Chronic Illness

What is CKD?
This is usually diagnosed by a blood test. It is a long term condition where, in some cases, the function of the kidneys very slowly reduces. This means the kidneys are not as able to do their usual jobs, such as removing excess water and waste from the body. It means we should take special care of your kidneys.

This is a very common condition with 1 in 7 adults having CKD. 50% of people aged over 75 have some degree of CKD, however most of these people do not actually have diseases of their kidneys; they have normal ageing of their kidneys. The vast majority of people have mild to moderate disease which will not progress to a serious illness.

What causes CKD?
CKD develops over a long time and is often caused by general wear and tear on the kidney that occurs with age and also some very common medical problems. For example:
– Diabetes
– Furred up blood vessels (vascular disease)
– High blood pressure

What are the symptoms of CKD?
In mild-moderate CKD people usually have no symptoms. Most people only develop symptoms when they have very advanced kidney disease.
The main symptoms people experience is mild fatigue. Some people get fluid retention that can cause ankle swelling and breathlessness. People with very advanced kidney disease may get more symptoms, however they will be under the care of the hospital based kidney specialists

How to keep your kidneys healthy:
– You should eat a healthy diet and maintain a healthy body weight. You should have a diet low in salt. You should aim to keep up regular and gentle exercise. It is very important to stop smoking if you are a smoker
– Your blood pressure should be kept under control; you may need medication for this. We will call you in to check your blood pressure at least once a year
– Your doctor may advise you go on some cholesterol lowering medication
– You should have a blood and urine test at least once a year, so that we can monitor your kidneys. It is very important that you attend for these tests
– There are certain medications that can be harmful for your kidneys. When you see a doctor, pharmacist, dentist or other health professional, you should let them know you have CKD, so that they know to avoid certain medications (this includes some over the counter and alternative therapies). Specifically you should avoid: Non steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen
– The antibiotics trimethoprim and nitrofurantoin (used for urine infections)
– You may be more vulnerable to infection, so you should ensure you have the flu vaccination every year and that you have had the one off pneumonia vaccination
Acute illness
– If you become unwell with another illness, particularly bad diarrhoea and vomiting or a severe infection, your kidney function may get worse. You should consult a doctor/nurse if you do not feel better within a few days

Useful websites:
Kidney Patient Guide
NHS chronic kidney disease
NICE guidelines
British Kidney Patients Association
National Kidney Foundation
Patient Info on CKD
St. George’s Kidney Patients Association
Kidney Care UK
Chronic Obstructive Pulmonary Disease is a long-term condition, which leads to narrowing of the airways and difficulty breathing. It is usually progressive but deterioration of the symptoms can be slowed with appropriate management. Currently approximately 1.2million people in the UK are diagnosed with COPD.

Usually COPD is a condition of older adults and one of the most important factors related to COPD is smoking. Although not all patients with COPD will have been smokers, for there is a clear link and the longer you have smoked for the higher your chance of developing COPD. Importantly, even after being diagnosed with COPD, giving up smoking can still dramatically improve your symptoms and reduce deterioration in the condition over time.

At the practice we focus both on routine managing patients with COPD with annual reviews to monitor and ensure appropriate treatment, but also on trying our best to help patients to quit smoking. For this reason we run an in-house Smoking Cessation clinic where our experienced nursing team will offer you support and where appropriate, medication to help you quit.

For those patients with a diagnosis of COPD, the practice will aim to offer a follow-up appointment 2 weeks after discharge from hospital following any admissions due to an exacerbation of COPD or a COPD related illness such as pneumonia; however, as we often do not receive discharge summaries in a timely manner, we would encourage you to book for a review with a GP following any hospital admission related to your COPD.

What can I do to help myself if I have been diagnosed with COPD?
– Read up about the condition on the links below. The best prevention of progression is achieved by a good understanding of the disease and early recognition of exacerbations or deteriorating symptoms
– Attend your annual reviews- these will usually be timed around your birthday but obviously we will always be happy to see you if you feel your symptoms are deteriorating before this.
– Give up smoking if you still smoke and try to avoid exposure to passive smoking if you don’t.
– Ensure you put in your medication/inhaler prescription requests in time so that you do not risk running out in an emergency. Equally, if you notice that your inhaler use has increased please book an appointment to come in for a review.
– Prevention is better than treatment! For this reason, if you are over 35 and smoke, the practice will offer you an appointment for Spirometry (lung function tests) which will help assess your risk of developing COPD and any current lung damage.

For more information on COPD go to the British lung foundation or search the Patient Information sources on COPD on
Asthma is one of the UK’s most common long-term respiratory (airways) diseases with approximately 5.4million people currently receiving treatment for it. It is caused by inflammation of the airways, which can be triggered in multiple situations and leads to restricted breathing. This may present as a wheeze or chronic cough.
It is a very variable condition with a huge range in severity and frequency of symptoms between patients. In fact, every patient’s asthma is different and the amount their symptoms effect their lifestyle may vary at different stages in their life. At its most serious, an asthma attack can be fatal so early recognition and treatment is therefore essential to prevent this.
For this reason we at the surgery take Asthma management very seriously and want to ensure that patients with asthma are reviewed annually to ensure they have a good understanding of their condition and are on optimal treatment.
What can you do to help yourself if you have a diagnosis of Asthma?
– Read up on Asthma from the links below. As prevention of asthma attacks is key- the more you understand about your condition, the better you can manage it.
– Ensure you always book and attend your annual reviews. This is the best way to ensure you are on the correct treatment as your requirements may vary at different times.
– Ensure you put in your medication/inhaler prescription requests in time so that you do not risk running out in an emergency. Equally, if you notice that your inhaler use has increased please book an appointment to come in for a review.
For convenience we try to arrange our annual reviews around the date of your birthday, but obviously if there is any worsening of symptoms please do not hesitate to book an appointment or ask to speak to a doctor or nurse.
Worldwide hypertension is the leading risk factor for premature death, stroke and heart disease and over 25% of adults in the UK have hypertension.

