Taking a headline, and running with it. Pun intended.

obesity, overweight
Moderation is key to a longer, healthier life. Sorry it’s boring.

Today’s award for the most unhelpful headline goes to the subeditors of the BBC with this little gem:

‘Exercise ‘not key to obesity fight’

So what happens is, if they want to say something they should say, they stick it in inverted commas to make it look like they’re not really saying it, when they’re saying it. Along the lines of ‘wasn’t me, guv’nor’. BBC, you must be so proud.

An editorial in the British Journal of Sports Medicine said that it was time to ‘bust the myth’ that exercise had a big effect on obesity. Naturally the reach of the BBC is wider than that of the British Journal of Sports Medicine – and the reach of the headline is far, far wider than the reach of the detail in the story. And that’s why headlines are risky, and need to thought about responsibly. Now we’ll have a situation where people think that the disembodied quote from three experts writing in a periodical they’ll never read is licence for them never to do exercise again.

But let’s look at it. Those experts are right in one sense – our diet is so far out of whack it dwarfs our sedentary lifestyle in how damaging it is to our long-term health. We like junk food, and it’s hard to avoid since it’s so cheap and plentiful. Those who are obese can have a tremendous effect on their weight if they cut their daily calorie intake from that of a pro cyclist down to that of a sedentary person (in some cases a drop in excess of 2000 calories). The other reason they’re right is that in those who are morbidly obese, really effective exercise is impossible. The first gains need to come from curbing intake.

But the key to success remains – a deficit between what calories you need, and what you actually consume. One of the results of exercise is to boost the deficit.

What was also not addressed was the fixation on obesity. I suppose it’s easy to fixate on because it’s so visible – but generally it’s not being fat that kills you, it’s heart disease, or diabetes that leads to complications, or a stroke or whatever. Obesity increases the risk of all of these. Exercise is great at reducing the risk of these. So exercise, whether you use it for calorie busting or not, is a great thing to have in your life.

The problem with obesity is the same as the problem with politics – we get hooked on the extreme – extreme eating, extreme dieting, extreme exercise, extreme left, extreme right. Actually there’s a sweet spot, and it’s at neither end of the spectrum. A reasonable diet and reasonable exercise will have you living healthier for longer. Yes, there are those who feel the need to eat a diet of raw wizardfruit and ground unicorn horn, or whatever’s currently trendy (I lose track); there’ll always fads and extremes – it’s just not where the success is.

Today’s message is just not encouraging. Exercise does work, and it works best when you’re paying attention to diet as well. People who are trying to make changes should be supported and encouraged, not discouraged by being told half the story. Moderation is something we can all do. For some of us, that’s a habit we need to learn – but that’s OK, recognising it is the best place to start.

Journalists: Be responsible

Experts: Stop trying to be extreme to get column inches

Everyone else: Be different, be average.



With type 2 Diabetes and heart disease on the increase, it’s good to know what the risks the are and how you can protect yourself and your family from these and other health nasties. We even calculate your risk of type 2 diabetes, cardiovascular events and osteoporosis.

FoxFit takes the guesswork out of getting fit. It’s our unique programme geared towards getting people fitter, healthier, and helping people achieve the body they want. It’s a bit like the NHS HealthCheck but better because it’s run by qualified nurses and it’s more thorough. We’re not just interested in your weight, we’re interested in ALL of you. It’s this sort of MOT everyone should have – but it’s only available at Fox Cycling (the NHS HealthCheck is not nearly as comprehensive, nor is it part of an ongoing plan).

Click above link to read more.

Suckers: how alternative medicine makes fools of us all – Rose Shapiro

This is an eye-opening and well-researched book. Very readable, but at the same time shocking to consider that so much money has been spent on treatments that don’t work – just because they’re trendy and people like them. In fact, what I found was the most disturbing was that the people who lay into Western medicine as being ‘artificial’ and dangerous are precisely the same people who reject the scientific approach of randomised controlled trials (the most rigorous form of evidence) because they ‘don’t work’ on complementary therapy. That’s probably all you need to know…

Treating Severe Hypoglycaemia

Patient is unable to self-treat. If conscious, and able to swallow safely, patient should be given one of the following:

  • 100ml Lucozade
  • 150ml non-diet fizzy drink
  • 200ml smooth orange juice
  • 5-6 dextrose tablets
  • 4 jelly babies
  • 7 jelly beans
  • 2 tubes glucose gel

Repeat as required and stay with patient until recovered.

If patient is unconscious, he should be put in recovery position, glucagon can be injected if trained to do so. Otherwise dial 999 for ambulance.

Symptoms of Diabetes

(Guide only, type 2 diabetes can be asymptomatic for years)

Symptoms Type 1 Diabetes Type 2 Diabetes
Onset Fast (days/weeks) Slow (months/years)
Thirst √ often profound
Bedwetting in children  –
Mood changes/irritability
Weight loss √++ √+/-
Visual disturbances
Thrush infections (genital)
Recurrent infections (boils/ulcers)
Tingling/pain/numbness in extremities
Occasionally abdominal pain
Confusion If advanced √ Especially in the elderly
Incontinence √ Especially in the elderly
Glucosuria May be absent especially in the elderly or if there is a high renal threshold
Ketones in urine or blood May be present (ketoacidosis) Likely to be present

Thanks to Practice Nurse 41 8

Symptoms of TIA

Definite Probably Not Alarm symptoms (may require admission)
Slurring Dizziness Known AF; or high stroke risk
Clumsiness Confusion Recurrent TIAs; more than 2 in last 2 weeks
Tingling/numbness General weakness Patient on anticoagulant. May need brain scan
Visual disturbance ABCD2 score of 4 or more

Thanks to Practice Nurse 41 8

Risk Factors for CHD

  • Age
  • Gender
  • Ethnicity
  • Family history
  • Past medical history of CVA or MI
  • High total cholesterol or LDL
  • Low HDL levels
  • Hypertension
  • Sedentary lifestyle
  • Obesity
  • Diabetes mellitus
  • Excessive alcohol consumption

ABCD2 Scoring tool for calculating risk of CVA

Age >60 years 1 point
Blood pressure >140/90mmHg 1 point
Clinical signs Unilateral weaknessSpeech disturbance 2 points1 point
Duration of symptoms 0-59 mins60 mins or more 1 point2 points
Diabetes Diabetes 1 point

Score 4 or more indicates significant risk of CVA

Thanks to Practice Nurse 41 8 for this.

