Showing posts with label Occupational Health. Show all posts
Showing posts with label Occupational Health. Show all posts

Sunday, November 09, 2008

Get Expert Help - Resources when you need them


Whatever your problem :
Get expert advice quickly

This may come from established experts, your friends, reading, the Internet. If you are faced with a problem with which you are not familiar, its time to Get Help

Where ever possible, don't let problems fester - knowing your luck, they will only get worse.
Finding other people who have also been through the mill helps too! for example http://www.standtoreason.org.uk/home





1 Financial

2 Employment

3 Health Advice


1 Financial Advice

Money Guardian
Learn about money where you can. Web based information on a wide range of money related issues.
http://www.guardian.co.uk/money

Money Saving Expert
A useful web based source of money saving information and ideas.
http://www.moneysavingexpert.com/

National Debtline
A free, confidential, independent telephone helpline for people with debt problems in England, Wales and Scotland.
Telephone 0808 808 4000 http://www.nationaldebtline.co.uk/

PayPlan
One of the country's leading debt advice agencies with over 12 years experience in helping people with their debt problems.
Telephone 0800 917 7823 http://www.payplan.com/

Consumer Credit Counselling Service
A charity that assists people who are in financial difficulty by providing free, independent, impartial and realistic advice. It is run by the Credit Industry, and has an interest in helping you pay your debts, as opposed to going bankrupt
Telephone 0800 138 1111 http://www.cccs.co.uk/

The UK Insolvency Helpline -
The UK Insolvency Helpline is a national telephone helpline for people with debt problems all over the UK. The service is free, confidential and independent
Telephone 0800 0746918 Website http://www.insolvencyhelpline.co.uk/

For doctors
Royal Medical Benevolent Fund Helps GMC registered doctors and their dependants in need, if resident in the UK. http://www.rmbf.org/

2 Employment Advice

Flexible working
Advice about flexible working and helping develop a life work balance that supports you and your family.
http://www.workingfamilies.org.uk/

Disability Discrimination
For Employers
A quick guide to your obligations under the Disability Discrimination Act
http://www.shaw-trust.org.uk/page/6/92/

How to approach the problem of mental health in the workplace
http://www.tacklementalhealth.org.uk/

For Employees,
Mental ill health is included in the Disability Discrimination legislation.

Disability as described by the Disabilty Discrimination Act
a) It has to be long term, ie it has already lasted or is likely to last more than 12 months
b) It has to be substantial,
c) It has to affect a person’s ordinary day to day activity, even if treatment effectively controls the symptoms.

Find out more
http://www.direct.gov.uk/en/DisabledPeople/RightsAndObligations/DisabilityRights/DG_4001068


3 Health Advice

i) Mental Health

Mental Health Foundation
http://www.mentalhealth.org.uk/

Mind Apples
http://mindapples.org/

Information about depression
www.bluepages.anu.edu.au/symptoms.html

Free online Computerised Cognitive Behaviour Therapy
http://www.moodgym.anu.edu.au/
http://www.myray.com/


ii) Lifestyle

Dr Liz Miller Top Ten Health tips
http://doctorbloggs.blogspot.com/2008/08/dr.html


iii) Diet
Improve your diet
http://www.sustainweb.org/pdf/MHRep_LowRes.pdf

The scientific evidence linking diet and mental health
http://www.mentalhealth.org.uk/publications/?EntryId5=40150&q=0%c2%acchanging+diets%c2%ac


iv) Reading list

The Natural Way to Beat Depression - Basant K. Puri, Hilary Boyd
Potatoes not Prozac - Kathleen DesMaisons
Manage your mind - Hope & Butler
Healing without Prozac – David Serban-Schreiber



Copyright (c) Dr. Liz Miller
http://www.drlizmiller.co.uk





http://www.lizmiller.info/

Find out more - Buy the Book!

Thursday, August 28, 2008

Repetitive Strain Injury RSI, Carpal Tunnel Syndrome CTS


Repetitive Strain Injury (RSI) became first Work Related Upper Limb Disorder (WRULD) and now Carpal Tunnel Syndrome (CTS). CTS is good news for private doctors, it comes with tests, and an operation. This offers a chance to generate waiting lists, consultation fees, investigations, second opinions, surgery and anaesthetists fees.

