Wyndham House Surgery

Keeping functional

We tend to measure our fitness in terms of how far or how quick we can get somewhere; to the shops, up the stairs. We recognise that as we get older we will not achieve the same speed but as long as our numbers do not deteriorate too quickly, we are doing well. The research strongly suggests that we should be thinking differently. If we want to ensure we maintain our ability to function independently for as long as possible we need to concentrate on how well we can squat down, raise our legs and stand still. Training to maintain strength and balance is much more important than anything else.

In older adults, poor muscle strength increases the risk of a fall by 76% and those who have already had a fall are three times more likely to fall again. Strength and balance activities not only help to prevent this, but also help improve your mood, sleeping patterns, increase your energy levels and reduce the risk of an early death.

No matter how old we are we quickly lose muscle strength and function if we become bed bound for even short periods of time. Our core muscle strength and balance abilities are the key factors in how quickly we recover. The Otago Strength and Balance exercise programme is an excellent guide to the types of exercise that are beneficial. There is a link to the programme on our website. The exercises are all designed as daily routines that will help maintain our most important core muscle strength.

Our ability to balance is dependent on the brain integrating information from our eyes, our lower leg joints (especially ankle and feet) and our central balance system, located adjacent to our inner ear. The information coming in has to be very quickly processed and then messages sent out to ensure our muscles coordinate to keep us upright. Aging affects both our muscle strength and brain processing speed and this means our ability to balance deteriorates. However, daily balance exercises can counter the aging process.

Standing on one leg is one of the most difficult challenges we can set ourselves. Standing on one leg with your eyes closed is even harder. The length of time we can do each of these changes as we get older and is a good predictor of life expectancy.  50 year olds should be able to stand on one leg eyes open for 30 – 40 seconds and eyes shut for 10 seconds. These times half by the age of 70 years. However, they can be improved by daily practice and this is well worthwhile as better balance means you are less likely to fall and better able to recover after any illness. Start by practicing daily with something to support you close by.  With time you will improve and before long will be able to brush your teeth in the morning and evening whilst standing on one leg.

The Friends of Wyndham House run both Balance Classes and Tai Chi sessions. There is a lot of evidence that shows attending such classes helps us improve muscle strength, coordination and balance. We should see these exercises in the same way as we would if we were training for a race or practicing a musical instrument.  Small daily routines will pay off in the long term race of life where we want to preserve our independent function through to the finish line.

Anthony O’Brien, Wyndham House Surgery

Placebos and Nocebos

If a doctor gives you a big red pill and tells you it will help the symptoms that you are suffering from there is a significant chance that these symptoms will improve. This is known as the Placebo effect; it is well established but not fully understood.  What we are less aware of is the Nocebo effect.  This is when a widely used medication has adverse publicity about possible side effects. This results in patients being more likely to suffer these side effects than would be expected from the blinded trials where they do not know what medication they are taking.

The Nocebo effect has been clearly demonstrated for statins. These are the drugs we use to reduce your chance of a heart attack or stroke by lowering cholesterol levels. Large numbers of patients decline to take them due to worries about side effects that have been nurtured in the media. However, a recent very large trial has now proved these concerns regarding side effects are unfounded.

Statins are one of the most prescribed medications in the world. Nearly eight million people in the UK take them to lower their cholesterol and in turn reduce the risk of heart attacks and stroke. However, currently up to a fifth of people stop taking them due to side-effects such as muscle aches, fatigue, feeling sick and joint pain. We now have two large trials showing that the Nocebo effect may account for almost all the associated symptoms, as statins only cause significant medical problems in less than 1% of patients.

Cardiovascular disease causes a quarter of all deaths in the UK; controlling blood pressure and lowering cholesterol with statins are the most significant tools we have to reduce risks. The higher your risk, the greater the benefit of taking a statin. Getting older increases your risk of heart disease and stroke. The trials are extremely reassuring for patients to whom we offer statins as they move into the higher risk group; over 70 years old with raised blood pressure.

