Please click on the item title to view it in full.
- What is a Heart Check?
- Keeping Active
- Smoking/Smoking Cessation
- Can reading improve your health?
- A Rear Pain
- Winter Sports
- What can you do about veins?
- Weight Budgeting
- Prostate Screening
- Youth Depression and Suicide
- Travel Medicine
- The Latest on Measles
- Who is your PHO?
- Sleep Issues?
- Use it or Lose it
- Medical Mirth
- Ultra-violet Light
- High Blood Pressure - what's it all about?
- Learning to be a Doctor Never Ceases
- Some thoughts for Middle-aged Men
- What is an Alcohol Problem?
- Calcium - Getting to the Heart of it
- What is Polymyalgia Rheumatica?
- Bowel Cancer Screening
- In the Heat of the Moment
- Fever and Illness in Childhood
- Tension Headaches
- Cuddling your Child
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.
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.
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.
(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.
- 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.
- 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.
- 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.
In some cases, if other forms of medication have been trialed and failed, and if the patient is partaking in a smoking cessation program, a government subsidy can be accessed by your doctor.
Psychological support from a trained health profession is effective. Most GP surgeries offer smoking cessation programmes at affordable prices.
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.
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.
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.
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.
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.
by Dr Stephen Barker
Right now the press and media are awash with stories about prostate cancer and screening. These stories inevitably beg the question – ‘Why don’t we have a national screening programme for prostate cancer?’ It seems so simple – enroll all New Zealand men in a screening programme and away we go! However, as with most things medical, it is not that easy. I have no doubt that one day we will have some form of national prostate screening. But there are good reasons why it may take a while longer to sort out exactly how this will look.
Firstly, the PSA (Prostate Specific Antigen) test – undeniably one of the most useful we have available in modern medical practice – is not fool-proof. There are a significant number of false negative and false positive results when using the PSA. Other conditions aside from cancer may raise the level, creating artificial anxiety. So, whilst it is a great test, it’s not perfect.
Secondly, what happens when a PSA test is confirmed as genuinely elevated? Typically, the next step is a prostate biopsy. This is a potentially uncomfortable test where a biopsy needle is passed via the rectum, directly into the prostate tissue, sampling several areas of the prostate. The test itself carries a small risk of bleeding and infection. Again, there are a number of false negative and false positive results that may occur.
If prostate cancer is diagnosed following the biopsy, then there is the question of what to expect regarding the progress of the cancer, and whether to treat or not to treat. Prostate cancer does not behave in the same way for everybody. On average, the older one is, the more likely it is that the prostate cancer will give less overall trouble. Whereas, in younger patients, there is more chance of aggressive prostate cancer. The latest studies support early treatment of prostate cancer, especially in younger men (‘younger’ usually means 50s or so guys!). However, it’s well known that treatment itself may have unwanted side effects.
As with every field of medicine, there will no doubt be improvements in the diagnostic tools and the treatment options. For the present though, it remains important to create the right kind of screening programme – one that maximises diagnostic benefit to some, yet minimises harm to the rest of the screened population. Meantime, most GPs are happy to offer a PSA test to male patients on an individual basis following appropriate discussion.
Youth suicide in New Zealand is a major issue. The 20-29-year-old group are more vulnerable than the teenage group. Our rates compare with the worst statistics worldwide. An internet search will find numerous articles on this issue, the underlying causes, the gender paradox (greater suicidal ideation among females but far worse male fatalities), psycho-social concepts in individuals and cultures.
What is it that prevents a youth from presenting their problem to someone and/or a healthcare professional? Is it because of the stigma attached to the term “mental health”? Is it a fear of it all being “in my head”? I am concerned that the medical and allied professions may have created a false dichotomy in the concept of health viz the physical versus the mental. Somehow the former seems legitimate – and the latter less so? Somehow it is OK to have a physical ailment – but not to be emotionally unwell? The question, “Is it all in my head doc?”, prompts the response “where else would it be?” How does one experience anything other than in one’s head!? The one diagnosis is as deserving as the other and neither should prompt judgement.
Surely we need to do better at creating an environment where, from an early age, our youth are comfortable disclosing their feelings of desperation without fear of judgement or stigma. Perhaps dispelling the myth of “mental vs. physical” is a good starting point .I am not suggesting that if we were informed about the issues confronting someone in such a state of despair, that we would necessarily prevent suicide, but it would at least afford the opportunity to try. If you have, or if you know anyone who has concerns about emotional wellness – particularly in the 15-29-year age group, ask for help.
