Medical Services & Clinics – Rush Hill and Weston Surgery

Asthma

Routine annual asthma checks are performed by the nurses. It is important to monitor asthma control regularly as poorly controlled asthma can cause severe health problems.

What is asthma?

Asthma is a common condition of the airways. Different triggers (e.g. infections, allergies, exercise) can cause narrowing of the airways. It presents with wheeze, cough, chest tightness and shortness of breath. It cannot be cured but with treatment symptoms can usually be well controlled.

Why do people get asthma?

Asthma is caused by inflammation in the airways. What starts the inflammatory process is not always clear. Often asthma starts in childhood and there may be a family history, but asthma could start at any age. At least 1 in 10 children and 1 in 20 adults have asthma.

However, we know that smoking, exercise, allergies, fumes and even emotions can make asthma worse. Dietary factors do not appear to play a major role in the control of asthma.

How is asthma diagnosed?

To make the correct diagnosis is very important but is not always straightforward.

Occasionally it is possible to make the diagnosis based on the presence of the typical symptoms. However sometimes further breathing tests including the use of a peak-flow meter to record a variation of the airflow is helpful. In some cases a further breathing test called spirometry can be necessary.

How is asthma treated?

For most people with treatment their asthma will not interfere with their normal activities of life and they will be able to exercise without problems. The main treatment is an inhaler. There are different types and the treatment needs to be tailored to everyone’s need.

The 2 main types of inhalers are:

Reliever:

These inhalers are taken as needed. They work almost immediately and will relieve the symptoms within minutes.
For some people this may be the only required treatment. If they have to be used very frequently this may indicate that
the asthma may require treatment with a preventer inhaler to improve the asthma control.

Preventer:

These inhalers are taken regularly and should prevent asthma symptoms. There are 2 main types:

Steroid inhalers reduce the inflammation of the airways – the mechanism at the heart of asthma. Their use is very safe and should not cause any health problems. They need to be taken regularly and should form the mainstay of most asthma treatments. However, they are not suited for the treatment of an acute problem.

Long acting bronchodilators are sometimes used in combination with a steroid inhaler. These medicines act similarly to a reliever but their action lasts for approximately 12 hours.

Occasionally people require additional treatment with tablets but overall this is not very common.

Does asthma go away?

There is no cure for asthma but approximately 50% of children with asthma will ‘grow out of it’ by the time they are adults.

For some adults their symptoms can be quite seasonal and may be worse due to cold air in winter or high pollen count in summer, which means that for the rest of the year they may not need any treatment.

For further information on asthma please visit the Asthma UK website.

Cervical smears

All women between the age of 20 and 65 should have a regular smear test every three to five years. We send out appointment reminders to all of our patients to let you know when your next smear is due.

Child development

We send out appointments for regular checks and immunisations for pre-school children. This is to make sure that our doctors and health visitors can check that children are developing normally and that there’s nothing to worry about.

Child health & child immunisations

Health Visitors

In BANES, the health visitors work in locality based teams where they offer help and advice about the wellbeing of your children. Their services range from the initial visit at home after your baby is born to comprehensive health promotion.

Our health visitors are based in the St Martin’s Childrens Centre hub and they may be able to help with many common childhood complaints including e.g. sleeping, eating problems. If you have any special needs their experience can prove invaluable in accessing support.

The health visiting team y run clinics from St Martin’s Children’s Centre, Weston Children’s Centre as well as Rush Hill & Weston Surgery.

Child Immunisations

Our Practice Nurses carry out the childhood immunisation programme.

We will contact you to arrange an appointment for your child to come in for their immunisations.

Childhood immunisations are vitally important for your child. If you have any queries about the immunisations programme, please do not hesistate to contact one of the Practice Nurses or your GP.

Please see the NHS website for more information on childhood vaccinations: www.nhs.uk

Complementary medicine

Physiotherapy

NHS Physiotherapy is available at Rush Hill Surgery (for all our patients), as well as at St Martin’s Hospital and the Royal United Hospital. Your GP will advise if they feel a course of physiotherapy would be beneficial to you and refer you appropriately.

Private Muscular Skeletal Service

We are pleased to welcome ‘The Medical’ to Rush Hill Surgery. ‘The Medical’ provide a range of Muscular Skeletal Services including physiotherapy, osteopathy, massage and chiropractic treatment.

More information is available online.

Apps

NHS Choices provide a range of interactive apps and widgets to help you look after your health. to view these apps please visit the NHS website: www.nhs.uk

Contraceptive services

Our doctors and nurses give confidential advice on all aspects of family planning, including coil fitting and emergency contraception.

Counsellors and advice services

Find out about local counsellors and advice services. You can access these services by speaking to your GP or the surgery’s receptionist.

