NICE: Blood Pressure Update

From Diagnosis and management of hypertension in adults. NICE guideline update 2019

BJGP Feb 2020 by Nicholas R Jones et al.

The last update by NICE was in 2011. The key changes are explained in this article.

High blood pressure is blood pressure over 140/90 if measured in the clinic.

Home measurements can be more reliable due to a natural rise in blood pressure in the clinic setting. Ambulatory monitoring can be done, but it is not always available or tolerated. My comment: The machine can be very uncomfortable and disrupts sleep. 

To take your blood pressure at home, take two readings, one minute apart, twice a day for 4 to 7 days.  Don’t count the first days readings. Then take the average of the others.

Hypertension is diagnosed if the average of home or ambulatory monitoring is over 135/85.

The BP should be taken standing for those people over 80, who have type two diabetes and if you have postural hypotension. You need to stand for at least a minute before taking the blood pressure and it is best to avoid talking. 

A blood pressure difference between the arms of over 15 mmHg is a marker for vascular disease. Thereafter the arm with the highest measurements should be chosen for monitoring.

Urgent admission is needed if the bp is over 180/110.

Target organ damage is assessed with looking at the retina, urine testing, U and E and eGFR, ECG and a cardiovascular risk score such as QRISK. Check up should be annually.

Lifestyle advice should be emphasised as this can result in taking fewer drugs.

People with blood pressures over 140/90 at the clinic or 135/85 who are aged 60 to 80 are currently advised to have treatment for their blood pressure. People over the age of 80 are fine with blood pressure targets lower than 150 systolic.

The treatment target for people with diabetes is now 140 systolic which is now the same as the general population.

The drugs to treat hypertension are:

ACE or ARB if type 2 diabetes, age under 55 or African or Caribbean origin.

The next step is to add a calcium channel blocker or thiazide like diuretic.

The next step is a combination of ACE or ARB, CCB and Thiazide.

If the potassium is less than 4.5, Spironolactone can be added as a next step.

If the potassium is over 4.5 then an alpha or beta blocker.

For all other patients the first step is a CCB or Thiazide. 

The next step is an ACE, ARB or Thiazide.

Then any combination of these.

If the potassium is under 4.5 then spironolactone can be added.

If the potassium is over 4.5 then an alpha or beta blocker can be added.

 

Fitter, better, sooner

From BJGP May 2020 by Hilary Swales et al.

Having an operation is a major event in anyone’s life. There is a lot a patient can do to improve their physical and mental health before surgery that will improve their recovery and long term health.

Fitter, better, sooner is a toolkit was produced by the Royal College of Anaesthetists with input from GPs, surgeons and patients.

The toolkit has, an electronic leaflet, an explanatory animation and six operation specific leaflet for cataract surgery, hysteroscopy, cystoscopy, hernia, knee arthroscopy and total knee joint replacement.

These can be seen at: https://www.rcoa.ac.uk/patient-information/preparing-surgery-fitter-better-sooner

The colleges want more active participation with patients in planning for their care.

The most common complications after surgery include wound infection and chest infection. Poor cardiorespiratory fitness worsens post op complications. Even modest improvement in activity can improve chest and heart function to some extent.  Keeping alcohol intake low can improve wound healing. Stopping smoking is also important for almost all complications. Measures to reduce anaemia also reduce immediate and long term problems from surgery and also reduce the need for blood transfusion. Blood transfusion is associated with poorer outcomes particularly with cancer surgery. HbA1Cs over 8.5% or 65 mmol/mol causes more wound complications and infections.  Blood pressure needs to be controlled to reduce cardiovascular instability during the operation and cardiovascular and neurological events afterwards.

This toolkit is already being used in surgical pre-assessment clinics but access to the materials in GP practices will also help. After all, the GPs are the ones who are initially referring the patients for surgery, and improving participation early can only be helpful.

It is hoped that this initiative will result in patients having fewer complications, better outcomes from surgery but also from their improved lifestyle.

 

Take your blood pressure pills at night

Adapted from BMJ Take anti-hypertensives at night says study. Susan Major 2 Nov 19

Taking your blood pressure medication at night gives you better blood pressure control and nearly halves cardiovascular events and deaths compared to taking them in the morning.