If you have been bereaved by suicide and would like some support, please contact WAVES a grief education programme for adults who have been affected by the suicide of someone they know. The group is faciliated by professional counsellors and educators and the programme runs over 8 weeks. For more information contact Marina Young at Equip on 09 477 2448 or email firstname.lastname@example.org .nz or alternatively contact Amanda Christian via email email@example.com
by Dr Bruce Sutherland
New Zealanders love to travel. Often this involves going from a place of low risk to areas of high risk. In addition, we often do things abroad that we wouldn’t do at home. There are a lot of things abroad that can hurt you and only some of these are infections. Consider where you are going, how long you are going for and what risks you may encounter whilst overseas.
Update preexisting vaccinations. Your doctor may advise updating influenza, tetanus, polio or measles vaccinations. These are usually inexpensive and easy to do in the surgery.
New vaccinations. Discuss vaccinations with your GP at least four weeks before your travel. Some vaccinations require a course of injections over several weeks, for example Hepatitis A.
Other vaccinations require referral to a certified travel clinic for administration, e.g. yellow fever. Some countries refuse entry with out yellow fever vaccination.
You may require medications to prevent infections. For example, malaria. Malaria treatment needs to be started one week before, and continued until two weeks after visiting a malarial area, as the parasite can ‘hide’ in the blood stream. Other medications are to be taken to treat illness such as antibiotics for travellers' diarrhea.
Don’t rely on vaccinations alone. Avoid mammal bites. Any mammal (no matter how cute) can carry rabies and rabies can be fatal. Avoid insect bites. Even while taking medication one can still contract malaria. Cover up, sleep under a net and wear light coloured clothes. Use DEET containing repellant and avoid going out at dawn and dusk when the malarial mosquito is about.
Most travel incidents are not caused by infections but more often by illness, crime or accident. Update all regular medications and ask your GP for a travel letter. Make sure you have comprehensive travel insurance and declare any pre-existing medical conditions.
Be familiar with your destinations. safetravel.govt.nz is a good site for New Zealand travellers and is updated regularly. It carries information on areas of political unrest.
Lastly, take steps to avoid exposure to crime. In many countries, we look and dress differently. Try not to attract unwanted attention, and avoid areas or times of night that may be dangerous.
Follow this link for an information sheet on measles produced for parents and caregivers by the Immunisation Advisory Centre.
by Dr Kate Baddock
I thought this might be a good opportunity to explain a few medical matters that are confusing even to those of us who spend every day working in health. First of all, a couple of definitions:
When you enroll with the doctor or practice of your choice, you are (through that enrolment) also enrolled with the PHO. Most of you will not even realize that you belong to a PHO but it is through that connection that the practices are able to provide certain programmes and care packages to you without charge. These programmes include:
- Diabetes Get Checked - an annual check for people with diabetes.
- Before Schools Check - a thorough health check for 4 year-olds.
- Immunisation Outreach – for following up children who have not had their immunisations.
- Cardiovascular Risk Check – to calculate your risk of heart disease.
- Primary Options – a programme that allows us to treat people in the community that would otherwise have required admission, e.g. IV antibiotics for tissue infections.
- Primary Lifestyle Options – a programme for people with mental health issues.
- Smoking Cessation programme – to help people stop smoking.
- Palliative Care programme – this allows us to care for people with terminal illness without having to charge them in the final stages of their illness.
- Asthma Clinics – to help in the management of people with asthma.
- Care Plus clinics – to assist in the education and management of people with longterm chronic conditions.
- Sexual Health Consultations – allow subsidized visits for certain age groups.
- Better at Work - an ACC initiative to work with patients and their employers around injury rehabilitation.
This list is not exhaustive but it gives you an idea of the wide variety of programmes that are made possible by belonging to a PHO.
PHOs came into being in 2002 when the then Labour Government introduced the Primary Health Care Strategy. Times have moved on since then but the idea of PHOs has withstood the test of time. PHOs are governed by a board made up of clinical people, e.g. doctors, nurses and pharmacists, together with iwi and community. They are charged with looking after enrolled populations primarily through General Practices but they also work directly with patients where this is appropriate. The programmes (as above) are funded primarily through contracts that the PHO holds with the Waitemata District Health Board.
The latest development is the National Government’s Better Sooner More Convenient policy and this has meant that PHOs, and other organisations, have been working even more closely with the Waitemata District Health Board to work out how to deliver services closer to, and more conveniently for, patients. Part of the planning is how to integrate services so that outpatient services, for instance, may occur in Warkworth and Wellsford. Also, in the future, public surgery may be offered at the Rodney Surgical Centre. These are possibilities for the future but it is where Waitemata PHO - your PHO - is trying to head.
by Dr Warwick Palmer
Difficulty with sleep is a very common problem with at least 30% of us suffering from insomnia at some stage. While medication may help in the short term, it can worsen the problem if used over an extended period.
Some practical suggestions:
- Develop a “pre-sleep” routine to help the body relax. Not too much TV, avoid computer work from one hour before bedtime, a warm bath, quiet reading and a warm milk drink can help. Restrict bedroom activities to sleep and sex only, not for study, work or intense discussion.