Carpal Tunnel syndrome is just the latest and most lucrative name for RSI. Other names include De Quervains synovitis when it is so bad the tendon "crackles", but don't forget, golfer's elbow, tennis elbow, sometimes frozen shoulder, dystonia (Awkward movements), writers' cramp, and good old myalgia (Pain in the muscles). In truth these conditions all have the same underlying cause.

The results are stiff, painful, swollen muscles in the hands, arms, shoulders and neck. The swelling in the arms puts pressure on the nerves. The Carpal Tunnel is literally a tunnel through which the nerves and tendons to the hands go through, the swelling causes pressure, and pain. Surgeons are tempted to relieve the pain by operating on the Carpal Tunnel.
However
a) no one knows what happens in the long term when a youngster has this surgery. It reminds me of the enthusiasm with which cartilages were removed from knees in the 1970s an 1980s and the knee pain and osteoarthritis which inevitably followed in the 1990s and 2000s .
b) It does not treat the cause, just one symptom.

This is the One Minute Medicine approach to RSI

1) RSI is caused by repeating one action or activity or a limited range of activities. Any activity done often enough, can cause RSI. From counting tickets, running on running machines (yes any limb, any activity - it used to be called "shin splints"), writing, data entry, to good old typing.

2) Hard working types get RSI. People going for the Word Speed Record, or Ticket Counting Tally. It is not a condition for idlers or the faintheartedly. Their enthusiasm means they ignore the first warning signs of pain and stiffness and wait until it becomes seriously painful.

3) RSI causes pain and stiffness in all of the muscles of the arms, shoulders and neck. The person is usually tense and rigid, and highly focused on work, and they do not notice the pain that this causes. This may be the only exercise they get. Wrists, hands and shoulders are stiff, often on both side and he or she can never pinch their shoulder blades together at the back.
The First step
Stop or reduce the activity - that is complete rest until pain goes and then start from scratch gradually increasing the activity with frequent breaks. This may be every ten minutes to at the beginning

Then Treatment is three fold


1) Find ways to avoid typing such as -

a) Voice recognition software, but it can be difficlt to train a computer and you have to speak to it slowly
b) Dictate the reports and get them back from India four hours later, ready for editing - for example, http://www.indraftsolutions.com/

2) Do the it differently -

a) work station assessments to make sure the person's posture is correct,
b) wrist rests and other aids, to make sure the person keeps their joints in a neutral position. For example, Track Balls instead of mice, big pens that are easier to grip and so on.
c) change your typing position - most of learn to type in a hit or miss sort of a way. A proper old fashioned typing coure can help someone unlearn bad habits and learn to type better and more effectively

The neutral position is the most efficient way to work a muscle and joint. Extending or stretchig to work at a distance from the body means that the muscles do not work efficiently. This causes pain quicker than if the joint or limb is held in a comfortable neutral position.

3) Loosen up !

a) Physiotherapists are best at managing RSI. They intuitively understand that all parts, wrists, arms, shoulders and neck need treating. Physio is essential if you want to solve the problem and prevent it coming back
b) learn to fidget rather than sit still - stretch and shake yourself out every few minutes, change positions, shrug your shoulders, keep moving!
c) do different physical activities - like dance, yoga, pilates, Alexander technique, different sports, gardening and other outdoor pursuits, rather than just the gym. Do a different type of exercise every day.
d) learn to relax and enjoy the day, rather than keep trying to chase your tail faster and faster - the harder you chase your tail, the faster it moves. Do things differently!
e) Quick exercise = Roll your shoulders forwards, Roll your shoulder backwards and shake your arms out! 10 of each every twenty minutes as required.

None of this suggests surgery. I wrote this post because this morning, I saw a young girl heading for surgery for her "Carpal Tunnel Syndrome". I was left wondering why after millions of years of evolution, and some of the finest biological design work imagineable, does a person suddenly need their wrists cut open in order to lead a normal life?



