Category Archives: Health

Dr Matthew Hind PhD FRCP Consultant Physician

Dr Matthew Hind PhD FRCP.
Consultant Physician Department of Respiratory Medicine.
Email: m.hind@rbht.nhs.uk

Secretary: 07394 478523
Email: secretary@drhind.co.uk
penny.heathwood@nhs.net

Clinic Date: 23 June 2023 Date Typed: 03 July 2023 Royal Brompton & Harefield Hospitals Specialist Care Sydney Street, London SW3 6NP Tel: 020 7351 8830 NHS No. Hospital Number. 4259439 OWS No. 1196770 Dr

Tim Lyons klyle@90sloanestreet.com
90 Sloane Street London SW1X 9PQ

Dear Tim Re: Mr Timothy Robarts.

DOB: 02/05/1952 57 Yeomans Row, London, SW3 2AL.

It was kind of you to ask me to see Tim Robarts, a 71 year old gentleman who has recently had a permanent pacemaker inserted under my colleague,Vias Markides, due to episodes of bradycardia on a background of atrial fibrillation and heart failure with a preserved ejection fraction. You asked me to see him for a respiratory opinion. He is an ex-smoker who smoked enthusiastically until the age of 35 when he quit. He describes exertional breathlessness such that he would struggle to climb up a flight of stairs. His breathlessness on the flat has improved since the pacemaker has been inserted. Prior to this he was limited at about 200 yards on the flat. Sleep has also improved since the pacemaker. He continues to describe episodic snoring and occasional apnoeas. He has never seen a respiratory physician in the past but I note he was admitted under the care of our colleague Inaki Bovil to the Lister Hospital a number of years ago and treated for an exacerbation of COPD. Clinical examination today revealed he is generally well. Resting oxygen saturations were 97%. Heart sounds were normal with a systolic murmur. Chest was clear. I agree with you I think a respiratory assessment would be helpful. I will arrange CT, lung function, and a home sleep study. I look forward to seeing him in due course with these results.

Once again, many thanks for asking me to be involved in his care. Royal Brompton Hospital Sydney Street, London SW3 6NP Harefield Hospital Hill End Road, Harefield UB9 6JH RB&HH Specialist Care Outpatients and Diagnostics 77 Wimpole Street, London W1G 9RU Tel: 020 7351 8830 | Fax: 020 7351 8535 | www.rbhh-specialistcare.co.uk With best wishes, Yours sincerely Dr Matthew Hind Consultant Physician.

The YOGA My Heart Study

J Arrhythm. 2015 Dec; 31(6): 337–338.

Published online 2015 Jun 6. doi: 10.1016/j.joa.2015.05.001

PMCID: PMC4672029

PMID: 26702311

The impact of yoga on atrial fibrillation: A review of The Yoga My Heart Study.

Steven Brent Deutsch, MD? and Eric Lawrence Krivitsky, MD.

Author information Article notes Copyright and License information Disclaimer

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Abstract

Atrial fibrillation is a common arrhythmia affecting thousands of individuals worldwide. It is a conduction disorder that causes the heart to beat irregularly and rapidly. There are a few medical approaches to manage this costly health care burden: antiarrhythmics to maintain normal sinus rhythm, beta blockers to achieve rate control while allowing atrial fibrillation to persist, and electro-physiologic intervention for rate and rhythm control. These treatments can be costly and are not without side effects. Yoga, an intervention that is available to people worldwide, has shown some promise in combating this widespread heart disorder.

Keywords: Arrhythmia, Atrial fibrillation, Health care cost reduction, Medication alternative, Exercise

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1.?Introduction

The Yoga My Heart Study was a single center study that brought to light the therapeutic impact a noninvasive, medication-free intervention has on a costly disease. Atrial fibrillation (AF) is a common cardiac arrhythmia that affects two to three million people worldwide. It is associated with significant morbidity and is also an independent risk factor for mortality. One of the most debilitating complications of the disease is thromboembolic stroke, though it is also known to precipitate and worsen the outcomes of congestive heart failure, a disease already known to represent a significant financial burden [1]. The treatment of AF and its associated complications increases healthcare resource utilization and contributes to increasing costs of healthcare, particularly costs associated with hospitalization (Fig. 1).

