Dr Tickle moving to 88 Harley Street

The last few years have been a particularly challenging time across all business sectors, but the medical profession has been especially affected by the pandemic and the associated health-based protective measures. This has been an opportunity to take pause, and to consider what is best for my patients and for the practice going forward.

I am therefore excited to welcome you to my new offices at 88 Harley Street, part of The Harley Street Clinic, from 9 May 2023. My rooms are calm and welcoming, and I will be ably assisted by Lisa Kearey, a dedicated and very experienced medical secretary, who will settle us all into my new practice.

Alongside the change in location, my new relationship with leading private healthcare group HCA Healthcare provides comprehensive levels of support and allows me to offer an improved and more efficient service to all of my patients. The return of the practice to Harley Street, where it belongs, is an excellent opportunity for patients to book a medical review, to update any change of address details, medications, or altered medical circumstances.

I’m also excited to re-establish the following electronic and remote services:

  • Remote booking for which we have a link
  • Pre-payment and electronic payments – more details to follow soon
  • Secure prescription requests – more details to follow soon.

Dr Tickle at 88 Harley Street

The new premises is a Grade II* listed building which provides the clinic with a comfortable and welcoming space and all requisite facilities.

Patient Reception is located on the Ground Floor and is manned by HCA Reception Staff who will assist in the completion of any required paperwork.

My clinic is located on the third floor, and there is a lift within the building for ease of access, the premises is also wheelchair accessible.

As always, it’s a privilege to be of service. Call when you need to and see you soon.

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Monkeypox – now a Global Public Health Emergency: Should we be worried?

While we are still learning if we can live with Covid-19, another new illness has emerged and is spreading throughout our communities. Monkeypox is here, and although there is some information out there, much is inaccurate or not clearly explained, so we know why this is of concern. I fear the lessons from the ongoing SARS-2 pandemic on early information sharing, thus enabling people to take care of themselves by educating the population, have not been learned.

The WHO has now classified the infection as a Public Health Emergency of International Concern, which suggests this infection is likely going to spread worldwide and potentially become a new pandemic. How worried should we be?

When and where?

Monkeypox was identified in the UK during May 2022 and is also seen throughout much of Europe and the Americas, with cases as far afield as Australia. There are now over 16,000 cases worldwide, and deaths have been reported in Brazil and India.

What is Monkeypox?

Monkeypox is a virus of the smallpox family that primarily affects monkeys and other small mammals. It is endemic in West-Central Africa, particularly in Nigeria. An endemic infection is one which exists in the community, much as the common cold or chickenpox are endemic in Europe.

What does it cause?

The virus causes severe muscular pains, fever, enlarged and extremely tender lymph nodes, followed a few days later by a pimply, then blistering rash which leaves noticeable scars. The rash is like a very severe chickenpox rash, although, unlike chickenpox, all the spots come at the same time. The spots are round, with a slight depression in the centre. They form blisters, then burst and then scab over, which takes up to four weeks.

The illness is usually self-limiting, meaning that most affected persons recover without treatments, but it has a quoted fatality rate of up to 6% in this outbreak.

How does it spread?

Monkeypox is spread by close contact and droplet spread, so it can be caught from infected persons by:

  • respiratory droplets during prolonged face-to-face contact, e.g., talking and whispering
  • intimate physical contact, including kissing and sexual intercourse
  • directly touching the infectious rash or body fluids of an infected person
  • touching clothing, bedding, and other materials that have been in contact with an infected person’s rash or body fluids

If a person becomes infected with Monkeypox, the incubation period before they begin to show symptoms can be anything from 5 to 21 days. During this period, they can pass this infection to others by some of the mechanisms above.

Who?

The present contagion is mainly centred in the LGBTQIA community, as around 95% of identified cases have been in men who have sex with men.

HOWEVER, this is not a sexually transmitted disease. It will be dangerous and pejorative to classify this as an illness that only affects gay or bisexual men, as it will make it harder for people to know they have had exposure or to dismiss the infection as a possibility.

