Live Support

Abdominal pain

introduction of stomach ache abdominal pain...

A stomach ache usually refers to cramps or a dull ache in the belly (abdomen). It is normally short lived and caused by a minor upset or bug.

Severe abdominal pain is a greater cause for concern. If it starts suddenly and unexpectedly, it should be regarded as a medical emergency, especially if the pain is concentrated in a particular area. Call your GP as soon as possible or go to your nearest hospital accident and emergency department if this is the case.

This topic covers the most common reasons for:

If you feel pain in the area around your ribs, read about chest pain for information and advice.

Stomach cramps due to trapped wind

Stomach cramps are often due to trapped wind and bloating. This is an extremely common problem that can be embarrassing but is easily dealt with - your chemist will be able to recommend a product, such as buscopan or mebeverine, which can be bought over the counter to treat the problem.

Sudden stomach cramps with diarrhoea

If your stomach cramps have started recently and you also have diarrhoea, the cause is probably a tummy bug (gastroenteritis). This means you have a viral or bacterial infection of the stomach and bowel, which should get better without treatment after a few days. A common cause of gastroenteritis is a norovirus.

Severe stomach cramps and diarrhoea that make you feel very ill (for example, causing chills or a fever) could be due to a more serious infection, such as food poisoning. This also usually gets better on its own without treatment.

If your stomach cramps and diarrhoea continue for more than a few days, you may have a long-term condition, such as irritable bowel syndrome.

Sudden, severe abdominal pain

If you have sudden, agonising pain in a particular area of your belly, call your GP immediately or go to your nearest hospital accident and emergency department. It may be a sign of a serious illness that will rapidly get worse without treatment.

The most common causes of sudden, severe abdominal pain include:

  • appendicitis – the swelling of the appendix (a finger-like pouch connected to the large intestine), which causes agonising pain in the lower right-hand side of your abdomen and means your appendix will need to be removed
  • a perforated peptic ulcer – an open sore that develops on the inside lining of your stomach or duodenum (upper small intestine) that has broken through the lining
  • gallstones – small stones that form in the gallbladder, which may mean the gallbladder will need to be removed
  • kidney stones – small stones may be passed out in your urine, but larger stones may block the kidney tubes and you will need to go to hospital to have these broken up
  • diverticulitis - inflammation of the small pouches that are part of the bowel

Sometimes, sudden and severe pain in your abdomen can also be caused by an infection of the stomach and bowel (gastroenteritis). It may also be caused by a pulled muscle in your abdomen or an injury.

Click on the links above for more information on these conditions. If your GP suspects that you have appendicitis, they will refer you to hospital immediately.

Long-term or recurring abdominal pain 

Adults who have persistent or repeated episodes of abdominal pain should see their GP. However, there is no need to panic as the cause is often not serious and can be managed.

Common causes in adults include:

  • irritable bowel syndrome – a common condition where the muscle in the bowel wall tends to go into spasm (tightens); pain is often relieved when you go to the toilet
  • Crohn's disease - a long-term condition that causes inflammation of the lining of the digestive system
  • a urinary tract infection that keeps returning (you will usually feel a burning sensation when you urinate)
  • a long-term peptic ulcer – an open sore that develops on the inside lining of your stomach or duodenum (upper small intestine) 
  • constipation
  • heartburn and acid reflux – stomach acid leaks from the stomach and up into the oesophagus, the tube that runs from the mouth to the stomach
  • period pain - painful muscle cramps in women that are linked to the menstrual cycle

Common causes in children include:

Click on the links above for more information on these conditions. 

Achalasia

introduction of achalasia...

Achalasia means that your gullet has lost its ability to move food along and the valve at the end of your gullet fails to open to allow food to pass into your stomach.

As a result, food gets stuck in your gullet and is often brought back up. 

A ring of muscle called the cardiac (or lower oesophageal) sphincter keeps the opening from the gullet to the stomach shut tight to prevent acid reflux (acidic stomach content moving back up into the gullet).

Normally, this muscle relaxes when you swallow to allow the food to pass into your stomach. In achalasia, this muscle does not relax properly and the end of your gullet becomes blocked with food.

Achalasia is an uncommon condition that affects about 6,000 people in Britain. It is sometimes known as cardiospasm.

What are the symptoms?

Symptoms of achalasia may start at any time of life and usually come on gradually.

Most people with achalasia have dysphagia, a condition where they find it difficult and sometimes painful to swallow food. This tends to get worse over a couple of years.

It may cause you to bring back up undigested food shortly after meals and some of the vomited food may have been held up in your gullet for some time.

Bringing up undigested food can lead to choking and coughing fits, chest pain and heartburn.

Occasionally, vomit may dribble out of your mouth and stain the pillow during the night. If it trickles down your windpipe, it can cause repeated chest infections and even pneumonia.

You may experience gradual but significant weight loss.

However, in some people achalasia causes no symptoms and is only discovered when a chest X-ray or other investigation is performed for another reason.

What is the cause?

Achalasia is caused by damage to and loss of the nerves in the gullet wall. The reason for this is unknown, although it could be due to a viral infection earlier in life.

There is no evidence to suggest that achalasia is an inherited illness. Women with achalasia can have a normal pregnancy and there's no reason why their children will not develop normally.

How is it diagnosed?

If your GP thinks you have achalasia, you will be referred to hospital to have some diagnostic tests performed.

Barium swallow

A barium swallow involves drinking a white liquid containing the chemical barium, which allows the gullet to be seen and videoed on an X-ray.

In achalasia, the exit at the lower end of your gullet never opens properly, which causes a delay in barium passing into your stomach.

An ordinary chest X-ray may show a wide gullet.

Endoscopy

A flexible instrument called an endoscope is passed down your throat to allow the doctor to look directly at the lining of your gullet and stomach. Trapped food will be visible.

The endoscope can be passed through the tight valve at the bottom of your gullet and into your stomach to check that there is no other disorder of the stomach.

Read more about having an endoscopy.

Manometry

Manometry measures pressure waves in your gullet. A small plastic tube is passed into your gullet through your mouth or nose and the pressure at different points in your gullet is measured.

In achalasia, there are usually weak or absent contractions of the gullet and sustained high pressure in the valve at the lower end of the gullet. It is this high pressure and the failure of the valve to relax in response to a swallow that causes difficulty in swallowing food and food remaining in the gullet.

How is it treated?

The aim of treatment is to disable the valve so that food can pass into the stomach easily. The underlying disease cannot be cured, but there are various ways in which the spasm at the end of the gullet can be reduced and symptoms improved.

Medication

The valve at the lower end of your gullet may be temporarily relaxed by medication. Tablets such as nitrates or nifedipine will only produce a brief improvement in swallowing and are not effective in some patients, but may be useful while a more permanent treatment is planned.

These tablets may cause headaches, but this usually improves with continued treatment.

Dilatation (stretching the valve)

This is done under a sedative or general anaesthetic (where you are put to sleep). A small balloon (about 3-4cm in diameter) is used to stretch and disrupt the muscle fibres of the valve at the lower end of your gullet. This usually improves swallowing. The dilatation may need to be repeated after one or more years.

Botulinum toxin (Botox injection)

Botox causes relaxation of the muscle fibres. It can be injected painlessly into the faulty valve through an endoscope. This is usually effective for a few months and occasionally for a few years, but then has to be repeated.

Surgery

Under general anaesthetic the gullet is accessed through the chest wall or the abdomen (tummy). The muscle fibres that fail to relax are cut, with a permanent improvement in swallowing. The operation is now often performed by keyhole surgery and only requires an overnight stay in hospital.

Recovering from treatment

There are a few things you can do after dilatation or surgery to reduce symptoms:

  • chew your food well
  • take your time eating
  • drink plenty of fluids with your meals
  • always eat food sitting upright
  • use several pillows or raise the head of your bed so that you sleep fairly upright, which prevents stomach acid rising into your gullet through the weakened valve and causing heartburn

If heartburn develops after treatment, consult your GP as medication may be needed to reduce the acid reflux. Sometimes your surgeon may suggest you take this routinely to prevent problems after surgery. Read about treatments for acid reflux. 

You should also see your GP if you still have swallowing difficulties or are continuing to lose weight.

It's normal for chest pain to persist for a while after treatment – drinking cold water often gives relief.

Addiction

introduction of addictions...

Addiction means not having control over doing, taking or using something harmful. You can't control how you use whatever you are addicted to and you become dependent on it to get through each day.

It's not only drugs and alcohol that you can become addicted to. Activities such as sex, gambling or overeating can also be addictive over time.

There is no single reason why addictions develop. Regularly drinking alcohol, eating excessive amounts of (usually unhealthy) food, smoking cigarettes or using drugs changes the way a person feels, both mentally and physically. Some people enjoy these feelings and have a strong desire to repeat them.

From habit to addiction

Some people regularly use substances or carry out potentially addictive activities, such as gambling, without having any major problems. However, for other people, their behaviour causes damaging physical and psychological effects as their habit turns into an addiction.

An activity like gambling may give a person a "high" if they win, followed by a desire to repeat the feeling. Eventually, gambling becomes a habit that can't be easily broken because it is seen as an important and regular part of life.

With substances, the more a person uses them, the more tolerant their body becomes, until they need it more frequently and in larger amounts to achieve the same effect.

If a person with an addiction stops using the substance that they are addicted to, they will experience psychological or physical withdrawal symptoms (or both). Withdrawal symptoms are wide-ranging and vary depending on the substance involved, but generally the person will have feelings of discomfort, distress and an intense craving for the substance.

Not only does an addiction have an adverse affect on a person’s health and happiness, it can also put a strain on their relationships with others, causing problems at home, work or school.

Read more information about drug, alcohol, sex and gambling addictions.

Treatment and support

There are many organisations that provide advice, support and treatment for people with addictions.

Many people consult their GP first, but help is also available from community addiction centres where you can drop in without an appointment.

Treatment and support is provided by a range of different people, including specialist addiction nurses, counsellors and psychiatrists.

There are also websites and helplines if you would rather access information yourself or discuss the problem anonymously. The following links provide further information and advice:

Local support services

Local support groups provide the opportunity to meet other people who have had similar experiences.

You can use the links below to help you find support services in your area for alcohol and drug addiction, and for help with giving up smoking:

mapofmedicinepage of addictions...

Aesthetics

How To Look Younger Without The Price Tag...

One of the many features of getting older is wanting to look younger. We’re very rarely entirely satisfied with our lots in life and it’s in all of our natures to strive for that little bit more. In many respects this is fantastic; it has made us into the planet dominating force we are as a race. However, individually it can make us quite easily depressed. It’s very rare that we achieve everything we could possibly want in life and even the people that we view as ‘having it all’ tend to want something more. That said, there’s plenty you can do to look and feel much younger for much longer and it doesn’t have to cost you the world to do so. Your skin is the part of your body that people see most. It has to be tough to protect us from the elements and as we get older this protection starts to take its toll. There are all sorts of things that you can do to make sure your skin says soft and healthy; it doesn’t have to look its age. Getting into the habit of regularly exfoliating, moisturising and cleansing your skin will help to keep it looking its best. Trying getting yourself onto an anti-inflammatory diet as this has been known to be a great help to youthful looking skin. Replace your caffeinated beverages with peppermint tea and you’ll be delighted with the effects! Your hair is another part of your body which people are going to see a lot of. As we get older each individual strand of hair will start to grow in much more wiry, making us look older. If you see a stylist or hairdresser and change your hairstyle to match your new hair type you should be able to counter this. There are also all sorts of hair nutrition products which you can use to keep your hair looking and feeling glossier for longer!

X-Factor Star Reveals 'Preventative' Anti-Age...

Reality talent show judge Nicole Scherzinger has been revealing her wellness skin routines that perk up tired-looking skin and delay the appearance of fine lines. The singer has regularly been in the limelight since she shot to fame with US band the Pussycat Dolls and despite what must be a gruelling work schedule she takes time to concentrate on her wellbeing.

Stay Hydrated

Living in the public eye puts many stars under pressure to look good all the time, and the singer has revealed how important it is to keep her skin hydrated, especially when she feels tired. Whether you're a global star or not, we can all benefit from moisturising when it comes to anti-ageing. As we get older skin can become drier and complexions look dull. Applying rich creams can bring moisture back to the facial cells and plump them out. Nicole reveals she is a fan of these kinds of anti-ageing products and even compares the effect they have on the skin to drinking “a tall glass of water”. In fact, both are good ways to revitalise tired and mature skin, as creams bring moisture to the outer layer of cells, while drinking water enriches cells from the inside.

Vitamins and Minerals

Moisture plumps up skin, but skin creams also help you look younger in other ways too. Many youth enhancing products feature vitamins and minerals, which Nicole is also a fan of. The star explained how one of her favourite creams – called SK1 - is packed with organic nutrients, amino acids and vitamins. All these ingredients reduce the signs of ageing in several different ways. Vitamins and minerals have a detoxing effect on damaging free radicals, while amino acids can assist your skin in making new cells or reveal fresh ones by having an exfoliating effect. Organic nutrients tend to go straight to where they are needed and are packed with nature's anti-ageing remedies.
Best eye makeup for older faces...

Quoted by Simply Anti Aging: "How many times have you looked in the mirror first thing in the morning and thought – thank goodness for makeup.

Eyes are a dead giveaway in more ways than one. How much or how little sleep you had, how happy or sad, how much alcohol you drank last night or exercise you didn’t get time to take – it all shows up in our eyes.

The right eye makeup can perform wonders on an older face – blending away dark circles and bags, replacing thinning brows and lashes and enhancing eye color and sparkle.

The most important word there is “right” because of course – the wrong eye makeup does exactly the opposite.

The problem is that sometimes we forget to update the look. Makeup and specifically eye makeup often gets forgotten. It’s as if we stay frozen in whatever time warp we last felt fashionable and on trend.

Doesn’t matter whether your personal time warp is the sixties, the eighties or the nineties – your face has changed since your glory days.

Eye makeup needs to work on the face you have now not the one you had then. Everyone ages differently but we all face similar problems around the eyes.

Based on my own experience – here’s some suggestions for eye makeup that helps solve the problems of older skin:

Best eye shadow for older skin

The big problem here is crepey skin which doesn’t hold eye color as well as it used to. Generally powder around the eyes is an ageing look – dull and dry when you want soft and glowing.

Powder shadow also has other disadvantages I find. Little specks of it fall onto my face when I’m applying it and how often has the tablet of compressed powder cracked up and emptied itself all over the inside of my purse.

All is not plain sailing with cream shadow either. Even expensive ones fail to stick – collecting in the ever growing creases in eyelids and even migrating to crows feet.

In the quest for the best eye shadow for my older eyelids I ended up with a drawer full of discarded products that just didn’t work for me. Finally I got there – Bobbi Brown long wear cream shadow.

In my humble opinion this really is the best eye shadow ever – for me anyway. It comes as a thick cream in a little pot so you can use every last bit. You can apply it with a brush or finger tip – brush works better – and it comes in a fantastic range of subtle colors either matt or some with a slight pearlized sheen which is very pretty on older skin.

Subtle is what you want as skin ages – leave the bright colors and the glitter to the teens and twenties and go for soft enhancement – “yourself only better” as Bobbi Brown puts it.

My favorite color is Sand Dollar – a lovely indistinct gray-taupe with a soft sheen. I wear it all the time and it wonderfully flattering to most skins. African-American, Hispanic or Asian skin tone would need something stronger in color but it could be a great highlighter.

I also bought some matt colors in smudgy muddy tones that blend with it well – Suede and Slate and a lovely deeper gray pearlized color for evening – Galaxy.

They can all be blended together – Bobbi Brown does a blender brush just for the purpose – or you can just use a soft clean makeup brush of your own.

For me the best thing about all these Bobbi Brown eye makeup colors – apart from how good they look – is how long they last. You put them on in the morning and they stay uncreased and untouched until you take your makeup off last thing at night – and that works after a full day’s heavy garden work (yes – I wear eye makeup to dig the garden!)

There’s no point suggesting an alternative since no other eye makeup I have ever used comes close.

Choose a gel eye liner

You might be used to adding definition with eye liner and there’s no reason not to as you get older but you may need a lighter touch. Avoid very dark brown and black liquid liners which can look hard – you need something with a softer focus.

Choose a color at least a tone lighter than you’re used to. The aim is for it to almost blend with your eye shadow color rather than stand out as a harsh black ribbon in Cleopatra or Amy Winehouse style.

Hard black lines close up the eye which appears smaller as we age anyway – most of us need to open up the eye and give it definition.

A good soft eye pencil is one option or – my current choice – a gel eyeliner that you mix with a little water to give a very soft paste. Gel eye liners are great for older lids because they give you a soft, gentle line which you can get very close to your lashes.

Mac have a good one which I have tried but the best gel liner for me is the Long Wear Gel Eye Liner by Bobbi Brown in Sepia Ink. Again – “long wear” is exactly what you get without smudging.

Apply with a fine short haired eye liner brush so you can control where the line goes and get it as close to the root of your lashes as possible. Don’t extend the line outwards as any downward droop at the outer corner of your eye will be emphasised.

Makeup tips for thinning eyebrows

Strange how these disappear as you get older – it isn’t just the hair on your head that can get thinner."

Age Old Remedies

Feel Devilishly Good: How Devil’s Claw Reli...

You wouldn’t think that something called Devil’s Claw is beneficial to your wellbeing, but the complementary wellness therapy has long been used in native African medicine. Its fruit is covered with sharp curved spines, hence the name, and Devil’s Claw has been used in a wide range of conditions, such as muscle pains, digestive problems, headaches, fever and skin inflammation. In the early 1900s, Dr Mehnert, a German pioneer, first noticed the dramatic success of the root tuber of this African herb, and so Devil’s Claw began to gain popularity in Europe. Today, the root tuber is often used in supplements to treat many types of aches and pains. Wellness experts the effectiveness of Devil’s Claw down to it’s content of harpagosides. Research shows that this vital ingredient has anti-inflammatory and analgesic properties, and so this makes Devil’s Claw a useful remedy for a wide variety of joint conditions. Back pain can be effectively relieved with Devil’s Claw. According to a study published in the journal Phytotherapy, the most effective dose of the supplement is four 600mg tablets per day. For the study, people with severe, long-term back pain either took this dose or a placebo for four weeks, and those who took the herb experienced a significant reduction in their back pain. However, Devil’s Claw did not seem to benefit those whose back pain had radiated down to their legs. Another condition which receives monumental relief with Devil’s Claw is arthritis. A clinical trial looked at the effects of the herb on people with moderate, rather than severe, chronic arthritis, giving some participants two 600mg tablets per day over eight weeks, while others received a placebo. The study showed that those who took Devil’s Claw found a greater improvement in their joint pain and spinal mobility than the placebo group. However, if you have gallstones or stomach acidity, you should not take Devil’s Claw, as the herb stimulates bile action. Yet, as Devil’s Claw does not work in the same way as conventional arthritis medicines do, it will not cause the associated upset stomach. There are actually very few side effects reported for Devil’s Claw, but, as with any supplement, you should consult your doctor before taking it.

The Greek Secret: Live Long and Drink Coffee...

Do you want to live longer? Deep amongst the Aegean Sea sits the small, remote island known as Ikaria – a place where “people forget to die.” It almost sounds as legendary as Zeus turning into a shower of gold or Helios rampaging through the sky dragging the sun behind him. The truth may be even stranger than you may believe. It is noted in the National Geographic by Dan Buttener that Ikaria is one of five “blue zones” (the other four being the Japanese island of Okinawa, Loma Linda in California, Sardinia in Italy and the Nicoya Peninsula in Costa Rica) – because of the mystery of its inhabitants' longevity, happiness and overall health. So incredible are its people's health that it is reported that those aged over 90 are of the healthiest in the world. The secret? A daily dose of coffee. Not just any coffee, however. Mediterranean coffee has some of the most incredible and natural substances to date – and in the case of Ikaria, they have the cream of the crop. Boiled in a stove known by the Greek inhabitants as a briki, the finely ground beans are tipped back into a small cup and served with sugar, where it gently foams as the roast beans sink to the bottom. So what makes it so special? Premature death through heart attacks are uncommon in Ikaria. Research done by Athens Medical School suspect that it is down to the daily amounts of coffee that the Ikarians drink. Whilst the exact reasons are unclear, the unusually happy disposition and the lack of cancerous or cardiac issues are certainly linked to the caffeine and antioxidants within the coffee. By increasing the heart rate, it may be the equivalent of regular exercise, where the blood is pumped thoroughly and quickly throughout the body. Buttener noted that it was difficult to get through Ikaria “without walking up 20 hills,” which indeed may be connected to Ikarian longevity. On the other side of the scale however, afternoon naps are also part of Ikarian – and indeed Greek – culture. In a study in Havard School of Public Health in Boston, it was noted that those that took afternoon naps were 30% less likely to die of heart disease. Caffiene, healthy living or pure luck? Perhaps it is worth finding out …
How to Use Herbs to Prevent Yourself Getting ...

Did you know that herbal tea could help to protect you against getting the flu? You may think that this advice does not apply to you as you have had the flu vaccination and have no need for complementary medicine. This is not quite true: the flu shot only protects against certain strains of the flu, that is, the ones that the manufacturers of the vaccine believe will be most prevalent this year. In order to protect your wellness against this horrible virus, the best thing to do is to build up your immune system. This does not stop you from contracting the virus, but ensures that you are strong enough to fight off the virus without being too detrimental to your wellbeing. One of the best ways to achieve this is through a combination of herbal teas and meditation. Keeping mentally strong through de-stressing techniques, thinking positive thoughts, prayer and meditation for around 5 to 10 minutes per day can help to ward off the flu. As far as tea goes, whole-plant infusions are the best possible kind to keep your body hydrated and well nourished. These types of herbs are packed full of vitamins, minerals, antioxidants and free radicals. Infusions should be made as strong as possible by using up to an ounce of the herb (or herb blend) with every quart of water, and it should be allowed to steep for at least four hours, or overnight if at all possible. The herbs that are best for boosting up the immune system and fighting viruses are St. John’s wort (proper name Hypericum perforatum) and Echinacea. If you actually have the flu, the dosage that you take should be greatly increased as at that point the herb is having to work harder to fight off the virus. Soups can also be used to get herbs like astragalus root, eleuthero, dandelion and burdock root into your diet, which also have excellent immune-boosting properties.

Agony Aunt

Ask Your Wellness (Agony Aunt) ...

Sandra says, ‘I’m so stressed at work. As Operations Manager for a chain of shops, I report to two regional managers who think I should be on call 24/7! The management team has reduced over the last year and my work load virtually doubled. Although I’m committed to my job, it’s now making my life impossible. I find it difficult to say ‘no’ in case my managers think I’m not ‘up to it’ and with all the cutbacks, I feel insecure. I find it hard to sleep and often awake about 3am with work problems buzzing in my head. I’ve become moody and irritable, both in and out of the office, and am neglecting  family life. Much of the time, I feel close to tears and have become resentful of my managers.  I can’t switch off from work, even at home.  Last week, my Doctor gave me sleeping pills but these don’t help – the only short-term benefit I get is from drinking a couple of glasses of wine each evening to help me get to sleep but when I wake in the middle of the night, I feel even more anxious!  Please help’

Carole Spiers says:

Sandra, your situation is, unfortunately, all too common. The root of your problem appears to be your difficulty in saying “no” to the unrealistic demands being made on your time. I suggest you sit down with both your managers and explain the situation. Tell them you are highly committed to your work but your workload has become unrealistic and some deadlines unachievable.  They may not have realised the situation as you’ve not said anything before. Once aware of your concerns, and in particular the stress the current situation is generating, your managers have a legal duty of care to work with you to alleviate any excess pressure you are experiencing. It’s also essential to look after your health. Don’t skip meals. Take daily vigorous exercise to balance your adrenaline levels. At night, a few minutes gentle exercising, then a warm drink, will promote a good night’s sleep. Oh, and go easy on the wine! At the office, if you start to feel emotional, do deep breathing exercises to regain your composure. If you’re able to, a 5-10 minute walk outside will also give you time to reframe your thinking, defuse any resentment you are feeling and help you relax.   
Carole Spiers is a leading authority on Corporate Stress and author of Show Stress Who’s Boss! £15.00 http://www.showstresswhosboss.co.uk

Nurse Shirley Scott, RGN, says:

Keep an exact account of what you do now compared to when you first joined the company and what you were doing a year ago, before the staff cuts. Look at areas you can delegate. When meeting your managers to discuss the problem, present them with a plan that shows you are not simply complaining but have a positive view of your role and where changes can be made. You may feel uncomfortable confronting them but you cannot be available round the clock. Perhaps you could offer to be available two or three evenings a week and switch your phone off the remaining time. Reaching for the corkscrew as soon as you get home is an easy habit, but alcohol causes dehydration which is why you wake and then can't get back to sleep. It can also induce palpitations which further add to your anxiety. Sleeping tablets may help short term but it’s far better to create a warm, relaxing environment in your bedroom. No TV or computer! Take a warm scented bath (lavender, valerian bath oils) and have a milky drink or herb tea, and use a lavender pillow. Keep a notepad by your bed so if you wake you can write down all that is worrying you to clear your mind.


Cheryl Rezek, Consultant Clinical Psychologist, says:

Fear often propels us to do things we know aren’t necessarily in our best interests, that stretch our moral and ethical beliefs, or even work against our health and well-being. When driven by fear, we become stressed and stress can translate itself into physical manifestations. It can be triggered by change, uncertainty, excessive demands or a life change such as redundancy or an illness. Lack of sleep, anxiety, depression, mood changes and anger are common features of stress, and people often use alcohol or drugs to try and ease their tension. It is sometimes helpful to differentiate between what stress is created from external sources, such as managers and economic crises, and what is generated from within ourselves as individuals. Difficulty in asserting oneself, a desire to please everyone all the time, fear of criticism or failure and a poor self esteem are examples of internal stress and these can be exacerbated by external stress. It is helpful to step out of the stressful situation and know there is a space between it and yourself.  Cheryl helps you understand what happens when you are stressed and ways of managing it in the Stress Clinic, here:  http://www.youtube.com/watch?v=jnY8TA18CmQ&feature=player_embedded#    


Dr Tim Robinson, GP, says:

In General Practice I hear your story too often. To have reached your position you are obviously good at your job, efficient and conscientious. However, I’m concerned your stress may lead onto depression, burn out or breakdown, which would lead to time off work and job threat. It’s important to address the root causes of the stress, but in the meantime homeopathic remedies can address your symptoms. Feelings of panic and acute anxiety are helped by taking Aconite 30c, repeated until the panic feelings pass – don’t worry, you can’t overdose! Anger and irritation towards your bosses are addressed effectively with Staphysagria to help prevent you exploding with rage. Three doses daily of the 30c potency is sufficient. For insomnia take Coffea 30c every 15 minutes until you get to sleep – these don’t have the addictive or hangover effects of alcohol or sleeping tablets. If you are in the habit of waking in the early hours of the night, take Arsenicum Album 30c at bed time – this is especially good for conscientious workers who wake at 1-2 am. If you do wake don’t forget to take Aconite to stop you worrying. Hopefully the medicines mentioned will address your various symptoms while you try to tackle the underlying stress. Good luck. Dr Tim Robinson MB BS MRCGP DRCOG MFHom practices homeopathy, nutritional medicine and acupuncture in Dorset. www.doctorTWRobinson.com

Jayney Goddard, President of The Complementary Medical Association, says:

You are exhibiting classic signs of stress which, while we tend to ignore it and chalk it up to ‘life’ is dangerous for health.  So, it’s great that you’ve recognised the problem and can do something about it. Many of us have an inability to say “No” or to set firm boundaries and end up being run ragged trying to do everything we think is expected of us. There are many reasons for this inability to say “No” – not least of which is a fear that refusing a request will make us unpopular, seem unwilling to do our job, or seem uncooperative. You might like to look at cognitive-behavioural therapy (CBT) which can help you identify any underlying reasons why you find it difficult to say “No”, or to set firm boundaries. CBT is incredibly effective and you can get a referral to a practitioner from your GP.

Christopher Pick, Naturopath, says:

I’m sure you will have had the usual advice about time-management, not allowing people to take liberties in the workplace, learn to say no and speaking to management.
But it seems to me, given your levels of stress, that these well-meaning suggestions may not help you. All of us, at some point in our lives, have to step back and ask ‘what is important for my physical and mental health, my family relationships and my overall wellbeing?’ From your email I can see that all of these important factors are being affected. When we are stressed out it is difficult to make choices that are the correct ones for us. Staying on the treadmill will only exacerbate your condition until possibly you are forced into taking time off work resulting in a much lot longer recovery period.  I would suggest that you take sick leave to recuperate and examine what is important to you. A less demanding job that allows you to enjoy your work, your family relationships, your free time and remain healthy seems to me to be the best course of action.
Lawyers, Doctors & Bankers; The Educated High...

When you think of a typical alcoholic, you don't picture a lawyer or a doctor, and yet it is estimated that between 15-24% of lawyers will suffer from alcoholism during their career, and doctors are 3 times more likely to develop cirrhosis of the liver than the general population.

Efficiency is not a habit which is traditionally associated with alcoholics but many are capable of feats of organization which few sober people could ever manage. To reach the top of a highly competitive corporate ladder or high profile position and then remain there for years is no easy task, especially when you are an addict. Functional alcoholics are aplenty, particularly in high pressure, high paid jobs. Famous high functioning addicts include Winston Churchill, Boris Yelstin, and Eric Clapton.

The ‘functioning alcoholic’

The name given to people who have a serious drinking problem but still remain able to maintain what, for an addict, is a relatively normal existence. Their health, relationships and working life will inevitably suffer but often not to the extent that they become unmanageable.

Admitting you have a problem is universally accepted as being the first step on the road to recovery from addiction but for someone like Gary, an advertising executive in London, alcoholism didn’t seem like too much of a problem. He managed to maintain this image of the model professional for several years while in the grip of what, in hindsight, he acknowledges was an addiction to alcohol, but it took its toll on every other aspect of his life,

“I was married to the perfect woman but my drinking cost me my marriage and my kids. I could keep it together at work, I’d get drunk every lunch time but I somehow had the discipline to continue to do a pretty good job. The amazing thing was I was able to continue to stay pretty professional when I was at work, even though I was never sober for more than a few hours at the start of the day and had been prescribed anti depressants which I was taking every single day. However, I couldn’t keep it together at home, I think the effort of maintaining a pretence all day in the office just left me drained and once I got home I just needed to drink to relieve the strain.”

As a functional alcoholic, Gary had never previously had to properly face his demons because although his drinking had been problematic the pay cheques still kept coming in which allowed him to sustain his lifestyle. It wasn't until he suffered a family bereavement and whilst he was on compassionate leave, that unbeknownst to his colleagues, he spent the time at The Cabin, a modern residential treatment centre in Chiang Mai.

The idea that a serious addiction will automatically destroy your life is a stereotype which is perpetuated by the British media. In reality, while many people do lose everything as a result of their addiction, there are those, who manage to continue on a comparatively even keel. The problem for these people is that while life goes on there is often very little incentive to seek treatment.

Alistair Mordey, the Programme Director and Head Counsellor at The Cabin comments:

"People seem to have the view that you must have lost everything and hit rock bottom before you need to access help or seek some kind of treatment. Some people, especially high functioning people have not lost everything, and there is the view that this somehow makes them a different kind of addict. We must differentiate between a material rock bottom, where the addict loses all their possesssions or status, and an emotional rock bottom where they are essentially having what we used to call a nervous breakdown. In rehab we talk about high rock bottoms as opposed to a low rock bottoms; not everyone who hits rehab is coming off a low rock bottom where they have lost everything. Many are coming from a high rock bottom where they still have successful careers but have nowhere to go in terms of mood imbalance and emotional crisis".

High functioning addicts start using for the same reason low functioning addicts do, to self medicate an imbalanced brain chemistry and calm the symptoms of depression, anxiety or lack of focus (hyperactivity). However using addictive drugs or alcohol to make them feel better eventually stops working as the chemicals this produces in the brain become exhausted and both high and low functioning addicts are left with issues that leave them no option but to seek treatment and not rely on addictive processes.

He continues:

"Treatment is about instilling new behaviours which will rebalance brain chemistry. This includes group therapy, exercise, new career or relationships goals etc. which are best implemented intensively in an inpatient setting, daily over a significant time span like 1-3 months. This is arguably why residential programmes are considered more effective.

Having a high rock bottom or a low rock bottom is often nothing more than social and environmental differences between individuals, ie how much we had to start out with. Whether you consistently manage to hang on to your material goods or social position, is not a good way to judge the severity of your addiction, but rather how much damage has it caused and will cause you, emotionally and mentally, is the true judge of whether you need treatment."

Addiction affects millions worldwide, whether it be the 5% of alcoholics on "skid row" or highly functional alcoholics, who are well-educated with good incomes.

Alastair Mordey (BA hons, RDAP, ADAP) is the Programme Director and Head Counsellor at The Cabin, an addiction treatment centre in Chiang Mai. He is a certified and accredited addiction counsellor with over 10 years’ experience working in treatment services. Website: The Cabin Chiang Mai www.thecabinchiangmai.com
Unhappiness at work 'on the rise'...

Quoted by The Press Association: "A survey of 1,000 workers by recruitment firm Badenoch & Clark showed that only a third were happy in their current job, while one in four said they were "distinctly unhappy".

The firm's Happiness at Work Index showed that employee happiness has steadily fallen this year, with only just over a third saying their morale was high.

Nicola Linkleter, managing director of Badenoch & Clark, said: "As the results of the Prime Minister's initial research into the UK's happiness demonstrated earlier this summer, happiness at work is as high on the agenda as ever before. With work cited as a top five concern for UK citizens, workplace morale must be addressed as a critical business issue.

"The fluctuation in workplace happiness over this year can be attributed to a number of factors, including longer hours, increased financial strain at work and home, and reticence from senior management to invest in additional talent. Coupled with a lack of tangible job security, happiness at work is remarkably low, and must be dealt with as a priority issue.

"Organisations must now take action to create a working environment where employees are able to develop a sense that their work is both valuable and valued. Failure to do so may result in loss of talent, which in turn may lead to loss of potential revenue."

Agony Aunt

'Tell loved ones they are overweight this Chr...

Quoted by BBC News: "Christmas may be a time of indulging for many, but health experts believe it is the perfect time to tell a loved one they are overweight.

The National Obesity Forum and International Chair on Cardiometabolic Risk said it was important to be upfront because of the health risks.

Being overweight - particularly around the waist - increases the risk of diabetes, heart disease and stroke.

But a poll by the groups suggests too many people shy away from the issue.

The survey of more than 2,000 people found 42% of 18 to 24-year-olds would not tell a loved one they should lose weight because of a fear they would hurt the other person's feelings.

For those aged 25 to 44 it was just over a third, while for older people it was about one in four.

Men find it hardest to tell their partners, while women were more worried about bringing up the issue with a friend.

But with families and friends getting together up and down the country over the festive period, the experts believe there is an opportunity that should not be missed.

Prof David Haslam, chair of the National Obesity Forum, said: "Suggesting to someone that they should consider losing a few pounds may not be a comfortable conversation to have.

"But if someone close to you has a large waistline then as long as you do it sensitively, discussing it with them now could help them avoid critical health risks later down the line and could even save their life."

Dr Jean Pierre Despres, scientific director of the International Chair on Cardiometabolic Risk, agreed.

"Start by encouraging someone close to you to make simple lifestyle changes such as becoming more active, making small alterations to their eating habits and replacing sugary drinks for water."

Agoraphobia

introduction of agoraphobia...

Agoraphobia is a fear of being in situations where escape might be difficult, or help wouldn't be available if things go wrong.

Many people assume that agoraphobia is simply a fear of open spaces but it is more complex than that. A person with agoraphobia may be scared of:

  • travelling on public transport
  • visiting a shopping centre
  • leaving home

If people with agoraphobia find themselves in a stressful situation they usually experience symptoms of a panic attack, such as:

  • rapid heartbeat
  • rapid breathing (hyperventilating)
  • feeling hot and sweaty
  • feeling sick

They avoid situations that cause anxiety and may only leave the house with a friend or partner, or order groceries online rather than go to the supermarket. This change in behaviour is known as avoidance.

Read more about the symptoms of agoraphobia.

Treating agoraphobia

Initial treatments can include a self-help programme guided by your GP, which is designed to help overcome phobias.

The next step is more complex treatments, including:

Read more about the treatment of agoraphobia.

What causes agoraphobia?

Agoraphobia usually develops as a complication of panic disorder (an anxiety disorder in which you have panic attacks and moments of intense fear). It may arise as a result of associating panic attacks with places or situations where the attacks occurred, and then avoiding them.

A minority of people with agoraphobia have no history of panic attacks. In these cases, their fear may be related to issues such as a fear of crime, terrorism, illness or being in an accident.

Traumatic events such as bereavement may contribute towards agoraphobia, as well as certain genes a person inherits from their parents.

Read more about possible causes of agoraphobia.

Who is affected

In the UK, up to two people in 100 have a panic disorder and it is thought around a third of those will go on to develop agoraphobia as a result.

Agoraphobia is twice as common in women as men, and the condition usually starts between the ages of 18 and 35.

Outlook

Around a third of people eventually achieve a complete cure and remain free from symptoms.

Around half experience an improvement in symptoms but they may have periods when symptoms become more troublesome; for example if they feel stressed.

And one-in-five people will continue to have troublesome symptoms, despite treatment. 


 

treatment of agoraphobia...

A stepwise approach is usually recommended for agoraphobia (and any underlying panic disorder).

The recommended steps are usually:

  • Step one: educate yourself about your condition, possible lifestyle changes you can make, and self-help techniques to help relieve symptoms.
  • Step two: enrol yourself on what is known as a guided self-help programme.
  • Step three: refer yourself or be referred to a more intensive type of therapy such as cognitive behavioural therapy or see if your symptoms can be controlled using medication.

Lifestyle changes and self-help techniques

Often, learning more about agoraphobia and its association with panic disorders and panic attacks can help you better control your symptoms.

For example, there are techniques you can use during a panic attack to bring your emotions better under control. Having more confidence in controlling your emotions may then make you more confident in coping with previously uncomfortable situations and environments.

These self-help techniques are described below.

  • Stay where you are, and try to resist the urge to run to a place of safety during a panic attack. If driving, pull over and park where it is safe to do so.
  • Focus. It's important for you to focus on something non-threatening and visible, such as the time passing on your watch, or items in a supermarket. Remind yourself  that the frightening thoughts and sensations are a sign of panic and will eventually pass.
  • Try slow, deep breathing. Feelings of panic and anxiety can get worse if you breathe too quickly. Try to focus on slow, deep breathing while counting slowly to three on each breath in and out.
  • Challenge your fear. Try to work out what it is you fear and challenge it. You can achieve this by constantly reminding yourself that what you fear is not real and will pass.
  • Creative visualisation. During a panic attack, try to resist the urge to think negative thoughts such as "disaster". Instead, think of a place or situation that makes you feel peaceful, relaxed or at ease. Once you have this image in your mind, try to focus your attention on it.
  • Don't fight an attack. Trying to fight symptoms of a panic attack can often make it worse. Instead, reassure yourself by accepting that although it may seem embarrassing, and your symptoms may be difficult to deal with, your attack is not life-threatening.

Some lifestyle changes can also help, such as:

  • taking regular exercise: exercise can relieve tension and stress while improving mood
  • eating a healthy diet: a poor diet can make symptoms of panic and anxiety worse
  • avoiding using drugs and alcohol: while they may provide short-term relief, in the long term they can make symptoms worse
  • avoiding drinks that contain caffeine, such as tea, coffee or cola: caffeine has a stimulant effect and can make your symptoms worse

Guided self-help

If your symptoms fail to respond to the above advice, your GP may recommend you enrol on a guided-self help programme. This involves working through self-help manuals detailing the types of issues you might be facing along with practical advice on how to deal with them.

There are also internet-based programmes you can access via a computer.

Guided self-help for agoraphobia is based on cognitive behavioural therapy (CBT), which aims to change unhelpful and unrealistic patterns of thinking to bring positive changes in behaviour (see below for more information on CBT).

In turn, CBT uses a type of therapy known as exposure therapy, which involves being gradually exposed to the feared object or situation and using relaxation techniques to help reduce anxiety.

As part of the programme you may have brief sessions with a CBT therapist (around 20 to 30 minutes) over the telephone or face-to-face.

You may also be invited to take part in group work with other people with a history of agoraphobia and panic disorders.

Most self-help programmes contain a series of goals to work towards over the course of five-to-six weeks.

More intensive therapies

If the self-help programme hasn't worked, you may be referred for more intensive therapies.

There are three main options:

  • cognitive behavioural therapy
  • applied relaxation
  • medication

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) is based on the idea that unhelpful and unrealistic thinking leads to negative behaviour.

CBT aims to break this cycle and find new ways of thinking that can help you behave in a more positive way.

For example, many people with agoraphobia have the unrealistic thought that if they have a panic attack it will kill them. So the therapist will try to shift to the more positive thought that having a panic attack may be unpleasant, but it is not fatal and it will pass. This shift in thinking can then lead to more positive behaviour in terms of a person being more willing to confront situations that previously scared them.

CBT is usually combined with exposure therapy. So your therapist will set relatively modest goals at the beginning of treatment such as going to your local corner shop. As you become more confident, more challenging goals can be set, such as going to a larger supermarket or having a meal in a busy restaurant.

A course of CBT usually consists of 12 to 15 weekly sessions; with each session lasting a hour.

Applied relaxation

Applied relaxation is based on the premise that people with agoraphobia and related panic disorder have lost their ability to relax. So the purpose of applied relaxation is to re-teach you how to relax.

This is done using a series of exercises designed to teach you how:

  • to spot the signs and feelings of tension
  • to relax your muscles to relieve that tension
  • to use these techniques in stressful or everyday situations to prevent you from feeling tense and panicky

As with CBT, a course of applied relaxation therapy consists of 12 to 15 weekly sessions lasting a hour.

Medication

In some cases, medication can be used as a sole treatment for agoraphobia. In more severe cases medication can also be used in combination with CBT or applied relaxation therapy.

Selective serotonin reuptake inhibitors

If medication is thought to be appropriate you will usually be given a course of selective serotonin reuptake inhibitors (SSRIs).

SSRIs were originally designed to treat depression but have subsequently proved to help treat other mood disorders such as anxiety, feelings of panic and obsessional thoughts.

An SSRI called sertraline is usually recommended for most people with agoraphobia.

There are several side effects of sertraline, including:

Side effects should improve over time, although some can occasionally persist.

If sertraline fails to improve your symptoms then you may be prescribed an alternative SSRI or similar type of medication known as serotonin-norepinephrine reuptake inhibitors (SNRIs).

The length of time you will have to take a SSRI (or SNRI) for will vary depending on your response to treatment. Some people may have to take SSRIs for longer than 6 to 12 months.

When you and your GP decide it is appropriate for you to stop taking SSRIs, you will be weaned off them by slowly reducing your dosage. You should never stop taking your medication unless your GP specifically advises you to.

Pregabalin

If you are unable to take SSRIs or SNRIs for medical reasons, or you experience troublesome side effects, another medication called pregabalin may be recommended.

Common side effects of pregabalin include:

  • dizziness
  • drowsiness

Benzodiazepines

If you experience a particularly severe flare-up of feelings of panic, you may be prescribed a short course of a type of medication known as benzodiazepines.

Benzodiazepines are tranquillisers designed to reduce anxiety and promote calmness and relaxation.

However, it is not usually recommended that you take benzodiazepines for more than two weeks in a row as the medication does have the potential to become addictive if taken for longer.


Antidepressants
Antidepressant medicine is used to treat depression. For example Fluoxetine, Paroxetine.
Benzodiazepines
Benzodiazepines are a group of medicines used to help sleep, reduce anxiety and as a muscle relaxant. For example, temazepam.
Panic
To panic is to be quickly overcome with a feeling of fear or worry.
Psychotherapy
Psychotherapy is the treatment of mental and emotional health conditions, using talking and listening.

symptoms of agoraphobia...

The severity of agoraphobia can vary significantly between different people with the condition.

For example, someone with severe agoraphobia may be unable to leave the house, whereas someone who has mild agoraphobia may be able to travel short distances without problems.

The symptoms of agoraphobia can be broadly classified into three types:

  • physical
  • cognitive (symptoms associated with thinking)
  • behavioural

These are explained in more detail below.

Physical symptoms

The physical symptoms of agoraphobia usually only occur when you find yourself in a situation or environment that causes anxiety. However, many people with agoraphobia rarely experience physical symptoms because they deliberately avoid situations that make them anxious.

The physical symptoms of agoraphobia can be similar to those of a panic attack and may include:

Cognitive symptoms

The cognitive symptoms of agoraphobia are feelings or thoughts that can be, but not always, related to the physical symptoms.

Cognitive symptoms may include fear that:

  • A panic attack will make you look stupid or embarrassed in front of other people.
  • A panic attack will be life-threatening. For example, you may be worried that your heart will stop or you will be unable to breathe.
  • You would be unable to escape from a place or situation if you were to have a panic attack.
  • You are losing your sanity.
  • You may lose control in public.
  • You may tremble and blush in front of people.
  • You may be stared at.

There are also psychological symptoms not related to panic attacks, including:

  • feeling that you would be unable to function, or survive, without the help of others
  • a fear of being left alone in your house (monophobia)
  • a general feeling of anxiety or dread

Behavioural symptoms

Symptoms of agoraphobia relating to behaviour include:

  • avoiding situations that could lead to panic attacks, such as crowded places, public transport and queues
  • not being able to leave the house for long periods of time (housebound)
  • needing to be with someone you trust when going anywhere
  • avoiding being far away from home

Some people are able to force themselves to confront uncomfortable situations but they feel considerable fear and anxiety while doing so.

When to seek medical advice

If you think you have the symptoms of agoraphobia, speak to your GP.

