�he �urgery
New take
on open-
heart
surgery
onty Python star Sir
Michael Palin, as
recently reported
in this newspaper,
is imminently due
to have open-heart
surgery to replace a leaky mitral
valve. “I should be back to normal,
or better than normal, within three
months,” he writes on his blog, as
indeed, he is likely to be: this is
a most successful operation that
has been constantly refined and
improved upon since it was first
performed more than 50 years ago.
The most recent refinement,
“minimally invasive mitral valve
surgery”, obviates the need to
cut through the breast bone (or
sternum) to gain access to the heart.
This traditionally resulted in a 9in
scar with subsequent restrictions on
activities, such as driving or lifting,
for six weeks.
The new method, by contrast,
only involves making a 2in incision
between the ribs on the right side,
through which a high-definition
video camera is inserted to assist the
surgeon in replacing the damaged
mitral valve. The operation itselftakes a bit longer, but is much
less traumatic and post-operative
recovery is a lot faster.
And, as recently reported by
cardiac surgeon Stuart Grant
and colleagues, a comparison of
the long-term outcomes of the
two procedures has shown the
“minimally invasive” method to be
equally safe and effective. For all
that, it is still not widely available –
accounting for just one fifth of the
operations carried out in Britain.
Those who may require mitral valve
replacement should investigate, as
they can opt to be referred to one of
the hospitals (such as the Liverpool
Heart and Chest) with experience of
the minimally invasive technique.Pregnancy infection
The hazards for mothers of
contracting an infection during
childbirth are, gratifyingly, vastlyless than in the past, but still
substantial, particularly following
a caesarean section. Here, the
simple expedient of administering a
single dose of an antibiotic reduces
the risk of septicaemia or a scar
or a womb infection by almost
two thirds and is thus currently
routinely recommended. The same
principle, it now appears, should be
extended to include any “operative”
vaginal childbirth requiring forceps
or vacuum-assisted delivery. A
recent study of more than 3,000
women reported in The Lancet
found that an intravenous dose of
a broad spectrum antibiotic halved
the risk of infection, while also
promoting more rapid healing of
damaged tissues. This indicates, the
authors observed, “an urgent need
to change current clinical practice”.Hair-cut syncopes
This week’s medical query comes
courtesy of Mrs KW from Leeds
whose husband collapsed earlier
this year while sitting at home
having his hair trimmed (“only
lightly, as there is not a lot of it”)
by her hairdresser. Since then,
he has had two uneventful trims,
but last month it happened again.This time he was unconscious for
a couple of minutes and required
a trip to casualty, where he was
fully recovered within half an hour.
These episodes are unlikely to be
cardiac, as both his blood pressure
and heart rate were normal. Has
anyone, she wonders, been similarly
troubled by hair-trimming syncope?Sticky nit treatment
Finally, further to the perennial
question of the optimal method
of eradicating head lice, primary
schoolteacher Janet Southern
writes to tell how, when on one
occasion she had a classroom full
of nit-infested children, a mother
inquired why she herself seemed to
be immune. “I thought it might be
the sticky hair gel I used to stop my
wayward hair from sticking up,” she
writes. So the whole class got the
hair gel treatment and “within the
week they were entirely nit-free”.GETTY IMAGESW
ith school starting
next week, now is
the time – if you
have children – to think
about how you can help
them get the most from
our current (lamentably
exam-focused) approach to
education, and to do their
best when exam times roll
around again.
Start by maximising your
child’s physical health.
Provide a regular routine in
three key areas:
Sleep: encourage them
to go to bed and get up at
regular times, appropriate
to their age. Be tolerant
and realistic when it
comes to teenagers. Megan
Hagenauer at the University
of Michigan has shown that
pubertal changes in the
brain promote a delayed
sleep phase, so teenagers
naturally want to go to
bed later, and therefore
may need extra sleep at
weekends to compensate for
sleep loss during the week.
The best way to help them
get off to sleep is to insist
they turn off their screens
20 minutes before bedtime.
Then make sure all screens
stay outside the bedroom
from bedtime until morning.
Diet: keep a steady supply
of healthy foods in the
house. Stock up on fruit
and additive-free whole
grains (pasta, rice, bread,
or whatever grains they
tolerate), and don’t buy
sugar-laden treats. Remind
them to drink plenty of
water: a study at Leeds
University estimated that upto 40 per cent of children
aren’t drinking enough
water for optimal brain
function.
Exercise: make sure it’s
easy for the whole family
to exercise regularly.
Buying or renting a piece of
cardio equipment is a great
investment – children can
take active study breaks in
the house that way. Not only
does this clear the brain, it
also helps stabilise mood.
When it comes to
homework, put some
thought into where they will
study. Make sure it’s as quiet
as possible, that screens
are at a good height, and
that lighting is adequate:
hunching and squinting
can impair blood flow to the
brain.
When children study
matters, as well. Insist they
do homework at regular
times. The optimal length
for a homework session for
anyone over eight is 20-50
minutes; 10-20 minutes
is enough for younger
children. Suggest they take
a 10-minute break at least
every 50 minutes to walk
around, stretch or enjoy a
healthy snack.
Make sure each child
writes out a study plan
before they start their
homework. It’s better to
plan by priority rather than
estimating a particular
amount of time for each
subject. When several topics
seem equally important,
encourage them to start with
the one they like best to get
“flow” going, then to take on
the most challenging subject
before they get tired, with
everything else to follow.
