Summertime!

 

With all the hot weather recently, I have decided to focus a little on the impacts that a warm summer might have on our health. (Cue thunderstorms and rain). Many associate summer with some of the finer things in life – trips to the coast, beautiful clear skies, Pimms and a high concentration of bank holidays. For others, it means unbearable heat, vicious sunburn, stifling sleepless nights, sun cream all over your clothes and the long agonising wait for the start of the domestic football season to begin again.

In order to enjoy the positive aspects, I have put together some tips on staying healthy through the change in environment during these warmer months.

Let us start first with how our bodies regulate heat. The word homeostasis is used to describe the way the body maintains balance in various processes, including electrolytes in the blood and blood pressure. Part of this homeostatic balance however is related to thermoregulation. In other words, the body’s constant battle to keep its core temperature stable within quite fine margins – around 37.0 degrees on average. Any higher or lower than ideal and this begins to affect many of the normal processes going on in the body at any one time. For example, diabetics tend to absorb more insulin in warmer weather and so a closer eye on insulin doses is required.

Our main tactic in controlling temperature, at least in losing heat, is through the process of sweating. As we sweat, the water from our tissues takes heat from beneath the skin, and the heat energy is lost as the sweat then evaporates. It stands to reason therefore that, in warmer weather we sweat more and so our requirements for fluid go up. Normally we should be drinking 6 to 8 glasses of water each day (about 1.2 litres) but in warmer weather, we should increase this to allow for the extra fluid loss. It is no surprise that summer is kidney stone season, with twice as many presentations when compared to the winter months. This is in part due to greater rates of dehydration but also, as your skin gets more sun exposure, you produce more vitamin D which in turn increases calcium absorption and promotes the build-up of these stones in the kidneys.

Although not particularly hairy when compared to most mammals, the small hairs that cover our skin also help in the process. If our body decides it needs to lose heat, signals from the hypothalamus in the brain prompt the hairs to flatten across our skin. Conversely, if we need to warm up, the hairs stand on end (hence goosebumps) thus creating a tiny layer of air trapped in amongst them to warm us up a bit.

If we are getting too hot, our heart rate tends to speed up in order to speed the circulation from the core out to the peripheries where the heat can be transferred from the body through our skin.

As you can see, we have some inbuilt mechanisms to prevent ourselves from becoming overheated, but sometimes that is not enough. Heat stroke can be nasty and causes headaches, dizziness, confusion, cramps, and pale clammy skin. If this happens on a warm day, lie down in a cool shaded place, try to cool the skin with water and a fan, and drink lots of water or rehydration solutions (you can get these over the counter at any pharmacy or supermarket and are good to have handy, particularly on holidays in the sun). If this is not improving things within half an hour, or if you are concerned, you must seek urgent medical attention.

To keep cool in general, avoid prolonged exposure in the sun (fairly obvious), wear a hat to provide some shade, make sure you are well hydrated and avoid drinking too much alcohol which can dehydrate you.

At night, warm temperatures can really disrupt sleep, leaving you tired and unrested the next day. If flipping the pillow to the cool side isn’t quite cutting it, you could try the following measures.

  • Start when you get up… close the blinds and keep windows closed during the day if it is hot outside to prevent heat building up inside.
  • Avoid a heavy meal, especially with spicy food before bedtime.
  • Drink cold water, but not ice cold as sometimes this can confuse the body’s normal heat losing measures.
  • Take a tepid shower before bed.
  • Use light, cotton bedding
  • Encourage air flow with a fan
  • You can even put your bedding in a bag and then in the freezer for a bit so it is extra cool at bedtime.

Summer’s drawbacks are not always directly related to heat though. The other big drawback is hay fever. This is a real menace for many people and ranges from the very mild to the debilitating. The most severe cases require specialist input with immunotherapy. It is not a new problem and even as far back as the 9th Century, numerous remedies were put forward, some more successful than others. Inhaling tobacco, chloride of ammonia, chlorophorm or using cocaine spray never really caught on.

Classically, hay fever causes sneezing, coughing, runny nose and itchy eyes but it can manifest itself in other ways too. Loss of smell, headaches around the temples and forehead and tiredness can also be signs.

Over the counter remedies are often your best option to treat these, such as anti-histamines and eye drops but you can alleviate some of the symptoms even more by following these steps:

  • Use vaseline under the nose
  • Don’t dry your clothes outside (so they don’t pick up all the pollen)
  • Keep the windows shut and stay indoors when you can on days with a high pollen count
  • Use wrap around sunglasses
  • Vacuum and dust regularly
  • You can even get fit pollen filters for your car air conditioning

Hopefully for the most part, all of the negatives of summer are outweighed by the positives but if you follow the above steps, it will make things even easier on your body. And in some cases, the sun can even improve things. Those with skin conditions like eczema and psoriasis will see an improvement in their symptoms due to the increase UV exposure (UV phototherapy is a recognised treatment for psoriasis). Having said that, for most cases you should protect your skin from the sun as much as possible. Sun cream is essential and, if you neglect it, in later life you will be far more prone to damaged and unhealthy skin, not to mention a far greater risk of skin cancer. You have been warned.   

