The evenings are stretching out and for many, training for the Woman’s Mini Marathon is getting under way.  If you haven’t yet dusted off your runners there is no better time to get active.

We should all get at least 30 minutes physical activity most days of the week, on top of our usual daily chores.  Walking is a great way to start, swimming provides exercise while protecting sore hips, knees or backs and heavy housework and gardening count too!

Variety is the key to sustaining exercise habits so why not take up a new activity today.  At this time of year there is one more term of classes before the break for the summer.  So do check out your local communities / parish centres or websites to see what classes are on offer.

www.dcyc.ie

www.killester.dublindiocese.ie

www.stanthonysclontarf.dublindiocese.ie

www.baldoyleforum.ie

There is new evidence that demonstrates that even if you are overweight but active, that improves your health outcomes immensely.  So, do not let the fact that you are overweight cloud your views on the benefits of becoming a little fitter.  It is in small steps that there is progress, one begins to enjoy exercise and the “feel good factor” encourages us to do a little more.

As the summer looms improving your activity level will have the added impact on your children.  We are all aware that children who are active are easier to deal with, happier in themselves and as a result there is more happiness in your life.

www.getirelandactive.ie

www.parentsforhealth.org

Many people find that the approaching cold winter evenings signify a difficult time of year for their mental health. Symptoms of depression, anxiety or difficulties with isolation or addiction can occur to anyone at any time of their life and it is often difficult to know where to turn. Bullying, bereavement, loss of a job or coping with relationships or sexuality can all leave us feeling unable to cope. You may feel alone, embarrassed or that no one else could understand what you are going through – and therefore that no one can help.

Remember that up to 25% of people in Ireland will experience mental ill-health at some stage in their lives – that’s one in four people. With a problem that common you are certainly not alone. However a real barrier does remain in people feeling they can tell others of their problems without fear of being looked on differently by family, friends or employers.

So where can you start?

 First of all look after your own mental health. Stay active, build relationships and interests, talk about your feelings and take time out from work to relax. Avoid using drugs or alcohol as a way to cope with life’s stresses.

Look out for your friends and family. Be aware of signs that someone may be in difficulty such as withdrawing from their social life of friends, irritable or unpredictable behaviour or moods, physical changes such as loss of energy, appetite or poor sleep.

If you or a loved one needs help – talk to someone you trust, see your GP or counsellor. Reach out to one of the many support agencies working for mental health in Ireland – information and links can be found at www.yourmentalhealth.ie , www.letsomeoneknow.ie , www.spunout.ie

In case of emergency or crisis – please contact your GP, GP out-of- hours service, Emergency department or  The Samaritans  (1850 609090) www.pieta.ie (01 601 0000) or www.childline.ie

The annual Influenza and Pneumonia vaccine will be available this month from your GP

Who should get the vaccine this year?

Vaccination is strongly recommended for - 

• Persons aged 65 and over,
• Those with a long-term medical condition such as diabetes, heart or lung disease,
• People whose immune system is impaired due to disease or treatment,
• Persons with a body mass index (BMI) over 40,
• Pregnant women (can be given at any stage of pregnancy),
• Residents of nursing homes and other long stay institutions,
• Healthcare workers,
• Carers,
• People with regular close contact with poultry, water fowl or pigs

 It is recommended that all “at risk groups” receive an annual flu vaccination.

• Information Leaflet on the Winter Flu Vaccine 2012 -2013. Available here.

Vomiting and Diarrhoea (V+D) is one of the most common illnesses seen in infants and young children. The vast majority of cases (>80%) are caused by a viral infection (viral gastroenteritis) and settle without any treatment within 48hrs. Most viral gastroenteritis occurs in winter and spring but it can happen any time of the year and nearly all children will have had this bug by the time they are 5 years old. The virus that causes gastroenteritis is very contagious and can passed very easily from person to person.

The biggest risk to a child with V+D if that they aren’t holding in enough fluids and become dehydrated.

Gastroenteritis usually starts suddenly and as well as V + D the patient may have crampy stomach pains, often before a bout of diarrhoea or vomiting, they may also have a temperature.

Vomiting can also be a symptom of other illnesses but these are all much less common than gastroenteritis, these include;

Gastro-oesophageal reflux (common) – Vomiting typically after feeds due to a weak stomach muscle, baby can be cranky but otherwise well, babies usually grow out of this without any treatment.

Appendicitis – child usually has constant tummy pain which gets worse.

Blocked intestine – Tummy pain and vomit is ‘grass green’ colour.

