What Is A Frozen Shoulder?

A ‘frozen shoulder’ – or adhesive capsulitis in medical terminology – is a problem affecting the shoulder joint. It is the result of scar tissue being formed in the joint, with thickening and shrinkage of the capsule which surrounds it.

What Causes Frozen Shoulder?

Any injury to the shoulder may trigger a frozen shoulder, but there are also certain medical conditions which may make it more likely. These include diabetes, arthritis or after certain types of surgery including breast, neck and chest surgery. If the shoulder joint is kept very still for long periods of time – such as when the arm is in a full-length plaster – there is also a risk of a frozen shoulder developing.

What Are The Signs And Symptoms Of Frozen Shoulder?

These are simple – a shoulder which is either immobile or very difficult to move, and pain in it when movement is attempted. Sufferers may notice they are unable to put their arm behind their back (e.g. to fasten a bra strap) or raise their arm in front or to one side of them (e.g. to reach for something). Not only is it painful when they try to move it themselves but if someone else tries to move their arm too, such as a doctor, then this is painful as well. There may be a small amount of movement of the arm when it is hanging by the side of the body, but pain begins when it is raised to the side. This usually prevents any further movement, but if the person is able to move their arm through the pain they often find that they become pain-free again when their arm is nearly vertical – the so-called ‘painful arc’ of movement.

Will I Have Any Tests Or Investigations?

The diagnosis is usually apparent from the history and the examination. There is often a great deal of reluctance and hesitancy to use the arm on the part of the patient, being apprehensive about anyone else moving it for them. Blood tests may be taken to rule out any other possible causes of inflammation around the shoulder, and simple X-rays of the shoulder joint can confirm or deny the presence of arthritis or wear and tear around it. Occasionally, a test called arthrography is needed if the condition is severe and fails to respond to treatment. In this test, a harmless dye which shows up on X-rays is injected into the shoulder joint, and an X-ray taken afterwards. A frozen shoulder shows up as a shrunken and inflamed shoulder capsule lining the joint.

What Treatment Might I Need?

The simplest treatment is usually a combination of NSAIDs (non-steroidal anti-inflammatory drugs, which reduce the pain and inflammation around the joint) and shoulder exercises or physiotherapy. The types of physiotherapy which can be used include ultrasound, regular exercises and electrical stimulation. Some patients find cold compresses or ice packs applied to the shoulder helpful in reducing their symptoms. A bag of crushed ice (or frozen peas!) wrapped in a towel is placed on the painful part of the shoulder and strapped into place with an elastic bandage.

This should not be so cold that it becomes painful but should be tolerable for about half an hour. After this time it is removed, but this can be repeated every 4-6 hours until the symptoms have eased. There may be occasions when these simple treatments do not cure the frozen shoulder. In such cases, an injection of hydrocortisone is injected into the joint. This is often given with a local anaesthetic at the same time, and fluid can also be drawn off the joint for inspection in a laboratory if this is felt to be necessary to check for bacteria.

Hydrocortisone has an anti-inflammatory effect and is longer lasting than NSAIDs. Should all these measures fail (fresistant frozen shoulders’) then surgery is considered. Under general anaesthetic, a keyhole procedure is undertaken where an arthroscope is inserted into the shoulder, allowing the surgeon to release any scar tissue in the shoulder. This is usually accompanied by vigorous manipulation of the joint to release any other adhesions and free it up.

This must always be followed by an intense programme of exercises for many weeks afterwards to prevent the shoulder stiffening up once more since it is only by keeping the shoulder joint supple that long-term benefits are obtained.

What Course Will The Illness Follow?

Without fairly aggressive treatment, a frozen shoulder can lead to permanent shoulder problems, so it is always essential to seek help sooner rather than later. It is common for people to suffer repeated attacks of a frozen shoulder over many years, and in either shoulder joint. Extremely mild cases may resolve by themselves with analgesia and simple exercises, but most will need medical treatment of some description.

Can I Do Anything To Help Myself?

* Seek medical advice sooner rather than later.

* Always remember to warm up and warm down before and after exercise.

* If you injure your shoulder playing sport, remember to use cold compresses on it as soon as possible.

* If you are prone to recurring frozen shoulders, practice regular shoulder exercises even when you are symptom-free.

Tell Your Doctor

1. When did you first notice your symptoms?

2. What movements or activities are you unable to perform?

3. Do you remember injuring your shoulder recently?

4. Have you tried any painkillers or exercises yourself?

5. Have you had any similar symptoms before?

Ask Your Doctor

1. Do I have to change my sporting activities?

2. Should I have a supply of NSAIDs at home in case this happens again?

3. Would I need to see a specialist?

4. How many hydrocortisone injections am I allowed to have?

5. What are the possible side effects of anti-inflammatory drugs?

Useful Contacts:

PainSupport

Contact Name: Jan Sadler

Email: jansadler[at]painsupport.co.uk

Website URL: painsupport.co.uk

Patients Association

Address: PO Box 935, Harrow, Middlesex, HA1 3YJ

Telephone: 0181 423 8999

Helpline: 0181 423 8999

Website URL: patients-association.com

Author Provides Free Medical Information And Medical Advice On A Variety Of Topics.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

What Are Gallstones?

These are small stones – often looking like bits of gravel – which form in the gallbladder. This is the collecting bag for bile, which helps us to digest fat, and is situated tucked under the liver just below the rib cage on the right. They are often present without causing symptoms, and it has been estimated that around 1 in 10 people in the UK have them, especially women, middle aged and overweight people.

What Causes Gallstones?

Gallstones are usually made up of cholesterol – the fat we eat in our diet as well as manufacturing ourselves – but can also consist of calcium and the products made from the break-up of red blood cells. It is unclear why some people appear to have a tendency to manufacture them (often over many years) but others do not.

What Are The Signs And Symptoms Of Gallstones?

Unless gallstones block the flow of bile from the gallbladder, or move out of the gallbladder itself into the bile drainage system to the small bowel, most people have no symptoms at all and do not know they have gallstones. Typical symptoms include;

* Pain below the right ribs, often after eating a heavy or fatty meal, sometimes going round to the back near the right shoulder blade.

* Sharp colicky pain, often with a high temperature. This suggests inflammation in the gallbladder (cholecystitis).

* Going yellow (jaundice), which is a sign of bile obstruction. The urine usually goes dark and the motions turn pale at this time. The yellowness affects the whites of the eyes and the skin may turn a rather sallow yellow shade.

Gallstones may cause regular attacks of symptoms or there may only be one episode in someone’s life.

Will I Have Any Tests Or Investigations?

Your GP will take a careful history and then examine your abdomen. You may be tender around your gallbladder, or have a slightly enlarged liver. Blood tests may be taken at the time looking for liver inflammation or signs of bile flow being blocked, and your doctor will usually arrange an ultrasound scan of your gallbladder. This is done at hospital and is the same sort of painless ultrasound that pregnant ladies have. It will show up any gallstones or other blockages around the gallbladder and liver area.

What Treatment Might I need For Gallstones?

If you have a severe inflammation of the gallbladder, it is sometimes necessary to be admitted to hospital for intravenous antibiotic treatment and rest. This usually settles all the symptoms within a few days and you can then return home. If gallstones cause your symptoms, surgery is usually recommended to remove them and there are two main ways to do this;

1. Laparoscopic, or keyhole surgery. This is now the treatment of choice, and only very small incisions are needed in the abdomen. Most people need to stay in hospital for one or two nights and can return to work within two to three weeks.

2. For some people, especially very large patients a more traditional operation is needed, with a larger cut along the abdomen. This involves a longer stay in hospital – of around six to seven days usually – and an antibiotic drip after the operation. There may be slightly more discomfort after this type of operation than the keyhole surgery.

In both cases, both the gallbladder and stones are removed. It is completely safe to live without your gallbladder, and bile continues to be produced into the bowel when it is needed. If a gallstone is stuck in one of the tubes leading to the bowel, another procedure can be done, called an ERCP – this is where a fibreoptic endoscope is passed through the mouth and stomach under sedation, and removes the trapped stones. In this case, the gallbladder is not removed. Very occasionally your doctor may suggest using medicines to try and dissolve your gallstones but these have a variable effectiveness and need to be taken for many months before any effect occurs.

What Course Will The Illness Follow?

Most people need no intervention for the occasional gallstone problems they experience. If gallstones are left alone because they are causing no symptoms they cause no other long-term problems.

Can I do anything to help myself?

Losing weight may be enough to greatly reduce symptoms. A low-fat diet often helps, and any food which causes symptoms – usually fatty or oily foods – should be avoided. Alcohol should be drunk very sparingly if at all. After a gallbladder operation it is still sensible to keep your intake of fat in your diet to a minimum but most people find they are able to eat what they like. Your intake of alcohol can return to the approved sensible levels post-operatively (21 units a week for men, 14 for women with one unit being half a pint of beer, a glass of wine or a single spirit measure).

Tell Your Doctor

1. Are your symptoms linked to eating or any particular food?

2. Do you have any pain in your back or around your shoulder blades?

3. Does the pain make you want to lie still or move about?

4. Have you had similar symptoms before?

5. Have you ever gone yellow?

Ask Your Doctor

1. Can I still take the contraceptive pill?

2. Are my children more at risk of having gallstones?

3. Am I more at risk of other stones such as kidney stones?

4. What are the risks involved with having an ERCP?

5. If I have only had an occasional, but severe attack of pain, do I need my gallstones removed?

Useful Contact:

British Liver Trust

Address: Ransomes Europark Ipswich IP3 9QG

Telephone: 01473 276326

Fax: 01473 276327

Helpline: 08 08 800 1000

Email: info[at]britishlivertrust.org.uk

Website URL: www.britishlivertrust.org.uk

Author Provides Free Medical Information And Medical Advice On A Variety Of Topics.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

We all experience headaches at one time or another – whether it be due to an attack of influenza, the result of too much alcohol, stress or the pressure of work. Only occasionally is a headache a sign of more serious illness such as a brain tumour, stroke or cancer. Headaches that have recurred for many years are almost never due to serious underlying causes. Headaches are one of the most common reasons why people visit their GP. There are several types of headaches and many different triggers.

Common types of headache

Most recurring headaches are either migraines or tension headaches. Migraine headaches last for hours to days, are severe enough to stop you working and can make you feel nauseated or cause you to vomit. One striking characteristic of migraines is their unpredictable nature. They often appear without warning and without any apparent trigger. They can be very frequent (one or two attacks per month) or very rare (one or two attacks in a lifetime). Migraines may run in your family. Around 10 per cent of people suffer from migraine at some time.

Tension headaches are less severe but more people suffer from them. They feel like a pressure sensation or band around the head and are also felt in the neck and shoulders. Tension headaches can occur every day and may last for days or weeks at a time.

Other types of headache

• Cluster headaches – usually felt around the eyes or temples. These headaches often occur in clusters for months at a time and then disappear for months at a time

• Episodic headaches – cause severe throbbing in the back of the head

• Sinus headaches – cause pain in the forehead, temples and eyes. They are caused by sinus congestion, often due to a cold, allergy or changes in weather

What causes headaches?

Usually it’s not difficult to determine the trigger of a headache. By carefully looking back at what you were doing, what you were eating and where you were immediately before experiencing the headache, you will probably be able to determine its trigger. It may have been due to a poor night’s sleep, a busy day or stress at home. We do not know what causes the pain of migraine. Pain occurs when part of the body is injured or inflamed. Headaches occur when the tough protective coverings that envelope the brain are affected, but the precise mechanism that causes the constriction of blood vessels surrounding the brain, and tension in the scalp and muscles, is not known.

Tension headaches are often associated with excessive contractions and spasms of neck and scalp muscles. A regular programme of daily massage can often help reduce these spasms. However, spasms can occur with any form of headache and do not explain why tension headaches occur.

What triggers headaches?

Although we don’t know exactly what causes headaches, we do know that certain factors can trigger them. These triggers vary from person to person (see box at bottom of the article).

You should keep a headache diary in order to work out the factors triggering your headaches. Write down what you were doing, where you were and what you were eating immediately prior to each headache. After two or three months you should be able to see a pattern emerging. If you can isolate your triggers then you can reduce the number of headaches you get by avoiding the triggers.

What treatment is available?

Today there are very effective treatment measures. If you suffer from occasional, mild headaches you can safely take aspirin, paracetamol or ibuprofen. Ibuprofen has been shown to be particularly effective in reducing headache pain. However, if you develop an unusually severe headache or one with a sudden onset, you should seek urgent advice from your GP.

You should also talk to your GP if your headaches have only started recently and you are over the age of 50, or if they are worse with coughing, sneezing or physical activity.

Even if you avoid whatever triggers your headaches, you may still need medication to control more severe attacks. You may need to work with your GP to find the type of medication that suits you. Your GP will also tell you about any possible side effects. Medications need to be used carefully because some of the common painkillers can actually bring on headaches if used excessively (for example, every day). If your headaches occur this frequently, your GP will be able to advise you about prevention medication (ie medication you can take whether you have a headache or not).

Prevention techniques

Don’t underestimate the effect that stress and worry can have. There are many forms of stress management techniques such as yoga, meditation and relaxation tapes. Choose a form of relaxation you enjoy and do it on a regular basis. You will get limited benefit only practicing once or twice a week.

At work, take regular breaks (try 20 seconds of stretching every 20 minutes). Make sure you take time out to have lunch. Ensure that the lighting in your work area is even and not flickering. If you work under fluorescent lighting, buy a small desk lamp for your work area.

