Sexual orientation and the NHS
Canada Goose Outlet Well in many ways it’s a very good idea. We know that lesbian, gay and bisexual people are disproportionately affected by many health issues. For example, poorer mental health, high risk of self harm and suicide, increased risk of sexually transmitted infections, drug and alcohol use for example. And in an equitable health service you have to make sure that your services are going to the people who most need them. And if you don’t have good data to tell you whether you’re doing that or not you don’t know whether you’re getting to everyone in need. Canada Goose Outlet
canadian goose jacket Well I’ve had a look at social media and I can see a canada goose shop uk wide range of opinion. Some people are quite happy to be asked, other people would really not wished to be asked. And I think some people have very good reasons for not wanting to be asked, particularly if they’re with a relative or a friend that they don’t want to disclose their sexuality to for example. The big problem that I have with this guidance or this information standard is that it hasn’t been tested in practice, we don’t really know what is going to suit people and what’s safest for people. And the other problem is when you ask for information to be gathered, if it’s going to be done face to face you have to be quite sensitive canada goose outlet toronto of that, if it’s going to be done with a bit of paper you have to make sure that people know what that data is being used for, who’s going to be allowed to see it, what protections that information has. And you have to accept that when https://www.getcanadagooseoutlet.com you ask the NHS to do more data collecting something else is going to have to stop being done in order to fit that in. canadian goose jacket
Canada Goose Jackets Well exactly and canada goose outlet florida this is the problem I think with binary approaches, it’s exactly the same issue we had under the quality and outcomes framework where GPs were incentivised to ask patients whether or not they smoked regardless of whether it was an appropriate time and place to ask that person if they smoked canada goose jacket outlet store and wanted help to stop smoking. We can see that some things might be a good idea but in the context of an individual consultation it might be quite insulting to be treating someone as though they were just like a factory patient willing to be processed in the same way as everyone else. And when we lose that humanity and sensitivity from consultations I think we’ve really lost the plot with the NHS. Canada Goose Jackets
canada goose store I use Google all the time, I love it. I think there are two big categories people who are searching for a diagnosis and people who already have a diagnosis and want more information about their treatment or options open to them. And it’s really the first the diagnosis issue that I have most problem with. So I’ve got a canada goose outlet in toronto bit of a cold just now and I googled headache, feeling tired, sore eyes and I got back as my top three diagnoses acute sinusitis, chronic sinusitis and multiple sclerosis. Now I’m confident I don’t have any of them but you can see how anxiety can be driven. So in some ways I think googling for a diagnosis is a bit like pond dipping you might get back something useful but then again you might not. And I suppose the problem is and there is preliminary research that suggests this that if you’re already feeling anxious about a condition and you go looking for information on the internet you may well find stuff on there that makes canada goose outlet online reviews you feel worse, rather than better, and actually drives your anxiety rather than helps to reduce it. And the problem is that the more searching you do the more anxious you can become. And the problem when people then come with poor information to the GP is that that whole consultation could be spent trying to debunk poor information rather canada goose outlet store near me than sitting patient and doctor on the same side trying to usefully find good information to make high quality decisions. canada goose store
Canada Goose sale My name is Cath. I first realised that I had joint hypermobility issues in my early 20s. Actually as a child I was very sporty, perhaps the hypermobility was helpful, I was very flexible so I was good at sports and gymnastics and didn’t have any sort of issues. And it was only when I started my first canada goose discount uk job that the hypermobility symptoms started to manifest themselves. Part of that was in my hands, I was suddenly doing an awful lot of administrative work in an office job. And at the same time I injured my knee playing sport and that seemed to be the trigger for the development of lots of other issues with different joints and feeling of weakness, combined with a lot of pain. Canada Goose sale
canada goose coats on sale If we are meant to be hunting and climbing trees and picking up fruits and running around being flexible is a good thing but that means you have to be strong. And in fact I tell patients in my clinic if you’re double jointed you have to be double strong. A phrase that I borrowed, although it does mean that certain aspects can occur or canada goose outlet new york city certain problems. For example, if you are flexible and you get an injury we know it takes longer to heal, for example. We know that people will describe like a shoulder popping out of its place, which could be quite painful. I have seen people where they can’t wash their hair because of that. The difficulty is if it is a sense of instability this person will go to their GP or to casualty or to rheumatologists or sometimes the orthopaedics, if you do an x ray an x ray will look normal. And sometimes that sort of leads to a disbelief that this person is maybe exaggerating their symptoms. They might be referred to physiotherapy, which is the right thing to do, but other times they will say oh take a paracetamol and you’ll get better. canada goose coats on sale
