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.

 

FullSizeRender 2

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?

shutterstock_405732325.jpg

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.

“If a migraine is just a headache, then Godzilla is just a lizard”

One in seven of us will suffer from migraines, so there is a good chance that someone you know suffers with migraines – it might even be you.

It is estimated that there are nearly 200,000 migraines every day in the UK. More common in women than in men, it can affect us at any age – even as children.  On average, a migraine sufferer will have 13 attacks a year, lasting up to 72 hours at a time.

shutterstock_516250924.jpg

 

Migraine is a complex problem and the truth is that medical science isn’t entirely certain on its cause. Whilst many people with migraines will experience headaches (usually a severe, throbbing, one-sided headache), there are many other symptoms and features of a migraine, such as: flashing lights or visual changes or sensitivity to the light, sensitivity to sound or smells, nausea or vomiting, numbness or pins and needles, slurred speech, irritability or abdominal pain. Sometimes, someone with a migraine will not even have a headache.

Migraines are thought to occur in five stages: prodrome, aura, main attack, resolution, recovery.

The prodrome can be tricky to pick out from normal day-to-day life, but those who can recognise it will talk about feelings of lethargy or irritability, or just feeling a bit off.

For some this will be followed by an ‘aura’. This would typically happen up to an hour before the attack. Someone might notice flashing lights, changes to their vision or speech, or other neurological features such as tingling or numbness. Migraine aura’s do not happen with every migraine, and it is estimated around one-fifth of migraines are associated with an aura.

I suffer with migraines – thankfully very rare these days, but when I get one they wipe me out. I don’t usually suffer with an aura when I do have a migraine  – but it has happened. If I do get one, it will be flashing lights – strange flickering light towards the edge of my vision – just enough to make me wonder if I have seen it at all – and I get a bit muddled – almost as if my brain is suddenly wading through thick treacle and I feel I have to work hard just to think. 

The main stage of the migraine is the ‘attack’ phase – this is when a headache (if present) will occur and can last up to 72 hours.

In the resolution and recovery phases, the headache and any other symptoms start to ebb away but patients will often say they feel particularly tired or wiped out, sometimes for a couple of days.

So if you suffer with migraines, what can you do about them? First off, it’s really important that if you are experiencing new, changing or worsening headaches you get these checked out by your doctor. If your doctor agrees that you are suffering with migraines you might then want to think about ‘triggers’.

Many migraine sufferers have triggers unique to them and there are so many possible triggers out there. To be able to start working out what might be setting your migraine off, a headache diary can be a great tool. You can download pre-set diaries or just use your calendar on your phone. Do this for a month or so and then look back over the information you have collected and see if any patterns jump out at you.  For me, it’s lack of sleep – every time!

Common triggers are: emotional upheaval whether that be happy or sad, worry or anger, poor sleep or over tiredness, changes to environment, periods for women (as well as contraceptive pills and the menopause), dehydration, citrus, caffeine, cheeses, chocolate, alcohol, pork and monosodium glutamate.

Treatments vary depending on the type of migraine, how often they happen and your medical history, Broadly speaking these can be divided into ‘acute’ treatments – ones you take when an attack is happening and ‘preventative’ treatments – ones to take to try and stop attacks from happening. Simple measures such as paracetamol, anti-inflammatories such as ibuprofen and rest in a darkened, quiet room can be enough for some people. A word of warning about using codeine containing medications though – codeine and other opiates can can worsen or even cause headaches so should be avoided unless your doctor has advised you specifically to use them.

So if you’re one of the one in seven people in the UK who are thought to suffer from migraines, first off I feel for you and share your (head) pain. Secondly, don’t suffer in silence.

Migraines cannot be cured, but they can be managed. To talk about treatments that might help, speak with your doctor. As with so many medical conditions, there is a lot we can do to help ourselves – so why not consider keeping a headache diary and see what you can learn about your migraines.

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.

shutterstock_547801399.jpg

 

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

 

shutterstock_596124212.jpg

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.

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.

shutterstock_385801849.jpg
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.

shutterstock_236452465
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.

shutterstock_455274628
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.

 

shutterstock_253166335

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.

Your sense of self: the magic five.

Self Confidence.

Self Esteem.

Self Worth.

Self Belief.

Self Respect.

All priceless. All fragile. All unique.

Our sense of self is intricately tied to our personalities, experiences, belief systems and the bubble we find ourselves in. It can take a life time to build and a second to shatter.

 

shutterstock_426966097.jpg

On the face of it, the five S’s may all seem similar concepts but each one is a like a snowflake – outwardly uniform but subtly different to the next.

