Archive for April, 2009

health tips from London

April 29, 2009

On my flight from the Algarve to London today I was reminded of the essential health tips for air travellers.

1 Never travel by plane with middle ear infections or sinusitis

2 Make sure you carry out pressure equalization manouvers frequently during take off and landing

3 Use a saline- or sea salt nasal inhaler to keep your mucous membranes moist and protected.

4 Move your feet as much as possible in economy seats to prevent thrombosis.

5 Drink plenty of water and little alcohol during air journeys

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Tips for infection prevention

April 28, 2009

With the influenza scare, infection prevention has become more important.

There are quite a few things you can do to limit the risk of infection.

1 Wash your hands frequently

2 Use a probiotic every to arm your intestines against viruses and bacteria.

3 Take a good antioxidant every day

4 Avoid crowded public places

5 Use a saline nasal spray, when flying.

6 Get plenty of sleep.

7 Practice regular physical exercise, but never train with a fever

Panic attacks and hyperventilation episodes, common and often missed.

April 26, 2009

Dear Patient,

panic attacks and hyperventilation are common problems. They go often unrecognized as such and are misdiagnosed.

The following article will give you some useful information about how to recognise and treat them.

Panic attacks and hyperventilation syndrome BACK TO PUBLICATIONS LIST  
   
  ‘In the worst case scenario, panic attacks can even present like epileptic fits’
‘In the worst case scenario, panic attacks can even present like epileptic fits’

Dear Reader,

I have attended so many patients suffering panic attacks this summer that I thought it would be interesting for you to know more about them. In medicine, it is particularly true that the best teacher is the patient. The person that taught me about panic attacks was my girlfriend in medical school. She was a highly-strung, very intelligent (and, of course, very pretty) psychology student who read too many scientific books. One night she had a classic panic attack, only the two of us did not recognise it as such. It started with her having pins and needles in her hands and feet and the feeling of a lump in her throat. As I said, she read too much and, from the initial symptoms, she diagnosed herself as suffering from tetanus.

We disregarded the diagnosis after reading more about it, but then she woke up in the middle of the night, shaking, with cramps in both arms. She also felt short of breath and these symptoms were, of course, causing a panic attack – in me too! I went next door to our neighbour, who was a physician. He had been fast asleep but it took him only a few seconds to recognise that my girlfriend did not have tetanus and was not suffering from a heart attack, but was experiencing a panic reaction or hyperventilation syndrome. He did not even need a Valium injection to heal her, reassuring words from an experienced doctor did the trick. Despite that, the patient had several episodes of the same symptoms over the next few days.

Panic attacks (hyperventilation spasm is probably the same phenomenon) come in many variations and there is no specific test you can do to ascertain the diagnosis. They are a fascinating illustration of how our body and mind are inter-linked and how powerful the influence of the mind can be on the body. The symptoms are shortness of breath, a tight feeling on the chest, the sensation of a ball in the throat (globus syndrome), pins and needles, cramps and shaking of the extremities, sweating, and the sensation of anxiety and panic. In the worst case scenario, panic attacks can even present like epileptic fits.

Patients do not imagine these symptoms – they have a real physical reason. When one experiences a worrying body sensation, one focuses more on it. Humans react to these circumstances by breathing deeper and faster. But breathing deeper and faster over a long period is like hyperventilating. When we hyperventilate, we create a metabolic reaction of alkalosis (an abnormal increase in alkalinity) in the blood. When there is alkalosis in our blood it means that more calcium is being bound onto proteins, leading to a lack of free and acting calcium in all systems. Calcium is an essential mineral for many tissues. A lack of it leads to cramps, hyper-excitability and faulty transmission of nerve impulses. This relative and temporary lack of calcium is responsible for the symptoms that can look so dramatic.

The treatment is reassurance, sedating medication and, occasionally, it is necessary to give calcium. It is very important to explain the mechanism of the panic reaction to the patient so that he or she can understand how to tackle them in the future. I am convinced that bystanders and traditional methods of dealing with threatening situations are among the reasons why hyperventilation syndromes occur in the first place. Haven’t we all been taught to breathe deeply when things are hurting or when we are anxious about something?

In the case of the last patient with a panic attack I attended this week, a first-aider was about to really get the patient in a state of deep hyperventilation by doing deep breathing exercises. He assumed that the patient was having a heart attack. I felt like my neighbour of 20 years ago – I immediately saw what was going on and sure enough the patient was soon better. No medication needed.

So here is my advice to you should you encounter this emergency:

• Use common sense. Young ladies under 45 are very unlikely to have heart attacks; they are more commonly affected by hyperventilation.