This study was done on nearly 20 thousand patients with an average age of 60 for six years. The reductions in events included cardiovascular death, heart attacks, coronary artery revascularisation, heart failure and stroke.

Professor of cardiovascular medicine at Sheffield, Tim Chico said, ” As taking medications at bedtime poses little risk there is enough evidence to recommend that patients consider taking their medication at bedtime.”

Bariatic surgery doubles congenital abnormalities in babies

From BMJ 30 Nov 19

A retrospective analysis from Quebec of 2 million pregnant women who had delivered between 1989 and 2016 showed that offspring of women who had become pregnant after bariatric surgery had roughly twice the risk of birth defects compared to women who were not obese or who were obese but had not had surgery.

The defects were mainly heart and musculoskeletal defects.

My comment: This short report does not go into possible causes for this. You would have thought that the risk would have been reduced to the level of the non obese women. I wonder if nutritional issues have a part to play as after bariatric surgery long term vitamin supplements need to be taken. 

Your brain needs 50g of glucose a day

Adapted from Richard Feinman’s Nutrition in Crisis 

We have all heard NHS dieticians and diabetologists telling us that we will die of brain failure or get severe brain damage when we go on low carb diets because the brain needs 130g of glucose a day.

We will typically remind them that the glucose does not need to be ingested since our livers are perfectly able to manufacture well over 130g of glucose a day, the process called gluconeogenesis.

Richard Feinman is a cell biologist and he has an even finer retort.

The 130g of glucose a day necessity was discovered by George Cahill. This was the amount of glucose that a brain uses in normal nutritional states. It is indeed the case that this glucose can be ingested or manufactured in the liver or both.

Under starvation conditions however, the brain will only use 50g of glucose a day.  In starvation, the utilisation of ketone bodies becomes more important for brain function.

Unfortunately, nutritionists picked up on the 130g of glucose a day message and have been repeating it ever since. Cahill is reported to have said that by the time he was aware of the simplified but inaccurate message, it was too late to stop it.

Thus, it is not always true that you need 130g of glucose a day for brain function and it is never true that this must be from dietary carbohydrate.

So, if you get the old chestnut thrown at you, you know what to say now!

 

 

 

 

 

Dr Chris Palmer: Ketogenic diet now being used in mental health

Dr Chris Palmer from Harvard has been using the low-carbohydrate and ketogenic diets in practice for over 15 years now mostly for weight loss. Recently, he has found an anti-psychotic and mood stabilizing effect from specific types of the ketogenic diet. Now he is pursuing clinical research in this area to better understand the topic. As a result, he has also been speaking at national and international conferences.

Here area few of his podcasts/interviews:

http://lowcarbmd.com/episode-49-dr-chris-palmer-treating-schizophrenia-with-lifestyle

https://www.chrispalmermd.com/ketogenic-diet-psychology…/ and keto putting schizophrenia into remission.

https://www.chrispalmermd.com/ketogenic-diet-remission…/

https://www.chrispalmermd.com/keto-naturopath-by-karl-goldcamp-interview-christopher-palmer/

My comment: It is a very good idea for those people with schizophrenia to be on a low carb diet, mainly due to the side effects of the anti-psychotics which give people metabolic syndrome and diabetes. It is even better to hear that there conditions are improved so they are less reliant on these drugs.

Dr Peter Tippett: Prevent a second covid wave

Saving Your Health, One Mask at a Time
Published on April 7, 2020

Peter Tippett MD PhD
CEO careMESH; Chairman DataMotion; ex Presidential Advisor; Norton Antivirus creator