Both the Placebo and Nocebo effects are real. It is wonderful that patients can feel better after being given a pill which has nothing in it. However, suffering symptoms when taking a pill that has been shown not to cause them is a disadvantage. We can now counter this by explaining to patients that any initial statin related symptoms are very unlikely to be directly related to the biochemical effects of the statin and will almost certainly resolve given time. There is no harm in stopping and then restarting statins a couple of times as this will often speed up the resolution of the symptoms.

If you are a patient who has previously been prescribed a statin but stopped taking it due to side effects then this research strongly suggests it would be worthwhile trying a statin again. It is now very clear that the benefits of this group of drugs far outweigh any risks. Trusting the scientific proof over the media speculation will make an enormous difference to many patients by preventing a very large number of heart attacks and strokes.

Anthony O’Brien, Wyndham House Surgery

The NHS App

Most successful political ideas start as grossly exaggerated aspirations that then over many years adapt, jump through administrative hurdles, get changed due to legal requirements and eventually are most often repackaged by the political party who in opposition opposed the introduction in the first place. However, if the idea is a good one and the aspiration apolitical then often this process does lead to success. The NHS App is an example of this and now is the time to get on board with it.

The idea of universal access to the NHS via smartphones started in 2018. The technology stuttered for many years and it was not until 2021 that the App had its first measurable success providing digital Covid passports for anyone travelling abroad. It has continued to slowly develop to the point that it now interacts seamlessly with GP computer systems. This means you can book appointments, see test results and view your medical record via the App. Understandably to set it up on your phone you do need to go through a procedure to prove your identity. This is reassuringly comprehensive but relatively quick, a strong testament to how much potential the App has.

We have therefore now reached the point where the current Health Secretary, Wes Streeting, is strongly promoting the App, making it one of the cornerstones of his 10 Year Plan for the NHS. GP practices are encouraging patients to download the App and register, however, so far not many patients are using it.

In Devon we are fortunate that RDUH is one of the leaders in Secondary Care electronic communication, adopting the MyCare system in 2021. Many patients will have experience of using the MyCare App to look at their hospital records and results. Although it does not directly link with the NHS App yet, almost all of the information is available via both Apps. If you need any help setting them up on your phone then please contact Joan Povey, our Digital Social Prescriber on 07958 190554, leave a message and arrange to meet her or drop in to Silverton Room4U on a Thursday  9.30 – 10.30.

Both the NHS App and MyCare combine well with the systems we have in place at Wyndham House. Our computer system now automatically texts patients when their medication is ready and this year’s Flu vaccine appointments were almost all booked using our on-line system. Sending an email via our website is also an excellent way of dealing with any administrative queries or tasks e.g. updating a medical certificate. However, for any clinical questions we think it is still much more efficient to ring and make an appointment with one of the GPs, either face-to-face or telephone, according to the circumstances.

Anthony O’Brien

Wyndham House Surgery

Scene 2026_web

Best things come in small packages

We are all keen to take a look under the tree to see what presents have our name on them.  Big ones and small ones are undoubtedly the most interesting. Among the small packages this year will be a large number of multi-functional watches that are able to check your pulse, your blood pressure, your oxygen levels and record your daily amount of exercise. They all come with targets and alarms about what you should be achieving.

However, there are no ‘shoulds’ in medicine. We are all individuals and what might be sensible for one person may be unachievable for someone else. The aim of all medical care is either to cure or optimise our risks of illness.  It is difficult to prevent all disease as the biggest factor in almost all cases are the genes you inherit. Luck is something we cannot control.  We are able to very significantly reduce our risks of lung cancer and heart disease by not smoking but this is the only intervention that makes an enormous difference to the statistics.  All other changes in behaviour are valuable but how much difference they make depends on the context. The analogy I use in consultations is comparing the difference in risks for someone driving a car or a motorbike. We are all comfortable driving cars without wearing crash helmets or protective clothing. However, we would not dream of getting on a motorbike without these on. Patients who have diabetes are at increased risk of heart attack and strokes in the same way that the motorcyclist is at increased risk of crashing.  Blood pressure medication and statins are the equivalent of the helmet and leathers. The same is true for anyone who has already suffered a cardiovascular event. So, what is the best blood pressure and lipid level for those at higher risk? The simple answer to this question is the lowest that causes no problems.  We titrate medications so that they are the optimal dose ie best readings with no side effects. This will be different for each individual.

