Dr. Phil Hariram’s Blog

Here is food for thought. Eating the correct food can reduce the risk of cancer. According to a report from the World Cancer Research Fund eating red meat or processed meat and drinking alcohol increase the risk of cancer. It is estimated that up to a third of cancers reported in Britain are linked to diet. That is 100,000 cases annually. By knowing the right foods to consume you can limit some foods and increase the consumption of others. This way you can reduce the risk by 35%.

The main foods to increase consumption of are fruit and vegetables. The average consumption in Britain is three pieces a day when the recommended daily consumption should be five portions or more. Scientists have discovered that there are substances in brocolli, sprouts, cauliflower and cabbage that can speed up DNA repair in cells. This gives good cancer protection.

Scientists have found that bowel cancers are caused by nitrosamines found in cured meats such as ham and bacon. Garlic contains substances that protect against this chemical and thereby boost the body’s defences.

Fibre is an important ingredient in any diet. Bowel cancer makes up 13% of all cancers in Britain. Eating more fibre cuts the risk by 50%

In addition to increasing foods that boost defences against cancers, you need to also reduce the consumption of foods known to cause cancers. Red meat is linked to bowel cancer, breast and stomach cancers. You should eat no more than 500 g of red meat a week You should also avoid processed meat and that means no bacon, sausage, salami, ham or burgers.

Instead eat white meat, such as chicken and lots of fish. Soya products like tofu, soya milk may reduce the risk of developing hormone related cancers such as prostate and breast cancers.

Salt is a culprit. Too much salt can cause stomach cancer. Keep to the limit of 6g of salt daily. Regularly eating meals high in saturated fats increases the risk of many cancers especially breast cancer. Use vegetable oil when cooking and avoid deep frying. When barbecueing, avoid cooking the food until it is black. This may produce chemicals that can increase cancer risk.

As for alcohol, the limit recommended by the government is 14 units a week for women and 21 for men. Cancer Research UK suggest that a pint of beer a day or one glass of wine raises the risk of bowel cancer by 10% and for women a glass of wine daily increases the risk of breast cancer by 6%

Anti-cancer diet is likely to make you lose weight. Obesity is linked with increased cancer risk.

Eat more of fruit and vegetables especially brocolli, cauliflower, sprout and cabbage. Stir fry or steam to retain a high amount of cancer resisting substances. Aim to use about two cloves a week. Fresh and not dried. Use hugh fibre foods like pasta, wholegrain bread, bran. You should consume about 30g a day. Use soya-based foods like tofu.

Eat less red and processed meat. Reduce your intake of pork, lamb and beef. Alcohol consumption should be 7 units for women and 14 for men weekly. Reduce saturated fats from your diet. Instead of butter and lard, use vegetable or olive oil. Cut down on foods high in fats i.e. cakes, biscuits and chocolate. Do not add salt to food and check the ingredients of ready made meals for the salt content.

Dr. Phil Hariram

A Group led by Professor Irving Kirsch, at the Department of Psychology at the University of Hull, looked at 47 clinical trials using data from Freedom of Information rules by the US Food and Drug Administration. They looked at the most commonly used anti-depressants such as fluoxetine (Prozac), venlafaxine (Efexor) and paroxetine (Seroxat).

They found that these anti-depressants had no greater effect than a placebo for mildly depressed patients and the majority of people suffering severe depression.

This new group of anti-depressants are called selective Serotonin re-uptake inhibitors. If the blood serotonin level is low, you feel depressed. These drugs improve this. The study confirmed that depression improved with these drugs but patients also improved with dummy pills. In other words depression will improve without chemical intervention.

Prof. Irvine Kirsch said, “Given these data, there seem little evidence to support the prescription of anti-depressant medication to any but the most depressed patients unless alternative treatments have failed to provide benefit.”

Nine out of ten GPs admit that they are forced into dishing out prescriptions because of poor access to treatments such as cognitive behavioural therapy. In Chelmsford the waiting time for CBT is very long.

Although there has been numerous side effects linked with these drugs and suicidal tendencies associated with prozac and seroxat, they are an improvement on the older drugs. GPs over prescribe these drugs and this research will change the prescribing habits across the country. It is certainly a step in the right direction if patients are given coping mechanisms to control depression. If and when depression recurs, they will know what to do for themselves rather than expect the magic pill to sort it out.

There are numerous times that I spent over twenty minutes talking to a depressed patient and prescribing the drug they expected from me and when they return for a follow up, they admitted that they did not take their tablets but took on board what I said, changed a few things in their lives, and that felt much better. There are also quite a few elderly patients on these drugs. They get their repeat prescriptions every month and stack them up in their cupboard and show no signs of any change.

