GREAT LUMLEY SURGERY

MEDICAL INFORMATION

ANXIETY

What is anxiety?
Anxiety is a natural part of human life and useful for helping us deal with problems and challenges. However there are times when feelings of anxiety can become so strong or continue for so long that they begin to interfere with daily life, causing misery and frustration.

What are the symptoms of anxiety?
The symptoms are variable but are often a mixture of physical and emotional sensations. These may include feeling tired and washed out but perhaps not sleeping well, worrying constantly, feeling irritable, not being able to concentrate. People may experience muscle tension and pain, a pounding heart, indigestion, diarrhoea or constipation, sweating, nausea, loss of appetite and a dry mouth. They may look pale and tense. Sometimes an unexpected surge of anxiety results in rapid or heavy breathing, palpitations, dizziness or faintness and a terrible feeling of panic - a panic attack. The physical sensations may be so strong that the anxious person may feel that they have a serious physical illness. Sometimes anxiety and panic may be associated with feelings of depression and hopelessness.

What causes anxiety?
Sometimes this kind of anxiety can be caused by particularly difficult circumstances or a traumatic experience. Sometimes it may be a symptom of underlying depression. However, for many people there may be no obvious reason why they develop anxiety and it probably arises from a mixture of different factors.

How can it be treated?
If anxiety has become disabling or long-term, a GP may prescribe an anti-depressant. These drugs are non-addictive and seem to help feelings of anxiety as well as depression. They can enable a person to feel in control of their lives again and able to plan some self-help strategies.

What self-help strategies can be useful?
Talking about the problem is an important aspect of self-help but requires a trusted listener. If family and friends seem inappropriate, the GP may be able to refer the sufferer to a counsellor or suggest a psychotherapist. Psychotherapists vary in their approach to anxiety; they may concentrate on trying to identify and tackle the cause of the anxiety or they may focus on trying to change destructive thought patterns and negative attitudes. There may be a self-help group locally where people who experience similar problems can meet and support each other.

Changes in daily routine can also be helpful. Regular exercise has been shown to lift the spirits and increase confidence. It is also worth making the effort to eat a diet which is balanced and rich in vitamins, rather than comfort eating. Learning to relax is another important strategy. There are many different techniques for doing this and there may be a teacher locally who can help. Audiocassettes for guided relaxation are also available if joining a class seems too daunting.

Useful sources of information:
MIND (mental health charity), 15-19 Broadway, London E15 4BQ. Telephone: 020 8519 2122. Information Line: 08457 660 163. Website: http://www.mind.org.uk
The Samaritans. Telephone: 0345 909090
No Panic, 93 Brands Farm Way, Telford TF3 2JQ. Telephone Helpline: 01952 590545. Information Line: 0800 783 1531. Website: http://www.no-panic.co.uk

BACKPAIN- ACUTE

What is acute back pain?
Acute back pain is a condition that lasts for less than four weeks, develops quickly and can be severe. Most acute back pain affects the lower back, and, in two out of three cases, clears up spontaneously.

What causes acute back pain?
The causes are varied and may include one or more of the following:

Posture - if your body is out of balance for long periods of time, certain sets of muscles are overused which may make them painful.
Prolapsed or ruptured disc - one of the vertebrae of the spine ruptures and part of its soft core protrudes, sometimes touching or trapping a nerve.
Pregnancy - towards the end of pregnancy, weight gain and shift of body balance may affect posture significantly.

How can acute back pain be treated?

Painkillers.
Manipulation from a qualified physiotherapist, osteopath or chiropractor.
Gentle regular activity.
If there has not been a resolution of your pain within 6 weeks, then your GP will start to arrange tests to explore further. This may include tests such as MRI (magnetic resonance imaging), CAT (computerised axial tomography) or referral to a specialist.

How can I help myself?

Improve my general fitness and flexibility of my back.
Control my weight.
Lift correctly - back straight, knees bent.
Move regularly to ensure even muscle activity.

Useful sources of information:
BackCare (formerly National Association of Back Pain), 16 Elmtree Road, Teddington TW11 8ST. Telephone: 020 8977 5474. Website: http://www.backpain.org
The General Osteopathic Council, Osteopathy House, 176, Tower Bridge Road, London SE1 3LU. Telephone: 020 7357 6655. Fax: 020 7357 0011. Website: http://www.osteopathy.org.uk

BACKPAIN – CHRONIC

What is chronic back pain?
Chronic back pain lasts for longer than three months. It may come on gradually over a period of time, or may develop from acute back pain. Most chronic back pain involves the lower back.

What causes chronic back pain?
The causes are varied and may include one or some of the following:

Posture - if your body is out of balance for long periods of time, certain sets of muscles are overused which may make them painful.
Prolapsed or ruptured disc - one of the vertebrae of the spine ruptures and part of its soft core protrudes, sometimes touching or trapping a nerve.
Spinal problems - e.g. scoliosis (twisting of the spine) or spondylolisthesis (dislocation of the spinal joints).

How is chronic back pain diagnosed?
In most cases, you will provide the relevant details.
On some occasions your GP may arrange further tests, such as MRI (magnetic resonance imaging), CAT (computerised axial tomography), or refer you to a specialist.

How is chronic back pain treated?

Manipulation from a qualified physiotherapist, osteopath or chiropractor.
Gentle regular activity and moderate exercise especially to strengthen stomach muscles.
Pain management - the use of painkillers, muscle relaxants and learning how to relax may all help the process of dealing with pain and discomfort.

How can I help myself?

Increase my level of fitness and flexibility of my back.
Increase awareness of my posture.
Find ways to move regularly, even small changes will help.
Control my weight.
Lift correctly with straight back and knees bent.

Useful sources of information:
BackCare (formerly National Association of Back Pain), 16 Elmtree Road, Teddington TW11 8ST. Telephone: 020 8977 5474. Website: http://www.backpain.org
The General Osteopathic Council, Osteopathy House, 176 Tower Bridge Road, London SE1 3LU. Telephone: 020 7357 6655. Website: http://www.osteopathy.org.uk

CERUMEN – EARWAX

Why do we have earwax?
The canal which leads from the outer ear is a short narrow passage (approximately 2.5cm long), closed at the far end by a thin flexible membrane called the eardrum. Earwax (or cerumen, as it is sometimes known), is produced by the lining of the ear canal near its exterior opening. Its role is to trap dust and debris, preventing them from reaching the eardrum. It is a normal body secretion and useful for the healthy functioning of the ear. Its colour is variable, ranging from yellow to very dark brown, and it may be almost liquid, sticky or dry in consistency. Not only are there variations in earwax between different individuals but there may be variations in the same individual at different times.

When do the ears need cleaning?
In most people the ear canal will not need cleaning, as it is, in a sense, self-cleaning. Earwax gradually migrates to the outside of the ear where it is removed by normal washing. It is continually replenished. Putting anything inside the ear canal, such as cotton buds, tends to push the earwax deeper into the canal and may pack it against the eardrum. The old adage of never inserting anything smaller than the tip of one's elbow into the ear still holds good.

However a few people do produce excessive amounts of earwax, which may lead to symptoms such as diminished hearing, a feeling of blockage and sometimes tenderness. In this case it may be necessary to intervene to remove some of the wax.

What causes excessive earwax?
Working in a dusty environment can stimulate the ears to produce more wax. If protectors are available, they may help. Trying to clean the ear canal also stimulates production of wax. In some cases excessive earwax is a family tendency.

What is the treatment?
Eardrops can be bought at the chemist to soften the wax. The drops should be inserted as directed and a piece of cotton wool tucked against the entrance to the ear canal will catch the wax as it drains away.
If this treatment is ineffective, the problem should be referred to a doctor, who may remove soft wax by syringing or by suction. If the wax is hard and does not soften after the application of drops, a fine instrument may be used to hook it out.

COMMON COLD

What is a cold?
A cold is a mild viral illness affecting the mucous membranes (soft lining) of the nose and throat. Most people will catch between two and four colds a year.

What are the symptoms of a cold?
Common symptoms include: a sore or itchy throat, sneezing, a runny nose, coughing, feeling unwell, and a raised temperature. Later, the discharge from the nose becomes thicker and yellow in colour.

How is a cold treated?
There is no effective treatment for a cold. It will clear up on its own within a few days. However, the following may help relieve the symptoms:

Keep warm.
Go to bed if you feel really unwell.
Drink plenty of fluids.
Take paracetamol if necessary.
Take over-the-counter cold remedies. Many of these also contain painkillers, so take them instead of, not as well as painkillers.
Many people find home-made hot lemon and honey drinks soothing.
Steam or menthol inhalations may ease a blocked nose.

Are there any complications?
Colds are common and usually no more than a nuisance, but some people are troubled by a complication such as sinusitis. Children, in particular, may get an infection of the middle ear. If you know you always get a complication following a cold, you may find it helpful to take preventative measures early on. For example, if you are an asthmatic, you may need to 'double up' your treatment at the first sign of a cold. Using decongestants may reduce the risk of sinusitis.

Is there any way to stop getting a cold?
Some people believe that taking one gram of vitamin C daily will prevent colds, but there is little evidence that this works. It has also been suggested that zinc supplements may help, but studies on this have been inconclusive.

Washing your hands, and avoiding touching your nose or eyes after coming into contact with someone with a cold will help stop you getting a cold.

If you have a cold, washing your hands frequently, especially after blowing your nose, will help prevent it spreading. Use paper tissues, rather than cloth handkerchiefs, and throw them away after use.

CONSTIPATION

What is constipation?
Constipation is the infrequent passage of hard stools.

What causes constipation?
The most common cause of constipation is lack of fibre (roughage) in the diet. Other common causes are:

Insufficient fluid intake.
Inactivity.
Misuse of laxatives.
Pregnancy.
Pre-menstrual syndrome.
Some drugs, for example, drugs containing morphine or codeine, iron tablets, some antidepressants, and some antacids.

Constipation may also be a feature of some medical conditions, for example:

Irritable bowel syndrome.
Underactive thyroid.
Diverticular disease.
Chronic renal failure.
Depression.

Constipation can sometimes be caused by cancer, but this is unusual.

What can be done to prevent constipation?
Constipation can be prevented by eating a diet high in fibre, and including fresh fruit and vegetables, unpeeled when possible. Drink plenty of water. Prune juice may be helpful, as can caffeine-containing hot drinks as caffeine stimulates the muscles of the bowel.

Try to develop good bowel habits. Don't ignore the urge to go, and try to set aside a time each day (after breakfast is a particularly good time) to have a bowel movement.

How can constipation be treated?
Most people have an occasional short period of constipation, for which there are a number of over-the counter treatments available from your pharmacist. These include bulking agents, which take about a week to work effectively, and stimulants such as senna. However, since overuse of laxatives can itself cause constipation, stimulants are strictly for short-term use only.

If constipation is a problem or you have suddenly become constipated for no apparent reason, you should contact your doctor. Keep a diary of bowel movements for a week or two before you see the doctor, and also take details of any drugs (including laxatives) you have taken.

CONTRACEPTION

What is contraception?
Contraception is any effective means of preventing a pregnancy.

What methods are available?

Barrier (eg condom, diaphragm)

This method works by stopping any sperm from getting into the uterus. Condoms also offer some protection from sexually transmitted diseases, including HIV.

Hormonal (eg 'the pill')

This method works by altering a woman's natural hormonal cycle.

Intrauterine device/system (IUD/IUS)

This method involves a small device being fitted into the uterus.

Natural family planning methods (the 'safe period')

These methods rely on a woman to understand her menstrual cycle, in order to recognise fertile and infertile times.

Sterilisation

This method involves surgery to permanently block the passage of sperm into the penis or eggs into the fallopian tubes.

Emergency contraception (eg 'the morning after pill')

This method is used when other methods have failed or have not been used.

Which method should I choose and how effective will it be?
Some methods are more effective than others, but no type of contraception is perfect. It is a good idea to discuss all the options with your GP, or practice nurse, in order to choose the method which is right for you. For example, sterilisation would only be recommended to someone who already had children, because it is a permanent method. Natural methods would be unsuitable if you definitely want to avoid pregnancy, because they rely on a regular and predictable menstrual cycle and are not as safe as some other methods.