The optimal amount of exercise is more complicated. Walking some distance every day is undoubtedly beneficial for our bones and joints. Taking some medication prior to exercise if needed is sensible. I have written many times about the enormous mental health benefits of being outside and interacting with nature; there is no optimal number of steps required to take advantage of this. However, cardiovascular health can be improved with short strenuous exercise. The research shows this is surprisingly short.  Raising your heart rate with 1 minute of vigorous exercise everyday has a significant effect. What you need to do to achieve this will vary with age; short sprint for the younger, fast power walk for the older. The aim is to have 60 seconds of effort a day.  As always not too much to cause side effects but sufficient to feel you have done something. A small package of time that will deliver large benefits; no electronic devices or large pieces of exercise equipment required.

Wishing everyone a very Happy Christmas from the Wyndham House Team

Natural Healing

It takes many years to learn a language or play a musical instrument with skill. 10,000 hours is the oft quoted amount of time you have to dedicate to become a consummate Olympic athlete. When you do the maths, this is a number of hours per day over a number of years that is unimaginable for everyone other than those with the evident talent at a young age. However, underlying all these pursuits lies the same formula.  Daily routines and practice. Few of us harbour the talent or the realistic desire to win Gold medals, however, we all have the potential to adopt regular short, simple daily activities that we will benefit from.

A recent study was published reiterating the benefits of regularly interacting with nature. Being outdoors can trigger measurable changes inside your body from lowering stress hormones, easing blood pressure and even improving your gut health. We think the reason for these positive body system responses is due to our autonomic nervous system; a network of nerves controlling unconscious processes. During our early life it learns to respond to stimuli associated with relaxation and recuperation. We are all aware of our flight/flight reflex that occurs the instant we feel danger. This is controlled by our peripheral nervous system and has evolved from when we were monkeys. Adrenaline pumps around the body, our heart races, our breathing rate increases, blood is diverted to our muscles as we prepare to defend ourselves. The autonomic system response is exactly the opposite: lowering blood pressure, dropping our pulse rate, relaxing all of our bodily systems.

Stimuli that we associate with feeling safe will trigger the autonomic nervous system.  Green spaces, birdsong, smell of citrus oils have all been shown to bring about these responses.  It is not surprising that putting our bodies in their ‘resting, safe, stand-by’ mode regularly during the day is of benefit to both our physical and mental well-being.  Our immune system is also bolstered, the theory being that it has time to re-energise.  Studies have shown that our virus fighting ability is increased by 25% after an extended periods in nature.

You don’t have to hike for hours to benefit from exposure to nature as maximum impact happens after just 20 minutes. So, a lunchtime walk to the park and then a sandwich on a bench or in your garden a few times a week will suffice. A diffuser producing the smell of a pine forest can make you calmer within just 90 seconds and that effect lasts for about 10 minutes. Flowers such as white or yellow roses have been shown to create the greatest calming effect on brain activity. Research has also confirmed that pictures of nature as your screensaver can trigger the same calming brainwave changes and reduce stress.

So simple, short and regular relaxing stimuli can be just as healthy as regular visits to the gym. Turning on our autonomic nervous system every day is easy if we set up our environment and our routines to give it a regular and repetitive workout.

Anthony O’Brien

Coughs and sneezes spread diseases

Prior to the Covid pandemic all preparations for how to deal with a rapidly spreading life threatening infection were focused on influenza. The public health campaign in the first 6 months of the 2020 pandemic concentrated on how flu spreads with the slogans: Catch it, kill it bin it and advice to wash our hands whilst singing Happy Birthday. However, as we learnt more about Covid the emphasis changed to social distancing. Over the last 2 years Covid is becoming much more like flu in its pattern of symptoms and the way it spreads. Currently there is a danger that we are becoming complacent about Covid and can be falsely reassured by tests that are not as good as we think.

Covid tests have never been that good as the test depends on how well the sample is taken and none of us are very good with sticking swabs up our own noses. The test does have a very high specificity rating; this means if it is positive then you definitely have Covid. However, the sensitivity of a test is much more important and, unfortunately, Covid tests have never scored well. The test will miss maybe 1 in 3 of all positive cases (more if the sample is not taken optimally). These are the reasons why towards the end of the pandemic, as restrictions were lifted, the health advice was to pay more attention to symptoms rather than the tests.

