Share Your Spare: Organ Donation

This week is Organ Donation Awareness week in the UK.

Transplanted organs save so many lives as medical science and surgical techniques advance, but the sad fact remains that that the number of people who need an organ outstrips the number of people who donate organs. It is thought that every day in the UK, three people die waiting for an organ.

 

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There have been some incredibly moving videos on social media lately – hearing the heartbeat of a deceased child beating strong in another person, meeting the recipient of your partners lung donation and so on. Emotive as they are, they do illustrate just how life changing organ donation can be to those who receive a transplant.

Talking about dying and organ donation can be really difficult, so it is understandable why we might shy away from thinking about it and talking to our loved ones about it. Somehow as if it’s almost tempting fate.

We can donate organs such as heart, lungs, kidneys, liver or pancreas, or we can donate tissues such as corneas (a clear layer of ‘skin’ at the front of the eye), heart valves, skin or bone.

Most people know about organ donation after death, however we can (in some circumstances) donate an organ whilst we are alive. The commonest situation would be to donate a kidney to another person in need, sometimes within our family. We have two kidneys but we can usually manage just fine with one. The brilliantly titled #ShareYourSpare is a social media campaign trying to raise awareness for living kidney donation.

Roughly 5000 people in the UK are waiting for a kidney transplant and as many as 250 patients died last year waiting for a kidney transplant – because they could not get a transplant in time.

Parts of the UK have different laws regarding consent for organ donation, and you should always check what the law is where you live.

In Wales there is an ‘opt-out’ system. This means that you can still voluntarily register to be an organ donor if you wish. However if you specifically do not want to be a donor, you need to register your intention not to donate. If you do nothing, it will be presumed that you do not object to donation.  For the rest of the UK, you still need to register your intention to donate your organs.

Regardless of your feelings or decisions about donation, it is important that you tell your next of kin or family. In the event that the worse happens, your family can help to share your wishes and make these known to the medical team looking after you. If they do not know you wanted to donate your organs, this could blind side them in an already very difficult time.

Talking about death and dying with our loved ones can be a difficult and painful process. As hard as these discussions are, having them sooner rather than later will ensure we’re all on the same page if the worse should happen. As we look to raise awareness of organ donation this week, try and take the opportunity to think about what you might want.

You can register as an organ donor or find out more about donation on the NHS donation website 

 

Vitamin D

Of all the vitamins, it seems like vitamin D has had the most air time of late. Certainly in our clinics, it’s the one patients seem to ask most about – are they getting enough, how do they know if they are getting enough and do they need to take supplements?

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Vitamin D helps our bodies to regulate the crucial minerals Calcium and Phosphate in our bodies. We need these to keep our bones, teeth, nerves and muscles healthy.

A lack of vitamin D causes bone abnormalities – you might have heard of rickets? Rickets is a disease in children caused by a vitamin D deficiency.

For most of us, we actually get our vitamin D from exposure to sunlight. This means here in the UK, it can be a challenge to get enough sun during the long winter months. We all know the dangers of sun exposure and it’s a sad fact that skin cancers seem to be on the rise. There is a real delicate balance between enabling the sun to provide us with enough vitamin D and over-exposing our skin to the sun and increasing our risk of sun-related skin damage.

It is recommended that to allow enough exposure of the skin to the sun, that our forearms, hands or lower legs are uncovered, for short periods of time, without sunscreen. There is no set amount of time we need in the sun – and this is because we all make vitamin D at different rates. Darker skin colours seem to take longer to produce vitamin D and will need longer in the sun than those with lighter skin colours.

Being in the sun enough to cause the skin to burn is never recommended – and if you do start to feel burnt – you need to cover up or apply a good strength sunscreen (at least SPF 15). Increased time in the sun or allowing the skin to burn can increase the risk of developing sun-related skin damage or skin cancers.

There are some foods which can provide vitamin D such as red meat, liver, fortified foods, cereals and oily fish such as salmon or mackerel. However if you follow a diet that does not include meat – it can be especially challenging to make sure you get enough vitamin D.

Children over the age of one and adults need 10 micrograms of vitamin D a day.

Recently, the guidelines on vitamin D supplementation changed. Here in the UK it is recommended that babies from birth to the age of one are given a daily supplement containing up to 10 micrograms of vitamin D. However if your baby is fed by formula, most of these have vitamin D and as such they would not need supplementation until they were having less than a pint (around 500ml) of formula feed. Children up to the age of four should also be given a daily supplement.
There is now advice that adults should also have a supplement during winter months, when we are less able to get our fix of sunshine.

It is also worth considering those who are at higher risk of vitamin D deficiency – and primarily these are people who do not get much sun exposure. Whether that be due to immobility or being housebound, or those who choose to cover up most of their body with clothing.