canada goose Believe it or not there are people canada goose outlet us who go on a regular basis to casualty with dislocations, of course casualty’s a very busy place but someone should think why this person is coming again and again with dislocations. They simply put the joint back, they might refer them to physiotherapy or they might not refer them to physiotherapy but no one seems to think why this person is coming with this issue. Dislocations normally happen with trauma, I’m talking about dislocation that happens with people reaching for the kettle. I’ve had a couple of patients recently where the kneecap simply dislocated or moved out in their sleep. So if we don’t recognise it first of all, dislocation is painful, so they might end up on very strong analgesia that doesn’t work, we have some patients where they were given the maximum dose of morphine and they become addicted to it. It’s not their fault, they were given the medication. So rather than addressing why the dislocations have occurred we are treating the pain as a result of the dislocation. So one is giving the wrong treatment, canada goose outlet in usa that it’s not going to work and it might make them addicted. The other one is what we call deconditioning if you don’t address the symptoms associated with hypermobility with the right form of exercise and that’s about strengthening the muscles, improving posture, if you don’t strengthen the joints you will end up with a weaker joint and also the person will stop exercising, especially if it is lower limbs. So people will stop doing normal activity, so gradually they will lose their fitness and they end up with what we call deconditioning. canada goose
The quick tip I give to my patients and my colleagues, if you’re looking at anyone with musculoskeletal problems just ask them to stand up and most of the time you will pick up generalised hypermobility from just the way the person is standing. Because these people, especially if it’s a lower body issue, when they stand their knee goes back so that’s hyperextension of the knees they will see that their feet are flat and they will have an abnormal posture. So sometimes the bottom of the spine it’s curved in, so that’s an exaggerated lordosis, and the top of the spine is curved, so that is kyphosis. And to be honest by just looking at the patient, which will take 30 seconds, from the front and the back, you would have had a good idea.
My name’s Simone and I have been hypermobile for all my life. I haven’t known about it all my life. I didn’t get a diagnosis until I was 30. I had pains in my legs when I was growing up in the night and I’d wake up crying. Nothing would stop that pain. I was always very flexible. It was a friend who actually spotted that I was hypermobile. I was sitting and she’s a physio, she saw my posture and said you’re hypermobile. And then when I went away and researched it it explained some of the canada goose outlet store toronto symptoms I’d had but I hadn’t considered them to be symptoms. And I then realised that my daughter was also hypermobile. Then started doing some exercises, suddenly some aches and pains went away.
I’m Dr Jane Simmonds and I’m a physiotherapist. So I’m doing this in standing but we would often do this lying down, it’s just looking at the hyperextension behind the knee here, so going beyond 10 degrees of hyperextension. We also look at the hands. With this we extend the little finger, Cath yeah these joints have over time we can see here that this extending up but what’s also quite obvious with Cath’s is this laxity of the skin, so by just drawing up the skin at the back of the hand here we can see how this connective tissue is looser and potentially a little bit more fragile and that’s one of the key marker signs for not just the joints but actually that tells us something about the collagen underlying.
canada goose coats In the joint we have in ever joint around the body we have bones, we have cartilage but what people sometimes we neglect that there are ligaments. The ligaments are like thick elastic bands, they hold the bones together and they are made of a protein called collagen. So collagen makes our ligaments and of course as many people will know it is in the skin. So if the collagen is a little bit stretchy, if that makes the ligaments a little bit stretchier that’s where the hypermobility comes from. And of course depends on is it only stretchy or is it actually deficient. Because now we come to where hypermobility could be a feature of a more hereditary connective tissue disorders, such as EDS, which is Ehlers Danlos Syndromes, which are a group of inherited connective tissue disorders. And in these patients you will have a mutation causing actually abnormalities in the collagen, so it’s beyond being just stretchy, sometimes you have a complete deficiency canada goose outlet london in some collagens. canada goose coats
If there is a recurrent dislocation of the joint, yes, you will get early osteoarthritis and that’s where we try to prevent it. The other problem also, which unfortunately occurs, that if a joint dislocates more than maybe twice and I’ve seen people where they were offered only a couple of sessions with physiotherapy, they’ll be referred to a surgeon and they will try to tighten the ligaments. So patients will end up with multiple surgical procedures and the procedures themselves canada goose outlet in new york will alter the dynamics and canada goose outlet canada also that will cause osteoarthritis.
