Two tins of soup by Libby Johnston

When asked to submit something for the blog quite some time ago, the suggestion was that the subject be something that readers would find moving in some way. Recent press has been highlighting the degree of loneliness some are experiencing and how it can effect wellbeing physically, mentally and isn’t always visible to others.

In the run up to Christmas festivities I went to one of the so-called Pound shops. It leans towards my frugal nature and there is nothing like a bargain. However many use such shops to survive with a limited budget.

As I wandered down the first aisle a rather frail but spritely elderly woman moved to allow me to pass and I thanked her and we exchanged pleasantries. As I made my way through the aisles and shelves she seemed on the same route and I couldn’t help but overhear her saying ‘Merry Christmas’ to virtually every person she encountered. I made my way to the checkout and there she was again in front of me in the line. As I looked at her clothes, I could see that she had many layers of threadbare jumpers and no coat on what was a cold day.

She seemed to know the person at the checkout and was asking if they were ready for the holidays and he asked her the same to which she answered yes this was her last shopping trip. On the conveyor belt were 2 tins of soup. He commented, ‘No turkey’? She shook her head, saying nothing and placed the tins of soup in her shopping bag, continuing to wish everyone around her a Merry Christmas and the same to us as she trudged out of the shop, bag in hand. My heart was full as she had shared the joy of the season with everyone she encountered in the shop and yet there was a loneliness to her life.

As a nurse and midwife (retired), it’s always been in my nature to reach out and help others in need. I desperately wanted to ask this dear lady if she was having a Christmas meal with anyone and if not invite her to share ours. I feared she might only be facing a tin of soup. However, she had disappeared from sight and I will never know.

It left me feeling a touch of sadness for her. There is much awareness about people being lonely and particularly at this time of year. Many organisations, charities are endeavouring to help those who may be lonely. There will always be those who won’t want help and soldier on like this woman who found some company, even joy in sharing festive greetings in a shop. A lesson perhaps for the less lonely to be bolder in reaching out to others not only at Christmas but in everyday life.

The government is investing in ‘loneliness’ as it is felt it has been shown to impact health and wellbeing. This is highlighted in this article in The Guardian:“UK to tackle loneliness crisis with £11.5m cash injection”

The money will help establish projects that will bring people together and in so doing reduce elements of loneliness, improving health and wellbeing.

 

“Loneliness and the feeling of being unwanted

is the most terrible poverty.”

Mother Teresa

Sending love at Christmas…. by Mairi Small

Christmas is inextricably linked with love…..

Dean Martin sings about having his “love to keep him warm” – if you would like to spend a couple of minutes warming the cockles of your heart click here –

Smokey Robinson and his Miracles feel that if their baby loves them too, it would be Christmas every day and annually, in early December, we’re reminded that all Mariah wants for Christmas is youuuuuuu. (The remainder of the song choices in the collage are for you to ponder whilst digesting your turkey on Tuesday)

In Cardiac Rehab we love to sing and have a soundtrack to each of our weekly exercise sessions which are held in venues throughout D&G. Sometimes, the music choices are a little bit Homes under the Hammer-esque…. “Dont Go Breaking My Heart”, “Under Pressure”…..  And of course who could forget the dulcet tones of Billy Rae Cyrus belting out “Achy Breaky Heart” in years gone by (for those under 30 reading this, Billy is Miley Cyrus dad). But C/R isn’t “just an exercise class” as anyone who has ever had experience of our service will testify – so what do we actually do?!

Well, since “last Christmas”, the C/R service in D&G has supported over 500 individuals following a cardiac event. The British Association for Cardiovascular Prevention and Rehabilitation (BACPR) define priority groups for inclusion as post MI, coronary revascularisation (stents or bypass) and heart failure.  Locally, we also include those with a diagnosis of angina, post valve repair/replacement, post implantation of cardiac defibrillators and resynchronisation devices, post heart transplantation and ventricular assist devices and adult congenital heart disease.

The service was set up in D&G in 1990, with an extensive, worldwide evidence base being consolidated since – C/R reduces cardiac mortality by 26% and unplanned hospital admissions by 18%. Currently based in Cluden Cardiac Unit in Crichton Hall, we are set to move into Mountainhall in early 2019. We see inpatients in both DGRI and GCH and run out patient clinics regionwide. We are a small team of nurses and physios who work closely with a wide range of health care professionals, services and organisations.

Although C/R nationally is undergoing a programme of modernisation in line with Scottish Government priorities, it maintains its traditional “menu based approach” with patients choosing the components that matter to them.  So, whats on the C/R menu this Christmas, and beyond?!

To start

Identification, referral and recruitment of eligible patient populations – referrals tend to be picked up during in patient stay or from tertiary centres but we also accept referrals from other HCPs.  Referrals can be sent electronically to – dumf-uhb.CardiacCommunication@nhs.net

Early initial assessment of individual patient needs – including medical history (a significant proportion of patients will have one or more co-morbidites), relevant investigations, social determinants of health, lifestyle risk factors, psychosocial health and medical risk factor management.  This may take place in hospital, the patients home or out patient clinic and may be completed over more than one contact.