The Pancreas

While the pancreas may not be one of the A-listers or showstoppers of the organ world (if there is such a thing), it is as important as any other cog in the system. For a long time, perhaps owing to its position behind the stomach, its true function was completely unknown. It is curious in appearance, shaped a bit like a leaf and rubbery in texture (apparently). This gave rise to a certain vagueness in its naming – it means ‘all flesh’ in Greek. Until the late nineteenth century, many thought its only function was as a shock absorber in the upper abdomen just below the ribs and the sternum.

 

 

The discovery of a sneaky duct that connects it with the first part of the small intestine was the first clue that it might have a deeper role. It was then discovered that the pancreas secretes a rich cocktail of juice and enzymes through this duct and into the intestine in order to help with our digestion. Specifically it helps in breaking down fats (with an enzyme called lipase), starches (with amylase) and proteins (with various different proteases). Basically, anything with ‘ase’ at the end generally means it is an enzyme of some form or other.

This is important because, without the ability to break these dietary components into smaller building blocks, we would not be able to absorb them from the intestines into our bloodstream. In addition, the pancreas produces lots of bicarbonate (an alkali) to neutralise all of the acids secreted in the stomach so that once your food gets into your intestine, it is at optimal pH for absorption.

That role alone is extremely useful you might say, but the pancreas is not finished there. While its function in digestion relates to what is known as the exocrine system (essentially ‘exo’ means outside and the digestive system is classed as ‘outside’ because it begins and ends outside!) the pancreas has a vital endocrine role. Endocrine relates to the travels of hormones throughout the closed circulatory system, i.e. the blood.

In those years where scientists considered the pancreas to be nothing more than a glorified cushion, hormones controlling the body’s sugar levels were thought to be pumped into the circulation from the brain. This idea persisted until a chap called Langerhans identified in 1869 an area of tissues in the pancreas different from the rest. When these areas were (rather cruelly) removed under anaesthetic from dogs, the animals went on to develop features of diabetes.

Through various means subsequent to this, it was proved that these ‘islets of Langerhans’ (useful to know for pub quizzes) secreted hormones, the first of which discovered was named insulin after the Latin term for ‘islands’. We now know that the pancreas also produces a second hormone called glucagon as well. As part of the endocrine system, these hormones are secreted from the pancreas into the bloodstream and it is here that they perform their vital work.

Insulin helps the cells around the body to take up sugar from the blood stream to use as fuel and also helps to store it in the liver. Glucagon performs the opposite role, mobilising energy stores in the liver and fatty tissue for those days when we’ve not had time for lunch or have decided to run a marathon.

In this way, to use a rather crude comparison, the pancreas is a bit like the national grid. When it receives certain signals that more energy than usual might be required, like going for a long run (just as TV coverage of a royal wedding, for example, might cause a surge in electricity uptake, to keep the national grid analogy alive), it prepares by secreting more glucagon to draw from the reserve of energy we keep stored in our livers and fatty tissue. If, on the other hand, we are providing more energy than we need by eating lots of sugar, the body switches to insulin to use up the sugar being eaten and store any spare energy left over. 

So evidently the pancreas when it is working well is extremely important. When it is not, diabetes can result. But what else might go wrong?

Sometimes, the pancreas can become inflamed and this is known as pancreatitis. Every medical student will most likely know (or at least have heard of) the pneumonic GET SMASHED. Each letter represents a potential cause for pancreatitis, the two most common being Gallstones and ETOH or Excessive Alcohol. ‘S’ stands for Scorpion venom and, as there are not many scorpions running around Henley, I’ll not dwell on that too much.

Pancreatitis can range from the mild to the severe and can even be life threatening. Symptoms include severe upper abdominal pain going through to the back, nausea and vomiting. You may also sometimes get a fever and also diarrhoea. It often results in a stay in hospital where you can receive pain relief, fluids and oxygen if needed.

The other main condition affecting the pancreas is cancer. Pancreatic cancer is the UK’s 11th most common cancer and tends to affect those in older age groups more. Around 9,600 people in the UK develop pancreatic cancer each year.

The big issue with pancreatic cancer that gives it a high mortality rate is the difficulty in its detection. This means that it is often picked up only at later stages. Researchers are always looking for effective tests that might be used as a good screening tool, but as yet none has been found. The symptoms are often very vague but include…

-Weight loss

-Dull, boring pain or fullness in the upper abdomen which can go through to the back as well

-Jaundice, often without pain or any other symptoms (this occurs because of the pancreas’s proximity to the bile duct which, if pressed on, causes a back-up of the pigment bilirubin in the blood.)

