A recent study among 1 million Americans found that 42% of women and 30% of men did not have severe chest pain during a heart attack. Other symptoms included a heavy feeling in the chest and feeling unwell, pain spreading to the back, arm or stomach and pain that resembles a bad case of indigestion. If you think you may be having a heart attack call 999.

Jack Straw stirred a hornet’s nest recently when he called on the government to get tough on whiplash claims as they were driving the cost of car insurance ever higher. This resulted in a steam of articles in response- from the disability groups complaining that the characterisation of all whiplash injury claimants as over egging their symptoms to get more money was unfair, to others saying we have the highest rate of whiplash claims in Europe, and countries which offer no compensation for whiplash( e.g. Lithuania) have a very low reported incidence of whiplash. The truth, as always, is more complex, and will not be shoe horned into a simplistic one-liner.
As an orthopaedic and spine surgeon I do medical reports for claimants for compensation and also treat patients with whiplash symptoms- so see both sides of the argument, and the problem.
There are many agencies cashing in on the whiplash bonanza- every week a new firm doing medico-legal work contacts me to be an expert on their panel. People get rung by them even if they had no intention of claiming. I‘ve certainly had a few texts asking me to claim for an accident I never had. These agencies pay fees for every lead that is passed onto them by anyone involved in accidents- insurance companies, the breakdown agencies etc.
The difficulty is that it is virtually impossible to confirm if a patient who claims to have pain after an accident, actually has it, or not. Most experts believe the patients. For soft tissue injuries of the neck, no x-ray or MRI scan provides objective evidence of the injury. There are many factors which can influence the injury, including age, the state of degeneration of the discs, the position of the head at the time of the impact, the deceleration involved etc.
Because of the feeling that most people with whiplash symptoms are just after compensation the patients with genuine complaints seeking treatment are often ignored and not offered prompt treatment.
One option that has been mooted to deal with the problem of soaring insurance premiums and the poor treatment of genuine patients is to accept that minor soft tissue injuries of the neck recover in 6-12 weeks and stop all payment for them. Allow claims only for severe injuries which are seen on x-rays and MRI scans. This would also reduce the number of patients seeing their GP and visiting A&E departments, merely to validate their symptoms for the claim.
At the same time we could get the insurance industry to create a fund to pay for expedited treatment for injuries following a accident. This will reduce the whole litigation culture, drop our insurance premiums and get patients with genuine symptoms quick and expert care they need to recover from these injuries.

There were 18,576 fewer deaths from heart attacks in Britain in 2010 than in 2002, a study from Oxford has found. It was published in the British Medical Journal . The causes for this amazing decline are many. They include the 2007 ban on smoking in public places, better treatment of patients in hospital, people giving up smoking and doing more exercise, better drugs to reduce cholesterol and blood pressure and people getting to hospital faster. Since heart attack victims are otherwise usually fit and well with many fruitful years ahead of them, this is very good news indeed.

It underscores the importance of simple things we can all do  to  reduce our risk of getting a hear attack. If you are a smoker quit today: it will prolong your life and improve your health. Get your cholesterol level and your blood pressure checked regularly. Exercise moderately 3-5 times a week. A brisk 30 minute walk is enough. Think about what you eat- reduce the meat and fat you eat  and increase the amount of fresh vegetables in your diet.  Simple ideas to live longer!

The next Spinal Coffee Morning in Tees will be on Tuesday 13th March  at 10am at the Nuffield Hospital Tees Hospital. It’s free and everyone is invited. You get the chance to meet other patients and  have a chat about treatment options in a relaxed setting.

To reserve a place please call Marta on 01642 367418.

The Tees Valley Spinal Support Group will meet between 10am and 12pm at the Teaching Centre, University of North Tees, Stockton on Tees TS19 8PE on Saturday 31st March.  No need to reserve a place –  friends and family welcome too!

The next Spinal Support Group in York will take place on Saturday 17th March between 11am and 1pm at the Nuffield Health York Hospital, Haxby Road, York. YO31 8TA.  No need to reserve a place – friends and family welcome too!

As tax payers we all pay the £130 billion bill for the NHS, but are not empowered  to demand a better quality of service or influence how  the money is spent. I see many patients with back pain frustrated by a  system that is not responsive to their needs and many wait years for treatment.

Working in the NHS I know that the quality of care on offer varies a lot, is hard to measure, and efforts to improve it from the top have had  limited success. There are few internal drivers to improve the quality of care . It is very difficult for patients to find out about the results of treatment in different hospitals and to decide where to go. If  money followed patients directly, and they could decide where they went for care, it would make all hospitals  focus on the quality of the patient experience and their clinical results. I do not see the reforms changing this.

