Irritable Bowel Syndrome – what is it and how can I manage it?

MaireadBy Mairead Keegan

Senior Specialist Dietitian, NHS Lanarkshire

With spring in bloom and April being the month for awareness of irritable bowel syndrome (IBS), it would be a shame to miss out on an opportunity to raise awareness of this condition and its treatment.

For many health professionals, they have a love/hate relationship with treating IBS. You could compare it to ‘marmite’: you either love it or hate it. I love it! Patients often think that Dietitians will ‘judge’ them on what they eat, or don’t eat; or suggest they make some radical changes to their diets, and whilst some do need a good overhaul we generally don’t do this. We’re here to offer advice to help patients take control and self-manage their condition.  Patients with IBS are sometimes so desperate to get symptom improvement, that they self-impose nutritionally inadequate diets, follow the latest ‘fad’ diet or buy the latest ‘superfood’ (no such thing!) for the treatment of IBS.

What I’ve decided to focus on, is the simple changes people can make that can have a significantly positive impact on their symptoms. But, before we look at dietary changes, let’s get some background on what IBS is.

IBS is a chronic, for some, life-long, debilitating, functional, gastrointestinal disorder. It affects twice as many women as men. Symptoms vary from individual to individual and can include bloating, abdominal pain, wind, altered bowel habit (diarrhoea, constipation or both), urgency to open bowels, nausea and lethargy.

In order to diagnose IBS, it’s important to note that one does not need to undergo invasive investigations, which is often a fear people have. I too would be dreading the thought of a colonoscopy or sigmoidoscopy! IBS, however, should be considered if a patient suffers from abdominal pain, discomfort, bloating or change in bowel habit, for at least six months. The National Institute for Health and Care Excellence (NICE) state: ‘diagnosis of IBS should be considered only if the person has abdominal pain or discomfort that is either relieved by defaecation or associated with altered bowel frequency or stool form. This should be accompanied by at least two of the following four symptoms:

  • altered stool passage (straining, urgency, incomplete evacuation)
  • abdominal bloating (more common in women than men), distension, tension or hardness
  • symptoms made worse by eating
  • passage of mucus.’ (1)

In addition to these, you will be asked to give a blood sample. This is to ensure you do not have coeliac disease or inflammatory bowel disease both of which require different treatments to IBS. If you present to your GP with what’s called ‘red flag’ indicators (see table below) then you should be referred to your local hospital for further investigation as appropriate.

Red FlagExamples of red flag indicators

  • Unexplained and unintentional weight loss
  • Rectal Bleeding
  • Anaemia
  • Abdominal or rectal masses
  • Family hisotry of bowel or ovarian cancer
  • A change in bowel habit to looser more frequent stools for more than six weeks in someone over 60

Once you have a diagnosis of IBS, you can then set about making simple but effective dietary and lifestyle changes to promote symptom resolution. Although everyone is talking about the low FODMAP diet as an effective treatment for patients with IBS, we need to remember it is not suitable for everyone. Don’t get me wrong; it is effective and probably one of the most successful approaches for the management of symptoms of IBS.

However, for some patients restrictive diets are not required, nor appropriate, but establishing a regular meal pattern and avoiding long gaps between meals, for example, can help.

My top ten tips for dietary and lifestyle management of IBS are:

  1. Eat three regular meals per day.
  2. Avoid eating on the go: take time to sit and eat in a relaxed environment, remember to chew your food well (I know I sound like your mum, but it works!).
  3. Avoid long gaps between meals, skipping meals or eating late at night.
  4. Reduce the amount of carbonated (fizzy) drinks and those containing caffeine and replace with non-caffeinated varieties, herbal teas or water.
  5. Aim to drink eight cups of fluid (as above) per day.
  6. Reduce the amount of alcohol consumed and limit to two units per day and have at least two alcohol free days per week.
  7. Reduce your intake of processed foods and cook from scratch, where possible.
  8. Reduce your intake of rich/fatty foods e.g. chips, fast food snacks, pies, creamy sauces, cakes, biscuits, crisps, burgers and sausages.
  9. Limit fresh fruit to three portions per day (one portion is 80g).
  10. Enjoy regular exercise e.g. swimming, walking, yoga (2)