• Panicking patients are restless, shaking, anxious and often feel short of breath. The best action is to reassure them (that helps in any case).

• If you think the patient may be having a panic attack, sit quietly with him or her and practice calming and controlled breathing with them.

• Breathe together with the patient – no more than 18 times per minute and in a normal, even a bit superficial, fashion – no deep breathing!

Next month I will write about the interesting problem of sleep apnoea (a temporary inability to breathe). Until then, dear reader, please make the most of the beautiful September in the Algarve. Yours Dr Thomas Kaiser

Dr. Kaiser can be contacted at the Vale do Lobo Family Medical Centre on 289 398 411

Here are the latest infos about high blood pressure

April 25, 2009

High Blood Pressure –  facts and myths

 

Dear Reader,

High blood pressure is one of the most common dangerous illnesses of our modern societies.

It is an important risk factor for the development of heart attacks and strokes. It also is detrimental for your blood vessels in general, your kidneys and your eyesight.

There are a lot of myths circulating about the meaning and cause of high blood pressure.

I will therefore try to explain today the essential facts about the blood pressure.

Your doctor will write BP as abbreviation for blood pressure and I will also use BP in the following text.

With BP we mean the physical pressure in arteries, not veins. The BP is a dynamic figure and depends on several variables. Blood pressure tends to be higher when you are up and active, stressed or worried, angry or excited. It is lower when we are asleep, relaxed and tired.

The most accurate way of measuring it is through inserting a pressure probe into an artery. This method is used during operations by anaesthetists. As you can imagine, this is not a method suitable for the daily work in the doctor´s office or the pharmacy. Therefore an indirect method is used by applying pressure through a cuff to the artery in the elbow crease until it is completely blocked. The pressure that is needed to do that is called the “systolic pressure”. That pressure is by definition the pressure in the arteries when the heart pumps blood full force into the circulation.

The doctor then releases the pressure and measures the pressure, when the artery is fully open again.  This pressure is called “diastolic pressure”. By definition this is the pressure when the heart is being filled passively with blood before the next contraction can take place.

You will get readings like 130/70 mmHg. The origine of the unit mmHg comes from the method that was used in the beginning, when the pressure was assessed in columns with Hg (chemical symbol for mercury). In Portugal the units is not mmHg but cmHg, giving you readings like 13,0/7,0.

Blood pressures up to 145/85 are considered normal. There is a gray area up to 160/90, when real high blood pressure starts. There are various classifications distinguishing between light, moderate, severe and critically high BP. A hypertensive crisis is defined by BPs of higher than 200/100 with symptoms like headaches, visual disturbance and  confusion.

I find these classifications not very helpful. The fact is that, the higher the BP the worse for you blood vessels. The mechanism how the level of pressure damages you blood vessels is probably through the effect of chronic overpressure that will also eventually destroy the  pipes of your heating system, if you run it consistently with too much pressure.

 

Frequently asked questions:

Does Cholesterol affect blood pressure?

No, there is no direct relationship between your Cholesterol levels and your BP. Both are independent risk factors for heart disease and strokes and if both are up it is particularly bad news for you blood vessels.

Can the BP be different between left and right arm?

Yes, it could be. The best method is to measure initially on both arms. The arm with higher pressure should be chosen for the continuous monitoring.

Can blood pressure be too low?

Yes ,  if the BP is below 100/60 or so some people will be prone to feeling  giddy, tired and weak.

Dehydration, blood loss, excess heat and being young and female can be the cause.

Which reading is more important, the systolic or the diastolic BP?

Both readings are equally important. The diastolic pressure tends to be the more constant figure, whilst the systolic goes up quicker under stress or exertion.

What is the cause of blood pressure?

About 90% of cases of hypertension are not caused by one particular reason. The cause is “multifactorial”, meaning several  determinants like age, sex, genetics, weight, lifestyle, diet and exercise play a role. This form of hypertension is also called “essential hypertension”.

The remaining 10% are caused by abnormalities of the kidneys or their blood vessels or rarely hormone producing  tumors.

What are the symptoms of high blood pressure?

Unfortunately moderate high BP causes little symptoms, that is why is often goes missed. If the blood pressure is very high it can cause headaches, nosebleeds, palpitations and chest pains.

What tests should be done if high BP was detected?

High BP should never be diagnosed by measuring during one occasion. At least 6 measurements on three occasions should be used. The gold standard test is a 24 hours BP assessment, which is reflecting the BP profile under normal daily living circumstances. That test is called MAPA in Portugal.

If blood pressure was established as too high you should have basic blood- and urine tests, an ECG, echocardiogram, scan of the kidneys and a thorough examination by an eye specialist.