- Get up at the same time each morning – don’t sleep in to catch up on a bad nights sleep – it will only shift your sleep cycle forward. Don’t sleep during the day.
- Develop a regular physical exercise routine and stick to it but don’t exercise within two hours of bedtime.
- Try to stop worrying – two things most affected by worry are sleep and sex. Try to become less focused on sleep and more on relaxing.
- Limit stimulating substances, especially in the evening – alcohol, coffee, tea. Quit smoking.
- Practice a physical relaxation routine after going to bed. Tighten every muscle group to the slow count of five, then relax to the slow count of five. Work your way through every muscle you can move – toes, feet, legs, hips, buttocks, stomach, chest, back, shoulders, arms, hands, neck, jaw, eyes, forehead. After you have reached the top of your head lie still and relaxed, form an image in your mind of a calm, peaceful scene – a palm lined beach at sunset, a yacht on a calm sea, anything relaxing, and DO NOT let your attention wander from that image. If other “thoughts” come into your mind dismiss them rapidly and refocus on your image.
Happy, relaxing and refreshing sleeping.
by Dr Stephen Barker
“Use It, or Lose It” is one of those old adages that comes in very handy. Whether it’s discussing loss of fitness with an overweight forty-something, or loss of balance with an unsteady seventy-something, there’s truth in those few words.
For many people the hardest time to keep up physical activity may be through the winter. Fewer daylight hours and wet weather are all very understandable excuses for failing to get outside and active. But if we don’t want to ‘Lose It’, then it’s important to resist the comforting lure of the couch and TV. Keeping active needn’t be hard. For some people it may mean leaving the car at home for short errands, playing actively with the kids, or for others it might be time to stop ignoring the dog, (or perhaps adopt a friend’s dog) and go walkies! There are often local classes for sports or fitness, including the popular Tai Chi sessions designed for older adults.
It’s a strange paradox that a sports-mad country like New Zealand should be seeing a steady increase in diseases such as diabetes. I suspect this is in part the fault of the huge industry that is Professional Sport. This industry relies on encouraging spectators, particularly through Sky TV, but not participators. Which may also leave some people feeling excluded because they don’t have the skill levels they see on the ‘Box’. Another artificial anxiety that affects our perception of sport is this strange need to have the latest hi-tech gear. Just take cycling for example – sure it’s a popular sport, but does everyone need the latest bike and all that lurid Lycra. Well no! You can ride any bike in any old clothing.
So ditch the Sky subscription, leave the car behind and reclaim the streets, parks and beaches. If everyone got out and about, it would make our communities safer too! For more information - www.sparc.org.nz & Push-Play.
by Dr Clinton Anderson
I thought, given that we have collectively covered many medial topics, and to avoid overlapping of content, that I might share with you some of the lighter moments encountered in the practice of medicine. In these times, when our “stress-o-meters” are running high, perhaps a bit of laughter has therapeutic value.
First up – a funny, but poignant account. I recall an evening session in a busy urban A & E. It was a cold winter’s night and this often brought in a number of homeless folk seeking a hot meal and shelter. My next patient was clearly one of these unfortunate souls, and exhibited quite obvious signs of the ravages of alcohol abuse. It transpired that her concern was the presence of some blood in her vomit. This symptom triggers a line of enquiry which may shed light on the underlying cause, one of which may be alcohol overuse. Despite proceeding as tactfully as possible, she flatly denied any alcohol intake. Somewhat frustrated, and given the time constraints in an A & E, I abandoned this tack and moved on. “Can you give me some idea of how much blood you vomited?” I asked. “About a tot”, she said.
Secondly, a brief malapropism from the same A & E. A patient arrived in some distress. Clutching her throat, and with a strained voice, she said, “I swallowed a fish bone and I think it’s stuck in my sarcophagus”. (The “joke” might have been on me if it turned out that she had merely been displaying foresight!)
Finally, an illustration of the importance of communication. A female patient presented with recurrent vaginal thrush. I advised that treating both her and her partner might be the solution. Having already used over-the-counter creams, she expressed a wish for an alternative approach that would “work”. I supplied her with a script for two capsules, one for her partner and one for herself. At her next visit, I enquired as to her progress. “I’m better”, she said, “but my partner decided it would be too painful to insert his capsule”. Ouch!
by Dr Bruce Sutherland
There is a lot of it around now, but what is UV and how does it affect skin?
UV is light at the far end of the violet spectrum. It is invisible to our naked eyes hence “beyond” or “ultra” violet.
UV light is essential to us for the production of vitamin D in our skin. One theory as to why Europeans have developed light coloured skin is to absorb the UV light from low light parts of the world and to optimise vitamin D production. Darker skin has more melanin which absorbs and disperses UV and therefore needs more sunlight to produce vitamin D.
