It’s cold, wet, dark and miserable outside, perfect weather for some internal contemplation.
This issue we will be tackling the Big One, The Big C, CANCER. One in two people will get cancer at some stage in their lives, so it’s now more of a “when” rather than an “if”. Outcomes and chances of cure, are far better if we find things earlier. The Screening section today will be devoted to the cancer screening programmes and what you need to look out for as early indicators, “Fore warned is Fore armed”.
Meet the team will be the PCN therapists.
Innovations section is an update on the new AccuRx triage system. We are doing an early assessment survey, this will be repeated later down the line once things have properly settled in to see if you are happy with the AccuRx system after you have used it a few times.
Premises footprint for the 21st Century moves ahead at a snail’s pace. Hopefully, the medium term buildings portfolio will be approved before the second half of the century, or at least before we enter the third decade of trying to replace some of our old building stock.
A new section “tried and tested” looks at external links you may be interested in, this month we are looking at exercise videos to get everyone moving in the comfort of your own home.
We also have links to ICB news.
Cancer – Don’t Die of Embarrassment
Worrisome symptoms will usually occur in places and circumstances that are private and embarrassing, but do not concern yourselves. There is literally nothing that can be said to one of our clinicians that they have not heard before. We may raise an eye brow, but we are essentially un-shockable, and there are no parts of the anatomy we have not donned a rubber glove to prod. It is important that everyone reads on, despite your blushes.
The most common cancers in the UK are Breast, Prostate, Bowel and Lung. These are closely followed by a selection of internal organ cancers such as bladder, ovarian, cervical, uterine, pancreatic, oesophageal, and oral cancers, and of course the slightly more obvious skin cancers, the minor versions of which are so numerous as to not even be counted in our general practice cancer prevalence rate statistics.
Screening programmes:
Breast cancer:
Women are called from the age of 47 every 3 years for mammogram (an xray), until 70, unless you are in a high risk group with female relatives that get breast cancer pre-menopausal, or you carry one of the BRAC genes, in which case you will be offered early screening. If you are aware of family members that fit this category, please speak to one of our clinicians as you may need to see the genetic breast clinic. This also applies to BRAC2 for ovarian cancer screening. Look out for lumps, puckering to breast skin, skin changes, nipple eczema, pain, tenderness, ulceration unexpected one sided changes in size.
https://www.nhs.uk/conditions/breast-screening-mammogram/
https://www.nhs.uk/conditions/ovarian-cancer/
Cervical cancer screening:
There was a very comprehensive section on this in the issue 6 Newsletter, but in summary, all women should attend from 25 to 64 for screening wen called, this is a very easy cancer to treat when found early, but gives symptoms late. Look out for unexplained bleeding, especially post coital, vaginal discharge or unexplained pelvic pain.
https://www.nhs.uk/conditions/cervical-screening/
Bowel Cancer:
From 54 – 74 everyone is now going to be offered a stool screening test for detecting blood in the stool every 2 years (soon to be everyone over 50). This is very easy to do, a swab (abit like a cotton bud) wiped on a stool that goes into a small plastic container and is sent to the lab by post. Please make sure you wear your glasses, as plonking it on the outside of the container will result in the sample being destroyed before testing. This test picks up around 70% of cancers, as they bleed more than the normal bowel lining. It also picks up other things that bleed, such as polyps and may be falsely positive if you have ulcers, bowel inflammation or are on blood thinners, but you will be offered an internal camera (endoscopy) examination to look at what is actually going on inside.
https://www.nhs.uk/conditions/bowel-cancer-screening/
Lung Cancer:
This has has been detailed at length in previous news letters, the targeted lung screening programme is underway for smokers or ex smokers 55-74, you may be offered a CT scan.
https://www.nhs.uk/conditions/lung-health-checks/
Other Cancers:
Prostate Cancer:
Although extremely common. most prostate symptoms can be caused by the age related enlargement of the prostate, with symptoms such as frequent urination, poor flow and erectile issues, but prostate cancer can also cause these. Young men with a family history of prostate cancer, be particularly vigilant. Blood, in urine or semen, is never normal, even if it only indicates an infection. Unfortunately every year we see late presentations of prostate cancer with bone pain, and other generalised symptoms from a cancer that has spread. There is no adequate way to screen for prostate cancer. The PSA blood test rises with age and the size of the prostate, so what is normal for one may be abnormal for another and there is a proportion of cancers that do not raise the standard PSA. So it may be better to ask to add a PSA prostate blood test to any routine annual blood test, at least with a base line level every once in a while, we can see if the PSA is rising, if you start to develop symptoms.
https://www.nhs.uk/conditions/prostate-cancer/
General cancer symptoms:
Blood:
Should be neatly contained in your arteries. Unexplained blood loss is never normal. Report without delay if you:
- Cough up blood – possible lung cancer
- Vomit blood – possible cancer anywhere from your mouth to your stomach
- Find blood in the toilet bowel, when wiping or in underwear- this could be bowel, urinary tract (anywhere from kidneys to bladder) or any of the female genital organs, depending on circumstances and needs further investigation. Do not dismiss as piles without speaking to a clinician.