Also seek medical advice if you have any of the following:

  • chest pain
  • shortness of breath
  • headaches
  • dizziness
  • fainting spells
  • unexplained weakness
  • sensation that your heart is beating irregularly (palpitations)
  • depression
  • thoughts of suicide or self-harm


Alcohol misuse

diagnosis of alcohol misuse...

If you visit your GP because you are concerned about your drinking, or you receive treatment for an alcohol-related injury or illness, they are likely to assess the extent of your alcohol misuse.

This is usually done by using a screening test that consists of a series of questions. It is important to be truthful when you answer the questions so that you can receive the right treatment. Your GP will not judge you.

Alcohol Use Disorders Identification Test (AUDIT)

One widely used screening test is the Alcohol Use Disorders Identification Test (AUDIT). This test involves answering 10 short questions about your drinking habits to help assess the effects it could have on you.

Fast Alcohol Screening Test (FAST)

The Fast Alcohol Screening Test (FAST) is a simpler test that you can use to check whether your drinking has reached hazardous levels.

FAST consists of four questions which are listed below. The number after each answer is that answer's score.

1. How often do you drink eight or more units (men) or six or more units (women) on one occasion?

  • never – if this is your answer you can stop the test
  • less than monthly – 1
  • monthly – 2
  • weekly – 3
  • daily or almost daily – 4

2. How often during the last year have you been unable to remember what happened the night before because you had been drinking?

  • never – 0
  • less than monthly – 1
  • monthly – 2
  • weekly – 3
  • daily or almost daily – 4

3. How often during the past year have you failed to do what was normally expected of you because you had been drinking?

  • never – 0 
  • less than monthly – 1
  • monthly – 2
  • weekly – 3
  • daily or almost daily – 4

4. In the last year has a relative or friend, or a doctor or other health worker been concerned about your drinking or suggested that you cut down?

  • no – 0
  • yes, on one occasion – 1
  • yes, on more than one occasion – 2

A FAST score of three or more would usually suggest that you're drinking at a hazardous level.
definition of alcohol misuse...

There are three main types of alcohol misuse – hazardous, harmful and dependent drinking. This is determined by the amount of alcohol consumed.

Hazardous drinking

Hazardous drinking is defined as when a person drinks over the recommended weekly limit of alcohol (21 units for men and 14 units for women).

It is also possible to drink hazardously by binge drinking, even if you are within your weekly limit. Binge drinking involves drinking a large amount of alcohol in a short space of time – eight units in a day for men and six units in a day for women.

If you are drinking hazardously, you may not yet have any health problems related to alcohol, but you are increasing your risk of experiencing problems in the future.

Hazardous drinking, particularly binge drinking, also carries additional risks such as:

  • being involved in an accident
  • becoming involved in an argument or fight
  • taking part in risky or illegal behaviour when drunk, such as drink-driving

Harmful drinking

Harmful drinking is defined as when a person drinks over the recommended weekly amount of alcohol and experiences health problems that are directly related to alcohol.

In some cases, there may be obvious problems such as:

Many of the health problems that occur as a result of harmful drinking do not cause any symptoms until they reach their most serious stages. These include: 

This means it can be easy to underestimate the levels of physical damage that is caused by harmful drinking. Harmful drinking can also cause related social problems, such as difficulties with your partner or spouse, family and friends or at work or college. 

Dependent drinking

Alcohol is both physically and psychologically addictive. It is possible to become dependent on it.

Being dependent on alcohol means that a person feels that they are unable to function without alcohol, and the consumption of alcohol becomes an important, or sometimes the most important, factor in their life.

Depending on their level of dependence, a person can experience withdrawal symptoms if they suddenly stop drinking alcohol. Withdrawal symptoms can be both physical and psychological.

Physical withdrawal symptoms include:

  • hand tremors ("the shakes")
  • sweating
  • nausea
  • visual hallucinations (seeing things that are not actually real)
  • seizures (fits) in the most serious cases

Psychological withdrawal symptoms include:

  • depression
  • anxiety 
  • irritability
  • restlessness
  • insomnia (difficulty sleeping)

Severely dependent drinkers usually experience severe withdrawal symptoms. They often fall into a pattern of "relief drinking", where they drink to avoid withdrawal symptoms.

Severely dependent drinkers are often able to tolerate very high levels of alcohol, and they are able to drink amounts that would incapacitate, or even kill, most other people.

Read more about the risks of alcohol misuse.

treatment of alcohol misuse...

The treatment options available for alcohol misuse depend on whether your drinking is hazardous, harmful or dependent, and whether you are trying to drink less or give up drinking completely.

Hazardous drinking

If you are drinking hazardous amounts of alcohol, it is likely that you will be referred to a short counselling session, known as a brief intervention. This may be following an alcohol-related accident or injury.  

A brief intervention lasts around 10 to 15 minutes and covers the risks associated with your pattern of drinking, advice on reducing the amount of alcohol you drink, alcohol support networks available to you and any emotional issues around your drinking.

You may be advised to keep a "drinking diary" so that you can record how many units of alcohol you drink a week. You may also be given tips on social drinking, such as alternating soft drinks with alcoholic drinks when you're out with friends.

Harmful drinking

If you are drinking harmful amounts of alcohol, you will first have to make the decision about whether you want to reduce your alcohol intake (moderation) or give up drinking alcohol altogether (abstinence).

Abstinence will obviously have a greater health benefit, although moderation is often a more realistic goal, or at least, a first step on the way to abstinence.

Ultimately, the choice is yours, although there are circumstances where abstinence is strongly recommended. These include:

  • if you have liver damage, such as liver disease or cirrhosis
  • if you have other medical problems that can be made worse by drinking, such as heart disease
  • if you are taking medication that can react badly with alcohol, such as antipsychotics
  • if you are pregnant or are planning to become pregnant

Abstinence may also be recommended if you have previously tried to achieve moderation and been unsuccessful.

If you choose moderation, you will probably be asked to attend further counselling sessions so that your progress can be monitored and further treatment and advice provided if necessary.

You may also have regular blood tests so the health of your liver can be carefully monitored.

Dependent drinking

As with harmful drinking, you will need to choose between moderation and abstinence. Abstinence will usually be recommended for people with moderate to severe dependency.

Whatever your level of alcohol dependency, it is recommended that you spend a period of time free from alcohol so that your body can recover from its effects.

Detoxification

How and where you attempt detoxification will be determined by your level of alcohol dependency. In mild cases you should be able to detox at home without the use of medication because your withdrawal symptoms should also be mild.

If your consumption of alcohol is high (over 20 units a day) or you have previously experienced withdrawal symptoms, you may also be able to detox at home with medication to help ease withdrawal symptoms. A tranquiliser called chlordiazepoxide is usually used for this purpose.

If you have severe dependency, you may go to a hospital or clinic to detox as the withdrawal symptoms will also be severe and are likely to need specialist treatment.  

Withdrawal symptoms

Your withdrawal symptoms will be at their worst for the first 48 hours. They should gradually start to improve as your body begins to adjust to being without alcohol. This usually takes between three and seven days from the time of your last drink.

You will also find that your sleep is disturbed. You may wake often during the night or have problems getting to sleep. This is to be expected and your sleep patterns should return to normal within a month.

During detox, you should drink plenty of fluids – about three litres a day. However, avoid drinking a large number of caffeinated drinks, including tea or coffee, because they can make your sleep problems worse and cause feelings of anxiety. Water or fruit juice is a better choice.

Try to eat regular meals even if you are not feeling hungry. Your appetite will return gradually.

If you are taking medication to help ease your withdrawal symptoms, you should not drive or operate heavy machinery because the medication will probably make you feel drowsy. Only take your medication as directed.

Detox can be a stressful time. Ways that you can try to relieve stress include listening to music, going for a walk or taking a bath. Read more about stress management.

If you are detoxing at home you will regularly see a nurse or other health professional. This might be at home, your GP practice or at a specialist NHS service. You will also be given the relevant contact details for other support services should you need additional support.

Withdrawal from alcohol is an important first step to overcoming your problems with alcohol. However, withdrawal is not an effective treatment by itself. You will be advised to undergo further treatment and support to help you in the long-term.

Abstinence

Several treatment options are available for abstinence. These often differ in effectiveness depending on the individual, so if you feel that a certain treatment is not working for you, you can discuss alternatives with your care team or your GP.

Medication

There are several medications recommended by NICE to treat alcohol misuse:

Before being prescribed medication you will have a full medical assessment, including blood tests. These medications are discussed in more detail below.

Acamprosate

Acamprosate (brand name Campral) is used to help prevent a relapse in people who have successfully achieved abstinence from alcohol. It is usually used in combination with counselling.

Acamprosate works by affecting levels of a chemical in the brain called gamma-amino-butyric acid (GABA). GABA is thought to be partially responsible for inducing a craving for alcohol.

If you are prescribed acamprosate, the course of medication will usually start as soon as you begin withdrawal from alcohol and can last for up to six months initially.

Naltrexone

Naltrexone is also used to prevent a relapse or limit the amount of alcohol someone drinks. It is usually used in combination with other medicine or counselling. It works by blocking the opioid receptors in the body, stopping the effects of alcohol.

If naltrexone is recommended for you, you should be informed that naltrexone will stop painkillers that contain opioids, such as morphine and codeine, from working.

If you feel unwell while taking naltrexone, stop the medication immediately and seek advice from your GP or care team.

A course of naltrexone can last for up to six months although it may sometimes be longer.

Disulfiram

Disulfiram (brand name Antabuse) is a medication that can be used if you are trying to achieve abstinence but are concerned that you may relapse, or if you've had previous relapses.

Disulfiram works by causing a series of very unpleasant physical reactions if you drink any alcohol to help deter you from drinking. This can include:

  • nausea
  • chest pain
  • vomiting
  • dizziness

As well as alcoholic drinks, it is important to avoid all sources of alcohol because they could also induce an unpleasant reaction. Products that may contain alcohol include:

  • aftershave
  • mouthwash
  • some types of vinegar
  • perfume

Try to avoid substances that give off alcoholic fumes, such as paint thinners and solvents.

You will continue to experience unpleasant reactions if you come into contact with alcohol for a week after you finish taking disulfiram, so it is important to maintain your abstinence during this time.

When taking disulfiram you will be seen by your healthcare team about once every two weeks for the first two months and then every month for the following four months.

Counselling

Self-help groups

Many people with a dependence on alcohol find it useful to attend self-help groups, such as Alcoholics Anonymous.

Alcoholics Anonymous believes that alcoholic dependence is a long-term and progressive, incurable condition and that total abstinence is the only solution.

The treatment plan promoted by Alcoholics Anonymous is based on a 12-step programme that is designed to help you overcome addiction. It includes the following steps:

  • You admit that you are powerless over alcohol and your life has become unmanageable.
  • You recognise that you need a power greater than yourself to restore your strength
  • You examine past errors in your life with the help of a sponsor (an experienced member of the group).
  • You make amends for those errors
  • You learn to live a new life with a new code of behaviour.
  • You help others who have an alcohol dependence.

Read more about alcohol support.

Twelve-step facilitation therapy

Twelve-step facilitation therapy is based on the programme devised by Alcoholics Anonymous. The difference is that you work through the stages on a one-to-one basis with a counsellor, rather than as a group.

Twelve-step facilitation therapy may be your preferred treatment option if you feel uneasy or unwilling to discuss your problems in a group setting.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is a talking therapy that emphasises a problem-solving approach to alcohol dependence.

CBT’s approach to alcohol dependence is to identify unhelpful and unrealistic thoughts and beliefs that may be contributing towards your alcohol dependence, such as:

  • "I can't relax without alcohol."
  • "My friends would find me boring if I was sober."
  • "Just drinking one pint can’t hurt."

Once such thoughts and beliefs are identified, you will be asked to base your behaviour on more realistic and helpful thoughts, such as:

  • "Lots of people have a good time without alcohol and I can be one of them."
  • "My friends like me for my personality, not for my drinking." 
  • "I know I can't stop drinking once I start."

CBT also helps you to identify triggers that can cause you to drink, such as:

  • stress
  • social anxiety
  • being in "high-risk" environments such a pub, club or restaurant

The therapist will teach you how to avoid certain triggers and how to cope effectively with those that are unavoidable.

Family therapy

Alcohol dependence doesn't just impact on an individual – it can also affect a whole family. Family therapy provides the opportunity for family members to:

  • learn about the nature of alcohol dependence
  • support the family member who is trying to abstain from alcohol

Help is also available for family members in their own right. It can be stressful living with someone who misuses alcohol and it can be helpful to receive support. Some specialist alcohol services provide support to family members as does AlAnon, an organisation affiliated to Alcoholics Anonymous.

Read more about the different types of talking therapies.

Allergies And Asthma

New Cell Discovery Linked to Eczema and Aller...

If your wellness is affected by eczema or other allergies, it may be due to a type of immune cell in your skin. This is according to a new study published this week in the journal Nature Immunology, which has come about thanks to a collaboration among researchers from the University of Sydney’s affiliated Centenary Institute and colleagues in New Zealand, the UK, and the US. Years ago, a family of cells, known as group 2 innate lymphoid cells (ILC2), was discovered ago in the laboratory of Professor Wolfgang Weninger, and this new cell type is part of this group. Professor Weninger’s lab has been responsible for developing techniques in marking different cells of your immune system, and tracking them live under the microscope. However, until now the identity of the immune cells has remained a mystery. According to Dr Ben Roediger, first author on the paper and a research officer in the Centenary’s Immune Imaging Laboratory, this is the first time such cells had been found in the skin, and they are relatively more numerous there. He noted, ‘Our data show that these skin ILC2 cells can likely suppress or stimulate inflammation under different conditions. They also suggest a potential link to allergic skin diseases.’ The researchers contacted Professor Graham Le Gros at the Malaghan Institute in New Zealand, one of the world’s foremost researchers into type 2 immunity (the part of your immune system that deals with infection by parasitic organisms), as they suspected that the cells may be associated with this system. The Professor not only confirmed this suspicion, but also provided a new strain of mouse developed in the United States that provided insight into the function of ILC2 cells. Roediger explained, ‘Using these mice, we found that ILC2 cells were the major population in the skin that produced interleukin 13, a molecule that has been linked to a number of allergic diseases, including eczema.’ He added, ‘We now have experiments underway in which we are actively looking for the direct involvement of these cells in the sort of skin diseases you would predict based on these findings.’

Could Phone Apps Help to Improve Asthma Educa...

Apps are a good way to remind patients to get vaccines, and educate them on ways to self-manage their chronic asthma and allergies. This is according to researchers at the National Association of Paediatric Nurse Practitioners 2013 Annual Meeting, who believe that smartphone apps are becoming an increasingly viable solution to overcome gaps in traditional patient reminder systems, and a useful patient education tool. The problem with traditional vaccine outreach reminder methods, such as telephone calls, mailed paper reminders, and in-person home visits, is that they are dependent on the reliability of your patient contact information. According to Jessica L. Peck, DNP, RN, MSN, CPNP-PC, CNE, CNL, of Capstone College of Nursing at the University of Alabama, ‘Providers have expressed a need for alternative recall methods that are not so time, labour and financially intensive. With 194 US smart phone users projected by the year 2015, the opportunity to harness technology for this purpose is present.’ Kathy Chojnacki RN, MSN, CPNP-AC, and Jodi Shroba RN, MSN, CPNP, both of Children's Mercy Hospitals and Clinics in Kansas City, Missouri, cited another wellness benefit that apps provide; improving health literacy among patients with chronic asthma and allergies. They wrote in a poster session, ‘Mobile devices such as tablets and smartphones are become more cost effective and more readily available forms of electronic communication. The healthcare system is primed and ready to utilize these devices in clinical practice.’ For their poster, Chojnacki and Shroba assessed the overall benefits and limitations of several apps for allergy, asthma and rhinitis, as well as exploring opportunities for integrating mobile technology into clinical practice. The AshtmaMD app revealed several benefits to asthmatic wellness, providing methods that patients can use to reduce symptomatic days, asthma-related ER visits, rescue therapy use and need for inhaler use to provide symptom relief. However, some of the apps used inaccurate or incomplete medical information from online sources, had a lack of wireless internet capabilities, reduced face-to-face interactions between providers and patients and were deemed to be too costly to implement in institution-wide systems. Yet, in spite of these concerns, the authors concluded ‘the increased use of smart phones and mobile devices provide the perfect climate for integration of applications into patient care.’

Can Dietary Changes Reduce Your Seasonal Alle...

The onset of allergy symptoms during Spring can have you desperate to find a way to relieve symptoms, and guard your wellbeing against them. Seasonal allergies, also known as allergic rhinitis, have an extensive list of natural treatments, but how do you know if they work? According to Dr Sezelle Gereau-Haddon, an ear, nose and throat specialist at Beth Israel Medical Centre’s Continuum Centre for Health and Healing in the Integrative Medicine Department, ‘Sometimes patients come in with wacky things — they get all kinds of things from the internet. But if they feel better, who knows if it’s the placebo versus a real cure? If the things that they’re on are things that aren’t potentially harmful to their liver or their kidneys or their stomach, I usually tolerate it.’ Dr Gereau-Haddon continues, ‘For example, patients routinely want to eliminate dairy. There’s not any clear evidence that eliminating dairy does anything for allergies or sinusitis complaints. But, empirically, when I see patients do it, some patients feel better. If a patient wants to try it, I certainly encourage them to try it.’ She adds, ‘Even patients who don’t have a known celiac disease or sensitivity to wheat specifically or a wheat allergy, sometimes if they eliminate gluten, you’ll see them land in a better place.’ Dr Roberta Lee, Integrative health practitioner at Beth Israel Medical Centre’s Continuum Centre for Health and Healing, comments that foods can definitely impact your response to an allergen, noting that you may have a harder time fighting off allergies ‘If you have saturated fats in your diet, if you’re a steak eater, if you’re a junk food eater, if you’re a fried food eater, if you’re a high cheese eater.’ This is because your body isn’t getting the vitamins it needs to stay healthy and allergy free, and junk foods also cause inflammation in your nose and throat. If you want a natural remedy to eliminate your allergy symptoms, Richard Mandelbaum, clinical herbalist of the ArborVitae School of Traditional Herbalism, recommends taking stinging nettles, whether in capsule form, as a tincture or in its completely unprocessed form. ‘Nettles have some natural antihistamine activity and can be very helpful in reducing the severity of the symptoms that one is experiencing,’ he says.

Alzheimer's disease

introduction of alzheimers disease...

Alzheimer's disease is the most common cause of dementia. Dementia is a group of symptoms associated with a decline in the way your brain functions, affecting your memory and the way you behave.

In Alzheimer's disease there is a progressive loss of brain cells.

The exact cause for this is unknown. However, there are a number of things thought to increase the risk of developing the condition, including:

  • increasing age
  • a family history of the condition
  • previous severe head injuries
  • lifestyle factors and conditions associated with vascular disease

Read more about the causes of Alzheimer’s disease.

Signs and symptoms of Alzheimer’s disease

Alzheimer’s disease is a progressive condition, which means that it will continue to get worse as it develops. Early symptoms include:

  • minor memory problems
  • difficulty saying the right words

These symptoms change as Alzheimer’s disease develops, and it may lead to:

  • disorientation
  • personality changes
  • behavioural changes

Read more about the symptoms of Alzheimer’s disease.

There is no single test that can be used to diagnose Alzheimer’s disease. Your GP will ask you questions about any problems you are experiencing and may do some tests to rule out other conditions. If Alzheimer's disease is suspected, you may be referred to a specialist to confirm the diagnosis and organise a treatment plan.

Read more about diagnosing Alzheimer’s disease.

Treating Alzheimer’s disease

There is no cure for Alzheimer’s disease, although medication is available that can slow down the development of the condition in some people.

As with the treatment of any type of dementia, a care plan should be arranged to provide care and support.

Read more about how Alzheimer’s disease is treated.

Who is affected

Alzheimer's disease is most common in people over 65 years of age, and affects slightly more women than men.

The Alzheimer’s Society estimates that dementia affects around 650,000 people in England, with Alzheimer’s disease responsible for around 62% of dementia cases.

Dementia in people under 65 years of age, known as early-onset dementia, is less common. In the UK, around 2% of all dementia cases are early-onset dementia.

The risk increases with age, and people who are over 80 years of age are thought to have a one in six chance of developing the condition.

Preventing Alzheimer's disease

There are several steps you can take which may help delay the onset of dementia, such as:

Taking these steps also has other health benefits, such as lowering your risk of cardiovascular disease and improving your overall mental health.

Read more information about preventing Alzheimer’s disease.



realstoriespage of alzheimers disease...

Stan Lintern has had Alzheimer’s disease for 10 years. He is cared for by his wife Denise, who helped to set up the Maidstone branch of the Alzheimer’s Society and runs the helpline. Last year, she was awarded an MBE for services to her local community. They have three children.

“I was 49 when Stan was diagnosed. He’d been having problems with his memory for a bit and after taking early retirement, he was lacking in motivation. We thought it was due to him missing his work. His behaviour began to be a bit odd at times, so when I was seeing our GP, I mentioned it. The GP suggested that Stan go for an appointment. After about six months of extensive tests, Stan was diagnosed with Alzheimer’s.

“It was a devastating shock, but also good because at least we knew what we were dealing with. It had been horrible not knowing what was causing his weird behaviour.

“For the first few years, we carried on with normal life. Stan was a Premier League table tennis player and he still enjoyed doing that. He continued to drive and we went on lots of holidays. He was a very meticulous man and liked everything to be ‘just so’. But, as the Alzheimer’s took over, he just decided he wasn’t going to do things any more. I think he thought that if he couldn’t do it the way he liked to do it he wasn’t going to bother any more.

“Every time there has been a big change with Stan, I have to stop and take stock. Stan needs full-time care now. He’s in a wheelchair and needs to be fed. He doesn’t speak any more and I’m not sure that he understands what I’m saying. I have some outside help during the week, but mostly it’s down to me.

“We still go away. I have a hoist for getting him around indoors and a transporter ‘truck’ with a hydraulic tail lift to go out in. We still like going to Holland to see my cousins and their families, and visiting various places in the UK. The only thing we don’t do is fly anywhere. I don’t feel a prisoner because I’ve made sure that I can be independent and that we can get away. Stan is always more awake and aware when we’re doing something different."
prevention of alzheimers disease...

As the exact cause of Alzheimer’s disease is still unknown, there is no way to prevent the condition. However, there are some steps that you can take which may help to delay the onset of dementia.

For example, you can help to prevent vascular dementia, as well as cardiovascular diseases such as stroke and heart attacks, by:

Read more information about preventing dementia.

Staying mentally active

There is some evidence suggesting that rates of dementia are lower in people who remain as mentally, physically, and socially active as possible throughout their lives, and also among those who enjoy a wide range of different activities and hobbies.

Some activities that may reduce the risk of developing dementia include:

  • reading
  • writing for pleasure
  • learning foreign languages
  • playing musical instruments
  • taking part in adult education courses
  • playing tennis
  • playing golf
  • swimming
  • group sports, such as bowling
  • walking

There is no evidence that playing ‘brain training’ computer games reduces the risk of dementia.

Future research

Research into Alzheimer’s disease is continuing, and as more is revealed about the condition, other ways to treat or prevent it may be found. However, research does not always produce successful results.

You can read more information about ongoing dementia research on the Alzheimer's Research UK website.

The National Institute for Health and Clinical Excellence (NICE) has advised that there is no evidence yet to support the use of the following to prevent dementia:



Amniocentesis

introduction of amniocentesis...

Amniocentesis is a diagnostic test carried out during pregnancy. It can assess whether the unborn baby (foetus) could develop, or has developed, an abnormality or serious health condition.

Things that increase the risk of an abnormality include:

  • the mother’s age
  • the mother’s medical history
  • a family history of genetic (inherited) conditions

Read more about when amniocentesis is used.

Amniocentesis can be used to detect a number of conditions such as:

  • Down's syndrome – a genetic condition that affects a person's physical appearance and mental development
  • spina bifida – a series of birth defects that affect the development of the spine and nervous system
  • sickle cell anaemia – a condition that causes unusually shaped red blood cells

Read more about why amniocentesis is used. 

What happens?

Amniocentesis is usually carried out during weeks 15-20 of pregnancy. A needle is used to extract a sample of amniotic fluid, the fluid that surrounds the foetus (the developing baby) in the womb (uterus). Amniotic fluid contains cells shed from the foetus that can be examined and tested for a number of conditions.

Read more about how amniocentesis is performed.

Chorionic villus sampling (CVS) is an alternative diagnostic test that can be carried out during weeks 10 to 13 of pregnancy.

Risks of amniocentesis

Diagnostic tests, such as amniocentesis, are usually only offered to women when there is a significant risk their baby will develop a serious condition or abnormality.

This is because the procedure is quite invasive (involves going into the body) and has a small associated risk of miscarriage (the loss of the pregnancy). This risk is estimated to be 1 in 100.

Read more about complications of amniocentesis.

If amniocentesis is recommended, the healthcare professional who carries out the test will explain why they think the procedure is necessary, as well as benefits and risks involved.

Diagnostic tests are voluntary, and counselling should be provided to make it easier to cope with the results of amniocentesis.

how-is-it-performed of amniocentesis...

During amniocentesis, a small sample of amniotic fluid is removed for testing in a laboratory. Amniotic fluid is the fluid that surrounds the foetus (unborn baby) in the womb (uterus). The fluid contains cells shed by the foetus, which are analysed to get information about the health of your baby.

Before having amniocentesis, a healthcare professional will explain the procedure to you, including benefits and risks. They will also tell you about alternative tests that may be appropriate. If you decide to have amniocentesis, you are usually asked to sign a consent form.

Read about complications of amniocentesis for more information on the risks.

Ultrasound scan

An ultrasound scan will be carried out before you have amniocentesis, and will be continued throughout the procedure. An ultrasound scan uses high-frequency sound waves to produce an image of your womb that is relayed to a television monitor.

The ultrasound scan will allow healthcare professionals to:

  • check the position of the foetus
  • find the best place to remove some amniotic fluid
  • ensure the needle can pass safely through the walls of your abdomen (tummy) and womb

Painkiller

Before the needle is inserted into your abdomen, the area may be numbed with anaesthetic. This involves having a small injection into your tummy that may sting slightly. However, anaesthetic is not usually necessary because research suggests that it does not have much effect in most cases.

The procedure

Firstly, your abdomen will be cleaned with an antiseptic solution to prevent infection. A long, thin needle will be inserted through your abdominal wall. This may cause a sharp, stinging sensation.

Using the ultrasound image as a guide, the needle will be passed into the amniotic sac that surrounds the foetus. A syringe removes a small sample of the amniotic fluid, which will be sent for analysis in a laboratory.

For about eight women in every 100 who have amniocentesis, not enough fluid is removed the first time the needle is inserted. If this happens, the needle is inserted again. 

Amniocentesis usually takes around 10 minutes. However, it can take slightly longer if the position or movement of the foetus makes it difficult to take a sample.

Amniocentesis is not usually painful, although you may feel uncomfortable during the procedure. Some women describe feeling a pain similar to period pain, or feeling pressure when the needle is taken out.

Recovery

After having amniocentesis, you are usually advised to rest for 24 hours. You may have cramps (similar to menstrual cramps) for a few hours and ‘spotting’ – that is, drops of blood from your cervix (the neck of the womb).

You should seek urgent medical attention if you:

  • feel shivery
  • have a high temperature (fever) of 38ºC (100.4ºF) or above
  • are bleeding from your vagina
  • have persistent lower back pain or abdominal pain
  • have clear watery fluid coming from your vagina (that is not urine)
  • have contractions (when your abdomen tightens then relaxes)

results of amniocentesis...

After you have had the amniocentesis procedure, the sample of amniotic fluid (the fluid that surrounds the unborn baby in the womb) will be taken to a laboratory for testing.

There are two different types of tests:

  • a rapid test
  • a full karotype

These are described in more detail below.

Rapid test

A rapid test looks for abnormalities on specific chromosomes (the parts of the body’s cells that carry genes). A rapid test can identify a number of chromosomal conditions that cause physical and mental abnormalities. These are:

  • Down's syndrome – caused by an extra chromosome 21
  • Edward's syndrome – caused by an extra chromosome 18
  • Patau’s syndrome – caused by an extra chromosome 13

The results of a rapid test should be ready after three working days. This test is almost 100% accurate, but it only tests for the three conditions listed above.

Full karotype

Each cell in the body contains 23 pairs of chromosomes. A full karotype checks all of these.

The cells in the sample of amniotic fluid are grown for up to 10 days in a laboratory before being examined under a microscope to check for:

  • the number of chromosomes
  • the appearance of the chromosomes

Results from a full karotype will usually be ready in two or three weeks. In about 1 in every 100 tests, the results may not be clear. This could be due to the mother’s blood contaminating the sample of amniotic fluid, which may have prevented the cells from growing properly. 

Negative test results

For most women who have amniocentesis, results of the procedure will be ‘negative’. That is, their baby will not have any disorders that were tested for.

It is possible to have a negative result from amniocentesis but your baby may still be born with the condition tested for or another chromosomal condition. This is because a normal test result does not exclude every chromosomal disorder.

Genetic (inherited) disorders are caused by mutations (changes) in the genes (units of genetic material). Each chromosome contains thousands of genes. This means it is not possible to test for every possible genetic mutation, so a baby may occasionally be born with a condition that was not detected.  

Positive test results

If your test result is ‘positive’ it means your baby has the disorder that was being tested for. If you receive a positive test result, the implications will be fully discussed with you. Be aware there is no cure for the majority of chromosomal conditions, so you need to consider your options carefully.

Your options may include:

  • continuing with your pregnancy while getting information and advice about the condition so you are prepared for caring for your baby
  • ending your pregnancy 

If you are considering ending your pregnancy, talk to your GP or midwife. They will provide you with important information and advice.

For example, your options for ending your pregnancy will depend on how many weeks pregnant you are when you make the decision. If you decide to end your pregnancy, you may wish to talk to a counsellor afterwards. Your GP or midwife will be able to arrange this for you.

Read more about genetic testing and counselling.

Anabolic steroid abuse

introduction of anabolic steroid abuse...

Anabolic steroids are prescription-only medicines that are sometimes taken illegally to increase muscle mass and athletic performance. If used in this way, they can cause serious side effects and addiction. 

Anabolic steroids are manufactured drugs that mimic the effects of the male hormone testosterone. They have limited medical uses and are not to be confused with corticosteroids, a different type of steroid drug commonly prescribed for a variety of conditions.

This page explains the dangers of misusing anabolic steroids and aims to advise and support those who are addicted to the drugs. It covers:

  • why people misuse anabolic steroids
  • how they are taken
  • side effects
  • addiction
  • getting help

Why people misuse anabolic steroids

Anabolic steroids are performance-enhancing drugs that increase muscle mass and decrease fat, as well as producing many undesirable effects. Read more about the side effects of anabolic steroids.

Some athletes, weightlifters and bodybuilders take them regularly to improve their physical performance and build up their bodies.

However, people of all ages have been known to abuse these drugs. This includes adolescent boys who suffer from body dysmorphia (when the way someone thinks of their body doesn't match the way it looks). Teenage boys and young men may take the drugs because they have 'reverse anorexia'. This is when they don't see themselves as being physically big enough or strong enough.

Some people believe that taking anabolic steroids is a way of getting healthy and fit. This is not true. Taking anabolic steroids is a dangerous drug habit.

How they are taken

Anabolic steroids are usually injected into the muscle, but can sometimes be taken as tablets or as a cream or gel applied to the skin.

Most users are aware of the dangers of taking the drugs, and have ways of getting the desired effect without the undesirable side effects. This involves injecting the drugs for a period of time, then stopping for a rest period before starting again. This is known as 'cycling'.

More than one type of anabolic steroid may be used at a time. Users believe that this increases the effectiveness. This is known as 'stacking'.

The term 'pyramiding' refers to a combination of both stacking and cycling. One or more anabolic steroids is taken in a low dose. This is gradually increased to a maximum dose over 6-12 weeks, before the dose is reduced to zero to give the body a break and the cycle is started again.

Users tend to exercise more when they are taking high doses, to make the most of their better performance during this time.

Athletes have been known to try to time their injections so the drug is out of their system by the time they are drug tested.

Side effects of anabolic steroids

Regularly taking anabolic steroids causes a range of male features, not just increased muscle mass. It may also result in a potentially dangerous medical condition, such as high blood pressure or a heart attack.

Physical effects

Effects of anabolic steroids in men include:

  • reduced sperm count
  • infertility
  • shrinking of testicles
  • baldness
  • breast development
  • increased risk of developing prostate cancer
  • splayed teeth and overgrowth of the forehead (giving an 'incredible hulk' appearance)
  • severe acne

In women, anabolic steroids can cause:

  • growth of facial and body hair
  • loss of breasts
  • swelling of the clitoris 
  • a deepened voice
  • an increased sex drive
  • problems with periods
  • hair loss
  • severe acne

In addition, both men and women who take anabolic steroids can develop any of the following medical conditions:

Psychological effects

Misusing anabolic steroids can also cause the following psychological or emotional effects:

  • aggressive behaviour 
  • mood swings
  • manic behaviour
  • hallucinations and delusions

Stunted growth in adolescents

Anabolic steroids accelerate bone growth, so if they are misused by adolescents who have not yet had the growth spurt associated with puberty, the drugs can cause premature ageing of the bones and restricted growth.

Addiction

Like many other substances, anabolic steroids are addictive. This means you can crave the drug, require more to get the same effect and have withdrawal effects if you suddenly stop taking them, with a strong desire to take them again. Someone addicted to anabolic steroids will continue to use the drugs despite experiencing unpleasant physical side effects.

When doctors prescribe any type of steroid medication, they advise coming off the drugs by gradually reducing the dose. Coming off anabolic steroids suddenly can result in withdrawal symptoms that include:

  • depression and apathy
  • feelings of anxiety
  • difficulty concentrating
  • insomnia
  • anorexia
  • decreased sex drive
  • fatigue
  • headaches
  • muscle and joint pain

Getting help 

If you think you may be addicted to anabolic steroids, see your GP. You may need to be referred to a counsellor. Anabolic steroid abuse is treated like any other drug or alcohol addiction.

To find out more, read our pages on:

Anal cancer

definition of cancer of the anus...

Aneurysm, abdominal aortic

diagnosis of Abdominal aortic aneurysm...

Abdominal aortic aneurysms are often diagnosed during a routine physical examination when a GP notices the distinctive vibrating sensation in the abdomen.

A diagnosis can be confirmed using an ultrasound scan. Ultrasounds can also determine the size of the aneurysm, which is an important factor in deciding on a course of treatment.

Screening

In 2009, the NHS launched a screening programme for aortic aneurysms. The programme is designed to offer all men who are 65 years old or over an ultrasound scan for aortic aneurysms.

The programme is expected to cover the whole of England by April 2013 and is being introduced in Wales later in the year. You can still request an ultrasound scan for aortic aneurysm. Contact your GP for advice.

Men should receive an invitation in the year that they turn 65 years old.

For more information, visit the NHS Abdominal Aortic Aneurysm Screening Programme website.

introduction of Abdominal aortic aneurysm...

An aneurysm is a bulge in a blood vessel caused by a weakness in the blood vessel wall. As blood passes through the weakened blood vessel, the blood pressure causes it to bulge outwards like a balloon.

Exactly what causes the blood vessel wall to weaken is unclear, though hardening of the arteries, smoking and high blood pressure are thought to increase the risk of an aneurysm.

Read more about the possible causes of an aneurysm.

Aneurysms can occur anywhere in the body, but the two most common places for them to form are in the abdominal aorta and the brain.

This topic is about abdominal aortic aneurysms. Find out more about brain aneurysm.

The abdominal aorta

The abdominal aorta is the largest blood vessel in the body. It is roughly the width of a garden hose. It transports oxygen-rich blood away from the heart to the rest of the body.

It runs in a straight line down from the heart, through the chest and abdomen before branching off into a network of smaller blood vessels.

In most cases, an abdominal aortic aneurysm causes no noticeable symptoms and does not pose a serious threat to health.

However, there’s a risk that a larger aneurysm could burst open (rupture). A ruptured abdominal aortic aneurysm can cause massive internal bleeding, which is usually fatal. Four out of five people with a ruptured aortic aneurysm will die as a result.

The most common symptom of a ruptured aortic aneurysm is sudden and severe pain in the abdomen.

If you suspect that you or someone else has had a ruptured aneurysm, call 999 immediately and ask for an ambulance.

Read more about the symptoms of an abdominal aortic aneurysm.

Treatment

The aim of treatment is to prevent the aneurysm from rupturing. This is usually done with surgery to replace the weakened section of the blood vessel with a piece of synthetic tubing.

However, preventative surgery carries a small risk of causing serious complications. It's usually only recommended if it’s thought that the risk of a rupture is high enough to justify the risk of surgery.

The size of the aneurysm is often used to measure the risk of it rupturing. Preventative surgery is often recommended for an abdominal aortic aneurysm that's larger than 5.5cm.

A number of non-surgical treatments can also be used to reduce the risk of an aneurysm rupturing. They include a type of medication known as a statin, or quitting smoking if you smoke.

Read more about treating abdominal aortic aneurysm.

Screening

In March 2009, the NHS launched a screening service to check men who are 65 years old or over for abdominal aortic aneurysms. The service is expected to cover the whole of England by April 2013 and is being introduced in Wales later in the year.

If you don't live in a part of the country that's currently covered by the scheme, you can ask your GP to refer you for screening if you or they feel that you have an increased risk of having an aortic aneurysm. For example, this might be the case if you're over 65 and are a heavy smoker.

Who is affected?

Abdominal aortic aneurysms are most common in men aged over 65, with around in 1 in 25 men being affected.

The number of aortic aneurysms that rupture is much smaller, with only around 1 in 10,000 people having a ruptured aortic aneurysm in any year in England.

Prevention

The best way to prevent getting an aneurysm, or reduce the risk of an aneurysm growing bigger and possibly rupturing, is to avoid any activities that could damage your blood vessels, such as:

  • smoking
  • eating a high-fat diet
  • not exercising regularly
  • being overweight or obese

Read more about preventing aneurysms.

prevention of Abdominal aortic aneurysm...

Reducing your risk of atherosclerosis will help to prevent an abdominal aortic aneurysm occurring.

Diet

One of the leading causes of atherosclerosis is eating a diet that's high in fat.

High-fat foods can cause a build-up of fatty plaques in your arteries. This is because fatty foods contain cholesterol. There are two main types of cholesterol:

  • Low-density lipoprotein (LDL) – this is mostly made up of fat, plus a small amount of protein. This type of cholesterol can block your arteries, so it's often referred to as bad cholesterol.
  • High-density lipoprotein (HDL) – this is mostly made up of protein, plus a small amount of fat. This type of cholesterol can reduce any blockage in your arteries, so it's often referred to as good cholesterol.

There are also two types of fat: saturated and unsaturated. Avoid food containing saturated fats because these will increase the levels of bad cholesterol in your blood.

Foods high in saturated fat include:

  • meat pies
  • sausages and fatty cuts of meat
  • butter
  • ghee (a type of butter often used in Indian cooking)
  • lard
  • cream
  • hard cheese
  • cakes and biscuits
  • foods that contain coconut or palm oil

However, eating a small amount of unsaturated fat will increase the level of good cholesterol and reduce any blockage.

Foods that are high in unsaturated fat include:

  • oily fish
  • avocados
  • nuts and seeds
  • sunflower, rapeseed and olive oil

Read more about healthy eating and find out the facts about fat.

Smoking

Smoking is a major risk factor for aneurysms because it causes atherosclerosis and raises your blood pressure. There may also be harmful substances in tobacco smoke that could damage the walls of the arteries.

It is known that smokers are seven times more likely than non-smokers to develop an aortic aneurysm.

If you decide to stop smoking, your GP will be able to refer you to an NHS Stop Smoking Service, which will give you dedicated help and advice about the best ways to give up smoking. You can also call the NHS Smokefree helpline on 0800 022 4332. The specially trained helpline staff can offer you free expert advice and encouragement.

If you're committed to giving up smoking but don't want to be referred to a stop-smoking service, your GP should be able to prescribe medical treatment to help with any withdrawal symptoms you may have after quitting.

Find out about treatment for quitting smoking and get tips to help you stop smoking.

High blood pressure

High blood pressure can often be reduced by eating a healthy diet, cutting down on alcohol, maintaining a healthy weight and doing regular exercise.

Diet

The advice on diet above also applies if you have high blood pressure. In addition, cut down on the amount of salt in your food and eat plenty of fruit and vegetables.

Salt raises your blood pressure. The more salt you eat, the higher your blood pressure. Aim to eat less than less than 6g (0.2oz) of salt a day – about a teaspoonful. Find out more about how to cut down on salt.

Eating a low-fat diet that includes lots of fibre (such as wholegrain rice, bread and pasta) and plenty of fruit and vegetables has been proven to help lower blood pressure. Fruit and vegetables are full of vitamins, minerals and fibre to keep your body in good condition. Aim to eat five portions of fruit and vegetables every day. Find out more about getting your 5 a day.

Alcohol

Regularly drinking more alcohol than is recommended will raise your blood pressure over time. Drinking within the recommended limits is the best way to reduce your risk of developing high blood pressure.

The NHS recommends:

  • men shouldn't regularly drink more than 3–4 units a day
  • women shouldn't regularly drink more than 2–3 units a day

Find out how many units are in your favourite drink, track your drinking over time and get tips to help you cut down on alcohol.

Alcohol is also high in calories, which will make you gain weight. This will also increase your blood pressure. Find out how many calories are in popular drinks.

Weight

Being overweight forces your heart to work harder to pump blood around your body, which can raise your blood pressure. Use the BMI healthy weight calculator to find out if you need to lose weight.

If you need to shed some weight, it's worth remembering that losing just a few pounds will make a big difference to your blood pressure and overall health. Get tips on losing weight safely.

Exercise

Being active and doing regular exercise lowers blood pressure by keeping your heart and blood vessels in good condition. Regular exercise can also help you lose weight, which will also help lower your blood pressure.

Adults should do at least 150 minutes (two hours and 30 minutes) of moderate-intensity aerobic activity every week. Examples of moderate intensity activity include cycling or fast walking. For it to count, the activity should make you feel warm and slightly out of breath. Someone who is overweight may only have to walk up a slope to get this feeling.

Physical activity can include anything from sport to walking and gardening. Get more ideas on being active.

Read more about preventing high blood pressure.

Aneurysm, brain

prevention of aneurysm...

While not all the risk factors for aneurysms can be prevented, the two leading risk factors can.

These are:

  • smoking
  • high blood pressure

Smoking

Smoking is a major risk factor for aneurysms because it causes atherosclerosis and raises your blood pressure. There may also be harmful substances in tobacco smoke that could damage the walls of the arteries.

If you decide to stop smoking, your GP will be able to refer you to an NHS Stop Smoking Service, which will give you dedicated help and advice about the best ways to give up smoking. You can also call the NHS Smoking Helpline on 0800 022 4332. The specially trained helpline staff can offer you free expert advice and encouragement.

If you're committed to giving up smoking but don't want to be referred to a stop-smoking service, your GP should be able to prescribe medical treatment to help with any withdrawal symptoms that you may have after quitting.

See Treatment for quitting smoking and Live Well: stop smoking for more information about giving up.

High blood pressure

High blood pressure can often be reduced by eating a healthy diet, moderating your alcohol intake, maintaining a healthy weight and doing regular exercise.

Diet

Cut down on the amount of salt in your food and eat plenty of fruit and vegetables.

Salt raises your blood pressure. The more salt you eat, the higher your blood pressure. Aim to eat less than less than 6g (0.2oz) of salt a day – about a teaspoonful. Find out more about how to cut down on salt.

Eating a low-fat diet that includes lots of fibre (for example, wholegrain rice, bread and pasta) and plenty of fruit and vegetables has been proven to help lower blood pressure. Fruit and vegetables are full of vitamins, minerals and fibre to keep your body in good condition. You should aim to eat five 80g portions of fruit and vegetables every day.

Find out more about getting your 5 A Day.

Alcohol

Regularly drinking alcohol above what the NHS recommends will raise your blood pressure over time. Staying within the recommended levels is the best way to reduce your risk of developing high blood pressure.

The NHS recommends:

  • men shouldn't regularly drink more than 3-4 units a day
  • women shouldn't regularly drink more than 2-3 units a day

Find out how many units are in your favourite tipple, track your drinking over time and get tips on cutting down.

Alcohol is also high in calories, which will make you gain weight. This will also increase your blood pressure. Find out how many calories are in popular drinks.

Weight

Being overweight forces your heart to work harder to pump blood around your body, which can raise your blood pressure. Use the BMI healthy weight calculator to find out if you need to lose weight.

If you need to shed some weight, it's worth remembering that losing just a few pounds will make a big difference to your blood pressure and overall health. Get tips on losing weight safely.

Exercise

Being active and taking regular exercise lowers blood pressure by keeping your heart and blood vessels in good condition. Regular exercise can also help you lose weight, which will also help lower your blood pressure.

Adults should do at least 150 minutes (two hours and 30 minutes) of moderate-intensity aerobic activity (i.e. cycling or fast walking) every week. For it to count, the activity should make you feel warm and slightly out of breath. Someone who is overweight may only have to walk up a slope to get this feeling.

Physical activity can include anything from sport to walking and gardening. Get more ideas on being active.

Read more about preventing high blood pressure.

Aneurysm
An aneurysm is a blood-filled sac that forms in a weakened part of a blood vessel.
Artery
Arteries are blood vessels that carry blood from the heart to the rest of the body.
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Cholesterol
Cholesterol is a fatty substance made by the body that lives in blood and tissue. It is used to make bile acid, hormones and vitamin D.
High blood pressure
Hypertension is when the pressure of the blood in your bloodstream is regularly above 140/90 mmHG.
Platelets
Platelets are cells in the blood that control bleeding by plugging the broken blood vessel and helping the blood to clot.
Rupturing
A rupture is a break or tear in an organ or tissue.
Ultrasound
Ultrasound scans are a way of producing pictures of inside the body using sound waves.

introduction of aneurysm...