 

 

 

You can get too much vitamin D – and this can cause an increased build up of calcium. Although we need calcium to keep our bones strong, actually too much can weaken our bones and cause heart and kidney problems.

Vitamin C

This crucial vitamin helps our skin to heal and protects the cells within our bodies.

 

You may have heard of scurvy, a scourge common in pirates, when they would spend days and months at sea and have limited access to fresh and varied foods. Scurvy is a lack of vitamin C. In patients suffering from scurvy, brown spots may appear on the skin and in more severe cases there may be open wounds, bleeding gums, loss of mobility and even death.

 

The good news for us, unlike our pirate ancestors, is that scurvy is relatively rare these days largely thanks to the abundance of sources of vitamin C. Good sources include citrus fruits such as oranges and orange juice, peppers, brussel sprouts, broccoli and strawberries.

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It is estimated that an adult needs around 40mg a day of vitamin C. It is possible to have too much vitamin C though, and too much can give us stomach upsets such as stomach pain and diarrhoea.

 

Patients often ask us if taking vitamin C supplements will protect them from common illnesses and infections, particularly from colds, but there is no evidence to support this.

 

There have been a number of studies in the last few years looking to the benefits of vitamin C and cancer prevention. Whilst there is no clear evidence to support this, there have been some suggestions of a weak correlation between vitamin C and reduced risk of lung cancer and possibly bowel cancer. However for every study that demonstrates a benefit, there appears to be another that demonstrates no benefit of vitamin C.

 

For the vast majority of people, a balanced healthy diet will enable you to get enough vitamin C.

Vitamin B

Next in our quick series of Vitamin FAQ’s we look at vitamin B (if you missed Vitamin A – you can read it here).

There are actually lots of different types of vitamin B, but for our bodies the main ones are:

  • B1 – thiamin
  • B2 – riboflavin
  • B3 – niacin
  • B5 – pantothenic acid
  • B6 – pyridoxine
  • B7 – biotin
  • Folate (folic acid)
  • B12

 

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In general, they all aid the process of breaking down key aspects of our food, releasing much needed energy into our system, as well as helping keep our eyes, skin and nervous system healthy.

Vitamin B6 has a specific role in using and storing the protein and carbohydrates we take in as part of our diet and helping our body to produce haemoglobin. Haemoglobin is what makes our blood look red and critically carries oxygen around the body.

Folic acid – most well known as the supplement that is needed in pregnancy – is crucial for reducing the risk of developmental defects of the central neural tube of unborn babies. The neural tube is the early form of our central nervous system. Developmental problems at this crucial stage of a baby’s growth can lead to problems such as spina bifida. However it’s not just pregnant women – it also helps all of us to make healthy red blood cells.

Perhaps the most well known is vitamin B12. This actually helps us to use folic acid. It also is vital in keeping the nervous system healthy and plays a key role in making red blood cells.

With so many types of B vitamins, the ways we can get this into our diet are varied. Importantly, some of these vitamins cannot be stored in the body – so we need a daily supply in our diet. Thiamin cannot be stored – and it’s recommended that men need around 1mg/day and women around 0.8mg/day. Similarly we need daily riboflavin at around 1.3mg for men and 1.1mg for women. Niacin also cannot be stored and men should aim for around 16.5mg and women around 13mg.

A word of caution about niacin – too much for a long time can lead to liver problems and cause skin flushes. Similarly B6 in excessive amounts  (e.g. more than 200mg) can lead to a problem called peripheral neuropathy. This is a problem of the nervous system where we can develop loss of sensation in our limbs (peripheries). Men should aim for around 1.4mg/day of B6 and women around 1.2mg.

Many foods are rich in a number of B vitamins including: eggs, fresh/dried fruit,  leafy green vegetables, broccoli, wholegrain bread, fortified cereals, milk (cow’s), nuts,

Some specific diets e.g. vegetarians and vegans can sometimes struggle with B vitamins, and B12 in particular. B vitamins are in abundance in animal products – meats, fish, eggs, cows milk etc. However with careful planning, it is possible to get all the recommended amounts in your diet without additional supplementation. However, a multivitamin can be a helpful addition to more restrictive diets and might be worth discussing with your doctor.

Folic Acid

As we have already learned, folic acid (or folate) is pivotal in a baby’s development and throughout our life by helping us produce red blood cells. The average adult needs 200micrograms of folic acid/day and it cannot be stored meaning you need a daily amount. An additional supplement is provided to pregnant women – either 400mcg of 5mg depending on their medical history. Caution is required with additional supplementation – too much can possibly cover up an existing B12 deficiency.

This is found in vegetables such as asparagus, peas, sprouts and broccoli. It is also prevalent in liver but this should be avoided in pregnancy.