One in ten cases may have a genetic element so, if a family member has had pancreatic cancer younger members may sometimes be screened.

If you are at all concerned about this, it is of course always worth coming to see your GP for a check.

As always, there is always more to learn. Even now, research is being done into other hormones produced by the pancreas which may perform roles as yet unknown, thereby, in the future, potentially opening up different possibilities for the treatment and understanding of various diseases, including diabetes. For that reason alone, I think the pancreas deserves a little more time in the limelight.

 

 

 

 

 

Heart and Soul

“Normally about the size of your fist (unless you’re Donald Trump)”

To say our bodies are complicated is somewhat of an understatement. The number of processes each one carries out every second is staggering. From managing all the thoughts racing through your brain, digesting last night’s dinner, pumping oxygen into the blood from the outside world and contracting a select group of muscles just to stop you from falling over, it is in perpetual activity even if it doesn’t always seem like it. The organs of the body take on all these different roles, each one vital to the workings of all the others.

For now, however, I will focus on one of the most vital of all our organs – the heart. For obvious reasons, it is pretty useful. With every beat, it pumps blood into the arteries taking with it all the vital components of the blood into your tissues and all the other organs of the body as well. Indeed so vital is its role that it is little wonder it has adopted an almost spiritual role. We’re often told to follow our hearts – though this makes little sense in literal terms – and apparently that’s where home is as well. Part of the reason the Aztecs most commonly extracted people’s hearts as a form of sacrifice was their belief that it was the seat of the individual, more so than the brain, a belief shared by classical philosophers such as Aristotle.

In reality, the only bearing it has on our thinking and individuality is in its relationship with the brain – without the heart, the brain would be nothing. Normally about the size of your fist (unless you’re Donald Trump), it is made up mostly of muscle and comprises four chambers. Two of these called the atria and these sit atop the two larger ventricles, which do most of the pumping. The right atrium and ventricle take returning blood from the veins of the body and send it straight out to the lungs to be resupplied with oxygen. From there, the blood returns to the left atrium and then left ventricle, where it is given a final push into the body to do all of its good work. Generally it takes around 20 seconds for blood to circulate round the body before it gets back to the right atrium again.   

To prevent back flow, there are several valves and, as these close, they cause the characteristic sound of your heart beating that we can listen to more closely using a stethoscope. Often we can pick up whether there is a bit of turbulence in the system if the valves are not functioning properly – ie a heart murmur.

If all is well, your heart will beat regularly and the signal for this comes from within the heart itself, from a collection of cells in the atria (called the sino-atrial node). Electrical impulses originate from here and spread like a circuit through the heart tissue, making the muscles contract in time with each other. In a lifetime, you can expect your heart to beat around 3 billion times, or 115,000 times a day. When the tissue that conducts these electrical impulses throughout the heart muscle is damaged, this can sometimes result in funny rhythms, or arrhythmias, of which there is a spectrum varying from serious to not so serious. Ultimately, the beating of the heart is governed ‘in house’ and though signals from the brain can stimulate it to speed up and slow down, the rhythm originates from the heart itself which is why, if a heart is removed from the body, it will continue to beat on its own for a little while.

Inevitably with such an important role, when things go wrong, we tend to know about it. In the past, infectious disease tended to be the leading cause of death but, since the middle of the last century, heart disease rose considerably, overtaking infectious disease (certainly in the developed world) as the biggest killer. However, due to plenty of research and advances in healthcare, in the last 15 years death rates from heart disease and stroke have reduced by about 50%. It is still the leading cause of death in males between the ages of 50 -79 years old and, though more common in men, heart disease is something we should all, including women, be thinking about.

Heart disease is a term thrown around a lot but what is it exactly? It falls into a broader category of cardiovascular disease which encompasses things like stroke as well. Essentially the main issue for any cardiovascular disease is the process in which arteries become blocked resulting in loss of blood flow to the areas these arteries supply. When the area that blocked arteries supply is heart muscle, we call this ischaemic heart disease. (Most strokes occur when blood supply is blocked to a part of the brain).

When an artery supplying heart muscle (coronary artery) is partially blocked, the heart needs to work harder as one exerts oneself. If the supply cannot meet the demand, this gives rise to chest pain which resolves when rested. This is angina.

When a coronary artery becomes blocked and blood supply is cut off completely, this results in chest pain not relieved by rest (often accompanied by nausea, shortness of breath, sweating and a feeling of impending doom), and areas of heart muscle can die. This is a heart attack, also known as a myocardial infarction. (myo = muscle, cardia = heart)

Following damage or weakening of the heart muscle (sometimes due to valve problems), the heart sometimes beats less powerfully than before and can result in reduced cardiac output that doesn’t meet the normal demands of the body. This can result in fluid build-up in the legs and reduced exercise tolerance and is known as heart failure.