Copyright (c) Dr. Liz Miller

http://www.drlizmiller.co.uk







http://www.lizmiller.info/

Find out more - Buy the Book!

Thursday, August 14, 2008

Dr Liz Miller's Top Ten Health Tips

1. Omega-3 Supplements

2. Exercise daily

3. Get outside and feel the rays

4. Eat healthy food

5. Avoid junk food

6. Avoid alcohol and other poisons

7. Breath from your belly

8. Rest and relax

9. Focus your mind

10. Learn all you can about health





1) Omega-3 Supplements

The easiest and quickest way to improve your health is through Omega –3 supplements. Omega 3 essential fatty acids help a wide range of medical conditions from heart disease, mental health to better joints.

Shop on-line at http://www.mindfirst.co.uk/. or at any health food store, on-line or in the High Street. It takes a couple months for their full benefit to be clear. Choose one without vitamin A or vitamin D. If you are a vegetarian and do not want to take fish oils, then Udo’s Oil and Hemp Seed Oil are fish free alternatives. The next step is a multimineral, multivitamin supplement and if you can choose natural vitamins in preference to synthetic ones.

Once upon a time, a balanced diet gave you the minerals and vitamins you needed but fifty years ago, fruit and vegetables contain five times the vitamins and minerals as they do today. Over-intensive farming, long periods of storage in warehouses, refrigeration, picking unripe fruit and vegetables mean food quality is getting worse.


2 Exercise daily

Exercise needs to be daily, varied and fun; like dancing, football, running, walking the dog, taking the stairs rather than the lift and running up the down escalator. The gym is fine, but variety is the spice of life and the key to being fit.


There are three types of exercise:
1) Those that concentrate on posture such as Yoga, Pilates, Alexander technique, postural alignment and martial arts training. These exercises concentrate on balance, so a person gets their ears above their shoulders, above their hips, above their knees, above their ankles.
2) Those that concentrate on building strength for short bursts of exercise, such as weightlifting, shot putt and gym machines. These exercises build muscle. Core strength is more important than bulging pecs. Regardless of how you look on the beach, if you have strong arms, strong legs and a weak back, you will develop back trouble. Rather than developing specific muscles, all round strength is important,
3) Exercises for stamina, such as running, swimming, football, dancing, skipping, cycling and fast walking.

Try a different exercise, each day of the week

3) Get outside and feel the rays

Sunshine is an instant pickmeup. Just half an hour in the midday sun, especially in winter makes a big difference to the day. Sunshine makes us feel better; so just getting out of the office for a quick wander, even in the rain there is more light outside than there is inside. If you find the winter depressing, think about buying a light box, or a light visor from http://www.outsidein.co.uk/ Put it on full blast while you clean your teeth and make your breakfast to stop the winter blues.

4) Eat healthy food

Start the day with a fresh fruit smoothie. Even easier, a glass of tap water, rehydrates ready for the new day. Eating a healthy diet is about eating natural food. If it was not around 10,000 years ago, then it is probably not good for you and you should not eat it. The best food is organic from your own garden or local farmer. You can have a box delivered to your door.

A natural diet and daily exercise keeps the blood sugar steady and that helps keep your energy up, and helps concentration.

5) Avoid junk food

Treat your stomach with respect. Always read the label. Factories turn food into junk. The purpose of a biscuit is to sell another biscuit. Did you ever see a Kit Kat tree? A packet of crisps can be stored for 2 or even three years, and the crisps are still crunchy, there is nothing alive in that bag. “You are what you eat” and do you want to end as a MacDonald and fries or a Pizza express?

A modern milking cow produces up 20 litres of milk a day, ten times as much as a natural cow. Modern milking cows produce high concentrations of hormones, most of which go into the milk. Dairy products do more for supermarkets selling yoghurt and semi-skimmed milk than for anyone else in the food chain.

The stomach is one of the most complex and interesting organs in the body. It even has its own nervous system or mini brain. It sorts out, digests and absorbs the complete range of diets different people across the world eat. On the other hand, putting something like Coca-Cola into this delicate and refined organ, is like pouring battery acid into your PC. It is hardly surprising people get indigestion.