It is recommended that if you develop a fever and muscular achiness, with enlarged glands which are very tender, ideally you should isolate in case this is Monkeypox, as it can be passed on before spots arrive. If there are no spots after a week, then the illness was not Monkeypox. If spots appear, then a diagnosis can be made, and we then recommend isolation until the spots have all scabbed over, as you can no longer pass on the infection after they are dry.

So, in summary:

  • Monkeypox is a known illness that is usually seen in Africa, but which is now circulating more widely.
  • The death rate in this round of infection is around 6%.
  • The illness can take up to three weeks to develop after exposure
  • It can take up to a month to recover.
  • It is spread by touch and close contact, which includes sexual contact.
  • It is not aerosol airborne but can spread by exhaled droplets.
  • A vaccination is available via the NHS for persons exposed to confirmed cases.
  • Prevention is achieved by avoidance – masks and gloves if you cannot avoid contact with a case.
  • If you think you have Monkeypox, stay in until you are sure.
  • If you have proven exposure to Monkeypox, a vaccine is available to prevent severe infection.
  • Isolation period once illness has started is a week initially, as no rash = not Monkeypox.
  • If it is Monkeypox, then a full month at home is required.

For more advice, call 08000 483 330 to arrange a consultation with Dr Tickle.

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The value in having an ongoing relationship with your GP 

Recently, a Norwegian study has highlighted the importance of a continuous relationship between patient and doctor, improving the general level of care and potentially saving lives. This study’s timing is particularly interesting considering the prime minister’s announcement this week that family doctors would be at the forefront of the Omicron-beating booster drive, putting face-to-face GP appointments under yet more pressure.

The research, published in the British Journal of General Practice, found that individuals who have had the same GP for more than 15 years have a 25% lower risk of death than those patients seeing a new doctor in the first year. They also have a lower risk of needing to go to A&E or be hospitalised.

“GPs are specialists for their patients. It can make it easier to detect changes in the patient and avoid exposing them to unnecessary and dangerous examinations,” the study’s author Professor Hogne Sandvik commented.

The benefits of the ongoing GP and patient relationship

This recent research confirmed the findings of an earlier UK study. Researchers at the Exeter University medical school analysed data from nine countries with different health systems and found that people who saw the same doctor had significantly lower death rates.

Reasons for this are that they are more likely to follow medical advice, particularly concerning making necessary lifestyle changes, and access other preventative care such as immunisations.

Continuity of care means that a patient can feel more comfortable discussing problems or sharing very personal information. Your GP will be able to accumulate knowledge over time that allows them to shape their advice and treatment plans for the patient’s individual needs. They will also be best placed to identify any emerging health conditions or symptoms that are of concern.

To arrange an initial consultation with Dr Elaine Tickle, who only offers one-to-one attention, call us on 07788 797 824 or email us on [email protected].

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London stress levels rising post-lockdown

Big city living is stressful enough without the events of the last two years – some studies have found that city dwellers have a 21% greater chance of developing anxiety than their rural neighbours. However, a new study has found that almost seven in 10 Londoners feel overloaded with stress currently.  At the time of writing, now Omicron is surging and the media reports are rolling in, this will doubtless become higher.

Researchers from Censuswide, commissioned by Microsoft, surveyed 2,007 adults in the capital, with 66% reporting that their stress levels are higher since lockdown restrictions have eased.

Returning to office-based work after many months of WFH, has left 42% of people struggling to keep up with the demands on their life and almost three-quarters are “showing signs of unhealthy perfectionism”, according to the study.

Joshua Fletcher, a psychotherapist, said: “As restrictions have eased, there is a sense of optimism and excitement for the upcoming festivities and getting back to old routines.

“However, there is clearly an underlying anxiety rooted in productivity weighing in the background for many of us.”

Managing work stress

Anyone can feel work-related stress, even if you love your job. Short-term pressures such as an approaching deadline are usually manageable, but when stress becomes long-term, it can be harmful to your physical and emotional health.