The process that blocks the arteries is known as atherosclerosis which is essentially a build-up of fatty material that circulates inside your blood vessels. Over time, this atheroma gradually accumulates, like a natural dam in a stream, and restricts the blood flow, often without any symptoms until the last minute. Like many things there is no one cause for this but rather a group of risk factors that are commonly preached about by healthcare professionals but that are worth repeating here.

Smoking (stop it!)

Inadequate physical activity

Poor diet

Obesity

High blood pressure (the higher the blood pressure in the blood vessels, the harder the heart has to pump to push the blood around, inducing extra strain that can damage heart muscle over a period of time, not to mention increasing the chance of blood vessels blocking)

High cholesterol

All of these are things that can be managed and optimised and are extremely important to consider, particularly if you have a family history of heart disease. If you are concerned about any of the above, it is always best to come and have a chat with your GP to talk about the best ways to reduce your risk of heart disease. Having a healthy heart doesn’t need to be more complicated than addressing the above factors and prevention is always better than the cure.

Exercise

“Fit and fat is better than being unfit and thin.”

Forget pills, staying active is the best medication.
After-all, when it comes to being healthy, there is almost nothing else that comes near it in terms of its effectiveness.

There is a quote from a health promotion consultant called Dr Nick Cavill that seems to pop up more and more regularly these days – ‘If exercise were a pill, it would be one of the most cost effective drugs ever invented.’ When you look at the statistics, it is difficult to disagree.

There is strong evidence to suggest that exercise reduces the risk of the following conditions by the following percentages…

Coronary artery disease and stroke – 35%
Type 2 Diabetes – 50%
Colon cancer – 50%
Breast cancer – 20%
Osteoarthritis – 83%
Depression – 30%
Dementia – 30%
Hip fractures – 68%
Falls in older adults – 30%

These are not insignificant numbers as I’m sure you will appreciate. Exercise really is good stuff and also helps with self esteem, sleep quality and energy levels.
The government’s aim is for everyone to be doing around 150 minutes of moderate aerobic exercise each week. Moderate exercise is something that essentially causes you to breath faster, increase your heart rate and feel warmer – a good way to gauge it is if you are breathing too heavily to sing the words to a song. Examples might be going for a brisk walk or hike or playing a game of volley ball. Only half of us in the UK are reaching that target. It doesn’t take too much of an imagination to consider the effect it would have of all of us matching this target on the mortality rates for all of the conditions above.

It goes deeper than this though. We are a species that evolved as hunter gatherers, constantly on the move, but in world with televisions and remote controls, motorised vehicles, and robots that do your hoovering for you, it comes as no surprise that we are suffering from the effects of a sedentary lifestyle. As such, even if we are reaching our exercise targets, if we spend the rest of the time sitting or lying down (and the average person in the UK sits for 7 hours a day, 10 hours if you’re over 65 years old) then those benefits are lost or at least have less impact on the risk of adverse health conditions.

It is therefore key for us to move about every now and again even if we’re not exercising. The recommendation is that every half an hour, we should get up and move about for 2-3 minutes. Practically I know sometimes it may seem difficult but actually when you think about it, is it really? Sometimes only the smallest things need adjusting to achieve this, whether it be an agreement with your boss to get up and walk around the office once in a while or maybe even (as horrifying as this sounds) keeping the remote in the shed at the bottom of the garden. Essentially we’ve all got a bit lazy and our bodies are experiencing the consequences.

For those thinking, ‘well my knee hurts too much for me to do any exercise’, or ‘the local volley ball court is too far away,’ I’m afraid that’s no excuse. Remember, moderate aerobic exercise is anything that gets you breathing and increases your heart rate, so if your knee hurts, do some swimming or even some armchair aerobics, likewise if you can’t get to your local sports centre easily, go for a brisk walk down the road or around the garden for 30 minutes every day. There is a mode of exercise for almost everyone.

Why does exercise and activity help you may ask? Recently, research has revealed quite in depth benefits that we were previously unaware of. Much of this has to do with the anti-inflammatory effects of activity. At the cellular level, our bodies are in constant turnover. Each cell in our body has something called a mitochondria which is essentially a mini power plant. It is here that we produce energy to be used in various processes throughout the body. Each mitochondria will build up a charge and if we are not using energy, they stay charged. The longer they do, bits of charge will gradually escape in the form of ‘free radicals’. These free radicals are bad news and contribute to cell and mitochondrial damage, aiding the ageing process and generally making us less healthy. It is thought that this process causes microscopic inflammation throughout the body.

Activity and exercise helps by utilising this energy and preventing release of free radicals but also produces anti-inflammatory substances from muscle that help to mediate the inflammation at a cellular level. That is not to mention its effect in increasing insulin sensitivity of cells, reducing risk of conditions like diabetes, along with strengthening heart muscle to reduce average heart rates and contributing to lower blood pressure and cholesterol.