As we enter the winter months both Covid and Flu will become more prevalent. Vaccination is very important to protect ourselves and others but it is even more important to pay attention to your symptoms. If you have viral symptoms and a temperature, please isolate yourself. Whilst a positive test confirms Covid, a negative test does not mean you have not got it. The evidence strongly encourages any patients with Covid-like symptoms to not do any testing; stay at home, reduce contacts, keep your distance and wait for symptoms to resolve. The title of this article was first used as a health slogan in the United States during the influenza pandemic that occurred after the First World War. It still holds today as a more modern variant – this winter make sure you keep your symptoms to yourself.

Our flu clinics are running on Friday 3^rd & Saturday 4^th October with Covid vaccines available at the same time for those eligible (patients over 75 years and those who are immunosuppressed). We will be running catch up clinics for patients who could not get to these clinics; we will send out information about these later this month.

Anthony O’Brien

Wyndham House Surgery

Continuing to flex our texts

This year’s Flu Clinic will be on Saturday 4^th October. The Joint Committee for Vaccination and Immunisation (JCVI) continue to recommend that patients over 75 years old and patients who are immunosuppressed (those being treated for cancer or on drugs that suppress their immune response) receive Covid vaccines every 6 months. This policy is working well. Covid is still present in the community; most people will know of someone who has recently suffered from it. However, it is rare for anyone to be admitted to hospital. Just like Flu, Covid is a 7+ day illness with fluctuating temperatures, aches, pains and feeling of exhaustion. Both illnesses will put an averagely fit young adult out of action for 7 – 10 days. This is why it remains important to prevent elderly and vulnerable patients contracting them and so patients over 75 years old will again be offered Flu and Covid vaccinations at the same time.

We have received a lot of very positive feedback regarding the ‘your medication is ready’ texts that we started sending out a couple of months ago. These have reduced both phone calls to the surgery and unnecessary visits to see whether medication is ready for pick up. Thank you to everyone for giving the dispensary team five days before you enquire but we are pleased to report that almost everyone is receiving their texts well within this timeframe.

This year we are going to use a new booking system for the Flu Clinic. Patients will be sent a text inviting you to book your appointment on Saturday 4^th Oct. The text will contain a link that will take you directly to a booking screen where you can choose from the slots available. This is replacing our previous ‘alphabet time slots’ system that has worked well over the last 5 years but we think booking a specific time during the day will give everyone more flexibility and make the clinic more efficient.

Patients who do not have a mobile phone should not be worried, we will be contacting them using a different route. We will be sending the texts out at the beginning of September and these will be staggered to ensure everyone will have access to appointments to choose from throughout the day. We would expect all patients eligible for flu vaccines (patients aged > 65 yrs old, those with Diabetes, Cardiac, Respiratory Disease or taking any immunosuppressive treatments) to have had the opportunity to book an appointment by the 10^th September.  Please do not contact us before we contact you. If you believe you are eligible for a Flu vaccine and have not heard from us by 15^th September then give us a ring.

Both of the above systems depend on us having a correct mobile phone number for all patients. Please could you ensure this is the case. Joan Povey our Digital Social Prescriber continues to be available to help anyone who would like to start to use a mobile phone or increase their confidence with it. Booking your flu vaccine appointment might be a great opportunity to link up with Joan for some help.  We are very happy to put patients in contact with her, just ask at reception.