UV light is also the primary cause of skin cancers. New Zealand has 50,000 new cases of skin cancer per year and most GPs see new skin cancers each week in their practices. In population studies it appears that the number of skin cancers is directly proportional to the amount of UV exposure. There are several types of UV – the two important ones being UVA and UVB.
UVB comprises >90% of UV light. It is this that causes sun burn and common skin cancers by directly damaging the skin’s DNA.
UVA on the other hand does not burn skin but causes indirect damage to collagen – causing premature aging and indirect damage to DNA causing specific types of cancer like melanoma.
SPF (skin protection factor) in sun creams is measured by the amount of UVB filtering. Early sun creams thus blocked UVB but did not block harmful UVA rays. This may have been the reason for an increase in skin cancers observed with the use of early sun blocks. Nowadays most sun creams have an SPF and UVA filter.
When choosing a sun block look for a high SPF, look for a waterproof rating and look for an agent with UVA filtering or “broad spectrum” protection.
by Dr Steve Barker
Have you ever wondered why doctors and nurses seem so keen on taking your blood pressure? No sooner have you sat down in the medical rooms and someone is folding the cuff around your upper arm and pumping it up! Not surprisingly there is a good reason for this.
A high number of New Zealanders, something around 1 in 5, will have problems with high blood pressure (hypertension). The difficulty with hypertension is that it's mostly a problem without noticeable symptoms.
Untreated high blood pressure causes stress and damage to the heart, but it also has effects on blood vessels elsewhere in the body; in particular the small or fragile blood vessels in the eyes and kidney.
A target healthy blood pressure for most people would be around the level of 130/80 whilst sitting resting. Sometimes higher or lower targets are acceptable. It is normal for blood pressure to rise briefly with exercise, excitement etc, but in a healthy individual the pressure will return to normal within a short time afterwards. To some extent it is also normal to have some blood pressure rise as one gets older. However, this is not to the degree that was once considered acceptable, and in general blood pressure targets are mostly similar whatever your age.
Blood pressure is one of the factors responsible for heart disease and strokes. Other important factors include raised blood cholesterol and smoking. In particular smoking itself can also aggravate high blood pressure.
Men over the age of 45 and women over 55 should have a fairly regular blood pressure check, for example yearly. With other medical conditions patients should take the advice of their doctor as to the frequency of checking. As with many things a healthy diet with plenty of fresh fruit and vegetables will help - in particular keeping salt intake relatively low, and using low fat dairy foods will help. A final important thing is to keep up with regular exercise.
by Dr Clinton Anderson
No, this is not about vertigo, but it is fairly heady stuff. I have a concern about the increased number of psychotropic prescriptions (sedatives, sleeping tabs, anti-depressants, anxiety medication). On researching this issue, it appears to be an international phenomenon. In America, 1995, about 13 million anti-depressant scripts were issued. By 2005 about 26 million were issued. This has become one of the most commonly prescribed classes of drug in the world. Why? What is going on?
Given that happiness, sadness, anxiety etc, etc., - the full spectrum of human emotion is normal, have we become that emotionally unsettled that so many more of us need to resort to medication? How did people cope in the past? (Presuming that, stresses, though different, have always been present.) Some may say, that if we are made up of mind, body and soul, then the latter, dealing with issues of our spirit, has fallen prey to science. Is it that, whereas spiritual confidants used to deal with many of these issues – they are now dealt with by health-care professionals? Some may offer that it is the triumph of marketing over common sense (about US$10 billion worth of revenue generated in the USA in 2008 from anti-depressants). Is it the "quick-fix" in a world that is spinning to fast?
Whatever the reason, there is little doubt that these medicines have helped a significant number of people. However, I cannot help wondering if many of those for whom these drugs were prescribed could have dealt with their level of “problem” by trying to address the issue of “balance”. As GP’s we are constantly going on about “lifestyle” adjustment being better than pills. Should we (all) not be trying the same remedy before resorting to psychotropic pills? If our pursuit for excellence, wealth, assets, status – comes at the expense of our (3-dimensional) health, will a pill change that? If we miss opportunities for fear of failure, rejection or hurt, is medication the solution to dealing with either the cause or consequence? If, for no identifiable reason, we find ourselves to be sad, fearful, or whatever, would we not be better served, at least initially, by embarking on a spectrum of lifestyle adjustments?
Perhaps, if we all took enough time to analyze what lends meaning to our brief and transient lives, we may discover the things that are truly important. This may help to restore balance and spare us resorting to inappropriate use of medication.
by Dr Warwick Palmer
Today, many practices are involved in teaching at various levels of medical education. In Warkworth, it is quite possible that your care may involve a medical student or a junior doctor in a post graduate training position.
At varying times, there are both 4th year and 6th year medical student practice attachments. These students are closely supervised, and anything they do will be carefully checked by senior doctors within the practice.