Outlined above are suggested changes patients with IBS should be attempting to improve their symptoms. Although I have outlined many changes which people can make, it is important to remember to make one change at a time. Trying to alter too many things at once is a real challenge and often patients fail to maintain changes because of it. Therefore, make changes one at a time. Also, completing a food diary may be helpful for some, as it can help you to identify what changes were of benefit and which ones weren’t.

In those where stress is a key trigger; firstly identifying this as a trigger is a start, as people often overlook it or perhaps haven’t yet realised the effect stress has on their symptoms of IBS. Therefore, discussing strategies to help with relaxation can be effective.

If you suffer from diarrhoea predominant IBS, in addition to the above, avoid sugar-free sweets, mints, chewing gum and drinks which contain sorbitol, mannitol and xylitol as foods containing these ingredients can exacerbate diarrhoea. Remember to drink plenty of fluid to replace your losses so you don’t become dehydrated!

If constipation is your predominant symptom, try slowly increasing the amount of fibre in your diet e.g. change to wholegrains, oats, vegetables, fruit. You could also try adding one tablespoon of brown or golden linseeds (ground or whole) to breakfast cereals, yoghurts, soup, or salads. With each tablespoon of linseeds consumed, remember to take a small glass/teacup (150ml) of fluid. It’s important to remember to avoid eating extra wheat bran.

Lastly, but by no means least, if bloating and wind cause you difficulties then try having oats in your diet e.g. porridge for breakfast. You can also try linseeds, as suggested above. Reducing your intake of gas producing foods e.g. beans, pulses, brussel sprouts and sugar-free items may be of benefit.

If you have tried the above advice but your symptoms persist, ask your GP to refer you to see a Dietitian who can provide you with further dietary information whilst ensuring your diet remains nutritionally adequate. Your Dietitian may suggest, if appropriate, a low FODMAP diet. Please, do not try this dietary approach without the guidance and support of a Dietitian who works in this field.

Remember dietary changes are effective and sometimes it’s the little changes that make the difference, so don’t think you need to follow a restrictive diet for life, seek help, and your local Dietitian will be happy to help you!

References

  1. NICE Clinical Guideline 61 (February 2015): Irritable Bowel Syndrome in Adults: Diagnosis and management of irritable bowel syndrome in primary care
  2. BDA Food Fact Sheet (2016): Irritable bowel syndrome and diet.

Advancing and Awarding Scotland’s AHPs

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The Advancing Healthcare Awards for 2016 took place in London on the 15th April

This is the 10th year of these awards which recognise and reward projects and professionals that have lead these with the aim of making  a difference to patients and clients they work with.

Scottish winners were plentiful. AHPScot is delighted to list some of the AHP and Healthcare Scientist awards below. If we have missed any please tweet and let us all know who. You can see the full list of winners here .

Next year it could be you……….

 

Recipe For Sucess: A Conference For People Who Have Undergone Bariatric Surgery

LogoBy Pam Lindsay

Bariatric Dietitian, NHS Ayrshire and Arran.

In early 2015 there was a call for anyone wishing to submit a bid for endowment funding. I had been thinking hard about how we could motivate people in the longer-term following weight loss or bariatric surgery. I also wanted to celebrate the success of the patients that have gone through weight loss surgery over the last few years in Ayrshire and Arran (since 2008). I contacted a few people who had had bariatric surgery and asked them what they thought about working together to plan a patient conference. We decided to give it a go!

My bid was successful. I was delighted, and daunted, as I had never planned such a big event.

Planning:

My first job was to get a group of patients together for a meeting. I asked 12 patients, Kevin McMahon (Bariatric Nurse), Gillian Dick (Dietetic Health Promotion Practitioner), and Lee Rogerson (Secretary) to attend. We had a great turnout and followed up with monthly meetings until the date of the event (6 meetings).