We all hear the same things: wash your hands, don’t touch your face, stay at home, stay 6 feet away from others. Viruses live on boxes and plastic and doorknobs and… EVERYWHERE.
How does the average person decide what measures to follow unless they truly understand how these things work or have a clear set of “rules” they can abide by?
I am an Internal Medicine-certified, Emergency Room MD with a PhD in Biochemistry. I have also spent much of my professional life in the high-tech world helping people understand how risk, infection, and the growth of infection behaves. So I thought it might be helpful to folks in my network to explain how personal protection from a virus like SARS-CoV-2 (the formal name of the virus that causes COVID-19) actually works, how any given measure individually lowers risk, how various countermeasures work together, and most importantly, to give you some simple guidelines for day-to-day living in this new COVID world.
Bottom Line on Masks & Gloves:
Wear a mask when you are in “exposure” zones (mainly places with other people).
Treat your home, car, and yard as safe places (no mask or gloves).
Be on high alert on what you are doing with your hands when you are in “danger zones.” This is when you must not touch your face.
Consider wearing gloves (even winter gloves or work gloves can be helpful) but only for short periods of time and only when in “touch exposure” danger zones.
Remove your gloves (and mask) when you return to your safe place.
Wash your hands every single time you take off your gloves or mask or move from a danger zone back to a safe zone.
When you are at home and after washing up, you can relax, scratch your nose, rub your eyes and floss your teeth…without worry.
Protections Work Together
All protections or countermeasures are only partially effective. For example, wearing the seat belt in your car reduces the likelihood of dying by about 50% compared with not wearing it. You can think about that as horrible (“it will fail half the time!”), or as great (“it cuts the risk of dying in half!”). For everything we care about, in all aspects of life, we solve this “risk” problem by using countermeasures together to improve their collective effectiveness. Independently, air bags reduce the risk of dying by about 30-40%. When added together with seatbelts, they are synergistic and reduce risk together by 65-70%. We add licensing, speed limits, anti-lock brakes, police enforcement and other things to achieve very good risk reduction (well into the upper 90s). We need to be even more careful when we drive in more dangerous situations, such as in a snowstorm. Protecting yourself (and society) from COVID works exactly the same way—you just can’t see the snow.
Getting Infected is Not “Black and White”
A tiny number of virus organisms placed in the back of a person’s throat one time is not likely to lead to the average person getting “sick” with COVID. If we placed a tiny number of live viruses in the throats of 1,000 people, less than half would probably get sick. If we placed 1,000 or 1,000,000 viral organisms, the average person probably would get sick. And if we placed a tiny number of organisms 10 or 100 times in a week, the average person would also likely get sick because of the multiple exposures. This is because even in your throat, your body has protective countermeasures such as mucus and cilia and your blood and other fluids likewise have generic immune and other protections. They are just not as strong as we need them to be. Even as people get and recover from COVID or get a future vaccine, 100% of the population won’t be 100% protected, but collectively we will be safe.
Your nose reduces the risk of viral particles getting to your throat. A mask reduces the risk of the viral particles getting to your nose, and social distancing reduces the risk of them getting to your mask. Together, these countermeasures work very well.
If your nose reduces the risk by 80% (see Caveat 1), and a mask by another 80% and the six-foot distance by 80% more, then collectively, the failure rate would be (0.2*0.2*0.2 = .008) = 0.8%. In other words, the collection of countermeasures would be (1 minus the failure rate) = over 99% effective in reducing your chances of getting sick. In this example, any two together would be 96% effective and any one alone would be 80% effective.
So based on this example calculation, if you are standing with your mouth closed and normally breathing close to a COVID carrier as they are speaking to you, you may have a 20% chance of getting sick from that exposure. Add a mask and that would go down to 4%, add distance and that goes to under 1%. Add repeated individual exposures from other people, and your risk gets worse. Add more countermeasures and your safety improves. The power of each individual countermeasure is much less important than their collective power in protecting you.
So How Does a Mask Really Work?
It hasn’t been measured for COVID, but I suspect that almost any mask, no matter how poor, is more effective than a seat belt is in your car. Masks that are FDA-cleared have been tested against a benchmark and have a rating. N95 masks have been shown to reduce 95% of passage of a certain size particle over a certain time period in specific laboratory conditions.
When I worked in a pre-COVID ER, I would change masks 6-12 times in a shift. However well it works in the test lab, wearing the same mask (N95 or not) for a 12-hour ER shift is definitely not as strong as using a fresh one—let alone using the same mask for a week. But it is far stronger than not wearing any mask at all. N95s have benefits over the simple dust masks typically used during construction work, for example, such as: (a) they are more comfortable to wear, (b) the air is more likely to go through the mask than around it, (c) exhaled air is less likely to fog your glasses, and (d) inhaled air is a bit less restricted.
These are similar characteristics to the beneficial properties of cloth masks. So, I am a big fan of cloth masks, even very simple ones. Any mask has 3 main protective properties:
They make it hard to touch your nose and mouth, thus providing great protection for what is the biggest infection vector in most situations — hand-to-face transmission.
They reduce the exposure of your nose and mouth to viruses in the ambient air (directly breathing in viral spray or viral fog).
They reduce the chance that others will get infected from you when you are sick and don’t know it (and when you are sick and do know it!).
Great masks and poor masks can both stop water droplets. Most coughs and sneezes are really composed of a fine spray of water droplets soaked with virus. Stopping the droplets also stops the virus. Dry virus “dies” (see Caveat 2) very quickly so even though individual virus particles are extremely tiny and can enter in the air around a mask, or even go through the mask, they are less likely to infect you than a droplet teeming with viruses being kept “alive” by the droplet. The most likely way a dose of virus will get in your nose or mouth is:
Via touch of your own hand (most likely by far)
Via water droplet-laden virus (cough, sneeze or even breathing)
Via free (or dry) virus “particles” (least worrisome)
The Nuance Behind Mask Testing
I’ve seen many articles that totally miss the mark on the benefits of masks. Many say things like “good to keep your germs from hurting others, but not very good at protecting yourself” or “we tested 1,2,3 layers of different materials and found x% of particles the size of viruses goes right through; therefore these are better than those”.
The testing that matters is way too difficult for anyone to actually do. It would test 1,000 people who wear “certified masks” versus 1,000 who wear homemade masks of different types and see what percentage of each get infected and what percent get hospitalized or die. Proving that virus-sized particles “go right through” old bandannas is mostly irrelevant if the most likely way you will get sick is by hand-face touching, where a bandanna might be 98% effective; or by virus-laden water droplets where the bandanna folded 4-times might be 90% effective; even though it is relatively poor at blocking dry, individual virus organisms, which is the least likely way you will get sick.
How and When You Are Likely to be Exposed
It is best to think of exposure scenarios. Scoring them relative to each other helps to illustrate the relative risk. (numbers are for illustrative purposes only)