The challenge with hypertension is that often patients remain without symptoms for a significant period of time so the only way to know if you have hypertension is to have your blood pressure checked. At both Cuckfield and The Vale surgeries we have blood pressure machines in the waiting room which you can use, these provide a print off of your results which you can provide to reception.

If you are diagnosed with Hypertension then you will likely be started on medication and advised regarding a number of factors you can do to improve your health.
Risk factors include that you as a patient may be able to change include:
– Excess weight
– Excess dietary salt intake
– Lack of physical activity
– Excessive alcohol intake
– Stress

You can self refer to local services through Mid-Sussex Wellbeing and they may be able to facilitate you to make some of these changes

Risk factors that you cannot change include:
– Older age
– Family History
– Ethnicity
– Gender

Once you are diagnosed and started on medication then we aim to have an up to date blood pressure reading every 6 months – it’s not good enough just to be on medication the aim should be that your blood pressure reading is less than 140/90mmHg; if this is not the case please make an appointment in surgery to discuss changes to medication.
White Coat Hypertension
If you find that your blood pressure reading in surgery is always higher than your home readings then it may be you struggle with white coat hypertension. The best way to overcome this and ensure you are not over treated is to have a machine at home. Take 2-3 readings twice daily for 7 days and provide these to the surgery.
Useful links:

Monitoring in Hypertension
If you are treated for hypertension your blood pressure should be less than 140/90mmHg.

It is important that we know and check you are on the appropriate dose of medication. We therefore ask that patients provide up to date readings every 6 months as you will not receive the health benefits of being treated if your blood pressure is above target. These readings can either be taken in reception or provided from home readings.

Home blood pressure machines can be purchased from local pharmacies, or on-line, and cost from as little as £20. We would recommend using one with an upper arm cuff as opposed to a wrist monitor. In surgery we use the OMRON branded machines but most pharmacies offer a wide range of machines and own brands which would be appropriate.

In addition there are some medications that you will be prescribed that require additional monitoring.
If you are prescribed:
– Ace-Inhibitor (Ramipril, Lisinopril, Captopril)
– Angiotensin Receptor Blocker (Losartan, Valsartan)
– Diuretic (Indapamide, Furosemide, Bendroflumethiazide)
These all require blood tests to check your kidney function on an annual basis and with every dose increase. Occasionally these can adversely affect the kidneys or your Potassium levels and thus it is important these are undertaken.
Diabetes is a lifelong condition that causes a person’s blood sugar level to become too high.

There are 2 main types of diabetes:
type 1 diabetes – where the body’s immune system attacks and destroys the cells that produce insulin
type 2 diabetes – where the body doesn’t produce enough insulin, or the body’s cells don’t react to insulin

Type 2 diabetes is far more common than type 1. In the UK, around 90% of all adults with diabetes have type 2.

During pregnancy, some women have such high levels of blood glucose that their body is unable to produce enough insulin to absorb it all. This is known as gestational diabetes.

Many more people have blood sugar levels above the normal range, but not high enough to be diagnosed as having diabetes.
This is sometimes known as pre-diabetes. If your blood sugar level is above the normal range, your risk of developing full-blown diabetes is increased.

It’s very important for diabetes to be diagnosed as early as possible because it will get progressively worse if left untreated.
When to see a doctor

Visit your GP as soon as possible if you experience the main symptoms of diabetes, which include:
– feeling very thirsty
– urinating more frequently than usual, particularly at night
– feeling very tired
– weight loss and loss of muscle bulk
– itching around the penis or vagina, or frequent episodes of thrush
– cuts or wounds that heal slowly
– blurred vision

Type 1 diabetes can develop quickly over weeks or even days.
Many people have type 2 diabetes for years without realising because the early symptoms tend to be general.

Causes of diabetes
The amount of sugar in the blood is controlled by a hormone called insulin, which is produced by the pancreas (a gland behind the stomach).
When food is digested and enters your bloodstream, insulin moves glucose out of the blood and into cells, where it’s broken down to produce energy.
However, if you have diabetes, your body is unable to break down glucose into energy. This is because there’s either not enough insulin to move the glucose, or the insulin produced doesn’t work properly.

Although there are no lifestyle changes you can make to lower your risk of type 1 diabetes, type 2 diabetes is often linked to being overweight.
Read about how to reduce your diabetes risk.

Living with diabetes
If you’re diagnosed with diabetes, you’ll need to eat healthily, take regular exercise and carry out regular blood tests to ensure your blood glucose levels stay balanced.
You can use the BMI healthy weight calculator to check whether you’re a healthy weight.

People diagnosed with type 1 diabetes also require regular insulin injections for the rest of their life.
As type 2 diabetes is a progressive condition, medication may eventually be required, usually in the form of tablets.

Read about:
treating type 1 diabetes
treating type 2 diabetes
living with diabetes

Diabetic eye screening
Everyone with diabetes aged 12 or over should be invited to have their eyes screened once a year.
If you have diabetes, your eyes are at risk from diabetic retinopathy, a condition that can lead to sight loss if it’s not treated.
Screening, which involves a half-hour check to examine the back of the eyes, is a way of detecting the condition early so it can be treated more effectively.