This is my piano. It is in the room where I see patients in my house. I frequently play it between appointments. Aren’t I lucky?

Music is almost as much a passion to me as are medicine and homeopathy. I sing in two classical choirs and have occasional singing lessons.

As a girl, I was a very serious piano student, mostly as I had a very serious piano teacher! I played in lots of concerts and competitions and did exams.

All this as well as years of academic exams has given me a lot of experience of exam pressure and performance anxiety.

GPs are frequently asked to help people facing such ordeals. Often it is for a driving test or to cope with giving presentations at work. I often prescribed a small dose of a beta-blocker, propranolol,10mg. It works by blocking the bad effects of adrenaline in the body, such as palpitations, trembling or sweating. Vitally, it is not at all sedative as it does not cross into the brain. Hence it is safe for driving and does not stop the brain working. Snooker players and violinists have used it for years to counter shaking fingers.

As a girl, waiting for my turn to play in a competition, I remember having sweaty hands, a sick feeling and running frequently to the loo. We each experience our own reaction to nerves. In some poor students their minds go blank when faced with a question. Whilst still happy to prescribe propranolol, I have a set of homeopathic remedies that also help, chosen according to the patient’s personal pattern of symptoms. These are, of course, safe and do not interfere with mental or physical performance. They are also legal for use in competitive sport.

Although, much of the Easter break has been cool, we did enjoy a few glorious days, like yesterday at Cragside, Northumberland. I hope you didn’t get burned. From now on, the sun is strong enough to cause damage, but also strong enough to tan and make vitamin D. We need to be careful how we balance its risks and benefits.

We hear a lot about vitamin D deficiency and I believe it is an important issue.  Vitamin D has many functions, more being discovered all the time, but the most important is that it pushes calcium into bones and teeth for strength. Deficiency causes rickets in children and osteomalacia and osteoporosis in adults.

Bones become too soft and so bend under the body’s weight and cause pain. Osteoporosis leads to fractures. People who lack vitamin D can have achey, weak muscles.

As a GP, we checked blood levels frequently and almost always, the vitamin D levels were seriously low. The patients (and their families) were then prescribed lifelong vitamin D supplements at huge cost to the NHS. However, with a little knowledge, it is easy to look after yourself.

We make vitamin D in the skin when it is exposed to sunlight. We can also get it from oily fish and supplements. We can store the vitamin for many months. Luckily, it is almost impossible to take or make too much (unlike vitamin A which is very toxic in high doses). The more time you spend in the sun and the more area of skin exposed, the higher the levels. We need to top  up when we can, to last through the winter. The sort of exposure that is useful is 15-20 mins with arms and legs bare if possible.

Of course, the sun does also cause skin damage and ageing .I saw this very clearly when I worked in New Zealand. The people who were genetically-similar to me(from Scottish stock) looked 10 years older than people in UK. Some skin cancers can be caused by sun exposure. So people have started using much more sunscreen to protect from the potential dangers. However, sunscreens block vitamin D production. I think we need to balance these issues. I am happy to share the principles I follow.

1. Burning is never good.

2. I use sunscreen on my face all summer,even in UK, particularly if there is any chance of getting trapped outside for a long time, such as at a sporting event.This is because the face gets far more exposure than the body and I care about wrinkles.

3. I take holidays in the sun and use factor 30. I still get a tan.

4. When my tan has faded, I start taking vit D supplements. I buy mine from Healthspan, a good company based in Jersey, with very competitive prices. I just buy the regular daily dose of 10 micrograms/400iu. This is widely- available and very cheap.

If you do need to completely avoid the sun, you can just take the tablets throughout the year.

Some groups of people are at particular risk of deficiency. I worry about the elderly who spend too much time indoors. I suspect all residents of care homes would be better on a supplement, though GPs have not targeted this group. Dark skins naturally protect from UV radiation, leading to some immigrant groups being at particular risk. Many of these groups also dress extremely modestly, further reducing the sun’s benefits. I suspect nearly every brown-skinned person in UK needs supplements. The NHS recommends vit D supplements for pregnant or breastfeeding women and for breastfed babies and small children.

I hope this helps you to make good choices for yourself.