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What is a Heart Check?

A heart check (or cardiovascular risk assessment) will let you know what your risk of having a heart attack or stroke is in the next five years and how you can reduce that risk. These checks can be done at the clinic by the Nurses as well as the Doctors.

The GP or Nurse will

  • Ask about your risk factors such as smoking, exercise and diet
  • Ask if there is any family history of heart attacks or stroke
  • Measure your blood pressure, height, weight and waist circumference
  • Test your cholesterol and blood glucose levels (for diabetes)

Some risk factors for cardiovascular disease cannot be changed. These include your age, gender, ethnicity and family history.

However the good news there are many ways you can reduce your risk and the GP or Nurse will talk to you about how you can reduce these risks in the future.

Keeping Active

(July 2012) by Dr Kate Baddock

There is a lot said and even more written about keeping fit and active. There are books on the subject and everyone has their opinion. But the facts are that we are what we eat minus what we burn off in energy – and keeping active is one of the simplest (as opposed to one of the easiest) ways to keep your metabolic rate up, burn off fat and keep fit. It's easier to sit with your feet up, watch television, or read a good book, but it is simple to keep fit and active.

It's going for a walk, or taking the dog out, playing with your children, or your grandchildren, going for a swim or a stroll on the beach. There are many ways to get that exercise and they are all good for you. When you exercise you burn calories – but not as many as you would like I'm sure. But the other benefit is that you raise your metabolic rate, not only while you exercise, but for an hour or so afterward, and that helps to burn more calories (as long as you don't eat them all again).

Then there are the known health benefits of exercise. Exercise decreases insulin resistance so that the cells take up sugar more readily and this decreases the risk of developing diabetes. Exercise also helps decrease blood pressure. These effects are not dependent upon exercise causing weight loss but are a direct effect of the exercise, even if you don't lose any weight. And then there is the effect of exercise upon serotonin levels. There are not many ways that you can have a positive impact on your serotonin levels but exercise is one of them. Serotonin in one of the very important neurotransmitters in the brain and when we don't have enough, we get depressed, so getting those levels up with exercise can be a very important part of keeping healthy.

So the next time you are thinking of going out for a bit of exercise, but you're tired or overworked, or would rather be doing something else, think of all the good you could be doing for yourself – both physically and mentally – and take that first step.

Smoking/Smoking Cessation

(July 2012) by Dr Warwick Palmer

Tobacco smoking is a major public health problem in New Zealand. Overall, around 23% of New Zealanders smoke tobacco. Prevalence is higher among Maori (46%) and Pacific people (36%).

Stopping smoking confers immediate health benefits on those who already have smoking-related disease and future health benefits for all smokers.

All medical centres have a commitment to enhancing and supporting the health and well being of patients, staff and visitors to the community. The aim of a smoke free environmental policy is to help prevent exposure to the harmful effects of environmental tobacco smoke.

With an ever increasing drive for a smoke free environment, the "smoke free environment policy" deserves revisiting.

It is part of our purpose as health care providers at every level to help and support those who smoke by requesting:

  • That all patients have their smoking status recorded on their medical records, so health care professionals are aware of their patient's health risks.
  • Doctors and nurses offer advice and support to those who smoke at every visit.
  • Our staff are trained to provide help and support to those who wish to stop smoking.
  • Referral to nurse practitioner clinics or smoking cessation counselors is available on request.
  • All practices are able to offer Nicotine Replacement Therapy for those unable to manage without nicotine whilst in a smoke free environment.
  • Leaflets and brochures are available on request for those who wish to stop smoking.
  • That all people who smoke are treated with consideration and respect and will not be pressured into stopping smoking if they are not ready to do so.

Smoking Cessation

(May 2011) by Dr Bruce Sutherland

Smoking is the commonest cause of preventable death in this country. About 20% of New Zealanders still smoke and 40% of Maori smoke.

One in two smokers will die of smoking related disorders. This amounts to about 4,500 NZ deaths per year.

The Ministry of Health's aim is to halve the number of smokers in NZ by 2015 and to make Aotearoa smoke free by 2025.