This research result will not just save the NHS money in reduced prescriptions, but will change patients expectation. They will know that to get better, they should first heed the statement of two letter words. “If it is to be, it is up to me.”

Dr. Phil Hariram.

Bowel cancer is the third most common cancer in Britain. It is estimated that more than 30,000 people annually are diagnosed with it and 16,000 dies from it every year. This cancer is treatable if caught early. Many sufferers leave it too long before seeking medical help. This delay can result in spread from the tumour to other organs causing poor treatment outcome.

The current screening program for bowel cancer is only available to individuals in the age group 60-69. Although the average age of diagnosis is 70, bowel cancer can develop in the younger age group. This screening test picks up cancer early and improves long term survival.

Now a urine test designed to enable people to find out if they are at risk of developing the disease is being tested. This means that if the test highlights a greater risk of developing bowel cancer, you can alter your diet and lifestyle to minimise the risk and continue regular monitoring.

The test looks for abnormal strands of DNA coming from damaged bowel cells. Apparently this genetic material called DNA adducts are found in the body at the start of the cancer. If trials on this test proves to be great success, it will be an important tool in the fight against this devastating cancer.

To prevent the development of bowel cancer, your best advice is to avoid obesity, and stick to a special diet. There are several trials at present to determine the link between diet and cancer. Having regular exercise and avoiding significant weight gain are two important ways to reduce the risk of cancer.

Dr. Phil Hariram

Polyclinics will be the most radical change in the NHS for over 60 years. In London a network of 150 polyclinics are planned. These clinics will be equipped with x-rays, ultrasound etc and will carry out as much as 50% of the outpatients clinics done at the Hospital. The concept was introduced by the new Health Minister, Sir Ara Dazi.

The announcement has been met with mixed reception. Prof. Bosanquet said it will lead to a complete gridlock in the Capital’s Health Service. Andrew Langley, the Concervative Spokesman, said that there are area where GP services are weak and a polyclinic will deliver better Community access to care. He also stated that there are areas where GP services are strong and that there was no case for shutting down hundreds of local GP surgeries.

Some argue that as the Hospital role changes, local hospitals doing routine work and acute hospitals doing specialised cases and trauma, patients will expect longer journeys for care especially emergency care and could threaten lives.

So is it a good idea? You decide.

The Super-structures will combine GPs, dentists, podiatrists and other specialists under one roof. It is hoped that this will reduce the time waiting for hospital appointments. Richard Vautrey of the BMA is worried about the loss of the Medical Generalists (GPs) and doctors would no longer provide the holistic and generalised service that patients value.

In the “Dr. Findlay” days, the family doctor was respected for his personal and continuous care. Is it the same today? With the introduction of the 24 hours access to GPs, you cannot book to see your GP in advance and when you make an appointment, you can only see the doctors available. One lady said she was lucky if she saw the same doctor twice. In addition, if you need a doctor out of working hours, you will not be seeing your own doctor. He is off duty.

The days of the family doctor that follows your progress from the cradle to the grave is long gone. But are polyclinics the right fit?

Dr. Phil Hariram

In a matter of a few days Arsenal seem to lose the high ground. There is no doubt that they are the most entertaining Football Team in the premiership. But of late the wheels seem to be falling off.

Firstly in the Carling Cup Semi, they were severely beaten by their near rival, Spurs. Last week they were humiliated by a Manchester United Side that is looking unbeatable. Mid-week they only managed a draw against AC Milan and have to do better away from home to progress in the Champion’s League. On Saturday they drew with Birmingham City while Man United romped home against Newcastle and the gap at the top is now only 3 points.

When Arsenal are winning, they look impressive but they are poor losers. Against Spurs in the Carling Cup Semi, two of their front men started fighting each other. Against United, one was sent off and to make things worse, their top striker was booked for diving. This reminds me of the FA Cup Semi-final against Man United when Tierry Henry dived and was booked when they did not have any hope of winning. Sadly Eboue was also booked for diving in the last Champion’s League match. That is two Arsenal bookings for diving in two matches.

To make matters worse, yesterday, their great North London rival, Tottenham Hotspur won the Carling Cup Final bringing silverware to the club for the first time in 9 years. With this manager, it seems there are more to come.