Diabetes

Regular check-ups are very important to prevent complications of diabetes. These consist of regular blood tests, blood pressure check and an extensive annual check by the practice nurse.

What is diabetes?

Diabetes presents with raised blood sugar concentrations. There are 2 distinct diseases:

Type I diabetes:
This type of diabetes, also called ‘juvenile’ diabetes, affects children and young adults. It is caused by an inability of the body to make insulin. Treatment is with Insulin injections and a healthy diet.

Type II diabetes:
This usually presents in people over the age of 40. Due to many factors the insulin produced by the body is not used properly and/or is not made in sufficient quantities. It is also called Non-Insulin Dependent Diabetes and is more common in overweight people. Initially the main aim is to lose weight which can correct most of the symptoms. Later tablets and even Insulin may need to be added to a diabetic diet.

How is diabetes diagnosed?

Both types of diabetes present with thirst and passing large quantities of urine, fatigue and weight loss. In type I diabetes the onset of these symptoms can be very rapid. Usually these symptoms can develop gradually over months and even years.

The diagnosis is confirmed with a blood test that reveals raised sugar levels, but urine tests can also be helpful.

What are the possible complications of diabetes?

The immediate danger of mainly type I diabetes is from very high blood sugar levels that can develop quite quickly. They can cause severe dehydration and drowsiness and can be life-threatening.

In type II diabetes raised blood sugar levels usually develop only slowly but if left untreated can also result in a serious acute illness.

Long term complication:
In both types of diabetes the permanently raised blood sugar levels will gradually damage small and large blood vessels over many years. This can result in:

Heart disease e.g. heart attacks
Kidney damage
Eye problems leading to blindness
Nerve damage resulting in numbness, paralysis or pain
Foot problems
Impotence

Good control of blood sugar with diet and medication can help to prevent some of these problems. It is also very important to check for other problems in particular for high blood pressure. Dealing with this can reduce these problems significantly.

How is diabetes treated?

Type I diabetes is always treated with Insulin and a healthy diet.

For many overweight people with type II diabetes the emphasis is on losing weight. This can initially improve or even normalise the blood sugar levels. Later, treatment with tablets that improve the way Insulin works will be used and sometimes tablets that will stimulate your body to produce more Insulin. Over time type II diabetes will gradually get worse and treatment will need to be adjusted. Eventually many people will need treatment with Insulin injections.

A suitable diabetic diet should always be at the heart of any treatment.

What are the goals of treatment?

These treatment goals apply to both forms of diabetes:

To normalise blood sugar levels with diet or medication. This will improve wellbeing considerably and will also educe the risk of late complications.
To reduce other risk factors e.g. high blood pressure or high blood cholesterol levels in order to prevent late complications.
To detect the onset of complications as early as possible. Treatment for complications can stop them from getting worse.

For further information please visit:

Diabetes Leaflets:

For information on BaNES Diabetes Wellbeing website to provide support and advice for those living with Type 2 Diabetes in Bath and North East Somerset please visit:-

www.diabeteswellbeing.org

Ear wax

Ear Wax

Ear wax is normal it provides protection for your ears
Your ears are self-cleaning
The movement of your jaw while eating and talking moves the wax along the canal
Ear wax only becomes a problem if it causes deafness, pain or if a health professional
needs a clear view of the ear drum

What makes ear wax worse?

The amount of wax produced varies from person to person
Some people produce excessive amounts of wax and this can block the ear canal
Wearing a hearing aid, ear plugs and or head phones can interfere with wax expulsion
Narrow and or hairy ear canals
If you are elderly – the wax produced may be harder and drier
Dry skin in people who suffer with eczema or psoriasis

What you shouldn’t do

Use cotton buds to clean the ear. This forces the wax deeper into the canal and can cause damage, trauma and possible infection
Do not use objects such as matches, hair grips, crochet hooks, knitting needles, keys etc. this can cause trauma and possible infection
If your ears are itchy do not scratch or rub them with your finger nails or any other objects
Do not use anything smaller than your elbow in your ear!!

What helps?

Try and keep your ears dry. When washing your hair, showering or swimming putting some Vaseline around the inner part of your ear can help
Don’t put your head under the water when bathing
If you regularly get blocked years, use olive oil drops weekly

When to see the GP or Advanced Nurse Practitioner

If you are experiencing the following symptoms:

Pain
Discharge or bleeding from the ear
Sudden deafness
Dizziness
Foreign bodies (you may be advised to attend A&E)

What you can do to manage the problem?

If you are not experiencing any of the symptoms on the previous page, the following is recommended:
Olive Oil Drops – The following needs to be done 2 -3 times daily for 14 days.

