Wyndham House Surgery

D for Don’t really know yet

It has been a long wet and dreary winter with little sun. There is no doubt this affects our mood and our vitamin D levels however whether these two are connected or just have the same causal link is currently a matter of scientific debate.

Our skin makes Vitamin D when exposed to the sun. We do not need much sun exposure to produce the amount of Vitamin D required to fulfil its main metabolic function of ensuring our bones have enough calcium.  In the summer this is easy but in the winter our Vitamin D levels will fall.  As we get older our skin is less efficient at making Vitamin D and this means that probably half of the older adult population has a low Vitamin D level in the winter.  As a result Public Health England advise older adults to take a Vitamin D supplement during the winter months.  These are 10mcg / 400 international unit tablets that can be bought cheaply over the counter in a pharmacy, they are not prescribed by GPs. Oily fish and eggs are the alternative main dietary source of Vitamin D. Optimising our bone strength is dependent on both having enough vitamin D and also doing sufficient daily exercise; walking in the sun ensures both needs are covered. Patients who have osteoporosis (weak bones), normally discovered following a low impact fracture, are treated with Vitamin D and calcium supplements plus a once weekly medication that ensures the calcium is deposited in the bones.

Whilst we have a good understanding of Vitamin D’s role in bone health the search continues for other roles that it might play within our bodies. There are Vitamin D receptors in some parts of our brain and there are also some trials that show it has a role in optimising our immune system. Taking a Vitamin D supplement in the winter is linked with fewer days of illness from viral infections. There is currently a trial being run by Exeter University testing whether taking very high daily doses of Vitamin D will decrease risks of dementia and other studies are trying to establish links to depression. No data is available yet. It is perhaps because so little is known, apart from the fact that levels are variable, that Vitamin D has been linked to so many pathological pathways. It was hailed as a panacea for Covid and as a protector against cardiovascular disease however neither of these claims stood up to scientific analysis.

One thing that is very clear from the research is that there is no benefit in measuring Vitamin D levels unless there is a clear medical indication for doing so.  This is because the levels are predictable; if you have reduced sun exposure your levels will be lower than they could be.  Nothing is gained from analysing the actual level as we are a long way from establishing what the most beneficial level is.  So, this summer get out, get exercising, use suncream (it does not affect Vitamin D production) and next winter consider taking a tablet during the darker months.

Anthony O’Brien, Wyndham House Surgery

Healthy digging

The arrival of Spring and the welcome return of longer days is always a signal in our house that the garden needs sorting out. The first cut of the lawn, weeding then mulching of flower beds, spreading compost on the vegetable patch often all coincide with the Easter holiday period. I have written before of the physical and mental health benefits of spending time in the garden. However, research over the last few years has also shown further benefits that gardeners accrue from the greater diversity of microbial life found in their intestines.

The best way to explain this is to use a horticultural analogy and thinking of our intestines as a garden. There are an enormous number of different microbes that live there in our guts, the same way that our gardens have a large variety of flowers, shrubs, herbs.  All of these have a multitude of species that spread and thrive according to the season and the composition of the soil. They all require basic nutrients to survive and some, like roses, require specific feeding with special fertilisers. For the garden to flourish and produce colourful flowers and large vegetables the gardener has to optimise the environment.  The intestines are similar; we know that microbes will produce vitamins and hormones that as well as aiding digestion are also absorbed to produce important benefits elsewhere in the body. If we create an environment in our bowels that promotes beneficial microbial growth our body will reap the rewards. We therefore need a gut flora that is optimally balanced and the food we eat is analogous to the soil in our gardens.

Bacteria were present on Earth long before humans.  We share DNA with them as we evolved from them over millions and millions of years.  Amazingly there are as many microbes living in our bodies as there are cells; we are a 50/50 split. Each of us consists of approximately 30 trillion human cells and 30 trillion microbial entities (bacteria, viruses, fungi) but because they are so small they only make up a very small percentage of our weight.  99% of these bugs live in harmony with us with only about 1% identified as being pathogenic ie causing illness.  We are all familiar with how our intestines adapt to our specific environment; bacteria in the water in some countries will be pathogenic to those who are travelling there, hence ‘travellers’ diarrhoea’.  Antibiotics taken for whatever reason will kill some of our intestinal bacterial, upsetting the balance and producing the common side effect of loose stools.