Sad to see a great talent as Eduardo so severely injured. I wish him all the best. There is one good that came out of the last match. It was the first goal scored by an Englishman for Arsenal in a year and he scored twice. It is also good for the home countries that the four goals were scored by British players. That Englishman that scored for Arsenal is a relative of the great Clive Walcott, one of my West Indian Cricketing heroes in my youth along with Weekes and Worrel. The three Ws.

I hope this was just a bad spell and Arsenal will be back firing on all cylinders soon and not keep looking behind them to see where Man United are but I suspect, as Gallas gave the game away, they are running scared.

I hope Wenger stops complaining and get his team back on the winning streak. Against United, he complained that ground was unsuitable. He complained about time wasting when Arsenal are experts at running the clock down. And his remark after that unfortunate tackle, although retracted, will linger and continue to affect a player who was simply beaten by sheer pace and brilliance as seen by the numerous replays on TV.

Good Luck Arsenal. Your course ahead in very bumpy. The Champion’s League will be an enormous struggle and for the Premiership, you have two big away matches. One against Chelsea and the other against Man United. If you win either of these, or both, you will deserve it. The alternative: Another year without a trophy.

Phil Hariram.

When I became a General Practitioner in 1977, there were limited options for treating anxiety and depression. In addition, the nearest Psychiatric Hospital, Severalls, was in Colchester, a distance away. There were huge gaps in the treatment of this group of patients. Once anxiety or depression was diagnosed, the next step was a prescription of tranquillisers or anti-depressants and these drugs had side effects and other problems. Barbiturates were still used for anxiety and Valium (diazepam) and Librium (chlordiazepoxide) were the most frequently used drugs. Stress was not a word in common use.

The anti-depressants were tri-cyclics and MAOI group of drugs. They all had terrible side effects. Drugs in this group are amitriptylline and prothiaden.

In time it became clear that tranquillisers and sleeping pills were addictive and some patients were actually taking these drugs just to feed their addiction. With the reduction of tranquilliser use, other forms of treatment were introduced and this created a better understanding and care. GPs had access to treatment such as Cognitive Behavioural Therapy, Counselling and Psychotherapy.

In addition, the newer anti-depressants, the Selective Serotonin Re-uptake Inhibitors, SSRI, changed the way we prescribed for depression. These drugs such as Prozac reduced side effects and most importantly significantly lowered the number of deaths from anti-depressant misuse.

Today Prozac, Seroxat and other SSRIs are the first line in the treatment of depression. They are so safe, some feel that they are badly abused and prescribed for minor problems when sound advice was all that was necessary. These drugs are very good and have made a significant difference to a large amount of people. So many people are now able to live a life of better quality as a result of these drugs.

Treatment for mental health today is very good. Patients now get the quality of care they need and with the introduction of some really effective drugs, they are able to get targeted treatment to get them back on their feet as soon as possible.

Today stress is a word in common use. Your doctor is more likely to say you are stressed rather that suffering anxiety. I intend to spend a lot of time in this blog discussing stress and how it is the underlying cause for as much as 90% of illnesses today. It is simply shocking how stress alters the chemicals circulating in your body.

This blog will show you various ways to reduce stress and minimise the risk of other illnesses. During my time a GP, I trained and practised Hypnotherapy and Acupuncture. I will explain how Hypnotherapy works and how it can alter perception and reduce stress. Subscribe to this blog to get post as it happens.

Stress in every where. Stress can also be as a result of a perception. If you think the resources you can muster to cope does not meet up to the challenge in front of you, you are already on the first step to stress.

Dr. Phil Hariram

Tagamet was introduced when I was a trainee GP or as it is called today, a GP registrar. Before Tagamet and the other anti-ulcer drugs, ulcer patients suffered severely. When antacids were ineffective and a barium meal showed an ulcer, surgery was the next option. There were procedures such as Vagotomy and pyloroplasty and the scary Bolroth. At the time there was a saying “You are not a successful executive unless you have an ulcer by 35.”

Ranitidine, the second anti-ulcer drug made Glaxo a big player in the Pharmaceutical Industry. Similarly Losec (Omeprazole) , a proton pump inhibitor, changed Astra, the Swedish Drug Company.

These drugs changed the lives of people with dyspepsia. For ulcers and acid reflux surgery became rare. The introduction of fibre optics into medicine meant endoscopies were carries out. Gastroscopies became a routine procedure and biopsies enabled the gastro-enterologists to grade the severily of the condition.

In 1982, the Australian duo and Nobel Prize Winner, Warren and Marshall, discovered a bacteria in the stomach of ulcer patients. The bacteria is Helicobacter pylori. Eradicating this bacteria allowed healing of ulcers. A combination of high dose antibiotics and anti-ulcer drugs for a week or two cured the ulcers.

Today gastric and duodenal ulcers are associated with Helicobacter pylori infection rather than stress, lifestyle or over indulgence.

Dr.Phil Hariram

When I finished my Vocational Training and ready and fully trained to enter General Practice, I had two choices. One of my brothers had moved to Alberta, Canada and I fell in love with Alberta especially the three National Parks Banff, Waterston and Jasper. Practising Medicine in Canada became very attractive.

I was offered a full partnership in a practice in a small town called ValleyView just north of Edmonton. The starting annual income was just amazing: 44,000 Canadian dollars in the first year. And this was in 1976. Wow!! At least three time what I was offered in my first year as a GP.

After much deliberation and long chats with my brother in West London, I decided that although the money was good, the sacrifice was too great. I could not live in a country that did not play cricket.

As a youngster growing up in Guyana, cricket was a sport every boy played. If we did not have a proper kit, we shaped coconut branches into bats and make cricket balls out of balata. Balata is a hard rubber like material made by drying the milky juice produced by the bully tree (species Manilkara bidentata). To shape balata into a cricket ball, we took a lump of balata and put it into the hollowed bottom of the large empty Wincarnis bottle. Wincarnis was a popular tonic drink. Very hot water was then placed into the hollow and the balata gently spun until it turned into a sphere. The ball lasted at least a week. For stumps, anything within reason was used from old barrels to tree trunks.

I love sport and enjoy football, rugby, golf, tennis, horse racing to name but a few. Moving to Canada meant no more cricket, football or rugby. This was not on. Today with Sky Sport and Setanta, I can watch most sporting events from the comfort of my lounge. How good is that?

Dr. Phil Hariram

I started as a full time General Practitioner in Chelmsford in 1977. I knew my senior partner was retiring in just over three years. The main surgery was really two rooms attached to his house. When he retired, I needed to find new premises. The branch surgery was not exactly ideal. In fact, I had to find two new premises.

I bought a house in Broomfield, and developed it strictly in compliance with the regional district surveyor. This meant the building qualified for cost rent. In other words, my mortgage repayment was offset by the rent from the Essex Health Authority.

At the same time, I expressed interest in a new surgery in North Springfield. I was offered a portacabin by Fairview while I looked for a suitable plot. Three surgeries between two doctors meant a lot of extra work and travel.

When my partner retired, we had a surgery in Broomfield and a portacabin in Springfield. The new purpose built surgery was complete and we moved in March 1982.

Having two surgeries posed a problem with regular contact. This, however, changed when the practice was split and we stayed in North Springfield.There was nothing better than having one surgery and all the doctors and related staff under one roof.

I had a young energetic forward thinking male partner and a lady doctor who was as qualified as any local Consultant Gynaecologist. What could be better?

One partner qualified in Sidney, Australia and the other, born and trained in India. I was born in Guyana, South America and trained in Glasgow, Scotland. It was an unusual mix but one that worked extremely well.

Dr.Phil Hariram

When I arrived in Britain, I was told that I needed A levels in Biology, Chemistry and Physics to get into Medical School. No one told me that, as a foreign students, there were only a few places available and in some Med Schools there were none. In fact I needed three A levels at A grade.

After my first year studying for my A level, I applied to the allocated number of Universities using the then UCCA form. I had interviews with three and put on a waiting list for all of them. When the A level results were out, I did as well as expected but I was not offered a place in Med School. I was offered alternative courses.

I waited a further two years before Glasgow unconditionally accepted me. I was not exempt from the first year. It meant I lost another year. It also meant I felt I was the happiest person in the world.

Med School was a fantastic experience and a sound training at Glasgow meant I was prepared to face anything. After I officially had MB, ChB after my name, I arrived back in London where my brother, Rock lived with a huge hat and a smoking a long slim panatella. Yes I had the world at my feet and felt top of the world.

I wanted to practice Medicine in my homeland but unfortunately politics in Guyana had taken a turn for the worse. I decided to practice in UK. When I started as a GP in Chelmsford, it was a challenge. My senior partner refused to have any staff other than his wife. She worked when he worked and I had no help. There was a branch surgery in Springfield where I spent most of my time. There was no receptionist so I received patients, did the filing, answered the phone and everything else while seeing patients.

When my senior partner retired and I took over, the practice changed. It was the first purpose built practice in Chelmsford and quickly became a practice that delivered top quality medicine.

Dr. Phil Hariram