Fig. 1

Yoga training effects on reducing.

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2.?Discussion

Current AF treatment mainly consists of antiarrhythmic drugs (AADs) and/or catheter ablation. Unfortunately, both strategies have met with less than optimal results and patient satisfaction. While catheter ablation may offer up to 70% of patient?s freedom from AF, this is at the toll of an invasive procedure. Furthermore, freedom from AF is often defined on the basis of symptom reduction rather than continuous monitoring for true freedom from arrhythmia [3]. While new, promising strategies such as FIRM and ganglionatedplexi ablation are on the, they are still associated with procedure-related risks including cardiac perforation, valvular injury, esophageal-atrial fistula formation, and phrenic nerve injury [4][5][6]. In addition, many patients who suffer from AF have significant comorbidities that preclude invasive strategies and effective AADs and may require an alternative treatment strategy [7].

In the study conducted by Lakkireddy et al., the authors tested the hypothesis that yoga could reduce the burden and symptoms of AF. This was a small, single center trial that ultimately included 49 participants. The unique approach of this study involved patients serving as their own controls; for the first 3 months, patients continued standard AF AAD therapy, followed by 3 months of 60-min biweekly yoga sessions. Patients were also encouraged to practice yoga at home on a daily basis. The primary outcome was a composite of the reductions in symptomatic AF, symptomatic non-AF, and asymptomatic AF episodes as recorded by a diary and correlated with a non-looping event monitor. Strikingly, the results validate the ability of yoga practice to reduce patient-reported AF symptoms. It also demonstrated a statistically significant impact on quality of life (QoL), mental health, physical functioning, depression, and anxiety. Yoga training reduced symptomatic AF episodes (3.8±3 vs. 2.1±2.6, p<0.001), symptomatic non-AF episodes (2.9±3.4 vs. 1.4±2.0; p<0.001), asymptomatic AF episodes (0.12±0.44 vs. 0.04±0.20; p<0.001), and depression and anxiety (p<0.001) while improving, QoL parameters including physical functioning, general health, vitality, social functioning, and mental health as assessed using the SF-36 (p=0.017, p<0.001, p<0.001, p=0.019, and p<0.001, respectively). There were significant decreases in heart rate and systolic and diastolic blood pressure after yoga training (p<0.001) [2].

Arguably as importantly, there was an objective reduction in AF burden. This is an important finding as many other studies of AF interventions rely solely on subjective history and intermittent EKGs. Furthermore, the study demonstrated a nonpharmacological approach to improve overall QoL in patients with a common medical condition [2]. This may directly result in decreased hospitalization and healthcare costs. Yoga is also an intervention free from medication-related side effects or the complications observed with cardiac ablation. Although the study does not present yoga as a treatment for AF, it does show it to be a favorable adjunct to current therapies.

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3.?Conclusion

Future directions for the study of the effect of yoga on AF are broad. A larger, randomized, and multi-center trial would certainly help validate the above findings. In addition, a longer-term follow-up would be needed to ensure the results persist, as this is a common weakness of other interventions. It may also be of value to echocardiographically monitor for signs of positive remodeling such as decreased left atrial volume over time as another potential benefit of yoga with broad antiarrhythmic potential.

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Disclosures

There are no conflicts of interest, financial associations, or relationships that could influence the objectivity, integrity, or interpretation of this publication.

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Conflict of interest

No grants or conflicts of interest.

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References

1. Reynolds M.R, Essebag V. Economic burden of atrial fibrillation: implications for intervention [published online 04.04.12].