Is a Hospital Mask Better Than Homemade?
In many respects, for home users, a mask made of cloth is comparable to a paper-based, certified medical mask. The first reason they are comparable is because the protection math works well whether the mask is 70% effective or 90% effective. In the example above, the total risk reduction would be somewhat better (99.6% vs 98.8%) between using a great mask and a good one when using it as part of a short list of countermeasures working together. That example math did not include other countermeasures you are likely to also use like washing your hands, or wearing glasses or a shield, or sometimes wearing gloves, or avoiding exposure in the first place. All of which would drive the total theoretical risk reduction well above 99% no matter which mask you wear.
First, countermeasures only work if you use them. If you keep a cloth mask in your pocket or purse or hanging around your neck, then when you get near a danger zone you will be more likely to use it. The N95 and similar masks don’t do well after being scrunched up in your pocket. Second, when you are back to your safe place, you can toss your cloth mask in the washing machine and use it again tomorrow. Or better yet, buy or make a couple of masks so one mask is always clean.
Treat masks like underwear: use a fresh one every day (and whenever things happen that make you want to change).
Cloth masks can be fitted, or folded, or worn as a bandanna. Two layers are much better than one, and three are somewhat better than two. Older cloth is likely to pass air better, making it easier to breath if you are wearing it tightly, which prevents air from escaping around the edges. If you are going to have air escape around the edges, arrange your mask so air escapes below your chin. Air turning more corners on the way to your nose makes it tougher for contaminated air to reach your nose, which improves protection.
Consider the inside of your mask as clean, and the outside as contaminated. When you remove it, you have just touched something contaminated so wash your hands, and then clean the mask as soon as it is practical.
Should I be Wearing Gloves, Too?
Wearing a mask uniformly reduces risk. Unfortunately, the case for non-medical people wearing gloves is much less clear because it can be totally useless. They become contaminated just as your hands do. Therefore, wearing gloves for long periods doesn’t help protect others. Both a contaminated glove and contaminated hand can pass a virus either way. If you handle money or touch a door that others will touch, you will both pick up the virus on your gloves and transfer it to the next object or person. If you touch your face wearing gloves, you will be just as likely to drive a virus to your eyes, nose or mouth as if you touched your face with an ungloved hand. Wearing gloves might help you avoid touching your face, but masks are much better for this.
Gloves are best for temporary situations in which you expect “touch exposure”. Use them, allow them to be contaminated, and when you are away from the touch exposure zone, take them off, wash your hands and get on with life.
So, use them for short periods of time for a specific purpose. For example, I recommend wearing gloves (and a mask) when you go to a store. Put them on when leaving your car, feel free to open doors, touch things, move things, with abandon, however, never touch your face when you are wearing gloves. Use them when paying, and when typing your pin or signing for your purchase. When you leave the store remove them and if they are disposable, throw them away. When you get to your car, open the door, clean your hands with your sanitizer or wipes, and go back to your safe zone.
My 90-something mother lives in an elder-care apartment complex. There are others there who have COVID. Her apartment is her safe zone. She wears a mask (just the sleeve from an old shirt) and winter gloves when she ventures into the hall and down the stairs to a common area to pick up her mail.

