Laughter; the best medicine

A study done at Oxford University by a professor of evolutionary psychology have shown that laughter causes the release of natural opiates. After watching funny videos people's pain thresholds went up but not if they viewed factual documentaries. We tend to view laughter as an emotion but it is in fact a form of exercise and by doing this type of exercise where we perform repeated forceful exhalation of air from our lungs by using the diaphragm we increase the production of endorphins which in turn will increase the pleasure of being made to laugh

Proceedings of the Royal Society 2012

Thoughts on assisted dying

This article was written by a friend of mine, Dr Duncan Stewart

Three elderly clerics are discussing the point at which Life begins.  The Anglican, slightly pompously, begins with “As soon as a newborn baby cries, Life has started.”  “Oh, No” responds the Catholic priest, who presumably has no firsthand experience of conception, “Life begins much earlier. It starts when the sperm fuses with the egg” They both look at the Rabbi who strokes his beard and slowly announces “In my opinion Life begins when the children leave home and the dog dies.” A very important debate about the end of life, with some equally whimsical moments, is swirling around the corridors and leather benches of our Parliament . The supporters of Assisted Dying are making progress in spite of sustained opposition to a change in our laws from senior religious figures whose predecessors obstructed the passing of more progressive social legislation than any group except the aristocracy.

It is generally agreed that life has ended and the undertaker can confidently be called when the heart beats for the last time .There is  less agreement about  those “not quite dead” states in which death is both inevitable and imminent , as  when other organs like the liver and kidneys fail or that “Old man’s friend ” pneumonia intervenes. Fortunately, in these forms of terminal illness, pain is not a prominent symptom so fewer ethical problems arise. We all fear uncontrolled pain but sufficient doses of  opiate drugs can control any pain and if the dose required causes a coma that is only ended by death , so be it. But what if you have a condition which is not only painful and terminal but has deprived you of speech, movement and continence? What then? If you could somehow summon effective help in such a situation, you would not request the presence a homeopath nor a priest, you require the help of doctor with a syringe driver full of Morphine .

  I can understand the importance to a   believer in an afterlife of being reassured  of this by the his priest but we live in an increasingly secular society so why does  religious thinking still dominate this territory? The opportunity to rob your neighbour, murder his noisy children or seduce his wife, has now passed.  In any case why do God’s earthly representatives object to doctors relieving pain and anguish  when all  the other  parties involved ; the patient, physician  and relatives , have all agreed after much careful debate that to end  life remains  the only humane act? I refuse to accept that anyone’s god is going to be seriously offended if a few souls smelling strongly of barbiturates reach him a few days ahead of schedule.

For myself, I imagine my final day lying in a comfortable bed surrounded by friends and family sorry to see me go but thinking, perfectly reasonably, about my last will and testament.  As  life slips  gently away I  will be reviewing my few successes , my many more numerous acts of timidity and unkindness and finally trying to compose a  witty last utterance. Maybe.

Forget the rising cost of living and ponder on the cost of prolonged dying.  I intend  to  vote for whoever wants to repopulate the House of Lords and legalize Assisted Dying and to  give more generously to our 2 superb local hospices, The Martlets and The Beacon to whose running costs our parsimonious government contributes only a miserly  30%. I will also check that my having made a Living Will, which lawyers refer to as an Advance Decision, is known to my family, solicitor and GP. This simply states one’s wish not to be resuscitated where this is clearly inappropriate and while it cannot override existing legislation it may help all who participate in that decision. You can download the paperwork very simply. I will also dust off my organ donor’s card in case any of my organs have a bit more mileage left in them.

You are probably aware that Switzerland, Holland Belgium and Luxemburg have succeeded in creating carefully crafted legislation which acknowledges the right of some, but by no means all, terminally ill and seriously disabled people, to decide when their life ends. Three states in the overtly God-fearing USA : Montana Washington and Oregon allow assisted suicide in similar situations. Simply wishing to die clearly does not qualify, it is suicide.

 Our 3 clerics would all have accepted the Paediatricians’ assertion that the first 12 hours of life, whenever it starts, are the most dangerous; but they are not as hazardous and uncertain as the last 12.  RIP

Physical activity should be done in moderation to look after your joints

People who engage in excessive high-intensity physical activity and those who do very little physical activity might be damaging their knee cartilage, according to research presented at the Radiological Society of North America 98th Scientific Assembly and Annual Meeting.