An aneurysm is a bulge in a blood vessel that's caused by a weakness in the blood vessel wall.

As the blood passes through the weakened blood vessel, the blood pressure causes it to bulge outwards like a balloon.

Aneurysm can occur anywhere in the body but the two most common places for them to form are in the abdominal aorta and the brain (see below).

This topic will be focusing on brain aneurysms. Read our separate topic for information on abdominal aortic aneurysm.

Brain aneurysm

The medical term for an aneurysm that develops inside the brain is an intracranial aneurysm (some doctors also use the term cerebral aneurysm).

Most brain aneurysms will only cause noticeable symptoms if they split open (the medical term for this is a ruptured aneurysm).

This will then trigger an extremely serious condition known as a subarachnoid haemorrhage, where the bleeding caused by the ruptured aneurysm can cause extensive brain damage and symptoms such as:

  • a sudden and severe headache – it has been described as a ‘thunderclap headache’, similar to a sudden hit on the head, resulting in a blinding pain that's unlike anything ever experienced before
  • stiff neck
  • sickness and vomiting

Read more about the symptoms of a brain aneurysm.

A ruptured brain aneurysm is a medical emergency. If you suspect that you or someone in your care has had a ruptured brain aneurysm, call 999 immediately and ask for an ambulance.

Treatment

The goal of treatment is to prevent aneurysms from rupturing in the first place. This is usually done with surgery.

This involves either strengthening the affected blood vessel with tiny metal coils or sealing it shut with a tiny metal clip. But not all aneurysms are routinely treated in this way.

Surgery carries a small risk of causing serious complications, some of which can be fatal. Therefore surgery is usually recommended only if the potential risk of the aneurysm rupturing outweighs the risks associated with surgery

The size and location of the aneurysm is often used to measure the risk of it rupturing. An aneurysm larger than 7mm or located in a section of blood vessel known as the posterior communicating artery has an increased risk of rupture.

A number of non-surgical treatments can also be used to reduce the risk of an aneurysm rupturing. They include a type of medication known as a statin, or quitting smoking if you smoke.

Read more about the treatment of aneurysms.

Causes

Exactly what causes the wall of affected blood vessels to weaken is still unclear though a number of risk factors have been identified.

These include:

In some cases, an aneurysm may develop because there was a weakness in the walls of the blood vessels at birth.

Aneurysms are also known to run in families.

Read more about the possible risk factors and causes of aneurysms.

Who is affected

It's difficult to estimate exactly how many people are affected by a brain aneurysm because in most cases they cause no symptoms and pass undetected. Some experts believe it could be as high as 1 in 20 people while others think the figure is much lower at around 1 in a 100 people.

Thankfully, the number of aneurysms that actually rupture is much smaller.

Only around 1 in 12,500 people will have a ruptured brain aneurysm in any given year in England.

Prevention

The best way to prevent getting an aneurysm, or reduce the risk of an aneurysm growing bigger and possibly rupturing, is to avoid any activities that could damage your blood vessels, such as:

  • smoking
  • eating a high-fat diet
  • not exercising regularly
  • being overweight or obese

Read more about preventing aneurysms.

Aneurysm
An aneurysm is a blood-filled sac that forms in a weakened part of a blood vessel.
Artery
Arteries are blood vessels that carry blood from the heart to the rest of the body.
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Blood vessel
Blood vessels are the tubes in which blood travels to and from parts of the body. The three main types of blood vessels are veins, arteries and capillaries.
Brain
The brain controls thought, memory and emotion. It sends messages to the body controlling movement, speech and senses.
Congenital
Congenital means a condition that is present at birth- the condition could be hereditary or develop during pregnancy.
Heart
The heart is a muscular organ that pumps blood around the body.
High blood pressure
Hypertension is when the pressure of the blood in your bloodstream is regularly above 140/90 mmHG.
Swelling
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

treatment of aneurysm...

There are two main types of treatment for a brain aneurysm:

  • preventative treatment: where an aneurysm is treated to prevent it from rupturing
  • emergency treatment: where an aneurysm is repaired after it ruptures

The mainstay of preventative treatment is surgery, though as with any type of surgery, it carries a risk of complications, some of which are serious, such as brain damage or a stroke.

Therefore, preventative surgery is usually only recommended if it's thought that the risk of a rupture is significant enough to justify the risk of surgery.

Preventative treatment

If you are diagnosed with a brain aneurysm, a risk assessment will be carried out to assess the risk of the aneurysm rupturing.

The assessment process is usually based on the following factors:

  • your age
  • the size of the aneurysm
  • where in the brain the aneurysm is located; brain aneurysms that are located near larger blood vessels have a high risk of a rupture
  • whether you have a family history of ruptured brain aneurysm
  • whether you have an underlying health condition that increases the risk of a rupture, such as autosomal dominant polycystic kidney disease or poorly controlled high blood pressure

The decision to surgically repair an aneurysm will be based on a number of factors individual to you, such as:

  • your age – research has found that in older adults the potential benefit of surgery in terms of extending natural lifespan is often outweighed by the risks associated with surgery
  • the size of the aneurysm – aneurysms larger than 7mm often require surgical treatment as do aneurysms larger than 3mm in cases where there are other risk factors
  • the location of the aneurysm – as mentioned above, aneurysms located near larger blood vessels have a high risk of a rupture

Your surgical team should be able give you a detailed assessment of whether the benefits of surgery outweigh the potential risks in your individual case.

Active observation

If it is thought that the risk of rupture is small then a policy of active observation is normally recommended.

Active observation means that you won't receive immediate surgery, but you'll be given regular check-ups so that your aneurysm can be carefully monitored.

You'll be referred for regular angiograms so that the size of the aneurysm can be carefully monitored.

You may also be given medication to lower your blood pressure as well as discussing lifestyle changes, such as losing weight and reducing the amount of fat in your diet.

Surgery

Two surgical techniques have proved to successfully treat brain aneurysms: neurosurgical clipping and endovascular coiling.

Neurosurgical clipping

Neurosurgical clipping is a procedure carried out under general anaesthetic (you're asleep throughout). A cut is made in your scalp and a small flap of bone is removed to reveal your brain underneath.

When the aneurysm is located, the neurosurgeon (an expert in surgery of the brain and nervous system) will seal it shut using a tiny metal clip. After the bone flap has been replaced, the scalp is stitched together.

Endovascular coiling

Endovascular coiling involves inserting a catheter into an artery in your leg or groin. The tube is guided through the network of blood vessels into your head and finally into the aneurysm.

Tiny platinum coils are then passed through the tube into the aneurysm. The coils block the flow of blood into the aneurysm. Over time this should seal the aneurysm off from the main artery to prevent it from rupturing.

Coiling or clipping?

Overall, coiling has been shown to be a more effective treatment method than clipping. However, there is a slightly higher risk of re-haemorrhage (bleeding) inside the brain with coiling.

An advantage of coiling is that it's less invasive than clipping and therefore has a faster recovery time. Also, as it’s less invasive, the risk of a person having seizures (fits) after surgery is reduced, which is a common complication of invasive brain surgery.

Sometimes, coiling may not be technically possible or suitable - for example, if the aneurysm is located in an area of the brain that can't be reached using a catheter.

Your surgical team will be able to provide more information about the pros and cons of both techniques.

Emergency treatment

Emergency treatment is based on the same principles as preventative treatment. Coils or clipping are used to repair ruptured brain aneurysms.

Due to the urgent nature of a ruptured aneurysm, the decision to perform open or endovascular surgery may be determined by the expertise and experience of the surgeons available.

Additional medication and treatments may also be used to prevent blood loss and organ damage. For example, nimodipine may be recommended. This medication is used to prevent ruptured blood vessels going into spasm and causing further blood loss.

Aneurysm
An aneurysm is a blood-filled sac that forms in a weakened part of a blood vessel.
Artery
Arteries are blood vessels that carry blood from the heart to the rest of the body.
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Brain
The brain controls thought, memory and emotion. It sends messages to the body controlling movement, speech and senses.
Drip
A drip is used to pass fluid or blood into your bloodstream, through a plastic tube and needle that goes into one of your arteries or veins.
Haemorrhage
To haemorrhage means to bleed or lose blood. 
Ruptures
A rupture is a break or tear in an organ or tissue.
Tissue
Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.  

Ankylosing spondylitis

introduction of ankylosing spondylitis...

Ankylosing spondylitis (AS) is a type of chronic (long-term) arthritis that affects parts of the spine, including bones, muscles and ligaments.

Arthritis is a common condition that causes pain and inflammation of the joints and tissues around them.

The symptoms of ankylosing spondylitis can vary, but most people experience back pain and stiffness. The condition can be severe, with around one in 10 people at risk of long-term disability.

What causes ankylosing spondylitis?

In ankylosing spondylitis, the spinal joints, ligaments and the sacroiliac joints (the joints at the base of the spine) become inflamed. This inflammation causes pain and stiffness in the neck and back. Sacroiliitis (inflammation of the sacroiliac joints) leads to pain in the lower back and buttocks.

It is not known what causes the condition, but there is thought to be a link with a particular gene known as HLA-B27.

Read more about the causes of ankylosing spondylitis.

Treating ankylosing spondylitis

There is no cure for ankylosing spondylitis. The aim of treatment is to ease the pain and stiffness and to keep the spine flexible. Treatment includes:

  • physiotherapy – where physical methods, such as massage and manipulation, are used to improve comfort and spinal flexibility (only the muscles and soft tissue should be manipulated and never the bones of the spine – manipulating bones in people with ankylosing spondylitis can cause injury)
  • medication – helps relieve pain and control symptoms
  • lifestyle changes – to minimise the risk of other health conditions and improve symptoms

Read more information about how ankylosing spondylitis is treated.

Complications

Inflammation of part of the eye (uveitis) is sometimes associated with ankylosing spondylitis. If you have ankylosing spondylitis and develop pain or redness in one of your eyes, you should urgently see your GP as it can lead to loss of vision.  

In advanced cases of ankylosing spondylitis, the pain and stiffness can lead to your posture becoming fixed in one position.

Read more about complications of ankylosing spondylitis.

Who is affected?

Ankylosing spondylitis can develop at any time from teenage years onwards, although it usually occurs between 15 and 35 years of age and rarely starts in old age. It is around three times more common in men than in women.



treatment of ankylosing spondylitis...

There is no cure for ankylosing spondylitis (AS). Treatment aims to relieve symptoms and slow the process of the spine stiffening.

Physiotherapy

Keeping active can improve your posture and your range of spinal movement, as well as preventing your spine from becoming stiff and painful.

As well as keeping active, physiotherapy is a key part of treating ankylosing spondylitis. A physiotherapist (a healthcare professional  trained in using physical methods of treatment) can advise about the most effective exercises and draw up an exercise programme suitable for you.

Types of physiotherapy recommended for ankylosing spondylitis include:

  • a group exercise programme, where you exercise with others
  • an individual exercise programme – you are given exercises to do by yourself
  • massage – your muscles and other soft tissues are manipulated to relieve pain and improve movement (the bones of the spine should never be manipulated as this can cause injury in people with ankylosing spondylitis)
  • hydrotherapy – exercise in water (usually a warm, shallow swimming pool or a special hydrotherapy bath); the weight of the water helps improve your circulation (blood flow), relieve pain and relax your muscles
  • electrotherapy – electric currents or impulses (small electric shocks) make your muscles contract (tighten), which can help ease pain and promote healing

Some people prefer to swim or play sport to keep flexible. This is usually fine, although some daily stretching and exercise is also important (see below).

Exercise

The National Ankylosing Spondylitis Society (NASS) provides detailed information about different types of exercise to help you manage your condition.

However, if you are in doubt, speak to your physiotherapist or rheumatologist before taking up a new form of exercise or sport.

Alongside physiotherapy, you will also probably be prescribed medication, such as:

  • painkillers
  • tumour necrosis factor (TNF) blockers
  • bisphosphonates
  • disease-modifying anti-rheumatic drugs (DMARDs)
  • corticosteroids

These are described below.

Painkillers

You may need painkillers to manage your condition while you are being referred to a rheumatologist. The rheumatologist may continue prescribing painkillers, although not everyone needs them, at least not all the time. The first type of painkiller usually prescribed is a non-steroidal anti-inflammatory drug (NSAID).

Non-steroidal anti-inflammatory drugs (NSAIDs)

As well as helping to ease pain, non-steroidal anti-inflammatory drugs (NSAIDs) help relieve inflammation (swelling) in your joints. Examples of NSAIDs include:

When prescribing NSAIDs, your GP or rheumatologist will try to find the one that suits you best and the lowest possible dose that relieves your symptoms. Your dose will be monitored and reviewed as necessary.

Paracetamol

If NSAIDs are unsuitable for you, an alternative painkiller, such as paracetamol, may be recommended.

Paracetamol rarely causes side effects and can be used in women who are pregnant or breastfeeding. However, paracetamol may not be suitable for people with liver problems or those dependent on alcohol (have an alcohol addiction).

Codeine

If necessary, as well as paracetamol, you may also be prescribed a stronger type of painkiller called codeine. Codeine can cause side effects including:

  • nausea (feeling sick)
  • vomiting (being sick)
  • constipation (an inability to empty your bowels)
  • drowsiness, which could affect your ability to drive

Tumour necrosis factor (TNF) blocker

If your symptoms cannot be controlled using painkillers or exercising and stretching, a tumour necrosis factor (TNF) blocker may be recommended. TNF is a chemical produced by cells when tissue is inflamed.

TNF blockers are given by injection and work by preventing the effects of TNF. This helps reduce inflammation in your joints caused by ankylosing spondylitis. Examples of TNF blockers include:

TNF alpha blockers are a relatively new form of treatment for ankylosing spondylitis, and their long-term effects are unknown. However, research into the use of TNF blockers for treating rheumatoid arthritis is providing clearer information about their long-term safety.

If your rheumatologist recommends using TNF blockers, the decision about whether they are right for you must be discussed carefully and your progress will be closely monitored. This is because TNF blockers interfere with the immune system (the body’s natural defence system).

NICE guidelines

The National Institute for Health and Clinical Excellence (NICE) has produced guidance about the use of these TNF blockers. NICE states that adalimumab, etanercept and golimumab may only be used if:

  • your diagnosis of ankylosing spondylitis has been confirmed
  • your level of pain is assessed twice (using a simple scale that you fill in) 12 weeks apart and confirms your condition is still active (has not improved)
  • your Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) is tested twice, 12 weeks apart, and confirms your condition is still active (BASDAI is a set of measures devised by experts to evaluate your condition by asking a number of questions about your symptoms)
  • treatment with two or more NSAIDs for four weeks at the highest possible dose has not controlled your symptoms

After 12 weeks of treatment with TNF blockers, your pain score and BASDAI will be tested again to see whether they have improved sufficiently to make continued treatment worthwhile for you. If they have, treatment will continue and you will be tested every 12 weeks.

If there is not enough improvement after 12 weeks, you will be tested again at a later date or the treatment will be stopped.

Infliximab is an alternative TNF blocker that may be used to treat ankylosing spondylitis. However, it is not recommended by NICE. If you are currently taking infliximab, you should continue to do so until you and your rheumatologist decide it is appropriate for you to stop.

Other new TNF blockers and similar medications are being developed and may be approved by NICE.

Bisphosphonates

Bisphosphonates are usually used to treat osteoporosis (weak and brittle bones), which can sometimes develop as a complication of ankylosing spondylitis. Bisphosphonates may also be effective in treating ankylosing spondylitis, although the evidence is not entirely clear. They may also be used if you have osteoporosis.

Bisphosphonates can be taken by mouth (orally) as tablets or given by injection.

Disease-modifying anti-rheumatic drugs (DMARDs)

Disease-modifying anti-rheumatic drugs (DMARDs) are an alternative type of medication often used to treat other types of arthritis. DMARDs may be prescribed for ankylosing spondylitis, although they are only beneficial if peripheral joints are involved rather than the spine.

Two DMARDs found helpful for inflammation of joints other than the spine include:

Corticosteroids

Corticosteroid medicines (steroids) have a powerful anti-inflammatory effect and can be taken in various ways, for example as:

  • tablets (oral)
  • injections (parenteral)

If a particular joint is inflamed, corticosteroids can be injected directly into the joint. After the injection you will need to rest the joint for up to 48 hours (two days). It is usually considered wise to have a corticosteroid injection up to three times in one year, with at least three months between injections in the same joint. This is because corticosteroids injections can cause a number of side effects, such as:

  • infection in response to the injection
  • the skin around the injection may change colour (depigmentation)
  • the surrounding tissue may waste away
  • a tendon (cord of tissue that connects muscles to bones) near the joint may rupture (burst)

Corticosteroids may also help to calm down painful swollen joints when taken as tablets. Occasionally, when pain and stiffness are severe, corticosteroids can be very helpful when given as an injection into your muscle (intramuscular injection).



complications of ankylosing spondylitis...

Ankylosing spondylitis (AS) is a complex condition that can affect many parts of your body. It can cause complications in your day-to-day life, and lead to additional health conditions.

Some complications associated with ankylosing spondylitis are outlined below.

Uveitis

Uveitis, also known as iritis, is a condition sometimes associated with ankylosing spondylitis. Uveitis is inflammation (redness and swelling) of part of the eye. It usually only affects one eye, not both. If you have uveitis, your eye will become:

  • red
  • painful
  • sensitive to light (photophobia)

Because uveitis can damage your eyesight, if you have ankylosing spondylitis and you develop pain or redness in one eye, or misty vision, you should urgently visit:

  • your GP 
  • an ophthalmologist (a medical doctor who specialises in eye disease and its treatment or surgery), or
  • an optometrist (a person who examines eyes and tests sight)

Uveitis is easily treated using eye drops. If treated quickly, uveitis usually clears up within two to three weeks. However, if uveitis is not treated quickly, it can cause the loss of some or all of your vision.

Osteoporosis

Osteoporosis is a condition that causes your bones to become weak and brittle. In ankylosing spondylitis, osteoporosis can develop in the spine.

Read more information about osteoporosis.

Spinal fractures

Having ankylosing spondylitis increases your risk of developing fractures (breaks) in the vertebrae of your spine. This risk increases with the duration of your condition.

Cardiovascular disease

If you have ankylosing spondylitis, you may also have an increased risk of developing cardiovascular disease. Cardiovascular diseases include:

  • heart disease – your heart's blood supply is blocked or interrupted by a build-up of fatty substances in the coronary arteries (the blood vessels that supply blood to the heart)
  • stroke – a serious medical condition that occurs when the blood supply to the brain is interrupted
  • deep vein thrombosis (DVT) – where blood clots develop in one of the deep veins in your body, usually in your legs 

Due to the increased risk, it is important to take steps to minimise your chances of developing cardiovascular disease.

Your rheumatologist (specialist in treating muscle and joint conditions) will be able to advise about lifestyle changes you should make to minimise your risk of developing a cardiovascular disease. These changes may include:

  • giving up smoking (if you smoke)
  • losing weight (if you are overweight or obese)
  • taking more regular exercise – 150 minutes of exercise per week can greatly increase your health
  • keeping other conditions you may have under control, such as diabetes (a long-term condition caused by too much glucose in the blood) or high blood pressure (hypertension)

Reduced flexibility

It is estimated that four in 10 people with ankylosing spondylitis will eventually have severely restricted spinal flexibility. Spinal deformities are likely to take at least 10 years to develop.  

Fixed posture

In very severe cases of ankylosing spondylitis, pain and stiffness in your lower back can also spread to the upper parts of your spine. This can decrease the mobility of your spine, making it difficult to move. As a result, your posture can become fixed in one position. This may:

  • make it difficult to look people in the eye
  • reduce your self-confidence

However, it is unlikely this will cause severe disability unless you also have severe arthritis (inflammation of the joints) in your hips or sometimes your knees.

Surgical treatment

Two types of surgical treatment are sometimes needed by people with ankylosing spondylitis:

  • joint replacement surgery
  • spinal corrective surgery

These are described in more detail below.

Joint replacement surgery

In some cases, it may be necessary to have surgery to replace a joint that has become severely damaged as a result of ankylosing spondylitis. For example, if hip joints are affected, a hip replacement may help to:

  • relieve pain
  • improve mobility

Read about hip replacement for more information about the procedure.

Spinal corrective surgery

It is now rare for people with ankylosing spondylitis to need their spine straightened, but if the spine becomes badly bent this can often be corrected by an operation.

Cauda equina syndrome

Cauda equina syndrome is a very rare complication of ankylosing spondylitis that occurs when nerves at the bottom of your spine become compressed (compacted).

Cauda equina syndrome causes:

  • pain or numbness in your lower back and buttocks
  • weakness in your legs, which can affect your ability to walk
  • urinary incontinence or bowel incontinence (when you cannot control your bladder or bowels)

See your GP as soon as possible if you have ankylosing spondylitis and you develop any of these symptoms.

Amyloidosis

In very rare cases, it is possible to develop amyloidosis as a complication of ankylosing spondylitis.

Amyloid is a protein produced by cells in your bone marrow (the spongy material found in the centres of some hollow bones). Amyloidosis is a condition where amyloid builds up in organs, such as your:

  • heart – a muscular organ that pumps blood around the body
  • kidneys – two bean-shaped organs that filter out waste products from the  blood
  • liver – the largest organ in the body; it performs many important functions, such as turning food into energy

Symptoms of amylodosis vary because the condition can affect different areas of your body. In some cases, there may be no symptoms at all.

Read more about amyloidosis.

Employment

As ankylosing spondylitis advances, it can affect your ability to work. It is estimated that a third of people with ankylosing spondylitis may be unable to work at all. Around one in six people may need changes to their working life in order to continue working, such as:

  • working part-time
  • working from home
  • not taking up physically demanding occupations 

When at work, it is important to maintain a good posture when sitting or standing for long periods of time. You should get up, stretch and move around regularly. This could mean adjusting your work station, or ensuring you take regular breaks.

Read more information about how to sit correctly.



Anorexia nervosa

realstorypg of anorexia nervosa...

Katie Metcalfe, 21, is starting a creative writing degree at Cumbria University, but seven years ago her life was very different.

"My battle with anorexia started when I was 14. My situation at the time was unusual: I was at a Rudolph Steiner school in Botton Village, near Whitby, in a class with three other boys. The pressure of being the only girl with hormone-raging teenagers was enormous. I had no self-confidence, and my body became a focus of paranoia.

"Stress in my life multiplied when my parents told me there was trouble in their marriage. In addition, we were about to move house.

"Nothing in my life seemed to be right. I started to think that perhaps if I lost some weight and improved my fitness, things would change for the better. I assumed that thin people had fantastic lives and I could too.

"I made a New Year’s resolution to go on a diet, so I began to restrict my eating. I cut out fats, carbs and dairy, and lived on rice cakes, apples and lettuce.

"As I began to lose weight I started to feel that life was worth living. At last I seemed to be achieving something. A voice began to whisper in my ear, and as I lost more weight, it became louder. Eventually, it was all I could hear. Nothing mattered more than satisfying the voice’s need for weight loss and, ultimately, perfection.

"My weight dropped from 8.5st to under 5st. My hair fell out, my skin cracked and bled, my bones ached and my periods stopped. I was also cycling between 13km (eight miles) and 24km (15 miles) a day to satisfy anorexia’s need for exercise. But I still didn’t believe I was thin enough. When I looked in the mirror, a mound of blubber stared back.

"My mum took me to the GP when my periods stopped, but they sent me home with a diet sheet, which said I must try to eat more.

"Eventually, I collapsed and ended up in hospital after having a minor heart attack while riding my bike. I was kept on a heart monitor for two days. I was sent home with another diet plan and the simple instruction: ‘eat’.

"Eventually, my GP realised I needed help. I was admitted to a psychiatric ward in a hospital in Middlesbrough, where I stayed for the next nine months.

"I was put on bed-rest for five months. My treatment involved cognitive therapy sessions once a week, and I gradually started to eat small amounts of food again. My recovery was slow. What really helped to pull me through was writing, and the consistent support from my family.

"I started to write about my experiences and realised that I wanted to recover so I could help others who were battling with the same problem. I gradually got better and went back home the day before my 16th birthday.

"I have had a couple of relapses, but five years on I am fully recovered, with few long-lasting effects. Although I have been diagnosed with the early stage of osteoporosis, my periods have come back, so I can have children.

"I still feel depressed at times but writing about it helps me get over it. I eat healthily and exercise for pleasure, not punishment. My book, A Stranger in the Family (Accent Press), has been published and I'm about to start a university degree. A few years ago I would never have imagined that.

"If you're going through what I went through, you must talk about how you are feeling to your parents, friends or doctor, no matter how insignificant you believe your issue might be. It's vital to express depressive feelings because things only get worse if you bottle them up, and this can lead to major health problems.

"Aim to live every day as though it is your last and not submit to anorexia. Try to defeat anorexia before it defeats you. Always remember that help is out there."
complications of anorexia nervosa...

If anorexia nervosa is not treated, the condition can lead to severe health problems.

If treatment is not working or your condition deteriorates, you may be admitted to hospital.

It's also quite common for anorexia to return after treatment – for example, if a woman tries to lose weight gained during pregnancy.

Other health problems

Long-term anorexia can lead to severe complications and health problems which can be permanent, such as damaged bones.

People with anorexia also have an increased risk of:

Anorexia can lead to another eating disorder called bulimia nervosa, where the person binge eats, then immediately makes themselves sick or uses laxatives to rid their body of the food.

Anorexia can also cause an imbalance of minerals in the blood, such as potassium, calcium and sodium.  These minerals play an important part in keeping you healthy.

A low level of potassium (hypokalaemia), can cause:

  • tiredness
  • weakness
  • dehydration 
  • kidney damage
  • seizures (fits)
  • irregular heartbeat (arrhythmia)

Low levels of calcium can cause muscle spasms, a lack of calcium and vitamin D can cause bone damage and a lack of sodium (hyponatraemia) can cause confusion and fits.

Other complications of anorexia include:

Misusing laxatives can permanently damage the bowels and cause permanent constipation.

Anorexia and pregnancy

If you have anorexia and are pregnant, you will be monitored closely. You may need extra health checks as part of your antenatal and postnatal care.

Anorexia during pregnancy can increase the risk of complications, such as

You are also likely to need extra care and support during pregnancy if you have previously had anorexia and recovered from it.

getting-help of anorexia nervosa...

People with anorexia nervosa do not often seek help, probably because they are afraid. Many hide their condition for a long time, sometimes years.

They usually find it difficult to admit they have a problem, or even talk about their symptoms. They will probably disagree they need to gain weight, and may not even realise anything is wrong.

If someone has anorexia, the most important step towards diagnosis and treatment is for them to:

  • recognise they need help
  • want to get better

However, to take this first step they may need lots of support and encouragement.

Helping yourself

If you have eating problems or think you may have anorexia, it is important to seek help as soon as possible. You could start by:

  • talking to someone you trust, such as one of your family or friends
  • asking them to go with you to see your GP

Helping someone else

If someone close to you is showing signs of anorexia, you may want to offer help and support.

You could try talking to the person about how they feel and encourage them to think about getting help. But try not to put pressure on them or be critical of them, as this could make things worse.

You may want to seek advice on how best you can help. For example, your GP or a support group can provide information on:

  • how to help the person recognise they have a problem
  • treatments available
  • how you can support them during their treatment

You could also offer to help by going with the person to see their GP. See treating anorexia nervosa for more information.

A leading charity for people with eating disorders is beat, which has a range of information on the help and support available for people with eating disorders, and their friends and families.

Antacid medicines

considerations of antacid medicines...

Antacids are not always suitable for everyone, sometimes they need to be taken with caution or avoided completely.

Use in children

Many antacid medicines are not recommended for children under the age of 12.

Antacids that contain calcium are not recommended for long-term use in children because they can interfere with the rate that calcium is absorbed into the body and carried through the bloodstream. The right levels of calcium are vital for healthy bones and childhood development.

Prolonged use of antacids that contain calcium can also lead to muscle weakness and cramps.

Furthermore, there have been a number of cases linking the prolonged use of antacids that contain magnesium and aluminium with rickets, a developmental disorder in infants that causes softening and weakening of the bones.

Always read the patient information leaflet that comes with a medicine to ensure it is suitable for children.  Check the correct dosage and seek the advice of your GP or pharmacist about giving antacids to children under 12 years old.

Use in pregnancy

Most types of antacids are generally considered to be safe to take during pregnancy.

However, if you are pregnant or breastfeeding, seek advice from your GP or pharmacist before taking antacids.

Use with other conditions

In some cases, you may be advised not to use some antacids if you have a certain health condition.

Speak to your GP or pharmacist if you have an existing health condition and are unsure whether antacids are suitable for you.

You can also check the patient information leaflet that comes with all medication to ensure the medicine is suitable for you.

Use with other medicines

Taking antacids can sometimes interfere with your body’s ability to absorb other medications you may be taking.

Therefore, you may be advised to stop taking other medication while you are taking antacids.

For example, you may not be able to take calcium supplements for a condition such as osteoporosis at the same time as some antacids. Antacids can also alter the effectiveness of some antibiotics.

However, it's important never to stop taking a medication prescribed for you without first consulting your GP or another suitably qualified healthcare professional.

definition of antacid medicines...

Antacids are a type of medication that can control the acid levels in your stomach.

They are available over the counter from pharmacies and are commonly used to treat the symptoms of heartburn and indigestion.

How antacids work

Antacids work by counteracting (neutralising) the acid in your stomach that is used to aid digestion. This can reduce the symptoms of heartburn and relieve pain.

Some antacids also coat the surface of the oesophagus with a protective barrier against stomach acid or produce a gel on the stomach’s surface which helps stop acid leaking into the oesophagus (gullet).

Different types of antacids

Antacids are available in the form of chewable tablets or liquid. They are sold under various brand names, but they contain common ingredients, including:

  • aluminium hydroxide
  • magnesium carbonate
  • magnesium trisilicate

Sometimes extra ingredients are added to help treat other problems, such as simeticone to relieve flatulence and alginates to prevent acid flowing into your oesophagus.

Who cannot take antacids?

Antacids are not suitable for everyone.

For example, many antacids are not recommended for children under the age of 12 and people with certain health conditions (such as kidney disease). Antacids can also interfere with other medications, so you may not be able to take them while you are being treated for another condition.

Antacids are generally considered safe to take during pregnancy, but you should discuss it with your GP or pharmacist beforehand.

Read more about who cannot take antacid medicines.

What are the possible side effects?

Like all medicines, antacids can have side effects. Common side effects include:

If you experience either constipation or diarrhoea after taking antacids, it may be possible to switch to an alternative medicine. Speak to your GP or pharmacist for advice.

Any side effects that you experience while taking antacids should pass once you stop taking the medication. However, you should visit your GP if they continue.

Missed or extra doses

Take antacid medicines as directed on the patient information leaflet that comes with the medicine, or as advised by your GP or pharmacist.

If you miss a dose of an antacid, it will usually not be necessary to alter your next dose. It is likely that you can carry on taking your normal dose. For specific advice about what to do, refer to the patient information leaflet that comes with your medicine.

Taking extra doses could cause several unpleasant side effects, such as nausea, vomiting, diarrhoea and constipation.

Contact your GP or pharmacist immediately if you think that you have taken more antacids than you should have. Alternatively, you can call NHS Direct on 0845 46 47 for advice.

Anti Inflammatory Foods

5 Inflammatory Food Products to Avoid for Bet...

Inflammation is the body’s natural response to injury and infection. When you get a cut or sore, the area around will become red and swollen as the body defends itself by sending immune cells and key nutrients to the wounded part to help it heal quickly. This inflammation will clear up quickly but chronic inflammation, where the immune cells are in constant production, can cause permanent damage to our long-term health. Triggers for chronic inflammation include obesity, stress and environmental factors such as air pollution. However, food can also affect inflammation – there are many products renowned for their anti-inflammatory properties but which ones do the opposite and actually exacerbate inflammation? Here are 5 foods to avoid if you suffer from chronic inflammation? Trans fats: commonly included in processed food such as ready meals, trans fat is also known as hydrogenated or partly hydrogenated oils. Too much trans fat can damage the cells in the lining of blood vessels and cause inflammation. Check the labels of any ready meals for its trans fat content to keep your consumption to a minimum. Sugar: Sugar consumption is very high, particularly in the developed world, and its inclusion in so many food products is being blamed by scientists for the rising obesity epidemic. However, sugar also has an effect on inflammation with too much causing the body to secrete too many inflammatory messengers called cytokines, leading to possible pain and inflammation. Refined grains: The processing of whole grains into the refined grains that are used to make white bread and pasta is known to make those products break down into sugar more quickly. Research shows a diet high in these refined grains can lead to increased inflammation while whole grains have the opposite effect. Omega 6 fatty acids: Found in vegetable oils such as soy oil and certain seeds, our bodies need a balance of omega 6 and omega 3 fatty acids for optimum health. However, too much omega 6 can cause inflammation and blood clotting. Gluten: Gluten intolerance is one of the rising dietary issues in the developed world and is linked to an astounding 55 different diseases and conditions, including celiac disease. Current research suggests a sensitivity to gluten can lead to bloating and digestive problems that are the body’s inflammatory response to the product.

Weaning From Gluten May Be Pointless For Many...

Quoted by Medical News Today: "People who do not have celiac disease and believe they have "non-celiac gluten sensitivity" may be weaning themselves off gluten unnecessarily, researchers from the University of Pavia, Italy, reported in Annals of Internal Medicine. The authors added that the majority of people who avoid gluten have "nonceliac gluten sensitivity" - those with celiac disease are a minority among gluten avoiders.

Individuals with celiac disease have a condition in which the lining of the small intestine becomes damaged; undermining their ability to absorb nutrients from food properly. This occurs because of a reaction to gluten, which is found in many cereals, such as rye, barley, wheat, and perhaps oats.

Celiac disease diagnosis occurs after specific bowel and blood tests are carried out.

A number of people who do not have celiac disease can still react to gluten if they eat it and experience gastrointestinal discomfort and fatigue. Experts refer to this condition as "non-celiac gluten sensitivity".

The number of people with non-celiac gluten sensitivity is considerably higher than those with celiac disease.

Gluten sensitivity can trigger the following symptoms if gluten is ingested:

    Intestinal symptoms

    bloating
    flatulence
    abdominal discomfort
    diarrhea
    Other symptoms

    headache
    ataxia (wobbliness, incoordination, unsteadiness)
    oral ulceration (recurrent)
    lethargy
    attention-deficit disorder

The authors say that some people who think they are food sensitive and do not have celiac disease may be abstaining from gluten unnecessarily. They suggest that non-celiac gluten sensitivity may be a perceived sensitivity, and one caused by the nocebo effect of gluten ingestion or wheat. Nocebo effect is a negative placebo effect, as may occur when somebody takes a medication and experiences unpleasant side-effects which are unrelated to the pharmacological action of the drug. The nocebo effect is linked to the individual's prior expectations of a side effect.

The researchers give examples of patients who strictly abstained from gluten, and believed their gluten-free diets helped reduce their symptoms. However, very few of them had ever undergone a proper diagnosis procedure.

They believe doctors should think about performing open or single-blind gluten challenge tests on those with non-celiac gluten sensitivity - at least until a valid biomarker for non-celiac gluten sensitivity is found."

Anti Inflammatory Foods - How Important Are T...

What are anti inflammatory foods? They are foods that reduce swelling in the body, promote better health and many more things. They are far important that we can realize.
 
Inflammation is distinct as a restricted response of tissue to injury, irritation, or infection. There are symptoms such as pain, swelling, loss of movement, and redness to the area. Although most people imagine it as being chronic arthritis, or painful muscles, but the medical profession are now looking at heart malady and strokes being linked to it as well.
 
By having natural anti inflammatory foods on your diet, it is felt that you can now stop the pain and stave off serious illness. Inflammation is part of your body's defense system against harmful bacteria and viruses, but scientists now believe that when it remains, it can cause a lot of problems. Make sure you take care of yourself by leading a healthy lifestyle. You should take regular exercise, stop smoking, try to reduce the stress of everyday life, and try to maintain your weight at an acceptable level.
 
This will help to reduce inflammation, but the best way is to change your eating habits. Adding anti inflammatory foods and supplements to your diet will greatly reduce the possibilities of chronic illness. Cut down on fatty sources such as red meat, and processed convenience foods.
 
To counter inflammation, we should be eating lots of fruit and vegetables. Fish is also good, though now there is the suggestion that some fish are polluted and contain high levels of mercury, and other toxins. The smaller fish, such as sardines and anchovies are considered to be healthy, and fish oil supplements are also recommended.
 
Whether or not you can gain those benefits from anti inflammatory foods, it depends on your willingness to start an eating plan based on them and to enjoy what you do. Basically, most dieting is common sense, and the motivation to live a healthy lifestyle. Adding a natural anti inflammatory supplement is also greatly helpful.
 

Anti-inflammatories, non-steroidal

how-does-it-work of anti inflammatories non s...

Non-steroidal anti-inflammatory drugs (NSAIDs) work by interfering with particular enzymes in your body.

Enzymes are a special type of protein which help to bring about, or speed up, a chemical reaction within your body. For example, digestive enzymes help your digestive system break up large food particles into smaller pieces so your body can absorb them.

Cyclo-oxyganase

NSAIDs interfere with an enzyme called cyclo-oxyganase (COX). Different parts of your body have different types of COX enzymes, which control the production of chemicals called prostaglandins. Different prostaglandins have different functions.

For example, the stomach contains COX-1 enzymes, these control the production of prostaglandins that help protect the stomach from acid (which is normally present in the stomach). White blood cells contain COX-2 enzymes, these control the prostaglandins involved in pain and inflammation.

NSAIDs can reduce pain and inflammation by preventing COX enzymes releasing the prostaglandin chemicals that cause pain and inflammation. However, prostaglandins carry out many different functions within your body. Interfering with them can cause a number of side effects, such as indigestion and stomach ulcers.

COX-2 inhibitors

To prevent side effects, researchers developed a new 'family' of NSAIDs known as COX-2 inhibitors.

These are designed to block the enzymes that cause pain and inflammation but avoid blocking the enzymes that protect the stomach lining. This helps reduce the risk of indigestion and stomach ulcers.

Although COX-2 inhibitors have less effect on the stomach, they may be more likely than traditional NSAIDs to cause side affects to the heart. This means they may be more suitable for someone at risk of developing stomach or intestinal problems, but less suitable for those with a heart or circulation problem.


Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign it has been damaged.
Swelling
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Tissue
Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.

introduction of anti inflammatories non stero...

Non-steroidal anti-inflammatory drugs (NSAIDs) are a medication widely used to:

  • relieve pain
  • reduce inflammation (redness and swelling)
  • bring down a high temperature (fever)

NSAIDs are used to treat a wide range of conditions.

Common acute (short-term) conditions that can be treated with NSAIDs include:

Common chronic (long-term) conditions that can be treated with NSAIDs include:

Things to consider when using NSAIDs 

NSAIDs are associated with a small increase in the risk of a person experiencing a heart attack, stroke or heart failure.

NSAIDs are only used in people who have an existing high risk of developing these types of conditions if there are no suitable alternatives and the medications bring significant benefit.

High-risk groups include:

  • those with a history of previous heart attack, stroke or heart failure
  • people aged 75 or over
  • people with diabetes
  • smokers
  • people with high blood pressure

NSAIDs are also not usually recommended for people who:

  • are pregnant or breastfeeding
  • have a history of kidney disease
  • have a history of liver disease
  • have active stomach ulcers (a sore in the lining of the stomach), or are at risk of developing stomach ulcers

Read more about the things to consider when using NSAIDs.

For people who are unable to take NSAIDs for medical reasons, the painkiller paracetamol can be used as a safe alternative. For more severe pain, prescription painkillers, such as codeine or tramadol, can be tried.

Or in cases of severe inflammation an injection of steroids (corticosteroids) can often help.

Read more about alternatives to non-steroidal anti-inflammatory drugs. 

Side effects

Most people take NSAIDs without having any side effects. Short term use is unlikely to cause significant problems, especially in younger patients.

If side effects do occur they usually affect the stomach and intestines (gastrointestinal tract) and can include:

In older patients (aged over 55), or those who have had previous stomach ulcers, but who need long term NSAID treatment, stomach acid suppression medications are often prescribed in combination with NSAIDs to reduce the risk of stomach ulcer complications. 

Read more about the side effects of NSAIDs.

Interactions

It is very important to read the patient information leaflet that comes with your medication as some NSAIDs can either react unpredictably with other medications, or make them less effective.

For example, it is usually not recommended to take an NSAID if you are also taking medication to prevent blood clots such as low-dose aspirin or warfarin.

Read more about potential interactions that can occur with NSAIDs.

Dosage

NSAIDs are available in:

  • tablet or capsule form
  • as a topical treatment (a cream, gel or lotion rubbed into a specific part of the body)
  • eye drops – used to treat eye pain

Less commonly, NSAIDs are used as a suppository – a capsule inserted into the rectum (back passage).

It is important to strictly follow all of the instructions about the recommended dosage for your particular NSAID. If you exceed the recommended dose, you risk experiencing a wide range of adverse effects, some of which can be serious.

Read more about the recommendations on dosage for NSAIDs.

Names

In Europe, the most commonly prescribed NSAIDs are:

Most of the NSAIDs listed above are generic medicines. This means that their production and distribution is not limited to a single company. Therefore, they are available under a range of different brand names.

Some NSAIDs are available over-the-counter, without the need for a prescription, such as aspirin, diclofenac, naproxen and ibuprofen.

However, because a medication is available over the counter it does not mean it is safe or suitable for everyone. Again, it is important to read the patient information leaflet that comes with your medication.

It is generally accepted that naproxen is the safest NSAID with regard to heart attacks and strokes and celecoxib is the safest with regard to stomach problems.

Note: Aspirin must NOT be given to children unless directed by a doctor. Also, some people with asthma get attacks triggered by aspirin or NSAIDs.


Anti-inflammatory
Anti-inflammatory medicines reduce swelling and inflammation.
Fever
A fever is when you have a high body temperature (over 38C or 100.4F).
Inflammation
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Joints
Joints are the connection point between two bones that allow movement.
Migraines
A migraine is type of recurring headache. It is usually accompanied by nausea, vomiting and sensitivity to light and sound.

dosage of anti inflammatories non steroidal...

Before prescribing a non-steroidal anti-inflammatory drug (NSAID), your GP will consider whether there is an alternative form of treatment that may be suitable. This will minimise your risk of having any side effects.

If your GP feels NSAIDs are the most appropriate form of treatment, they will prescribe the lowest effective dose for the shortest period of time necessary.

It is better to prescribe a low dose over a short period of time and, if necessary, to gradually increase it. By doing this, any side effects should not be as severe. 

Effects of specific NSAIDs

Your tolerance to different types of NSAIDs can vary greatly. While one type of NSAID may cause no side effects, another type may not be as effective or it may have an adverse effect on your gastrointestinal tract, heart, circulation or kidneys.

Therefore, before prescribing a different type of NSAID, your GP will carefully consider your individual circumstances and your likelihood of having any sort of reaction to the medicine. Do not switch between NSAIDs unless your GP agrees that it is safe for you to do so.

Overdose

It is important to strictly follow all instructions about the recommended dosage for your particular NSAID. If you exceed the recommended dose, you risk experiencing adverse effects, which could be minor, moderate, or serious.

Minor effects of an overdose include:

  • upset stomach
  • skin irritation
  • drowsiness
  • tachycardia (rapid heartbeat)

Moderate effects of an overdose include:

If you think you or someone else is having mild or moderate effects of an NSAID overdose, contact your GP immediately for advice. If this is not possible, call NHS Direct on 0845 4647.

Serious effects of an overdose include:

  • prolonged and repeated seizures (fits)
  • serious breathing difficulties
  • loss of consciousness
  • suddenly stopping breathing

A serious NSAID overdose is a medical emergency. If you think you or someone else is having serious effects of an NSAID overdose, call 999 immediately and ask for an ambulance.


Dose
Dose is a measured quantity of a medicine to be taken at any one time, such as a specified amount of medication.
Inflammation
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

Antibiotics

introduction of antibiotics penicillins...

Antibiotics are medications used to treat, and in some cases prevent, bacterial infections.

They can be used to treat relatively mild conditions such as acne as well as potentially life-threatening conditions such as pneumonia (a type of lung infection).

Read more about when antibiotics are used.

How do I take antibiotics?

Doses of antibiotics can be provided in several ways:

  • oral antibiotics – tablets, pills and capsules or a liquid that you drink
  • topical antibiotics – creams, lotions, sprays or drops
  • injections of antibiotics – they can be given as an injection, or an infusion through a drip, directly into the blood or a muscle

How the antibiotic is given will depend on the type of infection. Topical antibiotics are often used to treat skin infections while oral antibiotics can be used to treat most types of mild to moderate infections in the body. Antibiotic injections are usually reserved for more serious infections and are often given in hospital.

It is essential to finish taking a prescribed course of antibiotics, even if you feel better, unless a healthcare professional tells you otherwise. If you stop taking an antibiotic part way through a course, the bacteria can become resistant to the antibiotic (see below).

Types of antibiotics

There are now hundreds of different types of antibiotics but most of them can be broadly classified into six groups. These are outlined below.

Penicillin

Penicillin is widely used to treat certain infections such as skin infections, chest infections and urinary tract infections.

Some widely used types of penicillin include:

Around 1 in 15 people will have an allergic reaction after taking penicillin and a very small number of people will develop a severe allergic reaction (anaphylaxis).

It's important to let your doctor or the health professional treating you know if you think you may be allergic to penicillin.