She can hang on to the railings, punch buttons, open doors and breathe freely as she does her work outside of her safe zone. When she gets back to the apartment, she removes the mask and gloves, puts the mask in the wash (she has the others available if she needs a clean dry one), washes her hands and gets comfortable in her safe zone. By the way, the winter gloves will become un-contaminated over time as long as they are dry (see below), and they can be used again the next day since the inside is going to stay clean. If you really want to decontaminate them, they can be put in a 250-degree Fahrenheit oven for a half hour or set out in the sun.
What About Grocery Bags?
You can go crazy worrying about the bags and store items and packages you bring into your safe zone. In general, if they are dry, they are relatively safe. You can make them safer by letting them sit for an hour or more. Bright sunlight or dry air are both virus killers. Keep your hands away from your face while you are unpacking and wash your hands after you have finished putting things away, then consider yourself safe. No one is going to succeed at perfect sterile procedures in the real world, so make a routine that makes sense.
Hand Washing & Sanitizers
Wash or sanitize your hands whenever you enter your safe zone every single time, and when you finish working on things that have a chance of being contaminated. For example, if you are going to do the laundry, get everything loaded in the washing machine and then wash your hands. Same for unpacking the mail, or groceries, or an Amazon package delivery. While you are working on anything that is potentially contaminated, and every time you are in an unsafe environment, pay attention to your hands. When you are shopping or in other danger zones, it is not the time to scratch your nose or rub your eyes. And you should be wearing a mask anyway. Once you are back in your safe zone, wash up, and scratch your nose and rub your eyes all you want. You are in your safe place.
Washing with soap is better than using a sanitizer or wipes, but obviously you need a sink and soap for washing. Keep a pump or wipes in your car and at your home entrance to do a quick job on the way into your safe zones—mainly to keep your safe zone safe.
If you accidentally shake someone’s hand, or touch something worrisome, keep track of your hands, and keep them off of your face until you can wash or sanitize them. In some situations, you might consider letting one hand become contaminated while trying to keep the other relatively clean. You might use the same hand to open doors, for example and the other to do less dirty work until you can wash or sanitize them both.
But in general, if you are home or in another safe zone, quit worrying and don’t bother thinking about washing and face touching. No one can stay sterile for any extended length of time. Save those worries for shorter periods when you are in danger zones.
What about packages and mail delivered on the front porch?
Viruses are always dying. Viruses only “grow” (replicate making more viruses) when they are in the inside of an infected person (or a bat) cell. Everywhere else, they are dying. Depending on where they are and their local environment, they die quickly or they die slowly, but they constantly die. This is the big difference between viruses and bacteria. If you put a million viruses in a drop of water, they will start dying immediately. And there will never be more individual virus particles than you started with. Bacteria, on the other hand, can be in “standing water” with enough other environmental help to replicate and make a big, stinky, slimy mess. Just one or two bacteria double to 4, 8, 16, 32, 64, 128, 256, 512, 1024 eventually to millions of individual bacteria, in your soup, or milk, or pasta sauce, or whatever. Viruses never do this. Outside of the infected person they start dying and keep dying. We can take advantage of this fact to help keep us safe.
For those who think in exponential math, Viruses tend to die via a half-life. Just like bacteria grow exponentially in the soup, viruses grow exponentially in populations of people. Exponential growth is described with a “doubling time”. Similarly, exponential death is described as a “half-life”. Radioactive material has a constant, unchangeable half-life. The half-life for death of viruses, on the other hand, is a good property in the everyday world and is also easy to speed up, and easy to trust.
The half-life of virus particles might be a minute or two on a package on a dry warm day sitting in direct sunlight, or a half hour or more for the same package sitting in a cool humid environment like your basement. So, with these hypothetical numbers, for the package on the porch in the sun, ten half-lives kill off 99.9% of those virus particles in 20 minutes. The same package in your basement might need five hours to accomplish the same kill-off benefit. Sunlight (UV light), heat, dryness, soap, alcohol, peroxide, bleach all rapidly kill viruses.
So even if the outside of the box of Cheerios was contaminated a few hours ago by a sick shopper touching it, by the time you get it home, 99.9% of it is probably already dead, and by the time you eat breakfast tomorrow, after the box sitting in your dry cupboard, another 99.9% of it is likely dead.
Please don’t get sucked into breathless worry because the scientist who (correctly) shows that it is “possible” to find some live virus on cardboard after 2 days. Although true, the risk is infinitesimal. That scientist can find the last two living viruses, but you need a much bigger dose to cause any harm and, in most cases, that all went away yesterday.
But I work in a Grocery Store (or Warehouse)
Please wear a mask! Wear glasses instead of contacts. Wear something over your shirt or blouse that you can take off in the garage or other staging area before entering your safe zone car or home. Wear gloves or not (your employer probably has a requirement). Either way, wash your hands when you take your mask off and when you take your gloves off. When you quit work, wash before you get to your car. Take your outer layer off and gloves off before fully entering your car. Sanitize your hands on entering your car. Do it all over again in your garage or mudroom before getting inside your house. Put your clothes and mask in the wash and take a shower when you get home.
Key Takeaways
Social Distance—Stay six feet from people is a good thing. Ten feet is even better.
Safe Zone—For most folks, your house is a safe zone.
For you, and for family living with you, your yard is likely a safe zone.
When outside, and with no other people nearby, you are in a safe zone
For most people, your car should be a safe zone.
Masks—The easiest, most reliable precaution you can take when out of your safe zone
If you work with the public, you should absolutely be wearing a mask on the job.
If you are in a safe place, a mask has low value, because the risk is already low.
If you are going to put the same mask on and off, then treat the outside as contaminated and the inside as safe.
If you handle the outside of your mask, then consider your hands as contaminated, and wash them.
Don’t touch the inside of your mask with your hands or anything else dirty.
Put the cloth mask in the laundry at least daily. (or wash with warm water and soap).
Have at least two masks so one can be in the wash and the other clean when needed
Don’t bother boiling masks before you wear them. The detergent in your washing machine is easier, stronger, and more likely to succeed by far.
And above all—enjoy your safe zone with your family, friends, cat or dog.
Be Well,
Peter