Lie on your side with the affected ear uppermost
Pull the outer ear gently backwards and upwards to straighten the ear canal
Put 2 -3 drops of olive oil into the affected ear(s) and gently massage just in front of the ear
Stay lying on your side for 10 minutes to allow the wax to soak up the oil.
Afterwards, wipe away any excess oil but do not plug your ear with cotton wool as this simply absorbs the oil
Your hearing problem may initially worsen after first starting to use the olive oil drops; this is why you are advise d to concentrate on treating one ear at a time if both ears are blocked with wax.
In most cases, after 14 days, the wax will have softened sufficiently to encourage the wax to come out without further intervention.
However, if you feel your hearing is still impaired, please make an appointment with the practice nurse for further advice and management.

Alternatively

There are now a number of over-the -counter kits available from pharmacies. These contain a wax softener as drops which you use for 3 -4 days and a small bulb syringe to enable you to remove the wax from your ear canals yourself. They can easily be purchased from your pharmacy or online by searching for ‘ear bulb syringe’ e.g. aculife bulb ear syringe, otex express combi pack or macks wax away earwax removal system for examples.

The specially designed ear syringes are designed to create enough pressure to clear wax out of the ear without causing damage to the ear drum. It is very important to use hand -temperature, tepid body temperature water for this process having used olive oil or the drops in the previous days. Prolonged use of the drops in the over-the-counter preparations other than olive oil can cause irritation and soreness and should not be used for more than a few days at a time.

Family planning

All doctors at the Rush Hill and Weston surgery offer a complete and confidential family planning advice service. We are happy to discuss any related issues and we can advise you on the best contraception to suit your circumstances.

All contraception is free through the National Health Service.

Methods of contraception

The combined oral contraceptive pill

This is the most commonly used type of contraception. The ‘pill’ is a combination of an oestrogen and progesterone hormone. It is very safe; if taken properly less than 1 in 100 women will get pregnant in 1 year.

It does not suit every woman. After the age of 35 it should only be used by non-smokers and every woman needs to have her blood pressure checked.

If you suffer from diarrhoea and vomiting it may not work properly, also check with your doctor that it agrees with any other medicine you take.

The contraceptive injection (‘depot’)

With this method women will need an injection every 12 weeks. Less than 1 woman in 100 will get pregnant in 1 year.

With the injection you don’t have to think about contraception for the duration of the injection.

It can cause absent, irregular or long periods and it can take several months for your normal fertility to get back to normal.

All GP’s at surgery offer this service.

Long Acting Reversibile Contraception

The intrauterine device and system (‘the coil’)With these methods a small plastic or copper device is inserted into the womb by a doctor. Both methods are very safe with less than 1 woman in 100 getting pregnant over 1 year.

They can stay in for 3-10 years dependent on the type and provide contraception for the whole time.

There is a small chance of infection and with some types periods may be heavier than before.

Dr Jacobs and Dr Parish are trained and very experienced at fitting coils. Prior to booking an appointment for a coil fitting, you need to discuss this option with your usual GP and sign a consent form agreeing to the procedure.

We have designated appointments for coil fittings, so please book such an appointment directly via Reception:

Rush Hill: 01225 446087
Weston: 01225 446089

Contraceptive Implant

The contraceptive implant is a small flexible tube about 40mm long that’s inserted under the skin of your upper arm.

It’s inserted by a trained professional, such as a doctor, and lasts for three years.

Dr Oertel and Dr Parish are very experienced at fitting contraceptive implants. Prior to booking an appointment for an implant fitting, you need to discuss this option with your usual GP and sign a consent form agreeing to the procedure.

For more information on contraceptive implants, please visit the NHS website: www.nhs.uk

We have designated appointments for implant fittings, so please book such an appointment directly via Reception:

Rush Hill: 01225 446087
Weston: 01225 446089

Emergency contraception

If you have had sex without using contraception there are 2 methods to prevent pregnancy:

Emergency contraception tablets can be taken up to 72 hours after sex, but the earlier you take them the more reliable they are.

The coil can be fitted after unprotected intercourse for up to 5 days.

Health screening

We offer a wide range of health screening for men and women at our surgery.

Heart disease

Doctors and nurses are looking after people with heart disease to provide best current medical care.

However we also emphasise the need to adjust your lifestyle to prevent heart disease altogether, as we know that regular exercise, not smoking, a normal weight and healthy eating can help to reduce the risk of heart disease.

The term ‘heart disease’ usually means ‘coronary heart disease’ and refers to problems that are caused by narrowing of the blood vessels of the heart (‘coronary arteries’). This can lead to angina, heart attacks, heart failure and also to strokes if the narrowing affects the blood vessels of the brain.

For anyone with high blood pressure, diabetes, heart disease an annual check-up is important to improve health and reduce further risk. The surgery will inform you about your forthcoming appointment.