B12

The most well known of all B vitamins is B12. A deficiency of B12 is something that has been in the media more of late. This is the vitamin that those who avoid animal products in their most struggle with – as it is only found naturally in animal products – meats, milks, eggs.  It is some fortified cereals however.

We need around 1.5micrograms/day and this is something we can store in the body.

Deficiency in B12 causes wide ranging symptoms including low mood, changes in mental state, altered or abnormal sensation, fatigue, irritability, anaemia and reduced fertility. Whilst some changes can be reversed with treatment, if left unchecked and untreated, some of the damage can be permanent.

“All that I am, or ever hope to be, I owe to my Mother”

It’s Mother’s Day today in the UK and this gives us a chance to show our mums how much they mean to us – whether they are still with us or not. There is an undeniable connection to your mother, no matter what is going on in life.

As babies we are conditioned to bond to the person who provides us with the most care – this can be our mother, father or anyone that provides us the majority of our care. This bond is what psychologists call ‘Attachment Theory’. It’s a biological instinct where we equate our safety with being close to this person and that this person will take away our discomfort and protect us.

We don’t know about you, but that definitely describes our mums.

 

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In honour of our mums, we wanted to share some of the most valuable lessons we have learnt from them:

 

“Grant me serenity to accept the things I cannot change, courage to change the things I can and wisdom to know the difference”.

This was something we had on an ornament in our house growing up – and it followed us from house to house and has always stuck with me. Learning to let go and move on, or dig in and work hard are crucial life skills we all need.

 

“When driving, you don’t have to run a race”

When someone approaches in your rear view mirror, whether it be in the car or in life in general, you can choose to put your foot down or carry on at your own pace. Life is not a race or a competition. Enjoy the journey and don’t put your foot down and miss the beauty and opportunities around you.

 

“Never let the sun set on an argument”

A quote taken from Ephesians 4:26, in the heat of a disagreement it can be hard to reach resolution. Feelings of anger or resentment can be destructive if not handled properly, both to our physical and emotional health, but also can have a wide reaching impact on our relationships and careers.

 

“You are in charge of your own feelings”

This would often come during a typical teenage temper tantrum and mum would tell me that I was in charge of how I felt. At the time, I never understood it, but as I have got older it makes sense. Yes, a certain event or circumstance may trigger emotions e.g. an argument might make us angry, but we are in charge of how we deal with that anger. Do we bottle it up, or do we move on and resolve and forgive? You are in control of how you handle and react to your feelings.

 

“If you can’t do it, learn to do it”

If there was something I wasn’t able to do, mum would always work out if there was a way to learn it. She always believed education, in all it’s forms, was the way to improve oneself. As doctors, we are somewhat infamous for our poor handwriting, but even growing up my handwriting was questionable. So mum would keep buying me handwriting books to try and practice and improve. When we come up against something we struggle with, we are faced with two options: we can give up, or we can adapt and work through it, and it was my mum taught me that we didn’t give up.

 

“One day you’ll thank me”

They were right. We’re incredibly thankful for all they have done and taught us. Abraham Lincoln told us that “All that I am, or ever hope to be, I owe to my Mother”, and we’re inclined to agree.

 

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Why am I so tired all the time?

“Doctor, I’m just exhausted. All the time. I’m so tired, there must be something wrong with me”

Pretty much every GP or family doctor will hear this several times a day. Tiredness is ubiquitous with our fast paced modern lives, but at what point is it more than just our lifestyle and an indicator that something is medically wrong?

Feeling tired all the time, that feeling that even after a long sleep you don’t feel rested. It’s feeling like you could nap at pretty much any time of day. It’s draining for patients and can have a real knock on impact on their quality of life.

 

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There many medical explanations for tiredness such as hypothyroidism, anaemia and depression but it’s important to also examine your own habits and patterns to work out if it’s anything you might be able to change.

 

In my clinic I tend to try approach both the biological and the behavioural aspects of tiredness simultaneously. Lets get you looked at, examined and tested if relevant, but lets take pause to look at you as a whole – how are your stress levels, are you worried about anything, whats happening with your weight and your appetite, when do you go to bed – to get a sense of anything else we might be able to improve upon.

Stress, anxiety and depression can all impact upon our sleep. Often it might be one of the first signs that you might be suffering one of these conditions. Whether it be that your mind is racing over the days events when you try and go to bed, or thinking about the events of tomorrow or the future. Some patients with anxiety report increased palpitations (a sense of the heart racing in the chest) in the evening/night time which enhances their difficulty sleeping. Patients with depression might experience ‘early morning wakening’ when they are unable to stay asleep and wake in the early hours.

Sleep hygiene is often overlooked in the 21st century, we’re more connected than ever with a myriad of devices and with the increasing advent of flexible working we’re checking work emails in the evening and working later and later at home. There is also some misunderstanding about how much sleep we actually need.