There is a lot of focus these days on weight loss when it comes to exercise. This is quite a damaging concept and is reinforced by many commercial diet plans and courses. Although it is important to maintain a good weight and avoid obesity, weight loss is not the be all and end all. There are two types of fat. Subcutaneous fat (sub – beneath; cutaneous – skin) is the stuff that pads out our waist lines and is the most visible. However, arguably far more important is the fat that surrounds our organs like the liver and the heart. This is called visceral fat (viscera meant ‘internal’ in latin) and build-up of this visceral fat has significant implications for our general health. Even if our exercise seems to be doing nothing to our subcutaneous fat, it will be having far greater effects on our visceral fat and this is very important. Therefore we mustn’t measure the success of our exercise or indeed any form of activity with weight loss. Fit and fat is better than being unfit and thin.

The Eye

“…fingerprints have approximately 40 individual features but the average iris has 256.”

What do the following celebrities all have in common? Christopher Walken, Dan Akroyd, Simon Pegg and Jane Seymour. It takes only a quick glance at the title of this article to ascertain that it must be something to do with their eyes. Well done though if you said that they all have ‘Heterochromia’, which means that each of their eyes are different colours. Regardless of whether or not one’s eyes have this rather exotic trait, these clever and intricately complex little organs tend to be a focal point and, at an individual level, one of our most vivid and emotive defining features.

They are thought to have evolved initially in single celled organisms that held light sensitive proteins. Over many millions of years, the process of ‘seeing’ became a reality through a mind-boggling transition into the eyes that we see today. Across the animal kingdom, there are many different types of eye and, as is the outcome of all evolution, the creatures they serve benefit in different ways depending on the environments in which they live.

Geckos can see colour 350 times better than us, bees have 5 eyes, most spiders have 8 and worms merely have a collective of light sensitive receptor cells. Not all eyes are structurally the same. For example, some vertebrates, including cats, have an extra layer of tissue behind the retina (the layer of cells that collects and processes light) called the tapetum lucidum. This reflects any light that has got through first time round and reflects it back into the retina again, giving rise to excellent night vision – very handy for catching unsuspecting mice. It also results in the eye-shine we see when some type of mammal is lurking in the bushes and served as inspiration for the ‘cats’eyes’ we see on our roads.

We humans must make do without these handy features and we are limited to just the two eyes. This is better than one though, as it gives us a perception of depth. To enable us to see, we must collect the light from around us and process it. Light bounces off everything (almost) and if we look towards something the light from this will hit our eyes. This light travels first through the cornea and second through the pupils (the holes made by the retractable fibres that make up the iris (the part that gives our eyes their colour). Here it hits the lens, a rounded clear organ that alters in size as we focus differently. This allows it to redirect light from different distances onto the back of the eye where the retina sits, so that it doesn’t produce a blurry picture. At the retina, the light is converted by different types of cells into nerve signals and the information is then taken via the optic nerve to the brain where it is further compiled into what we understand as ‘sight’. Interestingingly, because of the way in which the light is focused on the retina, the unprocessed image is upside down and back to front, so the brain must flip these back the right way round.

As doctors, the eyes are a useful thing to check when examining a patient because they can tell us a lot about a person’s health. Shining lights into the eyes causes the pupils to constrict and faults here can point to certain neurological conditions as can double vision and loss of visual fields. Looking at the back of the eye, we can sometimes tell if there is raised pressure in the fluid surrounding the brain, and at the front, there are characteristic appearances in or around the eyes of people who might have thyroid problems or high cholesterol. In babies, it is important to check for something called the red reflex, the normal red-orange colour of the eye when light is shone. Asymmetry here or a white reflection can sometimes point to something called retinoblastoma which is a type of cancer.

The most common eye examination one might receive is the visual acuity check. Using the Snellen charts, reading the letters on rows of ever decreasing size, we challenge ourselves to get to the very bottom level. The phrase ‘20/20 vision’ is often talked about, which essentially means we can see something at 20 metres that the average person would see at 20 metres. Outside the USA, we use 6 metres as a scale and if you wanted really exceptional vision, you would aim for something more along the lines of 6/7 (in other words you could see something from 7 metres that the average person would only be able to read at 6 metres).

If our vision isn’t quite up to scratch, we might need a correction and this is where glasses and contact lenses come in. Depending on which survey you read, between 69% and 77% of people in the UK wear glasses or contact lenses – so many that it is isn’t surprising that they have become somewhat of a fashion accessory!

More seriously, there are currently approximately 2 million people in the UK living with a level of sight loss that has a significant impact on their daily life. There are around 350,000 people registered as blind or partially sighted alone.

There are a plethora of conditions that can cause such sight loss.

