St David's Osteopathic Clinic

Low blood pressure

2011-05-04T10:01:00.000-07:00

Readers, especially older people, may be interested in this article about unstable blood pressure and dizziness. (Orthostatic = standing upright)

Orthostatic Hypotension in Older Adults

The prevalence was surprisingly high.

Orthostatic hypotension is common in older adults, particularly among those taking hypotensive medications and those with diseases associated with autonomic dysfunction (e.g., diabetes, Parkinson disease). In this study from Ireland, researchers used a continuous noninvasive blood pressure (BP) monitoring device to measure orthostatic change on a single occasion in 442 community-dwelling, older adults (mean age, 72).

Mean baseline supine systolic BP (SBP) was 160 mm Hg. The changes from supine to standing SBP conformed to three general patterns:

"Small drop, fast overrecovery" (25% of participants): mean SBP drop within 30 seconds, 16 mm Hg; quick recovery exceeding baseline SBP at 30 seconds
"Medium drop, slow recovery" (54% of participants): mean SBP drop within 30 seconds, 35 mm Hg; return to near-baseline SBP at 30 seconds and at 2 minutes
"Large drop, nonrecovery" (21% of participants): mean SBP drop within 30 seconds, 62 mm Hg; gradual but incomplete return to baseline SBP during 2 minutes of monitoring

Eighty-five participants met a previously published definition of "initial orthostatic hypotension" — a symptomatic SBP drop of >40 mm Hg within 15 seconds (Clin Sci (Lond) 2007; 112:157). These elders, compared with other participants, were more likely to have fallen recently (25% vs. 10%), to be taking >4 medications (54% vs. 39%), and to meet criteria for frailty or prefrailty (71% vs. 52%).

Comment: Substantial orthostatic hypotension was surprisingly common among these older people. Many had "initial orthostatic hypotension," an entity characterized by an almost immediate drop in BP that can elude detection when clinicians use conventional measuring devices. Clinically important orthostatic hypotension — both initial and delayed — almost certainly is underrecognized among older patients. Clinicians should routinely ask older patients about postural dizziness, check for orthostatic changes during office visits, and adjust medications and make other recommendations that mitigate postural BP changes.

— Allan S. Brett, MD

Published in Journal Watch General Medicine April 28, 201

Mediterranean diets

2009-06-24T13:53:00.000-07:00

It's that time of year when thoughts naturally gravitate to the Med - sun, sea and tomatoes, aubergines, olive oil, red wine, etc.
Here's some more interesting information about all that, this time collected from the BMJ.

Salubrious Components of Mediterranean Diet Identified

A population-based cohort study in BMJ highlights the individual components of the Mediterranean diet that appear to have the greatest effect on mortality.

Researchers interviewed some 23,000 healthy Greek adults about their dietary habits and followed them for 8.5 years. They found that the following elements of the Mediterranean diet contributed the most to a mortality risk reduction:

-- moderate consumption of alcohol;
-- low intake of meat;
-- high consumption of vegetables, fruits, nuts, monounsaturated fats, and legumes.

In contrast, high intake of cereals, fish, and seafood -- and low consumption of dairy products -- showed little effect on mortality.