House surgeons (usually in their 2nd post graduate year, sometimes more senior) and registrars (usually at very least in their 3rd post graduate year) are able to see patients more autonomously, though they also have full access and support from senior doctors whenever they need it. Each of these latter two groups are well defined post graduate training positions – the junior doctor sees a smaller number of patients than partners in the practice, they have clearly defined learning goals, and their host practices have formal teaching contracts to meet with respect to their training.
The presence of these doctors is exciting and stimulating for both themselves and the practices to which they are attached – the teaching and learning environment is stimulating for us all. They bring to the practice their fresh, up to date academic knowledge, and their enthusiasm, whilst the practices to which they are attached offer a breadth of clinical experience needed to prepare them ultimately for unsupervised independent practice.
With general practice now a specialty in its own right, we are all expected to complete post graduate training for the Fellowship of the Royal New Zealand College of General Practitioners, involving a high stakes exam after a year of practice attachment (Part 1 or PRIMEX) then at least another two years in practice to complete Part 2. Once Fellowship is attained, that doctor is able to set up “independent” practice, but we all still have to demonstrate an ongoing commitment to medical education and learning with a Maintenance of Professional Standards (or MOPS) programme which is continuous on a three yearly ongoing cycle throughout our working lives.
Every single day should be a learning experience.
by Dr Warwick Palmer
At onset of midlife (that’s a broad one to define), our thoughts turn to prostate cancer, the almost universal scourge for old men. Yes, if we do live long enough, we should probably all develop prostate cancer eventually.
So what is really important to look out for, and what is worth checking?
For all men over 50, and some even in our late 40s, the prostate gland starts to enlarge. Situated at the base of the bladder, it concentrically enlarges around the bladder outlet and invariably takes its toll on urinary flow. “I’m no longer able to hit the wall doc”.
It is important to talk to your doctor about these changes. He or she will enquire about duration of symptoms, family history for prostate cancer, will likely examine your prostate through the back passage (“digital rectal examination”), and may order a blood test for PSA (prostate specific antigen), and kidney function.
Although there is a common impression that the PSA can confirm or deny prostate cancer, this is in fact not always the case. We can often get what we call both “false positives” or “false negatives”, so it is only a guide. Probably most important is:
- what you tell us
- any significant immediate family history (father or brothers)
- physical examination findings.
Also, as with many medical conditions, the diagnosis of benign prostatic enlargement or prostate cancer may only declare itself over time with regular checks and monitoring.
Finally, a word about the testicles. Check them yourself – the shower is a good place. The testes should be smooth and regular, the spermatic cord with vas deferens coming up from the back of the testes is a firm tube easily felt. Any extra lumps or bumps ... get them checked by a professional.
by Dr Bruce Sutherland
Whilst a glass of red wine at night can be a good thing, too much of a good thing can be harmful.
How much is harmful? It is estimated that up to 16% of people who consult a GP drink unsafe levels of alcohol. Being an unsafe drinker does not make you an alcoholic but it can mean you have a problem.
A unit is 8 grams or 10mL of pure alcohol. This equates to a small (125mL) glass of wine, or 250mL of beer (less than a small bottle). The recommended safe alcohol limit for men is 21 units per week, and for women it is 14 units per week (with no more than 8 units per session for men and 6 units for women).
1 or 2 alcohol free days per week are recommended. If this is difficult, then ask yourself if your drinking has become habitual.
Consider the “CAGE” questionnaire, and ask yourself these questions:
- C – Have you ever thought you should CUT DOWN your drinking?
- A – Have you every felt ANNOYED by others criticism of your drinking?
- G – Ever felt GUILTY about your drinking?
- E – Have you ever had an early morning EYE OPENER?
If you have answered positive to any one or more of these questions, then you are at risk of suffering from problems with the four Ls:
LIVER – Includes any health problems related to alcohol like unwanted sex, accidents, indigestion, high blood pressure, obesity.
LOVER – Relates to any family or relationship problems due to your drinking. Relationship breakups, divorce, domestic violence, etc.
LIVELIHOOD – Relates to poor work performance, discipline issues, demotion, days off work due to hang-over.
LAW – Legal problems such as assault charges or drink driving convictions.
So, are you drinking too much?
by Dr Bruce Sutherland
Vasectomy is a relatively straight forward method of family planning nowadays. For a variety of reasons, it seems that New Zealand men have taken to the procedure with New Zealand having one of the world’s highest vasectomy rates. The reasons for this are probably in some way a credit to the New Zealand male character – sharing the burden of family responsibility – but also cost and access to hospital clinics has a bearing on vasectomy rates.
A vasectomy can be done under general anaesthetic but most are done under a local anaesthetic by a specialist or GP. The procedure takes about an hour and generally can be arranged so that it does not incur loss of work days.
