply when the spasm passes.

 Most sufferers only have Raynaud's but it can be associated with other autoimmune conditions such as scleroderma, rheumatoid arthritis and lupus.

 The condition is not life threatening but can be very painful for sufferers and affect their ability to carry out certain tasks.
In some cases it can lead to tissue damage and even gangrene but these are thankfully rare.

Treatment consists of trying to avoid triggers, wearing warm clothing and using heat pads. Stopping smoking if the person smokes as this increase the risk of complications and medication that widens the blood vessels can be tried.