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

Unfortunately, due to a number of factors including a rise in patient numbers and some significant supply chain disruption, we are having to extend the time in which we fulfil repeat prescriptions.

From July 17^th we will be asking that patients allow 72 hours (3 working days) before collecting a pre ordered prescription. Our staff will still endeavour to fulfil prescriptions as quickly as possible, but we can no longer anticipate a 48 hour delivery.

The waiting time does not include Saturdays or Sundays as the surgery is closed at that time.

We apologise for the reduction in service, but thank you for your continued support.

A garden full of thoughts

April in the garden is an unpredictable month.  At the beginning there is little to see and at the end, after a lot of hard work, there is not much to demonstrate the toil you have put in.  We have been renovating a muddy section of our garden and whilst there is now a new patio, the surrounding beds are smarter but no fuller than they were 6 weeks ago.  This is despite a lot of digging, forking, composting, wheelbarrowing and at the end some raking and turf laying.  Although no flowers yet, metaphors have bloomed.

Hard work with little immediate evidence of outcome is common within many parts of our lives.  Relationships take time and regular nurturing.  Initially a lot of spade work might show nothing but underneath you start to create a rich, healthy base for friendships to form and companionship to blossom. In the last 6 weeks my father-in-law has painstakingly prepared a new asparagus bed and planted a crop. It will be three summers before he can reap any rewards but it will be worth it.

Physical exertion is beneficial on multiple levels.  There is nothing better for our bodies than mobilising, stretching and bending.  As we get older this becomes harder but the benefits greater.  Mild muscular discomfort or aching joints are common and normal; resting and stretching after an energetic day is sensible but if aches are predictable then it makes more sense to take the tablets before the activity. It is the equivalent of oiling and regularly using a trusty pair of shears; it makes them last for a lot longer than if left in the back of the shed. Painkillers and stretching are the oil for our hips and knees.

What is very clear as I open the curtains each morning and look down on our efforts is that slowly with time flowers will bloom, fruit will ripen and vegetables will grow. Some things will be predictable, some will be controllable and others will simply take us by surprise. Some projects will fail but there is no point in dwelling on these because we can just do some more digging and start again.  The patch of soil always has the potential to become something more enjoyable.  Life can be described as a bed of roses and whether we see this as a comfortable soft pillow of petals or a thorny, uncomfortable, difficult to prune mesh is often due to our current state of mind.  Life can seem like both of these at times and will vary unpredictably for all of us.  However, we can control how we view it.  One person’s “intermittent showery day” is another’s “quite a few sunny spells”.  Looking for the positive can be hard work, but just like April in the garden, it is well worth the effort.

Anthony O’Brien

Wyndham House Surgery

65% of our bodies consist of water.  It is essential for life.  So given its importance you would expect there to be a clear scientific answer to the question “How much should I drink a day?” This is not the case as our fluid requirements vary depending on a person’s age, body size, gender, environment and level of physical activity.

We need to ensure there is enough fluid in our bodies to maintain normal function of our heart and our kidneys.  To do this we naturally take in the equivalent of approximately 8 glasses of water (2 litres) per day. Children need less and pregnant women need a little more. Most of this fluid is from drinks, but some comes from food, such as soups, stews, fruit and vegetables. In a healthy body, the brain detects when the body is becoming dehydrated and initiates thirst to stimulate drinking. It also releases a hormone which signals to the kidneys to conserve water by concentrating the urine.

Being thirsty is not a sign of anything other than a need to drink and rebalance our body fluids.  It is a very sensitive mechanism.  When we are unwell, we need to drink more.  This is because temperature associated sweating, vomiting and loose stools all cause loss of water. Not passing any urine for 12 hours is a significant sign of dehydration, especially in children.

As we get older our body systems are less finely tuned, the cardiac muscles weaker and the kidneys not as good at keeping everything in physiological balance.  Combine this with a more sedate lifestyle and it is normal to experience some collection of water in the lower legs / ankles towards the end of the day. This is best treated by wearing support hosiery.  Some patients with heart or kidney conditions actually need to limit the amount of water they take to ensure the system is not overloaded. Doctors might suggest restricting intake to a certain number of drinks per day and will also use water tablets (diuretics) to help achieve a finer balance.

Ultimately, we do not need to be concerned about drinking an arbitrary amount of water per day: our bodies signal to us when we’re thirsty, much like they do when we’re hungry or tired. The only health benefit of drinking more than you need will be the extra calories you expend by running to the loo more often.

So, listen to your body and drink if you are thirsty. Listen to your doctor if they suggest you need to limit how much you drink.  If you hear nothing from either of these sources then you can be reassured you have it just right.