The main way of doing this is by increasing tobacco taxes, recently introduced in April 2010, and then again to be increased this year.

This has worked well so far, with more people presenting to Quit Line and to GPs for smoking cessation advice.

Government initiatives have also focused on smoking cessation medications. These mediations have been expensive but now different levels of Government subsidies apply.

  1. Nicotine replacement therapy (NRT)
    This comes as patches, gums or lozenges. NRT doubles the chance of quitting. It is safe and does not increase the risk of cancer. Side effects are minor and it can be used by most people safely. One should not use NRT and smoke at the same time. NRT is fully subsidised if accessed through Quit Line or your doctor and a course will cost approx $3.
  2. Zyban (Bupropione)
    This more than doubles the chance of quitting. It works by reducing the desire to smoke. It should be started whilst still smoking, approximately 2 weeks before quit date, and is continued for a 12 week course. In some countries, Zyban is used as an antidepressant and as such it has more side effects and drug interactions than NRT, and some people cannot take it. It is prescribed by your doctor. It now has government funding without restriction.
  3. Champix (Varenicline)
    Studies have shown Champix to be the most effective smoking cessation medication. Like Zyban it reduces the desire to smoke, in addition, it also gives smokers some of the satisfied feeling that smoking imparts. It is taken in the same way as Zyban. Champix can accentuate some of the side effects of smoking cessation: headache, nausea, abnormal dreams and poor sleep. There have been some reports of depression and even possibly an increase in suicidality. There are no known drug interactions. Champix is expensive, approximately $200 per month, and should be taken for 3 months.

Can reading improve your health?

(June 2012) by Dr Stephen Barker

The answer is certainly YES!

The developing mind is a fertile place in which to grow ideas. A child’s imagination should know no bounds and their potential in life is a wonderful resource that should not be squandered. Encouraging your child to become a life-long reader is one marvelous thing you can do which will help them towards a healthy, fulfilling and happy life. All children should have the opportunity to be read to by an adult, best of all by a parent. Take time from babyhood onwards to read to your child. Going over simple picture books will increase fluency and understanding. Then continuing to read to a child will help brain development. At an early age, it doesn’t really matter what content or format is used; I have seen wonderful “picture books” available for i-Pads. A half-hour spent reading with your child is vital bonding time, a time for communication beyond just what is being read, and it is probably this that has the most significant health benefit. Because an adult reading to a child, or simply reading for himself, also provides a moment’s break from the stresses and strains of daily life. Reading can keep your mind in shape too – using different areas of the brain from those used for more mundane day-to-day activities.

Reading is a vital tool for children, stimulating their inquisitive minds and allowing them to communicate more effectively with the world around them – skills which are associated with improved health outcomes.

So take time to read to your little ones from the earliest age. Join them up with the local library (an affordable way to find lots of new reading material), and be involved with your child if they are struggling with their reading. It is probably one of the most important things you can do for them.

Show by example – be a regular reader yourself and have books in your home.


A rear pain

(May 2012) by Dr Clinton Anderson

While it may not be the most delightful topic, haemorrhoids, or piles as they are commonly known, is a part of everyday medical practice. Piles could be defined as a distended portion of the vein/s in the anal canal. This ballooning of the vein can occur inside the canal (internal piles) or outside of it (external piles). Think of it as a varicose vein in the anus.

The cause of piles may be related to genetics – just as some families tend to have a predisposition to varicose veins, piles seem to be more common in some families. The bottom line is a failure of the vein wall to withstand the pressures generated in the anal canal. This may be during the passage of faeces (typically with constipation), and/or with the passage of a foetal head during a vaginal delivery. Hence, it is very common for women to get piles after a vaginal delivery.