Our sleep pattern is regulated by something called a circadian rhythm, an evolutionary clock that tells us to be up when its light and sleep when it’s dark. In the days of our ancestors, this helped us to be productive in the hours when there was light and to rest to in the dark when light sources would have been limited.

Stimulants such as caffeine, alcohol and nicotine as well alarm clocks and devices plus the addition of later working and shopping hours can all interfere with our natural sleep/wake cycle.

How much sleep do we need?  How do you stack up to the numbers below?

  • Newborns (0-3 months ): 14-17 hours each day
  • Infants (4-11 months): 12-15 hours
  • Toddlers (1-2 years): 11-14 hours
  • Preschoolers (3-5): 10-13 hours
  • School age children (6-13): 9-11 hours
  • (14-17): 8-10 hours
  • Younger adults (18-25):  7-9 hours
  • Adults (26-64): 7-9 hours
  • Older adults (65+): 7-8 hours

Sleep is a priority, we need that time to allow our brains to hit the reset button.  Simple but effective techniques for a better night include: sticking to a schedule – set yourself a bed time and try and stick to it, if you are someone who runs through to-do lists for the next day, make a list before you go to bed and put it to one side, getting exercise daily will help to naturally tire you out, make your bedroom as restful as possible – limit those electronic devices and televisions in the room and turn off your phone
Techniques such as deep breathing or meditation can help to quieten your mind to prepare your body for sleep. Try inhaling for three seconds and exhaling for six. Repeat this five times. Then try to tense your toes as tight as possible, then relax, work up your body – tense and relaxing groups of muscles in turn. This helps to give the body a sense of relaxation.

When is tiredness caused by more than a few late nights? We’ve looked at a few of the more common reasons we see in clinic:

Iron deficiency anaemia.

This is the most common nutritional deficiency in the world and is common in women having regular, heavy periods. Blood loss causes us to lose iron, and if we are not able to get enough iron back in through our diet, we can build up a deficit. Besides tiredness, symptoms can include skin that appears more pale, feeling cold,  feeling dizzy or lightheaded, hair loss and brittle nails. Picked up on a blood test, your doctor can advice on a cause of replacement and may recommend further testing to discover the cause.

Hypothyroidism.

The thyroid, a small gland in the neck, is responsible for producing hormones required in many different bodily functions. Symptoms include an inability to tolerate the cold, weight gain, constipation, low mood and of course, tiredness. Again, picked up on a blood test and treatment involves replacing the deficient hormone – usually as a daily tablet.

Chronic fatigue syndrome

Something that has divided medics for years. A condition that causes long-term fatigue, it’s cause is not known. It is thought that it starts with a flu-like illness and there have been suggestions is can have links with mononucleosis, lyme disease and chlamydia. There are no definitive tests to confirm this, so often the process will start by looking for other conditions that might cause tiredness.

Coeliac Disease.

A gluten intolerance that can cause weight loss, bloating, bowel habit changes as well as tiredness. Gluten is found in foods such as breads, cakes and cereals. It’s thought around 1 in 100 people in the UK have coeliac disease, but 90% of those affected do not know they have. Diagnosis involved blood tests and biopsies and is most often managed by avoiding gluten in the diet.

Sleep apnoea.

More common in people with a higher body mass index, where the breathing tube is compromised when patients are lying down, but can also be linked to alcohol intake and smoking.  In sleep apnoea patients will have periods of interruption in their breathing when asleep. Partners might report snoring – or evening being able to hear the moments when breathing is interrupted. Testing involves sleep studies and oxygen monitoring during sleep. Patients with confirmed sleep apnoea will be given advice about how to reduce their risk factors and in more extreme cases a machine (CPAP – continuous positive airway pressure) to wear overnight which helps to move air into the lungs and keep the airways open.

 

We could all do with taking stock of our sleeping habits and taking steps to improve our sleep hygiene. But if you think that there might be something underlying the tiredness, you should always discuss this with your own doctor.

Vitamin A

In a series of short posts we will be looking at crucial vitamins for our body – today we’re looking at Vitamin A.

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Mango

You might know Vitamin A as retinol, and is helpful for your body’s natural defence against illness as well as keeping our skin healthy. It’s also important in aiding us see in low light.

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Eggs

 

Men need around 0.7mg a day and women around 0.6mg, mango and apricots as well as eggs and cheese are good sources for vitamin A to include in your diet.

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Apricots

It may be possible to have too much vitamin A with studies suggesting that sustained high doses might lead to increase risk of osteoporosis – where bones break more easily.

 

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If you’re pregnant, larger amounts of vitamin A can also harm your unborn baby so it’s best to avoid foods that contain liver as these are particularly high in vitamin A.