Wyndham House Surgery

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

Essential and hard but inevitable

Grieving is multifaceted and complicated. It is very personal. The strength and value of our close relationships are ultimately only known to each of us internally.  Sadly, the importance of these are often only truly realised once someone is no longer with us. As humans we do not naturally dwell on our evident mortality; spending excessive time pondering our finite future is a symptom of low mood.  However, reflection on what will happen when you or someone close to you does die is a healthy activity. Planning for death through making a Will, organising a Lasting Power of Attorney, discussing inheritance with families, specifying the details of your own funeral are all normal things to do.  Many of these are prompted by the death of somebody else.

Following the death of the Queen last September we all experienced a month of grieving and a lot of this was uncharacteristically public.  Due to the circumstances this was grieving at scale and on TV; in this case, in my opinion, both very important.  As a result, there was a lot for us to both experience and learn from to help each of us through our own inevitable periods of grieving ahead.

The presence and support of family was very evident. None of us will ever have the forensic media analysis the Royal Family lives under, but we will all experience some degree of family rift at some point in our lives. Even if small and temporary these will make us feel uncomfortable.  If long and severe they will often be the underlying source of other physical or mental health problems.  If they are on-going, or occur coincidentally, at a time of loss then they can become amplified to much greater than their actual underlying significance.  As we have seen the initial grieving period is an ideal time to try repair these relationships and appropriately bury any hatchets.

How long should you grieve for? There is no correct answer to this question. Grieving is studied and taught as a subject at medical school. It is a normal process of variable length but you can get stuck. If you think this might be the case please come and talk with one of us at the surgery.  We have a variety of different services we can direct you to: Laura our Social Prescriber is trained in grief counselling, Bryn our new Mental Health Practitioner is a new resource. There are also excellent nationally run telephone helplines: Marie Curie Charity (0800 090 2309) and Cruse Bereavement counselling (0808 808 1677).

Grief is hard work but is an essential process; you cannot avoid it. It is too simplistic to think that you can pass through it.  Grief will always remain, however, with sharing and support from others life will build again around it.

Anthony O’Brien

Wyndham House Surgery

“The Richards Trust” Reg No 306787

Nearly 300 years ago, John Richards, a merchant from London, who had been born in the Parish of Silverton left £1200 to build and endow a boys school in the village. To this day his legacy still survives. It has changed from its original vision of building a boys school, to supporting all young people under the age of 25 years for their education and development.
Although the education system has changed dramatically since the 18th century, the charity is still here to help those in need of financial assistance. The charity can help with the costs of all sorts of educational development ranging from preschool, to university and apprenticeships. As well as social and physical development such as sports, music, clubs, cost of travel and equipment.
There are so many ways which the charity can help.
All applications are treated in the strictest confidence.
Applicants need to normally be resident in the Parish of Silverton.
To download an application form click on the link HERE.

The Government have announced plans for the season and those who will be eligible i.e. those over 65, those aged 18 to 64 at high risk and finally, those aged 50 to 64 not at high risk. For both vaccines we will be targeting the over 65 and ‘at risk’ groups first, followed by the over 50 lower risk later.

We will be delivering Covid and Flu vaccines concurrently but not at the same clinics. If you are contacted with a date please note clearly what the vaccine is that you are booked for. As in previous years we will be contacting people by e-mail and/or text giving a slot on a given day to attend the surgery. If not available you can attend in a different slot for the same vaccine.

People in England who have been fully vaccinated against COVID-19 can use the NHS COVID Pass to demonstrate their COVID-19 status.

If you’re aged 18 or over, you can get an NHS COVID Pass for domestic venues and events.

If you’re aged 16 or over you can get an NHS COVID Pass for travel abroad but you should follow the entry requirements of the country you are travelling to.

A full course is currently two doses of the Moderna, AstraZeneca or Pfizer vaccine, or one dose of the Janssen single-dose vaccine. Vaccine status will be available through the NHS COVID Pass service from:

• the NHS App which you can download from app stores
• the NHS website
• 119 – by requesting a paper letter

You will need to register to use the online services, if you have not already. It may take more than a week for your identity to be checked and verified.

If you cannot access the online services, and you have had both doses of the vaccine, you can request a paper letter from the NHS by calling 119. Only call 119 if you are due to travel outside the UK in the near future and have had your second dose (or one dose of the Janssen single-dose vaccine) more than 5 working days ago. It may take up to 5 working days for the letter to arrive.

This practice is not able to provide you with a letter that shows your COVID-19 vaccination status. Please do not contact the practice about your COVID-19 vaccination status unless you have been advised to by the 119 service.

When you’re planning your travel, you should check the latest information on demonstrating your COVID-19 status when travelling abroad on the gov.uk website. Make sure there is enough time to get proof of your COVID-19 vaccination status before you are due to travel.

Autumn Actions

Normally at this time of year I write an article about the value of vaccination and encourage patients to come for their Flu vaccine.  As a result of the pandemic, I no longer feel the need to explain the enormous value of vaccines. However, I do need to double down on my plea for everyone eligible to have two vaccines this autumn.

The Flu vaccine is probably more important than it has been for many years.  We have experienced very little influenza in the last 2 years and this means we lack some of our inherent immunity.  The strategy in the pandemic was all about protecting hospitals so that they were able to admit those who were seriously ill with Covid as well as sick patients with other conditions.  At the moment our hospitals find themselves under immense pressure with a reduction in the number of beds available, ambulances having difficulties getting patients in, and community health and social care services facing problems getting them out.  These pressures are currently most evident in West Devon however it would not take much to tip the balance in the East. Another Covid variant and/or an outbreak of flu presents a very serious risk. Hospitals would be under pressure greater than that seen during the pandemic. Be in no doubt, the health service faces a winter of trepidation.  On the plus side some of the protective behaviours we learnt have become ingrained.  We distance ourselves in queues and when we have upper respiratory infections, we are much better at reducing the risks of onward transmission.

Covid boosters and this year’s Flu vaccine will be offered from the surgery, initially to those over 65 years old and those with chronic disease.  When these are complete, those over 50 years old will be invited. We will be calling patients in cohorts via text and email (with letters to those who use neither of these).  All eligible patients will need to come twice. It will not matter in which order you have the vaccines; it just matters that you have both.  It is likely that our first Flu clinic will be at the end of September and that Covid clinics will run regularly on Wednesday afternoons. We are, however, dependent on when central supplies are delivered.

So, three important actions for this Autumn. One, get a flu vaccine – those eligible from the surgery, and others from a pharmacy.  Two, come when called for your Covid booster and three, please ensure the surgery has your up-to-date contact details.

Anthony O’Brien

Wyndham House Surgery