Summer Health Event

At our recent Summer Health Event, Dr Oge Ilozue, GP, and senior clinical advisor to vaccination programme - NHSE London region, answered questions relating to the Spring covid booster and about many other health issues including high and low blood pressure, losing weight, shingles, and prostate cancer.

This is an edited version of those discussions; we have chosen fifteen questions, some with two or three parts, from the event they are:

1. What is the latest Spring Booster?

The Spring Booster campaign started in April 2024 offering the vaccination to anyone over the age of seventy-five and those who are immunosuppressed as well as people living in care homes. The vaccination programme runs through to the end of June 2024.

2. What are the side effects of the covid vaccine?

The main side effects of the covid vaccination are sore arm at the point of entry or muscle aches. Some people do feel a bit unwell or rundown for a few days afterwards, or may get a fever, although it cannot give you covid, nor the flu vaccine give you flu.

There are rare complications like severe allergic reaction to some ingredients in the vaccine, similar to all medications, if a person has a known allergy, then they will be advised to get vaccinated in a hospital setting.

If you have had any side effects or problems with any medicine, vaccine or medical device, you should report it using the Yellow Card Scheme. The scheme relies on voluntary reporting of problems by any member of the public as well as from healthcare professionals. There are risks with every medication and we must weigh up the benefits with the risks.

3. How important is it to get the covid vaccine? I've had so many covid vaccines and boosters do I really need another one? I have had all the jabs and I still got covid do I need another one?

Vaccine fatigue is a very real issue, but we must go back to the original reason for vaccinations which is the prevention of infectious diseases.

In the case of covid, original messaging was that the vaccine would stop you getting it, but we realised it boosts your own immune system to create antibodies that protects you against covid. If you were to get covid we know that that infection will be much milder, so the aim became to prevent hospital admissions.

Covid is now endemic and will always be around like flu, and the common cold. They won’t ever go away but it's about protecting the most vulnerable in the population, in particular people who are at more risk of having severe illness.

We have the JCVI  (Joint Committee on vaccination and immunisation) that looks at the data and looks at the covid virus that's circulating, because we know that there are variants, and then they decide which cohorts are eligible and who should be offered a booster. It's not offered to everyone, and it's always done with evidence base.

We know that over time the antibody protection reduces so we top that up with the spring booster.

4. I have autoimmune encephalitis do I have to take the vaccine?

As an asthmatic (diagnosed during covid) I'm very sceptical about the vaccine are there any other options that can be taken?

In terms of keeping well, the vaccine is one tool in a plethora of toolkits about staying healthy and making sure your immune system is what it is. As an asthmatic it is important that you're having your annual asthma reviews, as well as reviewing your inhaler technique and the medication you're using. If you're using steroids as part of that treatment it may be that you're suppressing your immune system, and you may be more at risk. You may be one of the groups who we really want to come forward to protect.

Other things you can do, are keeping well and taking care of your immune system. Are you taking your vitamin C and vitamin D? Are you eating the rainbow? Are you staying hydrated? Are you building your lung capacity with exercise making sure you're moving each day; we recommend you take 150 minutes of a brisk walk each day – it goes a long way. All these things are in our tool kit, but vaccination is one of the most powerful interventions we have against infectious disease, so I’d say don't do one, do it all in parallel and holistically keep as well as you can.

5. Does anyone really know the impact of long covid and what are the symptoms?

Long covid is similar to chronic fatigue syndrome or ME. We don't fully know the mechanisms but its people becoming unwell with symptoms of fatigue or not able to do their normal day-to-day activities after a viral illness. It can strike at random and long covid has multi factors associated. It causes multiple symptoms, and it has caused a major impact in many people's lives with them not being able to return to work and function as they did before they had covid.

It's still poorly understood, there's lots of research going into it and it can affect every part of the body for example fatigue, brain fog, joint aches susceptibility to other infections. There are different mechanisms in terms of trying to address it with multi-disciplinary teams. There are hubs in each area that people can be referred to that health professional can then coordinate the care and identify what symptoms are affecting them as an individual and try to address it.

Research is ongoing and we want to prevent severe covid because we think there is some evidence that being vaccinated may reduce the risk or the impact of long covid.

6. Do we need to take high blood pressure medication for life, or will the medication ever stabilise or regulate my blood pressure. Can I treat high blood pressure with healthy food instead of taking more tablets?

High blood pressure occurs when the heart has to work too hard to pump the blood around the body and the force of the blood pushing against the artery walls is consistently too high. The arteries may harden with each decade, so the heart is having to work harder to pump the blood through. Blood pressure can be linked to genetics, ageing and lifestyle factors. Stress and loneliness for example can cause high blood pressure. High blood pressure can be the cause of both heart attacks and strokes, so it is important it is treated.

It can be controlled by making lifestyle changes so reducing salt in diet, eating the rainbow, keeping well hydrated and exercising. Also stopping smoking and making sure your weight is under control are things that you should be doing.

But it may also be that you do need medication to keep it under control. It’s a good idea to monitor your blood pressure regularly so that you can see if the tablets you are taking are working and your blood pressure is coming down.