Lumps:
Humans are essentially formed 12 weeks after conception. Things just get bigger. You should not be growing extra bits after this. If you find a lump growing anywhere, please get it looked at.
Don’t panic, as there are a lot of slow benign things, ganglions are fluid filled sacks push out around small joints, hernias pop up though abdominal wall fault lines in predictable areas, fat can regularly produce organised areas, lipomas, that are fine, and with age everyone gets the dreaded skin age spot, the seborrheic keratosis, translated as the “greasy wart”. Anything else, especially anything that is rapidly changing, needs looking at without delay.
Changes:
Things should change slowly and for a good reason, look out for unexplained changes:
- Weight loss
- Abdominal swelling
- Changes to bowel habit (especially increased frequency and looseness) more than 3 weeks
- Lumps (as above)
- Cough without an infection for more than 3 weeks
- Moles or skin lesions that grow, change colour, itch, bleed, hurt or ulcerate (and are not healed with simple antiseptic and a plaster in 1-2 weeks).
Ulcers:
Viral ulcers are common especially in mouth and genitals, these should clear in a week or 2. Any ulcer, including ulcers that suddenly appear in mouth, genitals or skin, should be looked at by a clinician if not cleared within a couple of weeks, particularly worrying is the ulcer associated with a recent unexplained lump. The only exception to this is the varicose vein leg ulcer that is common in our older patients. However, we would expect that you would have booked to see our nursing team for advice and treatment for healing these after a couple weeks if not improving, occasionally even these can be the result of a benign skin cancer that has ulcerated.
Pain:
All pain should have a cause. The bad back from heavy lifting, the arthritic knee, the sprained ankle from taking our advice about running from issue 6. Unexplained pain; constant pain; pain that is worsening; pain in vague and unusual places; particularly chest, non- muscular back pain, bone pain or abdominal pain – see a clinician, fast.
https://www.nhs.uk/conditions/cancer/symptoms/
Meet the team: The PCN therapy team.
https://hastingspcn.org/services/
This web site gives a detailed in site into their roles and services, you may be referred to them or see the podiatrist in the surgery. If you feel that you may benefit from their services, please let us know.
We have : an Occupational therapist (OT), an OT assistant, 3 Social Prescribers, 2 Wellbeing health coach’s, a Cancer care coordinator, a care coordinator, and 2 podiatrists
Tried and Tested:
Carrying on from the New Year’s Resolution theme of our last newsletter, we have been trying out online exercise programmes, and wanted to share the best we have found so far. There is something for everyone. Grand children, please get out your old iPads and get grandma set up with one of these YouTube videos. These are free videos, so you will need to help them get past adverts.
For the very elderly, or those that have been very infirm, this one was tested by a 90 year old relative who spent weeks immobilised in Hospital last year and has struggled with mobility. They were so pleased they could actually do this. This is a safe seated exercise routine from Dartmouth Health, and runs for less than 10 minutes.
https://www.youtube.com/watch?v=8BcPHWGQO44
For those recovering from joint injuries, surgery or arthritis, this 20 minute seated routine with the extraordinarily enthusiastic Deron Buboltz is a full body work out from your chair. We all have serious kitchen envy on this one. Two relatives with knee and hip issues have put this one through its paces for a couple of weeks and are already seeing results.
https://www.youtube.com/watch?v=3jdBXGVGj1w
For General Fitness, flexibility and balance this 7 minute Ski Fit programme (13 minutes including warm up and cool down) by Lucy Wyndham-Read, is for anyone who thinks they may want to get fit enough to at least get to the bar without falling over. It was tried by a relative who has not been able to properly exercise for 4 years, because of injury and surgery, and lost a lot of fitness during this time, After 5 sessions they are now able to bend to pick things off the floor. The mountain scenery is quite nice too, views without frostbite. It is quite fast, you need to watch the moves carefully.
https://www.youtube.com/watch?v=QxaC7VjR9dA&t=405s
If you have any suggestions that have helped you, please feel free to let us know, we will try to incorporate suggestions in future Patient Participation Newsletter Issues.
Innovations:
AccuRx triage is underway. All calls, visits to reception desk and online requests should be going through the AccuRx request system. The online service is open 8.30 to 5, medical appointment requests are according to on the day capacity.
If you have used the system please give your early impressions in the survey, we will be repeating this after a few weeks to see if things have settled. It appears from our daily call statistics that for the latter part of the week there are 150-200 calls less and currently 30% of requests are coming through via the online route rather than through phone calls.
AccuRx Survey:
https://www.surveymonkey.com/r/HLQK2BV
ICB News:
Keep up to date with what is happening in Sussex wide healthcare. There are some interesting articles on urgent and out of hours care, screening and asthma in children.
https://www.sussex.ics.nhs.uk/nhs-sussex-news-10-january-2025/
https://www.sussex.ics.nhs.uk/nhs-sussex-news-17-january-2025/
https://www.sussex.ics.nhs.uk/nhs-sussex-news-24-january-2025/