St Mary Cray Practice

St Mary Cray Practice NHS GP Practice, boundary applies, anyone living within the boundary can register to be a patient

02/04/2026

Hope everyone enjoys the long bank holiday weekend!

Of course I relax! Everything in moderation.
Relaxing, stress management, quality time with loved ones and adequate sleep is an important part of lifestyle medicine

01/04/2026

Have you noticed that your body odour has changed when you hit 40s?

There are several biological reasons for this!
👉🏽1. Falling oestrogen alters sweat production
As oestrogen levels fluctuate and gradually decline, the body’s temperature regulation becomes less stable. This leads to hot flushes and night sweats, which increase overall sweating. More moisture on the skin creates an ideal environment for odour‑producing bacteria to thrive

👉🏽2. Greater relative androgen (testosterone) effect
When oestrogen drops, testosterone becomes relatively more dominant. Androgens stimulate apocrine sweat glands (found in the armpits and groin), which release a thicker, protein‑ and lipid‑rich sweat. When skin bacteria break this down, it produces a stronger, muskier smell compared with normal eccrine sweat

👉🏽3. Changes in the skin microbiome and pH
Oestrogen helps maintain a balanced skin microbiome. Lower levels can shift the mix of skin bacteria toward species that produce more pungent odour compounds. Skin pH may also change, further favouring these bacteria

👉🏽4. Stress and anxiety‑related sweating
Perimenopause is often associated with increased anxiety. Stress sweat (also from apocrine glands) contains more proteins and fats than heat‑related sweat, making it more likely to smell when broken down by bacteria

👉🏽5. Heightened or altered sense of smell
Some women notice odour changes partly because smell perception itself changes in perimenopause (dysosmia or increased sensitivity). This can make normal body scents seem stronger or unfamiliar, even if others don’t notice a difference

6. Age‑related compounds (e.g. 2‑nonenal)
With age and hormonal change, the skin produces more fatty acids that oxidise into 2‑nonenal, a compound associated with a stronger, lingering “musty” or “onion‑like” odour. This is not water‑soluble and can persist despite good hygiene

31/03/2026

My wake up call!
Don’t be complacent!
These usually cause no symptoms and hence screening is advisable, especially if high risk (family history, ethnicity)
Prevention is better than cure!

Always seek medical advice this is for information only

28/03/2026

Thousands of doctors face unemployment due to a shortage of training posts.
After years of hard work and dedication it is difficult for me to hear this about my fellow colleagues. 💔
At the same time waiting lists to see specialists are getting longer. It will be more difficult for GPs to refer for specialist review under the new GP contract, shifting inappropriate workload shifted onto GP practices.
Changes to GP contract last year has already led to GPs spending more time doing triage and admin generated by allied health professionals as well as supervising them.
I welcome and respect my fellow colleagues and allied health professionals but we must remember that GPs are expected to find the time for supervision and are not given extra time or resources for this. It also generates more work for GPs to review (bloods and investigations are reviewed by the GP in most cases)

We are also expected to do admin on behalf of other community teams and our secondary care colleagues with each letter stating GP to kindly…..followed by a list of actions that should’ve been done by the hospital team. This is not usually down to laziness of my secondary care colleagues but more systemic and infrastructural/IT/budget/red tape issues.

Despite all this I am still grateful to be doing a job I love but I wish people making contractual changes and decisions had more of an idea of what happens at grass roots.

26/03/2026

⚠️ When strength training can worsen pelvic floor symptoms

Certain movements can increase pressure downward onto the pelvic floor, especially if:
* Breath is held (Valsalva)
* Heavy loads exceed your core control
* Technique requires strong intra‑abdominal pressure
* You already have pelvic floor weakness, prolapse, or urinary leaks
Common culprits:
* Heavy squats and deadlifts
* High‑impact plyometrics
* Abdominal bracing done incorrectly
* Heavy overhead pressing
* Double unders / jumping
These aren’t “bad” — they just need proper form and progressive loading.

—

✅ How to make strength training pelvic‑floor‑friendly
Evidence‑based physio guidance recommends:
1. Use exhale–on–effort
Exhale during the hardest part of the lift�→ This reduces pelvic pressure.
2. Coordinate with your pelvic floor
Before the lift:�👉 gentle pelvic floor engagement (“lift and squeeze”)�During the lift:�👉 maintain breathing, don’t brace excessively�After the lift:�👉 relax fully
3. Start with manageable loads
Increase gradually — avoid sudden jumps in weight.
4. Prioritise posture and core control
Neutral spine and rib position help distribute load.

—

💪 Exercises that are usually good for pelvic floor health
* Glute bridges
* Hip thrusts
* Dead bugs
* Bird dogs
* Modified planks
* Light‑to‑moderate squats / lunges
* Cable or band work
* Upper body strength training
These build strength around the pelvis without excessive pressure.

—

🚨 When to be cautious
If you notice:
* Leaking (urine or gas)
* Pelvic heaviness/dragging
* Lower abdominal bulging during lifts
* Low‑back pain
* Worsening prolapse symptoms
→ This means load or technique likely needs adjusting.
A women’s health physio can give tailored advice — especially if postpartum or with known pelvic floor dysfunction.pp

24/03/2026

Update:
Cases that have been genotyped show that the strain belongs to a group B meningococcus subtype designated as ST-485, P1.12-1,16-183, which has been present in England since 2020.

“The outbreak genome is clearly distinct within this subtype, having multiple potentially significant genetic differences when compared to the most closely related genomes,” the UKHSA report advises.
However, the agency added that it was not yet known whether differences in this strain affected the transmissibility or the severity of infection and that further work was under way to evaluate this.

