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

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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

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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

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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.

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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.

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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.

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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

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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

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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. 

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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

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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

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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

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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

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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.

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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 

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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.

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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

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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

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INSOMNIA

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)

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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

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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

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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.

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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