Everyone agreed the event should be called ‘Recipe for success’. This would tie in with the health and celebratory theme, as well as the new recipe book we produced for pre and post bariatric surgical patients called ‘Recipes for Life’. It was agreed that the conference should be a half day held around the beginning of November 2015. We decided it would feel more special if the event was in a Hotel. The patients chose Gailes Hotel, Irvine.

To further support the running of the event, the patients decided to have a fundraising night and successfully raised over £400 to help with room decorations and patient packs.

InvitationThe Audience:

The group came to the decision that patients and a friend or family member would be invited to the conference. It was suggested that clinicians involved in the bariatric patient pathway would also be invited and that this this would include GP’s and the hospital staff.

400 invitations were printed and included a Barcode that patients could scan on a smart phone (Mii tuu) to leave comments and suggestions regarding the day and/or share their story:

I did not envisage the level of Communication required between everyone involved in the Conference from presenters to planning group. 300 invites were sent out to patients and whilst we had a few responses there was not a lot. As a result I decided to phone everyone who had not responded. This increased our numbers greatly as an explanation helped people understand the reason for the event and it encourage them to attend.

The Programme:

We discussed having six stalls:

  • Exercise on Referral (3 Local Authority areas),
  • The Recipe Book (Health Promotion Dietetic Team),
  • Jump Start (young person’s weight management programme), and
  • A beauty/reflexology stall.

Gillian Dick would also bring 2-days of meals displaying appropriate portion sizes (from the ‘Recipes for life -Bariatric Recipe Book’).

ProgrammeIt was thought that patient photographs and quotes of their feelings could be projected onto the screens within the function suite for people to view throughout the afternoon tea break. A Clinical Psychologist from London, Dr Jennifer Nash, who specialises in working with people with Emotional eating problems also agreed to make a short film to show at the event. Together we also decided that inspirational music should be a big part of the event and it would be played when people were arriving and during the tea break. I asked via the patient Facebook page if there was anyone willing to sing. I was amazed by the response and before long we had a choir planning to sing ‘The Climb’ by Miley Cyrus.

The programme illustrated was sent to all who confirmed they wanted to attend.

Learning:

Below are some of the things I learned from planning this event:

  • Plan in partnership in a truly co-productive way
  • Meet at least monthly for 6 months before, and keep in touch via email and phone
  • Some people may change their mind about telling their experience
  • Arrange meetings before the support group to encourage good attendance
  • Contact numerous venues and draw up a comparison chart
  • Invite a small core group of patients willing to help with planning
  • Keep notes and prepare items to discuss at meetings
  • Ask a graphic designer to design the invite and programme
  • Invite speakers to come to the meetings to give a taste of what they will be talking about at the event.
  • Arrange a suitable venue and invite speakers to come for a run through
  • Go to the venue in advance and trial all equipment
  • Use appropriate background music at breaks and on arrival

125 patients, friends/family and staff attended the event on Thursday 12th November 2015 from 12.30-5pm at Gailes Hotel, Irvine. Below is examples of the feedback received:

  • ‘Patients decided what they wanted and it was delivered’
  • ‘A different meaningful experience where every contribution was hard to make, however greatly appreciated’
Bariatric Conf 3
The audience enjoying the ‘Sit, Fit’ session accompanied by Abba’s ‘Super Trouper’
Daily Meal Plans.jpg
Daily meal plans displayed as normal and liquidised consistency

Next Steps:

We plan to discuss the conference at our Scottish Bariatric Group meeting and decide whether we could do this on a bigger scale for Scottish Bariatric Surgical patients.

The recipe book ‘Recipes for Life’ will soon be available to purchase to Dietitians in the UK through NDR-UK (Nutrition and Diet Resources UK).

