Tendinopathy

"Tendonitis is a term often used to describe an inflamed and painful tendon. However, tendon pain can also be caused by small tears in the surrounding tissue or the gradual deterioration of a tendon where it connects to the bone. This type of tendon pain is often referred to as 'tendinopathy'." (http://www.nhs.uk/conditions/Tendonitis/Pages/Introduction.aspx) where the term tendinopathy is used to describe "tendon injuries collectively" (as above). These injuries can include tendonitis, tenosynovitis and deterioration of the tendon.

Tendosynovitis is a condition where "the sheath surrounding the tendon, rather than the tendon itself, becomes inflamed" (http://tinyurl.com/97qozs9).

Specifically one of the types of tendonitis that can occur is "Achilles tendonitis (heel)" (http://tinyurl.com/97qozs9) and is "commonly caused by a sports injury" such as walking or running where you may be "wearing shoes that do not fit or support the foot properly" (http://tinyurl.com/97qozs9).

To minimise the damage that could be caused "you should stop doing the exercise or activity that caused your symptoms. Self-help techniques, such as rest, painkillers and ice packs, can often help relieve tendonitis. More persistent cases of tendonitis may need to be treated with physiotherapy, corticosteroid injections or shock wave therapy." (http://tinyurl.com/yjz3rjh)

And to ease the pain of tendonitis whilst doing sport if you already have it "you should warm up properly before you start to prepare your body for more vigorous activity and help avoid injury. It is also important you cool down and stretch after you finish." (http://tinyurl.com/yjz3rjh).

There is a short video and a lot more information on the NHS website http://tinyurl.com/yjz3rjh which also gives an informative animation of tendonitis and gives a good overview of inflammation and the difference between tendocynovitis and tendonitis.



 

Sports Drinks

I found an article about sports drinks in THE WEEK 4th August 2012.

The article ran like this:

"The sports drink market is worth £1bn a year in Britain. But according to an article in the British Medical Journal, in most cases, people would do just as well, if not better, to drink water. The review of 104 popular brands found that although manufacturers make many grand claims for the effectiveness of their often calorie-laden drinks - whether in boosting performance or aiding recovery - there is a "striking lack of evidence" to back up most of them.

For instance, Lucozade Sport, the UK's bestselling sports drink, is said to have "an isotonic performance fuel to make you faster, stronger, for longer". But when Dr Carl Heneghan, director of the University of Oxford's Centre for Evidence-Based Medicine asked manufacturer GlaxoSmithKlise (GSK) if they could assess the research on which these claims rest, he was given what scientists call a "data dump" - 40 years' worth of research which included 176 studies. His team managed to examine 101, before concluding that "the quality of the evidence is poor, the size of the effect is often minuscule and it certainly doesn't apply to the population at large who are buying these products". They were similarly sceptical about claims that branched-chain amino acids - found in some of GSK's protein drinks - can enhance performance and recovery. One nutrition expert, Professor Mike Lean of the University of Glasgow, described the evidence for amino acids improving muscle strength as "absolute fringe", and in any case "totally irrelevant" in the context.However, GSK stands by it's claims, which it insists are backed up by science."

This article seems to play down the use of sports drinks branding them as a waste of money because there is no proof of their ability to increase performance or aid recovery. I then dug around in PubMed and on the BMJ to try to find some of the research papers where the data had come from and found this: http://tinyurl.com/cyzt7lp, a paper talking about the birth of sports drinks their use because of dehydration rather than thirst.

"The researchers also contend that much of the science behind sports drinks is biased or inconclusive and that empty calories from sports drinks are major contributors to childhood obesity and tooth decay" (http://tinyurl.com/coye356). So here we can see that there societal issues to do with the consumption of these drinks, although how many would one have to drink to lead to childhood obesity?

A BMJ article states that "Healthcare professionals should be encouraged to talk with patients about the calorific content of SSBs [sugar sweetened beverages] when discussing lifestyle modification to manage overweight and/or obesity . . . Consumption of water in preference to other beverages should be highlighted as a simple step towards healthier hydration: recommending 1.5 to 2 litres of water daily is the simplest and healthiest hydration advice you can give.” (http://www.bmj.com/content/343/bmj.d4280) So this article also agrees with the obesity issue arising from the consumption of sports drinks.

However I think that the killer argument came from the BMJ when Powerade were quoted on their website saying “water doesn’t have the performance benefits of a sports drink,”—but it does not go on to quantify what those benefits are" (http://tinyurl.com/cyzt7lp).

If you read the BMJ article (http://tinyurl.com/cyzt7lp then you can make up your own mind based on the evidence/lack of evidence of whether they actually are beneficial..?!
 

Seymour Medical Practice W/E

I had another two days of work experience last week at another General Practice in Bristol but this time in Easton rather than Hartcliffe.

It was very ineteresting to see the difference between the two Practices in terms of the way that they were run but also the cohort of patients that they had on their books. In Easton the patients were mainly of Caribbean, Central African or Indian origin opposed to the white cohort in Harcliffe. The issues that arose from the patients were also very different in Easton with less depression and long term illness but more cancers and varied illnesses. Due to there being a large number of African and Caribbean patients there was a lot of Prostate Cancer in the male patients, as the incidence of prostate cance is higher in black men than those of other ethnicities (http://seer.cancer.gov/statfacts/html/prost.html) with a lot of men coming in for the latter end of their courses of injections to control the cancer. 

There were a number of ethical situations raised in my time there. For example there were issues to do with the taking of medication and one man had not been taking it for some weeks, ignoring the doctors advice that it would be beneficial to his health. As it is not possible to force someone to take their tablets the doctor therefore gave a balanced argument for and against why he should take his pills and gave him the choice based on the data from drug trials and the discussion that they had had as to whether he should now continue with the drugs.

Another example was where someone was suspected of having lung cancer having spread from another part of his body, which he had already had operations for. It was then discussed whether he would like to attempt another operation to remove this next tumor which could soon be fatal. But he wished not to have any more surgery for the time being and wanted to try alternative herbal medicines. He thought that maybe this would be better than conventional medicine, as he had once seen someone get better on them and also believed in miracles. The doctor once again gave a balanced argument as to the benefits and risks of these medicines and gave the facts of the lack of data to suggest that they work efficiently and effectively in all patients.

I also spent time with one of the practice nurses who was in charge of the 'Stop Smoking' programme at the practice and consultations to do with malaria tablets and the options available and also asthma check ups.

It was just like Hillview Medical Practice in terms of the volume of patients through the doors every day and the number of patients on the books, but it was very evident as to the differences between the two practices in terms of the people that attended and the different sort of issues that they brought with them.