Where can I get contraception?

Your GP or practice nurse.
You should be able to go to any GP for contraception, including emergency contraception, but it is best to ring them first.
Family planning clinics.
Some sexual health clinics.
Condoms can be bought in pharmacies and other places, including supermarkets.
Emergency contraception can be obtained from accident and emergency departments, but telephone first.

What if contraception fails?
Emergency contraception can be used if usual methods have failed. If you have not used contraception and pregnancy is suspected, contact a doctor as soon as possible.

Useful sources of information:
The Family Planning Association (fpa), 2-12 Pentonville Road, London, N1 9FP, Helpline: 020 7837 4044. Website: http://www.fpa.org.uk
Brook Advisory Centres, 165 Gray's Inn Road, London, WC1X 8UD. Telephone: 0207 617 8000
Marie Stopes International, 153 Cleveland Street, London, W1P 5PG. Telephone: 0207 574 7400. Website: http://www.mariestopes.org.uk

COPING WITH BEREAVEMENT

Losing someone you love is one of life's most stressful events, and is an experience that most people have to cope with at some time. Many people are quite unprepared for the wide range of emotions, and even physical symptoms, that they experience following a death, even when the death was expected. Common emotions include guilt, denial, disbelief, shock, and anger, and are all a normal part of the grieving process.

Some ways to cope with grief

Do not bottle up your feelings. Talk to your friends and relatives about how you feel. If the person died in hospital or a hospice, for example, find out if the staff run a support group. Other people you can talk to include your general practitioner, a minister of religion, or a member of one of the support groups listed below.
Take care of your physical health, and make sure you eat properly.
Put off any major life changes.
Be patient. You will never stop missing your loved one and it may take months or even years before you accept that your life has changed.

Some ways that you can help other people to cope with grief

Encourage them to talk about their feelings.
Avoid platitudes such as saying 'It was for the best'.
Offer practical help (for example, cooking or shopping), but don't get upset if it is refused.
Suggest professional help if you feel it is necessary.

Useful contacts:
For all bereaved people:
Cruse Bereavement Care, 126 Sheen Road, Richmond, Surrey TW9 1UR. Telephone: 0870 167 1677. In Scotland, telephone: 0131 551 1511. In Wales, telephone: 0345 585565. In Northern Ireland, telephone: 0123 792 419. Website: http://www.crusebereavementcare.org.uk

For bereaved parents:
The Compassionate Friends, 53 North Street, Bristol BS3 1EN. Telephone Helpline: 0117 953 9639 (daily, 9.30am to 10.30pm). Website: http://www.tcf.org.uk

For advice and help on practical matters following a death:
Help The Aged, 207-221 Pentonville Road, London N1 9UZ. Telephone: 020 7278 1114. In Scotland, telephone: 0131 311 8500. Website: http://www.helptheaged.org.uk

For bereaved pet owners:
The National Coordinator, Pet Bereavement Support Service, The Blue Cross, Shilton Road, Burford, Oxon OX18 4PF. Telephone: 01993 822651. Helpline: 0800 096 6606. Website: http://www.bluecross.org.uk

For anyone finding it hard to cope:
The Samaritans National Helpline: 0345 909090

CUTTING DOWN ON CHOLESTEROL

What is cholesterol?
Cholesterol is a waxy, fatty substance, naturally produced by the liver. It is necessary for the body, forming part of all cell membranes. It also has a role in the formation of steroid hormones, and helps synthesise Vitamin D and bile acids, which are essential for the digestion of dietary fats.

Cholesterol is present in many foods, including eggs and shellfish.

Is cholesterol a problem?
Cholesterol is not a problem unless there is too much of it in the body. When this happens, it can contribute to the formation of fatty deposits - known as plaques - in the arteries, causing them to narrow. Eventually, the flow of blood in that artery may be blocked. If this happens to a blood vessel in the heart, it may cause a heart attack. If it happens in the brain, it may cause a stroke. Other factors, such as smoking, also contribute to plaque formation.

However, the situation is slightly more complicated because cholesterol is transported around the body as part of a substance known as a 'lipoprotein'. The two most important ones are:

Low density lipoproteins (LDL) - these are rich in cholesterol and transport cholesterol from the liver to the body tissues. Too many LDLs circulating in the blood are associated with an increased risk of heart disease.
High-density lipoproteins (HDL) - the role of these is to transport excess cholesterol from the tissues and walls of the arteries back to the liver, where they are broken down. In other words, these are the good cholesterol transporters.

The risk of developing heart or blood vessel disease also depends on the ratio of these two lipoproteins.

Other types of fat naturally found in the body are known as triglycerides. Raised levels of these are also associated with an increased risk of heart disease.

What causes raised cholesterol levels?
Causes include eating a diet high in saturated fat, stress, and a genetic predisposition.

How can I reduce my cholesterol levels?
If your cholesterol levels are high, you should comply with medical advice as to how to reduce them. Diet can help, particularly adopting a 'Mediterranean style' diet. This involves eating more fresh fruit and vegetables, whole-grain cereals, nuts and seeds, and substituting fish, poultry and pulses for red meat.

Eat more oily fish.

Oily fish contains essential fatty acids known as the Omega-3 family. These help reduce blood triglyceride levels and play a part in reducing the formation of blood clots, and in lowering blood pressure. Choose fish such as salmon, pilchards, sardines, mackerel, kippers and trout. It can be fresh or tinned, but avoid smoked varieties if possible. Tuna is actually an oily fish while fresh, but loses the Omega-3 properties once canned.

Current recommendations suggest that you should eat 2-3 large portions (around 100 grams per portion) per week.

This does not mean to suggest that white fish should be avoided - being low in fat, it forms a valuable part of a healthy diet. However, oily fish is better for the heart.

Choose the right type of fat.

Cut down on saturated fat (found in animal products), and opt for unsaturated fats, in particular, monounsaturated fats, such as in olive or rapeseed oil, nuts and seeds.

Eat more fruit, vegetables, nuts and pulses (beans, peas, lentils).

Current guidelines are to eat at least 5 portions each day. The following are examples of a portion:

1 apple/banana/pear/orange
2 small fruits - e.g. plums/kiwi fruits
12-15 grapes/berries
2 tablespoons vegetables/pulses
1 oz nuts/seeds

Fresh is best

Choosing fresh ingredients automatically serves to protect our bodies, as it also limits the intake of sodium, hidden fats, and additives.

What about alcohol?
A little of what you fancy does do you good, and a moderate amount of alcohol is thought to be beneficial to heart health. In the traditional Mediterranean diet, wine is consumed in moderate amounts, particularly at mealtimes.
It is wise to keep alcohol to moderate amounts and current recommendations suggest that men should drink no more than 21 units per week, and women should take no more than 14 units per week, spread out over a whole week. A unit of alcohol is equivalent to:

1 x 125 ml glass of wine (9%)
½ pint ordinary strength (3.5%) beer/lager/cider
¼ pint strong (8-9%) beer/lager/cider
1 x single pub measure of spirits
1 x single measure of sherry

Can I do anything else?
Other factors known to contribute to heart disease include smoking, hypertension, stress, being overweight, high blood pressure, and inactivity. So as well as following the dietary recommendations and maintaining a healthy weight, think about giving up smoking, taking regular exercise, and learning an effective relaxation technique.

CYSTITIS

What is cystitis?
Cystitis is an infection of the bladder, usually caused by bacteria entering via the urethra (the tube leading to the outside from the bladder).

What are the symptoms of cystitis?
The symptoms are:

Pain or burning sensation when passing urine.
Needing to pass urine frequently.
Cloudy or foul smelling urine, possibly with a small amount of blood
Pain just above the pubic bone.

Who gets cystitis?
Anyone can get cystitis. However, it is more common among women because they have a shorter urethra than men. Women are also more at risk because of the following:

During sexual intercourse, bacteria may be pushed up into the bladder.
Use of contraceptive diaphragms may irritate the urethra.
Hormonal changes during pregnancy, immediately after giving birth, and during the menopause.

Other risk factors are:

Diabetics because sugar in urine encourages bacterial growth.
Urinary tract obstruction, such as in men with an enlarged prostate gland which prevents the bladder from emptying properly.
Congenital abnormalities of the urinary tract.

How is cystitis treated?
Cystitis can be treated with antibiotics. Before starting treatment, a mid-stream sample of urine will be collected and sent to the laboratory for culture. Always complete the full course of treatment, even if things improve fairly quickly. If however, the infection does not seem to be improving within two or three days, go back to your doctor, as you may need a change of antibiotics.

Prevention is better than cure, so if you are prone to cystitis, the following may help to prevent attacks:

Wear cotton underwear and socks or stockings instead of tights.
Avoid wearing tight underwear or jeans.
Use a water-soluble lubricant during intercourse and empty your bladder as soon as possible after intercourse.
Take a shower rather than a bath. If you have a bath, don't use perfumed bubble bath.
Try changing your washing powder or fabric conditioner.
Cut down on coffee, tea and alcohol.
Drink plenty of water.
Sit properly on the toilet. "Hovering" over the toilet seat can prevent your bladder from emptying properly.

If you do have an attack, consult your doctor. In the meantime, the following may help with the symptoms:

Take paracetamol for the pain. A warm hot water bottle on your lower abdomen may also help.
Aim to drink a pint of water an hour during the initial stages of an attack.
Consult your pharmacist for an over the counter treatment. These work by making the urine alkaline which helps to prevent the bacteria multiplying.
Drinking lemon barley water or cranberry juice may help to relieve the symptoms.
You may find that sitting in a bath of warm water or pouring it over the area while you sit on the toilet soothes any discomfort.

Mild cases often resolve on their own if you follow the above advice. If, however, you have severe or recurrent attacks, you may need to be referred to a urology specialist for further investigations.

Useful source of information:
Cystitis and Candida Support Group, 6-9 Bridgewater Square, London EC2 8AH.
Telephone: 020 7256 2993

DEPRESSION

What is depression?
Depression is a common illness in which there is a prolonged low mood. This affects the ability to carry out everyday tasks.

How do I know if I'm depressed?
You may experience some or all of the following:

Lack of interest in and pleasure from usual activities and interests, including sex.
Poor attention and concentration.
Change in appetite, leading to noticeable weight gain or loss.
Constant feelings of tiredness, yet still feeling weary after sleep.
Finding it hard to make even simple decisions.
Feelings of worthlessness and hopelessness.
Thoughts of self-harm and suicide.
Early morning wakening (commonly 4 - 5 a.m.)

What causes depression?
Depression may be a response to significant life changing events, such as the death of someone close, loss of work or severe illness. There are times, however, when it can seem to come from 'out of the blue'. However, it is now known that an imbalance of certain chemicals in the brain also causes depression.

How is depression treated?
Ask for help from your doctor who may suggest a 'talking treatment' with a professional and/or prescribe antidepressants: these are not addictive and usually work by altering the balance of chemicals in the body. They often take a couple of weeks to take full effect.
Complementary medicine from a qualified practitioner may be of benefit in addition to the above.

Will I need to see a psychiatrist?
The vast majority of people are treated successfully by their GP If the symptoms are severe and prolonged, then expert psychiatric help may be needed.

How can I help myself?

Accept that you are experiencing depression which is a common experience.
Do talk about what's happening in your life and how you feel about it to others who can provide you with a 'listening ear'.
Focus on how good you will feel after physical activity and then do it: going for a walk is fine.
Set realistic and achievable goals

Useful sources of other information

Depression Alliance: Tel: 020 7633 9929. Website: http://www.depressionalliance.org

The Samaritans: Helpline: 0345 909090

DIET

What is a good diet?
A good diet is:

Enjoyable.
Made up of a range of foods.
Made up of the right amount of food to be a healthy weight.

What do I need to do to ensure that I'm following a good diet?
Buying and eating the five types of food in the correct proportion will usually ensure that our bodies have what they need to ensure growth, energy and repair.
The five types are:

Carbohydrates (complex rather than simple - e.g. bread, potatoes, pasta and rice).
Protein - e.g. meat, fish, cheese, eggs, nuts, pulses.
Fat - e.g. olive oil, butter.
Vitamins - found in a range of fresh foods.
Minerals - also found in a range of fresh foods.