Pyloric stenosis – Very forceful vomiting in baby <3months old.

Urine Infection – Vomiting, tummy pain, high temp and sometimes pain passing urine.

Meningitis (rare) – Vomiting, fever, lethargy, very irritable, spots that don’t fade when pressed.

Treatment of Gastro-enteritis

There is no cure for gastroenteritis and the bug generally passes within 48hours. The illness can go on for a week or more but the main objective is to keep the child hydrated with regular fluids.

The best fluids to rehydrate a child are oral rehydration solution (dioralyte) – it contains the perfect balance of salts and glucose to rehydrate a child. Other drinks i.e. 7up have a sugar content which is too high and they can actually make diarrhoea worse. Start rehydration giving small sips or a spoonful every 10-15mins for the first 4-6 hours. You can also freeze it and make it into ice pops. If you can’t get dioralyte you can dilute 7up to half strength with water.

After 6 hours you can try some soft food or milk – if they vomit up the food keep them on the dioralyte for 24 hours.

After 24 hours you should return to normal diet even if diarrhoea continues, prolonged starvation can actually make diarrhoea last longer. Diarrhoea may last up to 2 weeks. Child should be kept off school till diarrhoea settles as they re infectious.

There is no role for antibiotics in gastroenteritis, we do not give kids medications to stop diarrhoea.

Dehydration – is the main risk in gastroenteritis. The signs that indicate dehydration include, dry lips and tongue, pallor, lethargy, not wetting nappies, fast heartbeat. If your child develops these symptoms they should come to see the doctor.

The above information is general guidance about vomiting and diarrhoea in children, if your child develops any of the features underlined or if they are less than 6 months old I would be advising to come to see the doctor. Needless to say if you are worried about your child with vomiting and diarrhoea we would be happy to see them at any time.

Here in Dr. McEvoys Surgery, we are keen that our asthma patients have the best possible care. We run an asthma service overseen by our Practice Nurse Mary Llewellyn

We recommend that all our patients have

• Annual asthma reviews,
• Asthma management plan
• Spirometry Testing.

Stay well this Winter

People with asthma often find that chest infections, sudden changes in temperature, and cold or windy conditions can trigger their symptoms and these can cause problems during the autumn and winter months.

The general objective of our asthma care is to ensure that you maintain optimal control of your asthma. Our advice to you is:

1. Keep taking your regular medication as prescribed; this is especially important during the winter months when primary asthma triggers like airborne viruses and air pollution are prevalent.
2. Discuss with us whether you should have the flu vaccine. We recommend you have the vaccine if you are over 65 years of age, if your asthma is moderate to severe or if you have had an asthma attack in the last year.
3. If cold air triggers your asthma take two puffs of your reliever inhaler before going out.
4. Wrap up well and wear a scarf over nose and mouth.
5. Take extra care when exercising in cold weather. Warm up for 10-15 minutes. Take two puffs of your reliever inhaler before you start your exercise.

It is important that you have your own personal asthma management plan. This is a plan which should be completed by your Doctor or Asthma Nurse in discussion with you and contains the information you need to control your asthma. Winter time and coming into the winter months is a good opportunity to update and revise your personal asthma action plan.

This should include information about your: Asthma medications, signs of deterioration in your asthma and what you should do about it, emergency information and what to do if you have asthma attack.

What should I look out for?

• Waking at night with coughing, wheezing, shortness of breath or a tight chest
• Increased shortness of breath on waking up in the morning
• Needing more and more reliever treatment or reliever not working very well
• Unable to continue your usual level of activity or exercise

Asthma Attack …………….The Five Minute Rule

The Five Minute Rule contains the recommended steps to follow in an asthma attack

1. Ensure the reliever inhaler is taken immediately. This is usually blue and opens up narrowed air passages.
2. Sit down and loosen tight clothing.
3. Stay calm. Attacks may be frightening and it is important to stay calm.
4. If there is no immediate improvement continue to take the reliever inhaler every minute for five minutes or until symptoms improve: two puffs if MDI/evohaler or one puff if turbohaler.
5. If symptoms do not improve in five minutes, or if you are in doubt, call 999 or a doctor urgently. Continue to give reliever inhaler until help arrives or symptoms improve.

Do not be afraid of causing a fuss, even at night.  To get your Asthma Attack card contact the Asthma Society of Ireland or log onto www.asthmasociety.ie

It’s a scary time for any parent no matter how much experience they have when their child becomes sick. Parents often tell me they feel unsure how long it’s safe to care for their child at home and when they need to see the doctor. The short answer to this question is if you’re unsure then bring the child in to be seen or call myself, Dr. Kerry O’Connell or Dr McEvoy for advice.