Anthony O’Brien, Wyndham House Surgery

Published in Parish magazines April 2023

Bio-rhythms are important to our health.  We are animals that need to routinely eat, exercise and sleep; we have evolved patterns so all of these that are optimal for our well-being.  The benefits and science underlying regular meals and exercise is well understood, however, sleep remains more of a mystery.  Research into the biochemical rhythms and hormonal changes that occur during day and night continue to reveal information we can utilise.  The production of melatonin from our pineal gland, the levels of the stress hormone cortisol and the links of adenosine with sleep have all been studied extensively. Melatonin is now used in children with hyperactivity problems, we understand diurnal variation in blood pressure and the advantages of taking blood pressure medication at night, and we all are guilty of using caffeine to counter the build-up of adenosine to stave off sleep if we need to. However, treatment of sleep problems remains a challenge.  Sleeping tablets only have a limited role to relieve short term anxiety symptoms with the aim of resetting our normal pattern.  Long term they are addictive and their effect on sleep and functioning are extremely counter-productive.

Cognitive Behavioural Therapy has proved to be one of the best treatments.  It uses a well-ordered sequence of steps and the surgery has recently signed up to work with a group from Newcastle, Sleepstation, who offer on-line treatment courses. The research shows a very high percentage success rate. Sleepstation is easily found on-line (www.sleepstation.org.uk) and if you would like a referral, please contact one of the GPs.  As always if you need help setting up or using an on-line service Joan Povey, our Digital Social Prescriber, is easily contacted through the surgery and will be delighted to help.

One simple intervention that did evolve but has been lost over the last few hundred years is that of a siesta. The word comes from the Latin ‘sexta’ meaning 6^th hour. The Romans routinely took a snooze after lunch, as is still the custom in Spain, parts of Italy, Greece and the Philippines.  There is evidence that this biphasic sleep pattern has many advantages; allowing the brain to recoup for 30 minutes between 1pm and 3pm leads to greater cognitive power for the rest of the day.  Some universities actively encourage students to have ‘down time’ early afternoon. Google have sleep pods in all their offices which staff are encouraged to use during the working day. There are physiological advantages for the cardiovascular system as blood pressure will lower during a siesta and as long as no longer than 30 minutes then an early afternoon nap will also paradoxically improve night time sleep.  Changes in our patterns since Covid does mean more people are working from home and the opportunity to take a nap is actually more practical for many than ever before.  Those who are retired would benefit from putting a siesta into their daily routines. It will boost memory, mood, will-power, creativity, aid digestion and help at night. So, if you are looking for a simple method of improving both your physical and mental health setting up a sixth hour snooze might just work for you.

Anthony O’Brien

Wyndham House Surgery

Mind matters

We always think of keeping active as relating to the physical, however there is a strong argument that exercising our minds is equally important. Exercise helps keep muscular strength for longer but it is actually just as important to protect our ability to finely control the weakening muscles. This requires us to engage our brains in regular practice of slow steady movements as you find in Thai Chi and Balance Classes, both of which run in Silverton.

Whilst we accept that muscles will wear out, our understanding of longevity of cognitive function is less clear.  There are diseases that affect our memory, Alzheimer’s being the most familiar.  The other main cause of dementia is vascular damage; changes in blood flow to the brain, caused by long standing raised blood pressure, poorly controlled diabetes or smoking can lead to a series of very small strokes in discrete but very important parts of the brain.  We have medical approaches to try and prevent or slow down progression of both these diseases and regular physical exercise is an important one of them. However, regular cognitive challenges have a role to play too.  There are a range of simple things you can do on a daily basis that are likely to help over the years.  Crosswords, word puzzles and Suduko are the longest standing examples of brain workouts. Every day three million people around the globe tackle the challenge of the Wordle App (needing to find a 5 letter word) or Worldle (identify a country from its outline).  If you have not heard of these look them up and have a go.  If none of the last two sentences make sense then let us know at the surgery and we will put you in contact with Joan our Digital Social Prescriber who will be delighted to introduce you to the App Store.

However, you do not have to go digital; having a jigsaw always on the go is an excellent idea.  I used to have several patients where this was the case and when visiting I had to resist spending too much time helping them search for the next piece.  Taking up a new challenge, learning a new skill will also produce a lot of healthy mental stimulation.  It is also incredibly enjoyable and satisfying if you start to produce or create items either artistic or practical from painting, potting, or wood working.  I attended two oil painting courses in the last 6 months and thoroughly enjoyed both.

We are very fortunate to have a multitude of activities in and around Silverton.  They are all easy to find through the SCENE (Senior Citizens of the Exe Valley News & Events) booklet; the 2023 updated edition is just published and can be picked up from the front desk in the surgery.  As GPs we are always going to encourage you to get exercising, but this is not just physical – we also need to keep our grey cells on their toes.

Anthony O’Brien

Wyndham House Surgery