6) Avoid alcohol and other poisons

Alcohol reaches those parts that other poisons don’t. It damages the brain, the liver, and the pancreas. Few organs escape its effects. Nothing reduces a person’s energy, damages their lungs, narrows their blood-vessels, gives people wrinkles and increases their risk of cancer quicker than cigarettes. In the right environment, the body can recover from almost anything. Drinking and smoking stop the body healing.

7) Breath from your belly

Most people pant! They take far too many short breaths using only the top part of their lungs. Longer deeper breaths increase the oxygen in the blood without over breathing.

Real breathing comes from the belly and it has become counterintuitive. When you breathe in, the belly comes out as the diaphragm pushes down to allow the bottom of the lungs to fill. As you breathe out, the belly comes back in and pushes the air out, like a piston moving up and down. Belly breathing needs the shoulders to be relaxed down and back. Babies and small children naturally breathe from their belly. The first time you start to control your breathing it may feel as though you are going to suffocate, no one has yet.

Practise breathing from your belly for a few minutes everyday and gradually it will become more of a habit as you develop a more natural way of living. Being able to control your breathing, is the fastest way to control your state of mind. It is impossible to panic if you breathe gently and quietly!

8) Rest and relax

There are many ways to relax and calm the mind, from meditation through breathing, repeating a mantra, or just becoming more aware of what is happening from moment to moment. Other people relax by reading, sewing or through a hobby. Nonetheless everyone needs time just to chill out, rest and recover and let go the worries of the day.

9) Focus your mind

In some ways this is the opposite of the last tip. Just as the mind needs to relax, so it also needs to work. The most effective way to work is to focus or concentrate on one task at a time. It can take twenty minutes to recover from an interruption.

Modern life is full of diversions, e-mail, texts, mobile phones and it is easy to be continually distracted and do nothing all day. Multitasking sounds great but it is not efficient. People work better if they concentrate on one task at a time. The natural rhythm of concentration lasts between forty and fifty minutes. After that time, take a few minutes to recover, with some belly breathing, stilling the mind, and having a drink of water, before starting the next cycle.

Focus takes time to develop. Just as it takes time to get the body fit, it takes time to train the mind to focus on one task only. Start by setting a timer, to help you stay concentrated for a few minutes. As you get mentally fitter, your concentration span gets longer, until you can manage to concentrate intensely for up to forty or fifty minutes at a time.

A healthy mind is a fit mind. It is a mind that does what you want it to, rather one that is at the mercy of every passing whim and impulse.


10) Learn all you can about health

Although there is more and more health information available, much of it seems contradictory. One person says do this and another person says do that. Nonetheless, every health article usually has one or two good points worth remembering. But there always has to be a balance, for example, exercise is important but not if you have the flu. Activity has to be balanced with rest, concentration with relaxation and living a healthy life with the demands of earning a living. Some people recommend a low-fat diet, others a low sugar diet. You alone are the best person to find out what suits you and helps you feel healthy and energised.

By being interested in health, you learn more about yourself and this will encourage you to live a happier and healthier life.






Copyright (c) Dr. Liz Miller

http://www.drlizmiller.co.uk


Thursday, July 24, 2008

Occupational Health from Tragic to Trivial

Occupational health is a window on the world, I cannot prescribe drugs, nor order any tests but from my crow's nest I see life. Sometimes what I see disgusts me. No amount of appraisal, reappraisal, revalidation and 360 degree feedback will stop this awfulness happening, again, and again and again. Only doctors, nurses and people who selflessly care about patients can prevent these kind of tragedies.