canada goose clearance Physiotherapy’s at the cornerstone of the treatment and what can happen is that when people go to see the doctor it is that they might seem to be looking well, they’re moving quite well, in fact they’re hypermobile and someone might then suggest that actually you’re okay, actually just go away and do some exercises and you’ll be fine. So then the actual getting into services there are often long waiting periods but also there’s limitations in the amount of sessions often that people can get their treatments for and they may be referred for the one single joint, so it might be the knee which has been injured, but actually it’s a whole body thing. So it’s going to take more than just a few sessions to get someone sorted. So we do have the national centres UCLH at Stanmore, Great Ormond Street Hospital for Children but canada goose stockists uk in other centres around the country it is very difficult for people to access the expert care that they need and I think we’re relying on the charity sector to lead the way here. canada goose clearance
Physiotherapist Jane Simmonds and we have links to some of the patient groups working in this field on our website and to recently published guidelines on diagnosing the condition.
canada goose clearance sale You could be forgiven for thinking that the last thing someone with a breathing problem needs is smaller lungs but, counterintuitive as it may sound, lung reduction surgery is exactly what some people with COPD are now being offered at specialist centres canada goose outlet uk fake like the Royal Brompton Hospital in London. canada goose clearance sale
Canada Goose online Chronic Obstructive Pulmonary Disease COPD includes a number of different lung problems, like emphysema, that make it difficult to empty all the air out of your lungs. And if you can’t empty your lungs properly, you can’t take a deep breath, and so you become breathless. Canada Goose online
canada goose deals Nick Hopkinson is a Consultant Chest Physician at the Brompton. canada goose deals
cheap Canada Goose So a normal healthy lung is made up of lots and lots of tiny air sacks and is very elastic. What happens in emphysema is that the walls of these air sacks break down and the lung becomes baggy and full of holes and floppy, so that when you breathe in the lung, particularly the emphysematous parts of the lung, fill up but when you try to breathe out, because they’re floppy, the air gets trapped. So a person with emphysema will be breathing with a lot of air in their lungs that they can’t get out. You can actually experience what it’s like to have emphysema just by taking a big breath in, right to the top of your lungs, and a little breath canada goose outlet website legit out and just keeping breathing at that high lung level. cheap Canada Goose
buy canada goose jacket Most of the therapies that are available will help with the symptoms but don’t tend to actually reverse the actual process itself. I mean the most important thing for people who are still smoking is to stop smoking, which isn’t just prevention it’s canada goose outlet vancouver actually a treatment, so would improve symptoms. Flu vaccination of course. And one of the most effective treatments is actually taking part in a sort of supervised exercise programme. It doesn’t change the lung disease but it helps them to cope with the lung disease better. In terms of medications, most patients with COPD will be taking combinations of inhalers, do make people less breathless but they don’t make the problem go away. buy canada goose jacket
The idea of surgery and canada goose outlet ontario the first attempts at doing this were actually back in the 1950s. Now if someone has got part of the lung that is very damaged, the lungs are baggy, and another part that is not damaged, what will happen when they breathe in is that the damaged part of the lung will expand at the expense of the healthy lung. So if you can get rid of that damaged part of the lung, the remaining lung can work more effectively and rather than breathing at that very high uncomfortable lung volume with a lot of trapped air the person can breathe at a more comfortable level. It was first tried in the ’50s and at that point the surgical techniques weren’t there.
One of the issues is that this procedure isn’t being done. People are not clear quite what the criteria are for it, they’re not quite sure how to refer for it and they think it’s much riskier than it actually is. So it is an operation on the chest in someone who’s got significant lung disease, so you need to be careful about selecting the right patients, but in general the risk of it is exaggerated. So we estimate out of that 1.3 million people in the UK with a diagnosis of COPD that up to 20,000 people might be eligible for canada goose outlet this and about 100 procedures a year are being done. So there is a big unmet need here.
Canada Goose Parka It isn’t a last resort. If you think about the condition as mild, moderate, severe and very severe what we probably want is people with severe disease. And this is one of the problems at the moment with the sort of treatment pathways in general that there are struggles to deliver basic COPD care. At some sense in terms of priorities people say well you know we’re not even delivering the basics as well as we’d like to be. So a patient gets a diagnosis of COPD if they’re breathless they will probably be on inhalers, they may get to do pulmonary rehabilitation and then nothing very much is done often until they get to, if you like, the very late stage where this person is very, very breathless or this person now needs oxygen. There’s a window that’s been missed Canada Goose Parka.