Further Information:

Ccontact Pam Lindsay, Bariatric Dietitian 01292 614589
Pam.lindsay@aapct.scot.nhs.uk

Sit Less, Get Active

HelenBy Helen Ryall

Healthy University Project Coordinator, University of Edinburgh

Most people know that it’s good to move, right? But knowing why, what, how much, where and how often – and how to fit that into a busy life – and it can begin to feel a bit overwhelming to some of us. That’s where the University of Edinburgh’s MOOC called ‘Sit Less, Get Active’ can help.

MOOC Logo
University of Edinburgh MOOC ‘Sit Less, Get Active’ Logo

I can barely remember a day in the last 6 months where the word ‘MOOC’ hasn’t come out of my mouth. I didn’t even know what a MOOC was before then! The letters MOOC stand for Massive Open Online Course. MOOCs are online courses that can be taken by anyone from any part of the world as long as the person has access to the Internet. The main goal of this University of Edinburgh project is to empower and enable people to sit less and move more in various settings such as their neighbourhood, home, work, or school.

The course is the brainchild of a very enthusiastic colleague from the Usher Institute for Population Health Sciences and Informatics at the College of Medicine and Veterinary Medicine, University of Edinburgh. Originally a GP from Serbia, Danijela Gasevic came to Scotland and has shared her experience, passion and vision of creating opportunities for people so they sit less and move more. On this wave of enthusiasm, she has gathered up a few other keen physical activity promoters and colleagues on the way to make this dream a reality. They include myself (Helen Ryall), Dr Andrew Murray, Dr Graham Baker, Professor Chris Oliver and Professor Nanette Mutrie – as well as a large number of organisations who have advised us, endorsed us or worked with us in many capacities such as the Sport and Physical Activity Division of The Scottish Government, NHS Health Scotland, NHS Lothian, Sustrans Scotland, Edinburgh Leisure, and SPORTA.

MOOC Team
The MOOC Team

So what is the MOOC about? The main goal of this University of Edinburgh project is to empower and enable people to sit less and move more. Unlike other great courses that already exist, this isn’t a theoretical course that explains how the body works and the impact of physical activity on our body and mind. It’s a practical course that provides real examples on how to sit less and be more active in a variety of settings and help people learn how to set SMART physical activity goals, monitor their activity, and give some suggestions on how to make activity a habit. The course is presented in short 5 minute films that show the learner how people around Scotland are already making physical activity part of their lifestyle – they include children, older adults, teachers, parents, dancers, doctors and many more. We hope the course will inspire others to follow in their footsteps.

Although registration is already open, the course starts in May 20016 and will be three weeks long, with a commitment of not more than one hour per week. For the six months after the course, we will offer (and strongly encourage) people to receive short weekly physical activity e-mail messages, and monthly short videos as nudges to be more active.

We really encourage health professionals and others to be active themselves. We hope that they will take this course and treat it as continuous professional development that will have double benefits: it will help health practitioners be more active for their own health, and also equip them with the knowledge of how to help their patients sit less and be more active.

For more information about the course, please contact either myself at helen.ryall@ed.ac.uk or Danijela at danijela.gasevic@ed.ac.uk. Also, if you are active in social media, please follow us on Twitter @GetActiveMOOC where we post regular examples and ideas on how to be more active. And of course, don’t forget to sign up yourself https://www.coursera.org/learn/get-active.

In the meantime, we have a fast-approaching deadline to meet to get the course finished in time for the May launch. Ironically, when the launch date comes I am looking forward to having some time to sit down and put my feet up – but don’t tell anyone!

Lavender Touch

By Jan Beattie

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Have you ever gone along to something for “just one meeting” and found it develop into something else ?

I did in 2002 and it led into one of the most demanding, scary, challenging , varied and rewarding experiences of my life.

Screen Shot 2016-03-23 at 18.51.48However from this “one meeting “ grew The Lavender Touch, a charity in the Scottish Borders which supports people and their families across the region who have cancer.

The Lavender Touch is quite unique and an example of partnership working between the NHS, the voluntary sector, the local community, patients and carers.

