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.

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.

 

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.

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.

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

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.

Great news! The NHS has followed expert advice and reduced the recommended age at which to start bowel cancer screening from aged 60 to age 50.

Guess what? That is how we have worked here since I started the practice over 12 years ago.

Here at Dr Tickle, we believe in working together with you for your health. Prevention is always going to be better than cure, but one size does not fit all. Tailoring screening for harmful illnesses in a way that fits your history, genetic attributes, lifestyle risks and your views on how you would like to manage your health is key to keeping you well, physically, psychologically and financially.

To ensure that we can support you like this, I’ve spent the last 10 years studying the science behind disease prevention and the international expert panel recommendations on cancer screening.

It’s important to me that we only order tests that are safe, scientifically justified and will make a difference to the decisions you could make to enable better health in the future. It would be unethical and an abuse of your trust to do so.

Our approach to bowel cancer screening

Given our current understanding of the science, I now recommend the following:

  • Non-invasive screening for colon cancer for everyone. The test I recommend is a faecal occult blood test.
  • Start screening from aged 50 years and repeat every 12 months.
  • If one first degree relative (parent, children or siblings) or two or more second-degree relatives (grandparents, aunts and uncles) have had bowel cancer, start screening from the age at diagnosis of the youngest affected relative, minus 10 years.
  • If you have symptoms that could suggest a bowel condition, such as abdominal pains, change in digestive habits, diarrhoea, increased frequency of needing the toilet or blood/mucous in the excreta, then screening is not where you need to be. These symptoms need a prompt appointment for formal investigations with a specialist colleague, a gastroenterologist.

To discuss our bowel cancer screening further, call us on 07788797824.

There have recently been changes in how we use tests for cervical cancer screening. The new testing regime is safer and more reliable, which has simplified the diagnostic pathways and strategies we need to follow if you are found to have any abnormal results.

Why have changes been made to cervical cancer screening?

Over the last 20 years, it has become clear that pre-cancerous changes in the cells of the cervix are provoked by persistent Human Papilloma Virus (HPV) infection. So far as we can tell, there are no other causes. Now that we know this, we have discovered that it is much easier to test samples for HPV than it is to analyse cell samples under a microscope. The process is faster, more efficient, less prone to error and cheaper than the previous tests.

Human Papilloma Virus

Hang on – what is HPV?

Human Papilloma Virus (HPV) is best considered as ubiquitous, as all human beings carry one or more of these viruses on their person at any one time. Although this sounds scary, there are not usually any problems from this, as the skin cells and the multitude of friendly germs which cover us prevent the virus from harming us. From time to time, this first line immune defence can fail; when this happens on our outsides, we might develop warts or verrucas (which are warts on the sole of the foot).

HPV and cancer

Unfortunately, as the softer membranes of the body are not as robust as the skin cells on our outside, it can be easier for these cells to become infected by HPV. Usually, these infections are transient, and the immune system clears these without any assistance within a number or months; certainly, the clearance rate by 12 months is around 90%. In the remainder of cases, the affected cells might become disorganised and deregulated, where upon the cells become pre-cancerous. We have associated HPV infection with soft tissue cancers in the cervix, throat, anus, rectum and oesophagus. We expect that rates of these cancers will fall, as the impact of vaccinating younger people against HPV infection becomes apparent. The data on this is already quite encouraging, even after only 12 years of the programme.

What has not changed?

  • Cervical smears are still recommended from age 25 until the age of 64, ideally every 2-3 years.
  • The method for taking the sample has not changed – you will still require speculum examination by you Dr or nurse.
  • If we find HPV positive samples, the laboratory technicians can then undertake analysis of the cells, but only if the cervix has been sampled properly by passing a speculum, directly visualising the cervix and taking samples directly from those cells.

What has changed?

The only difference from your perspective will be the way in which results are reported after your smear. These will now show as either HPV negative, which put bluntly means there is no risk of developing precancerous changes, or HPV positive.

HPV positive DOES NOT equate to cancer, or even pre-cancerous changes. If your sample is HPV positive, the virus type(s) present will be identified as low or high-risk strains. It is only the high-risk strains that are problematic from a cancer-causing perspective. The HPV positive samples showing high-risk strains are then further processed, to analyse the cells, as previously happened for all samples. Depending on this result, you may be recommended to take further tests.