2. Lakkireddy D., Atkins D., Pillarisetti J. Effect of yoga on arrhythmia burden, anxiety, depression, and quality of life in paroxysmal atrial fibrillation: The YOGA My Heart Study. J Am Coll Cardiol. 2013;61:1177–1182. [PubMed] [Google Scholar]

3. Steinberg J.S., Palekar R., Sichrovsky T. Very long-term outcome after initially successful catheter ablation of atrial fibrillation. Heart Rhythm. 2014;11:771–776. [PubMed] [Google Scholar]

4. Pokushalov E., Romanov A., Artyomenko S. Ganglionatedplexi ablation for longstanding persistent atrial fibrillation. Europace. 2010;12:342–346. [PubMed] [Google Scholar]

5. Narayan S.M., Baykaner T., Clopton P. Ablation of rotor and focal sources reduces late recurrence of atrial fibrillation compared with trigger ablation alone: extended follow-up of the CONFIRM trial (Conventional Ablation for Atrial Fibrillation With or Without Focal Impulse and Rotor Modulation) J Am Coll Cardiol. 2014;63:1761–1768. [PMC free article] [PubMed] [Google Scholar]

6. Dagres N., Hindricks G., Kottkamp H. Complications of atrial fibrillation ablation in a high-volume center in 1,000 procedures: still cause for concern? J Cardiovasc Electrophysiol. 2009;20:1014–1019. [PubMed] [Google Scholar]

7. LaMori J., Mody S., Gross H. Burden of comorbidities among patients with atrial fibrillation. Ther Adv Cardiovasc Dis. 2013;7:53–62. [PubMed] [Google Scholar]


Articles from Journal of Arrhythmia are provided here courtesy of Japanese Heart Rhythm Society


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Yoga by Emmanuel Carrere

June 23, 2022GeneralHealthtimothyrobarts

Yoga by Emmanuel Carrere

“Outrageously Good”

This book is wonderful and you absolutely have to read it, and I say that as a man who has not been able to touch his toes for a decade and who flees for all mention of wellness like a startled horse. Writing this wonderful transcends such petty barriers.

I’m reluctant to go into specifics as I did not know what to expect and want you to feel what I felt as this unfurled before me. But one passage stands out so much that I need to talk about it, so I will make an exception.

Towards the end of the book, a piece of music is mentioned and viewed in text as a Youtube video. This video exists and we are none too subtly nudged towards watching it ourselves (this sort of audience participation would normally be met with a steely indifference from me, but Carrère had me in the palm of my hand at this point, I would have given him a major organ had he suggested it). Watching this clip alongside the author, and it really does feel like that, was one of the single greatest literary experiences of my life, a perfect few minutes. There is magic in these pages.

I love the indiscipline of this, the honesty, the divine humanness of it all. The best book I have read so far this year.

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An arresting and deeply contemplative self-portrait of a man forced to face himself anew as tragic events unfold in his life, Yoga is a powerful and revelatory memoir from the acclaimed author of The Adversary.

This is a book about yoga. Or at least, it was.

January 2015. High on literary success and familial bliss, Emmanuel Carrere embarks on a rigorous ten-day meditative retreat in rural France in search of clarity and material for his next book, which he thinks will be a subtle, upbeat introduction to yoga. But his trip is cut short, and he is brought down to earth with a thud as he returns to a Paris in turmoil in the aftermath of the Charlie Hebdo terrorist attack.

From then on, Carrere’s life begins to unravel, along with his novel-in-progress. He is diagnosed with Bipolar II Disorder and is sectioned to a psychiatric hospital for a four-month stint, where he is subject to electroshock therapy. His marriage crumbles, he is struck by grief at the death of a close friend and is haunted by a love affair with a mysterious woman who disappeared from his life. Pushed to the edge of sanity and forced to reckon with his identity as a man and a writer, Carrere sets out on a life of action instead of meditation.

This is a book that embraces the Yin and Yang of life: the pull between life and death, desire and despair, presence and absence, fight and flight. It is a book about a world and a man in tumult, and about how surprisingly far practising meditation – and writing about it – can take us in life. With raw honesty and humour, Yoga gives us the self-portrait of a man struggling to live with himself and others, by one of our greatest and most surprising international writers.