The charity initially provided complementary therapies for those diagnosed with cancer via referrals received from healthcare professionals. However in good partnership working style , took on board feedback from service users and quite quickly expanded to support cares who are vital to the individual’s care.

Screen Shot 2016-03-23 at 18.51.54All treatments are very person centred in that they are arranged in a venue, location and frequency to suit and fit in with other demands of each persons life at this time. e.g. some people prefer to attend during their chemotherapy and others when it has finished. When working with a family where a person is receiving end of life care, it is not unusual for carers to request to “save “ a treatment for after their loved one has passed away. They find that having one of The Lavender Touch therapists visit several months later of great benefit.

We have constantly monitored and evaluated our service, feedback has constantly shown that over 99% of those who use our service say they find it of benefit.

Laterally following on from requests we have developed sleepwear and skin products based on the information and knowledge gathered over the past 14 years.

Screen Shot 2016-03-23 at 18.52.02The sleepwear was developed by a previous service user who had experienced cold night sweats and vividly describes getting up for the third time during the night to change bed linen but being unable to see due the sweat dripping into her eyes as she had no eyebrows or hai because of the essential chemotherapy she needed. Pauline has a background in textiles and used her experience and knowledge to create a product which has transformed the lives of some people.

The Essential and Therapeutic range of products came about following on from many requests by people who had experienced the benefits of the varying blends the Lavender Touch therapists had been providing.

Being involved with the charity has certainly at times provided new experiences and pushed me out of my comfort zone. I have done radio broadcasts, judged jam making competitions, challenged the rules of what is the norm, drawn more raffles than I care to count, run a half marathon, listened to so many personal stories of despair and triumph and hugged Tinky Winky at one of the venues who took part in in our wear Lavender to Work day

Screen Shot 2016-03-23 at 18.52.13As an AHP in my day job I am often asked where the link is …. AHPs take a holistic approach to care, are resourceful, manage risk, are great problem solvers and very innovative. The Lavender Touch has developed using all of these qualities  and we continue to do so.

 

However the main key to its success is the partnership working with those who have lived experience and the local communities

You can find out more about Lavender Touch here and follow them on Twitter

On My Soapbox for Ovarian Cancer Awareness Month

ProfileBy Joanna Teece

Dietitian, NHS Fife

Over a sunny summer bank holiday weekend Janet was diagnosed with ovarian cancer. She was a fantastic cook and had a real thirst for life and fun. She was also a close relative. Sadly her story did not have a happy ending but it often reminds me why, as a Dietitian our role in disease and diet is so important.

Ovarian cancer is the 5th most common cancer among women and last year 7,100 people were diagnosed. There are a few main symptoms of ovarian cancer:

  • Increased abdominal size and persistent bloating (not bloating that comes and goes),
  • Persistent pelvic and abdominal pain, and
  • Difficulty eating or feeling full quickly
  • Needing to wee more urgently or more often than usual

Occasionally there can be other symptoms such as changes in bowel habits, extreme fatigue (feeling very tired), unexplained weight loss or loss of appetite. Any post-menopausal bleeding should always be investigated by a GP [1].

After hearing of Janet’s diagnosis a previous conversation about her starting a gluten free diet vividly hit me. She had found she was getting bloated and had read about gluten free diets thinking it might help. This bloating was a classic symptom of ovarian cancer but sadly we as a family, the health professionals she saw, or Janet never made the connection.

With my dietetic hat on, I remember mumbling to the family that she should really be encouraged to see the GP, as you should only need to follow a gluten free diet if you have coeliac diease or dermatitis herpetiformis. Looking back, perhaps I should have got on my soap box and ranted a bit louder that following a gluten free diet for any other reason will not benefit your health. I didn’t, but now is my chance! So I will say it again, gluten free diets should only be advocated for medical reasons such as coeliac disease and dermatitis herpetiformis.