Agreed personalised goals – to be reviewed throughout the episode of care.  This really is the “what matters to you” bit of the programme.  Goals may range from “aim for 3000 steps a day” to “get back to work” to “get back to singing with the choir”.

To follow

Health behaviour change and education – this may include addressing cardiac (or other) misconceptions and illness perceptions that may lead to increased disability and distress, support of the patient’s significant other/s, goal setting and pacing skills, and facilitation of self management skills. Discussions may include – pathophysiology and symptoms, management of risk factors such as BP and lipids, occupational/vocational and driving advice, resumption of sexual relations and dealing with sexual dysfunction.

Lifestyle risk factor management – a trio of physical activity and exercise, healthy eating and body composition and tobacco cessation.

Individualised advice on ADLs and a tailored activity and exercise plan aims to increase physical fitness as well as reduce sedentary behaviour. Home based exercise plans are offered for those unable to uptake on traditional group exercise sessions and patients also get the opportunity to exercise within local authority leisure facilities. We are currently exploring the use of technology by way of short term loan of Fitbits to ascertain baseline activity levels and encourage an increase in an individuals “active minutes”.

Following baseline assessment of dietary habits, weight, BMI and waist circumference, a focus is on the adoption of a cardioprotective diet which encompasses healthier dietary choices, correcting misconceptions about diet and health, and body weight maintenance (or reduction if appropriate).

Patients who are smokers at the time of assessment are referred to the Quit Your Way service in addition to the C/R team providing education and support in the preparation and attempt at smoking cessation.

Psychosocial health – all patients are screened for psychological distress using validated tools and individual assessment allows for discussion regarding illness perceptions and self-efficacy for health behaviour change, and to determine levels of social support. Patients are encouraged to practice relaxation strategies or mindfulness exercises regularly and are offered taster sessions as part of the programme.

Medical risk management – optimisation of cardioprotective therapies is guided by regular measurement of BP, heart rate and rhythm, glucose and lipids. This provides an opportunity to discuss dosage and adherence with the patient and address their beliefs around their medication regime. It is hoped that some of the team can become independent prescribers to streamline the process of up titration of the secondary prevention medication in the longer term.

BHF Heartstart training – all patients and their family/friends are invited to attend this two-hour session to learn how to recognise an MI/cardiac arrest and deal with a life threatening emergency – perform CPR, access and use an AED, deal with choking and serious bleeding. This year 239 individuals across D&G have attended a Heartstart session run by the C/R team.

To finish

Final assessment of individual patient needs – to determine the effectiveness of our interventions, we are currently reorganising our service to create time for a more comprehensive final assessment to take place. To date this has been done quite informally but we feel it would enhance the patient experience to revisit baseline measures and formalise the ongoing management plan collaboratively. Patients are given details of local community based services and opportunities to support their self management moving forward.

Audit and evaluation – the uptake of C/R throughout the UK is variable but it is pleasing that locally we are supporting many more than the national average of around 50% of patients following a cardiac diagnosis. We have a robust audit process in place within D&G and are currently exploring how this may feed into a UK wide dataset to further strengthen the evidence base for C/R interventions.

Coffee and mints

In keeping with C/R tradition, on noteworthy occasions such as retirements and birthdays an after dinner ode to the recipient is dished out along with the coffee. With this in mind….

An ode to NHS D&G staff at Christmas

As Andy Williams famously sang, “it’s the most wonderful time of the year”

Perhaps you’ve spent the last few weeks thinking to where did 2018 disappear?

Now is the time for some fun, rest and reflection, hopefully in equal measure

To celebrate Christmas your own way and with love, kindness and pleasure

Although joyous for many, the festive season can be a sad and difficult time its true

Loneliness, loss, illness, expectation and pressure, maybe feeling more than just a bit blue

Christmas, like a heart attack, doesn’t always look like it does on the big screen

A time of remembrance and contemplation, hopes of what the year may have been

The pace of change in modern healthcare often goes at a rate of knots

Feels like there’s hardly time to do the job, let alone gather your thoughts

We all know too well of the “winter pressures” which don’t seem to relent much year long

Working difficult and unsocial hours, away from our loved ones, where we belong

It’s sometimes hard to remember that we all do a great job and are part of a fab wider team

It’s easy to criticise and get despondent when it doesn’t feel like you’re living the dream

But our local health services are truly amazing and star several thousand of a diverse cast

Staff who are caring, loyal, highly skilled and adaptable, genuine healthcare enthusiasts

So, take some time to enjoy your Christmas soundtrack and whatever is on your menu

The little things in life are often the best, regardless of the venue

Take some time to do “what matters to you” and enjoy some festive cheer

Wishing you and those special to you, health, happiness and peace throughout the New Year.