Caveat 1: I will use statistical examples and numbers to illustrate how this works. The numbers I use are estimates only. I am using them because the exact numbers in each case can be off by huge margins, and the resulting understanding, recommendations and behavior will not change even if a particular situation or study shows instances that are quite different from my examples.
Caveat 2: I know that viruses are not “alive” nor “dead” but I will use “dead” to mean that they are no longer capable of infecting anyone and “alive” to mean they still can.
Reprints: Feel free to republish as you need for educational, public health, public good, and other nonprofit-making purposes. If you repurpose any of this document, then please give attribution to: “Peter Tippett, MD, PhD, CEO careMESH”

My comment: I made a mask out of sock and it looked terrible. I then bought some cotton masks from Amazon for £2.50 each and keep them in a drawer in the house.  I have one in my coat pocket and use it when I am shopping. I have disposable surgical masks that I can wear at work. On return home, I put the used mask in the shopping basket and put a clean one in my coat pocket.

 

Don’t rush to hospital with a burn

It’s now barbeque season, and with this in mind, new research has shown that the best first aid for a burn is to run cool water over the affected skin for at least 20 minutes.This should be started as soon as possible after the event.

In a study of 2,500 children, those given the full 20 minutes treatment were less likely to need hospital admission and half as likely to need a skin graft.