A gluten free diet is also not the same as a wheat free diet. Coeliac disease is an auto-immune condition where the body’s immune system attacks its own tissues. The reaction is triggered by gluten. Gluten is a protein found in wheat, barley and rye. When people with Coeliac Disease eat gluten, an immune reaction occurs. This damages the small bowel by causing inflammation of the gut lining. Following a strict gluten free diet for life is essential for their long term health. Despite this, and judging by the range of products I’ve spotted creeping onto the supermarket shelves which exclude sugar, wheat and gluten, these diets seems to become more mainstream each day. I guess I may need to shout a bit louder from my soapbox!

Although this story doesn’t have a happy ending, I am proud that later on when she was admitted to hospital over another bank holiday weekend with severe stomach pains and blockage of her bowel, I was able to help. Janet had not seen a Dietitian during her admission. She went home and was living on custard as she had no idea what the ‘low residue, high protein diet’ that she was advised to eat involved, or why it was needed. I was able to explain to her that the idea was to prevent her bowel becoming blocked again and to also improve her overall nutrition. I sent her some practical information and she was delighted that she could expand her repertoire beyond custard 3 times a day. She e-mailed;

“Thank you so very very much for sorting out the diet info. It’s really comprehensive and is just what I wanted! Can you believe that in a large hospital someone else couldn’t have pulled up something similar from a NHS site? Anyway – won’t stop now”.

Dietitians are experts at translating complex nutritional and medical information into practical dietary advice. I am very glad I was able to use these skills to improve Janet’s enjoyment of food butsaddened that I didn’t shout louder at the beginning.

So before I finish here is one final reminder, the signs of ovarian cancer can be:

  • Increased abdominal size and persistent bloating (not bloating that comes and goes),
  • Persistent pelvic and abdominal pain, and
  • Difficulty eating or feeling full quickly
  • Needing to wee more urgently or more often than usual [1]

Bloating does not mean you should start a gluten free, wheat free or dairy free diet. Your first step should be to seek advice from a health professional.

Gluten free diets should only be advocated for medical reasons such as coeliac disease and dermatitis herpetiformis.

A gluten free diet is not the same as a wheat free diet.

Always Trust a Dietitian to know about nutrition!

References

  1. Target Ovarian Cancer http://www.targetovariancancer.org.uk/about-ovarian-cancer/what-ovarian-cancer/ovarian-cancer-symptoms

Winston Churchill Fellowship – My Final Week in New Zealand

By Carolyn Bell

Physiotherapy Lead, Monklands Hospital, NHS Lanarkshire.

Friday 4th March
I’m getting ready to move on and picking up my hire car today. Local bus trips are always exciting but it’s good to feel a little more independent with your own transport.

Another free day so time to reflect and address what I have learned since commencing this amazing trip. I have learned so much by working with and talking to the individuals I have met, however at no time have I felt overwhelmed by information.

The treatments I have been giving are clearly sound, and whilst I now have “more tools in my tool box” and my treatments will be enhanced, my overall plans will be largely unchanged………with more emphasis on the nose of course! I am hugely reassured by that!
I just need to persuade many of my colleagues to become dysfunctional breathing champions!

Blog 4 Pic 1Another great show of spirit in Christchurch tonight. On walking through cathedral square I discovered it was filled with mobile kitchens, from caravans to pick up trucks. All cooking the most amazing food. Tables and chairs were set up, and were filled by families enjoying the food and listening to a guy singing. Ironic he should originate from Glasgow! A Nepalese curry was a great way to finish the day.

Saturday 5th March
Well another travelling day today but this time I’m driving myself. It’s nice to be able to choose the time you leave and where you want to stop. I have never been on a car journey that the instructions on the sat nav advise to turn right in 265 KM!!!

Blog 4 Pic 2I arrived safely in Dunedin, after a lunch stop at the Moeraki Boulders. Massive round boulders on a beach. Very bizzare. I’m hoping some of my friends with knowledge of Geology may be able to explain them to me!

