THERE is much to say but the essence is that we the patients have the absolute responsibility to look after our own health and that of our loved ones, especially our children. 

I guess that at least half the attendances at general practices would not be needed if our health, in our own hands, was optimal. This is a joint exercise with our doctors. I will select a few subjects which come to the front of my mind.

An actual ‘pandemic’ is obesity – in the western nations. The ill effects are numerous and include diabetes. This disorder, especially untreated, can cause dreadful disease of the blood vessels eg retinopathy, renal disease, and arterial blockage in the legs. 

It is a great burden on our NHS costed at over £2 billion pa. Girth is a simple measure of it and the thickness of fat around the belly. 

The Body Mass Index is more specific – divide an adult’s weight in kilograms by their height in metres squared. 

A BMI of 25 is a good target – mine stays around 24! When I walk around Newton Abbot on a Saturday I note about a third of adults are overweight, and some children as well. 

Smoking tobacco, with I am told over 200 chemicals mixed in, soon becomes a most vicious addiction. Some of the latter give a ‘quick fix’, interpreted as a calming effect! 

I see a great friend, my webmaster, putting a nicotine lozenge in his mouth some five years after he stopped smoking. 

The ill effects are numerous but the most killing is lung cancer and the most damaging vascular. A study about the former was carried out on doctors. 

It was shown that if one gave up smoking before the age of 40, the risk of cancer in the remaining years fell to that of the non-smoker. A study in Japan of farmers showed a risk of lung cancer in their non-smoking wives – so called passive smoking.

And smoking can cause other types of cancer. 

A husband of our daughter smoked since the age of 17, he being in the navy where the mess was often smoke filled. He had a most malignant bladder cancer.  

He ended up with cruel and mechanistic over the top surgery. All very clever but it added to his suffering. 

A saying from my years in training – ‘do not strive officiously to keep alive’. 

He needed Fiona’s hand and probably some days in the Yeatman Community Hospital – Sherborne where he would have had excellent care from the good general practice and the nurses. End of life care in our Devon Community Hospitals was often of the best, and close to loved ones of course.

Degenerative joint disease, osteoarthritis, is very common in the so called Caucasian ‘race’. And so is rheumatoid arthritis, one of many so called auto-immune diseases. 

The former can be managed by the patient in common sense ways. Weight reduced with BMI 25 the target, simple exercises to maintain muscle bulk and strength, and range of motion exercises to keep the joint moving through the greatest range possible. 

For the hip a stick in the opposite hand will help. Simple analgesia like paracetamol will help blunt the pain – often a bit worse when the atmospheric pressure is lower (interesting) and make a night’s sleep easier. I used to ask the patient if the condition dominated life.  If it did not the patient was encouraged to soldier on and to see the GP to be referred back if it did dominate.

If surgery was needed, for years I required my patients to lose weight if that was excessive. It was common when an operation was needed to be caring for a lady of about 14 stone. 

The menopause was a factor in weight gain. 

I discovered early on that they knew their weight when they married – say 40 years before. 

Usually it was around eight stone! So they were carrying almost double the weight when they were fitter and without joint disease. I used to suggest a target weight of say 10 stone. When that was achieved, and it was in a large majority, they were called from the waiting list. 

They were given a 1000 calorie diet sheet and told to weigh themselves fortnightly recording the figures on a graph. This added realism and a downward slope encouraged them! 

I found that with osteoathritis of the knee, weight reduction and easy cycling helped greatly, especially if there was no bow leg or knock knee deformity. 

It was good to have a note of thanks saying these very logical and simple things had given relief and banished disability. I had no time for fellow surgeons who operated on obese patients with these chronic conditions. 

This was in part for the reasons above. But also because with excess weight post-operative mobilisation was that more difficult, and DVT > pulmonary embolism more likely. The sooner the patient was up and walking, the lesser this risk.

There are other areas I could cover but I finish with the younger citizen and sexual health. 

The fact is that the younger, though exposed to more and more sexual stimulation, are largely ignorant.  

Sex education in the schools is not always done well. Fact – venereal disease is more common.  There are at least six types and the historic ones – syphilis and gonorrhoea, are more resistant to standard antibiotics.

A rather silent one in the female is chlamydia, aside from some chronic pelvic pain. 

This can lead to scarring of the Fallopian tubes and consequent infertility. 

The young woman ends up with probing, IVF etc. Why is this happening? Sexual promiscuity without the use of condoms is the cause.

This has followed the pill being the usual contraceptive method and the sole partner responsible for contraception being the female. 

Male responsibility is near zero. How does the ‘state’ respond? 

Poorly is the answer, and with yet more ‘vaccination’. For those with computers - ‘david halpin surgeon’ - search ‘mountjoy’ - two references. 

Choose ‘HPV immunisation: Helping Keep The Girls Healthy’.  

And know that in the US there are massive damages being paid for terrible damage to some adolescent girls, where caring and good sex education was the priority. 

The key in these relationships is respect for the other’s health and body.

Next week I will deal with ‘public health’ and include its side lining.

Next again – failures in care – hospital and general practice.