So what’s the problem? Firstly, some patients don’t like the way they look or feel. One might consider them an "obnoxious protuberance from a fundamental orifice". Secondly, pain. The severity can range from being mildly irritating to being an almighty pain in the rear, to the extent of preventing sitting and interfering with sleep. Thirdly, size. They can be as tiny as a pea or as large as a golf ball. Generally, pain increases with size. Fourthly, bleeding. Piles may rupture and bleed. If the bleeding becomes a long term or intermittent problem, one might develop iron deficiency which, if unchecked, may lead to anaemia. A dictum worth mentioning here is that in the presence of piles, do not presume that bleeding is from the piles – especially if one is 40 years or older. Sometimes the bleeding can be from higher up in the bowel. It is best to check it out.

Remedies range from keeping a regular bowel habit/avoiding constipation and straining at stool/defaecation. The use of topically applied remedies such as ointments and suppositories may help. The larger piles may be reduced in size with the use of ice packs. (Speak to your healthcare provider about how to do this safely). Lastly, there is a range of more aggressive strategies – from banding to injecting and, ultimately, surgery under anaesthesia.


Winter sports

(March 2012) by Dr Bruce Sutherland

The benefits of a regular exercise programme are well documented. Exercise reduces blood pressure, keeps weight down, reduces cholesterol, improves mental health, reduces stress, boosts your immune system and generally makes you feel better.

How much exercise gives benefit? The American Heart Association recommends 20 minutes of exercise that raises your heart rate by 80% of maximum, three times per week. Maximum heart rate is calculated as 220 minus your age. Alternatively, exercise for 20 minutes at a rate where, during the exercise, you are too puffed to talk to the person beside you, and do this three times per week.

In New Zealand, the “Push-Play” campaign recommends any form of even light exercise for 30 minutes each day.

Organised sport, especially team sports, can make exercise fun. Regular training with a rugby or netball team each week helps with motivation and makes getting fit easier.

One of the consequences of sport is the risk of injury. Warming up by stretching for five minutes before and five minutes after exercise can reduce the risk of injury on the field. If injury occurs use RICE: Rest, Ice, Compression (bandaging) and Elevation. This reduces the inflammatory response and causes blood vessels to spasm, reducing swelling and bruising, and hastens recovery. Ideally, this should be done as soon as possible and probably has little benefit after 48 hours.

The severity of an injury can be judged by the history of the event. Could you keep playing after the injury? Could you walk on it? Did you need to be carried off the field?

If a limb appears bent or deformed then invariably it is broken (fractured). If there is an associated open wound over the fracture then this is an “open” or “compound” fracture, and this is a medical emergency.

Do not try to straighten a fracture on the field. Cover wounds with a light dressing, apply ice and splint the limb with a make-shift splint. When the patient is comfortable, seek paramedical or medical help.


What can you do about veins?

(February 2012) by Dr Kate Baddock

Well that’s a question isn’t it? I’m sure we all have, or know someone who has, unsightly veins. Whether they are on the nose, the cheeks or the legs. Perhaps the ropy ones that look like snakes curling up and down your legs, or the ones that look like spiders – usually on the face. Or the networks of blue veins just under the surface of the skin – particularly on the thighs or around the ankles.

They are very common, and yet the reason they appear is somewhat complex and confusing. Veins become varicose for a number of reasons – the main one being heredity. We know that if your parent had varicose veins then, more than likely, you will too (some 10-15% of men and 20-25% of women will have varicose veins). If you become pregnant, the extra oestrogen circulating can contribute to their development, as can being on the combined contraceptive pill (but to a very much lesser extent). Other factors include excess weight and a lack of exercise.

Whatever the contributing cause, when the blood pools in the veins they become stretched and varicose. The blood may pool because the valves that are within the veins (particularly the deep veins) leak, and don’t do their job properly in helping move the blood back toward the heart; or the blood may pool because the walls of the veins are weaker and stretch.

Once you have them, how can you get rid of them? Well, the first thing to be aware of is that they do recur so getting rid of them will give you some respite for a number of years – but they do tend to come back. For the large tortuous ones in the legs, it is important to deal with the incompetent valves (the ones that are leaking) and often they are the large ones right at the top of the thigh. This involves surgery where the incompetent valve is tied off and then the vein lower down is stripped. Spider veins or telengiectasiae, can be injected (sclerotherapy) or treated with laser therapy. For those less severe varicose veins, compression stockings can be a real comfort and support.