Publisher: Vintage Publishing
ISBN: 9781787333215
Number of pages: 320
Weight: 437 g
Dimensions: 222 x 144 x 31 mm

Yoga by Emmanuel Carrere

Yoga by Emmanuel Carrere

“Outrageously Good”

This book is wonderful and you absolutely have to read it, and I say that as a man who has not been able to touch his toes for a decade and who flees for all mention of wellness like a startled horse. Writing this wonderful transcends such petty barriers.

I’m reluctant to go into specifics as I did not know what to expect and want you to feel what I felt as this unfurled before me. But one passage stands out so much that I need to talk about it, so I will make an exception.

Towards the end of the book, a piece of music is mentioned and viewed in text as a Youtube video. This video exists and we are none too subtly nudged towards watching it ourselves (this sort of audience participation would normally be met with a steely indifference from me, but Carrère had me in the palm of my hand at this point, I would have given him a major organ had he suggested it). Watching this clip alongside the author, and it really does feel like that, was one of the single greatest literary experiences of my life, a perfect few minutes. There is magic in these pages.

I love the indiscipline of this, the honesty, the divine humanness of it all. The best book I have read so far this year.

XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

An arresting and deeply contemplative self-portrait of a man forced to face himself anew as tragic events unfold in his life, Yoga is a powerful and revelatory memoir from the acclaimed author of The Adversary.

This is a book about yoga. Or at least, it was.

January 2015. High on literary success and familial bliss, Emmanuel Carrere embarks on a rigorous ten-day meditative retreat in rural France in search of clarity and material for his next book, which he thinks will be a subtle, upbeat introduction to yoga. But his trip is cut short, and he is brought down to earth with a thud as he returns to a Paris in turmoil in the aftermath of the Charlie Hebdo terrorist attack.

From then on, Carrere’s life begins to unravel, along with his novel-in-progress. He is diagnosed with Bipolar II Disorder and is sectioned to a psychiatric hospital for a four-month stint, where he is subject to electroshock therapy. His marriage crumbles, he is struck by grief at the death of a close friend and is haunted by a love affair with a mysterious woman who disappeared from his life. Pushed to the edge of sanity and forced to reckon with his identity as a man and a writer, Carrere sets out on a life of action instead of meditation.

This is a book that embraces the Yin and Yang of life: the pull between life and death, desire and despair, presence and absence, fight and flight. It is a book about a world and a man in tumult, and about how surprisingly far practising meditation – and writing about it – can take us in life. With raw honesty and humour, Yoga gives us the self-portrait of a man struggling to live with himself and others, by one of our greatest and most surprising international writers.

Publisher: Vintage Publishing
ISBN: 9781787333215
Number of pages: 320
Weight: 437 g
Dimensions: 222 x 144 x 31 mm

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Coronavirus Antibody blood test and swab test update

1.  SWAB (PCR) test – this is suitable for any patient who has possible or definite viral symptoms and who would like to know if they CURRENTLY have the Coronavirus. 

2.  ANTIBODY BLOOD TEST (Abbott) – this is suitable for anyone who thinks they have had the Coronavirus and who would like to have confirmation that they have developed antibodies. As it is an IgG antibody test, it is IMPORTANT to note that the test should only be done at least fourteen days, and preferably longer, after the illness.  As yet there is no definite information as to whether the presence of IgG antibodies confers any immunity and if so, how long it lasts. We also don’t know whether the presence of antibodies means that you can still be a carrier or not. I suspect with time we will know much more about this and can advise accordingly. As with the swab test above this test can be done at home, as a finger-prick blood sample, which is obviously more suitable for anyone who is self-isolating. Please note this test specifically requires proper laboratory testing and does not give an instant self-read result.

Harrow Community Covid-19 Response

From the headmaster of Harrow School

Alastair Land

Alastair Land, Head Master, went to Manchester Grammar School before he took a First in Natural Sciences at Trinity College, Cambridge, where he was President of the College’s Students Union. After completing his PGCE at Cambridge, he began his career at Eton as a teacher of Biology. There he became a Deputy House Master and held several extra-curricular responsibilities, including command of the CCF. Alastair then spent nine years at Winchester, where he was Master in College and a member of the Senior Management Team. Alastair was Deputy Head Master at Harrow for three years from 2012, before he moved to Repton as Headmaster. He returned to Harrow as Head Master in April 2019. He has retained his interests in outdoor activity and scholarship; Alastair is developing a process of strategic development of boys boarding in the twenty first century.