45 year man blind, from avoidable and treatable complications of cataract surgery.
Street Sweeper - Essential manual worker

Aged 38, rapidly progressive cataracts and hypertension. Waits eighteen months for surgery "to get his blood pressure under control". Operations 4 and 6 months ago. Not back at work, sent for Occupational Health referral. On examination, Light and Dark perception only. Likely diagnosis - Bilateral detached retinas, occuring a few days after surgery. Complications - no post operative check, not even before he has surgery on his second eye

Prognosis - Blind for the rest of his life

The trivial

Technician (aka Mechanic) for top car manufacturer
Non essential Manual worker

Pains in wrist, not severe, just aches occasionally. Third visit to private specialists - and private physiotherapists, following checks for Hand and Arm Vibration Syndrome and Carpal Tunnel Surgery.

Unknown fact - this employee races 1,000 cc bikes at the weekend, which puts his wrists into extension and this, combined with the vibration and weight of the bike, is hurting his wrist. Complications - at risk of private surgery for Carpal Tunnel Syndrome

Prognosis - excellent if he changes the bars on his bike




Copyright (c) Dr. Liz Miller

http://www.drlizmiller.co.uk




Sunday, May 25, 2008

Minor injuries and misdiagnosis

Back to medicine - at least Occupational health.

I generally tell people that I am a GP, because no one understands what Occupational Health physicians do. I still do some general practice, but largely in the context of Occupational Health. Occupational Health doctors are the ones your employers send you to see if you take too much time off work for sickness. Especially "minor illnesses"

The people who come to occupational health have "minor" illnesses, that is they are not about to die, rather they cannot work. They wait in casualty less than four hours, they attend their appointments and they are discharged from hospital care back to their general practitioner. Their general practitioner thoughtfully signs them off for another four weeks and then their employer sends them to see Occupational Health.

Employers want their employees back working. They refer to Occupational Health because a wheel has come off their business. They cannot afford to prop up poor basic health care. Not all cases are medical, many are "stress at work" but about once or twice a week, I make a new medical diagnosis, or find someone without a diagnosis.

This blog entry is dedicated to a young (man/woman), I saw last week, who with tears in their eyes gave me a hug as they left, because finally (he/she) had been listened to. (He/she) had been labeled with "sciatica" for three years, a former runner, no history of back injury or reason for back pain. It started out of the blue three years ago, has got worse, keeps them awake at night and has spread to their abdomen. (His/her) GP has given him/her painkillers and a course in physiotherapy and (he/she) is getting worse. (He/she) came to see me because they were not recovering from a minor limb injury. It is not surprising their recovery was slow, given the pain (he/she) is in from their back. I have written to (his/her) GP explaining the need for urgent further investigation. This is not sciatica.

These people are the victims of a poor quality service because doctors and managers only care about targets. Patients suffer while GPs, Hospital consultants etc, collect their performance related pay, without even passing go. Doctors everywhere are complaining about stress - the real stress is for the patients whose care is neglected.

In the last month I have found:

Missed nerve injury, causing pain on typing and potential loss of job
Non-united fracture, causing pain whilst cleaning, because no one took an Xray to confirm the break had healed
Shin Splints in the calf stopping a person walking
Pain in the gullet - related to lifestyle not their heart
Pain in the knee, related to wrongly placed enthusiasm for body building - arthroscopy normal
Repetitive strain injury - it is not just typists, but anyone who does the same thing time after time
Numerous individuals "waiting for a letter from the hospital"
Finally, severe back pain of unknown cause in a young man/woman

and I only work part-time.

The difference between Occupational Health and General Practice is that in Occupational Health we have time find out what is going on, the medical care, at work and at home. GPs insist on doing in 10 minutes what I spend up to an hour doing. Quality Health Care is about finding out what is going on, not making a series of "spot diagnoses".

The poor quality and failing of the NHS shows up when people lose their jobs because of injuries and illnesses that are not treated soon enough or well enough. It is not acceptable to keep a person off work for six months while they wait for an arthroscopy. The knee gets worse, the result of surgery is worse, the person loses their job and might never work (or even walk) again. When the Chairman of the British Medical Association and the (life) President of the General Medical Council chain themselves to the railings outside Parliament demanding "Better Care for Patients", there will be some hope for the National Health Service.

Copyright (c) Dr. Liz Miller

http://www.drlizmiller.co.uk



http://www.lizmiller.info/

Find out more - Buy the Book!