Varicose veins often do not require treatment, but they can be unsightly. They do need managing when they create problems with the skin – eczema and ulceration, or symptoms such as aching, swelling and tiredness.


Weight budgeting

(February 2012) by Dr Warwick Palmer

Something we all need to budget for (in a figurative sense) is our weight, food and calorie intake. Currently, over half of New Zealanders are overweight or obese. We all need to take care with food choices and portion sizes. For some, battling weight is a life long issue.

We need to balance (or budget) our food (and drink) to the energy we use in daily activity. Most of us can significantly reduce fat intake. Being overweight significantly increases risk of early death and major diseases – heart disease, diabetes, high blood pressure and many cancers.

Weight loss is not just dieting – it is looking at our overall eating behaviour, physical activity and exercise routines. We must start with realistic expectations about what can be achieved, starting with small steps or changes. Effective weight loss should be slow, steady and sustained.

Reducing our level of fat intake is a good start. Losing weight is more effective in a diet that is very low in fat and has moderate protein and carbohydrate. Fat has more than twice the calories per gram compared with other food types. Use lean meats, low fat dairy products and grill, bake, microwave or steam food rather than fry. High fibre foods help avoid hunger whilst not putting on calories. Try to continue eating regularly as skipped meals can lead to excessive hunger then binge eating. Limit alcohol – 1 to 2 standard drinks per day for men, 1 per day for women, and at least one alcohol free day per week for everyone. Alcohol is high in calories and often associated with snacking.

Try and increase water intake. 1-2 glasses of water before a meal will reduce food consumed. Gradually and steadily increase physical activity and exercise levels. Start with what you know you can do, no matter how easy, and gradually build from there. If you try to do too much exercise too quickly, your programme will likely be doomed to failure.

If you feel you need further help or a medical check, see your own family doctor – they and their nurses have a good repertoire for weight loss, eating behaviour change and exercise programmes. Diet pills have little or no place now and can have serious side effects.

As part of a wider perspective of budgeting in our lives, think about food, eating behaviour, weight loss and exercise programmes.


Prostate screening

(February 2012) by Dr Warwick Palmer

Something we all need to budget for (in a figurative sense) is our weight, food and calorie intake. Currently, over half of New Zealanders are overweight or obese. We all need to take care with food choices and portion sizes. For some, battling weight is a life long issue.

We need to balance (or budget) our food (and drink) to the energy we use in daily activity. Most of us can significantly reduce fat intake. Being overweight significantly increases risk of early death and major diseases – heart disease, diabetes, high blood pressure and many cancers.

Weight loss is not just dieting – it is looking at our overall eating behaviour, physical activity and exercise routines. We must start with realistic expectations about what can be achieved, starting with small steps or changes. Effective weight loss should be slow, steady and sustained.

Reducing our level of fat intake is a good start. Losing weight is more effective in a diet that is very low in fat and has moderate protein and carbohydrate. Fat has more than twice the calories per gram compared with other food types. Use lean meats, low fat dairy products and grill, bake, microwave or steam food rather than fry. High fibre foods help avoid hunger whilst not putting on calories. Try to continue eating regularly as skipped meals can lead to excessive hunger then binge eating. Limit alcohol – 1 to 2 standard drinks per day for men, 1 per day for women, and at least one alcohol free day per week for everyone. Alcohol is high in calories and often associated with snacking.

Try and increase water intake. 1-2 glasses of water before a meal will reduce food consumed. Gradually and steadily increase physical activity and exercise levels. Start with what you know you can do, no matter how easy, and gradually build from there. If you try to do too much exercise too quickly, your programme will likely be doomed to failure.

If you feel you need further help or a medical check, see your own family doctor – they and their nurses have a good repertoire for weight loss, eating behaviour change and exercise programmes. Diet pills have little or no place now and can have serious side effects.

As part of a wider perspective of budgeting in our lives, think about food, eating behaviour, weight loss and exercise programmes.