My aim in this section is to provide parents in our practice with a resource that can help them recognise common childhood illnesses and manage them at home if appropriate.

With the winter months are approaching and the kids back to school one of the most common attendances to our surgery is the chesty child.

The Chesty Child

The Facts

• 8-9/10 children with chest symptoms have viral infections and will settle without antibiotics.
• The average school aged child will have between 6-8 viral illnesses per year most of which will settle with conservative measures.
• If your child has a high temperature (>38.5C) and a rapid rate of breathing they are more likely to have an infection in the chest.
• A persistent cough (>2 weeks) in a well child may indicate asthma.

The Common Cold

 What they have

• Runny nose, sneezing, cough, sore throat, mild temperature, a little bit out of sorts.
• The coughing and sneezing is the body trying to expel the virus, usually the symptoms settle down within a week

How can you help?

• Paracetamol (Calpol) or Ibuprofen (Nurofen) for any mild temperature or pain.
• Plenty of fluids and rest
• A decongestant such as menthol drops can be used to unblock the nose.
• Antibiotics are not useful in the common cold.

Influenza (The Flu)

 What they have

• High temperature >39C , Sore head and pains all over, Dry cough, No energy or interest in food or playing
• This is the same virus that adults get, most common in school age children. There are slightly different strains of the flu each year and normally only children with serious underlying health problems are offered the flu vaccine.

 How can you help?

• Paracetamol or Ibuprofen for temperature and pain, strip him down to his vest if very warm.
• Regular small drinks of water or ice pops.
• If symptoms worsen discuss with doctor.
• Keep them off school.
• Antibiotics are not helpful in the flu.

 Bronchiolitis

 What they have

• Usually this is an illness of children under 18mths and happens in the colder months.

• Starts like a cold with temperature, runny nose and cough. Then cough gets worse and may develop some wheeze.
• Breathing often gets faster and more of an effort, sometimes babies can have short pauses in their breathing. Babies can have feeding difficulties due to rapid breathing.

 How can you help?

• If baby has nice pink colour, breathing is comfortable and are feeding well they can be cared for at home.
• Give small amounts of fluids regularly and control any temperature with Paracetamol.
• Sitting your baby up a little may help their cough and breathing.
• If baby becomes stops feeding or develops signs of respiratory distress they should be brought to see a doctor or to the hospital – the may well need to be given oxygen and iv fluids.
• Signs of Respiratory distress – Rapid rate of breathing, nostrils flaring to get more air in, sucking chest wall in and out , grunting sounds on breathing, pale skin and bluish tinge around lips and tongue.

Since the start of the Practice, providing antenatal care, care of the newborn and postnatal care has been a source of great  professional and personal satisfaction for all the staff, the Doctors, Nursing staff and the reception staff.  Simply put we enjoy your joy.

The Practice can confirm that you are pregnant, calculate your estimated date of delivery, discuss options for your care during your pregnancy, offer combined antenatal care, discuss antenatal screening, help with forms for sorting out your entitlements during your maternity leave.

Typically antenatal care is shared between the hospital of your choice and the GP.  Antenatal care in the practice is done using a state run scheme known as Combined Antenatal Care.  Typically there are 6 antenatal care visits to the Practice in a 1^stpregnancy 5 in subsequent pregnancies, 2 week check for the baby and a 6 week check for the mother and baby.  If there are significant illness such diabetes or hypertension there is leeway for a further 5 visits.  Illnesses not related to the pregnancy are not covered by the scheme.

If you are an existing patient of the Practice these visits are free of charge.  If you are a new patient to the Practice, the first visit will include registration and a general health check and will incur a consultation fee.

The benefit of this scheme is that the monitoring of your pregnancy will be with a doctor with whom you will become familiar with over the course of your pregnancy.

In the last 30-35yrs, there has been the tradition of hospital based care, however there is now recognition that some women will opt for home birth.  So if you want to avail of this service, you need to alert the community care of your local HSE office and request a list of midwives providing this service in your area.  You still need to sign up for the combined antenatal care scheme if attending a HSE or self employed community midwife.

Hospital Websites:

www.breastfeeding.ie

www.cuidiu-ict.ie

http://www.welfare.ie/EN/Schemes/BirthChildrenAndFamilies/MaternityBenefit/