Finally, encourage them
to rehash and reorder what
they’ve learnt, and to do so
continually. The more often
they use, reorder, rearrange
and tell you about what
they’ve learnt, the more
likely it is they’ll remember
the information and be able
to use it flexibly – and that’s
the secret to doing well
in exams.DOCTOR’S DIARY MIND HEALINGReal tonic: a dose of antibiotic halved
the risk of post-childbirth infectionGet your
kids ready
for school
This operation has
been constantly
refined and
improved over the
last 50 years
M
Email medical questions confidentially
to Dr James Le Fanu at drjames
@telegraph.co.ukJames Le Fanu
Linda Blair
Linda Blair is a clinical
psychologist and author of
Siblings: How to Handle Rivalry
and Create Lifelong Loving
Bonds. To order for £10.99,
call 0844 871 1514 or visit
books.telegraph.co.ukswims in the sea where he lives on
the south coast, all year round.
“There’s a massive growth in this
area, likely down to the great feel of
the water and the benefits of going
from a point to another point rather
than doing endless lengths. It can be
more of a workout, too, because you
don’t get to push off from the side as
you can in the pool. And you can just
let your mind wander.”
Holidays help people rethink
their priorities, he says, and if you’re
out of the habit they can be a great
motivator to start incorporating
regular exercise into your routine.Stop worrying about sleep
“When we’re on holiday we sleep
without stress,” says James Wilson, a
sleep behaviour expert who runs The
Sleep Geek consultancy. “The alarm
is removed, we sleep in a way that fits
our individual sleep type, stop using
trackers and listen to our body more.
“Of course, when you’re back at
home you can’t do all of that, but a
lot of sleep problems are related to
anxiety over how much people tell
themselves they need.
“I advise taking the pressure off
yourself and forcing yourself into bed
at particular times.”
Wilson adds that holidays often
encourage us to use technology in
a more healthy way and engage in
more relaxing pastimes before bed –
reading rather than checking emails.Recreate holiday sex
Dee Holmes suggests trying to work
some of the things you love most
about holidays into everyday life in
order to maintain your connection
with your partner. “If you think
about the things that make up a
holiday – you’re able to have that
morning cup of coffee at a café
watching the world go by, or go
for an evening walk before dinner.
Taking half an hour out of your
weekend to have coffee
together, or getting
out of the house and
going for a walk in
the evening can
really help.”
The same can
apply when it
comes to sex: “On
holiday people
might have sex
at times of day
when they’re not
usually able to in
their normal life.
In normal life you
think ‘we’ll have sex
tonight’ and then it’s
10pm and you’re too
tired. Find other times
of day to be together.”Mental cleansing: Nirpal Dhaliwal enjoyed an ‘internal silence’CONTINUED FROM PAGE 19In 2012, I found
myself mired
in a depression
that would last
several years,
releasing the
last of its grip a
year ago. It had
a devastating
effect, preventing
me from working,
shrinking my
social life
and wrecking
my romantic
relationship.
Getting well
was a slow and
cumulative
process that
involved many
components,
from exercise- yoga,
especially – and
meditation to
years of weekly
counselling
sessions.
It was after
reading an
interview with
Olympic gold
medallist
Victoria
Pendleton,
who thought
about suicide
before finally
seeking help,
that I decided
to try surfing.
Months later,
she attended
a surf school
in Costa Rica.
“I came back
feeling 50 per
cent better,” she
reflected.
Surfing
retreats are
growing in
popularity,
with many
combining the
sport with yoga
or meditation
for the ultimate
mental and
physical workout.
So powerful are
the benefits
that doctors in
Cornwall and
Devon are now
prescribing
surfing for
anxiety. The
US navy has
launched
a $1 million
programme,
Operation
Surf, which
helps wounded
British and US
war veterans
to overcome
depression and
PTSD through
surfing (check
out the Netflix
film, Resurface).
Inspired, I
signed up for
a week-long
surfing retreat
in Morocco run
by psychologist
Josh Dickson,
which combinesmorning surf
sessions with
afternoon
group therapy
and lectures
on “positive
psychology”.
Even though I
was a complete
novice, who only
ever managed to
get off my knees
on a handful
of occasions, I
still achieved
an enormous
mental cleansing.
“Surfing
creates a ‘forced
mindfulness’
where you have
to be focused
on what you’re
doing,” explains
Dickson. “For
the few hours
you’re in the
water, you’re
not thinking
about that bill or
anything else.”
By midweek,
I was aware
of an internal
silence I couldn’t
remember
enjoying before,
and each night
I fell into deep,
replenishing
sleeps brought
on by the intense
exercise, lulled
with visions of
the Atlantic as I
dropped off.The learning
of a new skill
also helped.
“Depression,”
says Dickson,
“involves feeling
helpless and the
genuine belief
that nothing
you do makes
a difference.
Activities
that provide
immediate
feedback, like
surfing, climbing,
painting or
playing an
instrument,
show you that
you can change.
Mastering any
new skill, even
by a little bit,
will raise your
self-esteem
and disrupt
the negative
thinking.”
The next time
I find myself in
a depression
that lingers too
long, I’ll be off
to Morocco,
Cornwall, Costa
Rica or wherever,
knowing the
ocean is always
there to wash it
from me.
Nirpal
DhaliwalDetails:
resurfaceuk.comy
coffee
g
nd
nex
it’s
oo
mes
her.”years of weekly
counselling
sessions.
It was after
reading an
interview with
Olympic gold
medallist
Victoria
Pendleton,
who thought
about suicide
before finally
seeking help
that Idecided
to try surfing.
Months later,
she attended
a surf school
in Costa Rica.Surfing therapy
How riding the waves quells anxiety
The Daily Telegraph Monday 26 August 2019 *** 21
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