Deep Breath In

Long covid with Melissa Heightman and Jenny Mollica

It has been estimated that 10% of people who get covid-19 are still experiencing symptoms over 10 weeks later, and the common symptoms of long covid include fatigue, breathlessness, chest pain and ‘brain fog’.
In this week’s episode, we discuss the challenges of assessing long covid symptoms, especially chest pain, in primary care. As we still don’t know enough about the trajectory of the disease, how can we balance the assumption that a patient’s symptom is caused by long covid, as is likely to be the case the majority of the time, with the potential risk of missing a critical diagnosis, such as lung cancer?
We talk about the importance of acknowledging and listening to our patients’ worries about long-term symptoms, even in the face of uncertainty, when reassurance is difficult to give. We also learn about the English National Opera’s new breathing and wellbeing programme, ENO Breathe, aimed at people recovering from covid-19.
Our guests:
Melissa Hightman is a respiratory consultant at UCLH, and the clinical lead for the trust’s COVID follow-up service.
Jenny Mollica is the director of ENO Baylis: the English National Opera’s learning and participation programme, which now includes ENO Breathe.

Tips on rolling out the covid-19 vaccine with Mark Porter, Andrew Pollard and Julia Marcus

Thanks to an incredible scientific effort, vaccines for COVID-19 have arrived in the UK and GPs, and other primary care health professionals, are now being faced with the monumental challenge of vaccinating high volumes of patients in a matter of days, whilst maintaining a COVID-safe environment, and fielding the myriad questions and concerns patients may have around the vaccine.
In this week’s episode, we talk about the practical difficulties in preparing and administering the vaccine. We discuss the rationale behind extending the interval between the first and second doses, and the controversy it has caused. How do we assuage these worries, and how do we temper patients’ expectations regarding immunity, and the speed at which life may go back to normal?
Finally, we talk about some lessons we can learn from HIV prevention to ensure equitable covid vaccination.
Our guests:
Mark Porter MBE is a GP in South Gloucestershire, and an award-winning journalist. He anchors the series ‘Inside Health’ on BBC Radio 4, he is the medical correspondent for The Times, and a columnist for Saga Magazine.
Andrew Pollard is a professor of Paediatric Infection and Immunity at the University of Oxford, an honorary consultant paediatrician at Oxford Children’s Hospital, and the director of the Oxford Vaccine Group.
Julia Marcus is an infectious disease epidemiologist and an assistant professor at Harvard Medical School’s Department of Population Medicine . She is also an HIV researcher.

The Deep Breath talking wellbeing evidence round-up of the year.

In this end-of-year podcast from Deep Breath In, we're bringing you a light hearted look back at 2020, and trying to remember some of the non-covid-19 medicine that has crossed our desks.
This festive quiz features the deep breath in gang, as well as Cat Chatfield from the Wellbeing podcast, and Helen Macdonald from our Talk Evidence podcasts.
Reading list;
Thyroid disease assessment and management: summary of NICE guidance
https://www.bmj.com/content/368/bmj.m41
Thyroid hormones treatment for subclinical hypothyroidism: a clinical practice guideline
https://www.bmj.com/content/365/bmj.l2006
Judd Brewer's advice for coping with burnout
https://drjud.com/

Changing behaviour with Cindy Gray and Shahroo Izadi

Old habits die hard, and never does the saying seem more apt than at this time of the year, when many of us start thinking about our New Year’s resolutions, and try to adopt a “new year, new me” mentality, in order to make positive changes to our health. As GPs, discussions around lowering alcohol consumption, smoking cessation, and becoming more active are commonplace in our consultations. However, how can we have meaningful conversations with our patients around “kicking the habit”, and help them to make lasting changes? Where do we draw the line between self-care and self-harm, and how can we introduce better self-care rituals for our physical & mental health?
Our guests:
Cindy Gray is an interdisciplinary professor of Health and Behaviour at Glasgow University’s Institute of Health and Wellbeing.
Shahroo Izadi is a behavioural change specialist, and author of ‘The Kindness Method: Changing Habits for Good’.

Insomnia with Lauren Hale and Michael Kelleher

GP consultations with patients about sleep problems can go in several directions – could they be a symptom of depression? Financial worries? Sleep apnoea? Is poor sleep merely a condition of modern life?
Sleep is a key component of our wellbeing, and talking to a patient about their sleep patterns and habits can be a great window into their life. For optimal sleep health, it is important to follow good sleep hygiene practices, but how can we convey what seems like such a simple message to patients who are experiencing insomnia?
In this week’s episode, we also discuss social determinants of sleep health, and managing the potentially addictive drugs prescribed for insomnia, such as benzodiazepines.
Our guests:
Lauren Hale is a professor of Family, Population and Preventive Medicine, Program in Public Health, at Stony Brook University in New York. She is a board member, and vice-chair, of the American National Sleep Foundation, as well as a board member of the National Scientific Advisory Board for Children and Screens.
Michael Kelleher is a consultant addiction psychiatrist, working as the clinical lead for Addictions for Lambeth at the South London and Maudsley NHS Trust.