Do I always need to take tablets if I was diagnosed with high BP?

No, if the BP is not very high it is possible to try lifestyle modifications.

There are 6 things you should implement:

1 Do not smoke

2 Reduce weight

3 Reduce salt intake

4 Reduce alcohol consumption

5 Reduce stress

6 Increase aerobic exercise

 

If I was started on medication, do I have to take it for the rest of my life?

No, once the blood pressure is reduced significantly and you have changed lifestyle factors one can reduce or even stop medication. In the majority of cases though the patient will go undertreated and not the opposite.

What is the rule of 50s in high BP management?

This rule of 50% reflects the fact that 50% of patients with high blood pressure are never diagnosed. Of the 50% that are diagnosed 50% go untreated. Of the 50% that receive treatment only 50% are treated to a satisfactory level of BP. This rule was used in the UK to enforce more emphasis on good BP management in primary care. You GP in England now will be very keen for you to come every year for a measurement. The days, when high blood pressure was trivialized are finally over and that is good so because high blood pressure is a silent killer.

How often should I have my BP checked, if it is normal?

A good , sensible policy is to have it checked every year. If you are hypertensive you should probably get a machine to self monitor you BP. If you buy one go for the machines with upper arm cuff.

News about antioxidants for health enthusiasts

April 25, 2009
Antioxidants: fountain of good health and youth BACK TO PUBLICATIONS LIST  
   
  ‘One main cause for infections, cancer, heart disease, Alzheimer’s and premature ageing are free radicals ‘
‘One main cause for infections, cancer, heart disease, Alzheimer’s and premature ageing are free radicals ‘

By DR THOMAS KAISER drsnotes@algarveresident.com

Dr Thomas Kaiser is the Medical Director of the Vale do Lobo Medical Centre and is a specialist in traditional General Practice for the whole family, state of the art aesthetic and cosmetic medicine.

YOU MUST have come across the term ‘antioxidants’. One reads a lot about them and the word is used often without explaining exactly what they are.

Here, I will try to shed light on this important medical topic.

The scale of the problem:

One main cause for infections, cancer, heart disease, Alzheimer’s and premature ageing are free radicals – a group of instable molecules that are readily reacting with other molecules. In that process, these chemical structures are being damaged or even destroyed.

Free radicals are a heterogeneous group that contains reactive oxygen and nitrous groups.

The damaging reactions are mostly oxidations. You can watch this chemical process very impressively on a slice of apple that turns brown when exposed to oxygen. The brownish colouration is caused by free radicals. Rust on metal is another example for oxidative processes. In your workshop, you may have used antioxidants already with great success in removing rusty spots from your bike or car.

Free radicals cause damage in our organism all the time when metabolic processes take place.

Conditions that increase the number of free radicals are smoking, pollution, too much food and sun, stress, excess exercise, unhealthy nutrition and chronic inflammation.

Our body has several mechanisms to counteract the damaging effect of free radicals. The better these mechanisms are developed, the healthier and fitter we are.

The molecules and substances that are protecting us from the effect of free radicals are called antioxidants. These molecules are found in vitamins, minerals and trace elements like zinc and copper. These substances can partly be produced in our bodies self sufficiently, but, in other cases, we rely on supply from food and drinks.

How much antioxidants a human body needs has been a debate for decades and great scientists, like Linus Pauling who received the Nobel Prize twice in his career, have advocated the usage of very high dosages of vitamins. Pauling was known to take up to 30g of vitamin C daily (30 high dose tablets).

Other experts doubt the use of high dose vitamin and mineral supplementation. The scientific data show though, that providing that you use good quality supplements, the benefits far outweigh the dangers. The possible risks are toxic reactions from high doses of vitamins E, D, K and A.

How can you find out how many antioxidants you have?

Antioxidant levels can be measured in blood samples. These measurements are rarely done because the values fluctuate from one moment to the other and have been shown to not be very reliable. A new method seems to have overcome this difficulty. The BioPhotonic Scanner measures the quantity of Carotenoids in the skin, which correlates well with the total antioxidant capacity of the person tested.

The method is quick and painless. Results are available within five minutes.

That way, the doctor or nutritionist can assess if the patient’s immune system is running at its best or if it could do better.

At the moment, there are only three scanners available in Portugal. Two of them are in the Medical Centres in Vale do Lobo and Quinta do Lago. In the US and Europe, several million patients have already been tested successfully.  

What can you do if you are not scoring well?

General measures to improve your antioxidant levels include healthy food, regular moderate exercise, enough sleep, a good amount of positive stresses, and less pollution in your environment.

More specific measures include the prescription of vitamin and mineral supplements.