The other big factor, which nobody wants to talk about , is that  as a nation we cannot afford  the rising cost of the NHS, given our current finances . Hard decisions will have to be made about where the axe will fall in health care spending. I think that GP’s are closest to the patients and their needs and by devolving spending authority to the GP’s they also want to give them the responsibility of rationing healthcare. I think it’s a fair way to go.

Its time we woke up to the reality that the NHS cannot deliver everything for everyone, and realised  some rationing is essential . We need a national debate on how this is to be achieved. I do not think the reforms go far enough and are a missed opportunity to empower patients, drive quality improvement from the bottom up, decentralise the NHS and free it from all vested interests, central controls, targets and diktats.

The debate around being a vegetarian usually revolves around the morality of killing animals and often degenerates to a point where one exclaims- ‘ How do you know carrots don’t have feelings’ ?. This misses an important fact : that a vegetarian diet offers many health advantages. Large scale studies have shown that incidence of heart disease was lower and mortality was 30% lower in vegetarian men and 20% lower in vegetarian women.

The incidence of certain cancers is also lower, particularly those of the colon. Vegetarians also have a lower body mass index, lower blood pressure, lower cholesterol levels , less chance of getting diabetes and less obesity. Vegetarians need to have a balanced diet to get all the nutrients needed. One of the problems people face is not knowing what to cook or eat , even if they wanted to increase the amount of vegetarian food in their diet.

The varied culinary influences in Britain make it easy to become vegetarian- Besides a renaissance in British Vegetarian cooking, food from India, South East-Asia and Italy offers many tasty and nutritious vegetarian choices.

Its also well established that in becoming vegetarian , we consume less of the earths resources- and its good for the planet. The German Federal Environmental Agency recommended that Germans reduce their meat consumption to once a week, to reduce global warming . In 2006, the United Nation’s Food and Agriculture Organization estimated that meat production accounts for 18 percent of greenhouse gas emissions. In comparison, it estimated that the world’s planes, cars, trains, and boats accounted for 13 percent of emissions.

Having read the evidence I have become vegetarian myself- but please do your own research and make up your own mind.

It’s the time of the year, when after the excesses of Christmas most of us resolve to go on a diet. A quarter of us in Britain are Obese. While dieting is not a bad idea, we must keep in mind research that shows that at the end of 2 years most people weigh more than when they first started their diet!

Professor Mann from the University of California analysed 31 long term studies into long term weight loss after a diet and found that at the end of 2 years, 83% of people weighed more than when they started.- though all lost weight in the short term. The best way to lose weight in the long term is to change your life style- become more active, take up a new sport, eat less food and different types of food, rather than deny yourself .

But exercise could be more important than dieting for good health.

In an important study published in The Lancet in August, researchers found that 15 minutes of moderate intensity exercise daily reduced mortality by 14% from all causes. Each additional 15 minutes a day reduced mortality by a further 4%, and mortality from all cancers by 1% . The current recommendations are that we should all exercise 150 minutes per week.

If you only make one resolution this year for your health- let it be this one- exercise 15 minutes per day!

The next coffee morning for patients with back and neck pain, is to be held at the York Nuffield hospital on 19th January at 10am. Here patients can meet other patients who have completed treatment, in a relaxed atmosphere. The event is free and open to all. To reserve a place please contact the hospital or Ruth Harvey at ruth.harvey@nuffieldhealth.com

Malaria kills 1 million people worldwide every year- mostly children. Researchers at the Sanger Institute in Cambridge have discovered the entry route used by malarial parasites to enter blood cells. They found a protein called PfRh5 on the parasite which is needed to gain entry into the blood cells.

By creating a vaccine which will train the immune system to attack this protein, they hope to make deaths from malaria a thing of the past. Another vaccine called RTS,S is already effective in preventing malaria in half the people vaccinated. As a surgeon I help one patient at a time, but these researchers, often poorly paid and unrecognized, can help millions with their discoveries.

There has been a 400% increase in alcohol related liver failure among young people in the last few years- so we all need to drink in moderation, and certainly not drink and drive. Our reflexes slow down and accidents become more common. In fact several European countries impose a total ban on drinking and driving (Britain is an outlier allowing alcohol levels up to 80mg/100ml in the blood).

I hope you have a great Christmas- and despite the economic gloom- remember we have so much to be grateful for. Lets count our blessings!

See you in 2012.