Cervical Cells

Vaccinations against HPV

Vaccinations against HPV have been available since around 2007. The UK government adopted a policy to vaccinate youngsters around the age of 12-13 against HPV. For the first 10 years of the national program, only girls were vaccinated, although this has been addressed and all children are now offered vaccination.

Gardasil ™ has been formulated to protect against the 9 most frequent high-risk strains of HPV. It is a well-tolerated vaccination and I fully recommend this for young people, preferably before likely sexual exposure to HPV has occurred. The national programme holds that vaccination is appropriate between ages of 12 and 13; however, the vaccination is licensed until aged 26 and it is even sensible to consider vaccination in older age groups on a case by case basis. The currently recommended course to achieve immunity is 2 shots if you are under the age of 14 or 3 shots if you are older than 14.

How we can help you at Dr Tickle

We will offer you smear appointments every 2 years; these dates will be kept in our diary reminders on your file so that we can help you to stay on top of this.

We offer vaccination against HPV – this is a course of two vaccinations, 6-12 months apart, which offers cover against 9 of the high-risk strains of HPV.

We are able to vaccinate young men and boys who have been excluded by the NHS so far; if you have sons, grandsons or nephews between the ages of 15 and 24 who would like to be vaccinated, we are able to offer this.

Should you have received a positive HPV result and this is causing you concern, we have longer appointments to discuss the implications of this and the next steps to resolve this issue.

Dr Tickle take-home message:

  • Smears are available at this clinic and are now cheaper and more efficient than they were before.
  • Unless there is a strong indication, such as family history or large number of sexual partners, cervical screening is recommended at a 2-3 year interval from aged 25 to aged 50, thereafter every 5 years.
  • HPV positivity does not equate to cancer. Keep calm – come see Dr Tickle.

Call 07788797824 to arrange an appointment at our private London GP clinic.

In addition to the clinical knowledge updates that are undertaken regularly, I also spend time every year considering to whom you should be referred should this be required. As you can imagine, in medicine there are often changes, an inevitable result of scientific evidence evolving and leading to new and improved best practice guidelines and advances in treatment options. In many surgical specialties, safety and outcome data are now routinely available. We should be using these resources to make good decisions together.

Orthopaedic Care

1 in 2 of us will eventually consider a joint replacement

I know that a lot of us develop significant aches and pains as we grow older, be that related to injury, ongoing osteoarthritis or other factors,@ and, as a result, some of us will eventually consider joint replacement surgery. Within the next 30 years, this may well be one in two people. Naturally, as this is a common problem, we have hordes of orthopaedic surgeons in private practice in the locale, so what is important in how we choose the specialist you would most benefit from?

How to choose an orthopaedic surgeon?

If I needed a replacement joint, I would want to know that the following bases are covered:

  • Does the surgeon perform a sufficient quantity of this type of surgery to be any good at it?
  • Are the surgeon’s outcome data available to review and is the surgeon happy to discuss?
  • Are the anaesthetists good at the hospital you will be admitted to?
  • What happens if things go wrong? Both in the short term – you are ill immediately after your surgery, or in the longer term if your joint does not recover as expected?
  • What is the post-operative journey like? How quickly will you approach your recovery, how soon will you be home and what
  • is the post-operative infection rate, does your rehabilitation plan fit you and is it included as part of your care package?
  • Will your insurance provider meet the costs involved?

What does this mean in practice?

Taking all of this into account, I am planning to send more of the orthopaedic referrals I make to the Schoen Clinic, as this clinic is set up to meet all of these ends and, most importantly, they have good checks and systems to ensure they are doing as well as they say that they are.

Safety is top of the agenda in this hospital, so much so that the ward doctors are all consultant anaesthetists who are specialised in ITU level care. This means that any peri-operative difficulties or complications can be spotted quickly and dealt with effectively.

Please note, this decision is based on overall outcomes, all data available in the public domain and I’ve also done a review of safety procedures in this modern, specialised orthopaedic hospital. This is by no means a commentary on the scope of practice or the ability of any of the other surgeons to whom I refer, nor a reflection on the safety or procedures of other hospitals in this area.

As I move through the clinical specialties, there will be more to follow on how I help you to make these decisions. All questions welcome at any stage.

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