Another problem with penicillin is that some strains of bacteria have become resistant to it because it has been so widely used.

Cephalosporins

Cephalosporins are broad-spectrum antibiotics, which means they are effective in treating a wide range of different types of infections including more serious infections, such as:

  • septicaemia – infection of the blood
  • pneumonia
  • meningitis – infection of the outer protective layer of the brain and spinal cord

Examples of cephalosporins include:

If you are allergic to penicillin you may also be allergic to cephalosporins.

Aminoglycosides

Aminoglycosides are a type of antibiotic that used to be widely prescribed until it was found that they could cause both damage to hearing and the kidneys. Because of this, they tend now to be used only to treat very serious illnesses such as meningitis.

Aminoglycosides break down quickly inside the digestive system so they have to be given by injection or as ear or eye drops. The most widely used aminoglycoside in England is called gentamicin.

Tetracyclines

Tetracyclines are another type of broad-spectrum antibiotic that can be used to treat a wide range of infections.

They are commonly used to treat severe acne and a condition called rosacea, which causes flushing of the skin and spots.

Macrolides

Macrolides are a type of antibiotic that can be particularly useful in treating lung and chest infections.

They can also be a useful alternative for people with a penicillin allergy or to treat penicillin-resistant strains of bacteria.

Examples of macrolides include:

Fluoroquinolones

Fluoroquinolones are the newest type of antibiotic. They are broad-spectrum antibiotics that can be used to treat a wide range of infections.

Examples of fluoroquinolones are:

Side effects

Most antibiotics (with the exception of the aminoglycosides) don't cause problems for people who take them and serious side effects are rare. The most common reported side effects of antibiotics are:

  • being sick
  • feeling sick
  • indigestion
  • diarrhoea 

Read more about the side effects of antibiotics.

Considerations and interactions

Some antibiotics are not suitable for people with certain medical conditions, or for women who are pregnant or breastfeeding. You should only ever take antibiotics that are prescribed to you – never 'borrow' them from a friend of family member.

Some antibiotics can also react unpredictably with other medications and the oral contraceptive pill. It is therefore important to read the information leaflet that comes with your medication carefully.

Read more about things to consider with antibiotics and things that interact with antibiotics.

Antibiotic resistance

Both the NHS and health organisations across the world are trying to reduce the use of antibiotics, especially for conditions that are not serious. This is to try to combat the problem of antibiotic resistance, which is when a strain of bacteria no longer responds to treatment with one or more types of antibiotics.

Antibiotic resistance can occur in several ways.

Strains of bacteria can mutate (change) and, over time, become resistant to a specific antibiotic. The chance of this increases if a person does not finish the course of antibiotics as some bacteria may be left to develop resistance.

Also, antibiotics can destroy many of the harmless strains of bacteria that live in and on the body. This allows resistant bacteria to multiply quickly and replace them.

The overuse of antibiotics in recent years has played a major part in antibiotic resistance. This includes using antibiotics to treat minor conditions that would have got better anyway.

It has led to the emergence of so-called ‘superbugs’. These are strains of bacteria that have developed resistance to many different types of antibiotics. They include:

These types of infections can be serious and challenging to treat, and are becoming an increasing cause of disability and death across the world. For example, the World Health Organization (WHO) estimates that there are around 150,000 deaths due to MDR-TB each year.

The biggest worry is that there may emerge new strains of bacteria that are effectively untreatable by any existing antibiotics.

There are already signs of this with the emergence of a type of bacteria called New Delhi metallo-beta-lactamase (NDM-1), which appears to be highly resistant to treatment.

Read more about how you can help prevent the further progression of antibiotic resistance.



uses of antibiotics penicillins...

Antibiotics are no longer routinely used to treat infections for a number of important reasons:

  • many infections are caused by viruses so antibiotics are not effective
  • even if the infection is bacterial, the use of antibiotics is unlikely to have much benefit in terms of speeding up the healing process and can cause unpleasant side effects
  • the more antibiotics are used to treat trivial conditions the more likely they are to become ineffective in treating more serious conditions because of antibiotic resistance

For example, antibiotics are now no longer routinely used to treat chest infections, ear infections in children and sore throats.

Your GP will only prescribe antibiotics to treat:

  • conditions that are not especially serious but are unlikely to clear up without the use of antibiotics, such as moderately severe acne
  • conditions that are not especially serious but could spread to other people if not promptly treated, such as the skin infection impetigo or the sexually transmitted infection chlamydia
  • conditions where there is evidence that using antibiotics would significantly speed up the recovery time, such as a kidney infection
  • conditions that carry a risk of causing more serious complications, such as cellulitis (an infection of the deeper layer of the skin) or pneumonia (lung infection)

Antibiotics may also be recommended for people who are more vulnerable to the harmful effects of infection. This may include:

  • people aged over 75 years
  • people with heart failure
  • people who have to take insulin to control their diabetes
  • people with a weakened immune system – either due to an underlying health condition such as HIV or as a side effect of certain treatments such as chemotherapy

Intravenous antibiotics

Intravenous antibiotics (injections or infusions of antibiotics directly into the blood or, less commonly, the muscles) are usually only required to treat more serious bacterial infections, such as:

Antibiotics to prevent infection

There are several circumstances in which you may be given antibiotics as a precaution to prevent, rather than treat, an infection. This is known as antibiotic prophylaxis.

For example, antibiotic prophylaxis is normally recommended if you are having surgery on a certain part of the body that is known to carry a high risk of infection or that could lead to devastating effects if it were to become accidentally infected.

For example, it may be used if you are going to have:

Your surgical team will be able to tell you if you require antibiotic prophylaxis.

Antibiotic prophylaxis may also be recommended if you have a bite or wound that has a high chance of becoming infected, for example because it has come into contact with soil or faeces.  

There are also several medical conditions that make people particularly vulnerable to infection, meaning antibiotic prophylaxis is necessary. For example, people with the blood disorder sickle cell anaemia often have to take antibiotics for the rest of their lives as their spleen does not work properly. (The spleen plays an important role in filtering out harmful bacteria from the blood.)  



qanda of antibiotics penicillins...

Why should antibiotics not be used to treat coughs and colds?

All colds and most coughs and sore throats are caused by viruses. Antibiotics do not work against viral infections.

How should I treat my cold?

The best way to treat most colds, coughs or sore throats is to rest and drink plenty of fluids.

Colds can last about two weeks and may end with a cough that brings up phlegm. There are many over-the-counter remedies to ease the symptoms, for example paracetamol. Ask your pharmacist for advice. If the cold lasts more than three weeks, or you become breathless or have chest pains, or if you already have a chest complaint, see your GP.

Read more about treating the common cold, coughs and sore throats.

But what about my children? They’re always getting coughs and colds.

It is common for children to get coughs and colds, especially when they go to school and mix with other children. Ask your pharmacist for advice. If the symptoms persist and you are concerned, see your GP, but do not expect to be prescribed antibiotics.

What is antibiotic resistance?

Bacteria can adapt and find ways to survive the effects of an antibiotic. They become antibiotic resistant, which means that the antibiotic no longer kills the bacteria.

The more we use an antibiotic, the more likely it is that bacteria will become resistant to it. Some bacteria that cause infections in hospitals, such as MRSA, are resistant to several antibiotics.

Why can’t other antibiotics be used instead?

Other antibiotics can be used, but they may not be as effective and they may have more side effects. Eventually, the bacteria will become resistant to them too.

Only two new types of antibiotics have been found in the past 30 years and there is no guarantee that new ones will be discovered.

How can antibiotic resistance be avoided?

By using antibiotics carefully, we can slow down the development of resistance. It is not possible to stop it completely, but slowing it down stops resistance spreading and buys some time to develop new types of antibiotics.

What can I do about antibiotic resistance?

You should only use antibiotics when it is appropriate to do so. We now know that most coughs and colds get better just as quickly without antibiotics.

When antibiotics are prescribed, the complete course should be taken to get rid of the bacteria completely. If the course is not completed, some bacteria may be left to develop resistance.

So when will I be prescribed antibiotics?

Your doctor will only prescribe antibiotics when you need them, for example, for a kidney infection or pneumonia. Antibiotics may be life-saving for infections such as meningitis. By using them only when necessary, they are more likely to work when we need them in future.

Anticoagulant medicines

interactions of anticoagulant medicines...

Anticoagulant medicines can interact with a wide range of other medication. In some cases, the interaction will stop the anticoagulant medicine working. In other cases, it will increase the anticoagulant effect.

If you are taking anticoagulants, and you start, stop, or change the dose of any other kind of medication, speak to your GP, pharmacist or another healthcare professional. This includes:

Prescription medicines that can interact with anticoagulants include the following:

For a full list of medicines that interact with the anticoagulant you are taking, see our anticoagulant medicines information pages.

Your prescription should also come with an information booklet that may provide this information, or you can ask your pharmacist or GP. If you have any further questions, you can call NHS Direct on 0845 4647.

Warfarin

Warfarin may not be effective if you take too much vitamin K, either through your diet or in supplements.

The effect of warfarin is increased by alcohol. If you are taking warfarin, do not drink more than one or two alcoholic drinks a day, and never binge drink. 

The maximum recommended daily limits for alcohol consumption are three-to-four units a day for a man, and two-to-three units a day for a woman. One unit of alcohol is approximately half a pint of weak lager or bitter.

Read more about which medicines interact with warfarin.



side-effects of anticoagulant medicines...

A side effect of all anticoagulants is the risk of excessive bleeding (haemorrhages). This is because these medicines increase the time it takes blood clots to form. If they take too long, you can experience excessive bleeding.

Other side effects

As well as excessive bleeding, there are other symptoms to look out for. These are more common with warfarin. If you notice any of the following symptoms when taking anticoagulants, seek medical attention immediately:

  • passing blood in your urine, or faeces (stools)
  • passing black faeces
  • severe bruising
  • prolonged nosebleeds (lasting longer than 10 minutes)
  • blood in your vomit
  • coughing up blood
  • unusual headaches
  • sudden severe back pain
  • difficulty breathing or chest pain
  • (in women) heavy or increased bleeding during your period or any other bleeding from your vagina

While you are taking anticoagulant medicines, you will be closely monitored to check that you are on the correct dose and not at risk of excessive bleeding (haemorrhages). The most common test for this is the international normalisation ratio (INR).

Warfarin

Additional side effects caused by warfarin include:

  • rashes
  • diarrhoea
  • nausea (feeling sick)
  • vomiting

Heparin

Although heparin occurs naturally within the body, extra amounts of it can cause side effects, including:

  • hair loss (alopecia)
  • thrombocytopenia – an abnormal drop in the number of platelets in your blood, which can cause bleeding into vital areas


cautions of anticoagulant medicines...

If you are prescribed anticoagulants, always follow the instructions of your GP or other healthcare professional. Taking too much of these medicines can result in severe bleeding, especially if you are bruised or injured.

If you are unsure of your instructions, check the patient information leaflet that should come with your medication, or call your GP. If you need further advice, you can contact NHS Direct on 0845 4647.

Having surgery

If you are taking anticoagulants and you need to have surgery, or any kind of invasive procedure, make sure that the healthcare professionals treating you are aware of your medication. This includes procedures used to diagnose other conditions, such an endoscopy, cystoscopy or colonoscopy.

Anticoagulants reduce the ability of your blood to clot, which could be dangerous if any kind of incision is made during a surgical procedure. It may be necessary to stop taking anticoagulants for a while before and after surgery. This will prevent excessive bleeding during surgery, and help the healing process afterwards.

If you are having a dental procedure, such as having a tooth removed, inform your dentist that you take anticoagulants. You do not usually need to stop taking your medication, but you may need to have your international normalisation ratio (INR) tested before the procedure, to make sure that it's at a safe level.

Only stop taking your medication on the advice of your GP or another healthcare professional.

Pregnancy

Warfarin is not suitable for pregnant women because it can cross the placenta (the organ that links the mother’s blood supply to her unborn baby’s) and affect the unborn baby. This can cause birth defects or excessive bleeding from the placenta or foetus.

Warfarin should be avoided in pregnancy if possible, and especially during the first trimester (up to week 13 of the pregnancy) and the third trimester (from week 27 until the birth of the baby).

Heparin may be taken during pregnancy to manage venous thromboembolism (when a blood clot forms in a blood vessel and breaks off, blocking the flow of blood) if the healthcare professional treating you thinks it's necessary.

If you are on anticoagulant medicines and find out you are pregnant, or you plan to start trying for a baby, speak to your GP about stopping or changing your prescription.

Breastfeeding

Warfarin should not usually be taken while you are breastfeeding, unless you are advised to do so by your GP or midwife.

Heparin is safe to take while you are breastfeeding.

If you are on anticoagulants and you are breastfeeding, or planning to breastfeed, speak to your GP or midwife to find out if you need to change your prescription.

Avoiding injury

Taking anticoagulant medicines can make you more prone to bleeding if you are injured. Try to avoid minor injuries and cuts and grazes by:

  • taking care when brushing your teeth and shaving
  • using protection when gardening, sewing or playing contact sports
  • using insect repellent to avoid insect bites or stings


Antidepressants

dosage of antidepressant drugs...

When prescribing antidepressants your GP will usually select the lowest possible dose thought necessary to improve your symptoms.  

This cautious approach is intended to reduce the risk of side effects. If this dose proves ineffective, it can be gradually increased.

Antidepressants are usually taken in tablet form. Depending on the type of antidepressant prescribed and the severity of your depression, you will usually have to take one to three tablets a day.

If you forget to take your tablets one day, don't take an extra dose the next in order to ‘make up’ your dose. Instead, carry on taking your tablets as usual.

If you take more tablets than prescribed contact your GP as soon as possible for advice. If this is not possible, contact your local out of hours service, or NHS Direct on 0845 46 47.

It will probably take about three weeks before you begin to notice the effects of the antidepressants.

It is important not to miss any dosage as this could make your treatment less effective.

It is usually recommended that a course of antidepressants lasts for at least six months. However, if you have experienced previous episodes of depression, a two-year course may be recommended.

You should not suddenly stop taking antidepressants even if you feel better. Stopping suddenly can lead to withdrawal symptoms such as:

  • stomach upsets
  • flu-like symptoms
  • anxiety
  • dizziness
  • vivid dreams at night
  • sensations in the body that feel like electric shocks
  • seizures (fits)

If your GP decides to stop your course of antidepressants, they will reduce the dose gradually, over time.
how-do-they-work of antidepressant drugs...

Antidepressants work by increasing the levels of chemicals called neurotransmitters in the brain.

Neurotransmitters are ‘messenger chemicals’ that are used to transmit signals between brain cells. They are also thought to have an important effect on your mood.

Examples of ‘mood enhancing’ neurotransmitters include:

  • serotonin
  • norepinephrine
  • dopamine

The role neurotransmitters play in the causes of depression (and other mental health conditions) is still poorly understood. However, most experts agree that depression is not simply the result of a chemical imbalance in the brain.

Depression is a complex condition with many contributing factors. While antidepressants can treat the symptoms of depression, they do not necessarily address its causes. This is why antidepressants are usually used in combination with therapy to treat moderate to severe depression or other mental health conditions, such as obsessive compulsive disorder (OCD).

Increasing levels of neurotransmitters is a gradual process, so most people will need to take antidepressants for two to four weeks before noticing any improvement in their symptoms.

Increasing the levels of neurotransmitters can disrupt the pain signals sent by the nerves, which may be why some antidepressants can also help relieve symptoms of chronic (long-term) pain.
what-it-is-used-for of antidepressant drugs...

The main use for antidepressants is treating depression. They are also used for some other mental health conditions and to treat long-term pain.

In most cases, people with moderate to severe depression are given antidepressants as a first form of treatment. They are usually given along with a talking therapy such as cognitive behavioural therapy (CBT). CBT is a type of therapy that uses a problem-solving approach to help improve thought, mood and behaviour.

Antidepressants are not usually recommended for treating mild depression because research has found that they have limited effectiveness.

However, exceptions can be made if:

  • symptoms of mild depression have lasted for more than two years
  • you have experienced previous episodes of moderate or severe depression

Initially, a selective serotonin reuptake inhibitor (SSRI) will usually be prescribed. If your symptoms have not improved after four weeks, an alternative antidepressant may be recommended. Depending on your personal circumstances, this may be a certain type of antidepressant such as:

  • a different type of SSRI
  • a serotonin-norepinephrine reuptake inhibitor (SNRI)
  • a tricyclic antidepressant (TCA)
  • a monoamine oxidase inhibitor (MAOI)

Other mental health conditions

Antidepressants can also be used to help treat other mental health conditions, including:

As with depression, SSRIs are usually the first choice of treatment for these conditions. If SSRIs prove ineffective, an alternative type of antidepressant can be used.

Long-term pain

Even though tricyclic antidepressants (TCAs) were not originally designed to be painkillers, there is evidence to suggest that they are effective in treating chronic (long-term) nerve pain in some people.

Chronic nerve pain, also known as neuropathic pain, is caused by nerve damage or other problems with the nerves, and is often unresponsive to traditional painkillers, such as paracetamol.

Amitriptyline is the TCA that is usually used to treat neuropathic pain. Conditions that may benefit from treatment with amitriptyline include:

Antidepressants have also been used to treat cases of chronic pain that do not involve the nerves (non-neuropathic pain). However, they are thought to be less effective for this purpose.

As well as TCAs, SSRIs and SSNIs can also be used to treat chronic non-neuropathic pain.

Conditions that cause non-neuropathic pain that may benefit from treatment with antidepressants include:

Bedwetting in children

TCAs are sometimes used to treat bedwetting in children as they can help relax the muscles of the bladder. This increases bladder capacity and reduces the urge to urinate.



Antifungal medicines

interactions of antifungal drugs...

When two or more medicines are taken at the same time, the effects of one of the medicines can be altered by the other. This is known as a drug-drug interaction. Some antifungal medicines can interact with other medicines.

Tell your GP or pharmacist what other medicines you are taking, including over-the-counter medicines, so they can decide whether an antifungal medicine is safe for you to take.

Medicines that antifungal medicines may interact with include:

side-effects of antifungal drugs...

Antifungal medicines can cause side effects. These will differ depending on the type of antifungal medicine you are using.

Topical antifungals

Topical antifungal medicines, such as creams, can cause:

  • itching
  • a mild burning sensation
  • redness

Stop using the medicine if any of these side effects are severe and see your GP or pharmacist to find an alternative.

Oral antifungals

Side effects of oral antifungals, such as capsules, include:

These side effects are usually mild and only last for a short period of time.

Antifungals can also cause severe reactions, such as:

  • an allergic reaction – swelling of your face, neck or tongue or difficulty breathing
  • a severe skin reaction – such as peeling or blistering skin

If you experience any of these reactions, stop taking your medicine and contact your GP immediately.

If you are having difficulty breathing, visit the accident and emergency (A&E) department of your nearest hospital or call 999 for an ambulance.

Liver damage

Liver damage is a rare, but more serious, side effect of oral antifungals. In particular, ketoconazole has been linked to liver problems.

If you experience any of the symptoms listed below, stop taking your medicine and contact your GP because they may be caused by damage to your liver:

  • loss of appetite
  • vomiting
  • feeling sick for a long time
  • jaundice – yellowing of your skin or the whites of your eyes 
  • unusually dark urine or pale faeces (stools)
  • unusual tiredness or weakness

Intravenous antifungals

Amphotericin (amphotericin B) is the most commonly used intravenous antifungal. This is usually given in hospital as an intravenous infusion (a continuous drip of medicine into a vein in your arm).

Side effects of amphotericin include:

  • loss of appetite 
  • feeling sick
  • vomiting
  • diarrhoea
  • epigastric pain (pain in the upper part of your tummy)
  • a high temperature (fever)
  • chills
  • headache 
  • muscle and joint pain
  • anaemia (a reduced number of red blood cells)
  • a rash

Amphotericin can also affect your:

  • kidneys – causing abnormally low levels of some minerals in your blood, such as potassium or magnesium  
  • heart – causing an irregular heartbeat or changes in your blood pressure
  • liver – affecting the way your liver functions, for example, causing a build-up of bilirubin in the blood; bilirubin is a yellow substance that is produced when red blood cells are broken down  
  • nervous system – affecting your brain, nerves and spinal cord, causing conditions such as hearing loss or peripheral neuropathy

As amphotericin is given in hospital under supervision, any adverse effects are usually quickly detected and treated.

considerations of antifungal drugs...

Before you take antifungals there are a number of things you should discuss with your GP.

Allergies

You are generally advised not to take an antifungal medicine if you are allergic to the medicine or any of the ingredients used in it.

In some cases, such as when treating invasive fungal infections in hospital, your doctors may feel the benefit of the medicine outweighs the risk of an allergic reaction. They may decide to use the medicine and monitor you closely.

Other conditions

Be careful with some oral antifungals if you have problems with your heart, liver or kidneys.

Discuss your condition with your GP or pharmacist to find out which antifungal medicines are safe for you to use.

Topical antifungals

If you are using a topical antifungal medicine, such as a cream, avoid it coming into contact with:

  • your eyes 
  • moist linings (mucous membranes), for example, inside your nose or mouth (unless it is a gel that is supposed to be used in your mouth)

Contraceptives

Some antifungal medicines are designed to be used on a man's penis or in or around a woman's vagina. Antifungal creams or  vaginal suppositories (pessaries) are sometimes used to treat thrush.

However, these types of antifungal medicines can damage latex condoms and diaphragms, making them less effective. Use a different method of contraception while you are using the antifungal medicine, or avoid having sex.

Some types of antifungal medicines can also interact with oestrogens and progestogens, which are found in some types of hormonal contraceptives, such as the combined contraceptive pill. You may experience some breakthrough bleeding while taking your antifungal medicine, but your contraceptive protection should not be affected.

Only oral antifungal medicines interact with oestrogens.

Pregnancy

Many antifungal medicines are not suitable to take during pregnancy. Check the patient information leaflet that comes with your medicine to find out.

However, if you have vaginal thrush during pregnancy, your GP may prescribe an antifungal suppository that can be inserted into your vagina (a pessary) or an antifungal cream.

Breastfeeding

Small amounts of some medicines can pass into your breast milk and may then be passed on to your baby if you are breastfeeding. Check the patient information leaflet that comes with your antifungal medicine, as many medicines should not be taken while breastfeeding.

Antihistamines

who-can-use-it of antihistamines...

Most people are able to take antihistamines. However, antihistamines are not recommended in certain circumstances.

These are explained below.

Health conditions

A number of health conditions can be made worse by taking antihistamines, or they can cause the antihistamines to react unpredictably. These include:

Before taking antihistamines, seek advice from your GP or pharmacist if you have another health condition and you are unsure whether antihistamines are suitable for you.

Pregnancy and breastfeeding

As a general rule, avoid taking any medication during pregnancy unless there's a clear clinical need. Always check with your GP, pharmacist or midwife before taking any medication.

If you're pregnant and feel that you need antihistamines, or you're advised to take them by your GP, loratadine or chlorphenamine are the antihistamines considered the safest to use.
However, chlorphenamine is a first-generation antihistamine, so it may make you feel drowsy.

If you can't take loratadine or chlorphenamine, your GP may recommend another oral antihistamine called cetirizine. Cetirizine is also considered safe to use during pregnancy.

Antihistamine eye drops and nasal sprays should be used with caution during pregnancy. Some people are allergic to antihistamine eye drops. Seek advice from your GP before using antihistamine eye drops or nasal sprays.

Most antihistamines will pass into breast milk. While this isn't thought to be particularly harmful, it's recommended as a precaution that you don't breastfeed while taking antihistamines.

Children

Some antihistamines, such as alimemazine and promethazine, aren't suitable for children under two years old. Therefore seek advice from your GP if your child is under two years old and you think that they require treatment with antihistamines.

Some antihistamines are not recommended for children with certain conditions. For example, the National Institute of Clinical Excellence (NICE) recommends that oral antihistamines should not be used routinely to treat children with atopic eczema.

Before giving your child any form of medication, always read the patient information leaflet for advice about whether the medication is suitable for them.

side-effects of antihistamines...

Like all medicines, antihistamines can have side effects. Generally, these are more significant with first-generation antihistamines.

For a full list of specific side effects of your medicine, see the information leaflet that comes with your medication.

Most information leaflets can also be found online on the Medicines and Healthcare Products Regulatory Agency (MHRA) or electronic Medicines Compendium (eMC) websites.

First-generation antihistamines

Common side effects of first-generation antihistamines include:

  • drowsiness
  • impaired thinking
  • dry mouth
  • dizziness
  • constipation
  • blurred vision
  • an inability to fully empty the bladder (urinary retention)

It's important not to underestimate the effects of antihistamine-related drowsiness. Some first-generation antihistamines can impair abilities such as co-ordination, reaction times and judgment in the same way that alcohol consumption can.

Therefore it's very important that you do not drive or use power tools or heavy machinery after taking a first-generation antihistamine.

Less common side effects of first-generation antihistamines include:

  • insomnia – difficulty sleeping
  • nightmares
  • hallucinations – seeing or hearing things that aren't real
  • itchy skin

Rare side effects of first-generation antihistamines include:

  • rapid heartbeat
  • chest tightness

Contact your GP if you experience these rare side effects.

Second-generation antihistamines

A few people will experience drowsiness after taking second-generation antihistamines. If you find yourself feeling drowsy, do not drive, drink alcohol or use tools or machines.

As well as drowsiness, other side effects of second-generation antihistamines include:

These side effects are usually short-lasting and should pass quickly.

Rarer side effects include:

  • rapid heartbeat
  • chest tightness

Contact your GP if you have these rare side effects.

Third-generation antihistamines

Third-generation antihistamines have some similar side effects to second-generation antihistamines, including:

  • drowsiness, although this is less common than with first-generation antihistamines
  • headache
  • dry mouth
  • feeling sick

However, third-generation antihistamines have been found not to have the same risk of heart problems.

H2 receptor antagonists

Antihistamines that are used to treat stomach ulcers are known as H2 receptor antagonists. Side effects of this type of antihistamine are uncommon but may include:

interactions of antihistamines...

The effect of antihistamines can sometimes be altered when they are combined with other substances.

This is known as "interaction" and it is important to try to avoid this whenever possible, as the effects can be unpredictable and potentially dangerous.

First-generation antihistamines

Avoid drinking alcohol when taking first-generation antihistamines because this will increase feelings of drowsiness.

The same is true for other types of medication known to have a sedating effect, such as:

Seek advice from your GP or pharmacist before taking a first-generation antihistamine if you're taking any of the medications listed above.

You shouldn't take a first generation antihistamine if you're also taking a type of antidepressant known as a monoamine oxidase inhibitor (MAOI). This is because the combination of the two substances can have unpredictable effects.

Second-generation antihistamines

Most second-generation antihistamines do not have important interactions when they're taken with other medications. However, the exceptions to this are:

  • rupatadine – this can cause unpredictable effects if taken with some types of antibiotics or grapefruit juice
  • mizolastine – this can cause unpredictable effects if taken with nifedipine (used to treat high blood pressure), cimetidine (used to treat heartburn) and ciclosporin (often used to treat people who've had an organ transplant)

Cough and cold medicines

Many cough and cold medicines available over the counter at pharmacies contain a mixture of different medications, such as paracetamol, decongestants and antihistamines.

Don't take cough and cold medicines if you have recently taken other antihistamine medication because there's a risk of taking an excess dose of antihistamine.

These types of cough and cold medicines aren't recommended for children under six years old because the risks of treatment are thought to outweigh any benefits.

Antiplatelets, aspirin, low dose

introduction of anti platelets aspirin low do...

Aspirin is an antiplatelet medicine, which means it reduces the risk of clots forming in your blood. This reduces your risk of having a stroke or heart attack.

Normally, when there is a cut or break in a small blood vessel, a blood clot forms to plug the hole until the blood vessel heals.

Small cells in the blood called platelets make the blood clot. When a platelet detects a damaged area of a blood vessel, it produces a chemical that attracts other platelets and makes them stick together to form a blood clot.

Aspirin reduces the ability of the platelets to stick together and reduces the risk of clots forming.

When is low-dose aspirin used?

Low-dose aspirin (usually 75mg a day) may be given to you if you have had:

It may also be given to you if you are considered at risk of having a heart attack or stroke. You may be considered at risk if you:

Treatment with an antiplatelet medicine such as aspirin is usually for life.

Higher doses of aspirin may be given for other conditions, but these pages focus on the use of low-dose aspirin.

Children

Aspirin may be given to children under specialist supervision after heart surgery, or to treat children with Kawasaki disease.

Aspirin must not be given to anyone under 16 years old, unless under specialist advice.

Things to consider

If you have certain health conditions such as a peptic ulcer or bleeding disorder you should not take aspirin.

You should also use aspirin with caution if you have asthma or uncontrolled high blood pressure.

Low-dose aspirin (75mg) may be taken if you are pregnant or breastfeeding, but only on the recommendation of your GP.

Read more information about things to consider before taking aspirin.

Although serious reactions are rare, aspirin can cause side effects including indigestion and nausea. In more serious cases it can cause vomiting, bleeding or an allergic reaction,

Read more information about the side effects of aspirin.

Aspirin can also interact with other medicines. Always read the patient information leaflet that comes with your medicine to check that it is safe to take with aspirin.  If you are unsure, ask your pharmacist or GP.

Read more information about how aspirin interacts with other medication.

Missed or extra doses

If you forget to take your dose of aspirin, take that dose as soon as you remember and then continue to take your course of aspirin as normal.

However, if it is almost time for the next dose, skip the missed dose and continue your regular schedule. Do not take a double dose to make up for a missed one.

If you have to take two doses closer together than normal, there is an increased risk of side effects.

The patient information leaflet that comes with your medicine includes advice about what to do if you miss a dose.

If you accidentally take an extra dose of low-dose aspirin, it is unlikely to cause you harm as larger doses of aspirin are given safely for other conditions.

However, if you feel unwell or are concerned speak to your GP or pharmacist or call NHS Direct on 0845 46 47.

interactions---other-medicines of anti platel...

When two or more medicines are taken at the same time, the effects of one of the medicines can be altered by the other (drug-drug interaction). Aspirin can interact with other medicines.

Some of the more common interactions are listed below. However, this is not a complete list.

If you want to check your medicines are safe to take with aspirin, ask your doctor or pharmacist, or read the patient information leaflet that comes with your medicine.

Anti-inflammatory painkillers

Aspirin should not be taken with anti-inflammatory painkillers such as diclofenac, ibuprofen, indometacin or naproxen, as this increases the risk of bleeding in the stomach.

Read more information on these medicines on our anti-inflammatory painkillers medicines info page.

Methotrexate

Aspirin can reduce the body's ability to remove methotrexate, and can therefore increase your risk of serious side effects from this drug.

SSRI antidepressants

Taking aspirin with SSRI antidepressants such as citalopram, fluoxetine, paroxetine, sertraline or venlafaxine may increase your risk of bleeding.

Read more information on these medicines on our SSRI antidepressants medicines info page.

Warfarin

Warfarin is an anticoagulant medicine that prevents your blood from clotting. Aspirin taken with warfarin can increase your risk of bleeding. However, there are some situations where you may be advised by your doctor to take aspirin and warfarin together.

Interactions with food and alcohol

There are no known interactions between aspirin and food.

However, it is a good idea to take aspirin with or after food, to help reduce irritation to the stomach.

It may be safe to drink alcohol with some painkillers that can be bought over the counter (OTC), as long as you:

  • check the patient information leaflet that comes with the medicine
  • take the correct dose of your medicine
  • do not drink more than the maximum recommended daily limits of alcohol

Taking more than the recommended dose of aspirin or ibuprofen increases the risk of irritation to your stomach lining. This risk is increased further if you drink more than the recommended daily limits and may lead to bleeding from the stomach.

side-effects of anti platelets aspirin low do...

Aspirin can cause side effects, although serious reactions are rare.

Common side effects include:

  • irritation of the stomach or bowel
  • indigestion
  • nausea (feeling sick)

However, less than 10% of people taking aspirin experience these side effects. If you experience side effects, try sticking to basic food and taking your aspirin after a meal. See your doctor if you are worried or continue to experience them.

Less common side effects

Less common side effects of aspirin include:

  • worsening of asthma caused by narrowing of airways
  • vomiting
  • inflammation (swelling) of the stomach
  • bleeding in the stomach
  • bruising

In rare cases, a possible side effect of taking low-dose aspirin is haemorrhagic stroke (bleeding in the brain).

See your doctor if you experience any of these side effects when taking aspirin.

Allergic reaction

In some cases aspirin can cause an allergic reaction, although this is more common in people who have asthma. Go to the nearest hospital's accident and emergency department (A&E) if you experience:

  • swelling of the lips, mouth or throat
  • breathing problems
  • a skin rash which appears quickly

Antiplatelets, clopidogrel

special-considerations of anti platelets clop...

Clopidogrel may not be suitable to take if you have certain health conditions.

When to avoid clopidogrel

Clopidogrel should not be taken if you have:

Clopidogrel must not be given to anyone under 16 years old, unless under specialist advice.

Using clopidogrel with caution

Clopidogrel should be taken with caution if you:

  • have liver problems
  • have kidney problems
  • are at risk of bleeding, for example, if you are at risk of peptic ulcers

Tell your GP if you have had an allergic reaction to any medications before taking clopidogrel.

Some people are advised to stop taking clopidogrel seven days before a planned operation or dental extraction (removal of a tooth). This should always be on the advice of your doctor or surgeon.

Pregnancy and breastfeeding

Clopidogrel is not recommended if you are pregnant or breastfeeding. This is because there is very little information on its use in pregnant and breastfeeding women.

interactions---other-medicines of anti platel...

When two or more medicines are taken at the same time, the effects of one of the medicines can alter the effects of the other. This is known as a drug-drug interaction. Clopidogrel can interact with other medicines.

Some of the more common interactions are listed below. However, this is not a complete list.

Increased risk of bleeding

There is an increased risk of bleeding when clopidogrel is taken with some other medications including:

If you want to check your medicines are safe to take with clopidogrel, ask your doctor or pharmacist or read the patient information leaflet that comes with your medicine.

Interactions with food and alcohol

There are no known interactions between clopidogrel and food, although it is a good idea to take clopidogrel with or after food, to help reduce irritation to the stomach.

It may be safe to drink alcohol with clopidogrel as long as you:

Taking more than the recommended dose increases the risk of irritation to your stomach lining. This risk is increased further if you drink more than the recommended daily limits and may lead to bleeding from the stomach.

side-effects of anti platelets clopidogrel...

Clopidogrel can cause side effects, although serious reactions are rare.

Common side effects of clopidogrel can include:

Speak to your GP if any of these side effects get worse or do not go away.

Serious side effects

More serious side effects can include:

  • rashes and itching
  • severe stomach ache or abdominal pain
  • uncontrolled bleeding or unusual bruising
  • vomiting with blood
  • blood in your urine
  • blood in your stools

Speak to your GP immediately if you experience any of these side effects or any other unusual problems while taking clopidogrel.

Allergic reaction

In some cases clopidogrel can cause an allergic reaction. Go to the nearest hospital's accident and emergency department (A&E) if you experience:

  • swelling of the lips, mouth or throat
  • breathing problems
  • a skin rash that appears quickly

Arthritis

introduction of arthritis...

Arthritis is a common condition that causes pain and inflammation within a joint.

In the UK, around 10 million people have arthritis. The condition affects people of all ages including children (see below).

There are many different types of arthritis that cause a wide range of symptoms. Two of the most common are osteoarthritis and rheumatoid arthritis. 

What is osteoarthritis?

Osteoarthritis is the most common form of arthritis in the UK, affecting an estimated 8.5 million people.

In people affected by osteoarthritis, the cartilage (connective tissue) between their bones gradually wastes away, leading to painful rubbing of bone on bone in the joints. The most frequently affected joints are in the hands, spine, knees and hips.

Osteoarthritis often develops in people who are over 50 years of age. However, it can develop at any age as a result of an injury or another joint-related condition.

Read more about osteoarthritis. 

What is rheumatoid arthritis?

Rheumatoid arthritis is a more severe, but less common, form of arthritis than osteoarthritis. It occurs when the body's immune system attacks and destroys the affected joints, causing pain and swelling to occur. This can lead to a reduction in movement and the breakdown of bone and cartilage.

In the UK, rheumatoid arthritis affects around 400,000 people, and  often starts in people between the ages of 40 and 50 years old. Women are three times more likely to be affected by the condition than men.

Read more about rheumatoid arthritis. 

Symptoms of arthritis

There are many different symptoms of arthritis and the symptoms you experience will vary depending on the type of arthritis you have. However, common arthritic symptoms include:

  • joint pain, tenderness and stiffness
  • inflammation in and around the joints
  • restricted movement of the joints
  • warmth and redness of the skin over the affected joint
  • weakness and muscle wasting

Arthritis and children

Although arthritis is often associated with older people, it can sometimes affect children. In the UK, about 12,000 children under 16 years of age have arthritis.

Most types of childhood arthritis are referred to as juvenile idiopathic arthritis (JIA). JIA causes pain and inflammation in one or more joints for at least six weeks.

Although the exact cause of JIA is unknown, the symptoms often improve as a child gets older, allowing them to lead a normal life.

The main types of JIA are discussed below.

Oligo-articular JIA

Oligo-articular JIA is the most common type of JIA. It affects four or less joints in the body, most commonly in the knees, ankles and wrists.

Oligo-articular JIA has good recovery rates and long-term effects are rare. However, there is a risk that children with the condition may develop eye problems, so it is recommended that they have regular eye checks with an ophthalmologist (an eye care specialist).

Polyarticular JIA (polyarthritis)

Polyarticular JIA, or polyarthritis, affects five or more joints. It can develop at any age during childhood.

The symptoms of polyarticular JIA are similar to those of adult rheumatoid arthritis. The condition is often accompanied by a rash and a high temperature (fever) of 38C (100.4F) or above.

Systemic onset JIA

Systemic onset JIA begins with symptoms such as a fever, rash, lethargy (lack of energy) and enlarged glands. Later on, joints can become swollen and inflamed.

Like polyarticular JIA, systemic onset JIA can affect children of any age.

Enthesitis-related arthritis

Enthesitis-related arthritis is a type of juvenile arthritis that affects older boys or teenagers. The condition can cause pain in the soles of the feet and around the knee and hip joints where the ligaments attach to the bone.

You can read more about arthritis in children on the Arthritis Care website.

Treating arthritis

There is no cure for arthritis but there are a number of treatments that can help slow down the condition’s progress.

Medication can help relieve the symptoms of arthritis. In severe cases, surgery may be recommended.

For osteoarthritis, analgesics (painkillers), non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids are often prescribed. In severe cases, surgery may be recommended such as:

  • arthroplasty (joint replacement)
  • arthodesis (joint fusion)
  • osteotomy (where a bone is cut and re-aligned)

Read more about how osteoarthritis is treated.

The aim in treating rheumatoid arthritis is to slow down the progress of the condition and minimise joint damage. Recommended treatments may include:

Read more about how rheumatoid arthritis is treated.

Support groups

Support groups, such as Arthritis Research UK and Arthritis Care offer information, advice and support for people living with arthritis.

You can also use the post code search to find arthritis services in your area and hospitals for arthritis.



paulsrealstory of arthritis...

Paul Casimir has been living with arthritis for half his life, but he doesn’t let it stop him from doing the things he enjoys. He tells his story.

Paul Casimir was diagnosed with rheumatoid arthritis at 20. He was a fast runner throughout his teens, but at 19 his body started to stiffen up.

“I had been feeling a little bit strange for about a year before I was diagnosed with arthritis,” says Paul. “I just seemed to move at the pace of a distracted goat. I didn’t really know what was going on. I was at drama school at the time and I kept getting cast as octogenarians.”

One day, after finishing a play, he collapsed into bed completely exhausted. When he woke up, his knees had swollen to the size of dumplings, and he was in bed for four days. His doctor was puzzled.

“It then went away for a while, but returned with a vengeance a couple of months later,” says Paul. "I was referred to a rheumatologist, who diagnosed rheumatoid arthritis. It was something I’d never heard of and I didn’t know why it was happening to me. I had tears in my eyes when she told me.”   

Paul managed his condition with painkillers and anti-inflammatory medication for the next few years. It was difficult for him to move properly. "Dancing was what got me through the roughest times," he says. "Even when I could barely move, I could still dance. Standing still was excruciating, but transferring my weight from one leg to the other was bearable."

One day, he decided to see how he would get on without medication. He has never looked back.

“I didn’t really notice much of a difference with the medication,” he says. “People diagnosed now would be offered different kinds of medication, such as disease-modifying medication, but I guess that wasn’t around when I was diagnosed.

“After a while it became really important to me to start challenging the condition, to take back control of my life.”

He started swimming and going out dancing, and stopped worrying about what other people thought. It's been five years since the last big flare-up.

“I just learnt to get on with life," he says."It’s easy to dwell on the pain and misfortune and to think ‘why me’. But, in the end, that's really quite futile. What’s important is to focus on all the things you enjoy. I swim regularly and enjoy a ramble in the woods, whereas 20 years ago I'd have thought 'Let's go for a walk' was the most ridiculous suggestion someone could make! The richer your experiences in life, the more you're distracted from the pain.

"And I still look good on the dancefloor, dancing like a robot from 1984!” 

diet of arthritis...

There are many food myths surrounding arthritis, but some studies suggest certain foods may help to reduce pain and inflammation and slow the progression of arthritis.

Some people say dairy products cause arthritis and that cider vinegar and honey will cure it.

Others believe acidic fruits, such as lemons, oranges and grapefruit, and nightshade vegetables, such as potatoes, aubergines and peppers, can make symptoms worse.

Many people living with arthritis, particularly rheumatoid arthritis, also say there is a link between certain foods and the flare-ups they experience.

Healthy, balanced diet

Although there is little evidence to support these claims, some studies suggest certain foods may help reduce the pain and inflammation caused by arthritis and slow down the condition's progression.

These foods all contribute to a healthy, balanced diet, which will help with your arthritis and also reduce your risk of developing health complications, such as heart disease, osteoporosis (weak and brittle bones) and obesity.

If you are taking steroids over a long period of time you are more likely to develop osteoporosis. To reduce your risk, eat foods rich in calcium and vitamin D.

Calcium-rich foods include dairy products (milk, cheese and yoghurt), nuts, seeds and fish, such as sardines or whitebait (particularly if you eat the bones).

Sunlight is our main source of vitamin D but it can also be found in oily fish and fortified foods, such as cereals and margarines.

There is increasing evidence that the Mediterranean diet is good for arthritis as well as a number of other conditions. This diet includes plenty of fruit and vegetables, fish, grains and pulses and a moderate amount of red meat.

Foods rich in omega-3 are believed to have an anti-inflammatory effect, which may reduce the pain associated with inflamed joints. Omega-3 is found in oily fish, such as sardines, mackerel and salmon.

You should try to eat at least two portions of oily fish a week. Omega-3 is also found in nuts and seeds (particularly linseed or flax seed), and is regularly used to fortify margarines, cereals and bio-live yoghurt drinks.

Certain foods, such as patés, uncooked meats and unpasteurised dairy products can increase the risk of developing food poisoning. If you are taking immunosuppressant medication, you should avoid these foods.

For more dietary advice, see the Arthritis Care website information about eating well.

Arthroscopy

introduction of arthroscopy...

An arthroscopy is a type of keyhole surgery that is used both to diagnose problems with the joints and to repair damage to the joints.

The procedure is most commonly used on the knees, wrists, elbows, ankles and shoulders.

If you have problems with your joints, such as swelling or stiffness, and initial imaging tests have not been able to find what is causing the problem, an arthroscopy might be recommended to look at the inside of the joint.

As well as allowing a surgeon to look inside a joint, an arthroscopy can also be used to treat a range of problems and conditions. For example, an arthroscopy can be used to:

Read more about what an arthroscopy can be used for.

What happens during an arthroscopy?

During an arthroscopy, a piece of equipment called an arthroscope is used.

An arthroscope is a small, flexible tube that is about the length and width of a drinking straw. Inside there is a bundle of fibre optics. These act as both a light source and a camera. Images are sent from the arthroscope to a video screen or an eyepiece so that the surgeon is able to see the joint.

It is also possible for tiny surgical instruments to be passed through an arthroscope to allow the surgeon to treat conditions or problems such as those listed above.

The surgeon will make a small incision next to the joint so that the arthroscope can be inserted. One or more small incisions will also be made to allow an examining probe or, if necessary, surgical instruments, to be inserted.

An arthroscopy is usually carried out under general anaesthetic. This is where the person having the procedure is put to sleep so that they do not feel any pain or discomfort. Occasionally, a local anaesthetic may be used, where the area being treated is numbed.

An arthroscopy is usually performed on an out-patient basis, which means that the person being treated is able to go home on the same day as the surgery.

Read more about how an arthroscopy is performed.

Safety

An arthroscopy is usually a safe type of surgery and the risk of serious complications developing is low (less than 1 in a 100).

However, possible complications include infection and accidental damage to nerves near the affected joint.

Read more about the complications of an arthroscopy.

Advantages

The advantages of an arthroscopy compared with traditional open surgery include:

  • less post-operative pain
  • a faster recovery time
  • a lower risk of complications

Read more about the advantages of an arthroscopy.

Recovery

The time it takes to recover from an arthroscopy can vary depending on the joint involved and whether it needs to be repaired.

It is usually possible for a person to do light, physical activities one to three weeks after having surgery. Full physical activities, such as lifting and sport, can usually be resumed after six to eight weeks.

Read more about recovering from an arthroscopy.

ashleys-story of arthroscopy...

Ashley French, 27, from north London, first noticed something was wrong with his knee six years ago. He decided to go ahead with an arthroscopy and has never looked back.