  • In the UK, age-related macular degeneration is a major cause (a deterioration of the macula, a part of the retina, due either to the formation of deposits on the retina or to fluid build-up underneath the macula).
  • Diabetes is a big cause of sight impairment as well – it causes progressive damage to the blood vessels at the back of the eye and is known as diabetic retinopathy.
  • Glaucoma is a build-up of pressure in the fluid within the eye. Your optician will check your pressures by puffing air at the eye using a machine. As long as it is well controlled and monitored it can be treated with certain medicated drops.
  • Cataracts are a gradual clouding of the lens. When vision is too severely affected, surgery is an option to correct this.
  • Retinal detachment is an emergency and characteristically involves a sudden curtain of vision loss falling over one eye. It may be preceded by flashing lights and a sudden increase of floaters and needs an immediate trip to eye casualty.

Incidentally, floaters are small bits of debris that float in the eye and move around with a slight lag as the direction of gaze changes – these are common, and, except as mentioned above, are not normally something to worry about, though they can be very annoying. Unfortunately they are essentially untreatable.

As GPs, we often see a handful of more common and less serious conditions that could have been dealt with first by a pharmacist or managed at home. Red and gunky eyes most often represent conjunctivitis, while red swollen eyelids (blepharitis) or a cyst or stye over the lid can be treated with hot compresses, and a watering eye can be your body compensating for a dry eye, so try some lubricating drops. Most eye conditions do not need antibiotic treatment.

If your eye is painful however or if you are not quite sure, this must be reviewed, especially if it is red as well. There will be a local eye casualty (if you’re in the UK) that patients can call if they are unable to get to their GP. This may be where your GP refers you if they feel it needs more in-depth specialist review.

The following recommendations can help to keep your eyes healthy:

  • Don’t smoke – Unsurprisingly this causes all sorts of problems including macular degeneration and cataracts.
  • Make sure you wear sunglasses – it protects against harmful UV rays and makes you look awesome.
  • Get regular optician checks – apparently around 10% of the adult UK population have never had an eye check. Problems are not always immediately evident and so it’s best to get checked every two years at the very least, more frequently if you’re over 40.
  • Eat the right things – generally anything with lots of omega 3 fatty acids and vitamin A (also known as retinol which helps with night vision!) Examples would be oily fish, kale, spinach, peppers, oranges, broccoli and eggs.

So overall, eyes are pretty marvellous things and, more than that, they are deeply personal. One only has to look at the rising use of retinal scanning to realise just how individual they are -fingerprints have approximately 40 individual features but the average iris has 256. We only have two of them, so we must take the best care of them possible.

The Ear

“The list of famous musicians who suffer from tinnitus is quite something: Bono, Pete Townsend, Chris Martin, Neil Young, Will. I. Am…”

“Music is like a dream. One that I cannot hear.”

The loss of hearing that Ludwig Van Beethoven suffered towards the end of his life was cruel and his words illustrate just how much we rely upon our hearing to enjoy the world around us.

Our ears, unsurprisingly, are integral to the process of ‘hearing’. This sense is one of which those who were born deaf simply have no concept; this set of channels, bones and nerve cells is able to convert vibrations from all around us into an almost indescribable entity in our heads.

To be fair, the really remarkable stuff all happens in the brain.  What we hear as ‘sound’ is merely the brain’s interpretation of what is happening in the physical world, much like what we see. But let’s not forget the ears’ role in all of this. A sound is essentially vibration of air particles that travel in waves at high speed. If I drop a saucepan on the floor, it will create ripples in the air that spread out in all directions. This wave of sound reaches the ear and is collected by the first section, the outer ear, where it is channelled inwards towards the ear drum.

As the air hits the ear drum, the ripples are conducted into three tiny ossicles (the smallest bones in the body) called the Malleus, Incus and Stapes (colloquially known as the hammer, anvil and stirrup). These are pretty special because they gradually reduce the amplitude of the vibrations, in effect scaling down the sound so it can be processed in ever smaller regions. The last of these bones is attached to another smaller drum that then transfers the vibrations into fluid which is contained in a tiny organ called the cochlea. The walls of the cochlea are covered in tiny hair-like nerve cells which, when excited by the vibrations, convert them into nerve impulses which then travel via the vestibulocochlear nerve to the brain where the magic happens.

This way of hearing sound is not the same throughout the animal kingdom. It is thought that the bones of our mammal ears were once incorporated into the jaws of a common ancestor of us and modern day reptiles. Indeed some reptiles, including snakes, use their jaws to ‘hear’ sounds, while others, such as insects, use antennae to detect vibrations in the air rather than ears.

Such a delicate system is of course vulnerable to the louder sounds. Anything above around 85 decibels (for example busy traffic, a motorbike or listening to music on full volume via headphones) will damage your hearing and the longer the exposure the worse it gets. Damage mainly comes from destruction of the tiny neural hairs in the cochlea which are irreplaceable.