One way to understand the correct daily proportions is as the shape of a pyramid with the following layers starting at the bottom:

Between 6-11 servings of complex carbohydrate.
At least 5 pieces of fruit and vegetables.
Up to 2-3 servings of meat, fish, pulses, eggs, nuts, milk. yoghurt and cheese.
Sparing amounts of fats and sugar.

What can I do for myself to ensure that I'm following a good diet?

Increase your understanding about which foods provide the elements that your body needs for growth, energy and repair.
Buy and eat a wide range of foods, especially carbohydrates, fruit and vegetables.
Use a variety of ways to cook food, i.e. grill, steam and poach as well as boiling, roasting and frying.
Buy fewer pre-made foods, which are often high in salt and fat.

Useful sources of information:
British Nutrition Foundation, High Holborn House, 52-54 High Holborn, London WC1V 6RQ
Telephone: 020 7404 6504. Fax: 020 7404 6747
Website: http://www.nutrition.org.uk

Weight Watchers. Telephone: 0345 123 000 (phone to find out about local groups).
Website: http://www.weightwatchers.co.uk

DRUG MISUSE

What is drug misuse?
Drug misuse is when someone uses an illegal drug, such as ecstasy, or a legal drug, such as tranquillisers, for no medical purpose. People can also misuse solvents, the gases found in some aerosol cans, and alcohol (if they drink to excess just to get drunk).

Why do people misuse drugs?
Many people who start to misuse drugs do so because they aren't aware of, or don't believe the dangers. One of the problems is that people may have seen someone else taking a drug, and if nothing bad has happened to that person, they don't think it will happen to them either. Other reasons for drug misuse include peer pressure, experimenting as a part of growing up, rebelling against authority, enjoying the short-term effects (the 'high'), or just that drugs are cheap or easily available.

What are the dangers of drug misuse?
The dangers depend on the type of drug, the amount taken, the person who takes it, and the circumstances in which the drug is taken. Problems include:

With illegal drugs, it is impossible to tell what the substance is, or what it has been mixed with. Therefore, the user doesn't know what effect the drug will have on them, even if they have tried it before.
Accidental overdose is a real danger with illegal drugs, as it is also impossible to tell how strong the drug is, or to control the dose being taken. Taking a drug just once can kill, even if someone else has taken it with no problems before.
Drug dependency or addiction - some drugs like heroin and crack cocaine are extremely addictive, but taking any kind of drug regularly can become a habit, and have adverse effects on health, even if the user is not physically dependent.
Contracting infections such as HIV or hepatitis from sharing needles
Serious adverse effects from mixing drugs, including taking drugs and drinking alcohol at the same time.
Possession of drugs is a criminal offence, and getting caught can result in a criminal record, and possibly a prison sentence. Having a criminal record for drug offences can affect the user's employment chances, and can make it hard to obtain a visa to travel to some countries.
Long-term physical and mental health problems.
Getting into risky situations when under the influence of drugs, such as getting run over, having a car crash, having unprotected sex.
Turning to crime to finance a drug habit.

How can I tell if someone I know is misusing drugs and what should I do?
Possible signs that someone is misusing are mood swings, excessive tiredness, loss of appetite, changes in school or work attendance, weight loss, poor skin, and being secretive. However, these signs don't definitely mean that someone is taking drugs. If you haven't seen someone in a state of intoxication, you can't be sure. The best thing to do if you are worried is to talk to them about it, but choose a sensible time and place, remain calm, and try not to let the situation turn into a confrontation. Think beforehand about what you will say and do if your child/friend admits they are taking drugs. There are many organisations to support families - see below for contact details.

What agencies provide help for drug misusers?

The National Drugs Helpline is the major source of information and support to drug users, giving free, confidential, 24-hour advice and information. They can also provide details of local agencies and specialist services. Contact them on 0800 77 66 00. Website: http://www.ndh.org.uk
Local drugs agencies provide advice, sterile needles and syringes, counselling, supervised detoxification and other therapies such as yoga and acupuncture. Contact the National Drugs Helpline for details of your local agency.
For people who are dependent on hard drugs, drug dependency units (DDUs) provide counselling, detoxification, substitute prescribing and other related therapies, and are usually located near hospitals. Waiting lists for treatment can be long.
Community drug teams (CDTs) offer similar services to DDUs, except as their name suggests, they are often located in the community.
Outreach services attempt to bring the service to the user, offering individual advice, and support such as clean injecting equipment and condoms.
Needle exchange schemes give out clean injecting equipment and collect used equipment. These services often offer information and advice, health check ups, safer sex advice and condoms. Some schemes are based within drug projects but others operate from hospitals or chemist shops.
Your GP may be able to offer advice, and can refer you to other specialist services
If you have been arrested for a drugs offence, Release runs a 24 helpline. Telephone: 020 7603 8654.
Narcotics Anonymous is a network of self-help groups for drug users based on the Alcoholics Anonymous approach. Telephone: 020 7251 4007. Website: http://www.ukna.org

Information for the families of those misusing drugs:

The National Drugs Helpline (see above) is an excellent source of information.
ADFAM is a national charity working with families affected by drugs and alcohol and is a leading agency in substance related family work. It provides a range of publications and resources for families about substances and criminal justice and operates an online message board and searchable database of local support groups that helps families hear about and talk to people who understand their situation. Adfam runs a range of training programmes on substances and family support. It also operates direct support services at London prisons for families of prisoners with drug problems. A list of resources is available online. Waterbridge House, 32-36 Loman Street, London SE1 0EH. Telephone: 020 7928 8898. Website: http://www.adfam.org.uk
Families Anonymous (self-help groups for families of people with drug problems). Telephone: 020 7498 4680. Website: http://www.famanon.org.uk

Other useful contacts:
DrugScope, Waterbridge House, 32-36 Loman Street, London SE1 0EE. Telephone: 020 7928 1211. Website: http://www.drugscope.org.uk
Drinkline (free and confidential advice about alcohol). Telephone: 0800 917 8282
Alcohol Concern: Telephone: 020 7928 7377. Website: http://www.alcoholconcern.org.uk
Department of Health drug misuse information: http://www.doh.gov.uk/drugs
Health Promotion England: http://www.hpe.org.uk
Trashed (a website for 14-19 years olds): http://www.trashed.co.uk
D-2K (a website for 14-16 year olds): http://www.d-2k.co.uk

HEAD LICE

What are head lice?

Head lice are small wingless insects that live on the human scalp. They feed by sucking blood, leaving tiny red bite marks that usually itch. They are very contagious. The eggs that they lay on hairs are called 'nits'.

What are the symptoms of head lice?

Many people experience itching because of the bites. You may also notice:

Small black dots (lice droppings) on your clothing.
Groups of tiny, pale eggs (nits) clustered around the base of individual hairs.
Small white dots (empty cases left after the 'nits' have hatched) in the hair.

How are head lice treated?

The best way to search for head lice and 'nits' is to use a special comb available from a pharmacy and then:

Wet the hair with water
Lean over a sheet of light coloured paper or cloth
Comb the hair in small sections from the roots to the very end of the hair.

If you find lice or 'nits' on the paper or cloth then one of the following treatments is possible:

Insecticides, available in lotion form from a pharmacist, which need to be applied according to instructions.
Wet combing or 'bug busting', which involves wetting the hair, applying conditioner, then combing it with a 'nit' comb for at least 30 minutes every third or fourth day over a two week period. The aim is to remove any live lice and eggs until none are left.
Ask your pharmacist: some herbal shampoos and essential oils, such as tea tree oil, may be helpful.

If one person in a family has lice, it's advisable to treat all members of the family.

HERPES SIMPLEX

What is herpes simplex?
Herpes Simplex is the name of the virus that causes both cold sores (also called oral herpes or herpes labialis) and genital herpes.

What are cold sores?
Cold sores are small blisters that usually occur around the mouth, although they can appear anywhere on the body. They are caused by a strain of the herpes virus known as HSV-1.

Who gets cold sores?
Anyone can get cold sores. Around 80% of the population are infected with the virus at some time in their lives, and 20% of these will suffer recurrent attacks.

What are the symptoms of cold sores?
At first, there is an unpleasant tingling or itching sensation in the skin. A day or two later, small blisters appear at the site of the tingling. These become covered by scabs which eventually fall off.

How are cold sores treated?
The best treatment is to take action at the first sign of symptoms. Ask your pharmacist for an over-the-counter antiviral cream before you have an attack and apply it as soon as the tingling starts. Once the blisters appear, there is little you can do except keep the area clean.

Can cold sores be prevented?
If you are susceptible to cold sores, there is probably little you can do to stop getting them. However, you can prevent other people from becoming infected by using your own towel and face cloth, by not kissing anyone or letting them touch the sores, and by avoiding oral sex while you have a sore.

What is genital herpes?
Genital herpes are 'cold sores' in the genital area. They are usually caused by a strain of the herpes virus known as HSV-2, but, in some cases, they can be caused by HSV-1.

What are the symptoms of genital herpes?
The first symptom is an unpleasant prickly or burning sensation in the genital and/or rectal area. Up to two days later, small blisters appear on the skin. These turn into small ulcers over the next two or three weeks. There can also be discomfort on passing urine. The first attack is usually the worst.

How is genital herpes treated?
Do not try to treat yourself. You can see your general practitioner or attend a genito-urinary medicine (GUM) clinic for specialist treatment. You can refer yourself to the clinic and treatment is confidential. Drugs used include antiviral creams and tablets.

Can genital herpes be prevented?
The following measures may help:

Always use a condom during sex, including oral sex.
Do not have sex if you or your partner have any blisters or ulcers in the genital region.
Avoid oral sex if you have a cold sore on your mouth.

Is there anything I can do to help myself?

Find out what triggers your attacks, and try to avoid it.
Don't touch the blisters and ulcers.
Seek medical help quickly if you think you have genital herpes, and if you have a repeat attack.

Pregnant women who are susceptible to genital herpes should inform their doctor, as delivery may need to be by caesarean section in order to minimise the small risk of the baby becoming infected.

Useful source of information:
The Herpes Virus Association, 41 North Road, London N7 9DP. Telephone: 020 7607 9661. Website: http://www.herpes.org.uk

HIATES HERNIA

What is a hiatus hernia?
The stomach and intestines are separated from the heart and lungs by a strong sheet of muscle called the diaphragm. Passing through this sheet of muscle is the oesophagus (gullet) - the tube linking the mouth to the stomach. Normally the opening in the diaphragm through which it passes is close-fitting, but in some people the opening becomes enlarged and weakened, allowing part of the upper stomach to slip up into the chest. This is known as a hiatus hernia.

What is the cause of hiatus hernia?
The cause is not known, although it is relatively common. Symptoms often occur in middle age, although the condition can be present at birth.

What are the symptoms of hiatus hernia?
Many people with a hiatus hernia experience no symptoms and may not know of its existence. The commonest symptom is indigestion or heartburn - a burning pain felt behind the breastbone, sometimes reaching through to the back. This may be exacerbated by bending or lying down, and may follow a meal, particularly a large or fatty meal. The pain of heartburn is caused by acid from the stomach being regurgitated into the oesophagus, because of the hiatus in the diaphragm. This is known as reflux.

How is a hiatus hernia diagnosed?
If heartburn is frequent and painful, it is important to visit the doctor to ensure that the symptoms do relate to the oesophagus. The diagnosis of hiatus hernia can be confirmed by a barium x-ray or by endoscopy, where a viewing tube is used to look at the oesophagus and stomach.

How is hiatus hernia to be treated?
Antacids, which neutralise the effects of gastric acid, can be bought over the counter, reducing the pain. There are also medicines available on prescription, which can decrease the amount of acid produced by the stomach or strengthen the muscles at the lower end of the oesophagus, thereby reducing the amount of reflux. Where medical treatment fails and complications develop - such as narrowing of the end of the oesophagus due to scarring from the gastric acid - an operation may be performed.