The loss of cartilage is progressive and irreversible. "Once the cartilage is gone, it is gone for good and cannot be recovered," said senior author Thomas M. Link, MD, PhD.  "This is why it is so important for people to do physical activity in moderation and to use safe practices when they do sports such as running and playing tennis. He also said  "I have seen people in their 20s who have completely destroyed their cartilage surface and I wonder what is going to happen to them. They are going to live another 50 or 60 years. They cannot walk on bone, so they will need a total joint replacement, perhaps several, over their lifetime. Each time the bone gets thinner and weaker because bone does not react well to total joint replacement. This is going to become a serious problem," he said   "People need to learn how to protect their joints when they do physical activities, he said. "People should be active, but they should make sure they're exercising in a safe way and not destroying their joints."

Radiological Society of North America (RSNA) 98th Scientific Assembly and Annual Meeting: Abstract LL-MKS-SU1B. Presented November 26, 2012.

Packing up smoking

Patients with spinal disorders who quit smoking may experience substantial improvements in back pain

Caleb Behrend, MD, from the University of Rochester Medical Center in New York, and colleagues present their findings in an article published in the December issue of the Journal of Bone & Joint Surgery.

The authors mention that smoking has been identified as a modifiable risk factor for chronic pain disorders. "Furthermore, with regard to chronic pain disorders, smokers have reported an increased magnitude of pain when compared with nonsmokers," the authors write. 

In the study, the authors reviewed questionnaires for 5333 patients . Patient-reported pain scores were assessed using a visual analog scale (VAS) of 1 being the least pain and 10 being the worst.

Compared with never-smokers, current smokers reported significantly greater pain scores at the latest follow-up ; mean VAS score, 4.49. 

Patients who quit smoking reported significantly greater improvements compared with current smokers in worst weekly pain.

In addition, nearly 2-fold more patients who quit smoking reported a more than 30% decrease in worst pain than current smokers (32.0% vs 16.6%), and never-smokers reported a greater mean improvement in disability. 

It was concluded that smoking cessation programs are needed to improve chronic pain among patients with spinal conditions. 

J Bone Joint Surg Am. 2012;94:2161-2166. Abstract

If you'd like help reaping the rewards associated with giving up smoking NLP and Hypnotherapy can help. Find out more at the Physio Therapy Centre

Taking Glucosamine, Chondroitin, and Fish Oil may reduce inflammation

Regular use of glucosamine, chondroitin, or fish oil supplements reduces high-sensitivity C-reactive protein (hs-CRP) by 16% to 22%, a marker of inflammation, according to a new study. Inflammation is now recognized as a factor in cancer and cardiovascular disease as well as many rheumatoid diseases. A number of over-the-counter dietary supplements are being marketed for the purpose of reducing inflammation, but data supporting the claims are limited.

In an article, published online  in the American Journal of Epidemiology, the researchers report that regular use of glucosamine, chondroitin, or fish oil significantly reduced serum hs-CRP.

In participants who regularly used a supplement, the researchers found hs-CRP reductions of 17%  with glucosamine, 22%  with chondroitin, and 16% with fish oil compared with participants who did not take the supplements. The analyses were adjusted for age, gender, race, smoking history, and body mass index.

Effects Limited to Women

The anti-inflammatory effects of glucosamine and chondroitin in the overall study population were driven by effects in women. Effects in men were small and nonsignificant.

The supplements methylsulfonylmethane, garlic, ginkgo biloba, saw palmetto, and pycnogenol were not associated with reduced inflammation.

Am J Epidemiol. Published online November 8, 2012. Abstract

A study of the effects on mortality of muscle strength in young people

CLINICAL CONTEXT

Although multiple studies have focused on the relationship between aerobic fitness and the risk for mortality, less research has been conducted on the possible association between muscle strength and mortality outcomes. Ruiz and colleagues addressed this issue in a study published in the July 1, 2008, issue of the BMJ. They found that higher muscle strength in the legs and chest among men between 20 and 80 years old was associated with reduced rates of overall mortality and cancer mortality. After adjustment for the degree of cardiorespiratory fitness, muscle strength did not significantly affect the risk for cardiovascular mortality.

Young adults have a very different epidemiology of mortality vs middle-aged and older adults. The current study by Ortega and colleagues evaluates the effect of muscular strength on the risk for early mortality among young people.