Symptoms of Influenza

  • Malaise
  • Fever (fast onset)
  • Shivering
  • Headache
  • Muscle aches/pains
  • Sore throat
  • Cough
  • Nausea
  • Loss of appetite

Symptoms of Prostate Cancer

  • Difficulty/pain on urination
  • Interrupted or weak flow of urine
  • Haematuria
  • Pain in lower back, hips or thighs

Treating Mild Hypoglycaemia

To raise blood glucose, take one of the following:

  • 100ml Lucozade
  • 150ml non-diet fizzy drink
  • 200ml smooth orange juice
  • 5-6 dextrose tablets
  • 4 jelly babies
  • 7 jelly beans
  • 2 tubes glucose gel

If blood glucose is still below 4mmol/l after 10 mins, or if patient doesn’t feel better, repeat one of the above treatments.

When feeling better, eat some starchy food such as a sandwich or a banana, monitoring blood glucose afterwards.

Coeliac Disease

This is an autoimmune condition triggered by the consumption of gluten found in wheat, barley, rye and occasionally oats. Frequently there is confusion of a patient’s symptoms, sometimes leading to a diagnosis of IBS or wheat intolerance. Untreated celiac disease can lead to increased risk of osteoporosis and small bowel cancer.

Symptoms of celiac disease include:

  • Nausea
  • Bloating
  • Flatulence
  • Constipation
  • Diarrhoea
  • Weight loss
  • Fatigue
  • Joint or bone pain
  • Mouth ulcers
  • Dematitis herpetiformis (a skin condition associated with coeliac disease)

Coeliac disease is diagnosed first of all with a blood test for immunoglobulin A or tissue transglutaminase amtonpdoes (tTGA). If this proves inconclusive. Endomysial antibodies may also be tested for, and later with an endoscopy and biopsy of the duodenum.

Gluten-free food including pasta, flour, biscuits, crackers and even breads and pizza bases are available on prescription.

SOFTMASH – mnemonic for assessing COPD

  • Symptoms
  • Occupation
  • Family history
  • Triggers, Treatment
  • Medications taken
  • Atrophy, Activity, Allergies
  • Smoking history, Socioeconomic status
  • History

Interpretation of ABPI

  • 1.3 or above may indicate arterial disease or calcification. Seek advice from tissue viability nurse
  • 1.0-1.3 normal arterial flow. Regular compression is probably safe, if not otherwise contraindicated
  • 0.8-1.0 Mild arterial disease, but sufficient for compression if not otherwise contraindicated
  • 0.5-0.8 Moderate arterial insufficiency. Seek advice from tissue viability nurse; reduced compression may be appropriate following specialist advice

Signs and Symptoms of Chronic Bronchitis

  • Cough
  • Increased production of mucus
  • Dyspnoea
  • Wheezing
  • Fatigue
  • Signs of global hypoxaemia

Taken from Nursing in Practice 62 p58

Signs and Symptoms of Emphysema

  • Dyspnoea
  • Barrel chest
  • Tachypn0ea
  • Pursed lip breathing
  • Tripod stance
  • Hypoxaemia/hypercapnia
  • Note wheezing is minimal
  • Signs of hypoxaemia

Taken from Nursing in Practice 62 p61

Korotkoff Sounds

  • Phase I – the initial appeance of faint, repetitive tapping sounds that grandually increase in intensity for at least two consecutive beats (the systolic blood pressure)
  • Phase II – a brief period during which the sounds soften and acquire a swishing quality. In some patients the sounds may even disappear briefly. This is known as an auscultatory gap
  • Phase III – the return of sharper sounds, which may even be stronger than those in Phase I
  • Phase IV – distinct, abrupt muffling sounds that become soft and blowing in quality
  • Phase V – all sounds finally disappearing (the point of diastolic blood pressure)

Thanks to Nursing in Practice 62 (2011)

Medical Research Council Dyspnoea Scale

  • Grade 1 – not troubled by breathlessness except during strenuous exercise
  • Grade 2 – short of breath when hurrying or walking up a slight hill
  • Grade 3 – walks slower than contemporaries on the level because of breathlessness, or has to stop for breath when walking at own pace
  • Grade 4 – stops for breath after walking about 100m or after a few minutes on the level
  • Grade 5 – too breathless to leave the house, or breathless when dressing or undressing

Conditions causing lower back pain

  • Injury
  • Strain
  • Fibromyalgia
  • Osteoarthritis
  • Spinal stenosis
  • Opsteomyelitis
  • Osteoporosis
  • Malignancy
  • Prolapsed intervertebral disc

 Taken from Independent Nurse 21/11/2011 p30

Signs and symptoms of ankylosing spondylitis

  • Morning stiffness
  • Pain in sacroiliac joints, buttocks and chest
  • Fever
  • Weight loss
  • Excessive kyphosis of thoracic spine
  • Reduced spinal flexion

Taken from Independent Nurse 21/11/2011 p29