No form of contraception is 100% reliable and vasectomy can have a failure rate of 0.5% initially but longer term failure rates are less than 1:2000 – one of the lowest failure rates of any method of contraception. Like any surgical procedure, there can be complications but these are generally minor, including bleeding, swelling, infection and short term pain.
There was some concern in the early days that vasectomy may be related to the development of prostate cancer in later life. At one point both vasectomy rates and prostate cancer rates seemed to be climbing. It now appears that prostate cancer increases are due to men living longer and larger studies have now shown no link to vasectomy rates world wide.
If you are interested in discussing this further, make an appointment to see your GP. The internet has some useful information. If you are interested in how the procedure is done then go to YouTube and you can watch vasectomies being performed by varying techniques. I have posted one of my vasectomies at www.youtube.com/watch?v=xmv_yKjPPT8
Don’t watch if you are squeamish!
by Dr Stephen Barker
It is a very confusing world out there! One week something can be good for you, the next week it’s bad and then perhaps there is a renaissance and it’s good all over again. Take calcium for example. It’s been in the news recently following the release of a recent study about calcium and heart health.
Calcium is an essential element in the human body, with many different roles, but perhaps best known as being an important component of strong healthy bones. This need for plenty of calcium in our bones has been the main reason people have taken calcium supplementation over the years. In the western diet, dairy produce has been far and away the biggest dietary source of calcium, although of course there are other calcium containing foods in our diet. For example, fish - particularly small boney fish such as sardines - and one or two surprises – think sesame seeds. For most adults, there is absolutely nothing wrong with a diet containing low fat dairy foods. It is unlikely that we will exceed the recommended allowances of calcium.
However, when it comes to calcium supplementation, it is easier to get a significant amount of calcium in a small tablet and therefore easier to end up taking too much. Usually a calcium supplement tablet contains between 500mg and 1000mg of available calcium. An approximate recommendation of suitable daily intake for women is not to exceed 1000mg and for men, 800mg. So you can see that if you do have a calcium rich diet and take a supplement on top, it is possible to exceed these amounts. Nevertheless, for those with relatively low amounts of calcium in the diet, they may well need a moderate calcium supplement to ensure bone health. The issue in relation to the heart arteries is not something that happens overnight so there is absolutely no need for any urgency or panic over this issue but it would be reasonable for anyone taking a prescription calcium supplement to discuss this with their doctor next time they have a check up. This discussion may result in them continuing on as usual or perhaps reducing their supplementation in some way.
Essentially the bones of this story are that sometimes you can have just a little too much of a good thing!
by Dr Kate Baddock
Polymyalgia rheumatica. Words many of you will have heard – not to be confused with fibromyalgia, which is not the same at all. Polymyalgia rheumatica or PMR as it is commonly known, is a condition which affects the two “girdles” – the shoulder girdle, which includes the shoulders and upper arms; and the pelvic girdle, which includes the hips and thighs.
The condition causes progressive aching and early morning stiffness and can go unrecognized and undiagnosed, sometimes for months. This is because the symptoms are very similar to ordinary arthritis, especially in the early phase, and are often mistaken for it. Some differences are that this condition is also associated with fatigue, a general feeling of unwellness, and even a slight fever.
During PMR, there is an inflammation of the blood vessels that line the involved joints of the shoulder and/or pelvic girdle, and there is some evidence to suggest that it may be caused by a number of different viruses, along with a genetic predisposition. It generally affects people older than 50 and women are twice as likely to get it as men.
A very important association is temporal arteritis, where the temporal artery (over your temple) becomes inflamed as part of the condition. This is characterized by severe localized headache and changes in vision. This is very significant and needs to be treated more aggressively.
PMR is diagnosed partly by the clinical picture, and partly by excluding other conditions. Tests for arthritis are negative, and often the only tests that are abnormal are the ESR (erythrocyte sedimentation rate) and CRP (complement reactive protein). These are both tests that measure inflammation and are very sensitive, but are not specific to PMR.
The treatment is prednisone orally, and treatment generally is for at least a year. As the inflammation gradually settles, the CRP (and ESR) returns to normal, and regular checking of the blood tests can be matched with slow reduction of the prednisone. It is not uncommon for there to be “flares” during that time with temporary increases in prednisone needed. Regular exercise is also helpful.
by Dr Bruce Sutherland
The Ministry of Health has just announced that the Waitemata region has been selected to run a pilot programme for bowel cancer screening. A first in New Zealand. This will begin late 2001 and will involve 130,000 adults from between 50-74 years of age. People in this age group will be sent a stool sampling kit by post. These kits are designed to detect hidden or “occult” quantities of blood in stool samples. If detected, patients are recalled to their GP for further investigations.