In today’s society when we are so often judged on how well we do our job, how many exams we passed, how productive we are, what material possessions we have or don’t have, it can be easy to conflate our self-confidence by listing our many achievements. However to face and accept our flaws and weaknesses takes real strength. It’s our self-esteem that allows us to look at these facets of our character and not be lessened by them. A robust sense of self esteem enables to us own our flaws, learn from them, use them, grow from them.
Alexander Pope wrote An Essay on Criticism in 1709 and told us “To err is human, to forgive is devine”. Whether you have faith in a higher power is immaterial, and whilst Pope may have been talking about literary critics, his words ring true when considering self-esteem.

Mistakes, flaws and errors are part of what makes us human. Being able to forgive ourselves is part of our ongoing development. We need to acknowledge and accept these to be able to move forwards.

Valuing what we can offer our friends, our family, our colleagues, the wider community or, more importantly, ourselves helps to re-affirm our sense of worth and place in the world. We all have a place.

What we do with that place, to a greater or lesser extent, has much to do with our self-belief. Einstein said that insanity is doing the same thing over and over and expecting different results. If we never change what we put in to something, how can we ever expect a different result?

At a couple of stages in my professional life I have had attacks of “Imposter Syndrome”, a pervasive feeling that at some point I would be uncovered as a fraud. I lacked the confidence and belief in myself and my abilities. The first was immediately after medical school. For years as I rotated through my house officer (residency) jobs, I kept all my old med school notes and textbooks – just in case the university called to tell me they had made a mistake and I hadn’t actually passed my finals!

The second time was shortly after I qualified as a GP. I worried all the time that I would be “found out” and that I wasn’t really “good enough” to do my job. Thankfully with time, supportive colleagues and a helpful husband, I learned to settle in my work. I still have moments when doubt starts to creep in, but using strategies I have developed over time to refocus my self-belief and confidence, I can pick myself back up.

Having a goal – whether it be in your work, your home life, weight loss or fitness goals – and the effort and drive it takes to reach it – all relies on your self-belief. That intense faith you place in yourself that you will reach your target. This one (as they all are) is tricky. It’s vulnerable to knocks along the way and this can lead you to deviate from your goals.

An analogy I often use with patients when we talk about goal setting is to imagine climbing a mountain. When you are in the foothills looking at the summit, it can seem an awful long way up. It’s easy to think of at least ten reasons not to start the journey – it’s a long way, it’ll be hard, I’m not prepared… But if you think of that same journey as a series of shorter journeys, perhaps from the foothills to base camp. From base camp to the next rest stop, and then to the next and so on until you reach the summit. Then at each rest stop allowing time to gather yourself and evaluate your progress. Whilst the journey might still seem a challenge, breaking it down to smaller chunks makes it more manageable.

shutterstock_524086885

A buzz phrase in medicine, and education generally, is SMART. A tool for setting goals, it tells us that goals should be:

Specific (what are you going to achieve)

Measurable (how will you know when you achieve it)

Achievable (is it within your ability – if your idea of art is drawing is limited to stick people it might not be achievable to think you’ll open at the Tate Modern or MOMA in twelve months time)

Realistic (perhaps you are a great artist but accept it might take ten years for an opening in prestigious galleries) and

Time Specific (when are you going to achieve it by)

Either way to get to our goal takes self-confidence to learn our strengths, self-esteem to accept our weaknesses, self -worth to believe we have value and the right to dream and self-belief to push on and achieve it.

Which leaves the toughest one of all, self-respect.

Underpinning all of these is the respect we have for ourselves. Our esteem, worth, belief and confidence are, in general, internal concepts. They are what we think. Our respect is generally what we do to ourselves in the physical sense. Self-respect doesn’t care what happened in the past, it’s about what you are doing right now.

If the other four S’s are talking the talk, your self-respect is walking the walk.

No one, in any shape or sphere can or should take your self-respect. The only person who has any right to your self-respect is you. If you have a bad day, or week, or even a bad month your esteem, confidence, worth or belief might take a beating, but it’s your self-respect that will build you back up.

Self-respect is lifetime work. There will always be critical voices and adverse life events ready to knock you. However if you can ensure you respect you for you, you’ll make it through. Imagine your self-respect as a small seed, planted in the ground. To grow, it needs to be nourished and fed to flourish, ignore it and it will risk withering and decaying.

Having respect for yourself means taking care of your body, your mind and your actions. Be proud of you. Don’t settle for something that is less than you deserve. Forgive yourself, we have all done things we are not proud of, but berating yourself for these for the rest of your life won’t get you anywhere. Surround yourself with positive people and influences. Take care of your body – you only get the one. Don’t compare yourselves to others. Theodore Roosevelt told us that “Comparison is the thief of joy”. Treat others with respect but do not allow others to disrespect you.

“Self-respect cannot be hunted. It cannot be purchased. It is never for sale. It cannot be fabricated out of public relations. It comes to us when we are alone, in quiet moments, in quiet places, when we suddenly realize that, knowing the good, we have done it; knowing the beautiful, we have served it; knowing the truth, we have spoken it” Alfred Whitney Grisworld

 

–Alex