If you have been prescribed medication but you're not taking it because of side effects, it's crucial you go back and have that conversation about how the medication is affecting you. There are other tablets your doctor can try.

7. I cannot lose weight no matter what I do are there any recommendations that you can give me?

Look at the small changes you can make that will work for you and your lifestyle and that you can be consistent with, because consistency is key. There's no point going on fad diets, they're not sustainable. As soon as you stop eating foods your body will demand what it has been deprived of and you put weight back on, so it is important to build in things that are sustainable for you over time.

If you're really struggling the NHS has weight management referrals, a national programme your GP can refer you to. if you're above a BMI of 30 or if you have risk factors like diabetes, hypertension or are within a certain ethnic group and are above BMI 27.5 you can be referred to a Weight Management Service. These services are sometimes online usually involving gym exercise and classes providing advice about nutrition. The peer support in the group can help which is positive as to have support or advice, as it can be a real minefield of where to start. You may also need a plan that's suited to and that is achievable with your individual goals and your lifestyle.

Don’t focus just on going on a diet but on lifestyle changes, so change what you are eating, choosing healthy foods like fruit, vegetables, and exercise more.

8. Can you give me more information about shingles and the shingles vaccination is it a live virus?

They have changed the vaccination recently, we are offering it to people from the age of 65 upwards but if you're immunosuppressed and over 50, you'll be offered it. It is currently being offered in a staggered way so you're only eligible at certain times and your practice nurse is the one that will know whether you are eligible and then you should be invited. This new vaccine has two doses six months apart approximately.

9. Can you tell me about the pneumonia vaccine too?

The pneumonia or pneumococcal vaccine is offered to people over 65 so everyone should be offered this at that age. People with certain conditions may be offered it earlier. It's a one-off dose. It's not repeated unless you have certain conditions where they may ask for it to be given every five years, but you'd be invited for that.

10. How can you track covid infections accurately as there's no testing?

I know that some people know they have covid because they get classic symptoms like losing their sense of smell but it's quite difficult especially if you've had your boosters to differentiate it from a nasty feverish cold or a mild flu.

They're not tracking it the same way they did in the height of the pandemic when there was mass free testing. But they are monitoring the hospital data in terms of admissions and can see when the number of infections is going up.

11. Whilst working in the garden this morning it occurred to me, should a gardener have a regular tetanus jab?

That's an interesting question because classically it was gardeners who caught tetanus because tetanus spores hang around in the soil. Now we recommend if you have not had a tetanus injection for 10 years you should get a booster. Many people get it when they're traveling but as gardener it is worth asking your GP.

12. What is the correct amount of water to drink in a day or does it depend on my size and weight?

There's no straightforward answer, it is important to balance it if you have heart disease or severe kidney disease. You may be restricted with the number of fluids you can take each day, and you will be told that by your specialist or your doctor.

The rule of thumb, although it can depend on your weight, is a litre and a half which is good marker. The colour of your urine is a good way to determine if you are drinking enough water. The different colours, from dark brown to a light yellow and it is a simple way to judge whether you are hydrated, especially during hot weather. If you're doing exercise or if you are in hot weather it is important to drink more because you're sweating more. If you're sweating more your cells are working harder so you may need to drink more than in colder weather.

 If you have a heart or kidney condition you should drink consistently throughout the day - little and often rather than great amounts in one go.

13. Does low blood pressure matter?

Your blood pressure may drop as you go from sitting to standing and this is particularly more common as we get older. Also, some blood pressure medications can increase the risk of this, so it is important to sometimes check your blood pressure from a sitting or lying position, and then stand up and check it because that's another measure that your medication is working for you.

If your blood pressure is dropping too low, then it could be over medication or an underlying illness, it's one of the signs of severe infection for example so always get checked if you blood pressure is low.

14. Can osteoarthritis cause swollen knee?

Yes, absolutely. Osteoarthritis is wear and tear where the joint can narrow and in the worst-case scenario you may get bone on bone rubbing, and the joint and the cartilage and the tendons can just wear. It can be very painful and commonly the most common joints are your knees or your hips, but you can get osteoarthritis in your shoulder, in your back, effectively in any joint in the body. It can cause swelling and pain and difficulty in moving. You can manage it with physiotherapy and pain relief but the definitive treatment, if it's bad enough and affecting your day-to-day life is a joint replacement, so we commonly see knee and hip replacements.

15. How regularly should men get tested for prostate cancer?

Unfortunately, there is no screening test available yet for prostate cancer. There is a blood test for our PSA levels, but it is not definitive. I always say people are an expert on their own bodies, you know what's normal for you. It's important to have those conversations with your doctor and have a talk about symptoms. Doctors will always put them in the context of that person in front of them and what symptoms they may be experiencing.

If you aged 45 and over and have a family history of prostate cancer or you're from a black background you can ask your GP if you can be checked. Otherwise, you can ask to be checked from the age of 50, especially if you're having symptoms like waking up two, three, four times at night to go to the toilet, you feel like you're not emptying your bladder properly, or the flow is not strong.

You can watch the full recording of the event with the full responses here.

Our thanks to Doctor Oge Ilozue for the time provided at this event.