UKHSA chief scientific officer, said, “This preliminary analysis offers strong reassurance that our existing vaccinations and antibiotic treatment offer will be effective against this strain. In collaboration with the research community, we will continue intensive laboratory investigations of the strain to determine how the spread of the outbreak may have been influenced by the bacterial strain, social or environmental conditions, and population immunity.”

The UKHSA briefing says that evidence suggests that university students, particularly first year students, have around 11 times as high a risk of meningococcal disease as non-students of the same age
The Joint Committee on Immunisation and Immunology is currently reviewing whether to start offering the meningitis B vaccine to teenagers. It is currently given only to infants as part of the childhood vaccination schedule.

https://www.bmj.com/content/392/bmj.s570.full

24/03/2026

Why Cardio After Strength Training Is Superior for Fat Loss

Evidence consistently supports the order of weights followed by cardio for fat loss:
* Strength training first uses available glycogen (“battery”), priming the body to burn more fat during subsequent cardio.
* Reduces interference with muscle gain, which is essential for metabolic rate and long‑term fat loss.
Improves workout safety and technique — lifting with full strength avoids neuromuscular fatigue from earlier cardio.

Based on current scientific evidence and multiple high‑quality fitness analyses, the most effective cardio after strength training for fat loss is:

1. High‑Intensity Interval Training (HIIT) — especially cycling HIIT (maximal fat loss in minimal time)

Why it works (evidence):
* HIIT produces the greatest Excess Post‑Exercise Oxygen Consumption (EPOC) — meaning a larger metabolic “afterburn”.
* HIIT cycling in particular is supported by research as optimal for fat loss while minimising interference with muscle gains.
* Short bursts of all‑out effort followed by rest elevate calorie burn long after the session ends.

Example protocol (evidence‑based):
* 20–30 sec all‑out cycling
* 1 min easy cycling
* Repeat 8–10 rounds (10–20 min total)
Best for:�Fat loss + retaining muscle mass (ideal after a heavy lifting session).

2. Moderate‑Intensity Steady State (MISS) — 20–30 min (fat loss plus recovery support)

Why it works:
* After lifting, glycogen is depleted, shifting the body to use a higher proportion of fat as fuel during steady cardio.
* Keeps intensity sustainable, reduces risk of overtraining, and complements recovery.
Example modalities:
* Incline treadmill walk
* Zone‑2 cycling
* Light rowing
Best for:�Patients or individuals who cannot tolerate high intensity, or on consecutive training days.

Excessive volumes of cardio can impede muscle recovery and gains. Excessively long or intense cardio can over stress the system. Keep cardio less than 30 minutes

https://pubmed.ncbi.nlm.nih.gov/36981649/ #:~:text=both%20HIIT%20and%20MICT%20can,2peak

https://pubmed.ncbi.nlm.nih.gov/22002517/

Omega 3 are essential fatty acids that are crucial for our health, our body cannot make it so it must be consumed.Oily f...
22/03/2026

Omega 3 are essential fatty acids that are crucial for our health, our body cannot make it so it must be consumed.
Oily fish are the best dietary source.

18/03/2026

As meningitis is currently in the headlines, here are some facts you may not know

https://assets.publishing.service.gov.uk/media/694a83a9033693d5d50eb8f7/Meningo-disease-guidelines-2025.pdf

Meningococcal carriage by age: a systematic review and meta-analysis
Hannah Christensen et al. Lancet Infect Dis. 2010 Dec.

The recent outbreak in Canterbury has been confirmed to be Meningitis B strain.Those at risk are being contactedHere are...
17/03/2026

The recent outbreak in Canterbury has been confirmed to be Meningitis B strain.
Those at risk are being contacted
Here are some facts about the meningitis vaccines.

Other vaccines such as the 6 in 1 vacccine also protect against meningitis. Hib are a type of bacteria that can cause meningitis and the 6 in 1 vaccine is given at 8 weeks, 12weeks, 16weeks and 18months old.

Pneumococcal vaccine given at 16weeks and 1 year of age protects against pneumococcal meningitis.

MMRV - meningitis is sometimes a complication of measles, mumps, rubella and chickenpox

Sadly there have been 2 deaths and 11 people unwell with symptoms of meningitis in Canterbury.Meningitis spreads through...
16/03/2026

Sadly there have been 2 deaths and 11 people unwell with symptoms of meningitis in Canterbury.

Meningitis spreads through close prolonged contact (coughing, sneezing, hugging, kissing)

It is important to seek medical attention if anyone has signs or symptoms suggestive of meningitis.

Vaccinations:

MenACWY is offered at 14 years of age at school. It is also offered to people up to the age of 25.
The MenACWY provides protection for up to 5 years. Booster doses may be necessary for those at higher risk.

Men B is offered to babies aged 8 weeks, followed by a second dose at 12weeks and a booster at 1 year.

13/03/2026

B12 deficiency:

⭐ Common symptoms/signs

Unexplained fatigue
Peripheral neuropathy (numbness), paraesthesia (pins and needles), gait disturbance, falls
Cognitive change, memory problems, depression
Glossitis, mouth ulcers
Macrocytosis Âą anaemia
Visual disturbance or optic neuropathy

⭐Risk factors:

Vegan/very low animal‑product diet
Malabsorption (e.g. autoimmune gastritis, coeliac disease, Crohn’s)
Previous gastric/ileal surgery or bariatric surgery
Long‑term metformin, PPIs, H2 antagonists
Nitrous oxide exposure
Other autoimmune disease (e.g. T1DM, thyroid disease)

(As per NICE NG239 and UK primary‑care guidance 12)

Address

322 High Street, St Mary Cray
Orpington

Opening Hours

Monday 8am - 6:30pm
Tuesday 8am - 6:30pm
Wednesday 8am - 6:30pm
Thursday 8am - 6:30pm
Friday 8am - 6:30pm

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