Statins and muscle aching

2009-06-18T14:11:00.000-07:00

For those of you on statins, and who have suffered myalgia (muscle pain) as a result, this may be of interest. It comes from Physician's First Watch. Our patients fairly commonly complain of muscle pain or aching in the legs in particular.
Red Yeast Rice -- Treatment Option for Patients Who Can't Tolerate Statins?
Red yeast rice lowers LDL cholesterol in patients who cannot tolerate statins, reports Annals of Internal Medicine.
Some 60 patients who had discontinued statins owing to myalgia were randomized to receive red yeast rice supplements (1800 mg twice daily) or placebo for 24 weeks. (Red yeast rice contains naturally occurring lovastatin.) All patients also participated in a 12-week lifestyle change program focused on nutrition, exercise, and relaxation techniques.
Mean LDL cholesterol levels at 12 and 24 weeks fell by 27% and 21% respectively, with red yeast rice, and by 6% and 9%, respectively, with placebo. The differences between groups were statistically significant. The supplement appeared safe in terms of new-onset muscle pain, as well as creatinine phosphokinase and liver enzyme levels.
The authors acknowledge the study's limitations, including the small sample size and short duration. Still, they conclude that their intervention "may provide a therapeutic lipid-lowering option for the large cohort of patients" with statin-associated myalgia.
These are the links:
http://click.jwatch.org/cts/click?q=227%3B67221979%3BkWKrd7DBzHFe5ubIRY%2B7fMo4KRD2U6vTAlwXtPn6im4%3D
Annals of Internal Medicine editorial (Subscription required) http://click.jwatch.org/cts/click?q=227%3B67221979%3BkWKrd7DBzHFe5ubIRY%2B7fNJpnnMaymyoAlwXtPn6im4%3D
Annals of Internal Medicine patient summary (Free) http://click.jwatch.org/cts/click?q=227%3B67221979%3BkWKrd7DBzHFe5ubIRY%2B7fIrRYuze0SGdAlwXtPn6im4%3D

Ask your GP if this is relevant to you.

NICE recommendations

2009-06-14T12:16:00.000-07:00

Readers may have noticed that the new NICE guidance for the treatment of chronic back pain on the NHS included a recommendation for manipulation or mobilisation amongst other protocols.
You can read their full guidance here.
As in all things in health care, notably when things have a cost implication, change happens slowly. So don't expect your GP practice to fund your osteopathic care just yet. But in the future, who knows... Here's hoping.
And... who knows if it helps - always ask.

Happy New Year!

2008-12-29T13:44:00.000-08:00

A Happy New Year to all our patients and clients. And let's hope it gets warmer soon, and that we have a decent summer. Dream on....

Xmas Works Outing

2008-12-13T06:55:00.000-08:00

Off we motored (yes, sorry - buses not too good from the Teign Valley) to Cairney's Bistro in Crediton for our Christmas do. This was a return trip, as we couldn't keep away any longer from Jim's superb cuisine.
Our pics show a fairly measured start to our celebrations (you wouldn't expect anything else -would you?) and Warwick assessing the merits of chocolate box contents. Colin's hiding behind the camera.

Fees

2008-11-28T13:56:00.000-08:00

We usually put our fees up at this time of year to cope with landlords' requirements of yearly increases, as well as all the other bills that increase without any obvious improvement of service. But as everyone is rather overstretched this year we've decided to tighten our own belts a notch or two instead. So our fees will remain the same as last year's, at £38 for an initial consultation, with £33 for follow-ups, and a £5 discount for children and unwaged.
There are no VAT changes as you don't pay VAT on osteopathic treatment.

2008-10-07T13:57:00.002-07:00

St David's Clinic was busy at the Mid-Devon Show at Tiverton in July, with lots of visitors, young and old.

David and Suzy were the main heroes of the day. Our picture shows Suzy entertaining a small crowd.

Gardening

2008-04-09T12:41:00.000-07:00

The gardening "season" is with us again. Well, I mean the longer days at least, and the valiant attempts by both gardeners and plants to produce a harvest of sorts before the other inhabitants of our garden thwart us in a fiendish variety of ways.
As usual the Blackthorn winter brings us cold weather, ie snow as usual, which means frustration for gardeners, who always want it to be warmer than it is. ADVICE: keep warm when you're outside. It's all too easy to work up a sweat and then get cold in the wind. That often leads to back problems. And try to divide your tasks up so you don't attempt to do too much at once. Fatigue and cold is not a good combination!

Book table

2008-04-09T12:34:00.000-07:00

Thanks again to everyone who has brought books in, and those who've bought them!
Our recent support has been to a charity called Mobility India, which helps people with disabilities, supplying prostheses, training etc to the poor in India (£120) and to the Devon Wildlife Trust (£80). Our charity of the moment is Rokpa, which supports Tibetan healthcare and educational projects in Tibet. The UK branch of Rokpa is based on Samye Ling Tibetan monastery in Scotland.

HAPPY CHRISTMAS!