“I did a lot of kickboxing and football so I suppose it wasn’t surprising that my knee started to play up. It wasn’t exactly sore, but it used to lock when I sat down. I could also feel some floating lumps around the kneecap, which, if I pressed them, would disappear into the joint. It was more uncomfortable than sore, but trying to straighten my locked knee did feel painful.

“I went to my GP who sent me to Old Church Hospital in Romford. They took some X-rays which showed that a piece of bone had broken away from my kneecap and this was what was causing my knee to lock.

“The consultant suggested I have an arthroscopy, and after being talked through the procedure I decided to go ahead. It seemed so much quicker and easier than open surgery. I was on the waiting list for a month. The operation was under general anaesthetic and I stayed overnight in the hospital. When I came round from the anaesthetic I was a bit sore and drowsy, but it wasn’t long before I felt like myself again.

“I was on crutches for a week or so and had to go back to the hospital for physiotherapy once a week for three weeks. They gave me some exercises to do at home and I was back boxing and playing football after a month.

“The operation was a few years ago now and I have never had any problems since. I would advise anyone to have an arthroscopy. There is nothing to worry about and my knee feels fantastic now.”

complications of arthroscopy...

An arthroscopy is generally a safe type of surgery and any complications, such as stiffness and swelling in the affected joint, are usually minor and temporary.

More serious complications are much rarer, occurring in less than 1 in 100 cases. They include:

You should contact your surgical team for advice if you think that you may have developed a complication after having an arthroscopy.

Artificial insemination

how-is-it-performed of artificial inseminatio...

Intrauterine insemination (IUI) is the technique used to carry out artificial insemination. 

IUI using a partner’s sperm

If a couple decides to have IUI using their own sperm, the man will be asked to provide a sperm sample at the fertility clinic, usually on the same day that IUI treatment takes place.

The man will be asked to masturbate into a specimen cup. He may also be asked not to have sexual intercourse or masturbate for two days before the sample is taken because this could affect the sperm sample’s quality.

The sperm sample will be "washed" and filtered using special equipment to remove any dead sperm and impurities. The faster-moving sperm will be kept and any slow-moving sperm will be removed. This produces a concentrated sample of healthy sperm.

An instrument called a speculum is inserted into the woman's vagina to keep the walls of the vagina open (in the same way as a smear test). A thin, flexible tube called a catheter is then placed inside the vagina and guided into the womb. This process is mostly painless, although some women may experience mild cramping, similar to period pains. The sperm sample will then be passed through the catheter and into the womb.

The process usually takes no more than 10 minutes, and the couple should be able to go home shortly after the procedure is finished.

IUI using a donor’s sperm

Choosing to use donated sperm can be a difficult decision, and a couple must have counselling before any decision is made by the clinic to proceed. 

If a couple decides to have IUI using the sperm of a donor, the same procedure is used. However, a sample of frozen sperm from a donor will be thawed out, "washed" and then inserted into the woman's womb.

All donated sperm is carefully checked for:

The fertility clinic can provide information about the physical characteristics of available donors, such as their ethnicity, physical build and hair and eye colour. This will enable a couple to try and match a potential donor’s characteristics with their own.

when-should-it-be-done of artificial insemina...

Before having intrauterine insemination (IUI), a couple’s fertility will need to be assessed to find out why they are having difficulty conceiving and to determine whether artificial insemination is suitable.

Read diagnosing infertility for more information about how infertility is assessed and the tests involved.

Assessing a woman's fallopian tubes

For a woman to have IUI, her fallopian tubes must be open and healthy. The fallopian tubes connect the ovaries to the womb. Eggs are released from the ovaries into the fallopian tubes each month, and this is where fertilisation takes place. If there is a problem with the fallopian tubes, it may prevent IUI from working.

Checking that the fallopian tubes are open and healthy is sometimes called a tubal patency test. The fallopian tubes can be assessed using one of two methods:

  • laparoscopy
  • hysterosalpingogram

Laparoscopy

A laparoscopy involves making a small cut in the lower abdomen. A thin, tubular microscope called a laparoscope is used to look more closely at the womb, fallopian tubes and ovaries. A dye may be injected through the neck of the womb into the fallopian tubes to highlight any blockages.

A laparoscopy is the preferred method of assessing the fallopian tubes. If a woman has had pelvic inflammatory disease (PID) in the past this will be an important investigation as PID is an infection that can damage and scar the fallopian tubes.

Hysterosalpingogram

A hysterosalpingogram is a type of X-ray taken of the womb and fallopian tubes after a special dye has been injected. This will help detect any abnormalities or defects, such as tumours or scar tissue.

Hydrosonagram

A hydrosonogram is a procedure where water is injected through the cervix and into the uterus to allow an ultrasound scan. This will help detect abnormalities such as fibroids or cervical polyps.

The timing of IUI

To maximise the chances of success, a cycle of IUI should be carried out just after ovulation. Ovulation is when one or more eggs are released from the ovaries into the fallopian tubes.

It is difficult to predict exactly when ovulation will occur, but in most women it usually happens 10 to 16 days before the start of their period. The menstrual cycle begins on the first day of a period (day one). Ovulation occurs some time after the period, which is followed by the next period 10 to 16 days later.

The exact day of ovulation can be detected by using urine ovulation kits or blood tests in the middle of the cycle.

IUI is usually carried out between day 12 and day 16 of the menstrual cycle.

Women may be given an ovulation prediction kit (OPK) to work out the date of ovulation with greater accuracy. An OPK device can detect hormones released during ovulation in urine or saliva. Alternatively, a woman may have blood or urine tests to find out when she is about to ovulate.

When an egg is mature, the woman may be given an injection of hormones to stimulate the egg’s release from the ovary.

introduction of artificial insemination...

Artificial insemination is a treatment for infertility, when a couple cannot conceive a baby. It involves directly inserting sperm into a woman’s womb.

It is most commonly used as part of a Donor Insemination (DI) programme, where donated sperm is used.

Artificial insemination on the NHS

The National Institute for Health and Care Excellence (NICE) recommends that up to six cycles of IUI treatment on the NHS may be offered if:

  • you are unable (or would find it very difficult) to have vaginal intercourse, for example because of a physical disability
  • you have a condition (such as a viral infection that can be sexually transmitted) that means you need specific help to conceive
  • you are in a same-sex relationship

Previously, IUI treatment on the NHS was offered if:

However, new guidelines released in 2013 state that IUI should no longer be offered in these circumstances. Instead, you should be advised to keep trying to conceive through regular unprotected sexual intercourse for a total of 2 years. After this time you may be offered in vitro fertilisation (IVF).

Availability

The availability of this fertility treatment on the NHS varies throughout the UK. In some areas, the waiting list for treatment can be very long. The criteria that must be met to be eligible for treatment can also vary.

IUI is also available from some private fertility clinics. Costs vary from £500 to £1,000 for each cycle of treatment.

Each cycle of IUI is timed to coincide with the woman’s natural reproductive cycle, so you will only be able to receive one cycle of IUI treatment a month.

Intrauterine insemination (IUI)

Intrauterine insemination (IUI) is the technique used for artificial insemination, and it has a good record of success.

Figures from the Human Fertilisation and Embryology Authority (HFEA) in 2006 suggest that intrauterine insemination (IUI) has a success rate of around 15% for each cycle of treatment. This estimate is based on women under 35 years of age using donor sperm.

As with most other types of fertility treatment, the younger a woman is, the greater her chance of having a successful pregnancy. Other things that can affect the success of IUI include:

  • sperm count and sperm quality - using fresh sperm is associated with higher conception rates than frozen and thawed sperm
  • technical aspects of IUI, such as working out the time of ovulation correctly

Read about when artificial insemination is used for more information on the timing of IUI.

How is IUI performed?

In IUI, a man provides a sample of sperm, which is then "washed" and filtered using special techniques. This ensures that only the highest-quality motile sperm are used for the procedure.

During the procedure, the concentrated sperm is passed directly into the woman’s womb through a thin tube called a catheter.

Read more about how artificial insemination is performed.

It is not recommended to use fertility medication in combination with IUI. This is because there are associated risks such as a higher chance of multiple pregnancy.

Read more about the risks associated with multiple pregnancies.

Sperm donation

If the male partner cannot produce healthy sperm, frozen sperm from a donor can be considered, although this is a personal decision.

In rare cases, couples obtain donated sperm from someone they know. However, in most cases, sperm is obtained and treatment is carried out at a registered or licensed sperm bank.

Donor anonymity

In the past, sperm donors remained anonymous from the parents and the child produced by the donated sperm. However, in 2005, the law regarding donor anonymity changed.

Anyone born from donated sperm after April 1 2005 can apply to HFEA to obtain information about the identity of the donor, once they have reached 18 years of age. They can apply for non-identifying information before this.

The HFEA is the independent regulator for all fertility clinics in the UK. If you are considering donor insemination (DI) you can visit the HFEA website for more information or to find your local fertility centre.

Asbestosis

prevention of asbestosis...

Under the Control of Asbestos Regulations (2012), certain measures have been put in place to reduce the risk of asbestos exposure, which can lead to asbestos-related diseases.

Examples of these measures include:

  • a licence from the Health and Safety Executive (HSE) to work in any occupation that deals with asbestos, such as asbestos insulation and coating
  • personal protective equipment, such as respirators, are needed to ensure safety
  • the second-hand use of asbestos products has been banned
  • suitable training is required for anyone who might be exposed to asbestos
  • a new control limit, which cannot be exceeded (0.1 fibres being breathed in per millilitre of air over a four-hour period)
  • employers cannot use their own workers to carry out work in their own premises that would usually require a licence without first obtaining a licence
  • whoever has control of a building must assess and manage any asbestos that exists in that building
  • a risk assessment must be carried out by all employers to assess the risk of their employees' exposure to asbestos
  • some non-licensed work needs to be notified to the relevant enforcing authority, and brief written records should be kept of non-licensed work that has to be notified
  • by April 2015, all workers/self-employed doing notifiable non-licensed work with asbestos must be under health surveillance by a doctor

Read the full Control of Asbestos Regulations 2012 (pdf, 142kb).

If you are not sure whether the asbestos materials you are working with pose a risk to your health, you should stop working and seek advice from your employer.

If you are still concerned after speaking to your employer, you can contact the Health and Safety Executive (HSE) or your trade union representative (if you have one).

Asbestos risks

Strict regulations were introduced in 1970 to regulate the use of asbestos in the workplace.

However, the import, supply and use of brown and blue types of asbestos was not banned in the UK until 1985. White asbestos was banned in 1999, except for a small number of specialist uses of the material. This means that buildings that were built or refurbished before the year 2000 could still contain asbestos.

Read the Health and Safety Executive (HSE) Asbestos Hidden Killer campaign leaflet (pdf, 362kb).

treatment of asbestosis...

There are no treatments available to cure asbestosis. However, you can take steps to relieve your symptoms and improve your quality of life.

These are outlined below.

Not smoking

If you have been diagnosed with asbestosis and you smoke, it is very important to give up as soon as possible.

Smoking will make your symptoms of breathlessness worse, and significantly increase your risk of developing lung cancer. Your asbestosis is more likely to get worse if you smoke as well.

Speak to your GP for help with giving up smoking. They can advise about nicotine replacement therapies and prescription medicines, such as bupropion, which can greatly increase your chances of quitting successfully. Your GP can also put you in touch with local support groups in your area.

You can also call the NHS Smokefree helpline (0800 022 4332) to get more help and advice about quitting smoking.

Read more information about stopping smoking.

Vaccinations

If you have asbestosis, your lungs will be more vulnerable to the effects of infection. Therefore, it is recommended you receive the influenza vaccination and a vaccination against the pneumococcus bacterium, which can cause serious conditions such as pneumonia. Your GP can arrange for you to have these vaccinations.

You will need the influenza vaccine every year. Most people only require one dose of the pneumococcus vaccine, although additional booster shots may be recommended if your general health is poor.

Read more information about pneumococcal infections.

Long-term oxygen therapy

If you have severe asbestosis, your body may not be getting all the oxygen it needs to function properly. If this is the case, oxygen therapy may be supplied through a machine called an oxygen concentrator. This form of treatment may be recommended if you have low levels of oxygen in your blood.

An oxygen concentrator is plugged into a mains socket. It purifies oxygen from the air in the room, which produces a more oxygen-rich supply of air. The oxygen-rich air can then be breathed in through a mask. The oxygen is breathed through a small soft plastic tube (nasal cannula), which is placed just inside your nostrils.

Do not smoke when you are using an oxygen concentrator. It produces an increased level of oxygen that is highly flammable, and a lit cigarette or flame could cause a fire or an explosion.

Ambulatory oxygen

In addition to the oxygen concentrator, you may be given a small, portable oxygen tank and mask, which you can use when you leave your house. This is known as ambulatory oxygen.

Medicines

The aim of treating asbestosis is to improve symptoms, such as shortness of breath, and to improve the person's overall quality of life. Most people with asbestosis will not benefit from any specific medication for the condition. More severe cases may benefit from medicines, such as small doses of morphine, to reduce breathlessness and cough. Extra oxygen can also be given to someone if their blood oxygen levels are low.

Morphine

Morphine in small doses is often used for patients with severe asbestosis. It has two main benefits:

  • reducing the sensation of breathlessness
  • suppressing the urge to cough

The dose required to achieve these benefits is usually small. Serious side effects are uncommon. The most common problem is constipation, and a laxative will usually be given at the same time.

diagnosis of asbestosis...

When diagnosing asbestosis, your GP will first ask about your symptoms and listen to your lungs with a stethoscope (a medical instrument used to listen to the heart and lungs). If your lungs have been affected by asbestos, they will make a crackling noise when you breathe in.

Your GP will also ask about your work history, particularly about periods when you may have been exposed to asbestos, how long you may have been exposed, and whether you were issued with any safety equipment, such as a face mask, when you were working.

Referral to a specialist

If asbestosis is suspected, you will be referred to a specialist in lung diseases for tests to confirm any lung scarring. These may include: 

  • chest X-ray – to detect abnormalities in the structure of your lungs that could be caused by asbestosis
  • computerised tomography (CT) scan of the lungs – produces more detailed images of the lungs and the membrane covering the lungs, which can help diagnose early stage asbestosis
  • lung function testing (see below)

Lung function testing

Lung function testing can help:

  • assess the impact of damage to the lungs by how well the airways conduct air into the lungs
  • determine the overall size of the lungs 
  • assess how well oxygen crosses the membrane of the lungs into your bloodstream, as this is usually reduced in cases of asbestosis

Before confirming a diagnosis of asbestosis, the chest specialist will consider and rule out other possible causes of lung scarring, such as rheumatoid arthritis. In confirming a diagnosis of asbestosis, the most important factors are the type of asbestos found, and the amount of asbestos exposure.

Aspergillosis

introduction of aspergillosis...

Aspergillosis is the name of a range of infections caused by a fungal mould called aspergillus. It usually affects the lungs, but it can spread to almost anywhere in the body.

Aspergillosis can range from mild to life threatening.

Aspergillosis usually only affects people with existing health conditions. Most healthy people have natural immunity to the aspergillus mould. If someone with damaged lungs or a weakened immune system breathes in aspergillus spores, the infection is more likely to stay.

Symptoms of aspergillosis can range from mild wheezing to coughing up blood, depending on the type of aspergillosis and where in the body the infection is (see below).

If you are at risk of aspergillosis, you should avoid areas where the aspergillus mould is likely to be, such as marshlands, compost heaps and piles of dead leaves.

You may also be advised to take extra precautions, such as wearing a face mask and taking antifungal medicines, if you have a weakened immune system. This may be the case if you're having chemotherapy, you've recently had an organ transplant or you're taking high doses of corticosteroid medication.

Read more information about the causes of aspergillosis and preventing aspergillosis.

When should I contact my GP?

Contact your GP or transplant team immediately if you develop symptoms that suggest you may have an infection, such as a fever or persistent coughing, and:

  • you're taking medication to suppress your immune system (immunosuppressants) after an organ or bone marrow transplant
  • you have a condition known to weaken the immune system, such as cancer

Types of aspergillosis

There are four main types of aspergillosis:

These are briefly described below.

Allergic bronchopulmonary aspergillosis (ABPA)

Allergic bronchopulmonary aspergillosis (ABPA) is caused by an allergic reaction to spores of fungus mould. It is the mildest form of aspergillosis.

ABPA usually affects people with asthma or cystic fibrosis. It is estimated to affect 0.25–0.8% of people with mild to moderate asthma, and 7% of people with cystic fibrosis.

ABPA affects an estimated 7–10% of people with more severe asthma that can only be controlled with steroid medication.

Aspergilloma

Aspergilloma is common in people who have cystic fibrosis or cavities (spaces) in their lungs. Coughing up blood is one of the most common symptoms of aspergilloma.

Aspergillus fungi enter the lungs and group together to form a dense knot of fungi, called a fungal ball.

Aspergilloma usually only affects people who have an existing lung condition, such as tuberculosis (TB), which means that they have cavities or damage in their lungs.

Chronic necrotizing aspergillosis (CNA)

Chronic necrotizing aspergillosis (CNA) is a slow-spreading, long-lasting infection of the lungs caused by the aspergillus fungus.

CNA usually only affects people with an existing lung condition, or people who have a weakened immune system. A weakened immune system may be caused by conditions such as diabetes, liver disease or long-term alcohol abuse.

CNA is thought to be rare, but little information is available to estimate exactly how many people develop CNA. If the symptoms of CNA are mild, it can go undiagnosed.

Invasive pulmonary aspergillosis (IPA)

Invasive pulmonary aspergillosis (IPA) is a common infection in people with severely weakened immune systems caused by illness or taking immunosuppressants. IPA is the most serious form of aspergillosis.

IPA is a fungal infection in the lungs that spreads rapidly through the body. The infection can spread to the blood, brain, heart and kidneys.

IPA usually only affects people with a severely weakened immune system, such as:

  • people with end-stage HIV
  • people undergoing high-dose chemotherapy
  • people taking immunosuppressants because they have had an organ or bone marrow transplant

IPA is a medical emergency that requires hospitalisation and prompt treatment with injections of antifungal medication.

IPA is estimated to occur in:

  • 5–13% of people who have had a bone marrow transplant
  • 5–25% of people who have had a heart or lung transplant
  • 10–20% of people who have high-dose radiotherapy for leukaemia (cancer of the blood cells)

How is aspergillosis treated?

Allergic bronchopulmonary aspergillosis (ABPA) is usually treated with steroid medications to prevent an allergic response. However, if ABPA reoccurs, a long-term course of steroids may be required.

Both aspergilloma and chronic necrotizing aspergillosis (CAN) can be treated with antifungal medications. In some cases, surgery may be required to remove the infection from the lungs.

Invasive pulmonary aspergillosis (IPA) can be treated with antifungal medication, although it is difficult to treat. The infection can spread very quickly, and someone who develops IPA is usually already very ill. An estimated 50% of people do not respond to treatment and die from the condition.

Read more information about how aspergillosis is treated.

prevention of aspergillosis...

It is nearly impossible to avoid the aspergillus fungus completely, but you can take precautions to prevent aspergillosis.

Avoiding exposure to the aspergillus fungus

The main way to prevent aspergillosis is to avoid being exposed to the aspergillus fungus.

If you have asthma, a weakened immune system or a history of lung disease, avoid places where the aspergillus fungus is likely to be, such as:

  • marshland and bogs
  • forests
  • compost heaps
  • grain stores
  • rotting vegetation
  • piles of dead leaves

The harmful effects of the fungus in buildings can be reduced by ensuring that there is good ventilation (such as open windows) and dust control. This is particularly important if construction or renovation work is being carried out.

Keeping the room disinfected, maintaining room temperature and ensuring adequate air flow are all useful ways of preventing an aspergillosis infection.

It is also important to clean skin injuries well with soap and water, especially if the injury has been exposed to soil or dust.

Extra precautions

Extra precautions may be recommended by your GP if you have a weakened immune system because:

  • you're having chemotherapy
  • you're taking immunosuppressant medication
  • you've recently had a transplant
  • you're taking high doses of corticosteroids

Extra precautions may include:

  • wearing a face mask when you're near a dusty environment, such as a construction site
  • avoiding activities that involve close contact with soil and dust, such as gardening
  • using air purifiers
  • taking antifungal medication

treatment of aspergillosis...

Treatment for aspergillosis varies depending on the type of infection. Treatment may include steroid or antifungal medication. In some cases, surgery is necessary.

Allergic bronchopulmonary aspergillosis (ABPA)

Allergic bronchopulmonary aspergillosis (ABPA) is treated using corticosteroid tablets (oral corticosteroids).

Corticosteroids suppress the immune system. This helps prevent the allergic reaction that ABPA can cause.

Most people need a three- to six-month course of oral corticosteroids. The dose is gradually reduced over time before treatment is stopped.

The side effects of oral corticosteroids include:

You will also need regular appointments to check for high blood pressure, diabetes and osteoporosis when taking corticosteroids.

Aspergilloma

Often, aspergilloma doesn't need to be treated. If your doctor thinks that treatment is needed, you may be given antifungal medications such as itraconazole. This is usually given as tablets.

How long you will need to take itraconazole depends on how well your symptoms react to it. Side effects are rare, but may include:

  • headaches
  • nausea
  • vomiting
  • a skin rash
  • hair loss

Surgical resection (see below) may also be an option in some cases.

Some people may need injections of an antifungal medication called amphotericin B. An injection is usually given directly into the lungs. The doctor giving the injection will use a CT scanner to guide the needle to the site of the fungal ball.

Chronic necrotizing aspergillosis (CNA) and invasive pulmonary aspergillosis (IPA)

Because of the similarities between the causes of chronic necrotizing aspergillosis (CNA) and invasive pulmonary aspergillosis (IPA), these conditions are treated in the same way.

If you are diagnosed with CNA or IPA, you may be admitted to hospital so that your health can be carefully monitored. You will also receive assistance with your breathing, if required.

CNA and IPA are usually treated with injections of a powerful antifungal medication called voriconazole.

Common side effects of voriconazole include:

  • visual disturbances
  • a rash
  • nausea
  • vomiting
  • diarrhoea 
  • headaches
  • stomach pains

Rarer side effects of voriconazole include:

  • flu-like symptoms such as joint and muscle pain
  • changes in mental state, such as depression or anxiety
  • dizziness
  • hallucinations (seeing or hearing things that are not real)
  • breathing difficulties
  • jaundice (yellowing of the skin and the whites of the eyes)
  • swelling of the lips or face

If you also have a weakened immune system, you may be given additional treatment to help strengthen it. This includes a type of medication known as colony-stimulating factors (CSFs). CSFs help encourage your bone marrow to produce more white blood cells, which fight infection.

A medication called interferon gamma can also be used to boost the immune system. Interferon gamma is a genetically engineered version of a protein that the immune system uses to fight off infection.

The most common side effects of interferon gamma and CSFs are flu-like symptoms, such as:

  • a high temperature of 38C (100.4F) or above
  • chills
  • joint and muscle pain
  • headaches
  • nausea

Surgery

Surgery may be required if CNA, IPA and aspergilloma do not respond to antifungal treatment, or if the coughing up of blood is thought to be life threatening. Extensive coughing up of blood can cause the lung tissue to become filled with blood, leading to suffocation.

Surgical resection

Surgical resection of the lung, to remove the infected piece of lung tissue, is one treatment option in severe CNA, IPA and aspergilloma.

Depending on the extent of the infection, the type of surgical resection used could be:

  • a wedge resection, where a small piece of lung is removed
  • a lobectomy, where the top or bottom half of the lung (known as a lobe) is removed
  • a pneumonectomy, where the entire lung is removed

Many people who have a surgical resection are worried that they will not be able to breathe properly afterwards, but it is possible to breathe with just one lung.

Bronchial artery embolisation

Bronchial artery embolisation (BAE) is a common treatment for coughing up of blood that is life threatening.

Coughing up blood is caused when one of the bronchial arteries (the major blood vessels in the lungs) is weakened by infection. The weakened artery ruptures, releasing blood. BAE is used to block the flow of blood out of the artery.

During a BAE, a small, flexible tube called a catheter is guided into your lungs. A CT scanner is usually used to guide the catheter to the exact site of the rupture.

A jelly-like solution is passed down the catheter. This blocks the site of the rupture and prevents further bleeding.

Asthma

living-with of asthma...

Daily life

With the right treatment and management, asthma shouldn’t restrict your daily life.

Sleeping

Asthma symptoms are often worse at night. This means you might wake up some nights coughing or with a tight chest. Effectively controlling your asthma with the treatment your doctor or nurse recommends will reduce your symptoms, so you should sleep better.

Read about living with insomnia for more tips on getting better sleep.

Exercise

If you have asthma symptoms during or after exercise, speak to your doctor or asthma nurse. It is likely they will review your general symptoms and personal asthma plan to make sure your asthma is under control

Your doctor or asthma nurse may also tell you to:

  • Use a reliever inhaler (usually blue) 10-15 minutes before you exercise and again after two hours of prolonged exercise, or when you finish. 
  • Structure your exercise plan around short-burst activities and ensure you warm up properly. 
  • Exercise in humid environments, such as swimming pools. 
  • Breathe through your nose to avoid hyperventilation (excessively rapid and deep breathing).

Read about health and fitness for more information on simple ways to exercise.

Diet

Most people with asthma can eat a normal, healthy diet. Occasionally, people with asthma may have food-based allergic triggers and will need to avoid foods such as cows' milk, eggs, fish, shellfish, yeast products, nuts, and some food colourings and preservatives. However, this is rare.

Read more information about good food and a healthy diet.

Want to know more?

Know your triggers

It is important to identify triggers where possible by making a note of any worsening symptoms or by using your peak flow meter during exposure to certain situations. Some triggers, such as air pollution, viral illness or certain weather conditions, can be hard to avoid. However, it may be possible to avoid other triggers, such as dust mites, fungal spores or pet fur.

Want to know more?

Complications of asthma

Quality of life

Badly controlled asthma can have an adverse effect on your quality of life. The condition can result in:

  • fatigue
  • underperformance or absence from work (in the UK, asthma accounts for at least 12.7 million work days lost each year)
  • psychological problems including stress, anxiety and depression

If you feel your asthma is seriously affecting your quality of life, contact your GP or asthma clinic. Your personal asthma action plan may need to be reviewed to better control the condition.

Respiratory complications

In rare cases, asthma can lead to a number of serious respiratory complications, including:

  • pneumonia (infection of the lungs)
  • a collapse of part or all of the lung
  • respiratory failure, where levels of oxygen in the blood become dangerously low, or levels of carbon dioxide become dangerously high)
  • status asthmaticus (severe asthma attacks that do not respond to treatment)

All these complications are life threatening and will need medical treatment.

Death

In the UK in 2009, there were 1,131 deaths from asthma, 12 of which were in children aged 14 or under. On average, three people a day die from asthma.

Asthma and pregnancy

There is no danger medicines you use for asthma will cause any problems for the developing baby in the womb. Due to changes that take place in the body during pregnancy, many women find their asthma symptoms change when they are pregnant. Some women’s asthma improves during pregnancy, some women’s asthma worsens and for others it stays the same.

The most severe asthma symptoms experienced by pregnant women tend to occur between the 24th and 36th week of pregnancy. Symptoms then decrease significantly during the last month of pregnancy. Only 10% of women experience asthma symptoms during labour and delivery, and these symptoms can normally be controlled through the use of reliever medicine.

You should manage your asthma in the same way as you did before you were pregnant. The medicines used for asthma have been proven to be safe to take during pregnancy and when breastfeeding your child. The one exception is leukotriene receptor antagonists which do not yet have enough evidence about their safety compared with other asthma medications.

However, if you need to take leukotriene receptor antagonists to control your asthma, your GP or asthma clinic may recommend you carry on taking them. This is because risks to you and your child from uncontrolled asthma are thought to be far higher than any potential risk from this medicine.

Read more information about asthma in pregnancy.

Want to know more?

Financial support

Asthma is classed as a disability if it has a substantial and long-term adverse effect on your ability to carry out normal daily activities. This impairment must:

  • have lasted for 12 months
  • be likely to last 12 months
  • be of a recurring nature where a recurrence is likely in a 12-month period

If you or your child has care or mobility needs because of asthma, you may be entitled to benefits.

Want to know more?

Occupational asthma

If you develop asthma because of your work and this is fully documented by your doctor and your employer, you can make a claim for Industrial Injuries Disablement Benefit from the Benefits Agency. This pays £20-100 a week to people with asthma that was caused by certain respiratory sensitisers. You can still claim even if your respiratory sensitiser is not on this list, as long as it is a 'known sensitiser' (a complete list is available from the Health and Safety Executive).

If you want to take legal action against your employer because of occupational asthma, your lawyer must act within three years of diagnosis.

Want to know more?

Get in touch with others

Many people with a long-term health condition experience feelings of stress, anxiety and depression.

You may find it helpful to talk about your experience of asthma with others in a similar position. Patient organisations have local groups where you can meet others who have been diagnosed with asthma and undergone treatment.

If you experience feelings of depression, talk to your GP. They will be able to give advice and support. Alternatively, you can find depression support services in your area.

Read more information about living with long-term conditions and long-term health conditions at school.

Want to know more?











shamimsstory of asthma...

For 49-year-old Shamim Arshad, a retired civil servant from Newcastle, walking has been a lifesaver

“Six years ago, a big asthma attack put me in hospital for two weeks. When I went home, I was put on steroids, which made me overweight and depressed. I got breathless just walking upstairs and I never went out because I was frightened I might have another asthma attack.  

“A friend persuaded me to walk just to the end of the road with her. She’d had treatment for breast cancer and I went thinking I was doing her a favour. I gradually increased my walks and now regularly walk two or three miles around my housing estate or local park. Walking makes me feel fresh and takes stress away.

“My confidence has increased and I’ve reduced the number of inhalers I need from four to one. On cold or damp days, when doctors have told me I shouldn’t walk outside, I do indoor walks around the nearby shopping centre with a friend. And I lead walks around the local area for groups of older people. I want them to enjoy it as much as I do.

“It does give you an incentive to take care of yourself. You know you don’t want to be in hospital in the high-dependency unit on BiPAP [bilevel positive airway pressure].

“It makes you think more about your triggers because that's the one way you can help yourself. The other thing I've learned and would like to pass on to others is that you should never panic. It will only make things worse. Try to relax. You will get help.”

 

 
rosemarysstory of asthma...

Fifty-six-year-old mother of three Rosemary Matthews first experienced asthma in her teenage years

“My first asthma attack happened when I was a teenager. I was outside chatting with my brother and my mother, enjoying the sunshine, when quite suddenly, I began to wheeze.

“I was really frightened, but none of us had any idea what was causing it. I was given a drink of water and, after I went indoors, it went away.

“Some time later, it happened again when I was with a boyfriend. I began wheezing and struggling for breath. He drove me straight to hospital where they told me it was asthma. I was quite relieved to know what it was. I thought, 'now I can do something about it.'

“I had to learn to live with it, to live life in a different way. There would be things I couldn’t do. I learned what my triggers were and began to control my asthma quite well. My triggers are pollen, house dust mites, cold air, aerosol sprays, the fumes from bleach and cigarette smoke.

"I still have asthma today and I probably have about two attacks a year. I have to be very careful about going out. If the pollen count is high or if it is cool outside, that's enough to set it off. Cigarette smoke is another trigger, so the smoking ban has been a good thing.

“The first thing you need to learn when you're diagnosed with asthma is how to use an inhaler correctly. It isn’t that easy. You need to learn your triggers and keep away from those things. If you can’t keep away from them, take as many precautions as you can. Wearing a scarf over your face if the outside air is cold is a good example.

“My asthma is under control now. I self-manage it, but I have had to make changes in my lifestyle in recent years. The things I miss most are going for walks with my husband and gardening. It was my one favourite hobby. I can do very little in the garden because of the pollen or the cold. You have to be careful of what’s in the air. 

“In the last three years, I've found I have to stay inside with the windows shut most of the time. In the hot weather, I have to use fans to keep cool.

“I've been advised to stay as fit as I can and I have an indoor exercise regime.

“I feel I am doing quite well. It's more than a year since I've had to go to the Accident and Emergency Department.

“It's very scary, especially when you're put on BiPAP [bilevel positive airway pressure]. It's a non-invasive ventilation system to help you get more air into your lungs. You know then that you're being kept alive only by this machine.”

Asthma in children

stephanies-story of asthma in children...

Around one child in ten in the UK has asthma. Find out what can trigger it, the treatment options and how your child can be active despite having asthma.
tashaurns-story of asthma in children...

Tashaurn, his mother and his nurse talk about living with childhood asthma.

living-with of asthma in children...

Daily life

With the right treatment and management, asthma should not restrict your child’s life.

Sleeping

Symptoms at night are an indication that asthma is poorly controlled. Your child might wake up some nights coughing or with a tight chest. Poor sleep can affect your child’s behaviour and concentration, as well as their ability to learn.

Achieving good control of asthma using the treatment your GP recommends will reduce symptoms, which means your child should sleep better.

Exercise

Children and young people should do at least 60 minutes (one hour) of aerobic activity every day, which should include a mix of moderate-intensity (such as fast walking) and vigorous-intensity (for example running) activities. Children generally want to be active, so if they are reluctant to exercise it may be an indication their asthma is not fully controlled.

If your child has asthma symptoms during or after exercise, speak to their doctor or asthma nurse. It is likely they will review your child's general symptoms and personal asthma plan to make sure their asthma is under control.

The doctor or asthma nurse may also tell your child to:

  • Use a reliever inhaler (usually blue) 10-15 minutes before they exercise and again after two hours of non-stop exercise or when they finish.
  • Start with warm-up exercises. 
  • Try to structure their exercise plan around short-burst activities.
  • Exercise in humid environments. 
  • Breathe through their nose if possible to avoid excessively rapid and deep breathing (hyperventilation).
  • Cool down correctly once exercise is finished.

Keeping well

Some medical conditions, such as rhinitis and sinusitis, are known to aggravate asthma. In children with asthma and allergic rhinitis, treating the allergic rhinitis as well as the asthma can help bring the asthma under control.

Want to know more?

Know their triggers

It is important, where possible, to identify the triggers of your child's asthma by making a note of when symptoms get worse and, sometimes, using their peak flow meter during exposures to certain situations. Some triggers, such as air pollution, viral illness or certain weather conditions, can be hard to avoid. Other triggers, such as dust mites, fungus spores or pet fur, can sometimes be avoided.

Want to know more?

Education

Most children with well-controlled asthma can learn and participate in their school’s activities completely unaffected by their condition. However, it is important to tell the school if your child has asthma and to make sure that they have information about your child’s asthma medicines.

You will need to supply the school with a reliever inhaler for your child to use if they experience symptoms during the school day.

Staff at the school should be able to recognise worsening asthma symptoms and know what to do in the event of an attack, particularly staff supervising sport or physical education.

Your child’s school should have an asthma policy in place, which you can ask to see.

Want to know more?

Complications of asthma

Quality of life

Poorly controlled asthma can have an adverse impact on your child's quality of life. The condition can lead to:

  • fatigue
  • underperformance or absence from school
  • psychological problems, including stress, anxiety and depression

Children may also feel excluded from their school friends if they cannot take part in games, sports and social activities.

If you feel your child's asthma is seriously affecting their quality of life, contact your GP or asthma clinic. Your child's personal asthma action plan may need to be reviewed.

Death

Asthma is the most common long-term condition in children and it can be life threatening. In the UK in 2009, 12 children under the age of 14 died from asthma. Your child’s personal asthma action plan will help you and them recognise symptoms of an asthma attack, what to do and when to seek medical attention.

Get in touch with others

You may find it helpful to talk about your experience of your child’s asthma with other people in a similar position. Asthma UK provides a forum for parents and carers to discuss their experiences.

Want to know more?












Atrial fibrillation

introduction of atrial fibrillation...

Atrial fibrillation is a heart condition that causes an irregular and often abnormally fast heart rate.

A normal heart rate should be between 60 and 100 beats a minute when you're resting. You can measure your heart rate by feeling the pulse in your wrist or neck. In atrial fibrillation, the heart rate may be over 140 beats a minute.

Atrial fibrillation may be defined in various ways, depending on the degree to which it affects you:

What happens in atrial fibrillation?

When the heart beats normally, its muscular walls contract (tighten and squeeze) to force blood out and around the body. They then relax, so the heart can fill with blood again. This process is repeated every time the heart beats.

In atrial fibrillation, the upper chambers of the heart, called the atria, contract randomly and sometimes so fast that the heart muscle cannot relax properly between contractions. This reduces the heart's efficiency and performance.

This may lead to a number of problems, including dizziness and shortness of breath. You may also be aware of a fast and irregular heartbeat (palpitations) and feel very tired.

Read more about the symptoms of atrial fibrillation.

Some people with atrial fibrillation have no symptoms and are completely unaware that their heart rate is not regular. 

Why it happens

Atrial fibrillation occurs when abnormal electrical impulses suddenly start firing in the atria. These impulses override the heart's natural pacemaker, which can no longer control the rhythm of the heart. This causes you to have a highly irregular pulse rate.

The cause is not fully understood, but it tends to occur in certain groups of people (see below) and may be triggered by certain situations, such as drinking excessive amounts of alcohol or smoking.

Read more about the causes of atrial fibrillation.

How common is atrial fibrillation?

Atrial fibrillation is the most common heart rhythm disturbance and affects up to 500,000 people in the UK.

Who is affected?

Atrial fibrillation can affect adults of any age. However, it affects more men than women and becomes more common the older you get. It affects about 10% of people over 75.

Atrial fibrillation is more likely to occur in people with other conditions, such as high blood pressure or atherosclerosis.

It is not common in younger people, but may be slightly more common in people with another heart condition, such as a heart valve problem.

Outlook

Atrial fibrillation is generally not life threatening, but it can be uncomfortable and often needs treatment.

Treatment may involve medication to control the heart rate or rhythm, and medication to prevent a stroke.

Find out more about treatment for atrial fibrillation.

treatment of atrial fibrillation...

The treatment of atrial fibrillation varies from person to person and depends on:

  • the type of atrial fibrillation
  • symptoms
  • treatment of any underlying cause
  • age
  • overall health

Some people may be treated by their GP, whereas others may be referred to a heart specialist, known as a cardiologist.

The first step is to try to find out the cause of the atrial fibrillation. If a cause is found, you may just need treatment for this.

For example, medication to correct hyperthyroidism (an overactive thyroid gland) may cure atrial fibrillation.

If no underlying cause can be found, the treatment options are:

  • medicines to control atrial fibrillation
  • medicines to reduce the risk of a stroke
  • cardioversion (electric shock treatment)
  • catheter ablation
  • having a pacemaker fitted

Medicines to control atrial fibrillation

Medicines called anti-arrhythmics can control atrial fibrillation by:

  • restoring a normal heart rhythm
  • controlling the rate at which the heart beats

The choice of anti-arrhythmic medicine depends on the type of atrial fibrillation, any other medical conditions you have, side effects of the medicine chosen and how well the atrial fibrillation responds.

Some people with atrial fibrillation may need more than one anti-arrhythmic medicine to control it.

Restoring a normal heart rhythm

A variety of drugs are available to restore normal heart rhythm. These include:

New drugs are in development that may restore normal heart rhythm, but they are not widely available yet. If a particular drug does not work or the side effects are troublesome, another may be tried.

Controlling the rate of the heartbeat

The aim is to reduce the resting heart rate to under 90 beats a minute, although in some people the target is under 110 beats a minute.

A beta-blocker (such as bisoprolol or atenolol) or a calcium channel blocker (such as verapamil or diltiazem) will be prescribed.

A medicine called digoxin may be added to help further control the heart rate. In some cases, amiodarone may be tried.

Side effects

As with any medicine, anti-arrhythmics can cause side effects. Read the patient information leaflet that comes with the medicine for more details.

The most common side effects of anti-arrhythmics are:

  • beta-blockers: tiredness, coldness of hands and feet, low blood pressure, nightmares and impotence
  • flecainide: nausea, vomiting and heart rhythm disorders
  • amiodarone: sensitivity to sunlight (high-protection sunscreen must be worn or skin covered up), lung problems, changes to liver function or thyroid function (regular blood tests can check for this) and deposits in the eye (these go away when treatment is stopped)
  • verapamil: constipation, low blood pressure, ankle swelling and heart failure

Medicines to reduce the risk of a stroke

The way the heart beats in atrial fibrillation means that there is a risk of blood clots forming in the heart chambers. If these get into the bloodstream, they can cause a stroke (see complications of atrial fibrillation for more information).

Your doctor will assess your risk to minimise your chance of a stroke. They will consider your age and whether you have a history of any of the following:

  • stroke or blood clots
  • heart valve problems
  • heart failure
  • high blood pressure
  • diabetes
  • heart disease

You will be classed as having a high, moderate or low risk of a stroke and will be given medication according to your risk.

Depending on your level of risk, you may be prescribed warfarin or aspirin.

Warfarin

People with atrial fibrillation who have a high or moderate risk of a stroke are usually prescribed warfarin, unless there is a reason they cannot take it.

Warfarin is an anticoagulant, which means it stops the blood from clotting. There is an increased risk of bleeding in people who take warfarin, but this small risk is usually outweighed by the benefits of preventing a stroke.

It is very important to take warfarin as directed by the doctor. People on warfarin need to have regular blood tests and, following these, their dose may be changed.

Many medicines can interact with warfarin and cause serious problems, so check that any new medicines are safe to take with warfarin.

Drinking more than moderate amounts of alcohol or drinking cranberry juice can also affect your warfarin and is not recommended.

Aspirin

People with atrial fibrillation who have a low risk of a stroke are likely to be given a low dose of aspirin to take every day instead of warfarin.

People who are unable to take warfarin may also be given aspirin instead.

Cardioversion

Cardioversion may be tried in some people with atrial fibrillation. The heart is given a controlled electric shock to try to restore a normal rhythm.

The procedure normally takes place in hospital, where the heart is carefully monitored.

In people who have had atrial fibrillation for more than two days, cardioversion is associated with an increased risk of clot formation. If this is the case, warfarin is given for three to four weeks before cardioversion and for at least four weeks afterwards to minimise the chance of having a stroke.

If the cardioversion is successful, warfarin may be stopped. However, some people may need to continue with warfarin after cardioversion if there is a high chance of their atrial fibrillation returning and they have a moderate to high risk of a stroke (see above).

Catheter ablation

Catheter ablation is a procedure that very carefully destroys the diseased area of your heart and interrupts abnormal electrical circuits. It is an option if medication has not been effective or tolerated.

Catheters (thin, soft wires) are guided through one of your veins into your heart, where they record electrical activity. When the source of the abnormality is found, an energy source (such as high-frequency radiowaves that generate heat) is transmitted through one of the catheters to destroy the tissue.

This procedure commonly takes two to three hours, so it may be done under general anaesthetic, where you are put to sleep.

For more detailed information on catheter ablation for atrial fibrillation, go to the Arrhythmia Alliance website.

Having a pacemaker fitted

A pacemaker is a small, battery-operated device that is implanted in your chest, just below your collarbone. It is usually used to prevent your heart rate going too slowly, but in atrial fibrillation it may help your heart beat regularly.

Having a pacemaker fitted is usually a minor surgical procedure performed under a local anaesthetic (where the area is numbed).

This treatment may be used when medicines are not effective or are unsuitable.

Find out more about pacemaker implantation.

frances-story of atrial fibrillation...

Frances, 57, was diagnosed with paroxysmal atrial fibrillation and keeps her heart rate under control with flecainide.

“I went to bed as normal one day and woke in the early hours feeling very strange. 

"My heart was beating heavily and I had a feeling similar to stomach rumbling, but it was in my chest. I could feel this across the upper part of my chest, including the top of my arm. I wasn’t worried as it didn’t hurt, and I drifted in and out of sleep.

“By 11am the next day, it was still going on, so I phoned the doctor. He told me to get a taxi to the surgery straight away, but I walked instead. Halfway there, I started to feel unwell and thought I was going to pass out.

“Once I’d made it to the doctor's, I didn’t feel too bad. My GP took my pulse and straight away said that I had an arrhythmia, which is an irregular heartbeat.

"He wired me up to an electrocardiogram (ECG) and managed to capture my arrhythmia on the printout. Apparently, this can come and go quite quickly.

“I was given a high dose of aspirin, to lower my risk of getting a stroke, and was referred to hospital immediately. By the time I reached hospital, my symptoms had stopped. Luckily, the doctors could see from my previous ECG that I had an arrhythmia and diagnosed me with paroxysmal atrial fibrillation.

"They made an appointment for me to have a 24-hour ECG, which records heart symptoms as you go about your normal daily activities, and then I was discharged.

“In the meantime, I had two more episodes of atrial fibrillation and had to come back to hospital. I was given an intravenous infusion of flecainide, which corrects an abnormal heartbeat. I was only on the drip for 10 minutes when the monitor showed my heartbeat going back to normal. I’ve been on low-dosage tablets of flecainide ever since.

“When my appointment came for the 24-hour ECG, I felt perfectly well. Since I’ve been on the tablets, I haven’t had anything like those three episodes.

"I also take aspirin daily to protect me from a stroke. Every day I experience extra heartbeats called ectopic beats, but they’re nothing to worry about.”

Autism and Asperger syndrome

treatment of autistic spectrum disorder...

There is currently no cure for autistic spectrum disorder (ASD). However, a range of specialist education and behavioural programmes (often referred to as interventions) can be effective in improving the skills of children with ASD.

There are many different types of intervention for ASD, so it is often hard to judge which one will work best for your child.

Some types of intervention can involve hours of intensive work, and this is not always possible for many families because of the practical, emotional and financial commitments necessary.

The National Autism Society website has information on the many different approaches, therapies and interventions available for ASD.

Any intervention should focus on important aspects of your child's development. These are:

  • communication skills – such as the ability to start conversations
  • social interaction skills – such as the ability to understand other people's feelings and respond to them
  • cognitive skills – such as encouraging imaginative play
  • academic skills – the "traditional" skills that a child needs to progress with their education, such as reading, writing and maths

Some widely used interventions for ASD are explained below.