Common headache trigger factors

* Changes in routine, such as oversleeping or starting shift work

* Alcohol. Red wine, beer, brandy and whisky contain certain additives which can trigger headaches. Too much alcohol results in dehydration and poor quality sleep

* Caffeine. Drinking less coffee or tea than usual can cause a headache that is brought on by caffeine withdrawal

* Hunger. Low blood sugar can cause headaches. People who don’t eat breakfast may develop a morning headache

* Emotional factors, such as stress, depression or frustration Headaches can also occur after stress is relieved

* Weather. Some people develop a headache just before a storm, in humid weather or in a biting wind

* Your environment. Bright or flickering lights and glare, as well as stuffy rooms or excessive noise, can trigger headaches

* Physical complaints. Wearing a tight hair band, toothache or eye strain can bring on a headache

* Car travel, due to motion or the headlights from oncoming cars

* Neck pain or injury

* Sinus problems. Blocked sinuses can cause a feeling of pressure in the nose and cause a headache

* Allergies, such as food allergies (particularly in children)

* Hormones. Some women find their headaches occur at certain stages of their menstrual cycle or at menopause

* Some medications. Even pain killers can have a rebound effect

Useful contacts

International Myeloma Foundation

Address: 31 Dunedin Street, Edinburgh, EH7 4JG

Telephone: 0131 557 3332

Helpline: 0800 980 3332

Email: myelomauk[at]myeloma.org.uk

Website URL: myeloma.org.uk

Migraine Action Association

Address: 4th Floor, 27 East Street, Leicester, LE1 6NB

Telephone: 0116 275 8317

Email: info[at]migraine.org.uk

Website URL: migraine.org.uk

PMS Help

Address: PO Box 83, Hereford, HR4 8YQ

The Migraine Trust

Address: 52-53 Russell Square, London, WC1B 4HP

Telephone: 0207 631 6970

Fax: 0207 436 2888

Email: info[at]migrainetrust.org

Website URL: migrainetrust.org

The Neurological Alliance

Address: 165 Queen’s Gate, London, SW7 5HE

Telephone: 0207 584 6457

Email: admin[at]neural.org.uk

Website URL: neural.org.uk

Author Provides Free Medical Information And Medical Advice On A Variety Of Topics.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

What Are Haemorrhoids?

Haemorrhoids (sometimes called ‘piles’) occur when the veins in the lower part of the rectum and around the anus become swollen, enlarged or damaged. Other conditions can also cause discomfort, pain or bleeding in this area. They include anal fissure and anal itching (pruritus). Although haemorrhoids are the most common cause of bleeding from the anus or rectum, they are not the only cause. Rectal bleeding may be the first sign of a serious condition such as cancer, so it should always be checked by a doctor to find out the exact cause and to allow the best possible treatment.

What Causes Haemorrhoids?

The veins that are involved in haemorrhoids are a normal part of our anatomy. They become enlarged if the flow of blood through them slows down or is obstructed – a little like varicose veins in the leg. Factors that can interfere with the blood flow and increase the risk of haemorrhoids include:

• constipation and straining to pass a bowel motion

• pregnancy and childbirth

• lifting heavy weights incorrectly

• chronic coughing

• being overweight

• liver disease

Who Is Most At Risk Of Getting Haemorrhoids?

Haemorrhoids are very common in our society, particularly in older people. Up to half the population will suffer from them at some time in their lives. Haemorrhoids are less common in people younger than 40, although they may suffer from anal or rectal discomfort due to other causes. The list of factors that contribute to haemorrhoids (above) indicates the people who are most at risk. Constipation is the biggest factor, and it’s also one that we can do something about.

The enormous changes in the body associated with being pregnant and having a child also hasten the development of haemorrhoids. Abdominal strain from coughing or lifting heavy weights may be difficult to avoid, but at least if you use the correct technique for lifting, you will help to reduce the problem. When lifting a heavy object, you should stand close to the object with your feet apart and bend your hips and knees, keeping your back straight. Then grip the object, keeping it close to you, and straighten your legs.

What Are The Symptoms Of Haemorrhoids?

The symptoms of haemorrhoids depend on the blood vessels involved, how long they have been present and the severity of the problem.

• Internal Haemorrhoids

Internal haemorrhoids develop from the veins in the lower part of the rectum. Usually they are not painful to start with, although they may cause a vague aching sensation. Often the first sign will be a small amount of bright red blood on the toilet paper or in the toilet bowl after passing a motion, or on the surface of the bowel motion itself. Haemorrhoids tend to grow in size over time. Pain and discomfort also become more likely, particularly if the haemorrhoid becomes inflamed or infected or if it develops a blood clot inside it. The haemorrhoid may become so large that it’s pushed through the anus when passing a bowel motion (prolapse), and then it may become ‘strangulated’.

• External Haemorrhoids

Sometimes when an internal haemorrhoid prolapses through the anus it is called ‘external’. However, the phrase ‘external haemorrhoids’ usually refers to changes in the blood vessels lying under the skin around the anus. These veins, too, can become enlarged and cause difficulties. An aching pain is often the first symptom of external haemorrhoids. The biggest problems occur when a blood clot inside the vein causes a blood blister to form just beneath the skin. Because the skin is rich in nerve endings, this can be very painful.

But Is It Haemorrhoids?

Several other common conditions can cause pain, itching or discomfort around the anus. An anal fissure is a tear in the skin lining the anus. It can be very painful, especially when passing a bowel motion, and can also lead to bleeding. Anal itching (pruritus) is another very common complaint. There are many causes for itching and tenderness, including:

• eczema

• thrush (infection with a fungus called Candida)

• pinworms or threadworms

• diarrhoea and other diseases of the digestive system

• some sexually transmitted diseases

Often, though, it isn’t possible to find the exact cause. Anal itching tends to be made worse by hot, humid weather, excessive sweating, and friction between the skin surfaces during exercise or from being overweight.

What Is Haemorrhoids Treatment?

Lifestyle changes, such as controlling constipation, weight loss and sensible hygiene can make a very big, long-term contribution (see box at the bottom of this article). Several types of medication are available to reduce the size of haemorrhoids and control symptoms of pain and itching. Surgery may be needed to treat large haemorrhoids or other conditions such as a clot in an external haemorrhoid.

Is It Serious? And Who Can Help?

Conditions affecting the anus and rectum are extremely common. Your doctor and pharmacist are used to discussing them, and you should not feel embarrassed about seeking their help. Your pharmacist will be able to give advice about medication to relieve the symptoms, and also advise about lifestyle changes such as reducing constipation. Remember that many conditions can cause anal and rectal symptoms. Unless you talk to your doctor, you could suffer more discomfort and anxiety than you need to. Also remember that bleeding from the rectum or anus can be the first sign of very serious diseases including colorectal cancer. Although bright blood after passing a bowel motion is likely to be due to haemorrhoids, it should be investigated by a doctor – just to make sure. You should see your doctor:

• If you have a change in your bowel habits (for example, constipation or diarrhoea), or any unexplained weight loss or anaemia

• If you have sudden or severe pain in the anus or rectum

• If treatment of the symptoms doesn’t provide enough relief

How can I help?

* Eating more fibre, drinking lots of liquids, and good bowel habits (such as trying not to postpone visits to the toilet) will help to reduce constipation

* Don’t add to the irritation around the anus by scratching, or trying to clean or scrub the area excessively when bathing

* Keep the area as dry and cool as possible.

* Wear loose clothing and underwear (avoid synthetic fabrics if possible)

* Clean gently after bowel movements. Use moistened cotton wool if necessary

* Do not use perfumed soaps or talcum powder (including baby powder), as these sometimes add to the irritation of sensitive skin

* Talk to your doctor

Author Provides Free Medical Information And Medical Advice On A Variety Of Topics.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

It is surprisingly difficult to say when pregnancy begins. Some consider love-making is the start. Others think it begins when a sperm fertilises an egg. Most doctors believe that pregnancy begins a few days after sexual intercourse when the fertilised egg implants into the womb.

When will the baby be due?

When you discuss pregnancy with your midwife or doctor they will they calculate your due date from the day your last period began. The date the baby is officially due is forty weeks after the first day of the last period. However very few babies are born on the due date. Women with shorter or longer menstrual cycles need adjustments to the calculations.

Beginnings Of Pregnancy

Fertilisation and implantation of the egg occur before the first missed period. Urine pregnancy tests will normally give a positive result a few days after the period would have been due. When you think about pregnancy you normally think of a baby but the placenta or afterbirth is vitally important. In the early stages the placenta is much bigger than the tissues that eventually develop into the baby. In fact pregnancy tests detect hormones from the placenta not the baby itself.

Some women will feel different in themselves: breast tenderness and mild nausea can occur. However, many women will not feel any ‘symptoms’ of pregnancy. Whether or not you will feel ‘symptoms’ is an individual thing and does not signify anything about the health or future of the pregnancy.

The pregnancy will normally last around forty weeks (although giving birth two weeks before or after the due date is quite normal). From the time of conception onwards, the cells that will become the baby begin to develop into an embryo. Over the next few weeks all the internal organs appear. By three months the fetus, or developing baby, is formed and over the next six months the baby matures and grows considerably.

What Are The Signs And Symptoms Of Pregnancy?

Before modern pregnancy tests were available the diagnosis of pregnancy relied on observing characteristic breast and nipple changes, as well as changes in the size of the womb. Changes in skin pigment can occur too. The baby’s first kick (called ‘quickening’) is often not felt until half way through pregnancy.

As the pregnancy develops enlargement of the womb becomes obvious. Breasts enlarge too and can produce a milky secretion. Less welcome features of pregnancy may include enlargement of veins – especially in the legs and sometimes on the vulva and in the back passage. Your midwife and doctor can advise and help with these. Stretch marks are not uncommon and usually appear on the tummy. They can also develop on the breast and thigh. Although red at first, the marks fade to white after the birth.

Pregnancy makes the heart work harder and in the last three months this can result in fatigue, breathlessness and puffing of the feet and ankles. Discuss these problems with your midwife or doctor if you develop them. The extra work done by the heart and circulation is one reason why maternity leave is available for women who work outside the home.

There are many other things that can occur to women in pregnancy. Common symptoms include indigestion and heartburn. Bladder symptoms are frequent and later on some women will occasionally leak a little urine due to the pressure of the pregnancy on the bladder. In preparation for childbirth certain joints relax and this can lead to aches in the pelvis and back.

What Course Does Pregnancy Follow?

Although the majority of women will have no medical complications in pregnancy some women do experience problems:

• First Trimester. About one in six women will miscarry. The vast majority of miscarriages occur in the first three months.

• Second Trimester. The second three months of pregnancy is usually trouble free.

• Third Trimester. During the final three months you will be seen more frequently by the midwife and doctor. They will be looking for signs of rising blood pressure and will be monitoring the growth of the baby. If problems crop up, for example should you experience pain or bleeding, you are advised to contact your doctor or midwife.

Labour

Eventually every pregnant woman gives birth to her child. Most women will do so within two weeks of their due date and most will go into labour on their own. This may follow a release of ‘the waters’ but in some women the waters do not break until they quite far into labour. Labour is defined as ‘painful regular contractions that dilate (or widen) the cervix’. It is possible to have contractions but not to be in labour – in such cases the pains are preparing the cervix for labour, this is when the cervix is not changing despite there being contractions.

Childbirth

Once the cervix or neck of the womb is fully open the second stage of labour can begin. This is the process of childbirth itself. After the baby has been born the afterbirth or placenta must be delivered. When this is expelled labour is over and motherhood begins.

Caesarean Section

Caesarean section is the operation of delivering the baby through a cut made in the mothers’ tummy and womb. The chance of having a Caesarean section is higher now than in previous years and depends very much on how the pregnancy is progressing and how well the baby is. This is something that can only be discussed with the obstetric doctors and your midwife.

Complications in pregnancy

Many women fear that something might go wrong. The actual figures are; one in six pregnancies will miscarry, usually in the first twelve weeks of pregnancy; less than one pregnancy in one hundred will result in a baby who is born dead (stillborn) or who dies within a week of delivery. Usually this happens in pregnancies that have had problems. If the pregnancy is uncomplicated the chance of having a live healthy baby is very high indeed.

Will I have any tests or investigations?

A variety of tests are offered to women during pregnancy. Some involve making sure the mother to be is well (for example: blood pressure (bp), blood group, urine testing, looking for anaemia) while others are to do with the baby’s welfare. Many women choose to have tests to look for abnormalities in the baby such as spina bifida and Down’s syndrome. These will be discussed with you early on by your doctor or midwife.

Ultrasound scans can check on the baby’s condition and provide good information on how advanced the pregnancy is. It is recommended that blood pressure be closely monitored throughout pregnancy. Later on the baby’s position will be examined. Caesarean section is usually advised if the baby is coming foot or bottom first (breech presentation). It is not practical to describe every test you may be offered in pregnancy but the following will give you an idea of some of the things you may be asked to consider:

• screening for inherited conditions – especially if there is a family or ethnic risk factor. For example Sickle cell anaemia, Thallasaemia, Cystic fibrosis

• screening for Down’s syndrome. This used to be offered to women over 35 years of age only, but now newer tests can help to identify younger women who are carrying an affected pregnancy

• screening for diabetes. Urine testing is performed regularly throughout pregnancy. If sugar is detected blood tests might be required. Some women can be identified as being at higher risk of developing diabetic-like changes in pregnancy. They may be offered blood tests irrespective of their urine test results

• screening for infection. Recently it was decided to offer all women HIV tests during pregnancy because those who have the virus may be unaware that they are HIV-positive. Knowing HIV status allows the mother to make choices that can have huge benefits for themselves and their unborn baby. There are other infections that can affect the pregnancy (for example vaginal streptococcal infection) that have a bearing on how the pregnancy or labour is conducted.

• close monitoring of women with medical conditions like high blood pressure, insulin dependent diabetes, epilepsy, heart problems

• close monitoring and support for women with emotional or mental health concerns. For example, depression can re-emerge during and after pregnancy

• choices of drugs and medication for treating other conditions during pregnancy require careful consideration

What treatments might I need?