2007-12-21T10:56:00.000-08:00

Our clinic will be open on Christmas Eve, Monday, then on Thursday through to Saturday as normal.

New Year's week we'll be open every day except for Tuesday.

Merry Christmas and a Happy New Year to everyone from the team!

Cerebral Palsy research project

2007-10-22T12:20:00.000-07:00

The Cerebral Palsy research trial funded by Cerebra, and organised by the Peninsular Medical School, Great Ormond Street Hospital and the Osteopathic Centre for Children is still running. We are part of the Devon end of the trial which will be recruiting new children until next Spring.
The Peninsular Medical School has some interesting information on this exciting project.

Who do we treat?

2007-09-29T04:23:00.000-07:00

It often seems to surprise people when we claim to treat problems other than low back pain or other spinal mishaps, so I thought it might be useful to analyse, briefly, the symptoms of the patients of one of our practitioners over the last fortnight.

Neck 22
Headache/pain 9
Shoulders 6
Thoracic/rib 4
Lumbar spine 14
Disc involvement (+sciatica) 6
Hips 1
Knees 2
Stress 16
Emotional/psychiatric 4
Post RTA multi area symptoms 4
Ears 3
Throat/swallowing 1
Cardiac (post operative & angina) 3
Babies - colic 3
Babies - plagiocephaly 1
Asthma 1
Multiple sclerosis 2
Muscular dystrophy 1
Parkinsons 1
Cerebral palsy 1
Fibromyalgia 1
ME 1
Rheumatoid arthritis 2
Osteo arthritis 2
Post-operative problems (scarring/adhesions) 2
Ovarian 1
Abdominal/bowels 1
No specific symptoms/maintenance 7
Dogs 1
So although spinal problems are the most significant issues for many(about 40%), people come to us with many other types of conditions, and often we can help. Most people will have had previous medical help or advice with these things which has either not helped enough or has caused other problems.

Emergency telephone number

2007-07-28T09:24:00.000-07:00

Osteopaths from all over Exeter have been co-operating to create an emergency telephone number for weekends and bank holidays, when most of our practices and clinics are shut. This number, 07014 223 466, will be answered by osteopaths working on a rota, to give advice and possibly treatment if circumstances allow. Our own involved osteopath is David Stainer-Smith.

This does not of course change our normal phone arrangements. As we are open on Saturdays already, patients who need treatment or advice can still get help on our usual number (o1392 221321) on Saturdays.

Holiday snap.

2007-04-27T12:44:00.000-07:00

OK, by popular request here's a pic of one of our intrepid osteopaths pretending to go native on a bedouin horse. That's at Petra in Jordan (at Easter).

Spring 2007

2007-03-31T11:12:00.001-07:00

The year is proceeding at frightening speed. Our clinic however is proceeding smoothly, steered competently by our wonderful reception staff, Suzie and Sue. This year Warwick has visited his daughter in Australia and has been raving about the wonders of Oz, Paul has had a great time in Robin Hood's Bay (Yorks) with his family, and has been wrestling with ongoing paediatric osteopathy for his cpd. Colin has been continuing with Biodynamics of cranial osteopathy (also cpd). And the research trial of osteopathy for children with cerebral palsy continues apace (see below). We're all looking forward to a short break for Easter, and hope the weather warms up again soon!

Bonnie gets her certificate

2007-02-08T13:09:00.000-08:00

As some of you might know, Bonnie, Colin's Scottish Terrier, has been going to Lapford Dog Club, for her version of Continuous Professional Development,(CPD), which we all do of course.

On Wednesday evening she passed her first exams, which she's very excited about.

The monks can't be wrong!

2007-02-07T14:11:00.000-08:00

Our book table

2007-01-21T05:52:00.000-08:00

Our waiting room book table, where we sell donated books for 50p for charity, is still doing well.
Contributions over the last year have gone to Hospicecare in Exeter (£139.12), Practical Action (76.25), Rokpa (£102.17) and Devon Wildlife (£81.59).
Practical Action is a small charity that provides low-tech solutions for basic problems the poorest communities in the world suffer from (eg animal shelters for the winter in the High Andes, floating vegetable plots in Bangladesh, donkey ploughs in arid parts of Africa...)
Rokpa is a Tibetan charity providing healthcare and education in Tibet, Nepal and Zimbabwe.
Thank you to everyone who contributed books, and to those who bought them.