What self-help measures can be taken?

Stop taking anti-inflammatory drugs, such as aspirin or ibuprofen, which worsen the symptoms. However, if you are taking prescribed anti-inflammatories, you should discuss this with your doctor.
Try to avoid large meals, particularly last thing in the evening. They increase the pressure inside the stomach, causing more reflux.
Try to avoid fatty meals. These are digested slowly, prolonging the discomfort.
If any foods seem to cause heartburn, avoid them. These may include alcohol and coffee.
If you are a smoker, seek help to stop smoking. Nicotine relaxes the muscle at the lower end of the oesophagus, increasing reflux.
If you are overweight, seek help and advice about achieving an appropriate weight for your height and build. Fatty tissue around the stomach and intestines raises the intra-abdominal pressure, causing more reflux.
If you suffer frequently from constipation, seek advice about how to avoid it, as any form of straining will increase reflux.
If heartburn is a particular problem at night, raise the head of the bed, either with pillows or by raising the mattress at the head end.

Useful source of information:
Digestive Disorders Foundation, 3, St Andrew's Place, Regents Park, London NW1 4LB.

HYPERTENSION

What is blood pressure?
Blood pressure is the force with which the heart pumps blood around the body. During the heart's action, there is a period when the pressure is high (called the systolic pressure) and a period when the heart is relaxed and the pressure is low (called the diastolic pressure). Blood pressure varies naturally over a 24-hour period and, just as there is no such thing as "normal" height, there is no such thing as "normal" blood pressure.

So what is high blood pressure (hypertension)?
As a rough guide, a systolic pressure of under 140 mm Hg and a diastolic blood pressure of under 90 mm Hg, written as 140/90 mm Hg, are considered normal. Figures above 160/100 mm Hg are considered high. However, most doctors will not make a diagnosis of hypertension until you have had a number of readings taken over a period of time, normally three months.

What causes hypertension?
Hypertension is caused when there is increased resistance to the flow of blood through the blood vessels. In some cases this may be as a result of kidney or other disease, but in many cases there is no underlying cause. However, it is known that smoking, being overweight, eating too much salt, and lack of exercise are all contributory factors to high blood pressure.

Is hypertension dangerous?
Hypertension is dangerous because it is a risk factor for both heart attack and stroke. The higher the blood pressure, the more at risk you are. In some people who have additional risk factors for these diseases, for example, diabetics, hypertension becomes dangerous at lower levels, so diabetics are treated if their blood pressure exceeds 140/80 mm Hg.

What are the symptoms of hypertension?
Usually hypertension has no symptoms.

How can hypertension be treated?
The best treatment is lifestyle changes. Stopping smoking, maintaining a healthy weight, reducing your fat and salt intake, and taking regular exercise are all helpful in keeping your blood pressure at a healthy level. Some people find that learning relaxation techniques also helps. Many people, however, need drugs to treat their hypertension. These drugs need to be taken for life.

Useful source of information:
The Hypertension Trust, 127 High Street, Teddington, Middlesex, TW11 8HH. Telephone: 020 8977 0011. Website: http://www.hypertensiontrust.org

INCONTINENCE

What is incontinence?
Incontinence is the inability to control your bladder or bowel, so that you wet or soil yourself. It is estimated that over three million adults in this country suffer from incontinence. Many of these suffer from nocturnal enuresis – bed wetting when asleep.

What causes incontinence?
Incontinence has a number of causes. In women, the pelvic floor may be weakened by childbirth. In men, the cause may be an enlarged prostate gland. Other causes include infection, bladder stones and spinal cord damage.

How can incontinence be treated?
Because incontinence is a symptom of several conditions, there is no one single treatment. It may be treatable with drugs or surgery. Your GP may be able to treat you, or it may be necessary for you to be referred to a hospital specialist for investigations and treatment. Many areas have specialist nurse continence advisers who may also be able to help.

Is there anything I can do to help myself?
There are a number of ways you can help yourself:

Drink at least six glasses of water a day as incontinence can be caused by over-concentrated urine irritating your bladder wall.
Cut down on drinks containing caffeine (tea, coffee, cola, chocolate), especially in the evening. Caffeine is a diuretic – that is, it makes you need to pass urine more often.
Avoid becoming constipated.
Some drugs may cause incontinence. If you think this may be the case, discuss it with your doctor, as there may be alternative drugs available or it may be possible to alter the dose. Do not stop taking any drugs without consulting your doctor.
If your problem is nocturnal enuresis, you may find that an enuresis alarm is helpful. Contact your GP or the nurse continence advisor.
If you are prone to cystitis, avoid anything that triggers an attack and treat attacks promptly.
Do pelvic floor exercises. Tighten your back passage as if you are trying to stop passing wind; now tighten the muscles around the base of your bladder as if you are trying to stop yourself passing urine. In both cases, count to four and let go. Repeat at least four times a day. Our leaflet “Pelvic floor exercises” gives more details or ask the nurse continence advisor to teach you how to do them.

Useful sources of information:
Continence Foundation, 307 Hatton Square, 16 Baldwin Gardens, London EC1N 7RL. Telephone: 020 7831 9831. Website: http://www.continence-foundation.org.uk
Incontact, United House, North Road, London N7 9DP. Telephone: 020 7700 7035. Website: http://www.incontact.demon.co.uk
For childhood bed wetting, contact ERIC (Enuresis Resource and Information Centre), 34 Old School House, Britannia Road, Kingswood, Bristol BS15 2DB. Telephone: 0117 960 3060. Website: http://www.enuresis.org.uk

INSOMNIA

What is insomnia?
Insomnia is when you have trouble sleeping. This may mean difficulty getting to sleep, waking frequently, or waking early and not being able to return to sleep.

What causes insomnia?
The causes are varied. Some of the following may apply to you:

Stress, worry or anxiety.
Shift working, which disturbs patterns of sleep.
Sleep apnoea, (severe snoring and waking with a start).
Restless legs syndrome (Ekbom syndrome), which features itchy, twitchy or burning sensations in the leg muscles.
Depression.
A personal over estimation of how much sleep we need - as we get older, so we need less sleep.

How is insomnia treated?
The key is to identify specifically how your sleep is affected and the cause.
Once identified, your treatment can then take one of the following forms:

Food: avoid eating too close to bedtime, or going to bed hungry.
Caffeine, alcohol and cigarettes all disrupt sleep, so avoid close to bedtime.
Increase your physical activity.
Develop a bedtime routine.
Learn relaxation techniques, e.g. yoga and meditation.
Talk with your GP about snoring.
Write a diary or journal to form part of your bedtime routine.
Consult a qualified complementary health practitioner, e.g. homeopath, reflexologist, masseur or acupuncturist.

Useful Sources of Information
British Snoring and Apnoea Association, 1 Duncroft Close, Reigate, Surrey, RH2 9DE. Tel: 01249 701010
Fax: 01737 248744. E-mail: helpline@britishsnoring.co.uk
Website: http://www.britishsnoring.co.uk
Narcolepsy Association UK, Craven House, 1st Floor, 121, Kingsway, London, WC2B 6PA.
Tel: 020 7721 8904. Fax: 01322 863056. E-mail: info@narcolepsy.org.uk
Website: http://www.narcolepsy.org.uk
Sleep Matters, Medical Advisory Service, PO Box 3087, London, W4 4ZR
Helpline: 020 8994 9874 (6 pm - 9 pm weekdays)

IRRITABLE BOWEL SYNDROME

What is irritable bowel syndrome?
Irritable bowel syndrome (IBS) is a common disorder characterised by a number of symptoms, including intermittent diarrhoea and/or constipation, abdominal bloating, abdominal pain and a feeling of incomplete emptying of the rectum.

What causes irritable bowel syndrome?
The cause is unknown. However, there does seem to be a loss of co-ordination of the normal peristaltic action of the bowel. This may be because the bowel is over-sensitive to certain stimuli, for example, certain foods. Stress and lack of physical activity have also been implicated.

It is estimated that about 1 in 3 people suffer occasionally from IBS; in 1 in 10 sufferers the symptoms are severe enough for them to go to the doctor.

How is irritable bowel syndrome diagnosed?
No single test will diagnose IBS. The diagnosis is usually made on clinical symptoms. Referral to a gastro-enterologist may be necessary for a few people to exclude other conditions.

It is important to note that, although it can be unpleasant, IBS is not life-threatening and will not lead to bowel cancer.

How is irritable bowel syndrome treated?
The following may help:
Avoid stress or learn techniques, such as yoga or meditation, to help you deal with it.
Drink plenty of water.
Try keeping a food diary to find out which foods make your symptoms worse. Coffee, tea, alcohol, red meat, dairy products and spicy foods are common triggers.
Eat a high fibre diet, including fresh fruit and vegetables.
Take regular exercise.
Certain drugs may help. Ask your pharmacist for advice, as most of them can be bought without a prescription. Otherwise, consult your GP.
Some alternative therapies may help.

Useful sources of information:
Digestive Disorders Foundation. Telephone: 020 7486 0341. Fax: 020 7224 2012. Website: http://www.digestivedisorders.org.uk
Or write to: Digestive Disorders Foundation, PO Box 251, Edgware, Middlesex, HA8 6HG (Please enclose an SAE).
IBS Network, Northern General Hospital, Herries Road, Sheffield, S5 7AU. Telephone: 0114 261 1531 (Please enclose an SAE and £1 coin if writing). Website: http://www.ibsnetwork.org.uk
The United Kingdom Register of IBS Therapists, PO Box 57, Warrington, WA5 1FG. Telephone: 01925 629 437

MENOPAUSE

What is the menopause?
The menopause, also referred to as the change of life or the climacteric, is the permanent cessation of periods. It usually happens between the ages of 45 and 55.

Why does the menopause occur?
The menopause occurs because the ovaries stop producing the hormone oestrogen. This happens gradually, so periods usually become irregular initially before stopping altogether.

What are the symptoms of the menopause?
Many women have few, if any symptoms. However, hot flushes and night sweats are fairly common. Other symptoms include:

Vaginal dryness.
Tiredness and difficulty sleeping.
Urinary problems.
Irritability, mood swings and poor concentration.
Reduced sex drive.

The fall in oestrogen levels also means that, after the menopause, women can develop osteoporosis (thinning of the bones) and become more prone to heart disease and stroke.

What can be done to alleviate the symptoms of the menopause?
Hormone replacement therapy (HRT) can be very effective in alleviating menopausal symptoms. HRT can be taken by mouth, implanted under the skin, or in the form of a gel or patch, and preparations are available containing different proportions of hormones. HRT is only available on prescription, and is not suitable for everyone.

Is there anything I can do to help myself?
Keep active. Regular weight-bearing exercise - such as walking - helps prevent osteoporosis and improves general well-being. Increase your calcium intake by eating low-fat dairy products. It has also been suggested - but is unproven - that soya products are beneficial because they contain substances known as phyto-oestrogens that are similar in action to oestrogen produced by the body.

Useful sources of information:
Women's Health, 52 Featherstone St, London EC1 8RT (enclose sae if writing). Telephone: 020 7251 6580 (09.30 am to 1.30 pm, Monday to Friday). Website: http://www.womenshealthlondon.org.uk
Women's Health Concern, PO Box 2126, Marlow, Bucks SL7 2RY. Telephone: 01628 488065. Helpline: 01628 483612. Website: http://www.womens-health-concern.org
The Amarant Trust. Helpline: 01293 413000 (11 am to 6 pm, Monday to Friday)
The British Menopause Society, 36 West Street, Marlow SL7 2NB. Telephone: 01628 890199. Website: http://www.the-bms.org

MENORRHAGIA

What is menorrhagia?
The word menorrhagia means heavy periods.

How do I know if my periods are heavy?
Blood loss during menstruation is very subjective, and what one person considers normal another may consider excessive. The average amount of blood lost during menstruation is about 60 mls. As a rough guide, your periods are heavy if you regularly soak through the most absorbent sanitary towel or tampon in less than two hours, or need to use a tampon and a towel together, or if bleeding lasts longer than seven days. You may also pass large clots. Many women experience an occasional heavy period, but, if your periods are disrupting your life every month, you are almost certainly suffering from menorrhagia.