We know that a lot of patients are already taking supplements but measuring the scores of millions of people with the BioPhotonic scanner has shown that only a minority of users achieve optimal results with their medication. Your doctor can help you improve your antioxidant levels by recommending a comprehensive regime of lifestyle changes, prescribing the right combination and amount of vitamins and minerals for you.

Finally, unfortunately I have some bad news for you. If you should be taking Ginkgo Biloba to improve your memory, you can stop. It does not work. In patients with existing cardio-vascular disease, it does even increase the risks. A large study which followed patients over seven years showed these disappointing results. You can read the details in JAMA’s latest issue.

I would like to wish you all a peaceful and harmonious Christmas and all the best for the New Year.

Dr Thomas Kaiser can be contacted by telephone on (00351) 289 398 009 or by emailing drsnotes@algarveresident.com

Try running every morning in a leasurely way, before breakfast. You will start the day in excellent spirit.

April 24, 2009
The best ways to exercise BACK TO PUBLICATIONS LIST  
   
  ‘Many have forgotten how good they feel after a game of squash, a good swim or a run’.
‘Many have forgotten how good they feel after a game of squash, a good swim or a run’.

By: DR THOMAS KAISER

medicine@the-resident.com

Dr Thomas Kaiser is the Medical Director of the Vale do Lobo Medical Centre and is a specialist in good traditional General Practice for the whole family, state of the art aesthetic and cosmetic medicine.

Dear Reader,

We all know that exercise is great fun and very healthy.

Recent studies have demonstrated that exercise has far more benefits than previously thought.

Not only does it prevent heart disease, strokes and obesity, but it also has protective powers against cancers, depression, erectile dysfunction, dementia and diabetes.

It has also become clear that you do not need to become a tri-athlete or marathon runner to enjoy these benefits.

Rather the opposite is true.

Three to four sessions of moderate exercise per week seem to have the best effect.

Despite all that knowledge, exercise is much underused as preventive medicine.

I believe one reason is that people are not choosing a sport they really enjoy and many have forgotten how good they feel after a game of squash, a good swim or a run and how rewarding these sore muscles can feel.

Here a few tips about how you can make the most of sporting activities.

Choose an activity you really like and one that you can realistically carry out on a regular base. Skiing would be the wrong choice if you live in Faro.

Make sure this activity is compatible with you private and professional life. If the whole family can join in, you are much more likely to stick to it.

Make sure the sport is safe for you and go to your doctor for a pre-exercise medical.

Use an expert to help you learn if you are new to the field. That time and money is mostly well invested and also likely to help you enjoy yourself more.

Expect a bit of pain and frustration in the beginning and do not be put off by it. You will soon become conditioned and better skilled.

Establish clearly what you expect from the exercise you are about to take up. Is it fitness, fun, weight loss or an enrichment of your social life? You can choose better if you know exactly what you want.

Set yourself realistic little goals and develop a training plan accordingly. Achieving your desired aims is highly motivating. This is also an area where an experienced professional can be very helpful.

Consider participating in competitions. You can only really improve when you try out your newly acquired skills under a bit of pressure.

Competitions can also be great fun not to mention the envious looks your friends will give you when seeing your trophies in the cupboard.

Try joining a group for your training. That way it is more fun and you are also likely to suffer the positive effects of peer pressure.

Change you training regularly, every three to six months. If you always do the same, you will not improve and get bored.

Train all the components of a good physical condition. These are endurance, power, speed, flexibility and co-ordination.

The Algarve is really a paradise for every taste when it comes to sport and exercise.

We are also lucky that many very skilled instructors, trainers and professionals live and practice in the area.

Dancing is a super exercise form. You should do it more often.

Get inspired and see great local and international talent at Dançart, the annual contemporary and classic dance competition, held at the fantastic Teatro das Figuras in Faro this weekend (March 14 to 16).

Dear reader, the spring has almost arrived and with it all these exciting positive feelings. Let us make the most of it.

Best health wishes,

Dr Thomas Kaiser

For more information, please call Dr Kaiser on 289 398 009.

A unique opportunity

You could join Rosemary Conley, one of the UK’s best-known fitness and diet experts, and Dr Kaiser for a week of sport, health, pampering and fun in June.

They will run a special fitness and health week in Vale do Lobo from June 1 to 8.

Please call 289 398 009 for more information.

Hello world!

April 24, 2009

 

 

Exciting times for the Algarve. Dr. Kaiser and Information technology guru Tarik have tonight started the blog health revolution for the people in the South West of Europe.

Do not miss their daily blog comments about health, wellness and fitness.

 

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Our suggestion today, to spice up your cultural program of the weekend: Watch the fantastic movie “Revanche”.