Risk Factors

Everybody can get heart disease but certain risk factors increase the risk of developing heart disease. These include:

High blood pressure
Diabetes
Smoking
Lack of exercise
Raised cholesterol
An unhealthy diet
Obesity
A strong family history of heart disease

Some of these risk factors cannot be changed; it is therefore even more important to address other risk factors.

Over time these can lead to narrowing of the blood vessels via the formation of fatty patches or ‘plaques’ that can reduce the blood supply to the heart. This can cause angina or a heart attack (‘myocardial infarct’).

Angina

Angina is a pain usually across the chest on exertion. It will normally disappear within 10 minutes when you are resting. Taking GTN Spray can sometimes stop it within 1-2 minutes.
Angina is usually identified through the history but a heart tracing (‘ECG’) and blood tests can be helpful.

Treatment is aimed at reducing the frequency of angina. Several medicines can be helpful e.g. b-blockers.

It is also important to reduce the ‘stickiness’ of blood platelets with Aspirin and lower cholesterol levels if they are raised.

Myocardial infarction

A heart attack is usually caused by a complete blockage of a coronary artery. This leads to severe central chest pain which can travel to the jaw or left arm. This is an emergency and requires immediate hospital admission.

If you suspect you are having a heart attack call 999 immediately.Clot busting drugs are given to open the blocked blood vessel up in hospital. Further treatment with medicines is also necessary. There are further techniques that can help to improve the blood supply to the heart that may be used.

The long term risks of heart attacks are heart failure due to a damaged heart and further heart attacks.

Hypertension

Hypertension means that the pressure inside your arteries (blood vessels) is too high. This can cause hardening of the arteries and result in heart attacks and strokes. For anyone with high blood pressure we offer regular checks by nurses and doctors to make sure that the risk of complications is minimised.

How is blood pressure measured?

Blood pressure is measured with a ‘sphygmomanometer’ which gives a reading in the form of 140/85 mmHg (140 over 85), it is measured in millimetres of mercury.

The first reading – the systolic blood pressure – reflects the blood pressure in the blood vessels when the heart contracts.

The second reading – the diastolic blood pressure – is the pressure when the heart rests between beats.

What is a high blood pressure reading?

This is a controversial issue but at present it appears that blood pressures that are persistently over 150/90 can cause health problems. For people with other medical problems, in particular diabetes, the blood pressure should even be below 130/80.

How is Hypertension diagnosed?

The diagnosis of hypertension is usually made when repeated blood pressure readings show persistently raised readings.

Occasionally readings taken from a home blood pressure monitor can be helpful and in some cases the doctor may want to request a 24-hour blood pressure monitoring with a portable machine.

Why is high blood pressure a problem?

People with high blood pressure rarely complain about acute symptoms. However over years the raised pressure damages blood vessels and can cause heart disease, strokes, dementia and kidney damage.

Other risk factors that can increase the risk of developing these conditions are:

Smoking
Obesity
Diabetes
High cholesterol levels
Excess alcohol intake
Lack of exercise

It is therefore of particular importance to address all of these factors simultaneously.

How is high blood pressure treated?

With only marginally raised blood pressure sometimes lifestyle changes are all that is required.

However many people do have to take medication regularly to lower the blood pressure. It is common to take 2 or more medicines to lower the blood pressure. These medicines usually need to be taken for life.

Mammograms

Women aged between 50 and 60 are advised to attend the Breast Screening Unit every three years for a mammography. This is to make sure we can check and detect any abnormalities as soon as possible. These appointments are sent out by the local Breast Unit.

Maternity care

Our antenatal and postnatal clinics are held at our surgery by our doctors and midwives.

Smoking cessation

Stopping smoking can make a big difference to your health. Please make an appointment with the practice nurse if you would like to stop, but find it difficult. Our practice nurses are very experienced at supporting patients in stopping smoking.

Why is smoking so bad?

Smoking is the greatest single cause of illness and premature death in the UK.

Over 100.000 people die of smoking related causes every year in the UK. Most of these deaths are due to heart disease, lung cancer and chronic obstructive airways disease (COPD, chronic bronchitis, emphysema).

About half of all smokers die from a smoking related illness. On average their life expectancy is reduced by 8-12 years compared with non-smokers.

Not all smoking related illnesses result in ‘quick deaths’, some of them e.g. COPD result in years to decades of severe disabling symptoms like breathlessness.

The health benefits of quitting start almost straight away. The earlier in life you stop the bigger are the benefits, however it is never to late to stop. Even with established heart or lung disease people will benefit from stopping.

The following websites can give you information and support:

Travel advice, vaccinations and immunisations

We offer routine vaccinations and general advice to our patients travelling abroad.

It may take up to eight weeks for a full course of vaccinations, so please contact us in advance to give you plenty of time if you’re planning to go abroad where you need to be vaccinated.

Non-NHS services

Some services available are not covered under our contract with the NHS. This means that these services need to be paid for.

The services that include charges are: