Addison’s disease is a rare auto-immune illness which results in failure of the adrenal glands. We have recently seen two patients with this condition. It is easy to miss if not tested for appropriately. In addition “adrenal weakness” has become a favourite diagnosis of non medical practitioners who may recommend spurious saliva testing- which is not appropriate to diagnose this condition. We are also actively involved in the synacthen testing process at our local laboratory The Doctors Laboratory.
The synacthen test uses a hormone injection to test how well the adrenal glands produce cortisol. It involves stimulating the adrenal glands and then checking to see if they respond. Synacthen is another name for tetracosactide, the chemical used in the test.
The adrenal glands are endocrine glands. This means they make and release (secrete) hormones. Hormones are chemicals which are released into the bloodstream. They act as messengers, affecting cells and tissues in distant parts of your body. The adrenal glands produce hormones which help to control a number of the body’s functions.
Samedaydoctor private doctor walk in clinics are open up to 7 days per week and offer the full range of blood and urine testing for a wide range of conditions.
We often see patients with Pyrexia of Unknown Origin (PUO). Ongoing fever without an obvious source of infection is a diagnostic challenge.
Having ruled out the common chest, bowel or urine infections, we have run blood and urine tests to look for tropical diseases (eg Dengue Fever or Malaria depending upon travel history) legionella, borrelia (Lyme disease) viral antibodies and inflammatory markers. We may have found no obvious cause initially but signs of infection ie elevated neutrophil white cell count and ESR/CRP. The next stage is to run blood cultures and carry out imaging including chest, abdomen and pelvis CT scans plus echocardiography.
We have successfully diagnosed in this way subacute bacterial endocarditis (SBE) which can be treated with a prolonged inpatient course of intravenous antibiotics and in one case heart valve replacement was necessary. Our work at samedaydoctor private walk in clinics is often challenging as we endeavour to use all available diagnostic options available to us to make a correct diagnosis and initiate treatment.
Back pain is one of the commonest causes of time off work and of consultations with General Practitioners. In particular patients with lower back pain, caused by abnormalities in the lumbar spine, are seen regularly in our clinics. While most back pain is manageable and not serious, there are sometimes rare complications, for example cauda equina syndrome which can cause irreversible damage to nerve fibres. We have also seen a few cases of the rare condition discitis which is caused by inflammation or infection of intervertebral discs. Sciatica, where there is pressure on the long sciatic nerve, may cause pain radiating from the lumbar spine to the foot, usually unilaterally.
It is important to take a detailed medical history including looking for red flags indicating possible complications, and to perform a clinical examination looking for evidence of nerve damage. We have open access to MRI scanning on a walk-in basis and these scans are invaluable in being able to view the structures in the spine with a high degree of accuracy, enabling us to treat and refer the patient as necessary. Samedaydoctor Private walk in GP clinics are open up to 7 days per week and appointments can be made by phone or email or patients can walk in during our opening hours.
We have seen a patient who presented with a painless ulcer in an unusual place on their body. Having referred them to see a dermatologist we then ran routine STD tests and found a positive syphilis test which explains the origin of this ulcer. The corollary of this is that often patients with symptoms of diabetes present to a private std clinic because their symptoms-including frequency of micturition- can easily be mistaken for a sexually transmitted illness when it is, in fact, due the the glycosuria of diabetes.
Having doctors who are trained both in general medicine and sexual health is helpful to keep an open mind while thinking about the patient’s presenting symptoms. Our Full Sexual Health Screen includes same day results for HIV, Hepatitis B, Syphilis, Chlamydia, NSU and Gonorrhoea. We have also found a number of positive cases of mycoplasma genetalium recently.
Samedaydoctor in Central London has considerable expertise in contraceptive services. These include general contraceptive advice and standard progesterone-only and combined oral contraceptive medication. In addition our doctors can insert and remove hormone implants as well as inject depot contraceptives.
Furthermore, we can insert and remove intrauterine devices (IUD’S) which include the Mirena coil and the new IUB (intrauterine ball) which is hormone free.
We can also offer sexual health screening (for all STD’s and HIV) and advice. Appointments for these specialist services can be made at our Central London Clinic by email or telephone. STD/STI testing is available at all clinics on a walk in basis.
A report in the Guardian newspaper highlighted that the number of adults and older teens with diabetes in the UK has more than doubled over the past 20 years, with 3.7 million people aged 17 or older now known to be living with the disease.
A new analysis, compiled by a diabetes charity appears to show that the number of diagnoses has shot up since 1998, at which point it is estimated 1.8 million over 16s were diagnosed with diabetes
The analysis does not break down figures into the two main forms of diabetes, type 1 and type 2. But Nikki Joule, policy manager at Diabetes UK, said that other research had shown diagnoses of both have increased, but the rise has been greater for type 2. “[The] rise in obesity has driven that largely over recent years,” she said.
While both types of diabetes are linked to genetics, type 1 diabetes is not associated with weight but is an autoimmune condition where insulin is not produced. It normally begins in childhood and accounts for about 10% of diabetes cases. Type 2 diabetes – where there is insulin resistance – is linked to obesity and typically starts later in life, with about 60% of cases thought to be preventable.
Both types bring with them the risk of complications such as blindness, stroke, cardiovascular disease, kidney failure and amputations. Samedaydoctor private doctor walk in clinics have the expertise to manage type 1 and type 2 diabetes.
The World Health Organisation (WHO) has published advice on vaccines which include the reminder that vaccines a rigorously tested before administration to humans.
They include the full list of vaccine preventable diseases named as follows; Cervical cancer, Cholera, Diphtheria, Hepatitis A, Hepatitis B, Influenza, Japanese encephalitis, Measles, Mumps, Pertussis, Pneumonia, Polio, Rabies,, Rotavirus, Rubella, Tetanus, Typhoid, Varicella, Yellow Fever.
These vaccines and antimalarials can be obtained from our Same Day Doctor walk in Private GP clinics in London and Manchester.
An article in the British Medical Journal has confirmed that the location of ticks responsible for transmitting Borrelia burgdorferi – which causes Lyme disease- has doubled in the years 2010 to 2016. In Greater London 80% of the area has the Ixodes ricinus tick and UK cases of Lyme disease increased from 867 in 2016 to 1171 in 2017.
Lyme disease can have serious consequences if untreated. We have successfully diagnosed and treated several cases of Lyme disease at Same Day Doctor private walk in clinics and we have the experience and expertise to deal with this condition.