Dunedin appears to sit in a valley headed by the sea. It’s also got lots of very steep hills…..including the steepest street in the world, and buildings ….and street names very reminiscent of Edinburgh!
I will investigate more tomorrow!

Blog 4 Pic 3Sunday 6th March
Once again “mundane job Sunday” has arrived! Once all jobs are done it’s time to explore Dunedin. It’s very strange to find yourself walking down Princes Street and George street! I spent a lovely 10 mins listening to a Maori choir singing and dancing in front of a statue of Robert Burns. I also had a chat to a vicar who was born and bred in Dunedin but had a broad Scottish accent! Lovely day to relax and catch up.

Meetings already set up for tomorrow so early start.

Monday 7th March
Meeting this morning with Bronagh Quinn. Bronagh treats patients with Neurological and vestibular problems, and also those with breathing dysfunction. She originates from Northern Ireland and still craves a “good cup of tea!” Bronagh is Bradcliff trained therefore the basis of her treatments involve the same core principles that have been evident through my trip however like all individuals she has developed her own techniques in presenting that information.

Bronagh incorporates breathing retraining with her neurological patients, as she finds many of her clients who have suffered a CVA over-use or fix with their upper chest. Another indication that I need to ensure all of my Physiotherapy colleagues have a raised awareness of breathing control!

A great analogy was used by Bronagh….when trying to encourage her patients to relax she asks her patients to ooze and melt!!!! I can definitely relate to that and it may be one analogy I adopt.

Once again Bronagh has been very generous in giving her time, sharing her experiences and material with me. Thank-you!

This afternoon sees me speaking to respiratory Physcians, ENT surgeon, Nursing staff and Physiotherapists at the Dunedin Hospital. I have to thank Dr Ben Brockway for arranging this.

It still feels a little odd presenting what I have learned to these individuals as I have come here to learn from them, however it is a great way to generate conversation!

Throughout my trip the basics of treatment have been consolidated but remain relatively constant, and this was no different in Dunedin. Very interesting discussions were generated including:

  • How we ensure patients are reassured that their issues are not “all in their head” when they are referred to Physiotherapy
  • How can we generate more research to validate our treatments?
  • We need to ensure we develop links with ENT to ensure patients are not subjected to a host of unnecessary investigations
  • There was recognition that staff working in call centres have high levels of stress, poor posture and due to reading from scripts can develop problems with speech patterning. Should we be addressing these groups of individuals when they commence employment in an attempt to prevent problems arising, rather than dealing with the problems once they are established? I have no doubt that in other areas of the world there will be a high incidence of people with dysfunctional breathing in specific professions. I have already come across individuals who treat a high number of lecturers. Can we be more proactive in these groups?

Whilst we did not come up with any specific answers to these questions it is clear that many of us are tackling the same issues on a day to day basis.

Another great day!

Tuesday 8th March
Blog 4 Pic 4Well no meetings today as I now have 2 tomorrow so an unexpected free day. Decided to travel to Portobello, St Kildas beach and St Claire’s beach. Its great having my own transport and being able to travel where and when suits both me and the weather! Today is cooler but fine. It’s very windy but not raining. The scenery is amazing and I am hugely privileged to have been given the opportunity to travel to this amazing place.

One of Winston Churchills beliefs is that if you live and work among people, you develop a greater understanding of who they are and why they function the way they do. This generates tolerance and a greater respect and unity. Reflecting today I can honestly say that the New Zealand people have been exceptionally friendly and accommodating. They have gone out of their way to ensure that my trip is as rich as it can be, both professionally and personally. I have been given access to their experience and wisdom in the treatment of patients and everyone has had great recommendations for restaurants, places to visit ……..and wines to drink!!!! I have been included in people’s family lives and been taken out for coffee, lunch and dinner! In all respects New Zealand is an amazing country.

Wednesday 9th March
Blog 4 Pic 5Well up bright and breezy this morning as I am speaking to a newly formed cardio respiratory group at Otago school of Physiotherapy. There are others joining via a weblink form Wellington.