Bowel cancer is the second most frequently diagnosed cancer in New Zealand and is the second highest cause of cancer death. For women, we have the third highest bowel cancer death rate in the OECD and the sixth highest for men. In 2007, 2800 were diagnosed with bowel cancer and 1252 people died of it.
Bowel screening programmes are already underway in Australia, United Kingdom, most European countries, Korea, Japan and Israel. Screening and early detection has been shown to detect more cancers at an earlier stage and therefore to reduce the overall death rates from bowel cancer.
Note: Screening is for the general population, for people who have no symptoms and no risk factors. If you experience a change in your regular bowel habit or if you notice blood in your motions or if you have a close family member or a number of extended family members diagnosed with bowel cancer, don’t wait for the screening programme to begin – see your doctor!
by Dr Clinton Anderson
I make no apology if the topics of sunburn and heat stroke/exhaustion have been covered before. After recent experience, I cannot help but think that the dangers surrounding these issues warrant repeating. The first incident refers to a patient, who embarked on a fishing trip at midday. He discarded his clothing, except for a pair of shorts, and did not apply sunscreen. He claims his exposure was less than an hour. By the time he saw me, he had 70% of his surface area covered with partial thickness burns. The second incident occurred whilst watching a cricket match. Temperatures rose to 30 degrees. While most spectators were sensible, there was a group who insisted on getting completely drunk. They stripped down to the minimum, did not apply sunscreen and ran riot, working up a sweat, and then quenched their thirst with more beer! This is heat stroke/exhaustion "waiting for a place to happen".
Firstly, sunburn. Let's dispense with the technicalities of ray- and skin- types, distance from the equator, holes in the ozone, etc. The best approach is to prevent it. The bottom line is, fair, ginger or dark - avoid the sun between 10/11am-2pm. Wear protective clothing, including a hat, preferably broad-brimmed (staying cool is more important than looking cool); seek shade where possible; apply sunscreen with a minimum protection factor of 30 and do so repeatedly whether the product claims to be water-resistant or not; there may be merit in preventatively taking a tablet containing Polypodium leucotomos. This is a tropical fern extract marketed in New Zealand as Heliocare(R). The latter contains additional anti-oxidants, green tea extract and beta-carotene. This should not replace the former-mentioned measures but rather be used in addition. Please read about safety issues in pregnancy and under-18s. If sunburn is incurred - keep cool with light clothing; cool water will soothe; keep up a good fluid intake (non-alcoholic); aloe vera topically may help; and oral pain relievers have a place if topicals are inadequate. Consult a healthcare professional if none of the above suffices.
Heat stroke/exhaustion is also best prevented. Technically, there are some differences between the two, but I don't want to delve into that here. In essence, whether by exposure to excessive heat with or without physical activity - it boils down to an uncontrollable rise in the core temperature of the body (above 38°C), manifesting as a red, hot and dry patient, possibly dizzy or light-headed, dehydrated, nauseous or vomiting, and possibly confused or disorientated. If unattended and in severe cases, seizures (especially in children), coma and even death may follow. So! Avoid excessive heat. More specifically, avoid physical exertion in excessive heat. Be aware that heat AND humidity is a dangerous combination in that the normal cooling mechanism of sweat-evaporation is diminished. Furthermore, take note that certain medications may inhibit that part of the nervous system essential in aiding cooling. For example, anti-spasmodics, some inhalers (tiotropium and ipratropium), central nervous system medications (Parkinsons disease) and antihistamines. Some natural products may also have this effect eg Belladonna, Henbane, Mandrake, and Deadly Nightshade. Be sure to replace fluid loss more aggressively in extreme heat even without activity. If one does suffer from heat stroke/exhaustion, cool down by stripping to a minimum of clothing, apply cooled wraps, sponging, or immerse in cool water and use fans to assist evaporation. Continue to aggressively rehydrate. Do not immerse in icy water as this is potentially harmful. Do not use drugs traditionally used to treat fever since they are ineffective and may do harm (eg paracetamol, anti-inflammatories). If there is no improvement, confusion or altered state of consciousness, seek urgent medical attention.
by Dr Stephen Barker
Firstly, just to say this article is really a summary of a few thoughts and ideas. To include everything would need a short book and I prefer mine to be of the entertaining variety!
What to think about when your child is unwell
(1) What is normal and common in self-limiting viral infections?
Certainly most children with a virus will feel at least a little off colour, perhaps tired, a little more irritable, and maybe have a reduced appetite. (See below for a comment on reduced breast or bottle feeding in infants). Temperatures under 38°, transient aches and pains, mild coughs, sore throat, ear ache and sometimes mild abdominal pain are common in viral infection.
(2) Things to watch out for that would need a discussion or consultation with a health professional might include:
- persistent fever above 38°, particularly if for more than 24 hours
- faster rate of breathing than usual
- difficulty drinking fluids (in the case of small infants any significant reduction in feeding, either breast or bottle)
- severe ear aches
- sore throats with spots in throat or mouth
- persistent bad coughs
- unusually irritable or distressed
- as well as those that are unexpectedly drowsy.