Harrow Community Response

I continue to be inspired by the response of the School community in these uncertain times. We have received thousands of masks, gloves and hand sanitisers from parents and friends. These have been distributed to local healthcare providers along with generous donations to the School’s Covid-19 Response Fund.

Harrow School continues to work closely with the local Borough to provide educational support for young people throughout the Coronavirus crisis. Our offer of classrooms, the Sports Centre and sports facilities for the educational provision for pupils with special educational, health or social care needs as well as the children of key workers formed a key part of the Council’s contingency planning and the site remains available for the Council to use. We are working closely with LEAs both in and outside of London to provide a bespoke learning resource for looked after children throughout the Summer Term and many beaks have volunteered to run live subject-specific Q&A sessions for looked after children and young carers in the area. In the Summer term we will be sharing reading lists and parts of our Super Curriculum and looking to run online lectures on a topic of the day with partner schools.

We continue to communicate regularly with Northwick Park Hospital to ensure that all possible support for our local hospital is coordinated and available. We continue to offer emergency accommodation on site as well as use of the Sports Centre for medical facilities and other parts of the School. We are making and distributing hundreds of protective visors in the D&T department and have provided large numbers of pieces of PPE locally. So far thousands of face masks and a large volume of hand sanitiser, goggles, gloves, protective suits and aprons have been delivered. All available PPE on the School site has been passed on and parents kindly continue to send in more equipment to support our local services. Our fleet of minibuses have been offered to the local Council, NHS, carers and charities for unlimited use as required.

A large volume of food and supplies have been delivered to local charities for dispersion amongst the most in need. Separately, we have set up a food bank distribution centre at the School dining hall that went live on 6 April. With the funds the School has donated, we are currently feeding 18 families (with a family unit of four) for seven days with essential supplies; this provision is in place for at least the next ten weeks. The food bank has been staffed by volunteer members of the catering team. We have arranged for food distribution to two other food bank hubs in the local area using our suppliers with the same discounts that we receive. This represents an initial, minimum £10,000 commitment to fighting food poverty. In terms of benefit to other food hubs and combined with other donations this value is significantly higher. If you feel you are able to make a resource or financial contribution to the fund, please send any donations to the Harrow Development Trust, using reference Covid-19 Aid, where it will be immediately used for relief of food poverty and support for the local community. Transfers can be made through the Development Trust’s account (NatWest; Sort code: 60-10-10; Account number: 37899120; BIC: NWBK GB 2L; IBAN: GB69 NWBK 601010 37899120).

We continue to work closely with our local partners: particularly Young Harrow Foundation and Harrow Carers. Significant financial donations have been made along with many vital food and equipment deliveries. A large number of staff are volunteering locally. So far, Harrow has distributed over £40,000 of the Long Ducker proceeds and parental donations to support organisations working in the community during the crisis. The School continues to run the Covid-19 response fund to raise money for those most affected by the current crisis. The Long Ducker and Long Ducker Bike Ride will be raising money for organisations at the forefront of the local response to the crisis.

https://www.harrowschool.org.uk/Support-and-resources

https://www.harrowschool.org.uk/Senior-Management-Team

https://www.cnwl.nhs.uk/application/files/1115/8618/7460/Wellbeing_pack_for_self_isolation.pdf

Covid-19 – Oxygen Saturation Test

There has been a great deal of interest in the media concerning the various different tests for the virus which until recently have only been available for those ill enough to be in hospital, and now for NHS staff. There is now a simple blood prick test to see whether you may have developed antibodies or not to the Coronavirus. Although this test may have a use, it is still under development and may not as yet be 100% reliable. It would therefore be preferable to wait for a full viral antibody profile which will be available in due course and would be done with a proper blood test sample and sent to the laboratory as normal.

The one piece of kit that might be useful is an Oxygen Saturation Meter, which is very useful in determining the overall function of the heart and lungs.