Long breath - when someone has problem swallowing pills

When someone, either an adult or child, has problem swallowing pills or capsules, there are some options open to help. In this podcast, a pharmacist and a psychologist join us to talk about liquid formulations, how to disguise the taste of medicine mixed with food, and some techniques that can be used to help with swallowing a whole pill.
Deonne Dersch-Mills is the clinical practice leader for pharmacy for paediatrics & neonatology with Alberta Health Services. She is based at Alberta Children’s Hospital, Calgary.
The article they talk about is Giving oral medicines and supplements to children - https://www.bmj.com/content/371/bmj.m3550
Bonnie J. Kaplan is a semi-retired research psychologist, and professor emerita from the Cumming School of Medicine, Calgary.

A lump in the throat with Nick Hamilton, Deonne Dersch-Mills and Bonnie Kaplan

A lump in the throat is a classic GP presentation, but one that often causes a lot of worry. Many people are struggling with high levels of anxiety anyway at the moment, and this may manifest physical symptoms, such as fatigue, insomnia and dysphagia.
In this week’s episode, we discuss how to differentiate between causes of a lump in the throat: is my patient experiencing laryngopharyngeal reflux, or could it be cancer? How do we reassure distressed patients when we need to refer them on for imaging, or a consultation with a specialist, before we can rule out a malignant cause?
We also talk about how to manage a patient who has difficulty swallowing pills, and the challenges of getting children, in particular, to take medication.
Our guests:
Nick Hamilton is a clinical lecturer in otorhinolaryngology at UCL, and also works as a specialist registrar in otorhinolaryngology head and neck surgery at North Thames Deanery, London.
Deonne Dersch-Mills is the clinical practice leader for pharmacy for paediatrics & neonatology with Alberta Health Services. She is based at Alberta Children’s Hospital, Calgary.
Bonnie J. Kaplan is a semi-retired research psychologist, and professor emerita from the Cumming School of Medicine, Calgary.

Deep Breath In - EUPD with Leisha Davies, Soumitra Burman-Roy and Marie Stella McClure

Personality disorder is often referred to as the “Cinderella” diagnosis of mental health. Around 1 in 20 people is estimated to have a personality disorder, and it is a neglected and under-resourced area of our healthcare system. In this week’s episode, we discuss the stigma surrounding personality disorder, which can often manifest itself in high levels of anxiety for both patients and GPs, when it comes to diagnosing and managing it, and how to help a patient come to terms with their diagnosis.
With suicidal ideation being experienced by many people with a personality disorder on a regular basis, we also talk about how we may best manage a situation of a patient in crisis presenting in primary care.
Our guests:
Leisha Davies is a clinical psychologist, originally from South Africa, who currently works in private practice.
Soumitra Burman-Roy is a consultant psychiatrist at the South London and Maudsley NHS Foundation Trust. He also works for Maudsley Learning, an organisation which provides mental health training for primary care.
Marie Stella McClure, who was diagnosed with borderline personality disorder at the age of 38, is the author of ‘Borderline: a Memoir’, a book about her life and experiences of BPD.

Coughing kids with Tim Spector and Edward Snelson

Persistent coughing in children is always a challenge, both for parents trying to describe and measure the cough, and for doctors making a diagnosis. In the current climate, this is all the more difficult, seeing as a continual cough is one of the major symptoms of COVID-19. UK Government guidance advises that anyone with a persistent cough should get a coronavirus test. But with the reopening of schools and the beginning of the cold & flu season both coinciding with a national shortage of tests available, should we all err on the side of caution and try to get a test at the first sign of a cough or sniffle, or can the data on cold virus symptoms help parents and GPs make an informed judgement on the likelihood that their child’s cough indicates COVID?
Our guests:
Tim Spector is a professor of Genetic Epidemiology, and director of the TwinsUK Registry, at King’s College London.
Edward Snelson is a paediatrician in the paediatric emergency department at Sheffield Children’s Hospital.

’Flu vaccine season - with Nikki Turner and Jeff Kwong

With the annual flu season looming, GPs are anticipating a frenzy of vaccinations, perhaps more so than ever this year.
As so many 'flu and respiratory viruses circulate every year, and as the 'flu vaccine is for one strain of influenza only, is the vaccine worth getting, and what are the risks associated with vaccinating vs. not vaccinating?
In this week’s episode, we discuss the high vaccine uptake in New Zealand, and the role that social distancing for COVID-19 may have played in their low numbers of seasonal flu.
We also talk about whether or not the message we give to patients about the benefits and risks of vaccination is transparent enough, and how we might communicate better with them to allow them to make an informed decision.
We feel pressure to increase vaccination rates, because we believe we are protecting people, but does the evidence support that?
Our guests:
Nikki Turner is the director of the Immunisation Advisory Centre (IMAC) at the university of Auckland. She is an academic general practitioner, and a professor at the university.
Jeff Kwong is a professor at the University of Toronto, and the interim director of the Centre for Vaccine Preventable Diseases at the university’s Dalla Lana School of Public Health.