Pregnancy is not a disease and so most women do not require treatment as such. However many women do need or benefit from treatments in pregnancy:

• Iron is frequently used. However, the only reasons to take iron are iron deficiency and twin/triplet pregnancy. The natural drop in blood counts during pregnancy must not be confused with iron deficiency. The natural drop in blood counts is a desirable result of the pregnancy. Only iron deficiency requires iron supplements

• Folic acid belongs to the B group of vitamins and should, in an ideal world, be started before conception. It is continued until twelve weeks into the pregnancy to reduce the risk of the baby developing spina bifida

• Antacids are frequently helpful in reducing heartburn and indigestion which can occur in the last few weeks of pregnancy

• Treatment for pregnancy or medical problems may be required (for example, medication to lower a high blood pressure)

• Paracetamol has never been shown to cause problems in pregnancy and is safe to use as a pain killer when required.

Can I do anything to help myself?

Pregnancy is a great time to make health improving changes in your life (and for your partner!). Attention to diet is good and the ‘Pregnancy Book’ that your doctor or midwife will give you has a lot of useful advice in it. Certain uncommon but serious infections can be caught through food. Listeria usually caught from soft cheeses, pre-prepared salads and cook-chill meals. These foods are almost always safe, but the low risks can be reduced by keeping the food cool after purchase and consuming them while they are still very fresh. Meat should be thoroughly cooked (barbecued meat is something to avoid). Smoked meats (for example salami) are probably best avoided as they carry a small risk of transmitting toxoplasmosis.

Reducing or, ideally, stopping smoking is always a good idea in pregnancy. Similarly stopping or reducing alcohol intake is also advisable. Some women use other medications or substances for recreational purposes. All doctors will advise these be stopped during and, if possible, before pregnancy.

Pregnancy is a time of life and life-style change. It is good to allow yourself the emotional space and time to make adjustments. Keeping a flexible approach is good too as pregnancies have a habit of springing the unexpected on you.

Tell Your Doctor

1. Early pregnancy information: Your doctor will want to know how long your menstrual cycle is (that is from the first day of one period until the first day of the next), the date your last period started on and whether you have had any discharge or bleeding since that date. If you have done pregnancy test(s) the doctor will want to know the dates of these and whether they were positive or negative.

2. Past medical history: If you have, or have had, any unusual or significant conditions your doctor will want to know about them. For example the occurrence of heart or kidney problems, diabetes, asthma, epilepsy, thrombosis and mental health problems are all important. If there are illnesses or conditions in your family or the baby’s father’s family it is worth mentioning them to your doctor early on in pregnancy

3. Employment and work matters: Very few jobs are hazardous to pregnant women. Examples of such jobs include sheep farming, working with certain chemicals (for example cytotoxic drugs), working with ionising radiation or perhaps jobs involving foreign travel. Mention what job you do – if you are employed – to your doctor

4. Medication: if you are taking any medication or drugs, your doctor needs to know about them. Women with diabetes or epilepsy are encouraged to discuss matters with their doctor before pregnancy. Most maternity units run pre-pregnancy clinics for women with these conditions. If you use recreational or illegal drugs this also needs to be considered. It is important that your doctor and midwife are sympathetic and helpful rather than judgmental in such instances. Ideally you should share this sensitive information with someone you feel you can trust

5. Social and lifestyle factors: Although the birth of a baby is a massive opportunity it can be a time of worry and anxiety over money, relationships or accommodation. Your midwife, doctor or hospital maternity unit should be able to arrange for a social worker to see you and, if possible, offer help in your situation. Particular issues and questions can arise in women who are single parents. Children are also born into gay relationships. The Internet can be a valuable source of helpful advice and information in these situations. Always visit Internet sites cautiously and weigh up their suggestions and advice carefully. planetoneparent.com has stuff for single parents.

Ask Your Doctor

1. Anxieties and concerns: Normally your doctor will ask you if you have any questions or if anything is worrying you. This is your opportunity to ask what you like. Most midwives and doctors would want you to ask anything, no matter how daft it might seem, rather than leave you unsure or worrying. These worries are important to you, so ask away

2. Entitlements: You are entitled to free dental care and free prescriptions during pregnancy. Should you have a pregnancy that results in a live birth or any birth after 26 weeks of pregnancy these benefits carry on for the twelve months after birth too. Ask for a form FW8. Send the completed form to your local health authority and an exemption certificate will be sent back to you. Details of this and form MAT B1 for statutory maternity pay are listed in ‘The Pregnancy Book’ which is available free from your doctor or midwife. You are entitled to have your baby where you wish but almost all doctors and midwives would want to help and advise you on the best choices so discuss this as well during the pregnancy

3. Exercise: In early pregnancy exercise will not harm the pregnancy so if you enjoy swimming or aerobics, carry on. Later in pregnancy you may find that the weight and bulk of the pregnancy will restrict things and vigorous activity will not only be unwise but also uncomfortable. Ask your doctor about this. You may also want to ask about sexual activity during pregnancy. Basically it depends on what is comfortable for you. Normal sexual intercourse will not cause miscarriage. The only situation where intercourse is inadvisable is if it is known that the afterbirth is lying very low in the womb. This is rare.

4. Travel: If you have foreign travel planned or wish to travel by air it is useful to enquire about this not only from your doctor but also from the airline if you hope to travel during the last three months of pregnancy. Travel to, or through, regions where malaria is endemic requires careful consideration so ask about this if it applies to you.

5. Delivery choices: Some women have very definite hopes and aspirations for how they wish to have the baby. For example some want home delivery and others may like a birth in water. Ask your midwife or doctor about this. Availability of the options varies from place to place. If you are worried about any aspect of pregnancy or childbirth you should feel encouraged to ask about this too.

Useful Contacts:

British Pregnancy Advisory Service (BPAS)

Address: 20 Timothys Bridge Road, Stratford Enterprise Park, Stratford-upon-Avon, Warwickshire, CV37 9BF

Telephone: 01789 416 569 OR 0945 365 5050

Fax: 0845 365 5051

Helpline: 08457 304030

Email: info[at]bpas.org

Website URL: bpas.org

Fertility UK

Address: Bury Knowle Health Centre, 207 London Road, Headington, Oxford, OX3 9JA

Email: admin[at]fertilityuk.org

Website URL: fertilityuk.org

North East London Fertility Services

Address: Doctors House, 40 Cameron Road, Seven Kings, Ilford, Essex, IG3 8LF

Telephone: (020) 8554 1214

Email: info@nelfs.co.uk

Website URL: nelfs.co.uk

Author Provides Free Medical Information And Medical Advice On A Variety Of Topics.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

What Is Rheumatoid Arthritis?

This is a complicated chronic condition, marked by inflammation of the joints and occasionally other body organs, which is often marked by periods when it appears to be much improved or worsened. In some cases it can even disappear completely – a condition known as ‘burnt out’ rheumatoid arthritis (RA). For most people with RA, if treated appropriately, there may be few symptoms and a full, active life is possible.

What Causes Rheumatoid Arthritis?

The basic cause of RA remains something of a mystery, but we know it occurs when the body’s immune (defence) system reacts to something abnormal in the body and tries to remove it. This response causes inflamed cells to build up in membranes surrounding the joints, and enzymes then released from these cells lead to the breakdown of normal bone and cartilage in that joint, and hence cause the characteristic symptoms of RA. Two features arising from this are usually looked for by doctors. The first is called a rheumatoid factor which is a specific antibody produced in large quantities in RA and no other form of arthritis. This can therefore be detected on special blood tests, and confirms the diagnosis. The second is the presence of rheumatoid nodules – lumps of inflamed cells usually seen on the backs of the hands, feet and elbows.

What Are The Signs And Symptoms Of Rheumatoid Arthritis?

There Are Three Main Symptoms In Rheumatoid Arthritis;

* 1. Pain

* 2. Stiffness

* 3. Swelling

It is typically the small joints – finger joints, knuckles and feet – which are affected first, but any joint in the body may develop symptoms. The pattern varies hugely from person to person but is characteristically seen as symmetrical; if one particular joint is affected on one side of the body then the same joint on the other side is usually affected too. The stiffness tends to be worse early in the morning after waking, and is usually accompanied by tiredness and general malaise. Simple everyday tasks such as dressing or writing may become uncomfortable or difficult.

Will I have any tests or investigations? Yes. It is important to diagnose RA quickly and correctly because the faster this is done, the earlier treatment can begin and the lower the chance of permanent damage to the joints. However, early on in RA most doctors will have to rely heavily on the history and clinical findings for the diagnosis although there are some useful tests;

* 1. Blood tests. Your doctor will look for anaemia (common in RA), presence of rheumatoid factor in the blood, evidence of inflammation from tests such as an ESR (erythrocyte sedimentation rate) and CRP (C – reactive protein) test. He will also usually assess other organs such as your kidneys, liver and thyroid gland at the same time.

* 2. X-rays. Once damage has been done, this becomes apparent on X-raying the joints. Such changes are often seen first in the feet, so your GP may X-ray these even though you do not have any symptoms in them. Other tests which aim to pick up the disease before active damage occurs include ultrasound scanning, bone density tests and magnetic resonance imaging (MRI) scans.

What treatment might I need?

This falls into three categories;

* Looking after your joints. Regular exercise – especially swimming – is vital to maintain joint function, and you should use trainers with thick soles to absorb impact when exercising. Your GP will advise you to see an occupational therapist who will show you simple ways to reduce any unnecessary strain on your joints.

* Drugs. These are the mainstay of most peoples treatment, and there are four kinds which may be used – simple painkillers, non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying anti-rheumatic drugs and corticosteroids.

* Simple painkillers. These include simple paracetamol and codeine-based painkillers, and side effects are relatively few in this group.

Drugs used in the treatment of rheumatoid arthritis:

• NSAIDs. These work to specifically reduce inflammation around a joint and so reduce symptoms. These include Ibuprofen, Diclofenac and Indomethacin and any side effects are usually indigestion so these are advised to be taken with food. The dose and type will be worked out between you and your doctor.

• Disease-modifying drugs. These are not painkillers as such but act to reduce inflammation and slow down the progress of RA. They can take many weeks to begin to work effectively, and are often taken for years. Side effects are more common with these types of drugs, so your doctor will monitor you regularly and take regular blood samples to make sure your body is still suiting them. These can be extremely safe and effective treatments in RA and common examples include sulphasalazine, gold injections, methotrexate, D-penicillamine and azathioprine.

• Corticosteroids, or ‘steroids’. These are not the same as those used by bodybuilders and athletes illegally! These are based on cortisone, a naturally occurring hormone which acts to damp down inflammation in the body – better than any other drug we have available to us. They unfortunately have side effects if taken for a long time – such as osteoporosis – and so need to be monitored carefully. However, they can be dramatically effective in controlling RA, and are given in one of three ways;

* by injection into an affected joint

* by intramuscular or intravenous injection to reduce an aggressive flare of RA, known as a ‘pulse’ of treatment

* by mouth, often at a dose of below 7mgs daily if possible.

If a large collection of fluid forms around a joint, this is known as an effusion and relief may be given by draining this fluid off the joint with a needle and syringe. Other possible treatments include physiotherapy and occupational therapy to promote muscle strength and joint movement and reduce the risk of joint deformity.

What course will the illness follow?

Every person suffering from RA has a unique pattern of their illness. Most people have a ‘remitting and relapsing’ pattern where symptoms become worse or lessen for a period – often for weeks or months – before settling again. There may be periods of months or years between flare-ups, during which time there is little inflammation. However, some damage is done to the joints each time they become inflamed. Around 1 in 20 people with RA will have steadily progressive RA but as many as 1 in 5 have very mild RA, causing few problems.

Can I do anything to help myself?

An understanding of the condition, allied to prompt treatment of any flare will prevent serious joint damage in the majority of people. It is important to try to maintain as active a life as possible, and take any prescribed medication correctly. Report any new symptoms to your doctor, and you may want to join a local branch of your arthritis support group which many people find extremely helpful.

Tell Your Doctor

1. When did your symptoms begin?

2. Are the same joints affected on both sides of your body?

3. Do you have any symptoms not involving your joints such as your eyes or breathing?

4. Have you had any similar symptoms before?

5. Do you have difficulty in doing normal daily activities?

Ask Your Doctor

1. Is there a diet which will help my RA?

2. Does the weather make any difference?

3. Should I avoid getting pregnant?

4. Does RA run in families?

5. Am I still allowed to take the contraceptive pill?

Useful contacts

Arthritis Research Campaign

Address: Arthritis Research UK, Copeman House, St Mary’s Gate, Chesterfield, Derbyshire, S41 7TD

Telephone: 0300 790 0400

Fax: 0300 790 0401

Email: enquiries[at]arthritisresearchuk.org

Website URL: arthritisresearchuk.org

PainSupport

Contact Name: Jan Sadler

Email: jansadler[at]painsupport.co.uk

Website URL: painsupport.co.uk

Patients Association

Address: PO Box 935, Harrow, Middlesex, HA1 3YJ

Telephone: 020 8423 9111

Helpline: 0845 608 4455

Website URL: patients-association.com

British Society for Rheumatology

Address: Bride House, 18-20 Bride Lane, London, EC4Y 8EE

Telephone: 020 7842 0900

Fax: 20 7842 0901

Email: bsr[at]rheumatology.org.uk

Website URL: rheumatology.org.uk

Institute of Optimum Nutrition

Address: Avalon House, 72 Lower Mortlake Road, Richmond Surrey, TW9 2JY

Telephone: 020 8614 7800

Website URL: ion.ac.uk

Primary Care Rheumatology Society

Address: PO Box 42, Northallerton, North Yorkshire, DL7 8YG

Telephone: 01609 774 794

Fax: 01609 774 794

Email: helen[at]pcrsociety.org

Contact Name: Helen Livesey

Website URL: pcrsociety.org

Author Provides Free Medical Information And Medical Advice On A Variety Of Topics.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

What is Gout?

Gout is a painful medical condition caused by an excess of uric acid in the body. This can cause repeated attacks of inflammation around joints, with deposits of hard lumps of uric acid being deposited in and around certain joints. These may also occur under the skin, or in the urinary system as kidney stones and the medical term for an elevated uric acid level is hyperuricaemia. It has the dubious distinction of being one of the earliest recorded medical illnesses, once being known as the ‘disease of kings and the king of diseases’. Fortunately modern treatments have made this condition readily treatable.