Rashes can be difficult. Although most rashes turn out not to be alarming, if you are unsure about the rash or your child is unwell, then it may be worth getting the rash checked.
Assuming discussion or examination by your health professional shows nothing too much to worry about, how best to manage the symptoms? Paracetamol and/or Ibuprofen liquids can be used by most children. Doses are usually at 4 or 6 hour intervals according to instructions on the bottle or from your doctor, pharmacist or nurse. However, there’s no need to continue using these routinely if you feel your child is improving. As a general rule, plenty of fluids is a good idea, mostly water if in doubt. Usually juice is not suitable unless it is very dilute. If fever is still an issue then make sure the child is not overdressed, ventilate the room, consider the use of a fan. If the child is awake then perhaps playing in a bath is reasonable. The old idea of tepid sponging is now no longer recommended as it doesn’t seem to have a great benefit and can be distressing for the child.
A note on diarrhoea; most diarrhoea in infants and children is viral. Often a rotavirus can be the culprit. These bugs are amongst the most easily spread. For this reason, if your child has a diarrhoea and vomiting bug but is managing to keep some fluids going, it is probably best to keep them at home and away from other people. At home, a higher level than usual of hand washing for other household members, particularly around meal times, is logical. The infection will usually clear spontaneously. If there is concern regarding hydration levels, prolonged duration of diarrhoea, or something unusual such as blood staining, then it is probably time to see or talk to your GP or practice nurse.
Hopefully this provides a helpful update. Remember, if in doubt then you can always ring your practice and be connected to a nurse for advice. Another resource for similar advice is Plunket Line – Phone 0800 933 922.
by Dr Warwick Palmer
Headaches can have many causes, however serious causes of headaches are quite rare, and these often have clear signals that can be picked up by health professionals.
We need to be particularly careful if:
- The patient is over 50 or under 10 years of age.
- Headache is very severe, continuous or different from one’s usual headache.
- Headache is getting progressively worse or has come on very suddenly.
Other symptoms can include nausea, vomiting, sensitivity to light and sound, numbness, pins and needles.
By far the commonest type of headache is tension headache. Often the real cause can be difficult to isolate, but frequently problems with stress, tiredness, the upper back and neck can all contribute. It can be helpful to use a headache diary to see if there is any clear pattern, or other obvious exacerbating factors.
Initially, simple pain killers such as paracetamol, or ibuprofen (Nurofen) can be very effective, but these may only provide short term relief and do not address underlying problems. Ongoing frequent use of pain killers can actually worsen the headache or create a “rebound headache” situation. Thus, it is best not to use pain killers more than 2 to 3 times per week and to avoid pain killers containing codeine.
Tension headaches are frequently caused by muscle tightness and tension in the upper back, neck and head. Any identifiable problems with posture, neck, or the back should be addressed. A hot flannel, warm bath or massage can often relieve tightness and tenderness. Physiotherapy, an exercise programme, yoga, pilates, acupuncture or meditation can all be helpful.
Identifying and addressing stresses is important. Talking about stress with a trusted family member, friend or health professional, and then making lifestyle changes may also help to relief stress.
by Dr Kate Baddock
Did you know how important it is to cuddle your child? Recent evidence has shown that 20% of parents do not think it is important. The other 80% do think it is important and that is a good thing. Especially as a leading epidemiologist from England is about to publish a study that supports those gut feelings that we all have about giving your child a cuddle. This study has shown that those children who are cuddled on a regular basis as three year olds, do much better when they grow up. They do better at school and they earn more as adults. This finding was true across all groups – whether they be rich or poor; the children do better as adults in terms of their learning and education, and in terms of their earning capacity.
There’s more. Not only is cuddling important but so is talking to your three year old. Do you all talk to your children every day? It’s another thing that affects their development. Having a conversation to your three year old is not silly or a waste of time – it makes a difference to their adult life. Just like cuddling, the benefits as an adult are huge – when children are talked to each day, they do better at school and they earn more later in life. The third thing that is so important to a three year old is being read to. Those three year olds who are read to every evening (and put to bed at a regular bedtime) again do better at school and earn more as adults.
These findings are incredible. We tend to believe that talking to, reading to and cuddling our children is good. But until very recently we did not know just how good. So for those of you who may be in that 20% who are not aware of its importance, now you know.
The thing about epidemiology is that it does not necessarily mean that one thing, e.g. cuddling, is the cause and one, e.g. earning more, is the effect. What it means is that there is an association between these two things. That where the parent spends time with their child – cuddling them, talking to them, and reading to them, these same children do better when they grow up. There may be other factors that are not taken into account but even so, these are powerful arguments.
So begin now and make a difference for your child.