The cockles of the heart are its ventricles, named by some in Latin as “cochleae cordis”, from “cochlea” (snail), alluding to their shape. The saying means to warm and gratify one’s deepest feelings.

Mairi Small is a Senior Physiotherapist at Cardiac Rehabilitation for NHS Dumfries and Galloway

Oh Christmas Tree by Catherine Nesbitt

Throughout my childhood, every December we went to Newcastle to see my mother’s best friend, Paddy. Paddy’s Christmas extravaganza was the highlight of my year! First, the pantomime (we once stumbled across the cast in a side-street restaurant… It was a bizarre combination of Linda Lusardi, Geoff Capes and Kenny Baker (at the time, Page-3 model, World’s Strongest Man and R2D2). From there, Fenwick’s Christmas Window (a MUST-SEE if you never have) and a local garden-centre decorated like Lapland but in Gosforth! Paddy bought armfuls of decorations there every year; my parents bought my sister and me one decoration each because they couldn’t afford more than that.

That was where I fell in love with the most beautiful Christmas tree I have ever seen; an 8ft tree with branches right to the floor. I begged to take it home with us, but no, our living room was too small.
Two years later when we moved to a house in Carlisle with 12ft ceilings, I asked again!
Again, it was denied; they just couldn’t afford a new tree.
The following year (aged 13) that 8ft tree was all I wanted for Christmas. Mum gave Dad one of “those looks” and the tree was mine; on the condition I decorated it from then on!

DEAL!

That tree and our growing collection of decorations were a perfect match and my sister and I have added decorations ourselves over the years. None of them match; there are no coordinated sets of baubles and no “theme”; some are cute, some are beautiful and some are downright bizarre!

A bear sitting on a drum and a little crate of toys marked ‘North Pole’ from our Christmas trips with Paddy (and a lovely Christmas reminder of her since she died in 2004). A clip-on peacock documents my lifelong affinity with them (‘peacock’ was my first word and aged 2, I tottered over to a particularly unfriendly one and still have a scar on my forehead for my troubles). A corduroy reindeer from when Starbucks first came to Newcastle, (my University flatmates and I agreed we would not set foot in Starbucks for the first time until it snowed to ensure the “full Starbucks experience” (i.e. as much like a movie-set in New York at Christmas as possible). But then it didn’t snow! One morning, with a few floaty snowflakes in the wind, we all ditched lectures to sit in Starbuck’s window, but the coffee machine had broken and the tables were piled high with dirty plates! It was so disappointing that we never went back but still chortle about it when we make our annual pilgrimage to see Fenwick’s window together!)

The hideous ones are mainly thanks to my sister. She worked in America as an aerospace engineer testing a new aircraft. Her first Christmas in California, the company produced commemorative decorations and she sent one home (an F35-Lightning-II in a wreath of flags) with the characteristically sarcastic message, “Because nothing says ‘Peace on earth and goodwill to all men’ quite like a 5th generation fighter aircraft!”
She later moved to Maryland and we road-tripped coast to coast collecting a haul of decorations en route: a sleigh bell from San Francisco, Santa in a reindeer rubber ring from San Diego, a “Get your kicks on Route 66” decoration from Arizona and a pottery camel made by the Mescalero Apache Tribe in New Mexico. On arriving in Maryland she sent home our most grotesque decoration: a crab-shell painted like Santa’s face!

In January 2005, only hours after taking the tree down, a flood hit Carlisle. We scooped the decorations up in a blanket and hauled them upstairs. My tree was lost, but the decorations survived. When the house was refurbished, I chose another tree which graced my parents’ living room for a decade, but only days after putting it up last year, a second flood hit Carlisle and that tree was lost too! As the water poured into their street, my parents stripped the tree of the decorations and saved them again. It sounds unlucky but earlier that year Dad decided to store the decorations in his workshop rather than back in the attic. If the tree had not been up when the flood hit, the decorations would’ve all been lost too. They are all the more precious now having survived when everything else did not.

Our tree represents our family history; where we’ve been, what we’ve done and the friends we’ve had. My parents’ frugality produced an extraordinary collection that I would totally recommend gathering for yourself. My mother even uses it to store sentimental things which have no obvious place to live. Since retiring from Nursing, she volunteers in a school and when one little girl recently left, she thanked Mum by giving her a necklace with a big elephant pendant. As Mum doesn’t wear necklaces she wasn’t sure what to do with this little gift, but exchanging the chain with a ribbon solved the problem. This year the elephant has been added to the tree.

Cheap or expensive, ugly or beautiful, they all have a place. The collection has become an heirloom in our family and one day my sister and I will divide them between us to keep the memories alive…. She can definitely have the crab!

Dr Catherine Nesbitt is a Clinical Psychologist in the Child and Adolescent Clinical Psychology Service at NHS Dumfries and Galloway.