What causes Gout?

The underlying cause – an excess of uric acid in the body – can have a number of causes. Uric acid is a breakdown product of purines which are present in many of the foods we eat such as seafoods, dried peas and beans and some meats such as liver and kidneys. Alcohol may also raise uric acid levels significantly. Gout can therefore be due to increased purine intake through the diet, too little uric acid being removed by the kidneys or – most commonly – an increase in the body’s own production of uric acid due to an inherited tendency for this to occur. Gout is nine times more common in men than women, and has a peak age for attacks of between 70 and 75. In women, most cases of gout occur after the menopause. It is more common in people suffering from obesity, high blood pressure and diabetes.

What Are The Signs And Symptoms Of Gout?

The commonest site for an acute attack of gout is the small joint at the base of the big toe but other sites include the ankles, wrists, elbows and knees. A characteristic attack follows the pattern of a very sudden onset of pain in the joint which then quickly becomes hot, swollen, red and exquisitely tender – even lightly brushing the skin can cause severe pain. There may be an associated fever, and most attacks last hours or days. It is unusual for an attack to last longer than this. Occasionally, crystals of uric acid can become deposited in tiny fluid-filled pockets, or bursae around a joint. This can lead to further pain and inflammation, causing larger swelling – a condition called bursitis. In people suffering from chronically raised levels of uric acid, small deposits of uric acid crystals (called tophi) can be found in soft tissue throughout the body but especially the hands, ears and skin.

Will I Have Any Tests Or Investigations For Gout?

The ultimate way of confirming an attack of gout is to draw off some of the fluid from around the affected joint (called arthrocentesis) and analysing it under a polarising microscope. The technique is performed under local anaesthetic using a sterile syringe and needle. Under the microscope, uric acid crystals have a classical shiny, multicoloured and needle-like appearance. Blood tests are also often used to check the blood uric acid level, but it is possible to have severe attacks of gout with either normal or even low levels of uric acid in the blood so these results may be misleading at times. There is often no need to perform any investigations as the clinical appearance of a gout attack is often so characteristic the diagnosis can be made on that alone.

What Treatment Might I Need For Gout?

Gout treatment falls into two categories – prevention and active treatment.

Measures that are helpful in preventing gout attacks include;

* a high fluid intake through the day

* losing weight

* controlling blood pressure

* avoiding purine rich foods

* strict control of the blood sugar if diabetes is present

Active treatment for acute gout attacks are based on the non-steroidal anti-inflammatory group of drugs (NSAIDs) and the commonest one used is called Indomethacin (or Indocid). In the short-term these are usually very safe, but can cause stomach acidity and ulceration if used for a very long time, or taken without food. After the attack settles, they are tailed off and stopped. Aspirin should be avoided during an acute attack, and people with a history of being allergic to aspirin should avoid NSAIDs because of the risk of an intense allergic reaction. In people suffering from repeated attacks of gout, treatment is aimed at keeping uric acid levels normal. The usual drug used to do this is called Allopurinol, taken on a regular basis, and this drug helps the kidney to remove uric acid from the blood more efficiently. It can however actually make an acute attack worse, and so should not be started until such an attack has settled. Popular home remedies include resting the affected joint, keeping it elevated and putting an ice pack on it regularly.

What Course Will The Illness Follow?

Most attacks will settle in a matter of days. With the correct treatment started early, and sensible dietary advice followed, most sufferers begin to feel their symptoms easing almost as soon as they begin their treatment.

Can I Do Anything To Help Myself?

The key things to do are connected with diet and lifestyle. A low-purine, high-fluid diet combined with a regular exercise programme for weight reduction will stop many attacks of gout from occurring. Many sufferers of gout always make sure they have a supply of Indomethacin in their house so they can begin these at the first sign of an attack, even before they see their doctor.

Tell Your Doctor

1. Have you had any such attacks before?

2. How bad is the pain?

3. What is your typical diet?

4. Does anyone else in your family suffer from gout?

5. Do you have a high alcohol intake?

Ask Your Doctor

1. Could any of my other tablets I take cause gout?

2. Am I likely to get repeated attacks?

3. What are the side effects of drugs such as Indomethacin and Allopurinol?

4. Am I allowed to work during an attack of gout?

5. Where can I get dietary advice about what to eat?

Useful Contacts:

Patients Association

Address: PO Box 935, Harrow, Middlesex, HA1 3YJ

Telephone: 0181 423 8999

Helpline: 0181 423 8999

Website URL: patients-association.com

Author Provides Free Medical Information And Medical Advice On A Variety Of Topics.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

What Is Heartburn?

Heartburn is a type of indigestion where acid from the stomach rises up your gullet (oesophagus), the tube that carries food from your throat to your stomach.

Overeating is a common cause of heartburn, as are alcohol, smoking and rich or spicy foods. Stress, worry and rushed meals can all make heartburn worse by increasing the production of stomach acid. Other triggers for heartburn are lying down after eating and pressure on the stomach from being overweight or pregnant, wearing tight clothes or bending over.

Like indigestion, recurrent heartburn may in some cases point to a stomach ulcer. Ulcers can develop if too much acid or an infection with the Helicobacter pylori bug damage the stomach wall. Some medicines, such as aspirin, can hurt your stomach lining as well.

Heartburn may also be a sign of a hiatus hernia, where part of your stomach protrudes into your chest. This weakens the valve at the top of the stomach that normally prevents food and acid from escaping into the gullet.

How Do I know If I Have Heartburn?

A burning feeling in your chest and upper stomach, sometimes extending to your throat, is normally a sign of heartburn.

Other symptoms include a sour, acid taste at the back of your mouth and excessive wind or belching. Sometimes you may find it painful taking in certain foods and drinks.

What Can I Do Immediately To Make My Heartburn Better?

• Steer clear of large meals, spicy foods, alcohol, coffee, cigarettes and anything else that brings on your heartburn. Both coffee and smoking relax the valve that stops stomach acid from rising into your gullet.

• Do not go without eating for long periods, as this increases the level of acid in your stomach.

• Instead, eat small amounts at regular intervals and chew your food well.

• Do not go to bed for at least an hour after eating. If your heartburn is particularly bad at night, prop yourself up with extra pillows or raise the bed-head a little. Sleeping on your left side will help your stomach to empty.

• When you have eaten, try to stay upright for at least an hour and do not bend over.

• Try to lose weight if that is the problem. Avoid wearing tight clothes around your stomach.

• Milky drinks, particularly taken at bedtime, should help to soothe the acid in your stomach.

• Think about whether stress may be contributing to your heartburn or indigestion.

• Do not take painkillers – especially aspirin – or other anti-inflammatory drugs (e.g., for rheumatism) unless you absolutely have to.

• Ask your pharmacist about medicines for relieving heartburn.

What can I do generally to avoid getting heartburn?

• Eat regularly and in moderation. Do not overdose on spicy foods, coffee, alcohol, etc.

• Give up smoking or at least try to cut down.

• Try not to rush your meals or to keep getting up and sitting down while you are eating.

• Get to bed on time and not too soon after eating.

• Keep your weight down and your stress levels manageable.

What Treatments Can I Buy Without A Prescription For Heartburn Remedy?

Your local pharmacist will be able to recommend a product for your particular symptoms of heartburn or indigestion.

So-called rafting agents which form a protective layer or raft on top of the stomach contents are particularly suitable for heartburn. They sold as tablets liquidssometimes combined with an antacid neutralises acid. Antacids most widely used remedies indigestion.

You can also buy newer treatments that cut down the amount of acid produced in your stomach. Some of these products can be taken in advance to prevent heartburn or indigestion. Make sure you follow the label directions carefully on these and other indigestion remedies.

Medicines for heartburn and indigestion treatments should not be taken regularly without consulting a doctor.

When Do I Need To See A Doctor?

• If you are getting severe or persistent indigestion, particularly at night.

• If your indigestion is not helped by dietary changes or non-prescription treatments.

• If you have stomach pains that get worse after eating.

• If you lose your appetite or your weight drops unexpectedly.

• If you have problems swallowing.

You Should Consult A Doctor Immediately If:

• You are vomiting repeatedly or vomiting blood.

• You feel weak or faint.

• After a bowel movement your stools look very dark or black.

In Summary …

• Avoid spicy food, alcohol, coffee, etc.

• Give up smoking or cut down.

• Eat regularly and in moderation.

• Do not eat too close to bedtime.

• Try not to get too stressed.

• Do not take aspirin or other anti-inflammatory drugs unless you have to.

• Ask your pharmacist about treatments for heartburn.

• See a doctor if you still have heartburn after changing your diet or taking non-prescription treatments.

Author Provides Free Medical Information And Medical Advice On A Variety Of Topics.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

They are sometimes associated with nausea or vomiting and can be sufficiently severe to stop any attempt at work or other activities. Many migraine sufferers are forced to seek out a quiet, darkened room where they can rest until the headache has passed. Migraine headaches come and go unpredictably and many sufferers cannot predict when the next attack is likely to occur. There are now a number of very good forms of treatment and you should ask your GP for advice about sensible use of medication to treat attacks.

What Causes Migraine?

The pain and other symptoms of migraine are due to changes occurring both within the brain itself and in the blood vessels and other tissues that surround the brain. The migraine comes from the swelling and bruising of these blood vessels and tissues. But it is not understood what mechanism starts each attack. You may have inherited a predisposition for migraines from one or both of your parents, as migraines tend to run in families. However, some people who suffer from migraines have no other family members who are affected.

Trigger Factors For Migraine

You may already be aware that certain things are likely to trigger a migraine attack. Common triggers include certain foods, alcohol, hot weather, changes in sleep (either too much sleep or lack of sleep), stress and neck pain. Women often find that migraines are triggered by their menstrual cycle. If you have not thought about looking for triggers, you should keep a diary of when your migraines started and the foods you ate, as well as activities you did in the few hours before each attack. After keeping this diary for two or three months, you can look back and see if there is any consistent pattern that may indicate a trigger which can be avoided in the future. Unfortunately, many people find that triggers only account for a small percentage of their migraine attacks.

Lifestyle Factors

Stress, overwork and irregular sleep patterns (that occur, for example, with shift work) are common triggers that increase the number of migraine attacks. Migraines often occur at the end of a stressful period, for example, you may find that your migraines occur when you go away on holidays or, if you work Monday to Friday, they may occur on the weekend. The best treatment for this problem is to recognise and reduce the stress and anxiety in your life. A daily program of relaxation (for example, listening to relaxation tapes, performing yoga or having a massage) can be very helpful.

Treatment Of An Attack Of Migraine

There are simple measures that can be used early in a migraine attack which can be helpful in relieving some of the symptoms. These measures include lying down in a quiet, darkened room, using hot or cold compresses or sensible use of painkillers such as aspirin or paracetamol. However, this is often not enough to relieve severe migraine symptoms. Ask your GP about specific medications that are very effective in treating migraines. Nausea is very common during migraines and is a sign that your stomach will not absorb medication efficiently (you may even vomit it up). This is why early treatment of an attack is so vital. Your GP can advise you about medication.

Prevention Of Migraine

If you get a migraine more than once or twice a week you may need preventative medication. Using painkillers more than a few times per week is not recommended as over time, this can lead to the development of analgesic or ‘rebound’ headaches which are headaches that are triggered by the use of painkillers. You should ask your GP for advice about suitable preventative medication if your migraine headaches occur this frequently.

Migraine In Children

Migraine can occur at all ages, even in children. Fortunately, it is uncommon for migraine to occur in children under the age of five. If your child has unexplained recurrent headaches, particularly if there is a history of migraine in the family, then you should seek advice from your GP. Occasionally, migraine can occur in children as recurrent stomach pain, without headache. As the child grows older, the stomach pains subside and may be replaced by headaches. Many children outgrow their migraine headaches.

Managing Migraine

* Look for triggers that may be causing your migraines and adjust your lifestyle to avoid them

* Start a daily program of relaxation to reduce the number of attacks you suffer

* Seek advice about the best medication to use and take your medicines early in the attack so they have the best ehance of working

* Explain to your friends and workmates what a migraine is like so that they can understand how the attacks affect your life

Useful Contacts:

British Brain and Spine Foundation

Address: 3.36 Canterbury Court, Kennington Park, 1-3 Brixton Road, London, SW9 6DE

Telephone: 020 7793 5900

Fax: 020 7793 5939

Email: info[at]brainandspine.org.uk

Website URL: brainandspine.org.uk

The Pain Research Institute

Address: Clinical Sciences Centre, University Hospital Aintree, Lower Lane, Liverpool, L9 7AL

Telephone: 0151 529 5820

Fax: 0151 529 5821

Contact Name: Mr D Emsley

Email: pri[at]liv.ac.uk

Website URL: liv.ac.uk/pri/

Migraine Action Association

Address: 4th Floor, 27 East Street, Leicester, LE1 6NB

Telephone: 0116 275 8317

Email: info[at]migraine.org.uk

Website URL: migraine.org.uk

PMS Help

Address: PO Box 83, Hereford, HR4 8YQ

The Migraine Trust

Address: 52-53 Russell Square, London, WC1B 4HP

Telephone: 0207 631 6970

Fax: 0207 436 2888

Email: info[at]migrainetrust.org

Website URL: migrainetrust.org

The Neurological Alliance

Address: 165 Queen’s Gate, London, SW7 5HE

Telephone: 0207 584 6457

Email: admin[at]neural.org.uk

Website URL: neural.org.uk

Email: info@neurologicalalliance.org.uk

Website URL: neurologicalalliance.org.uk

Author Provides Free Medical Information And Medical Advice On A Variety Of Topics.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

Exercise will:

* stimulate your metabolism – enabling you to maintain or lose weight more easily

* burn off unused adrenaline – relieving tension and giving your body a chance to let off steam

* make your muscles stronger – particularly the heart muscle, which is the most important muscle in the human body, which will

* reduce your risk of developing heart disease.