The research shows that for optimal health we need a healthy gut flora that is fed, via the food we eat, to produce the best microbial balance for our bodies. Fresh fruit and vegetables of varied colours (a rainbow diet), fibre rich food and regular meals with a chance for your bowels to rest overnight are all key. Having a diverse number of different organisms is also essential and recent studies have shown that gardeners have a healthier mix.  This could be because they eat their home-grown fruit and veg but more likely it is simply that getting grubby in the garden exposes you to a richer variety of microbes that infiltrate your gut.

So this Easter, get digging and get dirty to get healthy.

Dr Anthony O’Brien

Wyndham House Surgery

There are lots of questions about sleep that we do not know the answers to. However, we all know how important sleep is because the effects of not sleeping are very difficult to cope with. The good news is that we are developing a better understanding of what helps us sleep when the pattern goes awry.  Some of these are not what you expect.

We are animals used to routine and cycles of daily life that follow patterns dictated by sunlight. We have a great ability to train our bodies to respond to certain stimuli in a programmed way. When I was at medical school I took part in research projects that firmly established neural connections within the brain that promoted and engrained reward related behaviours. Sleep is one of these behaviours and the rituals of going to bed train the brain to switch to this ‘downtime’ operational mode. If sleep becomes difficult, sticking to these routines, or re-establishing them, is the first and most important step. Evening exercise helps, especially if followed by a hot bath before bedtime. This has recently been shown to increase the speed of ‘dropping off’ by 36%.  This is due to increase blood flow to the arms and legs causing the body’s core temperature to drop; a very old evolutionary trigger for sleep. Getting up at the same time each morning, whether you have slept or not, is also of vital importance.  It is the brain’s exposure to morning sunlight that turns off the production of melatonin (our sleep neurotransmitter) but at the same time it resets the clock for it to switch on again 12 hours later ie when you need it again.  Distraction techniques to help you drift off are not as good as concentrating on your breathing.  Emptying your mind by thinking about your respiratory rate, following a pattern of counting to 4 while breathing in, holding for a count of 2, and then another 1 to 4 whilst breathing out is a very effective technique. Lastly to help sleep at night, a quick nap in the afternoon has enormous benefits, especially as you get older.

Troublesome sleep is aften a sign of low mood or anxiety and we would advise you to make an appointment with a GP if it is associated with other symptoms such as loss of motivation, tearfulness or weight loss.  However, more often our patterns are disrupted temporarily and a reset will work. Wyndham House patients can access an on-line self-referral support service for free www.sleepstation.org.uk  which has a 75+% rate for helping patients improve their sleep.

So, if you are experiencing sleep difficulties short or long term it is worth trying some of the above. Diligently follow the same night time routine. Do some exercise to relax your muscles. Have a hot bath to help your body ‘cool’ down. Don’t lie in but get up early. Concentrate on your breathing to help you drift off. Most importantly do not allow your brain to associate lying quietly in bed as anything other than a direction to turn off.  If you cannot get to sleep then get up, leave the bedroom, read, watch TV, do a puzzle and then start again.

Anthony O’Brien

Wyndham House Surgery

Sleepstation NHS

On entering hospital it is now standard practice for the admitting clinical team to discuss with you what treatment you want if you become critically ill. This information is recorded on a document called a Treatment Escalation Plan (TEP) form. This focuses on which treatments may or may not be most helpful for you. A variety of treatments can be considered, such as antibiotics, artificial feeding or ventilation of your lungs. The option of whether it would be helpful or not to readmit you to hospital in the future for further treatments may also be included in your plan.

The most important part of this discussion is what happens if your heart stops beating. This will happen to all of us at some point in our lives and for the vast majority it will be the moment of our death. The TEP form looks at the important issue of cardiopulmonary resuscitation, also known as CPR. This is the medical treatment that can be used to try to restart the heart and lungs if they suddenly stop working.  It includes chest compressions and the use of a defibrillator to shock the heart back into beating. While resuscitation can be successful for some people, for others it is very unlikely to work. CPR can be very traumatic and it is not a suitable treatment for everybody. The older you are the less likely that you will recover your previous level of mental and physical function. The TEP form can be used to document the resuscitation decision that is right for your individual circumstances. If you decide that CPR would not be the right thing to do for you then the doctor will fill this in on the TEP form. It is called a do not attempt (try) to resuscitate or DNA CPR.