The body’s in-built stress response – known as the ‘fight-of-flight response’ – stimulates the production of hormones cortisol and adrenaline. If you frequently produce large amounts of these hormones, it can have a negative effect on your health.

Physical and emotional symptoms of stress include:

  • Anxiety or irritability
  • Depression
  • Panic attacks
  • Chest pains
  • Racing heart
  • Joint aches and muscle tension
  • Insomnia leading to a continual feeling of exhaustion
  • Headaches and dizziness
  • High blood pressure
  • Stomach or digestive problems
  • Weakened immune system

Strategies for addressing chronic stress include tracking your stressors, developing healthy responses such as exercise or making time for your hobbies, building healthy sleep habits, and establishing work-life boundaries. For more advice on managing work stress, call 07788 797 824 to consult with London private doctor Elaine Tickle.

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Can’t fit into the jeans you wore at 21? You might be at risk of diabetes

Diabetes experts have warned that if you can no longer fit into the trousers you wore at 21, you may be at risk of developing diabetes – even if you’re not overweight.

UK researchers presented these concerning findings at the online annual meeting of the European Association for the Study of Diabetes. Professor Roy Taylor, of Newcastle University, and his team found that too much fat around the liver and pancreas caused the disease even in those who were at a healthy weight according to their BMI.

Professor Taylor said: “As a rule of thumb, your waist size should be the same now as when you were 21. If you can’t get into the same size trousers now, you are carrying too much fat and therefore at risk of developing type 2 diabetes, even if you aren’t overweight.”

The difference between type 1 and type 2 diabetes

The main difference between the two conditions is that type 1 diabetes is a genetic disorder where you do not produce enough insulin and is normally discovered earlier on in life. Type 2 diabetes means you don’t respond to insulin well and is largely diet and lifestyle related and develops over time.

Type 1 diabetics must take insulin every day to keep their blood sugar levels in a healthy range, but the good news is that the study confirmed that type 2 diabetes can be reversed by losing weight, even in those who weren’t obese.

Eight out of the study’s 12 participants had a normal BMI and type 2 diabetes and were able to reverse the condition by losing 10 to 15% of their normal body weight following a diet programme.

Dr Tickle believes strongly in the power of lifestyle medicine and is a member of the British Society of Lifestyle Medicine (BSLM): “I truly believe diabetes can be pushed into remission and this set of research pretty much nails that.”

When should you have a diabetes assessment?

More people than ever are at risk of diabetes, and it is estimated that by 2030 5.5 million people will have diabetes in the UK, with approximately 90% living with type 2 diabetes.

Pandemic weight gain is a very real issue for many of us. Dr Tickle explains: “If you have gained more than 10% of your body weight or over 10kg during last 12 to 18 months, a diabetes assessment is recommended – many of these persons will have drifted into diabetes.”

“If you have a family history of diabetes and/or diabetes in pregnancy, you should also be assessed. I recommend five years before the age of diabetes onset in any close relatives and five years after pregnancy, if you developed gestational diabetes, even if the condition resolved itself after you gave birth.

“If you already have high BP, high cholesterol, high uric acid levels, then annual check on fasted insulin is very useful to see if you are heading off towards diabetes.”

As well as diabetes assessments, Dr Tickle offers Libre sensors to patients, a flash glucose monitoring system that measures your sugar levels throughout the day. The system is composted a small sensor your stick to your arm and a reader to scan the sensor. You can also use a smartphone app to scan the sensor.

The sensors usually last for 14 days and can be invaluable information about your condition and whether you need to make any lifestyle changes or look at treatment options. “We offer Libre sensors to all the patients so they can start to see what their blood sugars are doing. This is such a helpful step and makes a huge difference to motivation.”

For more advice on preventing or treating diabetes, call us on 07788 797 824 to arrange a consultation with Dr Tickle.

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Movember puts the spotlight on prostate health 

Every November, men are encouraged ‘grow a mo to save a bro’ as the Movember charity initiative raises awareness of men’s health. Initially focused on prostate cancer, the charity has expanded its focus to cover a whole host of health issues that men find difficult to talk about openly.