STUDY SYNOPSIS AND PERSPECTIVE

It is well known that hypertension and high body mass index during adolescence are associated with premature mortality. Now, a long-term prospective study of more than a million Swedish adolescents has turned up yet another risk factor: low levels of muscular strength.

The study was published online November 20 in the BMJ.

The authors of the study, led by Francisco Ortega,  point out that muscle strength in adulthood has been linked to all-cause and cardiovascular mortality in adults. Until now, however, similar data have been lacking in adolescents.

Similarly, they say, better cardiorespiratory fitness is associated with better mental health in adults, but there has been scant evidence whether muscle strength at any age is associated with future mental health and suicide mortality.

"This study provides strong evidence that a low level of muscular strength in late adolescence, as measured by knee extension and handgrip strength tests, is associated with all cause premature mortality to a similar extent as classic risk factors such as body mass index or blood pressure," the researchers write.

Ortega and colleagues followed up 1,142,599 young men aged between 16 and 19 years who were evaluated for service in the Swedish military. During a median follow-up of 24 years, the researchers assessed the extent to which muscle strength in adolescence was associated with all-cause premature mortality, which they defined as death before age 55 years. 

Participants who scored high on the knee extension and handgrip muscle strength tests had a 20% to 35% lower risk for death from any cause and from cardiovascular disease compared with those who scored low on the strength tests. Further, the researchers note, those differences were independent of body mass index or blood pressure status.

Ortega and his colleagues conclude, "Low muscular strength should be considered an emerging risk factor for major causes of death in young adulthood."

BMJ. Published online November 20, 2012. Full text

STUDY HIGHLIGHTS

• Study data were drawn from Swedish military conscripts registered between 1951 and 1976. Researchers focused on individuals who were 16 to 19 years old at the time of baseline testing.
• Participants also completed strength testing at baseline, including handgrip, elbow flexion, and knee extension power.
• Participants were observed until the time of death or immigration away from Sweden. Death registers were used to follow the main study outcome of early mortality, which was defined as death before age 50 years.
• Researchers focused on the relationship between muscle strength at baseline and mortality outcomes, with particular attention to death from suicide, cardiovascular disease, and cancer.
• The study outcomes were adjusted for year of birth and conscription office.
• 1,142,599 men provided data for study analysis. The mean follow-up period was 24.2 years.
• 26,145 men (2.3% of the study sample) died during follow-up. Suicide and unintentional injuries comprised nearly half of the deaths recorded. Cardiovascular disease was responsible for 7.8% of deaths, and cancer accounted for 14.9% of deaths.
• Overall, higher levels of muscle strength reduced the risks for early overall mortality and cardiovascular mortality by 20% to 35%, but strength did not affect the risk for cancer mortality.
• A mortality benefit of improved muscle strength was evident regardless of body mass index at baseline.

Keep your heart healthy with the BBC

Activity for a healthy heart

Patsy Westcott

Prevention is always better than cure. This section outlines how regular exercise can give you a healthier heart and how relaxing can help reduce stress levels.

• Healthy heart
• Active heart
• Aerobic exercise
• Resistance training
• Flexibility
• Where to exercise
• Safety first

• 
  

Healthy heart

Educating people about the risk factors of heart disease and persuading them to adopt a healthier lifestyle can have an impact on the number of people dying from heart disease and stroke.

Encouraging people to stop smoking, drink less, eat better and exercise regularly are particularly important. Doctors can help by asking about smoking habits and encouraging patients to use nicotine replacement treatment, such as nicotine patches.

Even if you've already been diagnosed with heart disease, making lifestyle changes can help you live a longer, healthier and more enjoyable life.

Active heart

Being active is essential for a healthy heart for the simple reason that your heart is a muscle. Even if you haven't been active for some time, your heart can become stronger so it's able to pump more efficiently, giving you more stamina and greater energy. Becoming more active will also improve the ability of your body's tissues to extract oxygen from your blood, help you maintain healthy levels of blood fats and speed your metabolism.

If you are overweight, you're 80 per cent more at risk of heart disease. The best way to control your weight is to eat a healthy diet and take regular exercise.

Three types of exercise are vital for all-round fitness: aerobic, resistance training and flexibility.

Aerobic exercise

Aerobic, or cardiovascular, exercise is particularly important in the prevention of coronary heart disease. This is any kind of activity that increases your breathing rate and gets you breathing more deeply. These activities include walking, running, swimming, dancing or any of the aerobic (cardiovascular) machines at the gym, such as the rowing machine, treadmill, stepper or elliptical trainer.

These are designed to increase the strength of your heart muscle by improving your body's ability to extract oxygen from the blood and transport it to the rest of the body. Aerobic exercise also enhances your body's ability to use oxygen efficiently and to burn (or metabolise) fats and carbohydrates for energy.

Resistance training

Resistance training helps to make your muscles stronger, strengthens your bones and protects your joints from the risk of injury.

This type of exercise can involve the use of free weights and weights machines such as those found in the gym, or any kind of activity in which you load your muscles. For example, carrying heavy shopping bags or exercises such as press-ups, lunges and squats, and some of the yoga exercises in which you use your body weight, are all good for resistance.

Resistance training doesn't increase the fitness of your heart like aerobic exercise, but it can help to control your weight because muscular tissue burns more calories than fat.

This type of exercise isn't recommended for people with uncontrolled high blood pressure or heart disease, so if you are affected by those conditions, check with your doctor.

Flexibility

Stretching helps relax and lengthen your muscles, encourages improved blood flow, and helps to keep you supple so you can move more easily. Experts say it's good to stretch for five to 10 minutes every day.

There are a number of simple stretches you can find in virtually any book about exercise, or be taught by the instructor at the gym.

If you want more organised stretching, yoga and Pilates are safe and gentle for people with heart problems, as they help calm the mind and body and reduce stress. That said, there may still be some exercises or postures that are not recommended if you have heart disease, so check with your doctor first and tell your instructor if you have high blood pressure or heart disease.

Where to exercise

There's no need to join a gym or take part in organised sport, unless you want to. Simply incorporating more activity into your daily life and doing activities such as walking, gardening and cycling can be just as effective as a structured exercise programme.

Your aim is to be moderately active for 30 minutes most days of the week. If you find it hard to fit this into your life, split it up into shorter periods. You should feel that your heart rate is increasing and that you're breathing more deeply and frequently. You should be able to walk and talk at the same time - if you can't, the activity is too strenuous.

Safety first

If you experience any or all of the following, stop exercising immediately and consult your doctor:

• Chest pain
• Dizziness, light-headedness or confusion
• Nausea or vomiting
• Cramp-like pains in the legs (intermittent claudication)
• Pale or bluish skin tone
• Breathlessness lasting for more than 10 minutes
• Palpitations (rapid or irregular heart beat).
• Continued fatigue (lasting for 24 hours or more)
• Fluid retention (swollen ankles, sudden weight gain)

Disclaimer

All content within BBC Health is provided for general information only, and should not be treated as a substitute for the medical advice of your own doctor or any other health care professional. The BBC is not responsible or liable for any diagnosis made by a user based on the content of the BBC Health website. The BBC is not liable for the contents of any external internet sites listed, nor does it endorse any commercial product or service mentioned or advised on any of the sites. See our Links Policy for more information. Always consult your own GP if you're in any way concerned about your health.

On your bike..

Just read an interesting article on why riding a bike is pretty special. The rite of passage from little kid to big kid when you get your first proper bike, dump the stabilisers and whizz away.

Interesting work by researchers in the Netherlands showed that riding a bike can tell us stuff about the brain and how it functions. Patients suffering with Parkinson's disease are often affected with tremors,  involuntary muscle movements and can have problems with balance, co ordination and  limb control. One such patient, a 58 year old man  had "gait freezing"where he was incapable of normal walking, needed visual guides to help him step one foot in front of the other and often lost his balance so that he needed to sit in his wheelchair. Yet put him on a cycle and he was able to ride it with out any problems. The video is available on YouTube and it shows him initially shuffling down a corridor with help and after a few steps he stumbles and falls. The second video shows him riding a bike with no signs of tremor pedaling at a consistent pace with perfect balance and coordination then he gets off the bike and he is once more unable to walk. This phenomenon is called kinesia paradoxia and the study of which  may lead on to different forms of physiotherapy treatment.  Further research is going on to study how the human is able to ride, how the cyclist interacts with the bike and the environment and all the requirements that are need to make what is a very complicated procedure look so simple