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Berwick Area Heart Support Group
January and February 2005 Newsletter
Next meeting February 2nd at the Day Hospital Berwick Infirmary 7pm – 9pm Guest Speaker Jae Jones from PALS The Patient Advice and Liaison Service (PALS) has been created countrywide to offer confidential support and advice to NHS patients North of Tyne PALS has local officers who deal with concerns involving the eight NHS Trusts that cover the area from the Tyne to the Border, from Kielder and the Cheviots to the coast
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Thanks again to Kathy and all her helpers for the lovely buffet they arranged for the December meeting.
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December’s Speakers – “Cardiac Rehab North of the Border”.
Health professionals Jenni Elliot and Diane Edgar crossed the Border in December to give us an account of the gathering pace of cardiac rehabilitation in Scotland. Both are from nursing.
Diane is a ‘clinician manager’ of a team embracing CHD, stroke & diabetes. A consultant, Peter Lesley, heads the team.
For CHD, the system is similar to that in Northumberland, with 4 phases of cardiac rehabilitation. The first phase is the first 5 days in hospital. Jenni is helping organise care for CHD and she stressed the need for follow-up when people get home from hospital (Phase II). After 6 weeks at home there is a return visit to hospital. The plan is then to get people into the next phase (‘Phase III’) [This is a course of exercise and educational talks, and very similar to the course we have at the Swan Centre, which is supervised by Mandy Thompson, from Well Close Clinic.] Nurses have been given key roles in helping to get people with heart disease into a ‘plan for life’.
Diane’s job is to get all the professionals to pull together, not just in the NHS, but involving others in local government, the British Heart Foundation, and additionally volunteer groups such as ours. Rehab organisation is patchy so far and there is still a poor uptake. The scheme needs rehab to be available for everybody. A nurse-led scheme is being put together specialising in dealing with care of Heart Failure. [Heart Failure, HF, can be the result of deterioration in the strength, or action, of the heart muscle, perhaps because of an earlier heart attack. Sometimes the heart enlarges and becomes weak and inefficient.] A lot can be done to restore mobility for HF patients and enable them to obtain the medical and personal benefits of activity. Diane also described the “Chest Pain Clinics” which are similar to these in Northumberland. Specialised nurses do rapid tests and assessments of anybody referred with chest pain
In general the aim is to get patients involved in developing services. [This is where people like us can be useful!] Patients and professionals can attend education and training days. ‘Diabetes UK’ has already shown the way by providing training. There is also scope to extend existing schemes for making emergency procedures, such as ‘clot busting’ available in the home. Overall, there is a great deal of scope for preventing people from having a first or even a second ‘acute event’. Lowering risk is the most effective approach.
The Border is not a barrier to co-operation. Where communities are widely spread and there is the problem of travel, co-ordination is essential. Diane and Jenni actively talk with Alice Whincup who organises the Cardiac Rehab in Northern England. [Alice organises our Phase III courses at the Swan Centre.]
[A note from your Committee; you can be sure we will keep you informed of any future courses you can attend either for Exercise Rehab for yourself, or to keep you better informed about how to manage your own condition and/or to help others. Cardiac rehabilitation is still in its very early days.]
Phil
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Wallys Yarn
Another little ode I came across in my travels
The moral of this, as my tale I unfold
That for me and you who are now growing old
It’s better to say, “I’m fine” with a grin
Than to let folk know the shape we are in.
How do I know that my youth is all spent?
Well, my get up and go, has got up and went.
But I don’t really mind when I think with a grin,
Of some of the places my “get up” has been.
I get up each morning and dust off my wits,
And pick up the paper and read the “Obits”
If my name is still missing, I know I’m not dead,
So I have a good breakfast, and go back to bed.
Click for Wally’s Yarns
Wally
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Recipe of the Month
Kathy’s quiche
So many of you enjoyed Kathy’s quiche at the buffet and asked for the recipe again .
1. 1 ptk. Precooked rice. (flavoured if preferred)
2. Mixed vegetables
3. 250 g Cottage Cheese
4. 3 eggs.
Method.
Partially cook mixed veg. Empty rice into ovenproof dish and spread across base, not too thick. Add mix veg. Mix cottage cheese and eggs together, and pour mixture over vegetables. Bake at about 180 degrees until firm to touch and a nice golden colour as all the good books say.
This is the basic recipe; there are all sorts of variations. I’m sure you will have your own favourite fillings; the good bit about this one is no pastry .So if you watch what you do put in, it could be a healthy meal.
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ARE YOU MANAGING YOUR MEDICINES?
Steve Gray, the pharmacist from Union Brae, was our first speaker in 2005. There was a good turnout.
For many reasons many of us do not always take our tablets. Steve highlighted the fact that 50% of prescriptions are not taken as prescribed. Even transplant patients do not always take the immuno-suppressive medicine on which their life depends because they need the drugs to prevent rejection of the transplant. All together, we waste half the £50 billion NHS drugs bill. Why? Perhaps we do not feel the benefit of the drug. For instance, an improvement in hypertension (high blood pressure) is not something we feel. Also, 80% of patients have some reservation about their medicine and 33% feel there are unwelcome side effects. When asked later, 20% say the side effects are still there. As Steve said, these figures make the pharmacist think!