One ‘unspoken’ health issue that affects millions of men over the age of 50 is an enlarged prostate. If you find yourself experiencing sleepless nights due to frequent trips to the bathroom, then you may be suffering from benign prostatic hyperplasia or BPH. Read on to discover other indicators you might have BPH and your treatment options…

What is BPH?

BPH is a benign enlargement of the prostate and one of the chief symptoms is a frequent urge to urinate. Many men just ascribe this to the ageing process, but this is a condition that can be treated and, if left undiagnosed, could result in permanent bladder damage.

While BPH is a benign condition and not related to prostate cancer, it can have a significant impact on quality of life. In one recent survey, 82% of men reported that they woke up at least once a night to urinate on a regular basis. Sixty-four per cent of the women surveyed responded that their sleep patterns were also affected by their partner’s condition.

Symptoms of an enlarged prostate

The prostate is a gland that is usually the size and shape of a walnut and is found underneath the bladder and surrounding the urethra, the tube through which men urinate and ejaculate. The prostate’s main job is to make semen.

An enlarged prostate is very common over the age of 50 and although not all men will experience symptoms, this is what you can expect:

  • Frequent need to urinate, particularly at night
  • Sudden urge to urinate
  • Difficulty starting to urinate
  • Weak flow when you do urinate
  • Stop and start flow
  • Dribbling urine afterwards
  • Sensation that your bladder hasn’t emptied properly

Less rare signs include:

  • Blood in the urine may be a symptom but is rare and can be a sign of something more serious
  • Urinary tract infections
  • Urinary incontinence
  • Inability to urinate, known as urine retention, which can result in bladder and kidney problems such as painful bladder stones

Diagnosing an enlarged prostate

The first step will be to discuss your symptoms. Dr Tickle will ask about your symptoms, how long you’ve been experiencing them and how they are affecting your life. You may want to record a diary prior to your appointment.

Dr Tickle will rule out other health issues, such as diabetes, and lifestyle factors. Certain medications, such as blood pressure medicines or anti-depressants, may cause similar symptoms.

A urine sample may be taken to check for infections. A prostate specific antigen (PSA) test can check whether you have raised PSA levels that could indicate a problem with your prostate. An enlarged prostate, urine infections and prostate cancer can all make your PSA level rise. A physical examination of your abdomen and rectum may be performed.

Dr Tickle may refer you to a urology specialist for further tests including a urine flow test, ultrasound scan of the bladder or kidneys, bladder pressure test, or a flexible cystoscopy to check for any blockages.

What are my treatment options for enlarged prostate?

There are three main treatment options for enlarged prostate:

Lifestyle changes: simple lifestyle changes can improve symptoms, so they are not affecting your quality of life. This can include drinking less alcohol, caffeine or fizzy drinks which can irritate the bladder. Regular exercise may also alleviate your symptoms and can also help you lose weight as being obese can worsen symptoms.

Medicines: if lifestyle changes fail to control your symptoms, certain medicines can treat an enlarged prostate. The main ones are alpha-blockers and 5-alpha-reductase inhibitors. These medicines do have side effects, though, which Dr Tickle will discuss with you in full.

Surgery: surgical intervention may be an option if your symptoms don’t improve with lifestyle changes or medicines, or if your symptoms are severe. The main types of surgery for enlarged prostate are transurethral resection of the prostate (TURP), laser surgery and a prostatic urethral lift.

FIND OUT MORE

If you’re concerned you may have an enlarged prostate that is affecting your quality of life, don’t think it’s just one of things you have to put up with as you get older. Call 07788 797 824 to arrange a consultation with Dr Tickle.

 

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How to live a bone healthy lifestyle during menopause

Every October, a spotlight is shone on the menopause and peri-menopause and the focus for 2021’s World Menopause Day is bone health.

Bone is living tissue with its own blood and nerve supply and healthy bone renews itself continually. The amount of bone tissue you have can be measured and this gives us a bone mineral density score.  From your late 30s, this will naturally start to decrease, eventually making your bones weaker and more susceptible to fracture. Women’s bone density reduces more quickly after menopause, as low or no oestrogen leads to reduced rates of new bone cell formation.