Our man in the field

2007-01-16T05:54:00.000-08:00

David Stainer-Smith, flanker for Wessex first team in the Devon/Cornwall league, shown here stemming the tide of a St Austell attack. Wessex won 48 - 12.

Happy New Year!

2007-01-09T12:53:00.000-08:00

After a rather exciting time around Christmas (for Colin at any rate - transported off to Venice for a surprise 60th birthday treat), the clinic returns to normal.....
....or does it? Warwick's turn next, and he's off to Australia for 3 weeks, returning fresh and tanned in early February. Colin, Paul and David will provide cover for his patients during this time, trying to control their envy as the rain pours down, wondering if he'll abscond for ever....

Cerebral Palsy research project

2006-12-13T13:41:00.000-08:00

The Osteopathic Centre for Children in London has joined the Peninsula
Medical School here in Exeter and UCL's Great Ormond Street's
Hospital for Children in London to research the value of cranial osteopathy in treating
children with cerebral palsy. We're very pleased to part of this
undertaking in the south west, with colleagues in Torbay and Plymouth.
Cerebra, the charity for children with cerebral palsy, is providing the funds for this project. For more information on Cerebra go to: http:// www.cerebra.org.uk/
For more information on the research project go to UCL's press release: http://www.ich.ucl.ac.uk/pressoffice/pressrelease_00483

Our new man

2006-12-13T13:34:00.000-08:00

David Stainer-Smith has joined us recently.
His interests in rugby and other extreme sports
will obviously fill a gap...

2006-12-11T06:06:00.000-08:00

Colin Crewdson.
Colin in his study, not looking studious.

2006-12-11T06:01:00.000-08:00

Warwick Downes.
Warwick, pictured here looking sceptical in the kitchen, has another life in the world of music and dance.

Osteopathic partners

2006-12-11T05:54:00.000-08:00

Paul Thompson perching on his desk. Paul has
the comfy room, with tv, music and loads of toys.

more of us..

2006-12-10T11:14:00.000-08:00

Occasional visitors to our clinic are Chloe the lurcher (shown here) and Bonnie, the Scottish terrier. They find life in the clinic a bit dull.

I didn't mention Rose in my last entry! How could I forget?
Rose Pell is a counsellor who works with us on an ad hoc basis, mostly with
clients who've suffered trauma in road accidents. For more information on Rose's work go to /www.devon-cornwall.police.uk/dcsc/educadvi/roadsupport.htm
(If the link doesn't work copy and paste on to your browser.)

Birthday

2006-12-09T09:33:00.000-08:00

Our clinic is 21 years old this autumn. So perhaps birth day is wrong; nothing else sounds right.
Colin Crewdson established the clinic in a basement room in Boxall & Freeman's orthodontic
practice in Richmond Road, near the clocktower in Exeter, sharing the lower two floors

with Brian and Penny Brown, chiropodists and podiatrists. A modest start in the autumn of 1985, but there are one or two patients who have remained with us since those (perforce) relaxed days.

Changes to the clinic occurred gradually, a move upstairs (perhaps a little too close to the overhead loos), teaming up with other practitioners (Dr Peter Bissen - homeopathy, Erica Read - postural integration, Cathy Jenkins - hypnotherapy) and eventually with other osteopaths
(Warwick Downes and Sharon McDaid).

In 1995 Colin, Warwick and Sharon joined forces with Jennie Dallas and Simon King, who run the Clinic of Chinese Medicine, to take on space in BBC Radio Devon's premises on St David's Hill, where we still work. A few personnel changes have ocurred since then, naturally: Colin and Warwick have been joined by osteopaths Paul Thompson (our third partner) and David Stainer-Smith. Other colleagues are Lorraine Findlay (homeopath), Angie Avis (counsellor and psychotherapist), and our invaluable receptionists Suzie Brown and Sue Ebanks. Jennie and Simon in the Chinese Clinic remain the other pillar in our establishment.