What causes menorrhagia?
The following may cause menorrhagia:

Fibroids.
Polyps.
Endometriosis.
Use of the intra-uterine contraceptive device.
Pelvic inflammatory disease.
Hormonal imbalances, particularly in early adolescence and as the menopause approaches.
Clotting disorders.

However, in many cases, there may be no obvious cause.

How is menorrhagia diagnosed?
Menorrhagia is diagnosed on the basis of your symptoms. Your doctor may examine you internally and take a cervical smear. You may also have a blood test to check for anaemia and, possibly, hormone levels.

If necessary, you will be referred to a gynaecologist.

How is menorrhagia treated?
Treatment depends on the underlying cause. You may be prescribed hormones, non-steroidal anti-inflammatory drugs, or tablets to help the blood clot more easily. Surgery, for example, endometrial ablation, may be a possibility. Although a hysterectomy will almost certainly solve the problem, this should be viewed as a last resort.

OBESITY

What is obesity?
In layman's terms, obesity means very overweight, but, medically, obesity means having a body mass index (BMI) of more than 30.

What is BMI?
BMI is a way of calculating whether your weight is in proportion to your height. To calculate your personal BMI, divide your weight in kilograms by your height in metres squared (that is, multiplied by itself). A BMI of between 20 and 25 is regarded as healthy, a BMI between 25 and 30 is regarded as overweight, and a BMI of greater than 30 is regarded as obese.

Why do people become obese?
The simple answer is that they have taken in more dietary calories than their body needs. These extra calories have been stored as fat. However, some people do seem to put on weight more easily than others, and the tendency to become overweight seems to depend on several factors such as genetics, your age, whether you smoke, the amount of exercise that you take, and the proportion of fat in your diet. About 2% of obese people have a medical problem that causes their obesity.

Is obesity dangerous?
Being obese puts you at greatly increased risk of developing heart disease, diabetes, osteoarthritis, and certain cancers. It is also unsightly.

What can I do to lose weight?
Dieting alone is not the answer. You need to make a few lifestyle changes, including:

Increase your level of physical activity. You could try taking a brisk walk daily, or join a gym or a swimming club. Many gyms run special sessions for people needing to lose weight.
Cut down on your fat intake, and eat more high fibre, high carbohydrate food, and fresh fruit and vegetables. Beware of hidden fat in many processed and pre-prepared foods.
Reduce your alcohol consumption. Alcohol is loaded with calories.
If you must nibble, nibble a piece of fruit or a carrot.

Accept that you may need help to lose weight. If you are not sure what foods are best to eat, ask your doctor to refer you to a dietician. Many people find the moral support of a slimming club, such as WeightWatchers, very helpful.

Diet pills, liquid meals, and special food supplements may help you lose weight in the short-term, but are not the answer to maintaining a healthy weight in the long-term.

Useful source of information:
WeightWatchers. Telephone: 0345 123 000 or look in your local paper or phone book for details of your nearest branch. Website: http://www.weightwatchers.co.uk

OSTEOARTHRITIS

What is osteoarthritis?
The term 'osteoarthritis' literally means joint damage and inflammation. In this type of arthritis, the smooth lining of the joints (cartilage) becomes damaged and deteriorates, causing the underlying bone to thicken and become distorted, sometimes leading to bony overgrowths known as osteophytes. The joint becomes swollen, inflamed, and painful. Although all joints can be affected, the most commonly affected are the knees, hips, spine (when it is known as spondylosis), fingers, and big toes. With the exception of the fingers, these are all weight bearing joints.

What causes osteoarthritis?
Osteoarthritis is commonly regarded as a disease of 'wear and tear', as it rarely affects anyone under the age of 40. Other risk factors include being overweight, and a previous joint injury. Some occupations may put extra stress on certain joints, for example, professional footballers are known to be at particular risk of developing osteoarthritis of the knee.

Heredity is known to play a part in a form of osteoarthritis known as nodal osteoarthritis, which commonly affects the hands. Some rarer types of osteoarthritis are caused by hereditary disorders of collagen - an essential component of cartilage.

What are the symptoms of osteoarthritis?

Joint stiffness and pain, worse after exercise and at the end of the day.
Backache.
Joint swelling.
Reduced range of movements in the affected joint.

How is osteoarthritis diagnosed?
A diagnosis may be made on the basis of the symptoms, although x-rays and possibly an MRI scan will help confirm the diagnosis. There is no blood test for osteoarthritis, but blood tests may be performed to exclude other types of arthritis.

How is osteoarthritis treated?

Drugs, such as painkillers or non-steroidal anti-inflammatories. Some of these can be bought over-the-counter without a prescription. Ask your pharmacist for advice.
Physiotherapy.
Steroid injections into the joint.
Joint replacement for severe disease of the hip or knee.

Is there anything I can do to help myself?

Maintain a healthy weight.
Take regular exercise. Swimming is excellent.
Wear shoes with shock-absorbing soles, such as trainers.
Don't overdo it. If you have a lot of housework or gardening to do, do it in short bursts with short breaks in between.
Think about modifying your home to minimise stress on your joints. An occupational therapist will be able to advise you on this, and may be able to arrange special equipment if necessary.
Some people find alternative therapies helpful. Acupuncture, in particular, seems to have a pain relieving effect.

Useful sources of information:
Arthritis Research Campaign, PO Box 177, Chesterfield, S41 7TQ. Website: http://www.arc.org.uk
Arthritis Care, 18 Stephenson Way, London NW1 2HD. Telephone 0808 800 4050 (12md - 4pm Monday to Friday). Website: http://www.arthritiscare.org.uk

PAEDIATRIC – BEDWETTING

Why do children wet the bed?
Although some children do have a medical condition that causes them to wet the bed, for the vast majority there is no obvious reason. It is likely that some children simply do not have the bladder capacity to last through the night, but also sleep so soundly that they do not wake up when their bladder is full. Bedwetting is also more likely to occur if the child is under psychological stress, for example, if there are problems at home or at school.

How common is bedwetting?
It is estimated that nearly 20% of five and six year-olds, and 1% of teenagers wet the bed, at least occasionally. Boys are more likely to be bedwetters than girls.

What can I do to help?
Firstly, it is important that you don't get angry or upset with your child. Children have little control over their bedwetting, and making them feel guilty may make matters worse. Although the problem usually resolves with time, the following tips may help:

Don't let the child have a drink within an hour of bedtime.
Make sure your child empties his/her bladder before going to bed.
Keep a potty near the bed and leave a nightlight on.
Protect the bed with a waterproof mattress cover.
Trainer pants may be helpful for younger children.
'Lift' your child onto the potty or toilet when you go to bed.
Older children may respond to the use of a 'star chart'.
Praise your child if he/she has a dry night.
Ask your health visitor to lend you a bedwetting alarm.

Your health visitor may be able to offer alternative advice if the above don't help.

When should I take my child to see a doctor?

If your child's urine smells 'fishy' or if he/she says it hurts to pass urine.
If your child seems to be passing more urine than usual, both day and night.
If your child suddenly starts wetting the bed, after previously being dry.
If your child is still wetting the bed after the age of six.

Useful source of information:
ERIC (Enuresis Resource and Information Centre), 34 Old School House, Britannia Road, Bristol BS15 8DB. Telephone: 0117 960 3060

PAEDIATRIC – BRONCHITIS

What is bronchitis?
It is the medical term for inflammation of the lungs, which is the condition that people are usually describing when they say that a cold has “gone down on to the lungs”. Indeed, bronchitis usually follows another infection, such as a cold, sore throat, or the flu. Bronchitis causes the tiny air passages inside the lungs to become inflamed and so swell, which reduces the amount of air that your child can breathe in. In addition, the infection causes mucous to build up inside the lungs (mucous is normally produced inside the lungs to stop them drying out), and this can also make breathing difficult.

What are the symptoms?

Wheeziness and difficulty breathing - a result of the swollen air tubes and the excessive amounts of mucous inside the lungs.

Dry, hacking cough - the mucous irritates the inside of the lungs, and so your child coughs to remove the irritation.

Vomiting - sometimes occurs after mucous that has been coughed up is then swallowed, or after a particularly severe coughing fit.

Raised temperature - a raised temperature is one that is 38 degrees C/ 100 degrees F or over.

Difficulty sleeping because of other symptoms.

Is bronchitis serious?
Not usually in children over a year old. However, babies under a year old may experience severe breathing problems and may even need to be hospitalised.

What should I do?
If your child is struggling to breathe or his or her skin is tinged with blue, this should be treated as an emergency and you should get medical assistance immediately. You should also contact the doctor if the infection seems to be getting worse. If your child seems hot or has a raised temperature, keep him or her cool (not too many clothes or covers). Also give him or her infant paracetamol mixture to help reduce the temperature as well as soothing your child and helping him or her to rest.

If your child is coughing a lot, try and encourage him or her to bring up the mucous (usually called phlegm) instead of swallowing it - this will ease his or her breathing. If your baby is too young to understand, then place him or her over your lap during coughing fits, and pat his or her back to help loosen the phlegm. Clear your baby's mouth of the phlegm to stop him or her choking. Prop your child up on pillows to help him or her breathe at night.

Keep your child warm, and try and keep him or her quiet and calm - crying or running around will make his or her breathing more difficult and the coughing fits more likely and more severe. Make sure your child is drinking fluids (plain water or fruit juice are best) frequently so that he or she does not become dehydrated.

Additional Patient Support Sheets: Healthy Medicine Cabinet, When to Call the Doctor

PAEDIATRIC – CRADLE CAP

What is it?
Cradle cap is a harmless scalp condition common in newborn babies. Your baby may have a mild case of flaky, dry skin that looks like dandruff, or a more severe case marked by thick, oily, yellowish, scaling, or crusting patches. It can also appear in the eyebrows, around the nose, and behind the ears. It is not caused by poor hygiene.

Who gets it?
Cradle cap usually appears anytime between two weeks to three months after birth, although it has been known to affect children up to the age of three years. It tends not to be a problem after a baby reaches six or seven months old.

What causes it?
Cradle cap is a form of seborrhoeic dermatitis, a skin condition in which the oil glands are stimulated by adult hormones. The glands produce too much oil, which turns into oily patches, and then dries and flakes off. Some doctors think that the extra hormones a mother produces and passes to her baby during childbirth causes the oil glands to over-produce.

What can be done about it?
The best way to remove the scales is to rub oil, such as baby oil or olive oil into your baby's scalp every day and leave it there for about 15 minutes. This will help to soften and loosen the scales. Then wash the scalp with mild shampoo - do not use anti-dandruff shampoo without consulting your doctor. Do not rub your baby's scalp hard when you are shampooing - the loose scales should wash away easily, although some may need further softening before they can be removed. Brushing the hair regularly with a soft-bristled brush will also help to loosen the scales, and will help prevent the build up of cradle cap in the first place.

When the hormones in your baby's body level out after the early months, the condition should go away.

If the scalp becomes very inflamed, or the cradle cap does not seem to be getting better, your doctor may prescribe a mild corticosteroid cream.

PAEDIATRIC – NAPPY RASH

What is nappy rash?

Nappy rash is a skin condition that occurs in the nappy area. It is very common and ranges in severity from a slightly red bottom to an angry rash with broken skin and blisters.

What causes nappy rash?

Irritation of the skin from contact with urine and faeces.
Reactions to washing powder/liquid if your baby wears cloth nappies.
Reactions to bathing products.
Thrush.
Eczema.

What can I do about nappy rash?

Change your baby's nappy frequently.
Change soiled nappies immediately after your baby has a bowel movement.
Clean your baby's skin thoroughly with a gentle cleansing product. Wipes are not suitable if they contain alcohol.
Apply a suitable protective cream to your baby's bottom. There are a number on the market, so it is a case of experimenting to find one that you like and which suits your baby. Consult your pharmacist for advice.
Don't use talcum powder.
Let your baby go bare-bottomed as often as possible.
If you use cloth nappies, try changing your washing powder/liquid. Use non-biological products and don't use fabric conditioner. Where possible, line dry nappies.
Use plain water for your baby's bath.