If you have had a heart attack a graded series of exercises can be prescribed to help you become fit again. Regular exercise reduces the level of fats in the blood so that your arteries are less likely to clog up; and it tightens the ligaments in the chest and pelvis.

If you have heart or lung disease then, over a period of time, regular exercise will improve your ability to live as full a life as possible.

In childhood and young adult life, regular exercise helps build bones. In later life it helps to protect these bones and to prevent the development of osteoporosis.

Children with asthma should be encouraged to exercise regularly since this will improve their breathing.

Even people with arthritis can benefit from sensible levels of exercise.

If you are overweight or obese then regular exercise is an essential part of every weight-loss programme. However, exercise must be taken in conjunction with diet and changed behaviour as it is extremely hard to lose weight by exercise alone. Nevertheless, if you are attempting to lose weight, regular exercise will stimulate your metabolism and help to burn off unnecessary fat.

Perhaps most importantly, regular exercise makes you feel better about yourself:

* Your body shape will grow tauter as the muscles tighten

* You will grow in confidence

* You will look better

* You will be more mobile

* You will feel more comfortable in your clothes

It is not necessary to visit a gym or to go jogging to take part in worthwhile exercise. Most people can get adequate exercise simply by increasing their normal activities, for example:

• climbing the stairs rather than going by lift

• walking or cycling to work or to school

• walking daily to the local shops rather than going by car to a supermarket once a week

• taking up walking as a weekly exercise

• avoiding using the car or bus for short journeys

• mowing the lawn regularly by hand

This type of exercise has the advantage that it can easily be fitted into a normal daily routine and it can be gradually increased according to a person’s level of fitness.

Modern 21st century life has for many people, removed the necessity for many ordinary everyday exercises. The availability of car travel; loss of school sports fields; increased time spent at work and less at play; the costs of taking part in sports – all have meant that the population now takes less exercise than it did 20 years ago. In the United States, the average American walks less then 150 yards per day.

It is this loss of everyday exercise that is blamed by many for increased numbers of heart attacks and strokes, for increased levels of obesity and overweight in the population; and for the growing problem of osteoporosis (a cause of bone fractures) in later life.

Many people will wish to take more vigorous exercise and to dedicate specific time to getting fit. Different activities require different levels of stamina. If you are unfit or if you are more than 55 years of age, then it is important to begin with an activity which requires a lower level of stamina.

Physical Activity: health benefit rating

One star Two star Three star Four star

Cricket Badminton Canoeing Cycling (hard)

Dancing Gymnastics Climbing stairs Jogging

Golf Judo Dancing (disco) Rowing

Weightlifting Mowing lawn (by hand) Digging garden Swimming (hard)

Yoga Tennis Football Water skiing

Sailing Walking (briskly) Hill walking Ditch digging

Bowling Horse back riding Roller skating Hand ball

Housework General gardening Squash Volley ball

Activities that have the most beneficial effect upon health are activities in which the increase in heart rate is sustained over a prolonged period – known as aerobic exercises. Activities that involve shorter bursts of energy for short periods of time are less beneficial – known as anaerobic exercises. If you are unsure what level of activity you should begin with, please discuss it with your practice nurse or doctor. Also your local gymnasium is likely to provide a pre-fitness assessment and advice.

Different types of exercise use different amounts of energy. The calorie and food equivalent of different types of exercise is shown in this table.

Activity Energy expended / Hr in kilocals Food equivalent expended / Hour

Driving a car 80 Slice of bread

Standing relaxed 100 Glass of white wine

Standing doing light work 180 Bag crisps

Walking 5km/hour 260 1.5 pints of beer

Walking 7 km/hour 420 2.5 oz peanuts

Running 9 km/hour 600 2 Mars bars

Swimming (crawl 50 metres/min) 840 6 chocolate digestive biscuits

Cross country Skiing (competitive) 1440 Roast dinner with sponge pudding

Once you have found a form of exercise you enjoy, then try to do it: often enough – 2 or 3 times a week for 20-30 minutes at a time hard enough – to make you fairly breathless but not gasping for breath long enough – it should become part of your life, for good!

Aerobic and anaerobic exercise Aerobic exercise is better for your health than anaerobic exercise. In aerobic exercise, the energy burning requirements of your body are balanced by the amount of oxygen you are breathing in. Your heart rate will be steady, your metabolism balanced and you will be able to sustain the activity for a long period of time.

If you exercise too fast, then your muscles will start to anaerobically. You will then be burning energy faster than your blood can carry oxygen to the muscles. Because of this toxic waste products (lactic acid) will form. Your muscles will begin to tire. Your heart rate will increase and within a short time you will have to stop exercising. This sort of exercise is not as good for your health as aerobic exercise.

The easiest way to tell when your muscles are starting to work anaerobically is by measuring your heart rate. It stay aerobic, you should aim to keep your heart working within the ideal target heart rate zone.

You can calculate your ideal heart rate zone using a special formula known as the Karvonen formula (shown below).

Your maximum heart rate = 220 – (Your age)

Your ideal target heart rate training zone is a percentage of this maximum permitted heart rate – usually between 70 and 80 percent. So a 40 year old person who is fit and who exercises regularly could work at between 70 and 80 percent of this permitted maximum heart rate.

Ie: Maximum Heart rate = 220 – 40 = 180

Training HR Zone = (180 times 70% = 126) to (180 times 80% = 144)

This means that this person should exercise so as to keep the heart rate between 126 and 144 if they wish to stay within the aerobic zone.

If the person is unfit then 20 should be subtracted from the 220 in the Maximum Heart rate formula.

NOTE: The average adult resting heart rate is 60 to 90 beats per minute. The lower the heart rate, the less work the heart has to perform for any given level of exercise. Not everyone is fit when they start exercising and this formula needs to be modified to suit individual circumstances. Your local gym, nurse or doctor will be able to provide more specific advice on how to begin your exercise programme.

Heart rate monitors with digital readouts are available at most gymnasia. Body monitors can be worn whilst taking part in sports like jogging.

Tell Your Doctor

1. If you are thinking of starting an exercise programme

2. If you have had any serious illnesses which might affect you taking exercise

3. If you have had any untoward events while taking exercise (for example breathlessness, chest pains and dizzy spells)

Ask Your Doctor

1. What sort of exercise would be good for you

2. If there are any special precautions you should take

3. Where there is a local fitness centre

4. If there is a special rehabilitation centre in your area, if you have had a specific illness

Author Provides Free Medical Information And Medical Advice On A Variety Of Topics.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

This is an infection of the base of the nails, caused by various fungal infections. The medical term for this is onychomycosis, and the usual fungal infection involved is called the dermophytes. It is an extremely common problem, affecting hundreds of thousands of people in the UK alone. It becomes more common with increasing age.

What Causes Fungal Nail Infection?

The dermophyte fungal infection thrives in moist conditions, such as those found in the feet. Any situation where people are walking around barefoot and in damp conditions is an area of risk for coming into contact with this fungal infection – examples include swimming pools and changing rooms. If there has been a recent injury to a nail, it makes that nail more prone to such infection, and certain diseases such as diabetes and circulation problems can mean it is more likely to suffer from fungal nails. Chronic infection with athlete’s foot may also predispose to it.

What Are The Signs And Symptoms Of Fungal Nail Infection?

Initially, the nail(s) become more yellowish or darker in colour, and often become thicker especially at the nail end. It may be more difficult to cut the nails easily, and small white marks may be scattered across the nail. There is usually no pain, but the thickened nail may begin to smell unpleasant. If the nail becomes extremely thick and hard to trim, there may be difficulty in walking without discomfort.

Will I Have Any Tests Or Investigations?

Although fungal nails are readily identified without needing any specific diagnostic tests, it is sometimes necessary to take some scrapings from under the nail and culture these in a laboratory for a few days. This allows the exact fungal organism to be identified so that the most accurate treatment can be begun quickly.

What Treatment Might I Need For Fungal Nail Infection?

This varies depending on the scale and severity of the problem. Simple, regular cleaning may prevent a very mild infection from spreading, and any white markings high up on the nail can be filed off. Simple anti-fungal over-the-counter liquid preparations can be painted onto the nail and these can be extremely effective if the fungus is fairly superficial. Chiropodists or podiatrists (foot specialists) may be needed to trim thick nails and provide the necessary simple cleaning of infected nails, but if the infection persists then medical advice should be sought.

New tablet forms of antifungal treatments have proved to be extremely effective against most cases of fungal nails and these are either taken on a regular basis, or as ‘pulses’ of treatment several weeks apart. If symptoms still persist, surgery may be required to remove the nail. This may be a temporary removal, allowing for antifungal treatment to be painted onto the nail bed, or permanent removal where the nail does not grow back. This is usually reserved for nails which are chronically painful and which has not responded to any treatment. This is done under local anaesthetic, and many GPs will do this themselves without the patient needing referral to hospital.

What Course Will The Illness Follow?

With oral treatment, most cases of fungal nail respond within 3 months. It is not unknown however for longer treatments of up to one year being needed in more stubborn cases. Milder cases usually respond within a few weeks of treatment.

Can I Do Anything To Help Myself?

There is a great deal which can be done here. A strict and regular pattern of foot hygiene is essential; daily washing with soap and water followed by careful drying is vital. Wear ‘shower shoes’ or ‘verucca socks’ when in public showers or swimming pools, and remember to change socks daily. Shoes should be of a ‘breathable’ material such as leather and when cutting toenails always cut straight across – never follow the curve of the toe. For women, nail polishes and varnishes can trap moisture beneath the nail and so make it more prone to infection but many women prefer to cover up infected nails with polish and so make the problem worse. Very tight hosiery also promotes the trapping of moisture as do tightly-fitting shoes.

Tell Your Doctor

1. How long have you had it?
2. What treatment have you tried yourself?
3. Do you use swimming pools/changing rooms/showers a lot?
4. Do you have any pain from your nails?
5. Do you find them harder to cut than previously?

Ask your Doctor

1. Do I need to have my own towels at home?
2. What are the side effects of any tablet treatments?
3. Will my nails look normal again?
4. Could it be a sign of any other illness?
5. Do I need chiropody or podiatry treatment?

Useful contacts

Patients Association
Address: PO Box 935, Harrow, Middlesex, HA1 3YJ
Telephone: 0181 423 8999
Helpline: 0181 423 8999
Website URL: http://www.patients-association.com

Free medical information published by Dr Vivienne Balonwu.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

What Are Piles?

Piles is the common term for haemorrhoids, which are swollen veins in and around the back passage (anus). Many people will develop piles at some time or another and, although highly uncomfortable, they are rarely cause for concern.

The most frequent cause of piles is constipation, where you have difficulty going to the toilet. The straining puts extra pressure on the haemorrhoidal veins in the anus. Piles can also develop during pregnancy and after childbirth, if you are overweight, and as a result of lifting heavy weights or standing/sitting for long periods.

Piles inside your back passage are known as internal haemorrhoids. They are generally less irritating than external haemorrhoids, which cluster around the opening to the anus and can making sitting difficult. In some cases internal piles may swell up to the point where they protrude or ‘prolapse’ outside the anus.

How Do I Know If I Have Piles?

The usual symptoms of piles are pain, itching or soreness around the anus, particularly when you go to the toilet, and bleeding after a bowel movement. You may be tipped off by blood on your toilet paper or in the lavatory pan. If haemorrhoids prolapse they may produce mucus around the opening to the anus.

External piles look a little like purple grapes and are felt as a soft lump or lumps around your anus. Prolapsing piles can be extremely painful if a clot forms inside the vein, making it hard for the growth to retreat back inside the anus.
What can I do immediately to make my piles better?

• If you are constipated, eat a varied, high-fibre diet (e.g., wholemeal bread, brown rice, bran cereals, pulses such as lentils, plenty of fruit and vegetables, pulses). Drinking lots of fluids (especially fruit juices) and taking regular exercise will also help your bowel movements.

• If you need to relieve the constipation straight away, you may want to use a ‘bulk-forming’ laxative, which will help soften your stools.
• Wear cool, loose-fitting clothing.
• Use soft toilet paper.
• Go to the toilet regularly if you can, and do not delay going when you get the urge.
• Try not to strain too much when you do go to the toilet.
• Do not scratch your piles as this will make them more uncomfortable.
• If the piles are protruding outside your anus, try to push them carefully back in (a warm bath and a lubricant will help).
• You can ease the pain, irritation and itching of piles with special creams, ointments and suppositories that you can buy in your local pharmacy.
• Applying an ice-pack to external piles will help relieve the pain and swelling. You can also soothe them by washing with warm water or using medicated wipes after going to the toilet. Make sure you then dry the affected area properly.

What Can I Do Generally To Avoid Piles?

• Take the steps recommended above to guard against constipation.
• Regular exercise will both aid digestion and lower pressure in the haemorrhoidal veins.
• Try to lose some weight if that is the problem.

What Treatments Can I Buy For Piles Without A Prescription?

Your pharmacy will have a variety of products for relieving the symptoms of piles. Many of them contain astringents or a local anaesthetic for soothing the pain and irritation of haemorrhoids and reducing the swelling.

A newer ingredient is the anti-inflammatory, hydrocortisone, which should not be used if you are pregnant, nor for more than seven days. Local anaesthetics can sometimes provoke an allergic reaction, so ask your pharmacist for advice.

You can buy these products as creams or ointments for rubbing into the affected area or as suppositories, which you insert into your anus. Suppositories are the best option for internal piles that cannot be reached with ointment or cream.

When Do I Need To See A Doctor?

• If your symptoms do not ease off despite treatment or are particularly painful.
• If you are not sure whether you have piles.
• If you are bleeding from your anus, especially if you also have stomach pain or have lost weight without knowing why.
• If your piles are particularly large.
• If you are over forty years old and have developed piles for the first time.

In Summary

• Eat a high-fibre diet, exercise and drink plenty of fluids to overcome or prevent constipation.
• Go to the toilet regularly and do not hold back.
• Use an ice-pack or special creams, ointments and suppositories to relieve pain and irritation.
• Talk to a doctor if you are worried about your symptoms.