Applied behavioural analysis (ABA)

Applied behavioural analysis (ABA) is based on:

  • breaking down skills (such as communication and cognitive skills) into small tasks, and then teaching those tasks in a highly structured way
  • rewarding and reinforcing positive behaviour while discouraging and redirecting inappropriate behaviour

ABA programmes usually take place in the home. They consist of 40 hours a week of intensive therapy over two to three years.

An ABA programme is usually delivered by a consultant, who oversees the programme, and a team consisting of at least three therapists who alternate working with your child.

The programme team will work with your child on a one-to-one basis, in sessions of two to three hours. The team will try to teach your child by breaking skills down into smaller tasks. These tasks are then taught in a repetitive and structured way, with a particular emphasis on praising your child and reinforcing positive behaviour.

An ABA programme usually begins with simple tasks. Over time, these small tasks will build up into more complex skills that will help with your child's development.

TEACCH

TEACCH is a type of educational intervention that places great emphasis on structured learning by using visual prompts. Research has found that children with ASD often respond better to information that is presented visually.

TEACCH is often delivered at special day centres, but you can also have training so you can continue the intervention activities in your own home.

Speech and language therapy (SLT)

Speech and language therapy is a type of skills training designed to improve your child's language skills. This can improve their ability to interact with others socially.

The therapist uses a number of techniques, such as visual aids, stories and toys to improve communications skills.

Funding

Many of the interventions mentioned above take a lot of time and labour, and can cost a significant amount of money.

Many local education authorities (LEAs) provide partial or sometimes total funding towards specialist education and training, but this varies widely between LEAs.

If you would like more advice on what funding is available and how to request it, the National Autism Society runs a special service called the Education Rights Service.

Medication

No medication is available to treat the core symptoms of ASD, but medication may be able to treat some of the related symptoms, such as:

  • repetitive thoughts and behaviour
  • aggressive behaviour, such as tantrums or self-harming

One type of medication used in the UK is the class of antidepressants called selective serotonin reuptake inhibitors (SSRIs). These work by changing the levels of a chemical called serotonin in the brain. Serotonin is known to affect behaviour and mood.

However, SSRIs are used only extremely rarely to treat children and young people, and only by specialist consultants such as a child psychiatrist.

It is more common for specialists to use melatonin or other prescribed medication to help sleep (which is commonly disturbed in ASD). Specialist consultants may also use stimulant medication such as methylphenidate for young people who also have attention deficit hyperactivity disorder (ADHD).

It is not possible to predict how an individual will respond to SSRIs and whether they are a suitable treatment, but the clinical use of SSRIs has increased greatly in the last decade.

Examples of SSRIs include:

Some children with ASD who are taking SSRIs can suddenly have a sharp rise in serotonin levels. This can trigger a group of side effects known as serotonin syndrome.

Symptoms of mild to moderate serotonin syndrome include:

  • confusion
  • agitation
  • muscle twitching
  • sweating
  • shivering
  • diarrhoea

If your child has any of the above symptoms, stop their medication and seek immediate advice from your GP. If this is not possible, call NHS Direct on 0845 4647.

Symptoms of severe serotonin syndrome include:

  • a high temperature of 39.4C (103F) or above
  • seizures (fits)
  • irregular heartbeat
  • unconsciousness

If your child has any of these severe symptoms, call 999 and ask for an ambulance.

Complementary and alternative medicines (CAM)

A number of studies have found that most parents have tried at least one type of complementary and alternative medicine (CAM) to improve their child's symptoms.

Examples of suggested CAMS to treat ASD include:

  • special diets, such as gluten-free diets
  • vitamin supplements
  • anti-fungal medication
  • chelation therapy, which uses medication or other agents to remove metal, in particular mercury, from the body

There is little or no evidence that any of these approaches are effective, and some may even be potentially dangerous.

Do not make changes to your child's diet without first consulting your GP.

It is strongly recommended that you do not try chelation therapy as there is no evidence of its effectiveness. It is based on a theory that mercury is responsible for the symptoms of ASD. But this theory is not shared by mainstream ASD experts, and it is potentially dangerous.

Risks associated with chelation therapy include kidney damage and liver failure. One child is reported to have died as a result of chelation therapy.

If you are considering a CAM, look out for certain claims and signs that suggest that the treatment may be unsound. These include claims that:

  • are based on overly simplified scientific theories – for example, that ASD is caused by mercury in the body
  • promise effective treatment for a wide range of unrelated symptoms
  • offer dramatic results or the possibility of a cure
  • rely on unpublished case reports rather than carefully designed studies
  • the treatment has no risks or side effects

introduction of autistic spectrum disorder...

Autism and Asperger syndrome are both part of a range of related developmental disorders known as autistic spectrum disorders (ASD). They begin in childhood and last through adulthood.

ASD can cause a wide range of symptoms, which are grouped into three categories:

  • problems and difficulties with social interaction – including lack of understanding and awareness of other people's emotions and feelings
  • impaired language and communication skills – including delayed language development and an inability to start conversations or take part in them properly
  • unusual patterns of thought and physical behaviour – including making repetitive physical movements, such as hand tapping or twisting (the child develops set routines of behaviour and can get upset if the routines are broken)

There is currently no cure for ASD. However, a wide range of treatments, including specialist education and behavioural programmes, can help improve symptoms. Read more about treating ASD.

In England, it is estimated that 1 in every 100 children has an ASD. The conditions are more common in boys than girls. Boys are three to four times more likely to develop an ASD than girls.

Types of ASD

The term "spectrum" is used because the symptoms of autistic spectrum disorder (ASD) can vary from person to person and range from mild to severe.

It is also common for children with ASD to have symptoms or aspects of other conditions such as: 

There are three main types of ASD:

  • autistic disorder, sometimes known as "classic autism"
  • Asperger syndrome
  • pervasive developmental disorder – not otherwise specified (PDD-NOS), also known as "atypical autism"

Autistic disorder

Children with autistic disorder usually have significant problems with language, social interaction and behaviour. Many children with autistic disorder also have learning difficulties and below-average intelligence.

Asperger syndrome

Children with Asperger syndrome have milder symptoms that affect social interaction and behaviour. Their language development is usually not affected. However, they often have problems in certain areas of language, such as understanding humour or figures of speech ("It's raining cats and dogs", for example).

Children with Asperger syndrome usually have intelligence within the normal range. Some children have particular skills in areas that require logic, memory and creativity, such as maths, computer science and music.

Pervasive developmental disorder – not otherwise specified

PDD-NOS is diagnosed in children who share some, but not all, of the traits of autistic disorder or Asperger syndrome.

Most children with PDD-NOS have milder symptoms than children with autistic disorder, but they do not share the language skills and normal range of intelligence associated with Asperger syndrome.

Autism in children

Autism can normally be diagnosed in children at around the age of two. However, it can be difficult to diagnose as the symptoms will often only become more noticeable as they get older.

See your GP if you notice any of the symptoms of ASD or if you’re concerned about your child’s development. You can discuss your concerns together in depth before deciding whether your child should be referred for a specialist assessment. Read more about diagnosing autism.

If your child is diagnosed with ASD, there will be many things to consider as a parent, including coping with daily life at home and choosing the right school. Read a parent's guide to autism for more information about coping with your child’s diagnosis.

Autism in adults

Some people with ASD grow up without ever being diagnosed, sometimes through choice. However, getting a diagnosis of autistic spectrum disorder (ASD) as an adult can often help people with ASD and their families understand the condition and work out what kind of support they need.

A range of autism-specific services is available to help adults with ASD find advice and support, get involved in leisure activities and find somewhere they are comfortable living.

Some adults with ASD may also have difficulty finding a job because of the social demands and changes in routine that working involves. However, they can get support to help them find a job that matches their abilities and skills.

Read more about living with autistic spectrum disorder (ASD) as an adult.

Are rates of autism increasing?

The number of diagnosed cases of ASD has increased over the past 20 years, but this does not necessarily mean that the condition is becoming more widespread.

Some experts argue that the rise in diagnosed cases may be due to health professionals getting better at diagnosing cases correctly. In the past, many children with an ASD may have been incorrectly labelled as "slow", "difficult" or "painfully shy", and not given the treatment they needed.

Some campaigners believe that the rise in cases is due to the MMR (mumps, measles and rubella) vaccine.

The MMR vaccine has been investigated extensively in a number of major studies around the world, involving millions of children. Researchers have found no evidence of a link between MMR and ASD.

In 2009, one of the country's leading ASD charities, the National Autism Society, released a statement supporting the claim that there is no link between MMR and ASD.

In the US, a compound containing mercury called thiomersal, which is used as a preservative in some vaccines, has also been claimed to cause ASD.

Thiomersal has been extensively studied and no evidence of a link to ASD has been found. Furthermore, thiomersal was removed from vaccines in the US after 1999, yet the rates of ASD have continued to rise.

Read more information about the causes of autistic spectrum disorder (ASD).

Outlook

Children with moderate symptoms who have average or above-average intelligence often grow up to be independent adults with jobs, long-term relationships and children.

Children with more severe symptoms who have below-average intelligence are likely to find it difficult to live independently as adults and may need additional care and assistance. However, there is no reason why they cannot enjoy a good quality of life.



adultswithautism1 of autistic spectrum disord...

Some people with autistic spectrum disorder (ASD) grow up without their condition being recognised, sometimes through choice. However, once diagnosed, adults may access a range of autism services, such as social groups that may be available locally.

Adults with ASD will need to consider where they'd like to live, and whether they might need any support at home.

It is never too late to be diagnosed with ASD, although it is not always easy as some primary care trusts (PCTs) do not provide NHS funding for diagnosing ASD in adults.

Read more information about diagnosing autistic spectrum disorder (ASD) in adults or see the National Autistic Society website for a range of diagnosis information for adults.

Where to live

Adults with ASD can live in all types of housing. For example, some people may be suited to a residential care home, while others may prefer to live on their own and receive home support. Others live completely independently.

Supported living can work very well for some adults with ASD. They can choose a place to live in the community, they can live alone or with other people, and get the support they need. They may need 24-hour care, or they may only need help with important tasks for a couple of hours each week.

Some adults with ASD may not want to move out of the family home. A 2001 survey by the National Autistic Society found that half of adults with ASD still lived with their parents. Caring for anyone with a disability can be challenging, and parents may need additional support. For more information, see the Carers Direct practical guide to caring.

Respite care is short-term care provided either in or outside the family home. It is funded by the local authority and gives families and carers of people with ASD a break from their daily care routine.

Read more information about breaks from caring.

The level of support an adult with ASD needs (from round-the-clock care to simple adaptations to the home) is decided after social services make an assessment and it is agreed with the person and their carer.

Access in the community

Community support services (or outreach services) help adults with ASD get out and about in their local area. They provide advice, support, social skills training and social or leisure opportunities.

For example, they may help people with ASD to get to the local gym for a couple of hours a week, to keep fit and healthy.

Find autism support services in your area.

Avian flu

introduction of avian flu...

Avian influenza, or bird flu, is an infectious virus that spreads among birds.

It affects many species of birds, including chickens, ducks, turkeys and geese. It can be passed between commercial, wild and pet birds. However, not all bird species are affected in the same way.

Bird flu is caused by a flu virus that is closely related to human flu viruses. It is spread through bird droppings, water, feed and equipment.

Like other types of flu, bird flu symptoms include a high temperature, aching muscles and headache.

Since December 2003, there have been many outbreaks of bird flu that have resulted in the death of poultry in countries across Europe, Asia and Africa.

There are 16 types of bird flu, but the type that has caused concern in recent years is the deadly H5N1 strain. The H5N1 virus doesn't infect people easily, although several infections have occurred in humans around the world.

Human cases

As of January 2012, the World Health Organization (WHO) has confirmed there have been 583 cases of H5N1 in humans. These have occurred in Azerbaijan, Bangladesh, Cambodia, China, Djibouti, Egypt, Indonesia, Iraq, Laos, Myanmar, Nigeria, Pakistan, Thailand, Turkey and Vietnam. This had led to 344 deaths.

People who have had bird flu are thought to have developed the virus after coming into close or direct contact with infected birds. Millions of poultry have been killed during outbreaks to prevent the disease spreading and being passed on to people.

Risks

In comparison to the number of birds that have been infected by avian flu, the number of humans who have been infected is very small.

The H5N1 virus does not spread easily to humans and there have been no reports of it passing from person to person.

However, there is a concern that the H5N1 strain may undergo genetic changes that could result in it spreading more easily from person to person, which would significantly increase the risk to humans.

Read more about how bird flu spreads to humans.

Travel advice

There are no travel restrictions for people travelling to affected countries that have been, or are currently, affected by bird flu.

However, it's important to observe the following precautions:

  • Avoid visiting live animal markets and poultry farms.
  • Avoid contact with surfaces that are contaminated with animal faeces.
  • Don't eat or handle undercooked or raw poultry, egg or duck dishes.
  • Don't attempt to bring any live poultry products back to the UK.
  • Don't pick up or touch dead or dying birds.
  • Always follow good personal hygiene practices, including washing your hands regularly.

The Health Protection Agency (HPA) has further travel advice on its website.

Read more about preventing bird flu and managing and treating bird flu in humans.

 

prevention of avian flu...

As the avian flu (bird flu) virus is carried by birds, there is no way to prevent it from spreading. However, monitoring how wild birds migrate should give early warnings of the arrival of infected flocks.

This means that species of birds that are known to carry the infection could be targeted and collected on arrival to stop the virus spreading to other birds.

Flu jab

Current flu vaccinations do not provide protection against the H5N1 strain. Various worldwide health organisations are currently working together to produce a vaccine against avian flu.

General precautions

To reduce your risk of developing and passing on viral infections, such as flu, always ensure that you:

  • Wash your hands regularly, particularly after going to the toilet and before handling food.
  • Turn away from other people and cover your mouth with tissues when you cough or sneeze.
  • Dispose of tissues immediately after use and wash your hands with soap and warm water.
  • If you are ill, avoid public places and contact with children or people with underlying illnesses.
  • Tell the receptionist at your GP surgery (when you visit) about your symptoms so that you can be seated away from other people and given a surgical mask if necessary.
  • Make sure that you maintain a good level of general health and that you have  any recommended vaccinations, such as the pneumococcal vaccination and seasonal flu vaccine, if you are in a high-risk group, for example, if you have a long-term illness such as asthma or you are 65 or over.

Preparing meat

Avian flu is not transmitted through cooked food. It is safe to eat poultry and eggs in areas that have had outbreaks of bird flu.

As a precaution, always ensure good hygiene standards when preparing and cooking meat. For example:

  • Use different utensils for cooked and raw meat.
  • Wash your hands thoroughly with soap and warm water before and after handling meat.
  • Ensure that meat is thoroughly cooked and piping hot before serving.

Read more about bird flu and food.

Contact with birds

You can feed wild birds and ducks, but it is important to ensure that you wash your hands thoroughly afterwards. Do not go near sick or dead birds.

Call the Department for Environment, Food and Rural Affairs (Defra) helpline on 08459 33 55 77 if you find:

  • one or more dead wild swans, ducks or geese (wild fowl)
  • three or more dead wild birds of the same species
  • five or more dead birds of different species in the same place

Keep away from bird droppings if possible and wash your hands thoroughly if you accidentally touch some.

Pets

In general, you don't need to change the way you look after your pets. If you have a dog that sometimes catches wild birds, try to avoid areas where this is likely to happen. In theory, H5N1 can be passed on to other animals, but it is very unlikely.

Travel

If you are travelling in a country that has had avian flu outbreaks, don't go to live animal markets or poultry farms.

Don't go near bird droppings or dead birds, and don't bring live birds or poultry products back to the UK with you, including feathers.

The NHS has plans in place to manage a potential outbreak of bird flu in the UK, although this is thought to be highly unlikely.

treatment of avian flu...

People with suspected symptoms of avian flu (bird flu) will be advised to stay at home or will be cared for in hospital (in isolation from other patients).

Depending on the type of flu they have, the patient may be kept in isolation for up to 10 days. The main recommendations are:

Antiviral medication

Antiviral medication works by stopping the virus from multiplying in your body.

Oseltamivir (Tamiflu) and zanamivir (Relenza) could be effective in treating influenza caused by the H5N1 bird flu virus. However, more studies are needed to demonstrate their effectiveness.

Treating complications

Complications, such as bacterial pneumonia, may develop in some people and can be treated with antibiotics. People who are severely affected may need to be given extra oxygen to help them breathe, for example, through a ventilator (a machine that assists with breathing).

Ayurveda

How Ayurveda can help treat allergies...

During the spring season, many people find that their body is more sensitive to pollen and other allergens. The body's natural defence against allergies is for the immune system to create an anti-inflammatory attack on the allergen - it does this as it believes the allergen to be harmful. The dust, pollen and even the smell of flowers can cause an attack. The antibodies produced by the body in response to these allergens can cause hypersensitivity, such as sniffling, sneezing and rashes on the skin. Most people notice these more in the spring and summer as this is when flowers come into bloom, making the problem worse. In Ayurveda allergies, the symptoms of allergies are rarely caused by the allergens. It's thought that how the immune system reacts to these allergens creates the allergic response, which is why the main factor for allergies is food which has not been digested properly, according to Ayurveda. This is known as Ama - Ama is a toxic substance which blocks channels of circulation, which blocks the body's main line of communication. In order to allow the body to respond without the defensive attack that it usually opts for. Ayurvedic medicine is an ancient form of healing originating from India, which has been practiced for more than 5000 years. It's used to help bring the body up to optimal health and wellbeing. This form of healing focuses on how we interact with the world, as well as our beliefs, perceptions and thoughts. Those who practice Ayurveda believe that our actions coincide with how we live in harmony with the world, ultimately helping us to create a more harmonious relationship with our body. You can help to reduce your allergies through using these techniques - Ayurveda tailors each scheme to each body, as everyone is unique and reacts to allergens differently.

Is Ayurveda As Good As Drugs For Knee Osteoar...

We often think that drugs and chemicals are the only treatment that should be considered for serious health problems, like those caused by knee osteoarthritis. We have relied on traditional scientifically-led medicines for a long time and they are those that are prescribed by doctors and medical professionals. But increasingly we are looking for alternative ways to deal with debilitating conditions. One of the most promising of these is Ayurveda, a traditional Indian approach. Now an Ayurvedic preparation has passed a test as an alternative to high-end drugs for the treatment of knee osteoarthritis. Perhaps even better news for supporters of Ayurveda is that it has shown few adverse effects, according to the study, which involved government-supported clinical trials across the country. The trials were held in 2006-07 and the findings have been published now in the British journal Rheumatology. The drugs that are commonly used to treat osteoarthritis in the knees are the high-end glucosamine sulphate and celecoxib. According to a number of experts, patients may deteriorate to end-stage arthritis and often require joint replacement surgery, which is very costly and not available for everyone. Osteoarthritis can also be treated with analgesics, which provide symptomatic, long-term pain relief but also expose patients to potentially serious toxins. For the first time ever this study saw scientists making a head-to-head comparison for traditional medicine and the Ayurveda method. They chose Ayurvedic formulations based on texts and expert opinion. They found that two shunthi-guduchi formulations, called SGC and SGCG, were equivalent to taking oral glucosamine sulphate and celecoxib in reducing knee pain and improving knee function in patients. This is very important as it shows that we no longer have to rely on medical science for treatments.

Are Ayurvedic concepts The New Way to Beautif...

For centuries, Ayurvedic treatments and systems have been used to treat illnesses, boost one’s wellbeing and improve your way of life. But there could be a new sector for this ancient system to be used in now – the beauty industry. According to new research, Ayurvedia is set to be at the forefront of the cosmetics and beauty industry, keeping in line with the more natural approach that many people are opting to take with their lifestyles, diets and weight loss regimes. Ayurvedic treatments take a natural and holistic approach to life, from treating illnesses to improving wellbeing through exercise and mental approach. With so many people choosing a lifestyle that aims to be closer to nature, such as organic produce and natural weight loss regimes that shy away from pills and fad diets, this way of working could lend itself well to the beauty industry’s demands for fewer chemicals but better results. Many people are aware of the dangers of chemicals in and on their bodies, but are at a loss of how to overcome this due to a lack of alternatives. But companies are catching on to what consumers are asking for and are looking to supply it through Ayurvedia. One of the key teachings of Ayurvedia is the control and reduction of stress, which is a common problem in today’s society. Stress is not only bad for your health but it’s one of the key factors in premature ageing, so is an aspect of skincare which the beauty industry is trying to hone in on. Through using Ayurvedic practices, it could manage this element of skincare more effectively through combining stress relief and anti-ageing with a more natural approach to looking after oneself. As the cosmetics companies look to better ways to offer consumers what they need and desire, this could be the solution to everyone’s requests.

Back pain

prevention of back pain...

Keeping your back strong and supple is the best way to avoid getting back pain. Regular exercise, maintaining good posture and lifting correctly will all help.

If you have recurring bouts of back pain, the following advice may be useful:

Exercise

Exercise is both an excellent way of preventing back pain and reducing back pain. However, if you have had back pain for more than six weeks, you should consult a healthcare professional before starting any exercise programme.

Exercises such as walking or swimming strengthen the muscles that support your back without putting any strain on it or subjecting it to a sudden jolt.

Activities such as yoga or pilates can improve the flexibility and the strength of your back muscles. It is important that you carry out these activities under the guidance of a properly qualified instructor.

Below are some simple exercises you can do at home to help prevent or relieve back pain.

  • Wall slides - stand with your back against a wall with your feet shoulder-width apart. Slide down into a crouch so that your knees are bent to about 90 degrees. Count to five and then slide back up the wall. Repeat five times.
  • Leg raises - lie flat on your back on the floor. Lift each heel in turn just off the floor while keeping your legs straight. Repeat five times.
  • Bottom lifts - lie flat on your back on the floor. Bend your knees so that your feet are flat on the floor. Lift your bottom in the air by tightening your stomach muscles while keeping your back straight. Repeat five times.

At first, you should do these exercises once or twice a day, before gradually increasing to six times a day, as your back allows.

These exercises are also useful for warming up your back. Many people injure their back when doing everyday chores at home or work, such as lifting, gardening or using a vacuum cleaner. Warming up your back before starting these chores can help prevent injury.

Read more about exercises for back pain.

Posture

How you sit, stand and lie down can have an important effect on your back. The following tips should help you maintain a good posture.

Standing

Stand upright, with your head facing forward and your back straight. Balance your weight evenly on both feet and keep your legs straight.

Sitting

Make sure you sit upright with support in the small of your back. Your knees and hips should be level and your feet should be flat on the floor (use a footstool if necessary). Some people find it useful to use a small cushion or rolled-up towel to support the small of the back.

If you use a keyboard, make sure that your forearms are horizontal and your elbows are at right angles.

Read more about how to sit correctly.

Driving

Make sure that your lower back is properly supported. Correctly positioning your wing mirrors will prevent you from having to twist around. Your foot controls should be squarely in front of your feet.

If you are driving long distances, take regular breaks so that you can stretch your legs.

Sleeping

Your mattress should be firm enough to support your body while supporting the weight of your shoulders and buttocks, keeping your spine straight.

If your mattress is too soft, place a firm board (ideally 2cm thick) on top of the base of your bed and under the mattress. Your head should be supported with a pillow, but make sure your neck is not forced up at a steep angle.

Lifting and handling

One of the biggest causes of back injury, particularly at work, is lifting or handling objects incorrectly. Learning and following the correct method for lifting and handling objects can help prevent back pain. You should:

  • think before you lift - can you manage the lift? Are there any handling aids you can use? Where is the load going?
  • start in a good position - your feet should be apart, with one leg slightly forward to maintain balance; when lifting, let your legs take the strain - bend your back, knees and hips slightly, but do not stoop or squat; tighten your stomach muscles to pull your pelvis in; do not straighten your legs before lifting as you may strain your back on the way up
  • keep the load close to your waist - keep the load as close to your body for as long as possible with the heaviest end nearest to you
  • avoid twisting your back or leaning sideways, particularly when your back is bent - your shoulders should be level and facing in the same direction as your hips; turning by moving your feet is better than lifting and twisting at the same time
  • keep your head up - once you have the load secure, look ahead, not down at the load
  • know your limits - there is a big difference between what you can lift and what you can safely lift; if in doubt, get help
  • push rather than pull - if you have to move a heavy object across the floor, it is better to push it rather than pull it
  • distribute the weight evenly - if you are carrying shopping bags or luggage, try to distribute the weight evenly on both sides of your body

See the back pain guide for more advice about how to sit, stand and lift correctly.

treatment of back pain...

Treatments for back pain will vary depending on how long you have had the pain, how severe it is and your individual needs and preferences.

Short-term back pain

Most cases of back pain that last no longer than six weeks can be treated with over-the-counter painkillers and home treatments.

Painkillers

Paracetamol is effective in treating most cases of back pain. Some people find non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, more effective. A stronger painkiller, such as codeine, is also an option and is sometimes taken in addition to paracetamol.

If you also experience muscle spasms in your back, your GP may recommend a short course of a muscle relaxant, such as diazepam.

Painkillers can have side effects, some can be addictive and others may not be suitable, depending on your state of health. Your GP or a pharmacist will be able to give you advice about the most appropriate type of medication for you.

Read more about the medicines for back pain.

Hot and cold treatments

Some people find that heat - for example, a hot bath or a hot water bottle placed on the affected area helps ease the pain.

Cold, such as an ice pack or a bag of frozen vegetables, placed on the painful area is also effective. Do not put the ice directly on to your skin because it might cause a cold burn. Wrap the frozen pack in a wet cloth before applying it to the affected area.

Another option is to alternate between hot and cold using ice packs and hot compression packs or a hot water bottle. Hot compression packs can be bought at most larger pharmacies.

Sleeping position

Changing your sleeping position can take some of the strain off your back and ease the pain.

If you sleep on your side, draw your legs up slightly towards your chest and put a pillow between your legs. If you sleep on your back, placing a pillow under your knees will help maintain the normal curve of your lower back.

Relaxation

Trying to relax is a crucial part of easing the pain because muscle tension caused by worrying about your condition can make things worse.

Research suggests that people who manage to stay positive despite the pain tend to recover quicker and avoid long-term back pain.

Read more about relaxation tips to relieve stress.

Keep moving

Most experts now agree that staying in bed, lying down or being inactive for long periods is bad for your back.

People who remain active are likely to recover more quickly. This may be difficult at first if the pain is severe, but try to move around as soon as you can and aim to do a little more each day.

Activity can range from walking around the house to walking to the shops. You will have to accept some discomfort but avoid anything that causes a lot of pain.

There is no need to wait until you are completely pain-free before returning to work. Going back to work will help you return to a normal pattern of activity, and it can often distract you from the pain.

Exercise and lifestyle

Try to address the causes of your back pain to prevent further episodes. Common causes include being overweight, poor posture and stress.

Regular exercise and being active on a daily basis will help keep your back strong and healthy. Activities such as walking, swimming and yoga are popular choices.

The important thing is to choose an enjoyable activity that you can benefit from without feeling pain.

Read more about preventing back pain.

Long-term back pain

If you have had back pain for more than six weeks (known as chronic back pain), your GP will advise you about which painkillers to take and recommend the treatments listed below.

  • Exercise - your programme should involve up to eight sessions over a period of up to 12 weeks. It will usually be a group class supervised by a qualified instructor. The classes may include exercises to strengthen your muscles and improve your posture, as well as aerobic and stretching exercises.
  • Manual therapy - there are different types of manual therapy including manipulation, mobilisation and massage, usually carried out by chiropractors, osteopaths or physiotherapists. If you choose a course of manual therapy, it should include up to nine sessions over a period of up to 12 weeks.
  • Acupuncture - an ancient Chinese treatment where fine needles are inserted at different points in the body. Acupuncture has been shown to help reduce lower back pain. A course should include up to 10 sessions over a period of up to 12 weeks.

These treatments are often effective for people whose back pain is seriously affecting their ability to carry out daily activities and who feel distressed and need help coping.

Nerve root blocks

A nerve root block is where a steroid or anaesthetic is injected into your back. If your back pain is caused by a trapped or inflamed nerve in your spinal column, the injection can help relieve the pain in your back, plus any associated leg pain.

To be effective, the injection needs to be made at exactly the right place in your back, so the procedure will be carried out under X-ray or CT guidance.

Facet joint injections

It is also possible to have anaesthetic or steroid injections in the facet joints. The facet joints are the joints that connect one vertebrae to another so that your spine is kept aligned. The joints are sometimes affected by arthritis. Facet joint injections are not always effective at relieving back pain.

Antidepressants

If the painkillers do not help, you will probably be prescribed tricyclic antidepressants (TCAs), such as amitriptyline. TCAs were originally intended to treat depression, but they are also effective at treating some cases of persistent pain.

If you are prescribed a TCA to treat persistent back pain, the dose is likely to be very small.  See medicines for back pain for more information.

Counselling

If the treatments described above are not effective, you may be offered counselling to help you deal with your condition.

While the pain in your back is very real, how you think and feel about your condition can make it worse. Cognitive behavioural therapy (CBT) works by helping you to manage your back pain better by changing how you think about your condition.

Studies have shown that people who have had CBT later reported lower levels of pain. They were also more likely to remain active and take regular exercise, further reducing the severity of their symptoms.

Surgery

Surgery for back pain is usually only recommended when all other treatment options have failed.

Surgery may be recommended if your back pain is so severe or persistent that you are unable to sleep or carry out your day-to-day activities. The type of surgery will depend on the type of back pain you have and its cause.

For example, a procedure known as a discectomy may be used if you have a prolapsed disc. The discs are the circular, spongy tissue between the vertebrae that help cushion your spine. A prolapsed disc is where the hard outer membrane of the disc is damaged, causing the soft, jelly-like fluid inside to leak out.

A discectomy involves removing the damaged part of the disc through an incision made in your back. It is now possible for surgeons to carry out the procedure using a very small incision and a microscope or magnifying lenses to find the damaged disc. This minimizes the amount of trauma to the surrounding tissue, reduces the pain and discomfort in the affected area and results in a smaller scar.

Spinal fusion surgery is a less common surgical procedure where the joint that is causing pain is fused to prevent it moving.

As bone is living tissue, it is possible to join two or more vertebrae together by placing an additional section of bone in the space between them. This prevents the damaged vertebrae irritating or compressing nearby nerves, muscles and ligaments, and reduces the symptoms of pain.

Spinal fusion is a complicated procedure and the results are not always satisfactory. For example, you may still experience some degree of pain and loss of movement following surgery.

Before you agree to have surgery to treat back pain, you should fully discuss the risks and benefits of the procedure being recommended with your surgeon.

Other treatments

A number of other treatments are sometimes used to treat long-term back pain. However, they are not recommended by the National Institute for Health and Clinical Excellence (NICE) due to a lack of evidence about their effectiveness. They include:

  • low level laser therapy - where low energy lasers are focused on your back to try to reduce inflammation and encourage tissue repair
  • interferential therapy (IFT) - where a device is used to pass an electrical current through your back to try to accelerate healing while stimulating the production of endorphins (the body’s natural painkillers)
  • therapeutic ultrasound - where ultrasound waves are directed at your back to accelerate healing and encourage tissue repair
  • transcutaneous electrical nerve stimulation (TENS) - where a TENS machine is used to deliver small electrical pulses to your back through electrodes (small sticky patches) that are attached to your skin; the pulses stimulate endorphin production and prevent pain signals travelling from your spine to your brain
  • lumbar supports - where cushions, pillows and braces are used to support your spine
  • traction - where a pulling force is applied to your spine
  • injections - where painkilling medication is injected directly into your back

diagnosis of back pain...

Most cases of back pain do not require medical attention and can be treated with over-the-counter painkillers and self-care.

However, you should visit your GP if you are worried about your condition or struggling to cope with the pain. Your GP will discuss your back pain symptoms with you and examine your back.

Examination and previous history

The examination will usually assess your ability to sit, stand, walk and lift your legs, as well as testing the range of movement in your back.

Your GP may ask you about any illnesses or injuries you may have had, as well as the type of work you do and your lifestyle.

Your back is a complex structure so finding the exact cause of the pain can often be difficult.

Below are some of the questions your GP may ask you. It may be helpful to consider these ahead of your appointment.

  • When did your back pain start?
  • Where are you feeling pain?
  • Have you had back problems in the past?
  • Can you describe the pain?
  • What makes the pain better or worse?

Your GP will want to make sure that your back pain isn't being caused by a more serious condition. They will ask you some questions to rule out an infection or fracture, although these are uncommon.

If your GP thinks there may be a more serious cause, they will refer you for further tests, such as an X-ray or an MRI scan.

You will be offered information about what you can do to reduce the effects of the pain.

Long-term back pain

If your back pain lasts for more than six weeks (chronic back pain), you may be referred to a specialist trained in providing a particular treatment. This may be a physiotherapist, osteopath, chiropractor, psychologist or an acupuncturist

Some people choose to go straight to one of these specialists as soon as the pain starts. However, in these circumstances, you would have to pay for this care privately.  

If you are not happy with your GP's diagnosis, or if your symptoms keep returning, go back to your GP or get a second opinion.

Find out about treating back pain. 

Bacterial vaginosis

treatment of bacterialvaginosis...

Bacterial vaginosis (BV) can be treated with antibiotics. If used correctly, treatment is effective in around 9 out of 10 cases.

There is currently no evidence that probiotics, such as those found in live yoghurt, are of any benefit in treating or preventing BV.

Metronidazole

Metronidazole is the most common and preferred antibiotic treatment for BV. It is available in three forms:

  • as tablets to be swallowed twice a day for seven days
  • as tablets to be taken as a single larger dose that you take only once
  • as a gel that you apply to your vagina once a day for five days

The most effective way to take metronidazole is in tablet form over 5-7 days. This is also the preferred treatment if you are pregnant or breastfeeding.

As a precaution, the use of metronidazole (and most other types of medication) is not normally recommended during pregnancy. But an exception is made in the case of BV, as not treating it poses a far bigger risk to the pregnancy than taking the medication.

More women find that their BV is more likely to return if they take the single larger dose. 

Side effects 

Metronidazole can cause nausea, vomiting and a slight metallic taste in your mouth. It is best to take it after eating food. If you start vomiting, contact your GP as the treatment will not be effective.

Do not drink alcohol while taking metronidazole and for at least 48 hours after finishing the course of antibiotics. Drinking alcohol while taking this medicine can cause more severe side effects.

If you cannot tolerate metronidazole, your GP may prescribe a single dose of another antibiotic called tinidazole.

After treatment

If your BV symptoms disappear after treatment, you will not need to be tested for BV again to confirm that the treatment has worked. However, you will need to be tested if:

  • your signs and symptoms do not go away
  • your signs and symptoms return
  • you are treated for BV while you are pregnant

Further treatment

The first course of treatment may not be effective in around 1 in 10 people.

If your treatment has been unsuccessful, your GP will need to check that you took the medicine correctly. If you did and it did not work, you may be prescribed one of the different options described above.

Referral to a specialist

If you have repeated episodes of BV in a short space of time, your GP may recommend that you are referred to a gynaecologist (a specialist in treating conditions of the female reproductive system) for further investigation.

If you are pregnant, you may be referred to an obstetrician (a specialist in pregnancies). They will be able to discuss further treatment options with you. 

Bacteria
Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease, and some are good for you.

Inflammation
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

Sexually transmitted infections (STIs)
STIs are diseases passed on through intimate sexual contact, such as vaginal, oral or anal sex.

Vagina
The vagina is a tube of muscle that runs from the cervix (the opening of the womb) to the vulva (the external sexual organs).
introduction of bacterialvaginosis...

Bacterial vaginosis (BV) is a common yet poorly understood condition in which the balance of bacteria inside the vagina becomes disrupted.

Around one in three women will experience at least once episode of BV at some point.

This imbalance often triggers a change to the usual vaginal discharge, which results in a fishy smelling, greyish discharge from the vagina. However, half of women with bacterial vaginosis have no symptoms. 

See your GP if you notice any abnormal discharge from your vagina, especially if you are pregnant. It is important to get this type of symptom diagnosed quickly to rule out other infections and prevent complications (see below).

If you do not have symptoms, there is no need to get tested as bacterial vaginosis without symptoms does not pose a threat to health or to pregnancy.

Read more about the symptoms of bacterial vaginosis.

What causes bacterial vaginosis?

The vagina contains a mix of so-called "good" bacteria, which can help protect against infection, and a smaller amount of "bad" bacteria, which can cause infection.

In cases of BV, the bad bacteria begin to outnumber the good bacteria, leading to inflammation inside the vagina, which can result in the fishy discharge.

What leads to this imbalance is still unclear. It is not classed as a typical sexually transmitted infection (STI), but it can develop after having sex with a new partner.

There is no evidence that a woman with BV can pass on any type of infection to her male sexual partner. But the same may not be true for women who have sex with other women.

You can also get bacterial vaginosis if you:

  • use scented soaps or bubble baths
  • have an intrauterine device (IUD)
  • smoke
  • use vaginal deodorant

Read more about the possible causes of bacterial vaginosis.

Treating bacterial vaginosis

BV can usually be successfully treated using a course of antibiotic tablets or gel.

However, it is common for BV to reoccur. Over half of women successfully treated with BV will have a reoccurrence of symptoms, usually within six months.

Women who have very frequent episodes of BV may be referred to a gynaecologist.

Read more about treating bacterial vaginosis.

Complications

BV is a concern if it develops in pregnant women as it increases the risk of pregnancy-related complications, such as premature birth or miscarriage. However, the increase in risk is small.

As a precaution, you should contact your GP if you are pregnant and you begin to have vaginal discharge (although discharges can be a normal part of pregnancy).

Bacterial vaginosis can also increase your risk or getting some STIs.

Read more about the complications of bacterial vaginosis.

Bacteria
Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease, and some are good for you.

Sexually transmitted infections (STIs)
STIs are diseases passed on through intimate sexual contact, such as vaginal, oral or anal sex.

Vagina
The vagina is a tube of muscle that runs from the cervix (the opening of the womb) to the vulva (the external sexual organs).

diagnosis of bacterialvaginosis...

See your GP as soon as possible if you have any abnormal discharge from your vagina.

It is important to get bacterial vaginosis (BV) diagnosed to rule out other infections, such as trichomonas vaginalis or gonorrhoea. These can both cause abnormal vaginal discharge.

If you prefer, you could visit a sexual health clinic for a diagnosis, instead of your GP. Sexual health clinics are sometimes known as genitourinary medicine (GUM) clinics. They are usually located in a hospital or are part of another health centre. Find your nearest sexual health service.

Examination

Your GP or healthcare professional may diagnose BV from a description of your symptoms and by examining your vagina. In particular, they will look for:

  • a thin, greyish discharge
  • an unpleasant smell

In some cases, this may be enough to confirm your diagnosis. However, if you are sexually active and may have a sexually transmitted infection (STI) instead of BV, you may need further tests. 

Tests

A sample of cells may be taken from the wall of your vagina using a plastic loop or swab. A swab looks a bit like a cotton bud but is smaller, soft and rounded.

The swab or loop picks up samples of discharge and cells. It only takes a few seconds and is not usually painful, although it may be slightly uncomfortable for a moment.

The samples are examined to check for BV. The result may be available immediately or the sample may be sent to a laboratory, in which case the result will usually be available within a week.

The pH (alkaline/acid balance) of your vagina may also be measured. A swab will be taken from inside your vagina and wiped over a piece of specially treated paper. The paper changes colour depending on the pH level. A pH level higher than 4.5 is an indication that you may have BV.

These tests and all sexual health services are free on the NHS. They are available to everyone, regardless of age. Treatment is also free, but if you go to your GP, you may have to pay a prescription charge.

Bacteria
Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease, and some are good for you.

Sexually transmitted infections (STIs)
STIs are diseases passed on through intimate sexual contact, such as vaginal, oral or anal sex.

Vagina
The vagina is a tube of muscle that runs from the cervix (the opening of the womb) to the vulva (the external sexual organs).

Baker's cyst

introduction of bakers cyst...

A Baker’s cyst, also called a popliteal cyst, is a fluid-filled swelling that develops at the back of the knee. It is caused by a problem with the knee joint or the tissue behind it.

The swelling may cause:

However, it may cause no symptoms at all.

Causes of a Baker's cyst include:

You can reduce the swelling and relieve any pain using ice, over-the-counter painkillers and bandages. The cyst may go away when the condition causing it has been treated. Find out more about treating a Baker's cyst.

A Baker's cyst is more common in women than men, probably because women are more likely to develop osteoarthritis and rheumatoid arthritis. It usually develops in people aged over 40, although it can affect people of any age, including children.

When to see your GP

See your GP if your cyst causes you problems and does not go away. It's important that any condition that causes it, such as arthritis, is properly managed.

In some cases, particularly if it's caused by osteoarthritis, the cyst may not go away and surgery may be needed to drain or remove it.

Cyst
A cyst is a fluid-filled sac or cavity in the body.
Inflammation
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Joint
Joints are the connection point between two bones that allow movement.

treatment of bakers cyst...

You can treat a Baker’s cyst yourself at home. Further treatment is only needed if your cyst stops you using your knee properly or causes pain that doesn't go away.

To treat a Baker's cyst:

  • Take non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, to reduce swelling and pain in the affected knee.
  • Hold an ice pack to the knee to reduce any swelling. Try a bag of frozen peas wrapped in a cloth (never put ice directly on your skin). 
  • Rest your knee joint.
  • Use compression bandages to support your knee joint. You can buy these from a pharmacy.

Further treatment

See your GP for further treatment if your cyst still causes problems after you have tried the treatments above.

One treatment option is to inject corticosteroid medication directly into the affected knee. This helps reduce inflammation and swelling.

Treating a ruptured cyst

In rare cases, a Baker’s cyst can burst, causing fluid to leak down into your calf. This can cause sharp pain and swelling in your calf. The fluid will gradually be reabsorbed into the body over one to four weeks.

Prescription painkillers – usually a combination of paracetamol and codeine – can be used to control any pain. See your GP for a prescription.

Surgery to repair damage to the knee

If there is a lot of damage to the knee joint, due to a condition such as osteoarthritis or a physical injury – surgery may be needed to fix the problem with the joint. This is usually done using a surgical technique called arthroscopy.

Arthroscopy is a form of keyhole surgery that is used to look inside a joint and repair or remove any damage that has occurred.

An instrument called an arthroscope is passed through the skin to light up and magnify the joint, so the surgeon can assess the inside of the joint and deal with any damaged tissue or bone. An arthroscope is a narrow tube with a light and camera attached that sends pictures back to a television monitor.

Cyst
A cyst is a fluid-filled sac or cavity in the body.

diagnosis of bakers cyst...

Your GP can usually diagnosis a Baker’s cyst by examining your knee and asking about your symptoms.

They will want to know if you have any associated health conditions, such as arthritis.

If your GP cannot diagnose it in this way, they may recommend further tests. These will be used to rule out very rare but more serious conditions, such as a tumour or an aneurysm (a bulge in a section of a blood vessel).

The tests may include:

  • an ultrasound – where a scanner that produces high-frequency sound waves is moved over your body to create an image of the inside of your body
  • a magnetic resonance imaging (MRI) scan – where you lie inside a large tube and strong magnetic fields and radio waves produce a detailed image of the inside of your body
Cyst
A cyst is a fluid-filled sac or cavity in the body.
Inflammation 
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Joint
Joints are the connection point between two bones that allow movement.
MRI
MRI stands for magnetic resonance imaging. It is the use of magnets and radio waves to take detailed pictures of inside the body.
X-ray
An X-ray is a painless way of producing pictures of inside the body using radiation.

Balanitis

introduction of balanitis...

Balanitis (balanoposthitis) is swelling of the head of the penis. The foreskin (the loose flap of skin that covers the head of the penis) is also often affected.

Balanitis is a common condition affecting both boys and men, although it happens more often in men who have not been circumcised.

Symptoms of balanitis include swelling, redness and soreness of the end of the penis. There might also be a thick discharge under the foreskin.

Read more about the symptoms of balanitis.

Balanitis is not normally serious and can usually be prevented with good hygiene. 

Read more about preventing balanitis.

When to see your GP

Visit your GP or local sexual health or genito-urinary (GUM) clinic if you have any of the symptoms of balanitis. While balanitis is not usually serious, it can be a sign of another condition, such as a sexually transmitted infection (STI) or thrush (a type of yeast infection).

Also visit your GP if your son develops balanitis. They may need prescription-only medication, such as antibiotics.

Who is affected?

Balanitis can happen at any age. An estimated 1 in 20 boys under five years old are affected by balanitis. One in 10 men who attend a sexual health or genito-urinary (GUM) clinic have balanitis.

Skin irritation is the most common cause of balanitis in boys. It is usually related to poor hygiene, such as not getting rid of excess urine from the end of the penis after urinating.

In men, balanitis can be caused by:

Read more about the causes of balanitis.

Treating balanitis 

Most cases of balanitis are easily managed with a combination of creams or ointments, good hygiene and avoiding substances that irritate the penis.

In rare cases of balanitis that keeps coming back, circumcision (surgical removal of the foreskin) may be recommended. For example, in cases where the foreskin can't be pulled back (phimosis) to be cleaned or there is persistent dribbling of urine following urination.

Read more about treatment for balanitis.

prevention of balanitis...

The best way to prevent developing balanitis is to always maintain good levels of hygiene.

For example:

  • if you get up during the night to urinate, make sure that the tip of your penis (glans) is completely dry and free of urine before going back to bed
  • carefully wash the head of your penis every day and gently clean under your foreskin
  • avoid using perfumed shower gels; using water on its own or with a mild soap is enough to clean your penis; alternatively, using aqueous cream as a soap substitute will help avoid irritation
  • after bathing or showering, make sure you dry your penis thoroughly before getting dressed

For tips on keeping your penis and testicles clean, read how to wash a penis.