Anthony O’Brien

Wyndham House Surgery

                                               Don’t call us, we’ll text you
Wyndham House has again scored in the very top percentile in the annual government
General Practice patient survey. A random 5% of adult patients in every GP surgery in England
receive a questionnaire asking them to rate their GP practice in a multitude of areas. An
enormous thank you to those who completed the questionnaires this year for rating our team
and our service so highly.
We are one of the approximately 1000 GP practices that can dispense medication to their
patients. This privilege comes with a lot of work but also enables us to solve problems with
medication quickly. Getting the correct medication in the required timeframe is often the
weakest link in medical care outside of hospital. Recently we have had some changes in our
dispensary team but we are now back to full strength with Caroline and Polly joining us over
the summer. We have also started to use an automated system that will let patients know
when their medications have been dispensed and are ready for collection. At the same time
as your bag of medication is placed on the shelf for pick up a text will be sent to your mobile
phone. This means you will no longer have to pop in to see if medication is ready; just wait for
the text.
We have always asked patients to leave 3 – 5 working days between requesting and collecting
their repeat medication. This needs to remain the expected time frame as occasionally
common drugs can be difficult to source due to manufacturing hiccoughs. This is the most
common reason for longer waits as we try to source then from elsewhere. However, since we
both prescribe and dispense there is always the option of prescribing an alternative and this
is what we do when required. Please do not ring the surgery asking about medication until
after the 5-day window. We are predicting that almost everyone will receive a text well within,
and sometimes a lot earlier, than the expected time. We hope patients will welcome the new
system.
This is an example of increasing the use of mobile phone communication alongside
development of the NHS App that is central to Government planning for the NHS. You can now
use the NHS App to see your clinical records and test results. You can also use it to order your
repeat prescriptions and book appointments. In the Autumn we are planning to pilot a new
system for booking flu vaccinations on-line. All these changes mean the benefits of using a
mobile phone continue to increase. Joan Povey, our Digital Social Prescriber, continues to run
sessions from RoomForU as well as being available for one-to-one assistance if you need help
setting up a device or you are new to the digital world. If you would like to meet with Joan, let
the Wyndham reception team know and we will put you in touch.

Anthony O’Brien
Wyndham House Surgery

Walking on the sunny side of the street

We have had a lot of sun during May and hopefully this will continue for the next few months. We should not be scared of getting out and enjoying the sunshine as bright sunny weather is of great benefit to our health.

Good exposure to the sun during April to September builds up our stores of Vitamin D. Like hibernating creatures, we store the Vitamin D we accrue over the summer in our fat reserves to keep us going through the dark winter months. This is very important in keeping our bones strong, it also boosts our immune system and may have other effects although research is still being done to confirm this.

There is no doubt that sunlight has a ‘feel good’ factor and this is also backed up by research studies. The most commonly used antidepressants work by boosting the level of Serotonin in our bodies and exposure to sunlight has been shown to have identical effects. One study found that people had higher levels of serotonin in their blood on bright days compared to overcast or cloudy ones. They also found that the rate of serotonin production in the brain was directly related to the duration of bright sunlight, regardless of the season or outside temperature. On top of this, there is some research to suggest that direct sunlight can trigger your skin cells to produce endorphins. These are neurotransmitters related to pleasure also released by exercise, eating, massage, chocolate and sex.

Sunlight has also been found to directly lower blood pressure. Scientists from Edinburgh University did an experiment showing that if you expose your arm to just 20 minutes of sunlight, that is enough to boost production of nitric oxide in your skin – which in turn causes your blood vessels to expand, bringing your blood pressure down.

Little and often is the best approach to topping up on sunshine plus minimising long exposure times is also the best way to avoid burning. Using suncream does not reduce any of the benefits I have listed above and protects the skin from damaged.

Skin cancers are directly related to sun damage. They can be broadly divided into two groups: melanoma and non-melanoma cancers.

Melanomas are abnormal looking moles. If you are over 40 and develop any new pigmented lesions then please make an appointment for a GP to take a look. We are particularly concerned about new moles or a mole that changes and meets any of the following ABCD criteria:

· Asymmetry: One half of the mole does not match the other.

· Border Irregularity: The edges of the mole are uneven, notched, or blurred.

· Colour: The mole has multiple shades of brown, black or blue.

· Diameter: The mole is larger than 6 millimeters (about 1/4 inch) in diameter

Non-melanoma skin cancers present as non-healing or persistent irritated areas or skin, often dry and red; once identified they can normally be treated by ourselves with a topical chemotherapy.

So, profit from the sunny weather, use suncream to protect your skin and if you have a growth on your skin that’s getting bigger, has changed colour or texture or an area of skin that hurts, itches, bleeds, crusts or scabs for more than 4 weeks please make an appointment.

Anthony O’Brien

Wyndham House Surgery