Published on Free Medical Advice website by Dr Vivienne Balonwu.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

Cystic fibrosis (which is also known as mucoviscidosis) was first described in 1938. It is an inherited condition in which mucous producing glands throughout the body produce an abnormally thick and sticky form of mucous. Such glands are present in the lungs, the bowel and the testes. The thick mucous blocks the outlet from the glands – this causes the glands to dilate and become susceptible to infection and scarring. The glands cannot perform their normal function and eventually they become ineffective and subject to recurrent infections. Because of this combination of effects, cystic fibrosis causes problems with bowel function and with breathing. Males will have impaired fertility.

What Causes Cystic Fibrosis?

Cystic fibrosis is the most commonly inherited condition of childhood. One in 25 persons is a carrier and it occurs in about 1 in every 3000 births in the UK. Not all children born into a family will be affected since the condition is inherited in an autosomal recessive manner. This means that both parents need to carry the gene and even then, only one in four children will be affected. Both boys and girls are equally affected. To develop cystic fibrosis, a baby has to inherit two cystic fibrosis genes (one from its mother and one its father). If a baby inherits one cystic fibrosis gene (from either the mother or father) and one normal gene, the baby will be a ‘carrier’ and will not develop cystic fibrosis.

Cystic fibrosis is most common in Caucasians. It is uncommon in Asians and in Africans.

What Are The Signs And Symptoms?

There Are Three Different Presentations Of The Cystic Fibrosis Disease:

1. Meconium Ileus:

This form presents at birth with a paralytic obstruction of the bowel, which sometimes perforates. It is caused by blockage of the bowel by the abnormal mucous produced by glands in the bowel wall. The perforation may occur while the baby is still in the mother’s womb, giving rise to peritonitis at the time of birth.

2. Gastro-intestinal:

This form of the disease is usually first noticed between three and eighteen months of life. Because there is a lack of digestive enzymes there is reduced absorption of foodstuffs, particularly fat, fat-soluble vitamins and protein. There is likely to be diarrhoea (loose, pale, fatty and offensive stools often containing undigested meat and starch granules) and a general failure of the baby to grow properly. Sometimes there may be a small hernia at the tummy button or a prolapse (the sinking down or falling down) of the rectum seen at the anus.

3. Respiratory:

Sooner or later respiratory infections occur because of lack of protective mucous and infection of the glands in the breathing tubes themselves. There is sometimes collapse of a lung, widening of the air-spaces (emphysema) or pneumonia. This group of respiratory symptoms usually start between six and eighteen months of life and may overlap with bowel symptoms.

Will There Be Any Tests Or Investigations?

People with cystic fibrosis produce more concentrated sweat than normal individuals and a ‘sweat test’ is usually used to make the diagnosis. The test is simple, takes only a short time and is usually performed twice. A small amount of a chemical called pilocarpine is placed on the skin. This causes sweating and the sweat is collected for measurement using a special absorptive dressing. In children with cystic fibrosis the concentration of sodium salt in the sweat is usually above 60mEq/litre.

The diagnosis can be further confirmed by passing a small tube down the throat, through the stomach, and into the duodenum. From there, digestive juices can be sampled. In cystic fibrosis, this juice is thicker than usual and lacking in the normal digestive enzymes. This is not a hard-and-fast rule however, since normal children may show low levels of digestive enzymes if they have had a recent bowel infection. Other more sophisticated blood tests can also be used to confirm the diagnosis. If the diagnosis is suspected at birth, blood from a heel prick may show an elevated level of an enzyme called trypsin.
Mothers who have had one child with cystic fibrosis will be offered screening tests during subsequent pregnancies to determine whether the child they are carrying is also affected. It is also possible to screen member of the population using cells from the lining of the mouth to determine whether they are carriers of cystic fibrosis.

What Treatment Might Be Necessary For Cystic Fibrosis?

Children with cystic fibrosis should receive at least part of their treatment in a specialist centre where regular monitoring of lung function, digestion and general condition can take place.

If the child is lacking in digestive enzymes, these can be given in the form of granules or capsules with meals. 5-15 grams of these enzymes (known as pancreatin) can be given each day according to the child’s age and this can improve digestion and absorption of protein, fat and other food substances. To make nutrition more successful, the child’s diet should be made as nourishing as possible with a high protein content. Fatty foods should be avoided but supplements of vitamins and minerals (particularly iron) are useful.

Every effort needs to be made to reduce the likelihood of respiratory symptoms and to treat these early and effectively when they occur. These days, the management of children with cystic fibrosis usually takes place at least partly in specialist centres where parents will be taught how to perform regular chest physiotherapy and postural drainage; how to recognise the early signs of infection, and what to do should this occur. A small and restricted choice of antibiotics is usually recommended for use in cystic fibrosis, in an attempt to reduce the likelihood of resistance to these antibiotics emerging in each individual patient.

Because absorption by mouth is often impaired by bowel problems, antibiotics are sometimes given by nebuliser. An aerosol of the antibiotic is breathed in by the patient over 15 to 30 minutes. Alternatively therapy can be delivered directly into the bloodstream through a long-term indwelling catheter. These days these are easy to use and well tolerated. A new treatment called recombinant Dnase (rhDNase) can be used by nebuliser to break down the thick mucous and reduce the frequency of respiratory infections. Oxygen therapy from a portable cylinder may be needed during severe lung infections.

Because of improved management, patients with cystic fibrosis are now living much longer than ever before and a number of other long-term conditions are emerging. They include diabetes, liver problems, infertility in men and osteoporosis. Each can be treated if and when it occurs.

What Course Will The Illness Follow?

At the present time cystic fibrosis is not curable and treatment is supportive so as to optimise nutrition and growth and prevent recurrent respiratory infections. With modern treatment, children with cystic fibrosis can look forward to many years of enjoyable and high quality life. It is anticipated that 85 percent of children with cystic fibrosis will live to at least 50 years of age.

In some cases, lung problems may become severe. In this situation, lung transplant has revolutionised the outlook. There are other reasons to be optimistic. The gene which is responsible for cystic fibrosis has recently been identified and there is hope that, in the future, new genetic techniques may enable us to develop improved ways of managing the condition or perhaps even finding a cure.

Tell Your Doctor

• if you have had any relatives who have had children with an inherited condition like cystic fibrosis

• if you have any concerns regarding your pregnancy

• if you have any concerns regarding your child’s growth

• if your child has any persistent breathing or bowel symptoms

Ask your doctor

• if there is a genetic counselling service in the area

• where the local child development clinic is held

• to ensure your child receives all the normal childhood immunisations including BCG

• where you can get your child weighed and measured regularly

• the telephone number of the health visitor

This article on medical information is by Dr Vivienne Balonwu on the free medical information website, http://www.viviennebalonwu.com.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

These are fluid-filled bags or sacs, usually very small although they can become quite large, which are within a woman’s ovaries. All ovarian cysts contain fluid to some degree.

What Causes Ovarian Cysts?

There are a number of reasons why some women should have cysts yet others have not. The commonest one is due to what is known as a follicular cyst. A follicle is a normal part of egg development, and is the fluid-filed sac that contains an egg. This usually bursts to release the egg but on occasions it may not, and continues to grow but then usually settles by itself over a period of weeks to months. Conditions such as polycystic ovary syndrome predispose women to growing ovarian cysts, and there may be cysts with blood in them – called haemorrhagic cysts – which are due to the leaking of blood from small blood vessels into an egg sac. Very occasionally, ovarian tissue grows abnormally to form cysts with other body tissue in them such as hair or teeth. These are known as dermoid cysts.

What Are The Signs And Symptoms Of Ovarian Cysts?

Most women with ovarian cysts have no symptoms at all. If symptoms do occur, pain in the lower abdomen or pelvis, sometimes worst around mid-cycle is common. Large cysts can twist on themselves and so affect the blood supply to them causing pain. Cysts that rupture may cause severe pain or discomfort at the time, and in polycystic ovaries there may be weight gain and skin hairiness too.

Will I Have Any Tests Or Investigations?

Yes. Ovarian cysts are diagnosed by ultrasound scans, which are painless and identical to ones pregnant women have. Very large cysts can sometimes be felt by examining the abdomen but this is uncommon. Blood tests, such as a CA-125 test can evaluate the potential of a cyst to become malignant, especially if there is a strong family history of ovarian cancer, but this test can be flawed. Women with an elevated CA-125 may have no cancer whereas a normal level need not exclude cancer, so it must always be used in association with ultrasound scans.

What Treatment Might I Need?

Most cysts require no treatment. Any cyst which is causing persisting symptoms, is enlarging or which causes concerns medically is removed surgically. This is usually through a keyhole, or laparoscopic incision and only requires a larger scar if the cyst is too large to remove otherwise.

What Course Will The Illness Follow?

Ovarian cysts usually resolve spontaneously and cause no problems. The main problems requiring medical treatment include rupture of the cyst, bleeding into the cyst or twisting round on itself to cut off its blood supply.
Can I do anything to help myself?
It is important to report any unusual abdominal pain, especially if this is around the time of ovulation, and any abdominal swelling should never be ignored. If there is a strong family history of ovarian cysts or tumours it is sensible to ask your doctor whether regular scans or blood tests may be useful in your particular case.

What To Tell Your Doctor

1. Do you know of any family history of ovarian problems?
2. Have you noticed any swelling of your abdomen?
3. Do you have any abdominal pain?
4. Are your periods regular?
5. Do you have any unusual vaginal bleeding?

What To Ask Your Doctor

1. Do simple ovarian cysts ever turn cancerous?
2. Is my fertility affected by ovarian cysts?
3. Is it safe for me to be on the contraceptive pill?
4. Can I still get ovarian cysts if I have had a hysterectomy but still have my ovaries?
5. Will I need regular check-ups as I get older?

Published by Dr Vivienne Balonwu at her Free Medical Advice website.

Useful Contacts: The Patients Association. Address: PO Box 935, Harrow, Middlesex, HA1 3YJ. Telephone: 0845 608 4455 and 0208 423 8999. Website URL: patients-association.com.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

Amnesia is a term used to cover the partial or complete loss of memory. It is most often a temporary condition and covers only a part of a person’s experience, such as immediate memory.

The main types of amnesia are:

Anterograde amnesia: People who find it hard to remember ongoing events after suffering damage to the head. They do not tend to forget their childhood or who they are, but have trouble remembering day-to-day events.

Retrograde amnesia: People who find it hard to retrieve memories prior to an incident in which they suffer damage to the head. Sometimes people never remember the seconds leading up to the incident.

Korsakoff’s psychosis: Memory loss caused by alcohol abuse. The person’s short-term memory may appear normal, but they will have severe problems recalling a simple story, lists of unrelated words, faces and complex patterns. ‘Confabulation’, where sufferers make up stories to fill the gaps in their memory is typical of this type of amnesia. This tends to be a progressive disorder and is usually accompanied by neurological problems, such as uncoordinated movements and loss of feeling in the fingers and toes. Even after 5 years of abstinence from alcohol, memory can still be affected.

Traumatic amnesia: This follows brain damage caused by a severe non-penetrative blow to the head, such as in a road accident. It can lead to anything from a loss of consciousness for a few seconds to coma.

Infantile/childhood amnesia: This refers to a person’s inability to recall events from early childhood. There are many theories on this, for example, Freud put it down to sexual repression but modern research has disputed the existence of such ‘buried memories’.

Transient global amnesia: This covers episodes of amnesia mostly linked to psychological trauma but sometimes following a medical procedure or vigorous exercise. Typically, it causes repetitive questioning and sometimes confusion but the person knows who they are. It lasts for 4-12 hours with a full recovery. If there is a loss of personal identity, then this is known as a fugue amnesia and due to severe psychological trauma. Usually, the memory comes back slowly or suddenly a few days later, although memory of the trauma may remain incomplete.

Treatment varies according to the type of amnesia and the suspected cause. Anyone suffering any symptoms of amnesia should seek medical attention.

Author. Medical Advice By Vivienne Balonwu, Free Medical Advice Online.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

Iron is needed to make haemoglobin. A shortage of iron is the most common cause of anaemia in the UK, known as iron-deficiency anaemia. This may be due to blood loss, either sudden – when a stomach ulcer bursts, for example – or over time, such as when a woman has heavy periods. After blood loss the body needs more iron in order to make more haemoglobin and blood cells. A lack of iron may also be due to a dietary deficiency.

Pregnancy is a time when the body may become lacking in iron such that anaemia develops.

As well as iron, vitamins B12 and folic acid are also needed to make properly functioning red blood cells, and anaemia may be caused by a shortage of these nutrients. Sometimes, especially as people get older, they become less able to take vitamin B12 in to the body from the food they eat and so they become anaemic. This can also happen because of an autoimmune disease which damages the stomach, and then the problem is called pernicious anaemia.

Red blood cells are made in bone marrow, so if this is damaged and can’t function properly a shortage of good red blood cells results. This is the case in a rare form of anaemia called aplastic anaemia, and with leukaemia.

In some conditions, red blood cells mature and are destroyed by the body too quickly. This type of anaemia is called haemolytic anaemia and is often caused by an inherited condition, such as sickle cell anaemia. Blood cells may be destroyed by mechanical devices implanted in the body such as heart valves.

People with chronic diseases may also suffer with anaemia, such as:

Cancer, Inflammatory bowel disease, Kidney failure, Rheumatoid arthritis

What are the symptoms?

Some people with anaemia don’t have any symptoms for months. When symptoms do appear, common ones include lethargy, weakness, dizzy spells and feeling faint.

As the anaemia becomes more severe, shortness of breath, palpitations, headaches, sore mouth and gums, and brittle nails may cause problems. People may look pale and find that others around them notice they’re looking peaky.

Anyone can suffer with anaemia. Most often it affects women of childbearing age, men and women over 75, growing children and teenagers. Usually it’s because their diet doesn’t contain enough iron, vitamin B12 and folic acid.