Hygiene and children

The hygiene tips above also apply to children, although young boys may not yet be able to clean under their foreskin. This should not be forced and should eventually become possible as they get older.

Babies and young children who still wear nappies may also be at a higher risk of balanitis due to the warm and moist conditions. Make sure you change your child's nappy regularly and use a barrier cream or ointment after each nappy change.

This will reduce the contact that your baby's skin has with urine and faeces. Zinc cream, zinc oxide ointment and petroleum jelly are all suitable barrier creams. Ask your pharmacist for advice about which cream is most suitable for your baby.

Avoiding irritants

The advice outlined below, regarding potential irritants, will also help you to avoid getting balanitis.

  • Urine – after urinating, make sure the tip of your penis is completely dry and free of urine before replacing your foreskin.
  • Condoms and lubricants – sometimes, the chemicals used in condoms or lubricants can irritate the penis. There are condoms made for sensitive skin. Ask your pharmacist, GP or nurse at your local sexual health or genito-urinary (GUM) clinic for advice.
  • Detergents – wash your underwear with non-biological washing powder and make sure the detergent has been rinsed out of your underwear before wearing it.
  • Chemicals – wash your hands before using the toilet if you work with chemicals or if you have traces of other products on your hands, which could irritate the delicate skin of your penis. 

treatment of balanitis...

If you or your child has balanitis, the recommended treatment will depend on what is causing your condition.

In all cases of balanitis you should avoid potential irritants and make sure to practise good hygiene. For example:

  • keep your penis clean by washing it with warm water twice a day
  • avoid using soap and other irritants - you could use aqueous cream as a soap substitute
  • wash your hands thoroughly after going to the toilet

Potential irritants to avoid

If you have balanitis, urine is the most important irritant to keep away from the skin of your penis. Other irritants to avoid include:

  • soap and shower gel
  • bubble baths
  • baby wipes
  • latex condoms
  • lubricants
  • antiseptics
  • hygiene sprays

Read about preventing balanitis for more information on hygiene and avoiding irritants.

Skin irritation

If your balanitis is the result of skin irritation caused by poor hygiene or exposure to a substance that has irritated your penis, you will usually be prescribed a topical corticosteroid (steroid cream or ointment).

Apply the cream to the head of your penis once or twice a day until your symptoms have gone. Do not use the medication for more than 14 days in a row because this could lead to side effects, such as itchy skin and a skin rash.

It is important to avoid potential irritants and make sure that the head of your penis and your foreskin do not come into contact with urine after you urinate.

Fungal infection

If your balanitis is the result of a fungal infection, you will be prescribed either an antifungal cream or an oral antifungal medication (tablet or capsule), such as fluconazole. 

Fluconazole is not recommended for children who are under 16 years old. It can also cause side effects, including:

  • headache
  • skin rash
  • nausea and vomiting
  • diarrhoea 

If your symptoms are particularly troublesome, you may also be prescribed a seven-day course of a topical corticosteroid, usually in the form of a cream or ointment.

Bacterial infection

If a bacterial infection is the cause of your balanitis, you will be prescribed a seven-day course of oral antibiotics (antibiotic tablets or capsules).

An antibiotic called amoxicillin is usually recommended. However, if you are allergic to penicillin, erythromycin or clarithromycin may be prescribed.

Common side effects of these types of antibiotics include:

  • skin rash
  • nausea and vomiting
  • diarrhoea
  • abdominal pain

Again, if your symptoms are particularly troublesome, you may also be prescribed a seven-day course of a topical corticosteroid.

Follow-up

All of the treatments listed above should start working in seven days. Contact your GP if your symptoms do not improve after this time because you may require an alternative treatment.

Referral to a specialist

If your balanitis is not caused by an infection and your GP cannot identify the cause, you may be referred to a dermatologist (skin specialist) or genito-urinary (GUM) clinic for further investigation.

If you have phimosis (a tight foreskin) and you have repeat episodes of balanitis, you may be advised to have a circumcision.

Bartholin's cyst

treatment of bartholins cyst...

If the Bartholin’s cyst is small and does not cause any symptoms, it's often better to leave it alone. However, you should still see your GP if you notice a lump.

If you have pain around the cyst, your GP may recommend that you:

Always read the manufacturer’s instructions when using over-the-counter (OTC) medication.

Treating an abscess

If the cyst becomes an abscess (a painful collection of pus), you may also be prescribed antibiotics to clear the infection.

Once the infection has been treated, your GP may still feel it necessary to drain the cyst, particularly if the abscess is large.

Draining a cyst

Drainage/balloon catheter insertion

When a Bartholin's cyst or abscess is inflamed, it may simply be cut open and drained if this is possible.

An alternative procedure for draining a cyst is known as balloon catheter insertion, or sometimes catheter placement or fistulisation.

This procedure is used to drain the fluid from the abscess or cyst and to create a permanent passage to drain away any future fluid that builds up.

You will have balloon catheter insertion as an outpatient, which means you won't need to stay in hospital overnight. It can be carried out under either local or general anaesthetic.

During the procedure, a cut is made in the abscess or cyst and the fluid is drained. A specially designed balloon catheter is inserted into the empty abscess or cyst. A balloon catheter is a thin, plastic tube with a small, inflatable balloon on one end.

The balloon is then filled with a small amount of salt water. This increases the size of the balloon so that it fills the cyst or abscess. If you have any pain, some of the solution can be removed to reduce the pressure slightly.

A stitch may be used to partially close the incision and the balloon catheter is held in place in the cyst. The catheter will stay in place while new cells grow around it (epithelialisation). This heals the surface of the wound but leaves a passage in place. This usually takes around four weeks, although in some cases it may take longer. After epithelialisation, the balloon is drained and the balloon catheter removed.

A few small studies have reported that, after balloon catheter insertion, 83–97% of women healed well and their cysts or abscesses did not reoccur.

Possible complications of balloon catheter insertion include:

  • pain from the catheter
  • pain during sex
  • swelling of the labia (the lips around the opening of the vagina)
  • infection
  • bleeding
  • scarring

Marsupialisation

If a cyst or abscess keeps coming back, a surgical procedure known as marsupialisation may be used. In marsupialisation, the cyst is opened with an incision and the fluid is drained out.

The edges of the skin are then stitched in a way that prevents further fluid build-up by allowing it to drain out. This creates a pouch (similar to a kangaroo’s pouch, hence the name marsupialisation).

Marsupialisation is often carried out as a day case, so you will not have to stay in hospital overnight. It can be carried out under:

  • local anaesthetic, where the area is numbed so you cannot feel anything but you remain conscious throughout the procedure
  • general anaesthetic, where you are unconscious and cannot feel anything

Although complications after marsupialisation are rare, they can include:

  • infection
  • the abscess reoccurring
  • bleeding
  • pain – you may be given painkillers to ease any pain in the first 24 hours after the procedure

Bartholin's cyst removal

In some cases, it may be necessary to remove the Bartholin's cyst. This procedure is often considered to have the best long-term benefits, but requires an overnight stay in hospital.

There is also a higher risk of complications when the whole cyst is removed, including bleeding or blood collecting in the wound (haematoma).

Alternative procedures

These procedures are alternative ways of treating a Bartholin’s cyst, but are rarely used or are not widely available.

Silver nitrate gland ablation

Silver nitrate is a mixture of chemicals sometimes used in medicine to cauterise (burn) blood vessels to stop bleeding. In silver nitrate gland ablation, a small solid stick of silver nitrate, which is 0.5cm wide and 0.5cm long, is used.

An incision is made in the skin of your vulva (your external sexual organs) and the wall of the cyst or abscess. The cyst or abscess is then drained and the stick of silver nitrate is inserted into the cavity (the empty space that is left after draining the fluid).

The silver nitrate causes the cyst cavity to form into a small, solid lump. After two or three days, the piece of silver nitrate and the cyst cavity are removed or they may fall off on their own.

It is possible for the silver nitrate to burn some of the skin of your vulva when it is first used. One small study reported that this occurs in 20% of women.

Carbon dioxide laser

A laser is used to create an opening in the skin of your vulva so that the cyst can be drained. The cyst can then be:

  • removed
  • destroyed using the laser
  • left attached but with a hole in it

Needle aspiration

During needle aspiration, a needle is used to drain the cyst.

Sometimes, this is combined with a procedure called alcohol sclerotherapy, where the cavity is then filled with a liquid that is 70% alcohol. This is left in the cyst cavity for five minutes and then drained out.  

introduction of bartholins cyst...

A Bartholin's cyst, also called a Bartholin's duct cyst, is a small growth just inside the opening of a woman’s vagina. Cysts are small fluid-filled sacs that are usually harmless.

A Bartholin's cyst can stay small and painless and may not cause any symptoms. However, the cyst can become infected, which can cause a painful collection of pus (an abscess) in the Bartholin’s gland.

Read more about the symptoms of a Bartholin’s cyst.

What causes a Bartholin’s cyst?

The Bartholin’s glands are a pair of pea-sized glands. They are found just behind and either side of the inner lips that surround the entrance to the vagina (the labia majora). The glands are not usually noticeable because they are rarely larger than 1cm (0.4 inches) across.

The Bartholin’s glands secrete fluid that acts as a lubricant during sex. The fluid travels down tiny tubes, called ducts, into the vagina. If the ducts become blocked, they will fill with fluid and expand. This then becomes a cyst.

Read more about the causes of a Bartholin’s cyst.

When should I see my GP?

Report any new lumps to your GP so that they can confirm or rule out a diagnosis of a Bartholin’s cyst and check for infection or other conditions.

Also see your GP if you have a cyst that becomes large or painful, or is uncomfortable when you sit or walk.

Several treatments are available to treat any pain or infection and, if necessary, drain the cyst. Most treatments involve a minor surgical procedure. However, Bartholin's cysts are known to come back in up to 38% of women.  

If you do not have any symptoms, it's unlikely that you will need treatment.

Read more about treating a Bartholin’s cyst.

Who is affected?

According to estimates, around 2% of women will develop a Bartholin’s cyst. The condition usually affects sexually active women who are 20 to 30 years old.

The Bartholin’s glands do not start functioning until puberty, so Bartholin’s cysts do not usually affect children.

symptoms of bartholins cyst...

Most Bartholin's cysts do not cause any symptoms. However, you may feel a soft, painless lump in your labia (the two pairs of lips that surround the entrance to your vagina).

You may not know that you have a cyst until it is found during a routine cervical screening test or another gynaecological examination. A gynaecologist is a specialist in treating conditions of the female reproductive system.

If the cyst grows very large, it can become uncomfortable and noticeable. You may feel pain in your vulva (external sexual organs) when you walk, sit down or have sex.

Sometimes, the cyst can affect the outer pair of lips around the opening of the vagina (labia majora). One side may look swollen or bigger than usual.

Abscess

If the cyst or gland becomes infected, it can cause an abscess. This is a painful collection of pus which often gets bigger over a few hours or days.

The cyst will become swollen, tender to touch and the skin around the abscess is likely to be red and hot. An abscess can also cause a high temperature of 38C (100.4F) or above.

When to see your GP

See your GP as soon as possible if the cyst does not improve after a few days of self-care treatment. If the cyst becomes large or painful, or if there are any other symptoms such as fever or vomiting, see your GP immediately.

If it is painful and causes discomfort when you walk or sit, it is likely that it has developed into an abscess and you will need treatment to drain the fluid.

Read more about treatment for a Bartholin’s cyst.

Also visit your GP or a sexual health clinic (GUM clinic) as soon as possible if you have symptoms such as vaginal discharge, itching or pain. You may have a sexually transmitted infection (STI).

If you have an STI, the sooner you receive treatment, the better.

Bartholin's cyst cancer

If you notice any swelling in your vagina or any changes such as pain or itching, see your GP as they may need to do further tests.

In very rare cases, a Bartholin’s cyst could develop into Bartholin's cyst cancer. It is also important for your GP to rule out vulval cancer.

Read more about how a Bartholin’s cyst is diagnosed.

Belly And Abs

Core Blimey! Do You Need to Strengthen Your C...

It’s harder to visualise your core muscles, and so you might neglect them when you’re exercising. However, keeping your core strong is vital to your workout wellness, and your overall wellbeing, taking care of everything form movement to posture. The 29 pairs of muscles that make up your core provide a stable base for practically any activity you perform, giving you balance, good posture and efficient arm and leg movement. Therefore, exercises that strengthen the core muscles are a vital part of any exercise routine. This could mean programmes based around pilates and yoga, which have multiple movements that support and build the core, but you can also experience certain benefits by simply balancing on one leg while stabilising your back and pelvis. Sit-ups and crunches seem like a natural option for building the core, but there are more effective ways of working most of the 29 pairs of core muscles. For example, a variety of push-ups will work all of these muscles. However, the mistakes that many people make are trying to go too fast and using an abbreviated range of motion, which is only wasting your time and energy. Instead of doing a set number of push-ups, try to work each individual one slowly, keeping your body straight. Making sure your elbows at a 45 degree angle to the body, try to gently touch the sternum to the floor and rise up to a straight-arm position. If you’re just starting out, you may want to do this with your knees on the floor, or else stand with your feet about three feet away from a wall, place your palms flat against it leaning forward, and then slowly push away from the wall. Once you get stronger, you can move into a traditional push up, and then, for a more complete core workout, try the reverse push-up. This involves using the same basic start position of the push-up, but instead of allowing your weight to move downward to the floor, you bend at the knees and hips and push backward until only your hands and feet are still on the floor, and your waist is totally bent. If you want an even more difficult version of this, and get even more of your core muscles involved, start the backward movement from your low position on the floor.

Six Pack Abs: How Men Can Achieve A Toned Sto...

Gaining a six pack is one of the main priorities for men, yet it is one of the hardest things to achieve. This area of the body is particularly hard to define, but before you even begin working on building stronger stomach muscles you need to remove your stomach fat. Many people make the mistake of thinking that doing hundreds of stomach crunches will build an enviable six pack, but this will only build a strong abdomen beneath the fat. Here’s how you can remove your stomach fat and start to see results. Including short, quick exercises into your weekly routine is a great way to start burning fat. This is largely done through cardiovascular exercises which burn fat overall, rather than in one specific area. Aim to include exercises such as planking, skipping or push-ups which are all great for increase your heart rate and burning fat. You should do around four to five sets of each of these, for around a minute each time, which will be most effective. Your diet is also an important part of a healthy lifestyle, and is important for building a toned stomach. It is crucial that you educate yourself in order know which foods are best for you. The best ways to reduce your stomach fat is to reduce the number of calories you’re consuming each day. Similarly, you should avoid sugars as your body converts this into fat – processes sugars are particularly bad for you, so avoid fizzy drinks, processed juices or sweet snacks. It is important to up your intake of vegetables, fruit and protein, as well as nuts and seeds, so that your body has all the necessary vitamins and minerals to work effectively. For many, insufficient sleep may just be a way of life, but often people don’t realise that this can also cause you problems. Sleep helps your body to produce cortisol, which helps limit insulin sensitivity, so aim to get at least seven hours of undisturbed sleep. Gaining a six pack is a difficult task, but it isn’t impossible – if you are dedicated to working out and eating nutritious and balanced meals, you will start to see results.

Gastric bands: What are they and do you need ...

Often mistaken as some sort of quick fix for obesity, gastric bands are actually one of the safest and simplest forms of bariatric surgery available. The procedure takes just thirty to forty minutes to perform, and you only need to stay in hospital overnight to recover. More importantly, it is around five to six times more effective than pills and diets in shifting excessive weight. As with many things with the advances in modern medicine, obesity is a problem which can be resolved with surgery. However, it isn’t a decision to be made lightly and you do need to meet certain criteria before you can go under the knife. Research has shown that those with a body mass of 35 to 40, in addition to weight-related health issues, are eligible for surgery. Surprisingly, the majority of the weight is lost around 18 months after the surgery, losing just a few kilograms a month before then. It also requires more work than people think – the band is simply a restrictive measure. You still need to make lifestyle changes, such as improving your diet, staying away from fat and sugar, and exercising in order to keep the weight from staying on. If you are choosing to have a gastric band fitted, it is important to gain support from family and friends. The surgery, whilst relatively simple and quick, is still a serious procedure and requires mental and emotional preparation. It also requires a few lifestyle changes before you go under the knife too. If you smoke, quitting is essential at least a month before surgery and a low carbohydrate diet is also advised. Laparoscopic banding leads to a smaller stomach over time, due to the weight loss. As your stomach shrinks, your band is tightened – this is generally administered six times over the course of year. Once you’ve met your goal weight, you will only require small adjustments, and many can go years without needing any changes at all. All in all, gastric bands are an effective solution to excessive weight loss and can offer the help your body requires in losing weight.

Beta blockers

introduction of beta blockers...

Beta-blockers (also known as beta-adrenoceptor blocking agents) are medications used to treat several conditions, often by decreasing heart activity. They block the release of the hormones adrenaline and noradrenaline in certain parts of the body.

Noradrenaline is a chemical released by nerves when they are stimulated. The noradrenaline passes messages to other parts of the body, such as muscles, blood vessels and heart.

When are they used?

Beta-blockers may be used to treat:

Read more information about the uses of beta-blockers.

Less commonly, beta-blockers are used to prevent migraine or treat:

There are several types of beta-blocker and each has its own characteristics. The type prescribed for you will depend on your condition but they are all equally effective.

Things to consider

There are several things to consider before taking beta-blockers.

Make sure your doctor is aware if you have a history of:

  • asthma or any lung disease
  • heart disease
  • kidney disease
  • diabetes (especially in diabetics who have frequent episodes of low blood sugar)
  • allergic reaction to any medication

Your GP can tell you which medicine to use if you are pregnant or breastfeeding. It is important you don’t stop taking beta-blockers without your GP's advice. In some cases, suddenly stopping the medicine may cause your condition to get worse.

If you want to check whether other medicines are safe to take with beta-blockers, ask your GP or pharmacist, or read the medicine's patient information leaflet.

Read more information about how beta-blockers interact with other medicines.

There may be side effects while taking beta-blockers, including the following:

  • dizziness
  • excessive tiredness
  • blurred vision
  • cold hands and feet
  • slow heartbeat
  • diarrhoea and nausea

Less common side effects include:

Missed or extra doses

If you forget to take a dose of beta-blockers, the general advice is described below.

  • If it is less than two hours late, take the dose as soon as you remember and continue as normal.
  • If it is more than two hours late, take the dose as soon as you remember, as long as the next dose is not due within a few hours, then continue as normal. If you take two doses closer together than normal, you may get more side effects.

If you are not sure what to do about your dose, check the patient information leaflet that comes with your medicine. This should give you advice about what to do.

If you need further advice, or accidentally take an extra dose of beta-blockers, contact your GP or call NHS Direct on 0845 46 47.



missed-or-extra-doses of beta blockers...

Missed doses

If you forget to take a dose of beta-blockers, the general advice is as follows:

  • If it is less than two hours late, take the dose as soon as you remember and continue as normal.
  • If it is more than two hours late, take the dose as soon as you remember, as long as the next dose is not due within a few hours, then continue as normal. If you take two doses closer together than normal, you may get more side effects.

If you are not sure what to do about your dose, check the patient information leaflet that comes with your medicine. This should give you advice about what to do.

If you need further advice, contact your GP or pharmacist or call NHS Direct on 0845 46 47.

Extra doses

If you accidentally take one or more extra doses of beta-blockers, contact your GP or call NHS Direct on 0845 46 47. They will be able to tell you what to do.
side-effects of beta blockers...

It is more common to experience side effects while taking beta-blockers when you start taking a new medicine, or if your dose is increased.

Contact your GP if the side effects are affecting your life or do not get better over time as your doctor may wish to review your dose or medication.

Common side effects of beta-blockers include:

Less common side effects include:

Driving while taking beta-blockers

Beta-blockers are unlikely to affect your ability to drive safely.

However, some people may sometimes feel dizzy or mentally or physically tired when taking beta-blockers. Do not drive if you have these side effects.



Better Sex

Your Basic Guide To Erectile Dysfunction Reme...

Erectile dysfunction is a condition which many men suffer from as they get older. It’s one of two conditions which the internet claims to be able to cure more than any other (the other being baldness) and it can cause men a great deal of anxiety. The condition can occur for all sorts of different reasons. Anxiety, stress, depression, blood flow issues and even some environmental stimuli can affect a man’s ability to get and then hold an erection. For many the case may simply be that the penis doesn’t get fully erect and for others it may be more severe. Regardless of the cause and the effect, there is a vast assortment of different treatments on the market today for erectile dysfunction: Pills – The most common erectile dysfunction pill is Viagra but there are a broad variety of different kinds on offer. They work by stimulating the blood flow to the penis through a reaction which relaxes the smooth muscles in the penis and allows more blood to enter it. Injections – These are generally only prescribed when oral medications (pills) fail to have the desired effect. The injections generally occur in the penis and this can put a lot of people off. Suppositories – This method is used by men who don’t like the thought of a needle in their penis but for whom pills have no effect. It involves inserting a tube into the urethra and using a drug called MUSE. This drug is absorbed directly into the penis but as it’s not put straight into the blood stream it’s not considered as effective as the injections are. Penis Pumps – Though they may seem quite amusing, the penis pump is actually an incredibly effective, non-invasive way to treat erectile dysfunction. Removing the air from the tube forces blood into the penis which helps to achieve erection.

Sex: Let’s talk About It And Break The Tabo...

Sex is something which is still a massive taboo in our culture. It’s much more spoken about now than it once was but the fact is that it still makes a lot of people very uncomfortable. The sad fact is that a lot of kids end up getting a good portion of their sexual education online and the internet isn’t a very good teaching source of anything alone. It’s a great resource but it has to be taken in moderation and with understanding. Accepting the things that you read online as undiluted fact without any additional research can lead you into problems. But when you’re young and you don’t know any better it’s much easier than having to talk to your Mum and Dad about such things. As with everything else, sex is something which we eventually get comfortable with. That comfort sometimes only reaches as far as the bedroom or close-knit groups but many will talk very openly about it. Being able to discuss matters like this openly and without judgement or fear is important for our evolution as a race. Sex is something which everyone does and the more it’s spoken about, the more normal it becomes. The more normal it becomes the easier it will be for people to talk about issues or concerns they may have. It can be hard to talk about these things with family members. Children don’t want to think of their parents as sexual entities and parents don’t want to accept that their babies might not be as naive as they once were. The fact is that knowledge is power and not knowing about STD’s or safe sex can lead to all sorts of terrible situations. An uncomfortable hour spent explaining things could save a lifetime of woe due to some ill-informed decisions made early in life. It’s always better to know.

Cialis Could Be A Great Help To Men Who Strug...

There are all manner of sexual issues which can affect you at any age. Generally however, issues with erection and ejaculation tend to become more of a problem for men as they get older. For a long time it was thought that ladies were the gender who had the only issues with achieving orgasm but it's become plain that men often have that same problem. At this time there's very little which can be offered to men who struggle to orgasm, which can be intensely distressing for those men. Unlike ladies, men need to achieve orgasm to fulfil their role in procreation. No orgasm means no semen and no semen means no baby. In older men this may not be much of an issue but for the younger, looking to start families, this can be the source of extreme distress. There are a good deal of drugs out there which are dedicated to helping men deal with erectile dysfunction. This is much easier to achieve as it's a fairly simple set of reactions. More often than not, a man’s inability to have an orgasm actually stems from the inability to attain an erection and fixing the latter fixes the former. Cialis is a drug which has proven greatly effective in the treatment of erectile dysfunction and is available all over the world today. Researchers have recently been looking into new uses for the drug however. In several studies Cialis was shown to have the potential to actually encourage ejaculation in men. These studies were fairly small and weren't specific enough to actually prove or disprove any correlation themselves. What they have done is shown a possibility and potential which researchers can now work towards. Cialis helped some men achieve orgasm where they hadn't been able to in the past. The next step in these studies will be working out how and why this works and then looking to replicate these findings on a much larger and more effective scale.

Bile duct cancer

introduction of cancer of the bile duct...

Bile duct cancer is a rare but aggressive type of cancer.

Cholangiocarcinoma is the medical term sometimes used for bile duct cancer.

In most cases, there are no signs of bile duct cancer until it reaches the later stages, when symptoms can include:

  • jaundice – yellowing of the skin and the whites of the eyes
  • clay-coloured stools (faeces)
  • dark-coloured urine

See your GP if you have signs of jaundice or are worried about other symptoms. While it is unlikely you will have bile duct cancer, it is best to get it checked.

Read more about the symptoms of bile duct cancer.

Why does bile duct cancer happen?

The exact cause of bile duct cancer is unknown. However, there are some things that can increase your chances of developing the condition. These include a chronic liver disease called primary sclerosing cholangitis (PSC), hepatitis B and hepatitis C.

In parts of the Far East, particularly Thailand, bile duct cancer is approximately 100 times more common than in the West. This is thought to be due to chronic bile duct infection by liver worms, which are common in those areas but not a factor in the West.

Read more about the causes of bile duct cancer.

Types of bile duct cancer

There are two main types of bile duct cancer, depending on where the cancer begins:

  • cancer that starts in a part of the bile duct that is inside the liver is known as intrahepatic bile duct cancer
  • cancer that starts in part of the bile duct outside the liver is known as extrahepatic bile duct cancer

Usually, intrahepatic bile duct cancer is treated in a similar way to primary liver cancer.

Diagnosis

Cancer of the bile duct can be difficult to diagnose, so you may need several tests, including blood tests, ultrasound scans, computerised tomography (CT) scans, and magnetic resonance imaging (MRI) scans. Some of these tests may require you to be injected with a special dye that highlights your bile ducts so they are easier to examine.

If possible, you will probably need a biopsy before bile duct cancer can be diagnosed. This involves removing a small sample of tissue so it can be studied under a microscope.

However, in some cases your surgeon may prefer to remove the suspected tumour based on the results of your scans alone.

Read more about diagnosing bile duct cancer.

How is bile duct cancer treated?

Cancer of the bile duct can usually only be cured if cancerous cells haven't spread. If this is the case, some or all of the bile duct may be surgically removed.

Unfortunately, only a small proportion of bile duct cancer cases are diagnosed at this stage and are suitable for surgery. This is because signs and symptoms usually develop at a late stage.  

Despite this, radiotherapy, chemotherapy and, to a lesser extent, surgery can relieve the symptoms of bile duct cancer and improve the quality of life of people in the advanced stages of the condition.

Read more about treating bile duct cancer.  

Who is affected?

Bile duct cancer is rare. Only about 1,000 people are diagnosed with the condition each year in the UK.

However, studies suggest that cases of bile duct cancer are increasing in most countries. The reasons for this are unknown.

Most cases of bile duct cancer occur in people over 60. The condition affects men and women almost equally.

Can bile duct cancer be prevented?

There are no guaranteed ways to avoid getting bile duct cancer. However, it is possible to reduce your chances of developing the condition.

The most effective ways of achieving this are not smoking, reducing your alcohol intake, and trying to ensure you do not become infected with hepatitis B or hepatitis C.

Read more about preventing bile duct cancer.

symptoms of cancer of the bile duct...

Bile duct cancer does not usually cause any symptoms until the flow of bile from the liver is blocked.

In most cases, the condition is at an advanced stage by this time.

The blockage will cause bile to move back into the blood and body tissue, resulting in symptoms such as:

  • jaundice – yellowing of the skin and whites of the eyes
  • clay-coloured stools (faeces)
  • dark-coloured urine
  • itchy skin
  • fatigue
  • loss of appetite
  • weight loss
  • abdominal pain – most people feel a dull ache in the upper right hand side of their abdomen (tummy)
  • high temperature (fever) of 38ºC (100.4ºF) or above
  • chills
  • night sweats

When to seek medical advice

Always visit your GP if you have jaundice. While jaundice is unlikely to be caused by bile duct cancer, it could indicate that there is an underlying problem with the liver, such as hepatitis.

causes of cancer of the bile duct...

The exact cause of bile duct cancer is unknown, although there are some things that can increase the risk of developing the condition.

How cancer begins

Cancer begins with a change in the coding information in cells that tells them when to grow and replicate. The code is read from deoxyribonucleic acid (DNA), found in all human cells.

A change in the code is known as a mutation, and can alter the instructions that control cell growth. The mutation can instruct the cells to carry on growing instead of stopping when they should. This causes the cells to reproduce uncontrollably, resulting in a lump of tissue known as a tumour.

How cancer spreads

If left untreated, cancer can quickly grow and spread to other parts of your body.

There are two ways that bile duct cancer can spread:

  • directly – the cancer spreads out of the bile duct and into surrounding tissue and organs, such as the liver and its blood vessels, the pancreas or the gallbladder
  • indirectly – the cancer cells spread via the blood or lymphatic system (see below) to other parts of the body, such as the lungs and bowel

The lymphatic system is a series of glands (or nodes) located throughout your body, much like your blood circulation system. The glands produce many of the specialised cells needed by the immune system (the body's natural defence against infection and illness).

Increased risk

A number of things have been identified that make it more likely that you will develop the condition. Some of these are discussed below.

Primary sclerosing cholangitis

Primary sclerosing cholangitis (PSC) is a rare type of liver disease that causes long-lasting (chronic) inflammation of the liver. It usually occurs in people who are between the ages of 30 and 50. In most cases, PSC is associated with chronic inflammation of the colon (ulcerative colitis).

It is not known exactly how many people with PSC will develop bile duct cancer, but estimates vary from 5-35%.

Your risk of developing bile duct cancer is thought to be higher if you have PSC and you smoke.

Bile duct abnormalities

Some people can have fluid-filled sacs (cysts) in their bile duct. These cysts are usually congenital, which means they are present from birth.

The most common types are choledochal cysts and Caroli's disease.

It is estimated that 6-30% of people with these conditions will develop cancer of the bile duct.

Biliary stones

Biliary stones are similar to gallstones, except they form inside the liver rather than inside the gallbladder.

Biliary stones are rare in western Europe, but are relatively common in parts of Asia, such as Japan and Taiwan. It is estimated that approximately 10% of people with biliary stones will develop bile duct cancer.

Inflammatory bowel disease

Inflammatory bowel disease is a general term that describes a number of conditions that cause inflammation inside the digestive system. The two most common types (although still rare in general terms) of inflammatory bowel disease are:

People who have either of these conditions are four times more likely to develop bile duct cancer than the population at large. However, this increased risk is still small. It is estimated that a person with an inflammatory bowel disease only has a one in 1,500 chance of developing bile duct cancer.

Viral hepatitis

Hepatitis B and hepatitis C are two types of viral liver infection thought to cause a tenfold increase in the risk of a person developing bile duct cancer.

Studies have found that about one in 10 people who develop bile duct cancer test positive for a hepatitis B or hepatitis C infection.

The risk is increased further if a person with hepatitis C has cirrhosis (a scarred liver) as a result of drinking excess amounts of alcohol. In these circumstances, the risk of developing bile duct cancer is thought to be 1,000 times higher compared to that of the general population.

Parasitic infection

Liver flukes are a type of parasitic insect known to increase the risk of developing bile duct cancer. You can become infected with liver flukes by eating undercooked fish that has been contaminated with fluke eggs.

Liver fluke infections are usually only a problem in Asia (especially Thailand) and Africa, where liver flukes are more widespread.

Exposure to toxins

Exposure to certain chemical toxins is known to increase the risk of developing bile duct cancer.

For example, if you are exposed to a chemical called thorotrast, your chances of developing bile duct cancer rises. Thorotrast was widely used in radiography until it was banned during the 1960s after its dangerous properties were fully understood.

Other toxins that may increase your chances of developing cancer of the bile duct include:

  • asbestos – a fire-resistant material which was widely used in construction and manufacturing but is now banned in this country
  • polychlorinated biphenyls (PCBs) – a chemical that was used in manufacturing and building but, like asbestos, has now been banned

Other factors

Binge eating

treatment of binge eating...

It is important that you seek medical advice if you think that you have a binge eating disorder. Your GP will assess you and recommend the best course of treatment for you.

The National Institute for Health and Care Excellence (NICE) recommends the following treatments for eating disorders:

These are described in more detail below.

Self-help programme

A self-help programme is the first step towards recovery. There are many different types of self-help and it is important to find one that suits you. Your GP may be able to recommend a self-help book or self-help group that would be suitable.

You can find information on self-help books from your local library or from the eating disorders charity Beat, which also has information on finding self-help and support groups for eating disorders.

If you are referred to a mental health professional for help, they might encourage you to work through a self-help book under their supervision. This is called "guided self-help".

Psychological therapy

People who binge eat are encouraged to stop relying on the cycle of bingeing and guilt as a way of dealing with their emotional problems.

It is possible to make a full recovery from binge eating by using certain types of psychological therapy, such as:

  • cognitive behavioural therapy (CBT) for binge eating disorder (CBT-BED) – a specially adapted type of CBT that involves talking to a therapist and working out new ways of thinking about situations, feelings and food 
  • an adapted form of dialectical behaviour therapy (DBT) – you discuss all aspects of your binge eating disorder with a therapist. DBT has been used effectively to treat other mental health disorders associated with impulsiveness
  • interpersonal therapy (IPT) – another form of brief therapy that has been shown to be helpful in treating patients with binge eating and bulimia 

Selective serotonin reuptake inhibitors

Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant that can help reduce binge eating. They are usually prescribed in combination with therapy.

SSRIs boost levels of a substance called serotonin. When serotonin is released in the brain, it helps to lift your mood. NICE recommends the use of SSRIs to help reduce binge eating, but the long-term effects of the treatment are unknown.

Known side effects of SSRIs include:

Read more information about selective serotonin reuptake inhibitors (SSRIs).

Losing weight

Although there are a number of psychological treatments available to treat binge eating, they might have a limited effect on your body weight.

However, underlying psychological issues need to be dealt with first to allow someone to regain control of their eating habits.

If you are overweight, you should follow a weight-loss plan that is drawn up by a healthcare professional, such as your GP or a dietitian (a food and nutrition specialist). The plan may involve the following:

  • keeping a food diary to highlight when you binge and the types of food you binge on that you think are fattening – you will be encouraged to include these in your eating plan to reduce the urge to binge on them
  • avoiding eating sugary foods, as eating quality carbohydrates (see below) will provide a slow and sustained energy release throughout the day
  • eating regular meals and snacks, and including complex carbohydrates, such as brown rice, wholemeal bread and cereal, lentils and potatoes – this will help keep you feeling full as well as stabilise your blood sugar

Read more information on eating good food and maintaining a healthy diet.

causes of binge eating...

There is no single cause for binge eating. However, like most eating disorders, it is seen as a way of coping with feelings of unhappiness and low self-esteem.

The binge eating cycle

People who binge eat often display a particular pattern of behaviour known as the binge eating cycle. The binge eating cycle (described below) is difficult to break.

  • binge eating leads to a surge in blood sugar that causes the pancreas to produce insulin (a hormone that helps to break down fat and carbohydrate in the body)
  • the insulin causes blood sugar levels to fall rapidly, resulting in a false message being sent to the brain that more food is needed to top up glucose levels
  • this results in cravings for sugary foods to provide a quick glucose fix, so the person eats large quantities of food even when they are not hungry
  • eating large amounts of sugary foods leads to a rapid increase in blood sugar levels and the production of insulin, causing the cycle to begin again

Depression

It is estimated that about 50% of people who binge eat have been depressed at some point in their life. However, it is not clear whether depression causes binge eating or whether binge eating causes depression.

Read more information about depression.

Stress and anxiety

Stress is another common trigger of eating disorders. Stressful events, such as moving house, job or school, or the death of a friend or relative, can sometimes cause someone to binge eat.

People with eating disorders usually experience difficulties in their personal life. Those who binge eat are often ashamed at the amount of food that they consume. They may also feel that their lack of control around food mirrors the lack of control they have over their personal lives.

Research has suggested that there are other factors or emotions that may bring on an episode of binge eating, including:

  • anger
  • boredom
  • worry or anxiety
  • sadness
  • low self-esteem

There are also specific behaviours that are more common in people with a binge eating disorder. These include:

  • impulsive behaviour – acting quickly without thinking about the consequences
  • alcohol misuse – regularly drinking more than the recommended daily amount of alcohol
  • avoiding discussing feelings and emotions openly
  • not feeling responsible for yourself or your actions

Trying to lose weight

The social pressure of trying to achieve a slim body shape can sometimes cause a person to binge eat.

People who binge eat may be unable to achieve their desired body shape. This can result in a sense of inadequacy, causing them to overeat and feel guilty afterwards.

It is not known whether dieting and binge eating are related. However, some people binge eat after:

  • skipping meals
  • not consuming enough food each day
  • avoiding certain foods

These are unhealthy methods of trying to lose weight and alter body shape, and these methods increase a person's risk of binge eating.

introduction of binge eating...

Binge eating is an eating disorder where a person feels compelled to overeat on a regular basis.

People who binge eat consume very large quantities of food over a short period of time and they often eat even when they are not hungry. Binges are often planned and can involve the person buying "special" binge foods.

Episodes of binge eating often alternate with periods where the person severely cuts down on the amount of food they eat, which can make the problem worse.

Binge eating usually takes place in private, with the person feeling that they have no control over their eating. They will often have feelings of guilt or disgust after binge eating. These feelings highlight underlying psychological issues, such as:

  • low self-esteem and lack of confidence
  • depression – feelings of extreme sadness that last for a long time
  • anxiety – a feeling of unease, such as worry or fear, that can range from mild to severe

These feelings can be made worse over time while the person is still binge eating.

Read more information about the causes of binge eating.

Who is affected by binge eating?

Anyone can be affected by binge eating. Unlike anorexia, where more women than men are affected, binge eating affects men and women equally. The condition tends to be more common in older adults than in younger people.

Binge eating and bulimia

People who binge eat and those with bulimia (another type of eating disorder) often eat until they are uncomfortably full. People with bulimia then purge (flush out) the food they have eaten by making themselves vomit or by taking laxatives (medicine to help empty the bowels).

Unlike those with bulimia, people who binge eat do not purge themselves to control their weight, and are more likely to try to limit weight gain by having periods of eating very little. However, this often leads to more binge eating and sometimes weight gain, which can lead to obesity (see below).

Binge eating and obesity

Binge eating is often associated with obesity, where someone is very overweight with a body mass index (BMI) of 30 or over. Obesity is a serious health problem that can lead to a number of serious chronic (long-term) health conditions, such as:

Being obese can also shorten your life expectancy. For example, the life expectancy of obese adults who are over the age of 40 can be shortened by six or seven years. 

Read more about the symptoms of binge eating for details of other health conditions related to obesity.

Seeing your GP

Visit your GP if you think that you have a binge eating problem. They will be able to diagnose the condition and refer you to a specialist, such as a psychiatrist or a psychologist. In some cases, you may also be referred to a dietitian.

In diagnosing binge eating, your GP will ask you about your eating habits and look for three or more of the following signs:

  • you eat much faster than normal during a binge
  • you eat until you feel uncomfortably full
  • you eat a large amount of food when you are not hungry
  • you eat alone or secretly due to being embarrassed about the amount of food you are consuming
  • you have feelings of guilt, shame or disgust after binge eating

People who regularly eat this way are likely to be diagnosed with a binge eating disorder.

Treating binge eating

Binge eating is a treatable condition and a number of different treatment options are available. For example, treatments include:

If you are overweight, a healthcare professional may draw up a weight loss plan once any psychological issues have been dealt with. This is to help you lose weight in a safe and effective way.

People can recover from binge eating if they can understand the psychological issues causing their condition, adopt regular eating patterns and receive realistic advice about food.

Read more about how binge eating is treated.

Biopsy

introduction of biopsy...

A biopsy is a medical procedure that involves taking a small sample of tissue so that it can be examined under a microscope.

A tissue sample can be taken from almost anywhere on, or in, your body, including the skin, stomach, kidneys, liver and lungs.

The term biopsy is often used to refer to both the act of taking the sample and the tissue sample itself.

What is a biopsy used for?

Biopsies are used to identify abnormal cells and to help diagnose many different health conditions or to find out a specific type or cause of a disease. In cases where a condition has been diagnosed, a biopsy can be used to measure how severe it is or what stage it's at.

For example, a biopsy can often help to diagnose or rule out:

Biopsies are commonly used to check whether a breast lump is non-cancerous (benign) or cancerous (malignant).

Read more about why a biopsy is necessary.

Types of biopsy

There are various types of biopsy that can be used to help identify a wide range of health conditions. Types of biopsy include:

  • scraping cells – removing cells from the surface layer of tissue, such as from the inside of the mouth, or from inside the cervix (neck of the womb) as part of a cervical screening test
  • a punch biopsy – is for diagnosing skin conditions by using a special instrument to punch a small hole in the skin to obtain a skin sample
  • a needle biopsy – a special hollow needle, guided by ultrasound, is used to obtain tissue from an organ or from tissue beneath the skin
  • an endoscopic biopsy – an endoscope is used to take a tissue sample, such as from the stomach during a gastroscopy (a diagnostic procedure of the stomach or upper gastrointestinal tract)
  • an excisional biopsy – surgery is used to take a larger section of tissue
  • perioperative biopsy – if consent is given, a perioperative biopsy can be performed during surgery; the sample will be tested within minutes so that the surgeon can be given the diagnoses and progress with appropriate treatment

How a biopsy is carried out will depend on where the tissue sample is being taken from.

After the tissue sample has been taken, the tissue will be closely examined under a microscope to see whether it appears abnormal. If it does, the pathologist examining the sample will try to identify the nature of the problem. This often means that a definite diagnosis is made.

The tissue may also be tested using various chemicals to see how it responds and to find out what it contains. The type of tests that are used will depend on the medical conditions being investigated.

Read more about how a biopsy is performed.

Recovery

Most biopsies will only require local anaesthetic, which means that you won't need to stay in hospital overnight. However, a general anaesthetic may be needed for surgery, in which case you may have to stay in hospital overnight.

You shouldn't usually feel pain after having most types of biopsy, although this depends on where from your body the biopsy is taken; you may feel a dull ache. This can be treated with painkillers on the advice of your doctor or surgeon.

Some types of biopsy may involve staying in hospital for a few hours or having stitches or a dressing applied before you leave.

Read more about recovering from a biopsy.

Getting your results

How quickly you get the results of a biopsy will depend on the urgency of your case and the hospital where you had the procedure.

If a serious condition is suspected, your results may be available within a few days. However, this is difficult to predict because there may be further tests needed after the first examination of the sample. Sometimes it is also necessary to send microscope slides away for a specialist's opinion. A cervical smear test result usually takes 10 to 14 days.

A different processing method is used when a biopsy is performed during surgery. This means that a result is often available within minutes, which enables the appropriate treatment to be given while the surgery is in progress.

Your GP, hospital consultant or practice nurse will give you your results and explain what they mean. Sometimes, a biopsy won't be conclusive, which means that it hasn't produced a definitive result. If this is the case, the biopsy may need to be repeated or you may need to have other tests to double-check your diagnosis.

recovery of biopsy...

Biopsies are usually straightforward and carried out as outpatient procedures using local anaesthetic. In such cases, you won't need to stay in hospital overnight.

However, some types of biopsy, such as those that involve taking a tissue sample from an internal organ, will require a general anaesthetic, which means you may need to stay in hospital overnight.

After having a biopsy, you won't usually feel any pain. However, if you've had a tissue sample taken from a major organ, such as your liver or from your bone marrow, you may feel a dull ache or a slight discomfort. Your doctor or surgeon will be able to advise you about the painkillers that you can take to help relieve this.

If an incision (cut) is required to remove a tissue sample – e.g. during an endoscopic biopsy or an excisional biopsy – the wound may need to be closed using stitches, or a dressing may need to be put on the wound.

If tissue is removed from an internal organ such as your liver or kidneys, you'll need to stay in hospital for a few hours after the procedure. This is so that you can rest and hospital staff can ensure that there's no internal bleeding. It's rare for serious bleeding to occur following a biopsy but if it does, you may need to have an operation or a blood transfusion.

Women who have had samples taken from their reproductive system, such as the lining of the neck of the womb (cervix), may have some light vaginal bleeding for a short while. Men who have had a prostate biopsy may have blood in their urine temporarily.

how-it-is-performed of biopsy...

There are many different ways of getting a tissue sample. The method used will depend on the type of tissue being collected and where in the body it's being taken from.

Scraping cells

In some cases, scraping cells from the surface layer of tissue, such as inside the mouth, is enough to provide a suitable sample for examination. This type of ‘scraping biopsy’ can be slightly uncomfortable but it's not painful, so anaesthetic isn't required.

A cervical screening test is a procedure in which a spatula, or small brush-like instrument, is used to gently remove a sample of cells from the neck of a woman’s womb (cervix). The cells are examined under a microscope for any abnormal changes (dysplasia).

If the cells display abnormal changes, it may mean that they're cancerous or that there's an increased risk that they will become cancerous.

Punch biopsy

A punch biopsy can often help to investigate skin conditions, such as deep spots and sores. During a punch biopsy, a special surgical instrument is used to make a small hole in your skin and remove samples of the top tissue layers. If you have a punch biopsy, you are usually given a local anaesthetic to numb the area.

Alternatively, a scalpel (a sharp medical knife) may be used to remove a small amount of surface skin. The wound will be closed using stitches. As with a punch biopsy, a local anaesthetic will be used for this procedure.

Needle biopsy

A fine-needle aspiration (FNA) biopsy is often used to take tissue samples from organs or from lumps that are below the surface of the skin. When a larger sample is needed, a core needle biopsy (CNB) may be used instead.

To obtain the sample, a special, hollow needle is inserted through your skin and into the area being examined. Ultrasound or X-rays will be used to help the doctor or surgeon guide the needle to exactly the right place.

When the needle is in position, it will ‘suck out’ a sample of tissue. If you have a needle biopsy, a local anaesthetic will usually be used to numb the area so that you won't feel any pain or discomfort.