In Berwick, the Infirmary is a partner in a contract scheme with the local pharmacists started 10 years ago to help manage prescriptions and drug regimes of the elderly (over 75) when they are at home.
Ideally there should be a review once a year for everybody on long term prescriptions. The review should ask:
Are there side effects?
When should particular medicines be stopped?
Are they still necessary?
Are they still working?
For CHD (and or diabetes) our statin intake is important. Some people even give up taking their aspirin.
Members raised the matter of the changing names or packaging and appearance of the medicine. Steve Gray recognised the problem, but the pharmacist cannot control the trade-marking by the drug companies. He told us also of his experience in reviewing local patients drug regimes. Even with only 20 minutes devoted to each case, it took more than a year to look at just 250 individuals
New developments?
“Supplementary prescribing” started in 2004. The GP makes the diagnosis and the clinical management plan (for example for hypertension control) and the pharmacist can prescribe within the boundaries of the plan. Your own chemist will be able to check with your medical records. This new approach is part of an attempt to improve management of chronic (long-term) disease, where patients can expect to be on medication over very long periods.
Steve’s pharmacy is feeling the benefit of new ‘robot’ dispensing kit. Essentially, once the number and type of pills has been decided and the instructions for the individual patient are written down, the machine can find and box and label without mistakes. It is safer and quicker. As the chemist types in the details the machine instantly creates the bar code and gets the pills.
There is a new contract this coming year between the chemists and the NHS. We will notice that the GP can issue a prescription good for 6 months. We will also get help if medicines have been discontinued and we do not need them anymore in the package. (The chemist will benefit from better stock control, which should mean better cost-control.)
Steve gave time to members on individual queries. Thank you very much Steve!
Phil
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Calorie-burning activities for the lazy
Proper weight control cannot be attained by dieting alone; however, many people who are engaged in sedentary occupations do not realize that calories can be burned by the hundreds by engaging in strenuous activities that do not require much (or any) physical exercise.
Here's the guide to calorie-burning activities and the number of calories per hour they consume.
Beating around the bush . . . . . . . . . . . . .75
Jumping to conclusions . . . . . . . . . . . . .100
Climbing the walls . . . . . . . . . . . . . . . . 150
Swallowing your pride. . . . . . . . . . . . . . .50
Passing the buck . . . . . . . . . . . . . . . . . . . 25
Pushing your luck. . . . . . . . . . . . . . . . . 250
Making mountains out of molehills. . . . 500
Hitting the nail on the head . . . . . . . . . . .50
Bending over backwards . . . . . . . . . . . . .75
Running around in circles. . . . . . . . . . . 350
Climbing the ladder of success . . . . . . . 650
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Recipe of the month
Broccoli soup
Serves 4
1 medium red onion - chopped
1 medium carrot - chopped or sliced
½ clove garlic - finely chopped
375mls chicken/vegetable stock
25g uncooked rice
150g broccoli chopped
250mls semi-skimmed milk
Pepper (cayenne works well) to taste
Method.
1. Place onion, carrot, garlic and stock in a pan and bring to the boil.
2. Add the rice, simmer for about 15 - 20 minutes or until the rice is tender.
3. Add the broccoli and simmer until broccoli is just tender.
4. Transfer to blender/food processor and blend until smooth.Return to pan, add milk and pepper.
5. Why not use wholemeal rice to increase the fibre (you may need a little more liquid to cook it through).
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Porridge makes a comeback
The media attention that porridge is getting as part of the new!!! GI "glycaemic index" diet will undoubtedly be followed by TV adverts pushing various "Instant porridges". You can in fact make porridge in the microwave using normal porridge oats.
Recipe for Microwave Porridge
Serves 1
Original, old fashioned or Wholemeal porridge oats
Put a 1/4 pint water or semi skimmed milk in jug
add enough oats to fill the water or milk
cook on full power 2 1/2 - 3 minutes watch for the mixture to rise in the jug as it cooks ,add sugar, salt, milk to taste, it delicious with soya milk.
Real Scotsmen don't add sugar to their porridge, but according to the "Sunday Post" they put jaffa cakes on the top and wait till they melt.
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The oat bran part of the product is particularly useful. Oats have the highest protein of all the food grains (typically 12%, but it can be higher) and oatbran is 17% protein. The oat protein is the most 'complete' and useful of all the different grain protein. Oats are also rich in other useful substances, particularly soluble fibres that tend to reduce blood cholesterol. Highly processed oats, however, might be too easily digested - see below - and you could lose some of the benefit. The latest 'instant oats' are very expensive, usually 12 times the price for the same size bowl of porridge!