It is therefore important to take precautions to reduce such exposure (for example, by ensuring that you use noise cancelling headphones rather than turning your music up just to cancel outside sounds and not listening at more than 60% volume). Ear protectors in noisy work environments are important. A sure sign that you are damaging your hearing is the ringing sound that tends to be experienced after a loud concert. If you’re lucky, this will fade after a few hours but repeated exposure can cause tinnitus. This is a really unpleasant and often intrusive condition in which a sufferer will experience that ringing in the ears all of the time when there is no obvious source.

The list of famous musicians who suffer from tinnitus is quite something: Bono, Pete Townsend, Chris Martin, Neil Young, Will. I. Am. Unfortunately, there is no known cure for this although, depending on how intrusive it is, there are measures you can take to introduce distractions and psychological techniques that help combat the depression which is often strongly associated with this complaint. If you develop a one-sided tinnitus, it may be a good idea to get this checked out with your GP, as sometimes there can be other underlying causes.

Probably the most common ailment we see in General Practice when it comes to ears is infection. Any part of the body exposed to the outside world is vulnerable and the ear is no exception. Happily, the vast majority of earaches are caused by viruses that can track up from the tube at the back of the mouth (Eustachian tube) that helps equalize the pressure between the inner and outer ears. (If this gets blocked, you lose that ability and so the difference in pressure can become very uncomfortable, particularly if you travel on an aeroplane). Most ear infections will be cleared up by the body’s own immune system after about 3-5 days and so otherwise healthy adults shouldn’t need to see a GP (even if you’re about to go on holiday) until after this. Your best first port of call is your pharmacist. If, however, there is a lot of discharge coming from the ear or you are feeling feverish and shivery, it is worthwhile getting us to check on things.  Note also that children with ear infections should be seen more promptly.

Critically, and contrary to what seems to be an ongoing fashion, you do not need to clean your ears. The wax in your ears is there for a reason. It is a mixture of oil, sweat and dead skin cells which, as unpleasant as that sounds, help to collect the very things that might cause infection. The wax brings these out as the skin of the ear canal gradually grows outwards, a bit like a natural conveyor belt. Just occasionally, wax can build up to excessive levels causing a conductive hearing loss and it is at this point that we might be able to help out with some syringing or micro suction. You should not, however, be putting anything like cotton buds in your ears. All this does is push wax further in and irritate the skin of the canal, predisposing it to infection.  Nothing smaller than your elbow is the rule!

The ear has one final trick up its sleeve. There is a separate part of each cochlea which forms a series of canals called the semi-circular canals. It is here that the body derives its sense of balance. These canals are filled with fluid that moves in one direction en masse as we ourselves move. This stimulates hair cells on the walls that send signals to the brain indicating we are on the move. If all is working well, it combines in the brain with visual information from our eyes to give us a sense of position.

If however there is a bit of loose material in the semi-circular canals that brushes against the hair cells independently of the direction of movement, this sends a lot of confusing signals that don’t match up with what we see. This can give rise to something called Benign Positional Paroxysmal Vertigo (BPPV) which causes a nasty dizziness, often described as a sensation that the room is spinning or a feeling akin to being on a swaying boat. It causes nausea and vomiting and tends to be triggered by turning the head. Fortunately, this is something that does eventually fade on its own but not before a period of fairly uncomfortable and enforced inactivity. Medications to help with the nausea are available and the only other ‘cure’ is something called the Epley’s manoeuvre which can be attempted by some GPs if symptoms are not abating naturally.

So, overall, the ear is a complex and valuable part of our lives. If you do have a feeling your hearing isn’t what it once was, don’t be afraid to get it checked.  Hearing loss is unfortunately something that occurs frequently as we get older. There are hearing aids available now that can make a really big difference, not to mention their crucial role in placating the neighbours who have to put up with the TV volume set to maximum!

The Brain

While we know more than we ever have, there is still a lot to learn meaning that, in an ironic sense, the brain is still something we can’t fully get our head around.

Someone once said that if the human brain were so simple that we could understand it then we would be so simple that we couldn’t. I would have to agree. The brain is our vastly complicated seat of consciousness and individuality, controlling most functions of the body, some of which we are aware of and some of which are on a more subconscious level.

If one were to zoom in to see it under a microscope, one would find literally billions of nerve cells, or neurons, forming a continuous interconnected network signalling to each other using electrical pulses and chemical transfers. There are around 86 billion of these neurons in the adult brain, meaning that if you were to pick an area of the brain the size of a small grain of sand you might find as many as 100,000 neurons in just that one area. What’s more, each one connects to around 1,000 others via connections known as synapses.

As we zoom out again, we see that the brain has a wrinkled surface that, if stretched out flat, would cover the area of four A4 sheets of paper. It is cushioned and bathed by a viscous layer of cerebrospinal fluid that, as the name suggests, runs all the way down around the spine as well.  Weighing in at around 2% of our body weight, our brains manage around 98% of human function, which is a pretty good return. It follows therefore that it needs a fairly good power supply and, indeed, it has an important network of blood vessels that supply it with oxygenated blood and nutrients – it uses around 20% of the body’s energy supplies.