If the nappy rash does not clear up, consult your health visitor for advice. If the cause is likely to be thrush or eczema, she will also be able to advise on whether you need to take the baby to see the doctor.

PAEDIATRIC – OTITIS MEDIA

What is otitis media?
It is the medical term for inflammation of the middle part of the ear. The ear is divided into three segments - the middle part, which is fluid filled and lies behind the ear drum, is connected to the throat via the Eustachian tube. In children, the Eustachian tube is relatively short, so any infections in the throat, such as if your child has a cold, sore throat, or tonsillitis, can easily travel to the middle ear. The infection can block the Eustachian tube, preventing fluid and mucus in the middle ear from draining away as normal. This causes the fluid in the middle ear to build up, leading to pressure in the ear and earache. If the trapped mucus is not released, it usually increases and becomes sticky, leading to glue ear.

What are the symptoms?
These usually follow a cold or throat infection:

Severe pain in the ear - babies may rub or tug at their cheek or ear, young children may be unable to locate the pain precisely
A raised temperature - over 37 degrees C / 98.4 degrees F
Loss of hearing
Discharge of pus - about 4% of otitis media cases result in a burst ear drum; the ear drum usually heals by itself.

Is otitis media serious?
It can sometimes cause hearing loss if it is severe and occurs in both ears. However, it is not serious in the vast majority of cases.

What should you do?
Earache is often worse at night when the child is lying flat - your child is may find it difficult to get to sleep or may wake up distressed and in pain. Sitting up your child will help relieve the pressure in the middle ear, and infant paracetamol mixture will help to relieve the pain. If there is no discharge from the ears, then a little warm oil or ear drops poured in to the ear may help to relieve the situation; however, it is best to check with your doctor first. Warmth often helps to relieve the pain - place a warm hot water bottle wrapped in a towel next to your child's ear. If your child is under a year old, do not leave him or her alone with a hot water bottle in case he or she overheats.If your child continues to have pain, has a high temperature, or there is a discharge from the ear(s), contact your doctor. Make sure no water enters the ear when your child is having a bath or shower, and don't let him or her go swimming until two weeks after the infection has cleared up completely.

What might your doctor do?
Your doctor may be prescribe antibiotics to clear up the infection. If your child seems deaf after an episode of otitis media, your doctor will probably check him or her again after a month or two in case he or she has developed glue ear. If your child frequently suffers from glue ear, your doctor may refer him or her to an ENT specialist, who may recommend that grommets (small plastic tubes) are inserted in each ear. These help the fluid to drain away easily. The grommets usually fall out after a few months once the ears are healthy again.

Additional Patient Support Sheets: Earache, Taking Antibiotics

PAEDIATRIC – TEETHING

What is teething?

This is the term used when a baby's first set of teeth are coming through. The first tooth usually comes through at about the age of six months, and the whole set of 20 is normally complete by the age of two years. There is, however, some variations in these times.

What are the symptoms?

Many babies teeth without any problems, while some find it a very unhappy experience. When a tooth is about to erupt, symptoms include:

Irritability and fretfulness.
Crying and 'clinginess'.
Difficulties settling and sleeping.
Hot cheeks - and an inflamed hard lump on the gum where a tooth is about to come through.
Rubbing or scratching cheeks, ears, or neck.
Dribbling - more saliva than normal is being produced.
Biting and chewing - desire to bite on anything, such as fingers, that he or she can get into the mouth.

Any other symptoms, such as a high temperature, nappy rash, or diarrhoea, may be the symptoms of an underlying illness. Consult your doctor if you are concerned.

What can you do?

Give your baby something suitable to chew, for example, a piece of apple or a stick of carrot. Chill them first in the fridge. Because of the possibility of choking, do not leave him alone with food.
A teething ring may help, particularly if you keep it in the fridge.
Try rubbing your baby's gums with a clean finger or commercial painkilling gel (follow the instructions on the box).
Infant paracetamol can be given if your baby is obviously in pain. Follow the instructions as regards dosage.
If your baby temporarily seems to have 'gone off' his food, don't worry. Babies rarely lose their appetites for long.

If you have any concerns about your baby's teething, consult your health visitor.

PAEDIATRIC – UTRICARIA

What is urticaria, or hives?
Also known as hives or nettle or heat rash, it is a particular type of skin rash. It is easy to recognise - the rash consists of white and raised lumps against red inflamed skin. The lumps can be tiny pimples or centimetres across, and can merge to form large raised lumps. The lumps are usually very hot and itchy. The rash usually appears only in certain areas of the body, although in severe cases they can cover the entire body.

What causes it?
There are a variety of reasons, such as:

Skin is irritated by contact with certain plants or insects, such as stinging nettles or primulas; wasps or bees
Reaction to something that has been eaten, frequently strawberries, shellfish, eggs, or nuts
Reaction to certain drugs
The skin's response to cold or sunlight, or to sweating bought on by exercise or heat

Is it serious?
Not usually. However, in rare cases the rash occurs in or around the mouth, and is accompanied by swelling. In this instance, it can be very serious as the air passage may be blocked by the swelling of the tongue or the throat. If this happens, get medical assistance immediately - medically, this is known as angioneurotic oedema

What can you do?
If you suspect that your child is reacting to certain foods, keep a note of each time the rash appears. Exclude the food from his or her diet for a week or two and then reintroduce a small amount of it and check if the rash appears. If you think it may be caused by a particular drug, discuss things with your doctor - details about allergies to drugs, especially penicillin, is something your child should keep on him or herself at all times in case of accidents. If circumstances appear to trigger the rash (this is quite rare), such as sudden exposure to strong sunlight, try building up to it gradually or trying different ways of minimising the effect. In the case of heat rash, a daily beta carotene supplement can help in some cases, although always check with your doctor or health visitor before giving any vitamin supplements to children.

If your child reacts badly to the stings of bees or wasps, then he or she should try and avoid eating sweet things (ice cream, lollies, jam - the insects love them) outside in summer, and should be very wary of being stung. However, try and teach your child that moving suddenly as a wasp or bee comes near is often counterproductive - scared insects are the ones that are most likely to sting and moving suddenly and shouting startles them. So your child should slowly and calmly move away from the insect, and try not to startle it. Any nests and hives in the vicinity of the house should, of course, be removed promptly by professionals, preferably when your child is not at home.

Urticaria often clears up of its own accord as the child grows up. However, this is not always the case if it is caused by an allergic reaction to food or drugs, when increased sensitivity can occur with each exposure. Once your child has the rash you should -

Apply calamine lotion to the rash
Make sure that clothing isn't irritating the skin any further
Give your child a tepid bath to relieve the itching
Consult your doctor if the rash lasts for several days or is very severe

What might your doctor do?
If your child's rash is caused by an allergic reaction to certain substances or to the stings or bees or wasps, your doctor may prescribe anti-histamine tablets or medicine to relieve it.

Useful souce of informaytion:
Food Allergy Association, 4 Gorse Bank Close, Rock Road, Storringham, Pulborough, W Sussex BN16 4BW

Additional Patient Support Sheets: Hayfever, Food Allergies

PAEDIATRIC – WHEN TO CALL THE DOCTOR

A baby, like any other young mammal, often reacts quite alarmingly to even small problems, and it can be very difficult, especially when you are a first-time parent, to know when to call the doctor. There are some circumstances when medical help should be sought immediately, and these will usually be obvious (see When is it an emergency? on accompanying sheet). However, there are other times when you may be unsure about the severity of the illness and whether you should contact the doctor or not, and this sheet has been designed to help you decide. This sheet is only intended as a guide, however. You know your baby better than anyone and if you feel anxious about his or her health, but can't quite put your finger on what' wrong, then you should contact the doctor - your doctor would much rather be safe than sorry.

When might symptoms be significant?
There are a number of different symptoms that indicate that a baby is ill; the severity and combination of symptoms are the significant factors in determining if the doctor should be called:

Crying - even very fretful babies are rarely seriously ill - most crying is an indication of discomfort or loneliness. However, it could be significant if your baby's crying is unusual or different from normal, including cries that are high-pitched, weak, moaning, or painful sounding. If high-pitched moaning cries are combined with purpura (see Rashes) and a temperature (see Temperature), then contact the doctor immediately.

Fluid & food intake - it is significant if your baby refuses all food or his or her fluid intake is less than half the normal intake over a 24 hour period, especially if your baby is also less alert than usual (see Drowsiness & alertness) or if the fontanelles (soft places in your baby's skull) have dipped.

Vomiting - most babies bring a little bit of milk back up after a feed, and this is perfectly normal. However, it may be significant if at least half the feed is vomited after three or more feeds in a row, if the vomit is green-coloured, or if the vomiting is accompanied by persistent diarrhoea.

Dry or bloody nappies - it is significant if your baby's nappy is noticeably drier than normal over the course of three or more changes or if there is a large quantity of blood in the nappy (not just a tiny amount).

Diarrhoea - it could be significant if your baby has diarrhoea for six hours or more, especially if he or she also has a raised temperature (see Temperature).

Drowsiness & alertness - even the most placid baby is usually aware of what is going an around him or her. If your baby is noticeably drowsy, is not watching you, and is not responding to anything, then it is significant, especially if other symptoms are present.

Floppiness - some babies are more relaxed than others, but you will know how cuddly, relaxed, firm, and strong your baby's body normally is, and if your baby's body is much more floppy than normal, it could be significant. This is particularly so if accompanied by a raised temperature (see Temperature), purpura (see Rashes), and a high-pitched, moaning cry (see Crying).

Breathing problems & wheezing - It is significant if your baby is having problems breathing (the bottom of the chest will dip at every breath), or if he or she is wheezing (whistling sort of noise) when breathing out, especially if he or she is also pale (see Paleness & poor circulation) with blueing around the lips or is red in the face.

Paleness & poor circulation - some babies are naturally pale, but if your baby's body is much paler than normal then this is significant, especially if his or her nails are tinged slightly blue.

Rashes - if your baby has a rash that covers a large area of his or her body, if the rash is weeping and sore, or if the spots don't vanish when pressed with the side of a glass (known as purpura) then this is significant, especially if your baby has also got a high temperature (see Temperature) and is make a high-pitched, moaning cry (see Crying).

Temperature - a raised temperature is over 38.3 degrees C (100.8 degrees F). It is especially significant if combined with other symptoms, such as a stiff neck, high-pitched moaning cries, or vomiting and diarrhoea, if it drops and then rises again, if it is maintained for three days or more, or if your child has a raised temperature and has had a fit in the past. A low temperature - below 35 degrees (95 degrees F) - when accompanied by clammy cold skin, drowsiness, and lack of alertness is also significant.

Hernia - some young babies develop hernias (soft swelling) near the navel or in the groin. All babies should be checked by the doctor if they develop a hernia, although most hernias do clear up by themselves.

When is it an emergency?
If your baby experiences any of the following he or she requires urgent medical assistance:

Stops breathing, or his or her skin turns blue

Has a fit (convulsion)

Cannot be roused or woken

Is very unresponsive and isn't aware of what is going on around him or her

Has glazed eyes and isn't focussing on anything

Has a deep wound that is bleeding badly

Is burned or scalded

You suspected he or she has a fractured or broken bone

Has swallowed or eaten drugs, chemicals, or anything poisonous

Has been bitten by a snake or animal

Useful sources of information:
Baby Check Ltd, PO Box 324, Wroxham, Norwich NR12 8EQ Tel: 01603 784400
For a copy of the Department of Health's excellent booklet Baby Check. £8.95, including a digital thermometer

BM CRY-SIS, London WC1N 3XX Tel: 0171 404 5011 For parents under stress because of a child who continually cries. Will give you a local number to ring for support

PELVIC FLOOR EXERCISES

The pelvic floor forms a firm base to the pelvis. It is made up of muscle layers forming a sling that supports the pelvic organs. These muscles can weaken with age, or can be damaged following childbirth. Exercising these muscles can strengthen them, helping to prevent impotence and incontinence as well as preventing prolapses. Pelvic floor exercises are sometimes called “Kegel” exercises.