These individuals had all agreed to meet at 8.00 before they started their day jobs at 9.00!

The individuals present had a mix of backgrounds from ITU Physiotherapy to MSK. Dr Margot Skinner was also present. Dr Skinner co-ordinates the cardiovascular/pulmonary sections of the physiotherapy curriculum at the School of Physiotherapy, University of Otago. She has had a long standing interest in the physiotherapy management for people with chronic diseases including the diseases of lifestyle and the management of sleep disordered breathing.

It is clear that in New Zealand they are trying to encourage Physiotherapists from very early in their training to consider the patient as a whole. This includes recognition that if a patient presents with a musculoskeletal problem the role of their diaphragm and breathing must be considered ……….if they can’t breathe they can’t move!!! This is definitely an area that I feel we need to make a bigger priority.

Other areas that were discussed were:

  • The prevalence of dysfunctional breathing following pulmonary embolus and pneumonia. Some of my patients do present following both of these scenarios so is this something we should be more aware of and educate in the acute phase?
  • Recognition that there are many children from the Christchurch area that are developing dysfunctional breathing. This is one area of “trauma” but this could be extrapolated to other scenarios.
  • The necessity to consider sleep health.

A very beneficial morning!

At lunchtime I met Justine Turner who is a Physiotherapist who works in a practice which is owned by an osteopath. She recognised that whilst he could improve his patients they often returned with similar issues. Many of his patients required education and training and in many cases this included instruction into correct breathing patterns. Justine comes from an MSK background but recognised the role that breathing control has to play in MSK conditions. She again is Bradcliff trained and utilises the philosophy they have developed, whilst like all practitioners she has developed her own methods of delivery.

Once again it is amazing the small things you can pick up by chatting about the types of patients we treat and the methods that we use. I must thank Justine for lunch and her partner for an exceedingly good cup of coffee!

Well that’s the last meeting of my Fellowship. The time has passed immensely quickly!
I have deliberately left tomorrow free to allow me to reflect on my experiences so far, and think about my next steps.

Thursday 10th March

Well everything feels a little different today! No meetings planned, no venues to find or presentations to give!

I have struggled to find the words to sum up this amazing experience. I have been able to travel to a fantastic country and met some very inspiring individuals and world leaders in the treatment of dysfunctional breathing. I have been met with nothing but kindness and everyone has gone out of their way to help in any way that they could.

Thankyou to the Winston Churchill Trust for giving me this opportunity.

I also need to remember to thank all of my colleagues back in the UK who have supported me throughout the planning of this trip, and those who have covered my work whilst I have been away! I should probably also apologise to them in advance as I am sure I will be very enthusiastic on my return and probably a little unbearable!!!

This is now beginning to sound like an Oscars speech so time to move on!

I think to summarise, the consensus of all the key points of treatment of patients with dysfunctional breathing are:

  • Recognition of dysfunctional Breathing and triggers
  • Education
  • Nasal hygiene / Nose breathing
  • Relaxation and breathing control – in all positions
  • Posture management
  • Self management including speech control, exercise, rescue remedies any specific issues to patient
  • Sleep Health

Easy!!!!!!!

A few key learning points from my trip………..there are many more!!!

  • The nose is under utilised and under considered!
  • Need to consider breathing pattern dysfunction when treating all patients!
  • Very strong links to Vocal Cord Dysfunction, Pelvic floor dysfunction and Gastric issues
  • There are many different ways to treat breathing dysfunction but all rely on same underlying principles
  • Need to address Breathing Dysfunction prevention – Asthmatics – Workforce
  • Need to engage Physiotherapy staff and medical staff at an early stage
  • Using “tech” may persuade some non believers – very useful with athletes
  • Research is required!

I am under no doubt that the real journey will begin once I return to work and start analysing all of the information I have gained however, this is a very exciting time both for me, my colleagues and my patients!!!!

Thanks for reading my blog!