The GI diet, was originally designed for diabetics and is often prescribed to cardiac patients. The diet is based on scientific evidence that different sources of carbohydrate raise blood sugar levels faster than others. (However, it is not always easy, scientifically, to get fully reproducible results showing a clear difference between the enormous variety of products that we can buy. Generally, though, white bread or any processed food made with "refined" flour or sugar, is digested very quickly, and rapidly raises blood sugar. We get the "sugar spike". Potato does the same.) The evidence was first identified by Dr David Jenkins, a professor of nutrition at Canada's University of Toronto in 1980. Unlike many other fashionable celebrity high protein, low-carb or fruit-specific diets, the GI diet allows you to eat a variety of different foods including protein, carbohydrates and fats. The difference is that if you no longer eat much of the high glycaemic index (G.I.) carbohydrates then, on average, the energy in the food is released more slowly. Some people find that this reduces the urge to keep on eating, and allows them to feel fuller for longer. White bread and jam, cake or biscuits, for example, seem to stimulate appetite not satisfy it, especially in the first 20 minutes, and lead to "2nd helpings". Try a small experiment!
It is IMPORTANT to note that although FAT is very low GI and does not give you any "sugar spike", a high fat meal does give a "FAT SPIKE", and your arteries notice the effect for hours! (Do not try this experiment!)
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LOWER GLYCAEMIC CHOICES
CARBOHYDRATES
Vegetables
Avocado, lettuce, asparagus, mushrooms, green beans, olives, peppers, onions, broccoli, peas, brussel sprouts, peas, cabbage, carrots, potatoes (boiled new), cauliflower, radishes, celery, sugar snap peas, cucumbers, spinach, aubergine, tomatoes, courgette, leek.
Fresh fruits
Apples, blackberries, blueberries, cherries, grapefruit, grapes, lemons, oranges, peaches, plums, raspberries, strawberries. Fresh currants are wonderful if you can get them, and all the berries, including the wild ones.
Bottled, canned, frozen fruits
Canned peaches in juice or water, canned pears in juice or water, bottled apple sauce (unsweetened).
NOTE. If you drink or eat a lot of processed fruit or juice, especially the sweeter ones, you will take in a lot of sugar very fast compared with chewing 2 or 3 apples!
PROTEINS
Meats
Choose lean cuts or trim off visible fat. Back bacon, beef (lean cuts), chicken breast (skinless), minced beef (extra lean), lean ham. This selection significantly cuts down the 'saturated' fat, even though it does not eliminate it.
Fish
A typical portion should fit into the palm of your hand and be about as thick. All fresh, frozen or canned fish and seafood isa good source of protein, although some of the useful anti-MI fish oil has been lost from much of the canned fish. The list includes bass, trout, sole, sardines, herring, mackerel, salmon, tuna, fresh, tuna tinned in water, dory, cod, haddock, halibut, snapper, swordfish, calamari, oysters, clams, crayfish, lobster, crab, scallops.
Eggs
You can perhaps (?) buy "omega-3 eggs" - eggs laid by chickens who have been fed with foods that have had omega-3 oil, such as linseed, added to them. Eggs are high in protein and very low in fat but the yolks are very high in cholesterol. Probably the yolk cholesterol does not matter for most of us, but if you are worried, the egg-white contains most of the protein and no cholesterol. Any source of omega-3 oil will help a bit in preventing heart attack.
Dairy
Buttermilk, fat-free cheese, low-fat or fat-free cottage cheese, sugar-free frozen yoghurt, sugar-free fruit yoghurt, low-fat and sugar-free ice cream. Whey protein is expensive but is almost pure protein, with the milk sugar and milk fat taken out. (Milk fats are very high in saturated fat).
Vegetarian options
Soy protein powder is the highest value of the plant (vegetable) proteins.. It's great for non-vegetarians too. The purified Soy protein is expensive, but Soya wholemeal, which is less expensive, can be obtained. Soya wholemeal although high in oil is low in saturated fat.
Textured vegetable protein (TVP) is reasonably high in Soya protein and very low in oil, but may have lost some of the other useful Soya substances.
"Peas, beans, lentils are all low GI foods and are very nutritious. Lentils and most types of beans are 25% protein in the dry state. Beans need soaking overnight before cooking, lentils can simply be cooked. The protein will add value to the protein from grains such as oats, rice etc."
DRINKS
Water or filtered or sparkling water is a good idea before and after each meal or snack. Green or black tea (without fat milk) is fine. Tea, particularly green tea continues to get a 'good scientific press' as a source of anti-cancer, anti-heart attack substances. , Coffee (decaffeinated probably has less diuretic effect), sugar-free soft drinks, skimmed milk, fruit juice with no added sugar, and in moderation - see the note above, are 'low GI' alternatives.
FATS AND OILS
Nuts are 'low GI' and good sources of proteins and minerals, but generally are high or very high in oil. Fresh almonds are very low in saturated fat, and are probably good for hearts and arteries. Hazelnuts are also nutritious. Walnuts also get a very 'good scientific press' as anti-heart disease food and have some omega3 oil. Linseed (the Americans call it flax seed) is rich in omega3 and can be taken in small quantities as crushed seed. (If you buy the food-grade linseed oil, it must be stored in the fridge, otherwise it becomes more useful for cricket bats). Olive oil is a good substitute for 'vegetable oil', for salads or dressings generally. Rapeseed oil is a good choice for cooking oil. Margarine without trans-fats and based on olive oil or polyunsaturated oil can be taken sparingly.
Phil & Terry
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