Pregnant women must watch out for anaemia and vegetarians must ensure they get enough iron from food other than meat.

Anaemia also becomes more common with age because the stomach becomes less efficient at producing a special chemical called ‘Intrinsic factor’ which is needed to transport vitamin B12 into the body.

Anaemia is uncommon in newborn babies but may result from haemorrhage (including from the placenta), transfusion between twins in the womb and breakdown of blood in rhesus disease, and other blood group incompatibilities between mother and foetus.

After the newborn period, the most common cause of anaemia in children is iron deficiency caused by an inadequate diet. Iron deficiency is more common in premature babies, deprived populations or developing countries. It’s also important to look out for it in teenage girls who’ve started their periods.

Anaemia from blood loss is less common but may occur from repeated blood sampling in sick babies, or from parasitic infections such as hookworm.

Children with anaemia, like adults, may appear pale, tired and short of breath. Another sign of iron deficiency in children is pica – the inappropriate eating of non-food material such as soil or chalk. Iron deficiency may also affect brain development and lead to behavioural and intellectual problems (which are reversible with treatment).

Other symptoms may reflect the causes of anaemia and include, for example, jaundice, weight loss or sickle cell crises.

Treatment depends on the cause of the anaemia, so this should be explored first. Reversible causes should be treated. If the anaemia is due to a lack of iron, eating iron-rich food may be all that’s needed.

Foods that are rich in essential nutrients include:

Iron – red meat, liver, green vegetables, eggs, dried apricots, sardines, spinach, fortified breakfast cereals, wholemeal bread

Vitamin B12 – meat, poultry, fish, eggs, milk, cheese, fortified breakfast cereals

Folic acid – wheatgerm, broccoli, green cabbage, pulses, nuts, yeast extract

It’s also important to have plenty of vitamin C because it helps the body to absorb iron from the diet.Sometimes it’s advisable to take iron supplements to speed up the process, but always get medical advice first for children. Never give children adult iron tablets unless your doctor tells you to. Some people need folic acid supplements.

In older people or those with pernicious anaemia, vitamin B12 tablets are not effective because the body cannot absorb the vitamin through the gut. So it must be given as a regular injection into the muscles once every few months.

When the anaemia is more severe, a blood transfusion is often necessary.

Author. Medical Advice By Vivienne Balonwu, Free Medical Advice Online.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

Although the cause of Ankylosing Spondylitis is not fully understood, genetic factors play a part, and the condition may be triggered by some sort of environmental event (such as a viral infection) occurring in someone who is genetically predisposed.

A number of genes have been identified as possibly to blame. It’s been known for some time, for example, that there is a link between Ankylosing Spondylitis and people with a certain blood type called Human Leukocyte Antigen B27 (HLA B27), indicating a genetic link.

The underlying process involves episodes of inflammation affecting the joints of the spine, as well as other joints such as the pelvis, hips, ribs, feet, shoulders, knees, wrists and ankles. The inflammation particularly occurs at the points where ligaments and tendons attach to the bone. As the inflammation subsides, new bone grows, replacing the elastic tissue of the tendons and ligaments and so making the joints stiff or fused together.

In some cases of Ankylosing Spondylitis, other parts of the body such as the eyes, bowel, lungs and heart may be affected.

Ankylosing Spondylitis may cause lower back pain that can spread and be felt in the buttocks and thighs, lower back stiffness. Other symptoms include tiredness, weight loss and a mild fever.

Pain and stiffness in the affected joints are usually worse early in the morning and after resting, but improve with exercise as the day progresses.

Because the spine loses its normal shape, people may find their back becomes bent forwards. This can make walking and moving around painful and difficult.

If the ribs and chest wall become stiff or fused, then it may become more difficult to breathe in and the affected person may rely on moving their diaphragm to shift air in and out of the lungs. They may find it harder to get over colds and respiratory infections.

AS usually starts in the late teens and early 20s. Men are affected more than women.

It’s not possible to prevent Ankylosing Spondylitis, AS and there’s no cure. However, people with AS can prevent further problems by sticking to a healthy weight, eating a diet rich in calcium, vitamin D and protein, and avoiding contact sports that may damage the joints.

Physiotherapy that includes back and breathing exercises helps to keep the spine and joints strong. Keeping active and taking regular exercise is key to keeping symptoms under control, improving posture and preventing spine deformities.

Paracetamol or anti-inflammatory medication, such as ibuprofen, are used to relieve pain and inflammation. More powerful anti-inflammatory drugs such as steroids may be recommended, especially during acute flare-ups of the condition. Other more powerful drugs that are sometimes used include anti-TNF therapy and Disease Modifying Anti-Rheumatic Drugs (DMARDS).

In serious cases, surgery may be needed, especially to replace damaged joints or correct the shape of the spine.

Unlike most inflammatory conditions, many people find their ankylosing spondylitis gets much better as they get older.

Author. Medical Advice By Vivienne Balonwu, Free Medical Advice Online.

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The term anaesthesia is derived from the Greek (an-aisthesis) meaning “without feeling”.

Most major and many minor operations in the UK are carried out under general anaesthesia where patients are completely unconscious, pain free and unaware of events.

How do anaesthetics work?

Anaesthesia can be induced and maintained by drugs injected into a vein (intravenous anaesthesia) or by the use of anaesthetic gases inhaled by the patient (inhalational anaesthesia). These methods are often combined.

General anaesthesia has been in use for over 150 years but, amazingly, we still lack a comprehensive explanation as to how the various drugs act on the brain to cause loss of consciousness.

The wealth of clinical and research based knowledge that has accumulated, however, makes anaesthesia a safe and well-tolerated process.

Who administers and controls general anaesthetics?

In the UK qualified doctors administer anaesthesia, assisted by technicians.

For major surgery your anaesthetic will be conducted or closely supervised by a consultant anaesthetist.

Specialist training to become a consultant in anaesthesia takes a minimum of six years.

What will my anaesthetist need to know at the pre-operative visit?

Your anaesthetist will ask about your past and present health, smoking habits, alcohol consumption and any medicines you are taking.

It is also important for the anaesthetist to know of drug allergies and whether you, or members of your family, have had an abnormal response to an anaesthetic.

This is because there are rare, inherited conditions, where individuals react abnormally to anaesthetic drugs or paralysing agents (muscle relaxants).

More commonly patients may say they feel excessively “sick” after anaesthetics, in which case a plan can be put in place to minimise these side effects.

The anaesthetist needs to know the state of your teeth and whether you have dentures, crowns or loose teeth.

An airway device is placed in the mouth even for short anaesthetics and for major surgery a tube is placed into the airway below the larynx.

Damage to teeth can therefore occur, but can be avoided if the anaesthetist is forewarned of problems.

Will the anaesthetic procedure be explained to me?

Yes. Treatment to alleviate pain and sickness after surgery will be discussed.

If you are scheduled for major surgery involving pain relieving techniques such epidural anaesthesia (local anaesthetic drugs injected via a catheter placed near the spinal cord) then the relative risks and benefits will be explained.

Other issues such as the possibility of blood transfusion will also be discussed.

For any routine operation patients are asked not to eat solid food for at least six hours prior to surgery.

Water is allowed up until two hours before. Most medications are continued up until the time of surgery and can be taken with sips of water.

Certain drugs, particularly those used to “thin the blood” and prevent clotting (eg: aspirin and warfarin) may need to be stopped before your admission to hospital and you will be advised of this.

Sedative drugs may be given to you an hour or two before surgery either as an intramuscular injection or, more commonly, in the form of tablets.

This sedation is termed the “pre-med” and it may help to relax you and alleviate anxiety. In practice most well informed patients do not require a “pre-med”.

Finally, the anaesthetist will explain how you will be anaesthetised.

Following the attachment of monitors to measure your blood pressure and monitor your heart beat plus oxygen levels an anaesthetic drug is injected into a vein at the back of the hand or in the lower arm.

At the same time oxygen will be administered by facemask, as a safety measure.

You will then drift off to sleep and wake up at the end of the procedure.

What are the risks?

Modern anaesthesia is very safe. Deaths occur in the UK in approximately one in every 200,000 anaesthetics administered.

Against the background that death by murder affects one in 100,000 people this seems an acceptable risk.

The overall risk for an individual undergoing surgery, however, relates to a number of factors including their pre-existing medical condition and the type of operation.

For example, the death rate for coronary artery surgery is currently 1-2%.

This is obviously the risk which is important to a patient, and far outweighs the risk of anaesthesia (by itself) in this situation.

Is there any chance I might wake up during the operation?

The chance of a patient being awake (ie: able to re-call events during an operation) is calculated to be approximately one in 1,000.

The risk that a patient will experience pain if awake is considerably less than this.

These risks are higher for operations such as caesarean section and emergency surgery in very ill patients, and so the overall risk for routine surgery is low.

Newer monitoring techniques for measuring the level of anaesthetic agents and the activity of the brain during anaesthesia are likely to reduce the risk of being “aware” in the future.

Can I improve my health prior to surgery?

It is important that medical conditions you have – for instance, diabetes, high blood pressure, asthma, chest pain – are investigated and treated appropriately before surgery.

You should continue any routine medicines unless specifically advised not to.

If you feel unwell before surgery, for example, if you have “flu” or a chest infection, you should notify your surgical team.

For routine surgery your health should be “as good as you normally expect it to be”.

It is important to stop smoking at least six to eight weeks before surgery.

This allows your respiratory tract to recover and will help your breathing during and after the anaesthetic.

Stopping smoking a day or two before operation is of little help.

If you are overweight reasonable loss of weight can be helpful and it is beneficial to cut down alcohol consumption.

Where can I find additional information regarding my surgery and anaesthetic?

Most hospitals have patient information leaflets for different operations.

Further information on all aspects of anaesthesia can be found on the Royal College of Anaesthetists’ website.

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Fatigue and lethargy are some of the most common complaints amongst adult patients. If you have symptoms such as tiredness, fearfulness, allergies, frequent influenza, arthritis, anxiety, depression, reduced memory, difficulties in concentrating, insomnia, worn-out, and the inability to lose weight after extensive effort you may be suffering from Adrenal Fatigue (technically known as hypoadrenia).

Adrenal Fatigue has a broad spectrum of non-specific, yet often debilitating symptoms. The onset of this condition is often slow and insidious. Patients are told that they are stressed and need to learn to relax more. Yes, we all know that “stress kills” to a large extent. But, the question is how?

The real truth is that stress and Adrenal Fatigue are not a mysterious entity at all. Our body has a built-in mechanism to deal with it. Being able to handle stress is a key to survival, and the control center in our bodies is the adrenal glands.

Adrenal Fatique Video

Adrenal Fatigue was first described in the medical texts in the 1800′s as a clinical condition. It was one of the most prevalent conditions, afflicting almost every adult in one way or another. Despite effective diagnostic tools and treatment programs, most conventional physicians were simply not informed of Adrenal Fatigue and not prepared to take Adrenal Fatigue as a serious threat to health. This condition was seldom diagnosed as a sickness for the past 50 years. Instead, Adrenal Fatigue was considered a condition whereby no treatment was available other than to tell the person to “relax” and take anti-depressants. This often makes the condition worse as the root cause is left unresolved. Over time, the condition worsens as the natural progression of this pathology takes its course. Adrenal Fatigue is not a medical condition recognized by mainstream institutions, though it is now being taken seriously by forward looking physicians.

Adrenal Fatigue should not be confused with another medical condition called Addison’s disease where the adrenal glands are not functioning. While Addison’s disease is often caused by an auto-immune dysfunction, Adrenal Fatigue is largely caused by stress along with a host of other factors. Adrenal Fatigue is the non-Addison’s form of adrenal dysfunction sub-clinically. Unfortunately, conventional medicine only recognizes Addison’s disease as hypoadrenia. As such, do not be surprised if your doctor is unfamiliar with this condition.

Signs and Symptoms of Adrenal Fatigue:

* Tendency to gain weight and unable to lose it, especially around the waist.
* High frequency of getting the flu and other respiratory diseases and these symptoms tend to last longer than usual.
* Tendency to tremble when under pressure.
* Reduced sex drive.
* Lightheaded when rising from a horizontal position.
* Unable to remember things.
* Lack of energy in the mornings and in the afternoon between 3 to 5 pm.
* Feel better suddenly for a brief period after a meal.
* Often feel tired from 9 – 10 pm, but resist going to bed.
* Need coffee or stimulants to get going in the morning.
* Cravings for salty, fatty, and high protein food such as meat and cheese.
* Increased symptoms of PMS for women; periods are heavy and then stop, or are almost stopped on the 4th day, only to start flow again on the 5th or 6th day.
* Pain in the upper back or neck with no apparent reason.
* Feels better when stress is relieved, such as on a vacation.
* Difficulties in getting up in the morning.
* Lightheaded.

Other signs and symptoms include:

* Mild depression
* Food and or inhalant allergies
* Lethargy and lack of energy
* Increased effort to perform daily tasks
* Decreased ability to handle stress
* Dry and thin skin
* Hypoglycemia
* Low body temperature
* Nervousness
* Palpitation
* Unexplained hair loss
* Alternating constipation and diarrhea
* Dyspepsia

If you have many of these signs and symptoms, and you have ruled out other organic pathologies, it is time to consider Adrenal Fatigue as a possible cause. None of the signs or symptoms by themselves can definitively pinpoint Adrenal Fatigue. When taken as a group, these signs and symptoms do form a specific Adrenal Fatigue syndrome or picture of a person under stress. These signs and symptoms are often the end result of acute, severe, chronic, or excessive stress and the inability of the body to reduce such stress. Stress, once a “basket” term used by physicians to explain non-specific symptoms, undetectable by conventional blood tests, is not a mystery to the body at all.

The ability to handle stress, physical or emotional, is a cornerstone to human survival. Our body has a complete set of stress modulation systems in place, and the control center is the adrenal glands. When these glands become dysfunctional, our body’s ability to handle stress is reduced.