How to do pelvic floor exercises:
Sit, stand or lie with your legs slightly apart. Tighten your back passage as if you are trying to stop yourself passing wind. Count to four and let go.

In the same position, tighten the muscles around the base of the bladder as if you are trying to stop yourself passing urine. Count to four and let go. If you have problems identifying which muscles these are, wait until you are actually passing urine, then try to stop the flow. Another way to identify the muscles is to imagine you are trying to hold on to an imaginary tampon that is slipping out.

Some people find it helpful to imagine that the muscles of the pelvic floor are a 'lift'. Normally, the lift is on the ground floor. Tighten the muscles in stages, going up to the first and then the second floor. As you get more experienced, try going up to the third floor. Loosen the muscles slowly to return to the ground floor. Relax all your muscles and go down to the basement. Now come back to the ground floor.

Pelvic floor exercises should be done at least four times a day. Some people find it useful to place coloured stickers in strategic places around the house to remind them to do them. However, if you have just had a baby, ask your midwife for advice on how often you need to do them. If you have continence problems, your GP or health visitor can advise you, or you may be able to consult a specialist nurse continence advisor who will also be able to check that you are doing them correctly.

For further information on incontinence, see our patient advice sheet entitled 'Incontinence'.

PRE-MENSTRUAL SYNDROME

What is Premenstrual Syndrome (PMS)?
Most menstruating women experience some kind of physical or psychological change in the week or two before their period begins which disappears once their period has started. If symptoms restart after ten consecutive symptom-free days, a diagnosis of PMS can be made. For most women the symptoms are mild, however, for a small proportion, the symptoms are severe and can affect their daily life.

What are the symptoms?
Very many symptoms are recognised, although most women experience only a handful. The most common are: -

Irritability and mood swings - anger, rage, tension and depression.
Fluid retention - bloating and breast tenderness.
Headaches and sometimes migraines.
Muscle cramps - backache, lower abdominal pain or tenderness.
Clumsiness.
Tendency to daydream and poor concentration.
Intense sensitivity and a heightened awareness.

What causes Premenstrual Syndrome?
The cause is not known. Most doctors believe that it is linked to the fluctuating levels of female hormones that are experienced following ovulation; this may explain the bloating that occurs. It is possible that PMS sufferers may have a lower level of a chemical called serotonin in their brain and this would explain the irritability, depression and mood swings experienced. It is not thought to be caused by a hormone deficiency.

What treatments are available?
Treatment will depend on the nature of the symptoms and their severity. There is much that can be done to gain relief.

Diet

For many women, simple changes to their diet and lifestyle, such as reducing alcohol and caffeine intake and smoking, all help to make the symptoms more bearable. Many women report craving for sweet or starchy (carbohydrate) foods just before their period is due. Eating carbohydrates helps relieve many symptoms by increasing serotonin levels. However, it must be remembered that complex carbohydrates like fruit and wholemeal bread are better than simple carbohydrates such as sweets and biscuits, as these are likely to cause the blood sugar level to rise and a feeling of shakiness and irritability to follow.

Exercise

Being active and exercising regularly helps to keep the hormones in balance. Aerobic, non-weight-bearing exercise such as swimming, cycling or brisk walking is most appropriate. Stress can increase the frequency and intensity of the symptoms. Anything that helps relaxation such as yoga or meditation will help relieve symptoms.

Supplements

Some studies suggest that capsules of Evening Primrose Oil alleviate pre-menstrual breast pain. Vitamin B6 (pyridoxine) may help mood swings. Diuretics (water tablets) may give relief for ankle swelling, but will not effect abdominal bloating as this is caused by muscle distension in the bowel.

Antidepressants

In some cases, antidepressants may be helpful

Synthetic Hormones

The Combined Oral Contraceptive Pill (COC) is often prescribed in PMS especially if contraception is required. It is believed to help by stopping ovulation and reducing the body's natural fluctuation in the hormones thought to be responsible for PMS. It is available by free prescription. Oestrogen patches can suppress ovulation and reduce hormonal fluctuations. Scientific evidence supports the use of oestrogen, but it can be obtained only on prescription. In severe and difficult to treat cases LHRH analogues (Zoladex, Synarel) are used, but these are potent, expensive drugs.

Surgery

For a small minority of women, surgical removal of the ovaries is the only measure that will allow a normal existence free of PMS.

Useful Source of Information:
National Association for Premenstrual Syndrome, 7 Swift's Court, High Street, Seal TN15 0EG. Telephone: 01732 760011. Website: http://www.pms.org.uk

SCHIZOPHRENIA

What is schizophrenia?
Schizophrenia is a serious mental illness, affecting about one in a hundred people in Britain today.

What are the signs and symptoms?
Schizophrenia has nothing to do with 'split personality', although the word means 'split mind'. It is as if there is a split between the mind and everyday life. If you have schizophrenia, you may feel as if you are experiencing the world in a different way from everyone else. You may feel as if you have lost control over your thoughts and actions, or as if someone else is controlling them. You may hear voices which sound so clear and real that it seems impossible they are actually in your own mind. You may feel like replying to them or shouting at them.

Your brain may interpret the world differently from other people's; you may feel that you have a special role or that some things have a special significance which other people cannot understand. You may find everyday life an effort. It can be difficult to get up in the morning and to mix with people. You may feel better staying in your room.

What causes schizophrenia?
The cause is not really known, although it sometimes runs in families. Stress is not a cause, but a stressful event may trigger an attack. Like everyone else, people with schizophrenia may be of high or low intelligence and it is rare for them to be violent - in fact many are original, talented people.

What can be done?
Schizophrenia cannot yet be cured but it can be treated and controlled. Drugs can be given which will gradually suppress the 'voices' and feelings of lost control. There are many people who can work with you to help you return to a normal life - people like your consultant, your GP and your community psychiatric nurse. There may be times when you need treatment in hospital, but as you recover from an episode you may find it helpful to attend a day centre.

What can I do to help my recovery?

Do keep taking your medication. It is tempting to stop taking it when you feel better, especially as it may give you some side effects, but unfortunately stopping it will lead to a return of the symptoms.
Don't take any other drugs unless they have been prescribed for you; they may not mix well with your own medication. Do avoid drugs like alcohol or cannabis, because they are likely to make your symptoms worse.
Try to avoid stress if possible. You may find it useful to talk to your doctor or nurse about what is stressful in your life.
Eat a good diet and take care of yourself. You may not feel like it during an attack so it pays to eat well when you are able.
Don't neglect your supporters. Having a family or small group of friends around you to give support during the difficult times will make a big difference to you. If you have no close friends, why not contact one of the organisations listed below, who will understand your situation.
Think positive. Many cases of schizophrenia clear up, and even if yours isn't one of them, it is very likely you will be able to continue a normal, productive life.

Useful sources of information

MIND (National Association for Mental Health)
Granta House, 1519 Broadway, Stratford, London E15 4BQ
http://www.mind.org.uk/

National Schizophrenia Fellowship (NSF)
30 Tabernacle Street, London EC2A 4DD
Telephone: 020 7330 9100
http://www.nsf.org.uk/

SANELINE
National helpline run by the organisation SANE, to offer help and advice to anyone coping with mental illness.
Telephone: 0345 67 80 00 (2pm - 12mn)
http://www.cab.org.je/10050401.htm

SHINGLES

What is shingles?
Shingles, also known as Herpes Zoster, is a painful rash of small yellow blisters, which spread over an area, dry up, and form scabs. The rash spreads as a band around one side of the body. It can also affect the face, especially on the brow and round the eye.

Who gets shingles?
You can only get shingles if you have already had chickenpox (also called varicella). Shingles can occur in both adults and children, but is more common in the over 50s.

What causes it?
Once you have had chickenpox, the virus that causes it can lie dormant in the nerves of your body without doing any harm. However, if reactivated, this virus can cause shingles. An attack of shingles often occurs when people are run down, or under stress.

What are the symptoms?
The first sign is a burning sensation or feeling of tenderness on the nerve paths along which the virus is travelling. However, some people just feel slightly unwell. Two or three days later, a red spotty rash appears. These spots blister rapidly. After one or two weeks, these blisters dry up and form scabs.

The rash only affects the side of the body served by the affected nerves and is sometimes extremely painful - some people can't even bear their clothes to touch the rash. The pain can continue after the spots have gone, for weeks or even months, and is called post-herpetic neuralgia, but this is not common.

If your eyes or the side of your head are affected, you should see a doctor urgently as shingles can cause blindness.

How is shingles treated?
A light dusting powder such as zinc oxide or calamine lotion can help to soothe the irritation. Alternatively xylocaine ointment can be bought over the counter and spread on the area. Other analgesic creams are available on prescription.

The only treatment for shingles itself is anti-viral drugs. There are several of these, but they work best when started within three days of an attack starting. These drugs are only available on prescription.

If post herpetic neuralgia persists, sedatives and analgesics can be prescribed for the pain. Carbamazepine or amitriptyline may be prescribed in severe cases.

Useful source of information:
Shingles Support Society, 41 North Road, London N7 9DP. Send an SAE and donation for self-help advice and drug treatment information. Website: http://www.astrabis.co.uk/sites/herpesvirusesa/shingles.htm

STROKE

What is a stroke?
A stroke is a sudden attack of weakness or paralysis affecting one side of the body.

What is the cause?
A stroke can be caused by a blood clot stopping the flow of blood in the brain, or by a burst blood vessel in the brain causing bleeding into the surrounding cells. A blood clot can develop inside a blood vessel (a thrombosis), or may be carried in the bloodstream from another part of the body (an embolism).

What are the symptoms?
The symptoms depend on which part of the brain is damaged, but most commonly, one side of the body is affected by a loss of sensation, leading to weakness or paralysis of limbs. A person may have problems walking, or lose balance and co-ordination. They may also become confused or dizzy, and have difficulty in speaking or understanding speech. Stroke can also lead to difficulty in swallowing and visual disturbances.

What are the risk factors?
Risk factors include:

Smoking: Smoking can cause blood vessel damage and thickening of the blood, both increasing the risk for stroke.
Age: The older you are, the more likely you are to have a stroke.
Men suffer more strokes than women.
High blood pressure, high cholesterol, and diabetes, which can all cause blood vessel damage.
Family history.
Heart disease, including atrial fibrillation.
Heavy alcohol consumption.
Obesity.

What is the treatment?
A stroke causes permanent damage to the brain cells affected. However, sometimes enough cells are unaffected for the patient to recover mobility. Some people may have a temporary stroke known as a 'transient ischaemic attack' in which symptoms disappear completely within the first 24 hours. However, some patients do not recover fully from a stroke. In very rare cases, surgery will be used to prevent another stroke or to repair vascular damage or malformations in and around the brain. Rehabilitation can be helped by physiotherapy. To reduce the risk of further strokes, the patient may be given medication, e.g., for high blood pressure, but should also stop smoking, reduce alcohol intake and lose weight if necessary.

Useful sources of information:

The Stroke Association. Helpline: 0845 30 33 100. Their website on http://www.stroke.org.uk offers a huge list of contacts in all regions of the UK. For a free copy of their magazine, 'Stroke News', ring the editor on 020 7566 0327
Stroke Family - this is a website run by and created for the victims of stroke and their families on http://www.strokefamily.org
National Institute of Neurological Disorders and Stroke (NINDS). This is an American website but it does offer interesting and useful information about the latest research and news on

http://www.ninds.nih.gov

TEENAGE GIRL

There are some fundamental facts of life about which you should be aware:-

Teenage love affairs are gut wrenchingly powerful (in Romeo and Juliet Shakespeare made Juliet 14 because this is the age when the passions are most dangerous) but sadly, in almost all cases, short lived - weeks or months as a rule.

If you want to have sex think about it, think about it again, and then think about it one more time.

Sex and the Girls Body.

If you have sex at a young age then this can have bad health effects later on. There is clear evidence that early sex is linked to cancer in later life. If you use condoms, this can reduce the risk.

Babies and Single Teenage Mothers.