Oestrogen is an important hormone for maintaining bone density, and reduced oestrogen levels result in old bone cells breaking down faster than the body can grow new bone tissue. The average decrease in bone mass density during the menopausal transition is estimated to be 10% and this can mean that some women are losing even rapidly, perhaps as much as 20%.

Why does bone health matter?

Our bones support us and help us to keep moving. They protect our brain, heart, lungs, and other organs from serious injury. They contain bone marrow that grows blood cells, and they store important minerals, such as calcium and phosphorous, which can be utilised by our body when we need them.

Osteoporosis, the progressive condition whereby our bones become more fragile and less dense, is thought to affect around 3 million people in the UK. More women than men are affected, in a ratio of 4:1.  One in two women over the age of 50 will break a bone at some stage in their lives.

To support this year’s focus on bone health, the International Menopause Society commissioned two leading experts in osteoporosis and the menopause to propose practical management strategies.

Entitled ‘Update on bone health: the International Menopause Society White Paper 2021’ written by T. J. de Villiersa and S. R. Goldstein, part of the focus was on bone-friendly lifestyle measures.

This includes “optimization of calcium and vitamin D status, appropriate exercise, cessation of tobacco smoking and the abuse of alcohol, and the avoidance of bone-toxic medication.

“The IMS recommends that menopausal hormone therapy (MHT) be considered in women at risk of fracture before the age of 60 or within 10 years after menopause. This recommendation is based on the risk reduction seen in all fractures in the Women’s Health Initiative study and a favourable benefit/risk ratio in the younger woman.”

How to boost bone health during the menopause?

Dr Tickle can advise you on how to adopt a bone-friendly lifestyle during this period of transition and beyond. This can include the following:

  • Exercise can help alleviate many menopause symptoms and strength training in particular is highly beneficial for promoting bone density. Numerous studies have shown that it can not only slow down bone loss but even help to rebuild bones
  • Optimise your dietary intake of calcium by eating foods such dairy products and green leafy vegetables
  • Check your vitamin D levels, as a vitamin D deficiency can be addressed with supplements
  • Avoid smoking as it slows down the bone renewal process – the good news is that the moment you give up smoking, your risk of fracture begins to return to normal
  • Limit alcohol consumption as this also reduces the rate of bone renewal.
  • Consider reduction of caffeine intake as this reduces the body’s ability to absorb calcium.

HRT can also be highly beneficial for women for this reason. “Hormone Replacement Therapy is highly protective of bone health,” Dr Tickle explains. “The rate of bone loss is significantly reduced if you are on oestrogen, and as we’re living longer and more active lives this can have profound consequences.”

For more advice on HRT or non-hormonal approaches to maintaining bone health, call us on 08000 483 330 to arrange a consultation with Dr Tickle.

For more information on how to improve dietary calcium intake, use one of these guides to help yourself make better choices.

Osteoporosis Foundation Calcium Calculator
University of Edinburgh Calcium Calculator
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Teenagers to be ‘offered’ vaccine in bid to reduce further disruption to education

The UK’s four chief medical officers have decided that children aged between 12 and 15 should be offered COVID vaccinations, it was announced yesterday. In an attempt to minimise any further disruption to their education, all children in this age group will be offered their first Pfizer jab through in-school vaccination services.

This contradicts the advice of the Joint Committee on Vaccination and Immunisation (JCVI) that ruled that while the health gains did outweigh the risks, the “margin of benefit is considered too small” to support the decision. Unlike adults and older teens, though, this age group will not receive their second vaccination eight weeks later. A second injection may potentially be given in the spring term, but it has been deemed necessary to gather more information about the possible health risks.

In a move that is bound to concern some parents, children can overrule parental consent and receive the jab if they are considered ‘competent to make that decision. So, is it safe for younger teenagers to receive the COVID vaccine?