Adrenal Gland Basics

The adrenal glands are two small glands, each about the size of a large grape. They are situated on top of the kidneys. Their purpose is to help the body cope with stress and help it to survive. Each adrenal gland has two compartments. The inner or medulla compartment, modulates the sympathetic nervous system through secretion and regulation of two hormones, called epinephrine and norepinephrine, which are responsible for the fight or flight response. The outer adrenal cortex comprises 80 percent of the adrenal gland and is responsible for producing over 50 different types of hormones in three major classes – glucocorticoids, mineralcorticoids and androgens.

The most important glucocorticoid is cortisol. When this is lowered, the body will be unable to deal with stress. This happens in Adrenal Fatigue.

Mineralcorticoids, such as aldosterone, modulate the delicate balance of minerals in the cell, especially sodium and potassium. It therefore regulates our blood pressure and the fluid in the body. Stress increases the release of aldosterone, causing sodium retention (leading to water retention and high blood pressure) and the loss of potassium and magnesium in the early stages of Adrenal Fatigue. Magnesium is involved in over 300 enzymatic reactions in the body. When the body lacks magnesium, it will suffer from a variety of pathological conditions such as cardiac arrhythmias.

The adrenal cortex is also responsible for producing all of the sex hormones, although in small amounts. One exception is DHEA, a weak androgenic hormone that is made in large amounts in both sexes. DHEA, together with testosterone and estrogen, are made from pregnenolone.

Pregnenolone also leads to the production of progesterone and is one of the intermediary steps in the making of cortisol. Pregnenolone is therefore one of the most important intermediate hormones being produced in the hormonal cascade. Prolonged deficiencies in pregnenolone, which are found in Adrenal Fatigue, will lead to the reduction of both glucocorticosteroids and mineralcorticoids such as cortisol and aldosterone respectively.

Read more about Adrenal Fatigue here …

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Scientists say a pill called Vemurafenib appears to give patients a greater chance of surviving longer than chemotherapy.

It was tested on a group of 675 patients with advanced melanoma.

Another drug, taken intravenously, called Ipilimumab, is said to give patients extra years of life.

The results were presented at a meeting of the American Society of Clinical Oncology.

During a trial, 84% of patients who took Vemurafenib pills twice a day were still alive six months later. This compares with 64% of those on standard chemotherapy.

The drug works by acting on a faulty gene, BRAF, found in half of terminally ill patients whose cancer has spread to other organs.

The results were so impressive that the British experts running the trial stopped it early so they could switch all patients in the group over to Vemurafenib.

And trials showed the drug reduced the risk of the disease worsening by 74%, compared with chemotherapy.

Meanwhile, trial results from another study show that a one-course infusion treatment of Ipilimumab may extend the survival of patients with advanced melanoma.

‘Enormous advance‘

Several patients have lived for years when they might otherwise have died in weeks or months, say investigators. At least one is still alive five years after receiving the treatment.

Research is now being conducted to find out whether Vemurafenib could be used for other cancers, including ovarian, thyroid and bowel cancer.

Both treatments are now being assessed by European licensing bodies and could become available to UK patients within months, subject to approval.

Although it is unclear if the NHS would be able to afford to use these relatively expensive drugs that cost tens of thousands of pounds.

Professor Richard Marais, whose work at the Institute of Cancer Research demonstrated the importance of BRAF in melanoma, said: “This is the biggest breakthrough in melanoma treatment in more than 30 years.

“The results demonstrate for the first time that a targeted therapy can work in melanoma and will change our approach to treating this disease. It is an enormous advance in the field.”

Professor Peter Johnson, Cancer Research UK’s chief clinician, said: “For the first time, we have effective treatments becoming available for melanoma.

“Both show how the research we have been doing is feeding through into help for patients.

“It is a first step but a vitally important one, and it encourages us to redouble our efforts for people with this most dangerous type of skin cancer.”

Malignant melanoma kills more than 2,000 people in the UK each year, and more than 11,000 people annually develop the disease.
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When I was a child playing house with my friends, I knew exactly what I wanted my grown-up life to be like. I’d be married to a tall, handsome pop singer (not telling which one — it would date me too much). We’d have four children, two boys and two girls with two years between each child. Out of that lovely fantasy, one thing came true. I got married.

I’m not sure why two years between children seemed like the perfect pregnancy spacing in my 9-year-old imagination. As an adult who started having children a little later in life, two years seemed too long between babies – yet my second and third children are two and a half years apart.

In the end, pregnancy spacing is often based on a combination of personal preference and luck. You might want to space your babies close together so you get the diapers and child care done earlier. You might want to space them further apart so you can enjoy the specific stages of growth and development with each child before you introduce another child. Sometimes you get pregnant sooner than you thought you would or long after you hoped you would.

When you’re planning your next pregnancy, you have many things to consider:

Your health. Has your body completely recovered from pregnancy and birth? It can take a year or even longer to develop stores of essential nutrients that may have been depleted during pregnancy and breast-feeding.Your children. How will another baby affect your older child or children? Some people space children close together, hoping that the kids will feel like best friends. Others space them further apart to make sure that each child gets individual attention or is more independent when the next one comes along.Your finances.

What’s the state of your budget? Having babies close together might get the drain of child care off the budget sooner, and it might be easier to focus on your career if the kids are all in school at the same time. On the other hand, spacing children further apart can give you more time to recover from the financial and emotional impact of pregnancy and early child care.Finally, remember that things don’t always go according to plan — so be flexible. In the end, the ideal spacing between children is what works for you and your family.

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The World Health Organization’s cancer research agency says mobile phones are “possibly carcinogenic”.

A review of evidence suggests an increased risk of a malignant type of brain cancer cannot be ruled out.

However, any link is not certain – they concluded that it was “not clearly established that it does cause cancer in humans”.

A cancer charity said the evidence was too weak to draw strong conclusions from.

A group of 31 experts has been meeting in Lyon, France, to review human evidence coming from epidemiological studies.

They said they looked at all relevant human studies of people using mobile phones and exposure to electromagnetic fields in their workplace.

The WHO’s International Agency for Research on Cancer (IARC) can give mobile phones one of five scientific labels: carcinogenic, probably carcinogenic, possibly carcinogenic, not classifiable or probably not carcinogenic.

It concluded that mobiles should be rated as “possibly carcinogenic” because of a possible link with a type of brain cancer – glioma.

Ed Yong, head of health information at Cancer Research UK, said: “The WHO’s verdict means that there is some evidence linking mobile phones to cancer but it is too weak to draw strong conclusions from.

“The vast majority of existing studies have not found a link between phones and cancer, and if such a link exists, it is unlikely to be a large one.

“The risk of brain cancer is similar in people who use mobile phones compared to those who don’t, and rates of this cancer have not gone up in recent years despite a dramatic rise in phone use during the 1980s.

“However, not enough is known to totally rule out a risk, and there has been very little research on the long-term effects of using phones.”

The WHO estimated that there are five billion mobile phone subscriptions globally.

Christopher Wild, director of the IARC, said: “Given the potential consequences for public health of this classification and findings it is important that additional research be conducted into the long term, heavy use of mobile phones.

“Pending the availability of such information, it is important to take pragmatic measures to reduce exposure such as hands free devices or texting.”

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Chemicals which interfere with a mosquito’s ability to sniff out humans have been developed by US researchers, according to research in Nature.

It is hoped they could be used to develop the next generation of mosquito traps and repellents.

A UK expert said the discovery could be a “major step forward” if the chemicals were safe and cheap.

Female mosquitoes use carbon dioxide in people’s exhaled breath to find their next meal.

They can detect minute changes in the concentration of the gas and track it back to a human breath.

This knowledge is already used in carbon dioxide traps, but requires dry ice or gas cylinders – which mean they are rarely used in developing countries.

Researchers have been looking for chemicals which can disrupt or confuse a mosquito’s carbon dioxide sense.

Deception

Scientists at the University of California, Riverside, tested smelly chemicals on three species of mosquito: Anopheles gambiae, which spreads malaria; Culex quinquefasciatus, which spreads filariasis and West Nile virus; and Aedes aegypti which spreads dengue and yellow fever.

Between them these insects are thought to spread disease to half a billion people each year and cause millions of deaths.

The researchers identified three groups of chemicals, which disrupt a mosquito’s carbon dioxide receptors.

One mimicked carbon dioxide and could be used as bait in insect traps, another prevented the mosquito from detecting carbon dioxide and the last group tricked the mosquito’s brain into thinking it was surrounded by huge quantities of the gas – so it could not pick which way to go.

Professor Anandasankar Ray, from the University of California, Riverside, said: “These chemicals offer powerful advantages as potential tools for reducing mosquito-human contact, and can lead to the development of new generations of insect repellents and lures.

“The identification of such odour molecules, which can work even at low concentrations, and are therefore economical, could be enormously effective in compromising the ability of mosquitoes to seek humans, thus helping control the spread of mosquito-borne diseases.”

Carbon dioxide is not the only way mosquitoes can find their dinner however, as the smell of human sweat and skin can also be used.

Dr James Logan, from the London School of Hygiene and Tropical Medicine, said: “Whilst this is an exciting study, the authors are yet to show that the chemicals are capable of protecting a human being from being bitten.

“Although carbon dioxide is an important cue for mosquitoes, we know that mosquitoes respond differently to a trap releasing carbon dioxide than to a real human being, which releases a complex mixture of many attractive chemicals, heat, visual cues and moisture.

“The key question is – do the ‘response modifying odours’ actually protect a human being?”

The chemicals also need to be used at high concentrations, which could be hazardous to human health. The researchers say their next step is to develop safer chemicals.

Dr Nikolai Windbichler, from Imperial College London, said work needed to be done to ensure they were safe and could be produced at low cost.

He added: “These compounds have novel and desirable properties because they can confuse the mosquitoes’ host seeking behaviour even when the substances are no longer present or the mosquitoes have left the area of application.

“This, if realised, could be a major step forward and could protect large groups of people or large areas, something that is not currently feasible with existing repellents.”

Mark Stopfer, from the US National Institutes of Health, said the study offered “a promising line of defence.”

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People should use stronger sun cream to protect against cancer, a journal has warned.

People should use stronger sun cream to protect against cancer, a medical journal has warned.

Guidelines from the National Institute for Health and Clinical Excellence (NICE) stated that “SPF 15 is sufficient if applied adequately”.

However, the Drug and Therapeutics Bulletin argued that few people apply enough sun cream, and that SPF 30 should be recommended instead.

NICE said the guidelines were balanced and for England, not hotter climates.

Ultraviolet (UV) radiation damages the skin and increases the risk of developing skin cancer.

Sun cream acts as a protective layer, preventing the damaging radiation from reaching the skin.

Research has shown that SPF 15 is strong enough if it is applied thickly. The standard is set at 2 mg/cm². For an adult that works out at about a sixth of a 200ml bottle to cover the whole body.

Yet many people apply much less, between 0.4 and 1.5 mg/cm².

‘Blunder’

The study said that in reality people were getting “no more than half, at best, of the protection indicated by the labelled SPF”.

Dr Ike Iheanacho, the editor of Drug and Therapeutics Bulletin, said: “NICE’s recommendation to use sunscreens with an SPF as low as 15 is a blunder that overlooks the key evidence and is not in the best interests of public health.

“This advice needs urgent review and correction.”

The journal recommended that: “Products labelled with an SPF of 30 will more reliably deliver adequate sun protection to most people who use sunscreens and would be sufficient to prevent sunburn under most circumstances.”

Professor Mike Kelly, director of the Centre for Public Health Excellence at NICE, said: “The NICE guidance referred to was not an assessment of which sun protection factor is optimal, but rather was concerned with the most effective ways of reducing skin cancer in England through provision of information, supply of resources and changes to the physical environment.

“It also sought to make clear that sunshine can be good for us, in that it provides a good source of vitamin D, and the opportunity to be physically active out of doors.

“We felt it was important, in producing this guidance, to maintain a balance – recognising on the one hand the very real dangers of skin cancer, but also remembering on the other hand that we should not extrapolate from research carried out in much hotter, sunnier climates than our own.

“We commissioned an expert report on the use of sunscreen in preventing skin cancer in England. According to this evidence, which was presented to the committee, SPF 15 should be sufficient as long as it is applied adequately.

“However, the guidance also acknowledges that to take account of people not applying sufficient quantities of sunscreen, SPF 30 was also recommended in an expert paper.”

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A study suggests that people who are most distressed during a heart attack have higher levels of particular chemical markers in their blood.

People with an intense fear of dying during a heart attack could suffer a worse outcome, research suggests.

London-led researchers asked 208 patients to rate their levels of fear following a severe cardiac event.

People who reported they were most distressed during an attack had higher levels of chemical markers – linked to inflammation – in their blood.

Writing in the European Heart Journal, the authors say heightened inflammation may lead to poorer long-term health.

“Large inflammatory responses are known to be damaging to the heart, and to increase the risk of longer-term cardiac problems such as having another heart attack, ” said British Heart Foundation professor of psychology, Andrew Steptoe.

The research, led by a team at Imperial College, found that patients who reported an intense fear of dying had raised levels of TNF alpha – a marker that has been linked to inflammatory processes in the body.

They also measured heart rate variability and the stress hormone cortisol, three weeks after the event.

Professor Steptoe, who worked on the study, said: “Fear of dying is not just an emotional response, but is linked into the biological changes that go on during acute cardiac events.

“This is an observational study, so we do not know whether helping people overcome their fears would improve the clinical outlook.”

Dr Mike Knapton, associate medical director at the British Heart Foundation, said: “This study suggests that people who are most distressed during a heart attack have higher levels of particular chemical markers in their blood, which are associated with greater inflammation in the body.

“Inflammation has previously been linked with an increased risk of heart attack but we don’t yet fully understand why.

“What we need to know now is whether we can allay people’s fears at the time of a heart attack and whether this actually translates into better outcomes in the long term.”

Read more on the Heart Attack Fear Study here ».

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