Most teenagers who have a baby are very soon a single mother. The father does not normally offer any real help.

As doctors we find that such women are frequently depressed, upset, and can even find themselves resenting the baby. "I wanted a baby so much, and now all it does is cry" is a sadly familiar line. This is not good either for the mother or the baby.

Unless your parents are fully behind you and willing to look after the baby while you continue your education or develop your career, having a baby is likely to be a huge error.

Aids HIV and Safe Sex.

There are lots of Sexually Transmitted Diseases, of which HIV is the best known and most serious. Apart from saying no, condoms are the best protection are the best protection against ALL sexually tranmitted diseases. Simple rule - no condom, no sex. If he complains, kick him out of bed. I (the writer) am a man and can tell you that yes, wearing a condom does reduce the feeling a little, but sex with a condom is still a great pleasure. If he respects you he will wear it. There is also of course the female condom, which is a fine alternative.

If you do not wish to talk to your GP, contact a local family planning clinic.

TENNIS ELBOW

What is tennis elbow?
Tennis elbow is inflammation of the tendons on the side of the elbow and the forearm. Tendons are fibrous cords which join muscle to bone.

What causes tennis elbow?
Tennis elbow is usually caused by overuse of the arm, and despite its name, it usually results from repeated movements of the arm in other ways, such as washing windows, or using tools in a repetitive way. Playing tennis only increases the risk if your training schedule is intense. The problem can be triggered by sitting or standing in an awkward position while working, or using badly-designed tools or equipment.

What are the symptoms of tennis elbow?

Pain and tenderness on the outer site of the elbow. The pain is often worse when lifting objects with the palm of the hand facing downwards
The area may become swollen
Stiffness around the affected joint.

How is tennis elbow treated?

The initial treatment is painkillers and/or anti-inflammatory drugs, and rest
If the pain or inflammation does not get better in a few weeks your doctor may suggest a cortisone injection
Physiotherapy is sometimes helpful.

What can I do to help?

Lift objects with the palm of the hand facing upwards
Some people find that alternative therapies such as acupuncture may relieve the symptoms
To prevent injury make sure that the tools and equipment you use at work are the right size for you, and try not to work in awkward positions
Seek advice from a specialist sports' shop or qualified instructor about appropriate sports' equipment, techniques, and a suitable training schedule, and always warm-up and cool down properly when exercising.

Useful source of information:
Health and Safety Executive. Telephone: 08701 545500. Website: http://www.hse.gov.uk

TINEA

What is Tinea?
Tinea is the name given to a group of contagious fungal infections that can affect the scalp, the body (particularly the groin), the feet (athlete's foot), or the nails. These are common conditions in young people and adults, and are usually referred to as ringworm. People can get ringworm from direct skin to skin contact, by contact with the soil, or from pets and other animals.

What are the symptoms?
A red itchy rash occurs in the spaces between the toes or a scaly patch appears on the scalp. The infection on the body appears as a characteristic ring of redness on the arm or leg, and it itches. Sometimes the red skin furrows and becomes marked with ridges resembling chalked lines.

Common Tineal infections are:

Tinea corpus: commonly affecting the chest, back arms or legs. It forms a red ring around an area of white unaffected skin. It is common in children who have close contact with animals.
Tinea capitis: is also common among children and consists again of a red circle around unaffected skin on the scalp. Hair may be lost and regrowth may be patchy. In severe cases a swollen mass discharging pus, called a kerion, may form.
Tinea pedis: also called athlete's foot, is found as an itchy sore between the fourth and fifth toes, that goes soggy and white and starts to crack and peel. It spreads easily to other parts of the foot and to other people. It occurs frequently in warm, sweaty feet.
Tinea unguium: affects the toe nails especially if the person has athlete's foot. The nails become thickened and white or yellow in colour. If untreated, the nail will split and rise away from the nail bed, crumble and be lost.
Tinea cruris: or 'jock itch' is common in men, especially those who are sporty, wear tight underwear, or who sit on plastic seats for extended periods of time. It starts as small red spots on the inside of the upper thighs and these spread to form an itchy, reddened, scaly patch.

What is the treatment?
Topical antifungal creams can successfully treat the infection. It often takes two or three weeks to control the fungus. Occasional cases may require oral antifungal medicine or tablets as well. If a large kerion that is discharging pus has formed, antibiotics may be prescribed. Toenail infections can take as long as six months to treat.

What can I do to help?

Avoid sharing hairbrushes, towels or other personal belongings.
Avoid wearing tight clothing especially if it is synthetic.
Let the air get to your skin and wear cotton or wool socks.
Wear shoes that let your feet breathe. If you have athlete's foot then dust the inside of your shoes and between your toes with special powder obtained from the pharmacist.
Dry skin thoroughly especially between the toes, and in the groin.

Prompt treatment will prevent the fungus getting a hold.

TRAVELLERS HEALTH – DVT

What is deep vein thrombosis?
Thrombosis is the medical term for a blood clot inside the body. The term 'deep vein thrombosis' usually refers to a blood clot that forms in the deep veins of the legs. It is also referred to as 'venous thrombosis' and can be abbreviated simply to DVT.

What causes DVT?
DVT occurs when there is reduced blood flow in the lower limbs. The most common cause of reduced blood flow is prolonged immobility. Other factors that pre-dispose to DVT include:

Taking oral contraceptives.
Pregnancy.
Heart failure.
Recent surgery.

What are the symptoms of DVT?
Symptoms include pain, swelling and redness of the calf. A low-grade fever may also be present.

Is DVT dangerous?
The danger of a DVT is that all or part of the blood clot may break off and travel to the lungs. Clots that lodge in the lungs are referred to as pulmonary emboli, and can be life threatening.

Are travellers at risk of DVT?
Travellers who remain immobile for a long time, for example, in an aeroplane seat, are at risk of DVT. Air travel may also carry a slightly increased risk in that the air inside the cabin is dry, and may contribute to dehydration, which can further reduce blood flow.

What can I do to reduce my risk of DVT while flying?
On flights lasting six hours or more, or on multiple short-haul flights:

Avoid alcohol and caffeinated drinks.
Drink plenty of non-alcoholic fluids.
Do not cross your legs while seated.
Wear loose-fitting clothing.
Walk around the cabin as often as possible, ideally at least once every two-to-three hours.
Do leg and foot exercises while seated. For example, try 'circling' each ankle, first in a clockwise, and then in an anticlockwise direction.
Follow any specific advice on prevention given by the airline.
If you have a history of a previous DVT, or any other risk factors, consult your doctor for advice on prophylaxis.

What about aspirin for prevention of DVT?
Although some doctors do recommend taking half an aspirin before a long flight to reduce the risk of DVT, there is little evidence that it actually works. Some people, for example asthmatics, and those on certain drugs, should not take aspirin.

How is DVT treated?
DVT is treated with anticoagulants. They may be given by injection initially, and then in tablet form. However, the best treatment is prevention.

TRAVELLERS HEALTH – SAFER SEX & STD’s

What does safer sex mean?
You are having safer sex when you have taken sensible precautions against sexually transmitted diseases.

What do I need to do?
The most important element of safer sex is always, without fail, using a condom. Whether you are male or female, you should always carry new and undamaged condoms with you if there is any chance you may be going to have sex. The more partners your partner has had the greater the risk that they are infected with a sexually transmitted disease. It is usually impossible to tell when someone has a sexually transmitted infection.

Why is it important for travellers?
Safer sex is important for everyone, but it is in some ways an especially significant issue for travellers because:

Many people find they are more likely to have casual sex while they are away from home. This is because people lose their inhibitions, particularly when they are on holiday. The more partners you have, the greater the risks.
In many areas of the world, particularly Asia and Africa, a high proportion of prostitutes are HIV positive and many also carry other sexually transmitted diseases.
Condoms may not always be readily available, especially in places where contraception is against the religious traditions of the country.

It may be difficult to get help or treatment if you get a sexually transmitted disease or if you fear you might have been at risk.

TRAVELLERS HEALTH – SUN AND SKIN

Although most people enjoy going outside in the sunshine, too much sun can cause sunburn and damage the skin leading to premature skin ageing and an increased risk of skin cancer.

To make the most of the sun, and avoid burning, you should take the following precautions:

Avoid going out in the sun when the suns rays are at their strongest. In the UK, this is between 12md and 2pm, but, in many holiday destinations, the times to avoid are between 11am and 3pm.
Stay in the shade whenever possible.
Wear loose-fitting closely woven cotton clothes.
Wear a broad-brimmed hat.
Do not stay too close to water as ultra-violet rays (the ones that cause the damage) are reflected by water.
Use a sunscreen that protects against both UVA and UVB rays, and has a sun protection factor (SPF) of at least 15. Note that the SPF numbers on American products are double those on European products, so an American SPF 8 is only a European SPF 4.
Apply sunscreen liberally and frequently.
Always re-apply sunscreen after being in water, even if it claims to be waterproof.
Wear sunglasses.
You should also drink plenty of non-alcoholic fluids to prevent dehydration.

If you do get burnt, try cooling the burnt area in tepid water for between 30 minutes and one hour, or try applying natural yoghurt or calamine lotion to the area.

Remember that children are at particular risk of burning and small children should stay out of direct sunlight as much as possible. If a small child or baby gets sunburnt you should seek medical advice.

VARICOSE VEINS

What are varicose veins?
Vessels that carry blood from the body parts towards the heart are called veins. They have thin walls and, unlike arteries (which carry blood from the heart towards the organs), they are not elastic and have no pulse. Instead they have valves to prevent blood flowing backwards. If for some reason the valves do not work effectively, blood stagnates in them and causes the veins to become swollen and twisted. Although this can occur in any part of the body, varicose veins usually develop in the legs. They may also develop in the anal canal where they are called haemorrhoids. When there is liver disease they may occur in the oesophagus.

Who gets varicose veins?
This is a common problem affecting between 10-20% of the population. It is four times more common in women than men. Varicose veins develop with increasing age and are most common in people over the age of 50 years. They tend to run in families, although anyone who spends a lot of time standing or who is overweight is more likely to have them. They may also develop temporarily during pregnancy.

What can be done about them?
If your legs are constantly aching, or if the veins irritate during the day and standing up causes discomfort, seek help from a doctor to discuss what treatment is necessary. In all cases it is best to avoid too much standing. You should rest your legs higher than your head for ten minutes each day when possible, and exercise to keep the circulation going.

Lightweight, elastic support stockings or tights may help in the short term. There are also a number of complementary medicines reputed to help circulation, but you should only takes these on the advice of a specialist practitioner. Aromatherapy can also be used to improve the general tone of the veins.

If the condition becomes more serious a complete removal of the vein (surgical ligation) can be done and this involves a few days in hospital. There is also a new treatment available that involves injecting an irritant into the vein, causing the opposite walls of the vein to stick together. The effect, however, is not lasting.

VERRUCAE

What are verrucae?
Verrucae are also called verrucas. They are warts found on the soles of the feet, and are also known as plantar warts. They are caused by one of the human papillomavirus group of viruses, which is contagious and seems to thrive in damp conditions such as swimming pools, showers and bathrooms. Cuts or injuries to the foot increase the risk of infection. Verrucae mainly affect young children.

What do verrucae look like?
Verrucae usually start as a tiny pink area speckled with black dots. They then become dark brown in colour with a rough crumbly surface, sometimes covered by a layer of hard skin. When the surface of a verruca is pared off, several dark spots can be seen - these are the blood vessels which supply it. Verrucae occur either as a single spot or in irregularly shaped groups. They usually are painful when pinched rather than painful by direct pressure.

How are verrucae treated?
Quite often a verruca will go away within a year or two, without treatment, as the body's natural immune system rejects it. If it does not hurt and is not getting any bigger, it is best to leave well alone. However, there are a number of over-the counter-treatments available from a pharmacist. If the verruca is very large or persistent it may be best to see a chiropodist or doctor, who can then freeze or lance it under local anaesthetic.

Useful source of further information:
The Society of Chiropodists, 53, Welbeck Street, London W1M 7HE. Telephone: 0207 234 8620