 

My comment: In my childhood my mother put butter on burns. Don’t do this! It does not work. The area that I notice most people have burns is on their wrists on the thumb side. This is from removing hot dishes from the oven and brushing their arm against the hot door or oven sides. Of course you are carrying a hot, full dish of food, so can’t pull back as fast as you would like. Although many of us then run our arms under a tap, it would be a good idea to do this for longer than it takes for the immediate pain to subside. You can also use oven gauntlets in preference to gloves or folded up tea towels as these are longer in the arm. 

BMJ 2019; 367:1572

Public Health Collaboration conference online a great success

The Public Health collaboration online conference 2020  was very successful.  The videos are available on You Tube for free making the conference even more accessible for everyone who needs advice on what to eat to stay healthy.

If you are able to contribute to the PHC fund to keep up our good work please do so. Sam Feltham has suggested £2.00.  This is via the PHC site.

This year there were contributions from mainly the UK but also the USA.

Visitors to this site will be very pleased to know that keeping your weight in the normal range, keeping your blood sugars tightly controlled, keeping your vitamin D levels up, and keeping fit from activity and exercise, are all important factors in having a good result if you are unfortunate enough to be affected by Covid-19. We have been promoting these factors in our book and website for several years now, mainly with the view to making life more enjoyable, especially for people with diabetes, now and in the future. The reduction in the severity  to the effects of   coronavirus is a side effect of these healthy living practices.

Several talks went into the factors and reasons for this, but in a nutshell, if you are in a pro-inflammatory state already, you will have a much more pronounced cytokine inflammatory response to the virus than is useful for clearing the virus, and you end up with inflammed lung tissue which leaks fluid thereby impairing your blood oxygen levels.

A talk that I found particularly apt was the talk from a GP who had had a heart attack at the age of 44 despite a lack of risk factors except for massive stress. He gives a list of self care practices that helped him. I would also include playing with your animals. Emma and I are cat lovers and can vouch for this!

My talk is about VR Fitness, which was the only talk this year which was specifically exercise related. The Oculus Quest has only been out a year and has been sold out since shortly after New Year. I was fortunate enough to buy one in anticipation of my imminent retirement, and it has been great as an exercise tool over the long, cold, dark winter and more useful than I had ever anticipated over the lockdown as a social tool.

There were several very professional cooking and baking demonstrations on the conference this year, and indeed, this could not have otherwise happened on a traditional stage format.  We had low carb “rice”, bread, pancakes and pizza demonstrations which may well help you if you prefer to see how it is done step by step or if you want to broaden your repertoire.

I was particularly taken with the pizza base idea from Emma Porter and I will follow up with this in a later post.  The whole video is available from the PHC  site which takes you to all the videos on You Tube.

 

 

 

Self caring during illness

Adapted from online presentation by Beverly Bostock ANP 7 May 2020

If you have diabetes you are more at risk of serious complications from Covid-19 and should seek medical advice early in the illness.

Any febrile illness can raise your blood sugars, including the prodromal phase when you don’t otherwise have symptoms. Once you are aware that you are coming down with something there are some useful ways of remembering how to monitor yourself.

Particularly for insulin users:

S – SUGAR – check your blood sugar more frequently than usual. For instance, if you would normally check your blood sugar every 5 hours during the day, double this to every 2.5 hours.

I – INSULIN – Adjust your insulin according to your blood sugars to keep within your target blood sugar level.

C – CARBOHYDRATE – If your blood sugar is low eat or drink more glucose or sugar/starch food items. If your blood sugar is high, drink plain water or more diet drinks.

K – KETONES – Use blood ketone stix or urine ketone stix to monitor your ketones if you are a type one diabetic every 4 hours or so. This is particularly important if you feel very ill, are nauseated, vomiting or have abdominal pain. If your ketones are high consider extra insulin, keep well hydrated and alert medical staff sooner rather than later.

Particularly for type twos:

It is important to keep well hydrated when you experience any illness but particularly an illness where you are febrile, or have  vomiting, limited oral intake, or severe diarrhea.

Some drugs can worsen your response to dehydrating illness and you may need to seek advice from a doctor, nurse or pharmacist about stopping certain drugs and when it is appropriate to restart them.

You can remember what they are with the mnemonic: SADMAN

SGLT2 inhibitors, ACE inhibitors, Diuretics, Metformin, ARBs, and Non- steroidal anti-inflammatory drugs.