Until now this recording of a patient’s wishes was held on a piece of paper that could easily get misplaced. In the next few months these TEP forms will be available for all medical professionals to access on the Devon and Cornwall Care record. This is a new secure computer system that brings together information about your health and care and presents it as a single record. Healthcare staff can now see the details held by GP practices, hospitals and other health and care organisations across Devon, Cornwall and the Isles of ScillyHaving a more complete view of your medical history helps healthcare professionals identify problems more effectively and make quicker diagnoses. For instance, they can see which allergies you suffer from, any treatment and medication you have received plus quickly understand advance care decisions you have made using a TEP form.

You do not have to be in hospital to complete a TEP form. GPs are very happy to have this conversation with patients and complete the form together. It is actually more sensible to have the discussion when you are well rather than when you are sick and having to deal with the disorientating circumstances of being admitted to hospital.

We all understand the importance of writing a Will.  Over the next few years, I think completing a TEP will be considered in a similar way.  The fact that we can now record the information so it is easily accessed by hospital and ambulance teams means it can be reviewed and changed at any point with everyone knowing exactly what your wishes are.

Anthony O’Brien, Wyndham House Surgery

Following the Call For Volunteers a group of us met in the Practice Manager’s office on 16 November to re-launch the Patient Participation Group.

We’ll be helping with

• Advising the practice on the patient perspective
• Communicating with the wider patient body    (that’s you, the reader…)
• Influencing the practice or NHS Devon to improve commissioning of services

The group will be a “critical friend” for the surgery, to help keep the surgery in good shape for the future. You might also think of the group as a “patient partner” to the surgery.

If you have any thoughts, please let us know. We’d like to hear from all types of patients or carers who use the surgery. You can contact the group by emailing

wyndhamhousepatientsgroup@gmail.com

Finally there is space on the core team for further volunteers should anyone be interested. All registered patients are welcome to join.

“4 words: a film, often watched at Christmas – first word sounds like…”

There are a lot of things we associate with Christmas. Family traditions and childhood memories are strongly embedded in our memories.  This is why it is often a mix of a happy celebration that comes paired with thoughts for those we have lost and good times that, for multiple reasons, we can no longer re-enact.  Hopefully for everyone the spirit of the holiday season being about giving and sharing will be present somewhere. Looking out for family, friends and neighbours who might be finding it harder this year is an important role for all of us.

One of the common themes shared between all of our Christmases, past and present, will be playing games. As long as the competition does not get too intense (always a risk in our household) then the fun, the sharing, the pure simplicity can be a strong linking and uplifting force.  When I was a child there was the perception that games were for children and not adults, however, I suspect there are not many who still believe this. Board games, card games, charades, are all easily accessible as family groups and work across generations.

Playing is now recognised as being extremely important for us as humans. The mental agility and concentration required varies enormously, but the same challenges exist whether completing a simple jigsaw, playing Snakes & Ladders or tackling Mahjong. We are challenging ourselves with problems that require our brains to opt out of automatic function. This is often more enjoyable when shared with others and there is a sense of satisfaction when the puzzle is solved or the competition finishes. It should not matter whether you win or lose, it is the taking part that counts and this is never truer than over the festive period.

Games and community participation are very important in keeping our minds cognitively agile and protecting ourselves against deteriorating memory in later life. An athlete who does not exercise, a musician who does not practice will lose their skills.  We need to keep our brains active and challenged; games or any sort are an excellent way of doing this.

Whilst Christmas is an opportunity for playing face to face there are also a multitude of opportunities available on-line.  Joan Povey our Digital Social Prescriber is now running regular sessions at the Room4U in Silverton to help those who would like help with anything digital.  The surgery is going to acquire an iPad that Joan will loan out to those who wish to experiment.  So, if you are you ‘internet shy’ or have a mobile phone, laptop/tablet or iPad that you don’t quite know how to use and you would like help to do things online such as shopping, order prescriptions, play games, facetime family then drop in to Room4U on a Thursday morning.  Upcoming dates are December 7th and 14^th & January 4th, 11th, 18th and 25^th. All sessions from 10am – 11am. Please call Joan 07958 190554, or just pop in on a Thursday.

