Cycling on the NHS will need a hard push
A patient had perfected a technique of riding so slowly that it required less exertion than walking
As a cycling GP, I was delighted to hear about an initiative in Cardiff to offer “bicycles on prescription” to encourage patients to take to the saddle as a way of improving health and fitness.
Like many inner-city GPS, I have always found the bike the fastest and most efficient means of getting to and from the surgery, and for getting in and out of complex estates for home visits. In the past, it could be a sartorial challenge – one elderly lady once complained when I turned up in summer without a tie and wearing shorts. But now that the tie has been banished as an infection risk and everybody seems to be wearing high-vis jackets, this seems to be less of a problem.
No doubt cycling also has aerobic benefits, though spluttering through London’s diesel fumes sometimes make this seem questionable. Dr Tom Porter, the Cardiff GP promoting the scheme – in which doctors will be able to prescribe six months’ free subscription to a bike hire firm, without charge – believes that cycling can improve cardiovascular fitness and reduce the risk of death from heart disease. I am
sure that this is true, but he will need to encourage his patients to put some serious effort into their pedalling if they are to reap these benefits.
I recall a patient who suffered from such severe coronary artery disease that he experienced angina chest pains on walking just a few yards. He had, however, perfected a technique of riding his rickety bike so slowly that it required less exertion than walking, and he could accomplish the half-mile journey to the surgery without difficulty.
He reminded me of the elderly cyclists in Flann O’brien’s novel The Third Policeman who spend “most of their lives riding iron bicycles over the rocky roadsteads of this parish” and got “their personalities mixed up with the personalities of their bicycle”. The author’s reflection that “you would be surprised at the number of people in these parts who nearly are half people and half bicycles” also seems appropriate to those skinny middleaged men in Lycra who seem to regard dodging the London traffic as training for the Tour de France.
Here’s a heads up...
One weekend many years ago I visited a man who was, literally, banging his head on the wall because of a cluster headache – a particularly acute form of migraine. Reaching into my bag, the only analgesic I could find was a vial of diamorphine, aka heroin, with which I promptly injected him.
He turned up at the surgery the following day, transformed. “What was that stuff? It was brilliant, can I have some more?” he asked. I discreetly advised him that we should try some more conservative treatments.
It is interesting to reflect that current guidelines for this notorious condition still include a long list of medications (including opiates, like heroin) that we used to prescribe but have been found to be ineffective and are no longer recommended.
It is good news then that a new treatment for cluster headaches – non-invasive vagus nerve stimulation – which delivers a small electrical current to the neck, has been found to be a safe and effective treatment and is now available on the NHS.
A quick appendix
The vagus nerve linking the gut to the brain features in a study claiming that people who have had their appendixes removed are at (slightly) increased risk of Parkinson’s disease.
Dr Mohammed Sheriff, of Cleveland, focused on alpha synuclein, a protein found in the gastrointestinal tract at early stages of Parkinson’s, and also in Lewy bodies in the brain in advanced cases. Though the vagus may provide a pathway for this link, the mechanism remains obscure.
In 1812, Dr James Parkinson, who five years later described his eponymous syndrome, noted the link between appendicitis and peritonitis.
Whether appendicectomy carries a long-term increased Parkinson’s risk is doubtful, but a failure to carry out appendicectomy in cases of appendicitis would carry a substantial risk of death in the short term.