This is a question that Dr Elaine Tickle has been asked often by her patients with younger children. “I think this is a hard decision. The noise about vaccines not being adequately tested is bothersome, but largely pseudoscience. The issue about children being barely affected by COVID is relevant but should not be our only criteria in this decision.”

The main issues in vaccinating children

With all schools and colleges now back in full education, it is inevitable that there will be an increase in COVID infections. “We know that adolescents are spreading COVID around their communities,” Elaine explains. “It is also clear that the vaccination significantly reduces the risk of transmission. It is not surprising that this decision has been wrested from us parents, as the government has obviously found the figures too big not to push for this.”

However, there are concerns which Dr Tickle puts into context for her patients:

  • risk of clots – this is smaller than advertised and at least one factor of magnitude less than the rate of clots from catching COVID.
  • risk of an untoward immune response – after several million doses given, this does not seem to be an issue.
  • consideration on fertility – there is no data support this concern and some to refute it, in that conceptions have occurred between two vaccinated persons without any obvious difficulties. “Of course, we are quickly into the philosophy of science 101 on this, as proving something is not there is tricky. By the time data accrues, will we be in trouble? I would say not that likely, as pathologically and physiologically implausible constructs.”

“The killer question though: am I vaccinating my kids? Yes, as soon as we are allowed. My daughter had COVID when she was aged 10 and it has taken her 15 months to return to usual lung function and she has mild asthma. My fear for her is that further infection would further affect her lungs.” Teenagers to be ‘offered’ vaccine

For more advice on teenagers to be ‘offered’ vaccine or any child healthcare issue get in touch, call us on 08000 483 330 to arrange a consultation with Dr Tickle.

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Dr Tickle moves to London Medical

We are delighted to announce that Dr Tickle has moved to London Medical, London’s premier multi-disciplinary clinic, located on Marylebone High Street. London Medical regularly wins awards for its outstanding patient care and excellence as a diagnostic clinic.

For many years Dr Tickle has been referring her patients to specialists based at London Medical, so it makes good sense to locate the practice right in the heart of a clinic with so many consultants, all experts in their fields. The coverage is especially focussed on common medical problems, so suits a General Medical Practice more closely than a centre based on surgical specialities, like LDC.

We can refer to specialist consultants in the following fields:

  • Cardiology
  • Diabetes and Endocrinology
  • General Medicine including gastroenterology and respiratory
  • Gynaecology
  • Clinical Psychology
  • Dietetics and Nutrition
  • Click here for the full list of specialist consultants

Additionally, there is an onsite pharmacist, for all your medication needs. Blood tests, ECG services, including exercise ECGs, which are only required for some specialised occupational medicals, are on site. We have a large eye examination suite and the nursing team are superb, so we know you will be very well looked after.

You can find out more about the clinic in this video:

Dr Tickle at London Medical

At London Medical you will be helped by a team of medical secretaries, who work 8am to 8pm. You can reach them on the same number you use now; 07788797824.

Best wishes,
Dr Elaine Tickle

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Health – how I can help you

No matter who you are, what you are doing or where you are going, without a reasonable quality of health it will be much harder.

After more than 20 years in medical practice, I truly believe that we can achieve better health and become our best selves with just a little knowledge, nudging and effort. When I practise medicine, I aim to guide you to this good place.

Ideally, we would all enjoy excellent health… all of the time.

However, life is not predictable and we don’t always get what we want. Sometimes illness or injury hits us and it can be hard to know where to turn. In addition, it seems we are increasingly busy in an ever more complicated world; finding time to take stock of and attend to our own wellbeing is tricky.

Why choose a private GP

Of course, there are no guidebooks and the quantity of medical, health and wellness information out there is MASSIVE. Not all of it is worthwhile and much of it seems contradictory. I can help you to navigate, translate, accommodate and cut through all of this information and often conflicting advice, to get you closer to being your healthiest you.

In effect, I’m offering to be your medical friend – let’s work together for your health. Call 07788797824 to arrange your initial consultation.

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Find us

88 Harley Street, London W1G 7HR

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