With such a complex make-up and such a plethora of responsibilities, it is no wonder that it is regarded with such intense interest and yet is still relatively poorly understood compared with other organs of the body. As with much scientific endeavour, much progress has been made in its understanding over the last century.

Take the frontal lobe for example. As part of the quest to understand the brain in more detail, scientists identify areas in accordance with their perceived function. The frontal lobe is thought to be involved in executive function such as judgement, decision-making, planning and control of behaviour – functions that became clear following an accident involving a railway worker named Phineas Gage in which, rather unfortunately, he received a metal pole through his forehead. Though he survived this ordeal, the once calm and understated worker famously showed a marked change in personality towards aggression and surliness.

Had the pole gone through his occipital lobe, he might have had trouble with his vision and, if it had pierced the temporal lobe, he would potentially have had trouble processing sound, using his memory and producing speech.

The point is that certain areas of the brain are involved in particular tasks. This can become apparent when someone has a stroke. Most strokes happen when blood supply to an area of brain tissue is interrupted.  The result can be, for example, loss of motor function in one side of the body. If there is a problem in one half of the brain, then the problem (when talking about motor function – i.e. moving an arm) manifests in the other side of the body. This is because nerve fibres from each side of the brain cross over at a certain point before descending the spine to the rest of the body.

We know that the brain performs so many functions. It allows us to move, to smell, to hear and to sense temperature. It also enables us to think. While this complexity is admirable, when it goes wrong the consequences can often be very distressing. Infection, head injury and cardiovascular disease all affect the brain’s health, as well as conditions such as Parkinson’s disease which affects the production of dopamine, (normally used to regulate our movement) and resulting in involuntary shaking, slow movement and stiff muscles.

Most significant of all, as our population grows older, dementia is becoming the largest cause of mortality in the UK and all over the developed world. Research is ongoing and we still have a long way to go both in understanding the processes involved and in treating the effects. It should be mentioned that dementia is not a single disease, rather a term to describe the symptoms that occur when there is a decline in brain function.

Alzheimer’s is the biggest cause of dementia. Though not fully understood, it is believed to be related firstly to the build-up of amyloid plaques and secondly to neurofibrillary tangles made up of proteins called TAU proteins. As more of these build up, the ability of the neurons in the brain to transmit information gradually diminishes. Research is currently focusing on the processes involved in the development of these two features. Just as importantly, the search is on for biomarkers (markers that we can sample in the blood or spinal fluid) that might give us an idea of whether someone might be developing a dementing condition, giving greater opportunity to take early steps to manage the condition and also to research disease progression over longer periods of time. Although it can be difficult to face, and often slow to present, if you have any concerns about memory, it is important to see your GP as there is often support available and it may also be the result of more benign and treatable conditions (for example low vitamin B12 levels or underlying infection).

When concentrating on the more physical effects of the brain, it is sometimes easy to overlook the deeper thought processes that are involved in our mental health. Much of our individuality comes through the environment in which we grow up. In the same way that we form new connections and synapses in our brains through repetition as we learn an instrument or practise our times-tables for example, it is thought that personality traits develop to some extent in the same way. For untold reasons, however, our minds can be fragile and depression and anxiety can be extremely damaging. Often there are so many different factors, both social and physical, that make such emotional issues difficult not only to treat but also to recognise. Chemical imbalance plays its part, for example in relation to levels of serotonin in the brain, and in such cases there can be a role for medication. More recently, there has been a push for increased awareness of mental health conditions in an attempt to remove any stigma attached to something that can cause a lot of problems if left unaddressed.

How do we look after our brains? Staying happy is a good start and there is plenty of support available for people for whom this is not the case. Keeping your mind busy helps to maintain your ‘neural plasticity’ – it ensures you are creating new synapses by learning new things. Maintaining healthy social networks is equally as important.

Regular exercise is vital for brain health as it increases the blood supply to the neurons, reduces blood pressure, helps blood sugar balance, improves cholesterol and reduces mental stress.

Getting enough sleep each night is important (8 hours being the aim).

Your diet can also give you benefits. Anything rich in omega 3 such as oily fish is useful and a ‘Mediterranean-style’ diet is a good start. Blueberries are rich in anti-oxidants, thought potentially to reduce inflammation involved in plaque formation in the brain, and dark leafy greens, such as kale and spinach, will give you good sources of vitamins C and E and folates – all thought potentially to reduce the risk of Alzheimer’s.

There is some evidence to suggest that certain people may benefit from medications like statins and aspirin but it’s always a good idea to come in to discuss any medication with your GP or pharmacist. And don’t forget not to smoke or drink too much alcohol.

While we know more than we ever have, there is still a lot to learn meaning that, in an ironic sense, the brain is still something we can’t fully get our head around.