Wishing everyone a very Happy Christmas and hope it contains some games that you enjoy playing no matter what age you are.

Anthony O’Brien

Wyndham House Surgery

The inevitability of us all arriving at a point in our lives when our bodies succumb to age and/or illness is one we accept but rarely address until we have to face it.  During those last stages of life our role as GPs is to guide, inform and accompany. Often there is a gap between a patient receiving a terminal diagnosis in hospital and entering the last stages of illness at home. This can be a difficult and unpredictable stage, filled with questions and uncertainties. To help patients during this period Jan Hebditch has returned to work for us as a special Palliative Care liaison nurse. Lots of our patients will know Jan from her many years leading our superb District Nursing team. Her clinical skills, knowledge, experience and contacts within the local healthcare system are second to none. Jan’s role is unique to Wyndham House; we have specifically designed it to fill a gap that exists in the current NHS service.  We are incredibly lucky to have Jan re-join us and we owe an enormous thank you to the Friends of Wyndham House for funding this very bespoke role.

Expectation and understanding of what happens as a disease progresses is essential to helping patients and their families. It is important to remember that there are no ‘musts’ in terminal care apart from a patient passing away pain free and peacefully. Choices about this are very personal.  Passing away at home is not everyone’s wish; for some it might be very important, for others it is something they may strongly want to avoid.  It is absolutely fine to change your mind mid-journey.  Patients and their families need time and space to talk about what they feel most comfortable with. We can adapt to all needs and one of Jan’s roles will be to facilitate this when the time is right.

Whilst death is always accompanied by sadness of the loss, the process should be as smooth and supportive as possible. Good communication between everyone involved is key and as a surgery we continually strive to maximise this as much as we can.  As individuals we have little power over the nature and speed of our last illness but as carers we can ensure our patients and their relatives have as much control as possible to fulfil their end of life choices with dignity.

Dr Anthony O’Brien

Wyndham House Surgery

An apple a day…..

Few days go by without us hearing a news story about certain foods lengthening or shortening our life.  One week we are supposed to be eating red meat alongside a glass of wine, the next week we hear the advantages of being vegetarian and teetotal.  This occurs because there are so many large studies recording information about what we eat. The computer analysis of the results continually looks for patterns that might help direct the next phase of study. The scientific marker of significance is that there is less than a 1 in 20 chance of the correlation occurring by chance alone. This is roughly equivalent to the chance of rolling two dice and getting two ones or a one and a two.  So, with so many large studies across the world there are lots of correlations that are initially thought to be significant but we will ultimately find are just down to chance. To be proved true the correlation needs to occur consistently in all the studies ie the two dice roll scores three or less every time. However, the journalists do not wait for this scientific proof they are happy to write about what sounds interesting.

The truth is that if you eat a broad, balanced diet, low in saturated fats and with enough fibre and fruit to ensure a regular bowel habit then there are very few other dietary manipulations that will genuinely affect your mortality. However, there is one consistent scientifically accepted food choice that studies clearly show will help prevent heart disease plus reduce your chances of developing Type 2 Diabetes and dementia. This is eating foods rich in flavonoids. These are the chemicals that are responsible for giving colour to fruits and vegetables. They interact with our biochemical systems at a cellular level, effecting enzyme interactions, altering production and destruction of certain proteins that protects the immune and cardiovascular systems. Decrease blood pressures are seen in populations who ingest more flavonoids.

As a generalisation, foods high in flavonoids have strong rich colours.  There are plenty around at this time of year: apples, blueberries and grapes are all great sources.  One research project in women in Australia showed that eating apples regularly lengthens your life by a significant number of years.  They showed that it does not matter how the apples are prepared; stewed, baked or picked direct from the tree are equally as good.  The skin does contain a lot of the goodness but it is not essential. It is eating apples regularly that counts.  There is therefore a scientific truth to the well know aphorism.  So, enjoy and profit from the apple season this year, we have a plentiful supply from a tree in our garden.  As the winter then draws in, get baking some apple crumble but go easy on the cream.  Other good sources of flavonoids are dark chocolate and green tea, so maybe round off your meal with one of them!

Anthony O’Brien

Prescription charges increased on 1st April 2023.

See details and ways you can reduce the cost Here