Breast lumps

A needle biopsy can be used in most cases to get more information about a breast lump. The needle is inserted into the lump and a sample of tissue is taken for testing. A core needle biopsy (CNB) is often used to gain a larger sample of tissue. In some cases a fine needle aspiration (FNA) biopsy may be used to drain a cyst.

Organs

A thicker, hollow needle is used for taking biopsies of organs, such as the liver or kidneys. You will be asked to breathe in and hold your breath while the needle is inserted into your abdomen. It takes a few seconds for a small sample of tissue to be taken. A local anaesthetic will usually be used for this type of biopsy because you need to be awake to breathe in.

Bone marrow

A thick needle is also used to take samples of bone marrow (the soft, jelly-like tissue that's found in the hollow centre of all large bones). Bone marrow biopsies are carried out for different reasons, including:

  • to find out why you have a low or high number of red blood cells (anaemia)
  • to find out why you have a low or high number of white blood cells (leucopenia)
  • to find out why you have a low or high number of platelets (blood-clotting cells)

A number of different health conditions may be responsible for these types of blood abnormalities, such as leukaemia (cancer of the bone marrow and white blood cells).

Samples of bone marrow are also sometimes taken to check how well treatment for leukaemia is working, or to tell how far certain types of cancer have progressed (what stage it's at).

Bone marrow biopsies are usually taken from the top of the pelvis bone, just below your waist. You will usually have a local anaesthetic to numb the area, and may also be given a sedative (medication) to help you relax and cope with any discomfort, nerves or anxiety.

Endoscopic biopsy

An endoscope is a medical instrument that's used to look inside your body. It's a thin, flexible tube that has a light and a camera at one end. Tiny cutting tools can also be attached to the end of an endoscope to allow the surgeon to take a tissue sample.

An endoscope can be inserted through your throat, back passage (anus) or through small cuts made by the surgeon.

Depending on the area of the body being investigated and the entry point of the endoscope, either local or general anaesthetic may be used.

Excisional biopsy

An excisional biopsy is where surgery is used to remove a larger area of tissue, such as a lump, for closer examination.

Depending on where in the body the lump is located, an excisional biopsy may be performed under either a local or a general anaesthetic.

Perioperative biopsy

Sometimes, a biopsy is performed during surgery that is being carried out for another, unrelated reason. A tissue sample is taken during surgery and is checked immediately so that the surgeon gets the results quickly and can decide how to progress with treatment.

A lump that's found during surgery may be removed completely if the patient is still under anaesthetic and has previously given their consent (approval).

Bipolar disorder

prevention of bipolar disorder...

Although it is usually a long-term condition, effective treatments for bipolar disorder combined with self-help techniques can limit its impact on your everyday life.

Staying active and eating well

Eating well and keeping fit are important for everyone. Exercise can also help reduce the symptoms (particularly depressive symptoms) of bipolar disorder. It may also give you something to focus on and provide a routine, which is important for many people.

A healthy diet combined with exercise may also help limit weight gain, which is a common side effect of medical treatments for bipolar disorder.

Some treatments also increase the risk of developing diabetes or that diabetes gets worse. Maintaining a healthy weight and exercising is an important way of limiting that risk.

You should have a check-up at least once a year to monitor your risk of developing cardiovascular disease or diabetes. This will include recording your weight, checking your blood pressure and having any appropriate blood tests

Read more information about losing weight and improving fitness.

Self care and self management

Self care

Self care is an essential part of daily life. It involves taking responsibility for your own health and wellbeing with support from the people involved in your care. Self care includes staying fit and maintaining good physical and mental health, preventing illness or accidents and caring more effectively for minor ailments and long-term conditions.

People with long-term conditions can benefit enormously from being helped with self care. They can live longer, have less pain, anxiety, depression and fatigue, have a better quality of life and be more active and independent.

Self-management programmes

Self-management programmes aim to help people with bipolar disorder take an active part in their own recovery, so that they're not controlled by their condition.

One course run by MDF The Bipolar Organisation aims to teach people with bipolar disorder how to manage their illness. The programme includes information about:

  • triggers and warning signs
  • coping strategies and self-medication
  • support networks and action plans
  • maintaining a healthy lifestyle
  • drawing up an advance directive
  • complementary therapies
  • action plans

There are other courses, such as those run by the Expert Patients Programme, for mild to moderate mental health conditions.

Courses like these help people who may feel distressed and uncertain about their bipolar disorder to improve their own lives.

Talking about it

Some people with bipolar disorder find it easy to talk to family and friends about their condition and its effects. Other people find it easier to turn to charities and support groups. Many organisations run self-help groups that can put you in touch with other people with the condition. This enables people to share helpful ideas and realise that they're not alone in feeling the way they do. These organisations also provide online support in forums and blogs.

Some useful charities, support groups and associations include:

Talking therapies are useful for managing bipolar disorder, particularly during periods of stability.

Services that can help

During treatment for bipolar disorder, you may be involved with many different services. Some are accessed through referral from your GP, others through your local authority. These services may include:

  • Community mental health teams (CMHT) – these provide the main part of local specialist mental health services. They offer assessment, treatment and social care to people with bipolar disorder and other mental illnesses.
  • Early intervention teams – these provide early identification and treatment for people who have the first symptoms of psychosis. Your GP may be able to refer you directly to be seen by an early intervention team.
  • Crisis services – these allow people to be treated at home, instead of in hospital, for an acute episode of illness. They're specialist mental health teams that help with crises that occur outside normal office hours.
  • Acute day hospital – these exist in some places as an alternative to inpatient care in a hospital. You can visit every day or as often as necessary.
  • Assertive outreach teams – these deliver intensive treatment and rehabilitation in the community for people with severe mental health problems. They provide rapid help in a crisis. Staff often visit people at home and liaise with other services, such as your GP or social services. They can also help with practical problems, such as helping to find housing and work, or doing the shopping and cooking.

Avoiding drugs and alcohol

Some people with bipolar disorder use alcohol or illegal drugs to try to take away their pain and distress. Both have well-known harmful physical and social effects, and they're not a substitute for effective treatment and good healthcare.

Some people with bipolar disorder find that once they're on effective treatments, they can stop misusing alcohol and drugs. Others may have separate but related problems of alcohol and drug abuse, which may need to be treated separately.

Avoiding alcohol and drugs is an important part of recovery from episodes of manic, hypomanic or depressive symptoms, and can contribute to periods of stability.

Read more information about alcohol misuse and drug misuse.

Money and benefits

It's important to avoid too much stress, including work-related stress. If you're employed, you may be able to work shorter hours or in a more flexible way, particularly if job pressures play a role in episodes of symptoms. Under the Disability Discrimination Act (1995), all employers must make reasonable adjustments to make the employment of people with disabilities possible. This can include people with a diagnosis of bipolar disorder or other mental illnesses.

A range of benefits may be available to people with bipolar disorder who cannot work as a result of their mental illness. These may include:

Want to know more?

Living with or caring for someone with bipolar disorder

People living with or caring for someone with bipolar disorder can have a tough time. During episodes of illness, the personalities of people with bipolar disorder may change, and they may become abusive or even violent. Sometimes, social workers and the police may become involved. Relationships and family life are likely to feel the strain.

If you're the nearest relative (as defined by the Mental Health Act 1983) of a person with bipolar disorder, you have certain rights, which can be used to protect the person's interests. These include requesting that the local social services authority ask an approved mental health professional to consider whether the person with bipolar disorder should be detained in hospital (also known as "sectioning").

If you’re caring for someone with bipolar disorder, you may feel at a loss. Finding a support group and talking to other people in a similar situation might help.

If you’re having relationship or marriage difficulties, you can contact specialist relationship counsellors who can talk things through with you and your partner.

Want to know more?

Dealing with suicidal feelings

Having suicidal thoughts is a common depressive symptom of bipolar disorder. Without treatment, these thoughts may get stronger. Some research has shown that the risk of suicide for people with bipolar disorder is 15 to 20 times greater than the general population. Studies have also shown that as many as 25–50% of people with bipolar disorder attempt suicide at least once.

The risk of suicide seems to be higher earlier in the course of the illness, so early recognition and intervention may help prevent it.

If you're feeling suicidal or you're having severe depressive symptoms, contact your GP, care co-ordinator or the local mental health emergency services as soon as possible. 

If you can't or don’t want to contact these people, contact the Samaritans on 08457 90 90 90. You can call them 24 hours a day, seven days a week. Alternatively, visit the Samaritans website or email jo@samaritans.org.

Self-harm

Self-harm (sometimes called self-injury) is often a symptom of mental health problems such as bipolar disorder. For some people, self-harm is a way of gaining control over their lives or temporarily distracting themselves from mental distress. It may not be related to suicide or attempted suicide.

Want to know more? 

Recommended communities

Online communities help you talk to people, share your experiences and learn from others.

The SANE Discussion Board allows people to share their feelings and provide mutual support to anyone with mental health issues, as well as their friends and family.

treatment of bipolar disorder...

Treatments for bipolar disorder aim to reduce the severity and frequency of the episodes of depression and mania so that a person can live life as normally as possible.

Treatment options for bipolar disorder

If they are not treated, episodes of bipolar-related depression or mania can last for 6 to 12 months. On average, someone with bipolar disorder will have five or six episodes over a period of 20 years. However, with effective treatment, episodes usually improve within about three months.

Most people with bipolar disorder can be treated using a combination of different treatments. The treatment may include one or more of the following:

  • medication to prevent episodes of mania, hypomania (less severe mania) and depression – these are known as mood stabilisers and are taken every day, on a long-term basis
  • medication to treat the main symptoms of depression and mania when they occur
  • learning to recognise the triggers and signs of an episode of depression or mania
  • psychological treatment such as talking therapy to help deal with depression and to give you advice about how to improve your relationships
  • lifestyle advice such as doing regular exercise, planning activities that you enjoy and that give you a sense of achievement, and advice on improving your diet and getting more sleep.

Read more information about living with bipolar disorder.

Most people with bipolar disorder can receive most of their treatment without having to stay in hospital.

However, treatment in hospital may be required if your symptoms are severe, or if you are being treated under the Mental Health Act because there is a danger that you will harm yourself or others. In some circumstances, you may be able to have treatment in a day hospital and return home at night.

Medication

Several medications are available to help stabilise mood swings. These include:

If you are already taking medication for bipolar disorder and you develop depression, your GP will check that you are taking the correct dose and, if necessary, will adjust it.

Episodes of depression in bipolar disorder can be treated in a similar way to clinical depression. This includes using antidepressant medication. Read information about how depression is treated and antidepressants.

If your GP or psychiatrist recommends that you stop taking medication for bipolar disorder, the dose should be gradually reduced over a minimum of four weeks, and up to three months if you are taking an antipsychotic or lithium. If you have to stop taking lithium for any reason, see your GP about taking an antipsychotic or valproate (see below) instead.

Lithium carbonate

In the UK, lithium carbonate (often referred to as just lithium) is the medication that is most commonly used to treat bipolar disorder. Lithium is a long-term method of treatment for episodes of mania, hypomania and depression. It is usually prescribed for a minimum of six months.

If you are prescribed lithium, stick to the prescribed dose and do not stop taking it suddenly (unless told to by your doctor).

For lithium to be effective, the dosage must be correct. If the dose is incorrect, it may cause side effects, such as diarrhoea and vomiting. If you are taking lithium and you have side effects, tell your doctor immediately.

While taking lithium, you will need to have regular blood tests (at least once every three months) to ensure that your levels of lithium are not too high or too low. Your kidney and thyroid function will also need to be checked every two to three months if the dose of lithium is being adjusted, and every 12 months in all other cases.

While you are taking lithium, avoid using non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, unless they are prescribed by your GP. Your GP can advise you further about this.

In the UK, lithium is currently the only medication that is licensed for use in children who have bipolar disorder (who are aged 12 or over). However, in 2000, the Royal College of Paediatrics and Child Health stated that unlicensed medicines may be prescribed for children if there are no suitable alternatives, and where their use can be justified by expert agreement.

Anticonvulsant medicines

Anticonvulsant medicines include:

These medicines are sometimes used to treat episodes of mania. Like lithium, they are long-term mood stabilisers. Anticonvulsant medicines are often used to treat epilepsy, but they are also effective in treating bipolar disorder.

A single anticonvulsant medicine may be used or, where the condition does not respond to lithium on its own, they may be used in combination with lithium.

Valproate

Valproate is not usually prescribed for women of child-bearing age because there is a risk that it could damage an unborn child. However, if there is no alternative, your GP will need to ensure that you are using a reliable form of contraception.

If you are prescribed valproate, you will need to visit your GP to have a blood count when you begin the medication and then again six months later.

Carbamazepine

Carbamazepine is usually only prescribed on the advice of an expert in bipolar disorder. To begin with, the dose will be low before it's gradually increased. If you're taking other medication (including the contraceptive pill), your progress will be carefully monitored.

Blood tests to check your liver and kidney function will be carried out when you start taking carbamazepine and again after six months. You will also need to have a blood count (at the start and after six months) and you may also have your weight and height monitored.  

Lamotrigine

If you are prescribed lamotrigine, you will usually be started on a low dose that will be increased gradually.

If you are taking lamotrigine and you develop a rash, see your GP immediately. You will need to have an annual health check, but other tests will not usually be required.

Women who are taking the contraceptive pill should talk to their GP about changing to a different method of contraception.

Antipsychotic medicines

Antipsychotic medicines are sometimes prescribed to treat episodes of mania or hypomania. Antipsychotic medicines include: 

They may also be used as a long-term mood stabiliser. Quetiapine may be used for long-term bipolar depression.

Antipsychotic medicines can be particularly useful if symptoms are severe or behaviour is disturbed. As antipsychotics can cause side effects, such as blurred vision, dry mouth, constipation and weight gain, the initial dose will usually be kept low.

If you are prescribed an antipsychotic medicine, you will need to have regular health checks (at least every three months but possibly more often), particularly if you have diabetes. If your symptoms do not improve, you may be offered lithium and valproate as well.

Rapid cycling

If you have rapid cycling (you quickly change from highs to lows without a "normal" period in between), you may be prescribed a combination of lithium and valproate.

If this does not help, you may be offered lithium on its own or a combination of lithium, valproate and lamotrigine. However, you will not usually be prescribed an antidepressant unless an expert in bipolar disorder has recommended it.

Learning to recognise triggers

If you have bipolar disorder, you can learn to recognise the warning signs of an approaching episode of mania or depression.

This will not prevent the episode from occurring, but it will allow you to get help in time.

This may mean making some changes to your treatment, perhaps adding an antidepressant or antipsychotic medicine to the mood-stabilising medication you are already taking. Your GP or specialist can advise you about this.

Psychological treatment

Some people find psychological treatment helpful when used alongside medication in between episodes of mania or depression. This may include:

  • psychoeducation to help you find out more about bipolar disorder
  • cognitive behavioural therapy (CBT), which is most useful when treating depression
  • family therapy, a type of psychotherapy that focuses on family relationships (such as marriage) and encourages everyone within the family or relationship to work together to improve mental health

Pregnancy

The management of bipolar disorder in women who are pregnant, or those who are trying to conceive, is complex and challenging. One of the main problems is that the risks of taking medication during pregnancy are not always that well understood.

The National Institute for Health and Clinical Excellence (NICE) recommends that the risks of treating or not treating women with bipolar disorder during pregnancy should be fully discussed.

NICE also recommends that specialist mental health services should work closely with maternity services. A written plan for managing the treatment of a pregnant woman with bipolar disorder should be developed as soon as possible. The plan should be drawn up with the patient, her partner, her obstetrician (pregnancy specialist), midwife, GP and health visitor.

The following medication is not routinely prescribed for pregnant women with bipolar disorder:

  • valproate – there is a risk to the foetus and the subsequent development of the child
  • carbamazepine – it has limited effectiveness and there is risk of harm to the foetus
  • lithium – there is a risk of harm to the foetus, such as cardiac problems
  • lamotrigine – there is a risk of harm to the foetus
  • paroxetine – there is a risk of harm to the foetus, such as cardiovascular malformations
  • long-term treatment with benzodiazepines – there are risks during the pregnancy and immediately after the birth, such as cleft palate and floppy baby syndrome

introduction of bipolar disorder...

Bipolar disorder – known in the past as manic depression – is a condition that affects your moods, which can swing from one extreme to another.

If you have bipolar disorder, you will have periods or "episodes" of:

  • depression – where you feel very low and lethargic
  • mania – where you feel very high and overactive (less severe mania is known as hypomania)

The symptoms of bipolar disorder depend on which mood you are experiencing. Unlike simple mood swings, each extreme episode of bipolar disorder can last for several weeks or longer, and some people may not experience a "normal" mood very often.

Depression

The depression phase of bipolar disorder is often diagnosed first. You may initially be diagnosed with clinical depression before having a manic episode later (sometimes years later), after which you may be diagnosed with bipolar disorder.

During an episode of depression, you may have overwhelming feelings of worthlessness, which can potentially lead to thoughts of suicide.

If you're feeling suicidal or having severe depressive symptoms, contact your GP, care co-ordinator or the local mental health emergency services as soon as possible.

If you can't or don’t want to contact these people, call the Samaritans on 08457 90 90 90. You can call them 24 hours a day, seven days a week. Alternatively, visit the Samaritans website or email jo@samaritans.org.

Mania

During a manic phase of bipolar disorder, you may feel very happy and have lots of ambitious plans and ideas. You may spend large amounts of money on things that you cannot afford and would not normally want. Not feeling like eating or sleeping, talking quickly and becoming annoyed easily are also common characteristics of the manic phase of bipolar disorder.

During the manic phase, you may feel very creative and view mania as a positive experience. However, during the manic phase of bipolar disorder, you may also have symptoms of psychosis (where you see or hear things that are not there or become convinced of things that are not true).

Living with bipolar disorder

The high and low phases of bipolar disorder are often so extreme that they interfere with everyday life. However, there are several options for treating bipolar disorder that can make a difference. They aim to control the effects of an episode and help someone with bipolar disorder to live life as normally as possible.

It is thought that using a combination of treatments is the best way to control bipolar disorder. Treatment can include:

  • medication to prevent episodes of mania, hypomania (less severe mania) and depression – these are known as mood stabilisers and are taken every day, on a long-term basis
  • medication to treat the main symptoms of depression and mania when they occur
  • learning to recognise the triggers and signs of an episode of depression or mania
  • psychological treatment such as talking therapy to help deal with depression and to give you advice about how to improve your relationships
  • lifestyle advice such as doing regular exercise, planning activities that you enjoy and that give you a sense of achievement, and advice on improving your diet and getting more sleep

Help and advice for people with a long-term condition or their carers is also available from charities, support groups and associations. This includes self-help and self-management advice and dealing with the practical aspects of a long-term condition. Find out more about living with bipolar disorder.

What causes bipolar disorder?

The exact causes of bipolar disorder are not known. However, it is thought that several things can trigger an episode. Extreme stress, overwhelming problems and life-changing events are often thought to contribute, as well as genetic and chemical factors.

Who is affected?

Bipolar disorder is relatively common. Around one person in 100 is diagnosed with the condition.

Bipolar disorder can occur at any age, although it often develops between the ages of 18 and 24 years. Men and women from all backgrounds are equally likely to develop bipolar disorder.

The pattern of mood swings in bipolar disorder varies widely between people. For example, some people will only have a couple of bipolar episodes in their lifetime and will be stable in between, while others may experience many episodes.

Bladder cancer

treatment of cancer of the bladder...

Many hospitals use multidisciplinary teams (MDTs) to treat bladder cancer.

MDTs are teams of specialists that work together to make decisions about the best way to proceed with your treatment.

Members of your MDT will probably include a:

  • surgeon
  • clinical oncologist (a specialist in the non-surgical treatment of cancer)
  • pathologist (a specialist in diseased tissue)
  • radiologist (a specialist in radiotherapy)
  • urologist (a doctor who specialises in treating conditions that affect the urinary tract)
  • social worker
  • psychologist
  • specialist cancer nurse, who will usually be your first point of contact with the rest of the team

Deciding what treatment is best for you can be difficult. Your MDT will make recommendations, but remember that the final decision is yours. 

Before discussing your treatment options, you may find it useful to write a list of questions to ask.

Non-muscle invasive bladder cancer

Your treatment plan

If you have been diagnosed with non-muscle invasive bladder cancer, your recommended treatment plan will depend on the risk of the cancer returning or spreading beyond the lining of your bladder.

This risk is calculated using a series of factors, including:

  • the number of tumours that are present in your bladder
  • whether the tumours are larger than 3cm (one inch) in diameter
  • whether you have had bladder cancer before
  • whether the tumours are limited to your bladder lining, or whether they've started spreading beyond the lining
  • the grade of the cancer cells

The grade of the cancer cells describes how aggressively they are likely to grow and spread, with low grade being the least aggressive and high grade being the most aggressive.

If the risk of your cancer returning or spreading is low, your recommended treatment plan will usually be surgery to remove the tumours followed by a course of chemotherapy that is placed inside your bladder.

If the risk of your cancer returning or spreading is moderate, you will be given a longer course of chemotherapy after you've had surgery.

If the risk of your cancer returning or spreading is high, as well as surgery and chemotherapy you will be given an additional medication known as the Bacillus Calmette-Guérin (BCG) vaccine.

Surgery, chemotherapy and the BCG vaccine for non-muscle invasive bladder cancer are discussed in more detail below.

Surgery

The standard surgical treatment for non-muscle invasive bladder cancer is known as a transurethral resection (TUR). In most cases, a TUR can be performed at the same time as a biopsy.

A TUR is carried out under general anaesthetic. The surgeon will use an instrument called a cystoscope to locate all of the visible tumours and will then cut them away from the lining of the bladder.

Once the tumour(s) have been removed, any bleeding can be stopped using a mild electric current to seal (cauterise) the remaining wound.

If you experience significant bleeding, a thin, flexible tube called a catheter may be inserted into your urethra and passed up into your bladder. The catheter will be used to drain away any blood and debris from your bladder. It may need to be kept in place for several days.

Most people are able to leave hospital within 48 hours of having a TUR and are able to resume normal physical activity within two weeks.

Chemotherapy

After having surgery, you will be given one or more courses of chemotherapy. You will have your first course after surgery has been completed and you have recovered from the effects of the general anaesthetic.

A type of chemotherapy called intravesical chemotherapy is used. It involves placing a liquid solution of chemotherapy medication directly into your bladder using a catheter. The solution will be kept in your bladder for about an hour before being drained away.

Some residue of the chemotherapy medication may be left in your urine, so be careful not to splash yourself or the toilet seat with urine because it could irritate your skin. After passing urine, wash the skin around your genitals with soap and water.

The advantage of using intravesical chemotherapy is that because the chemotherapy medication is placed inside your bladder, rather than being injected into your blood so you will not experience the side effects that are most commonly associated with chemotherapy, such as nausea, fatigue and hair loss.

The most common side effect of intravesical chemotherapy is irritation and inflammation of the bladder lining. This can sometimes cause a frequent need to urinate and pain when urinating. These side effects should pass within a few days.

If your cancer is low-risk, you should not require any additional treatment. However, if your cancer is medium- or high-risk, you will be given additional courses of chemotherapy, usually once a week over six weeks.

If you have sex, it is important that you use contraception while you are having intravesical chemotherapy because the medication that is used can temporarily affect the quality of a man’s sperm and a woman’s eggs. This increases the risk of birth defects.

Read more about chemotherapy.

Bacillus Calmette-Guérin (BCG) vaccine

The BCG vaccine is used to treat high-risk cases of non-muscle invasive bladder cancer in order to reduce the risk of the cancer returning.

The BCG vaccine was originally used to treat tuberculosis (TB), but it has also proved to be an effective treatment against bladder cancer. Exactly how the BCG vaccine works is still unclear. It appears to stimulate the immune system in such a way that it begins to target and destroy any remaining cancer cells.

The BCG vaccine is given in the same way as intravesical chemotherapy. A liquidised version of the vaccine is passed into your bladder. The vaccine will be left in your bladder for two hours before being drained away.

The above precaution about not splashing yourself or the toilet seat with urine also applies to the BCG vaccine.

Most people require weekly treatments over a six-week period. Depending on your circumstances, maintenance therapy may also be recommended. This involves receiving further doses of the BCG every six months, with a series of three-weekly doses.

Maintenance therapy usually lasts for three years.

Common side effects of the BCG include:

  • a frequent need to urinate
  • pain when urinating
  • blood in your urine (haematureia)

You should inform your MDT if the side effects become particularly troublesome because additional treatments are available for them.

Muscle-invasive bladder cancer

Your treatment plan

The recommended treatment plan for muscle-invasive bladder cancer will depend on how far the cancer has spread (see diagnosing bladder cancer for more information about staging).

With T2, T3 and T4a bladder cancer, a cure may be possible using a combination of chemotherapy, radiotherapy and surgery to remove some, or all, of your bladder.

With T4b bladder cancer, the prospect of achieving a cure is slim. However, it is possible to control the symptoms and slow the spread of the cancer using chemotherapy and radiotherapy, and sometimes surgery.

Surgery

The most widely used type of surgery in bladder cancer is a radical cystectomy.

This is where all of your bladder is removed as well as nearby lymph nodes, part of the urethra, the prostate (in men), and the cervix and womb (in women).

A radical cystectomy carries the obvious disadvantage of a loss of normal bladder function. To compensate for this, further surgery will be required to create an alternative way for urine to leave your body. This type of surgery is known as urinary diversion.

Men also have the risk of being unable to get or maintain an erection (erectile dysfunction) after having a radical cystectomy. This is because the operation can sometimes damage the nerves that are responsible for getting an erection. However, treatments for erectile dysfunction are available.

Read more information about the complications of bladder cancer surgery.

Radiotherapy

Radiotherapy is an alternative treatment option for muscle-invasive bladder cancer.

Radiotherapy is a type of treatment that uses pulses of radiation to destroy cancerous cells.

There are three main ways that radiotherapy can be used to treat bladder cancer which are explained below. Radiotherapy can be used:

  • before you have a cystectomy, to shrink the tumour(s) and increase the chances of the operation being successful
  • as a primary treatment to try to cure bladder cancer; this may be a preferred option if your general health is thought to be too poor to withstand the effects of a cystectomy
  • to help control the symptoms in cases of incurable bladder cancer; known as palliative radiotherapy

External radiotherapy

Radiotherapy that is used to shrink tumours and achieve a cure is given by a machine that beams the radiation at the bladder (external radiotherapy).

Sessions of external radiotherapy for bladder cancer are usually given on a daily basis for five days a week, over the course of four-to-seven weeks. Each session lasts for about 10 to 15 minutes.

As well as destroying cancerous cells, radiotherapy can also damage healthy cells, which means it can cause a number of different side effects. These include:

  • diarrhoea
  • inflammation of the bladder (cystitis),
  • which can cause pain when urinating as well as an increased need to urinate
  • tightening of the vagina (in women), which can make having sex difficult and painful
  • erectile dysfunction (in men)
  • loss of pubic hair
  • infertility

With the exception of infertility, these side effects should pass a few weeks after your treatment finishes. The fact that radiation has been directed at your pelvis will usually mean that you will be infertile for the rest of your life. If you still want to have children, discuss possible treatment options with your MDT.

For example, men can have samples of their sperm frozen and women can have their eggs frozen for use in future artificial insemination treatments or IVF. However, this will not be possible for women who have a radical cystectomy because their womb will be removed.

External radiotherapy will not make you radioactive and you will pose no danger to other people, including children and pregnant women.

Palliative radiotherapy

Palliative radiotherapy, where the aim is to relieve symptoms rather than achieve a complete cure, is usually only given for a few minutes, so it will not usually cause side effects. If there are any side effects, they will only last for a short time.

Read more about radiotherapy.

Surgery or radiotherapy?

Your MDT may recommend that you use a specific treatment option due to your individual circumstances.

For example, surgery is often recommended in cases where bladder cancer is more advanced because it is usually more effective in preventing the cancer from returning. Radiotherapy is often recommended for people who are too ill to withstand the effects of surgery.

However, in many cases, the decision about whether to have surgery or radiotherapy will be a matter of personal preference. Both treatment options have their own set of pros and cons.

The pros of having a radical cystectomy include:

  • You avoid the side effects of radiotherapy, such as diarrhoea or an increased need to urinate.
  • You don't need to attend as many follow-up appointments as you would if you had radiotherapy.

The cons of having a radical cystectomy include:

  • Further surgery will be required to create a new way of passing urine out of your body.
  • It can take up to three months to fully recover from the effects of bladder surgery.
  • There is a relatively high risk of erectile dysfunction in men (estimated at around 90%) and reduced sexual pleasure in women (just under half of women will experience this) after surgery.
  • There's around a 1 in 50 chance of a radical cystectomy causing a fatal complication, such as a heart attack or stroke.

The pros of having radiotherapy include:

  • There is no need to have surgery, which is often an important consideration for people who are in poor health.
  • It is usually possible to maintain normal bladder function.
  • There is less chance of causing erectile dysfunction (estimated at around 30% compared with 90% for a radical cystectomy).

The cons of having radiotherapy include:

  • You will require regular sessions of radiotherapy for four-to-seven weeks.
  • There is an increased risk of the cancer returning which may mean that you would still need to have surgery to remove your bladder.
  • Side effects, such as diarrhoea, tiredness and inflammation of the bladder (cystitis) are common.
  • There is a chance that the bladder could be permanently damaged, which could lead to a loss of bladder control and the involuntary leakage of urine (urinary incontinence).

Before making a decision about which treatment to have, you should fully discuss the pros and cons of each treatment option with your MDT.

Chemotherapy

There are three main ways that chemotherapy can be used to treat muscle-invasive bladder cancer. It can be used:

  • before radiotherapy and surgery to shrink the size of any tumours
  • in combination with radiotherapy before surgery (chemoradiation)
  • to slow the spread of incurable, advanced bladder cancer

As yet, there is not enough evidence to say whether chemotherapy is an effective treatment when it is given after surgery to prevent the cancer returning.

Intravenous chemotherapy is used to treat muscle-invasive bladder cancer, which involves a combination of different chemotherapy medications being injected into your vein.

Chemotherapy is usually given two days a week for several weeks. You will then have a week off to allow your body to recover from the effects of the treatment. This cycle will then be repeated for a few months.

A total course of chemotherapy can last for up to six months. As the chemotherapy medication is being injected into your blood, you will experience a wider range of side effects than if you were having intravesical chemotherapy (where chemotherapy medication is placed directly into your bladder).

The side effects of chemotherapy can include:

  • nausea
  • vomiting
  • hair loss
  • lack of appetite
  • tiredness

These side effects should stop after the treatment has finished. Chemotherapy can also weaken your immune system, making you more vulnerable to infection.

It is therefore important to report any symptoms of a potential infection, such as a high temperature, persistent cough or reddening of the skin, to your MDT. Avoid close contact with people who are known to have an infection.

Read more about chemotherapy. 

Follow-up

If your treatment did not involve removing all of your bladder (which is usually the case with non-muscle invasive bladder cancer and some cases of muscle-invasive bladder cancer), there is a risk that the cancer will return. This can be as high as 80% in high-risk cases.

Factors that increase the risk of the cancer returning include:

  • having multiple tumours
  • having a tumour(s) that are larger than 3cm (one inch) in diameter
  • having a previous history of recurring bladder cancer

Due to this risk, it is recommended that you have regular urinary cytography tests or cystoscopies to assess the state of your bladder. The frequency of these tests will depend on how likely your MDT thinks it is that the cancer will return.

If the risk of the cancer returning is thought to be relatively low, you will probably only need to have a cystoscopy three months after your treatment is completed. If the results of this prove negative, a further cystoscopy will be carried out nine months later and then yearly for five years.

If the risk of the cancer returning is thought to be high, you will probably need to have a cystoscopy and a urinary cytography every three months for two years. If the results of both tests prove negative, the frequency can then be reduced to every six months for five years and followed by yearly testing after that date.

Your MDT will be able to provide more advice and recommendations regarding the timing of your follow-ups.

If you have had your bladder removed, there is still a chance that cancerous cells could return else where in your body, such as in your lungs, abdomen or pelvis. It may be recommended that you attend annual appointments so that your lungs can be checked using a chest X-ray and your abdomen and pelvis checked using a computer tomography (CT) scan.



complications of cancer of the bladder...

Urinary diversion

If your bladder is removed during a radical cystectomy, an alternative way of passing urine out of your kidneys will need to be found.

There are various treatment options, which are described below. In some cases, you may be able to make a choice based on your personal preferences. However, certain treatment options will not be suitable for everyone.

Your multi-disciplinary team (MDT) will be able to provide you with information about which option(s) are suitable for you.

Urostomy

A urostomy is the most common type of urinary diversion operation. During the operation, the surgeon will make a hole in your abdominal wall. The hole is known as a stoma.

A small section of your small bowel will be removed and connected to your ureters (the two tubes that normally carry urine out of the kidneys). The other end of the small bowel will be connected to your stoma. A flat, waterproof pouch will be connected to the stoma to collect the urine.

After the operation, you will be introduced to a stoma nurse who will teach you how to care for your stoma and how and when to change the pouch. Most people will need to empty their pouch the same number of times they would usually pass urine.

The Urostomy Association is a UK-based charity who provide information and assistance to people who have recently had, or are about to have, a urostomy.

Continent urinary diversion

A continent urinary diversion is a similar type of operation to an urostomy, but it does not involve using a pouch. Instead, a section of your bowel will be used to create an internal pouch that is used to store urine.

The pouch will be connected to your ureters at one end and to a stoma that is made in your abdominal wall at the other end. The pouch can be emptied by inserting a catheter (a thin, flexible tube) into the stoma to drain away the urine. Most people need to empty their pouch about four or five times a day.

Bladder reconstruction

In some cases, it may be possible to create a new bladder, known as a neobladder. This involves removing a section of your bowel and reconstructing it into a balloon-like sac, before connecting it to your urethra at one end and your ureters at the other end.

Bladder reconstruction is not a suitable treatment for everyone. For example, it cannot be used if the cancer has spread to your urethra because your urethra will have to be removed.

You will be taught how to empty your neobladder by relaxing the muscles in your pelvis while at the same time tightening the muscles in your abdomen.

Your neobladder will not contain the same types of nerve endings as a real bladder so you will not get the distinctive sensation that tells you that you need to pass urine. Some people experience a feeling of fullness inside their abdomen while others have reported that they feel like they need to pass wind.

Due to the loss of normal nerve function, around 25% of people with a neobladder will experience some episodes of urinary incontinence (involuntary passing of urine), which usually occurs during the night while asleep.

You may find it useful to empty your neobladder at set times during day, including before you go to bed, because this may help to prevent incontinence (accidentally wetting yourself).

Guy’s and St Thomas’ Hospital Trust has more information and advice about creating and living with a neobladder (PDF, 80kb).

Sexual problems

Erectile dysfunction

Contact your GP if you lose the ability to obtain or maintain an erection. It may be possible for you to be treated with a type of medicine known as phosphodiesterase type 5 inhibitors (PDE5). PDE5s work by increasing the blood supply to your penis.

The most commonly used PDE5 is sildenafil (Viagra). However, other PDE5s are available if sildenafil is not effective.

An alternative to PDE5s is a device called a vacuum pump, which consists of a tube that is connected to a pump. The penis is placed inside the tube and the air is pumped out. This creates a vacuum that causes blood to rush to the penis. A rubber ring is then placed around the base of the penis, which keeps the blood in place and allows an erection to be maintained for around 30 minutes.

Read more about treating erectile dysfunction.

Narrowing of the vagina

Both radiotherapy and cystectomy can cause a woman’s vagina to become shortened and narrowed, which can make having sex painful or difficult.

There are two main treatment options available if you have a narrowed vagina. The first is to apply hormonal cream to your vagina which should help to increase moisture inside your vagina, making sex easier. The second is to use a vaginal dilator. This is a tampon shaped device that is made out of plastic and designed to help make your vagina more supple.

It is usually recommended that you insert the dilator for five to ten minutes at a time on a regular basis during the day over the course of six to 12 months.

Many women find this an embarrassing issue to discuss but it is a standard and well recognised treatment for narrowing of the vagina. Your specialist cancer nurse should be able to provide you with more information and advice.

You may find that the more times you have penetrative sex, the less painful it becomes. However, it may be several months before you feel emotionally ready to be intimate with a sexual partner.

Macmillan Cancer Support has some excellent information and a video about sexuality and cancer.

Emotional impact

The emotional impact of living with bladder cancer can be significant. Many people report experiencing a kind of "rollercoaster" effect.

For example, you may feel very down at receiving a diagnosis, feel up when you get confirmation that the cancer has been removed from your body and then feel down again as you try to come to terms with the after-effects of your treatment.

This type of emotional disruption can sometimes trigger feelings of depression. Signs that you may be depressed include:

  • being bothered during the past month by feeling down or hopeless
  • no longer taking pleasure in the things you enjoy

Contact your GP for advice if you think you may be depressed. There is a range of relatively successful treatments for depression, including antidepressant medication and talking therapies, such as cognitive behavioural therapy (CBT).

Read more about depression and coping with cancer.



prevention of cancer of the bladder...

Smoking

If you smoke, giving up is the best way to reduce your risk of developing cancer of the bladder, as well as other serious and potentially fatal health conditions, such as heart attack and stroke.

If you decide to stop smoking, your GP will be able to refer you to the NHS Stop Smoking Service, which will provide you with dedicated help and advice about the best ways to give up smoking.

You can also call the NHS Smoking Helpline on 0800 022 4332 (7am to 11pm). The specially trained helpline staff will be able to offer you free expert advice and encouragement.

If you are committed to giving up smoking but you do not want to be referred to a stop smoking service, your GP should be able to prescribe medical treatment to help with any withdrawal symptoms that you may experience after giving up.

For more information and advice about giving up smoking, see treatment for quitting smoking and stop smoking.

Workplace safety

If your job involves exposure to chemicals, your risk of developing bladder cancer could be increased. Occupations that have been linked to an increased risk of bladder cancer are manufacturing jobs that involve the following substances:

  • rubber
  • dyes
  • textiles
  • plastic
  • chemicals

Nowadays, there should be rigorous safety protocols in place that are designed to minimise your risk of exposure. If you are uncertain about what these protocols involve, talk to your line manager or health and safety representative.

If you are concerned that your employer may be disregarding recommendations about workplace safety, you should contact the Health and Safety Executive for advice.

Diet

There is some evidence to suggest that a diet that is high in fruit and vegetables and low in fat can help prevent bladder cancer. Even if though this evidence is limited, it is a good idea to follow this type of healthy a diet because it can help prevent other types of cancer, such as bowel cancer, as well as other serious health conditions, such as high blood pressure (hypertension), stroke and heart disease.

A low-fat, high-fibre diet is recommended, including plenty of fresh fruit and vegetables (five portions a day) and whole grains. Limit the amount of salt that you eat to no more than 6g (0.2oz) a day (one teaspoon) because too much salt will increase your blood pressure.

There are two types of fat: saturated and unsaturated. Try to avoid foods that contain saturated fats because they will increase your cholesterol levels.

Foods that are high in saturated fat include:

  • meat pies
  • sausages and fatty cuts of meat
  • butter
  • ghee (a type of butter often used in Indian cooking)
  • lard
  • cream
  • hard cheese
  • cakes and biscuits
  • foods that contain coconut or palm oil

However, a balanced diet should include a small amount of unsaturated fat because it will actually help to reduce your cholesterol levels.

Foods that are high in unsaturated fat include:

  • oily fish
  • avocados
  • nuts and seeds
  • sunflower, rapeseed, olive and vegetable oils

Read more about healthy eating and facts about fat.



Blood pressure (high)

andysstrokestory of blood pressure (high)...

Andy Jones liked to eat a lot of salt with his food. Whatever he ate, whether it was a Chinese takeaway or fish and chips, Andy would always add plenty of seasoning.

Although he didn’t consider himself unhealthy, Andy didn’t exercise and was overweight, which earned him the nickname Chunky.

The excessive salt Andy was adding to his food had raised his blood pressure to dangerous levels. High blood pressure caused his arteries to fur up and put extra strain on his heart. 

Most people with high blood pressure don’t have any symptoms, but the condition sharply increases the risk of having a stroke.

In December 2003, Andy, who ran a courier business in Warwick, collapsed at someone’s doorstep during a delivery.

“I had a feeling like vertigo and I felt dizzy,” he says. “I knocked on the door and I told the person who answered that I was feeling unwell. I collapsed moments later.”

He had lost the use of his right side and his speech was slurred. Hospital tests confirmed he had had a stroke caused by a blood clot.

Cholesterol control

Andy was in hospital for a week, where he was given physiotherapy and speech therapy. He took medication to control his blood pressure and cholesterol.

“I was home for Christmas Eve,” he says. “I was walking again by then, but it took me three months to regain the use of my hand and arm.

“My speech and my ability to swallow came back within 24 hours. However, even now I struggle with tying shoelaces and using keys.”

He says his family were crucial in his recovery. “They helped with my determination to get better,” he says. “My mother walked with me every day.”

Having a stroke at 40 was a big shock for Andy. “I thought strokes didn’t happen to people my age,” he says.

In fact, out of the 150,000 people who have a stroke in the UK each year, 31,000 are under 60.

“It took me a long time to come to terms with my stroke,” Andy says. “I still suffer bouts of anxiety and depression.”

Returning to work

Andy says the stroke has left few traces, but its less obvious effects include moments of extreme tiredness.

“It’s a hidden disability that’s hard to explain,” he says. “It’s a fatigue I’ve never experienced before and it’s quite debilitating.”

He lost his business soon after the stroke, but was keen to get back to work as soon as possible, to rebuild his self-esteem. After working as a driver in the voluntary sector, Andy now works part-time in a betting shop.

Cutting out salt

He is now a lot more careful about what he eats, has cut down on takeaways and greatly reduced the amount of salt in his diet.

“I don’t add salt to my food,” he says. “If I feel like a snack, I’ll have fruit.”

He says he eats his meals more slowly, which leaves him more satisfied. “I always aim to be the last to finish,” he says. “It means I eat less but feel fuller.”

Andy believes his excessive consumption of salt helped lead to his stroke. “My diet and lack of exercise contributed greatly to my stroke,” he says.

“I wish I had known I had high blood pressure. I would have done something about it and would probably have prevented the stroke.”

Some good has come out of Andy's experience: he may have saved his younger brother from a stroke.

“After my stroke, he went to have his blood pressure checked and found it was too high. Now he’s addressing that.”
complications of blood pressure (high)...

High blood pressure (hypertension) puts extra strain on your heart and blood vessels.

If untreated, over time this extra pressure can increase your risk of a heart attack, stroke and kidney disease.

Cardiovascular disease

High blood pressure can cause many different diseases of the heart and blood vessels (medically known as cardiovascular diseases), including:

  • stroke: occurs when the blood supply to part of the brain is cut off
  • heart attack: happens when the supply of blood to the heart is suddenly blocked
  • embolism: occurs when a blood clot or air bubble blocks the flow of blood in a vessel
  • aneurysm: occurs when a blood vessel wall bursts causing internal bleeding

Kidney disease

High blood pressure can also damage the small blood vessels in your kidneys and stop them from working properly.

This can cause a number of symptoms, including:

  • tiredness
  • swollen ankles, feet or hands (due to water retention)
  • shortness of breath
  • blood in your urine
  • urinating more often, particularly at night
  • itchy skin

Kidney disease can be treated using a combination of medication and food supplements.

More serious cases may require dialysis (a treatment where waste products are artificially removed from the body) or a kidney transplant.

Find out about how to prevent high blood pressure.


Angina
Angina is chest pain caused by a reduced flow of blood to the heart, typically resulting from heart disease.
Arteries
Arteries are blood vessels that carry blood from the heart to the rest of the body.
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Blood vessels
Blood vessels are the tubes in which blood travels to and from parts of the body. The three main types of blood vessels are veins, arteries and capillaries.
Brain
The brain controls thought, memory and emotion. It sends messages to the body controlling movement, speech and senses.
Heart
The heart is a muscular organ that pumps blood around the body.
Heart attack
A heart attack happens when there is a blockage in one of the arteries in the heart.  
Kidneys
Kidneys are a pair of bean-shaped organs located at the back of the abdomen, which remove waste and extra fluid from the blood and pass them out of the body as urine.

introduction of blood pressure (high)...

Known as the "silent killer", high blood pressure rarely has obvious symptoms.

Around 30% of people in England have high blood pressure but many don't know it. If left untreated, high blood pressure increases your risk of a heart attack or stroke.

The only way of knowing there is a problem is to have your blood pressure measured. 

All adults should have their blood pressure checked at least every five years. If you haven’t had yours measured, or you don’t know what your blood pressure reading is, ask your GP to check it for you.

What is high blood pressure?

Blood pressure measures how strongly blood presses against the walls of your arteries (large blood vessels) as it is pumped around your body by your heart. If this pressure is too high it puts a strain on your arteries and your heart, which makes it more likely that you will suffer a heart attack, a stroke or kidney disease.

Blood pressure is measured in millimetres of mercury (mmHg) and it is recorded as two figures:

  • systolic pressure: the pressure of the blood when your heart beats to pump blood out
  • diastolic pressure: the pressure of the blood when your heart rests in between beats

    For example, if your GP says your blood pressure is "140 over 90", or 140/90mmHg, it means you have a systolic pressure of 140mmHg and a diastolic pressure of 90mmHg.

    You are said to have high blood pressure (medically known as hypertension) if readings on separate occasions consistently show your blood pressure to be 140/90mmHg or higher.

    A blood pressure reading below 130/80mmHg is considered to be normal.

    Who is most at risk?

    Your chances of having high blood pressure increase as you get older. There is often no clear cause of high blood pressure but you are at increased risk if you:

    • are overweight
    • have a relative with high blood pressure
    • are of African or Caribbean descent
    • eat a lot of salt
    • don't eat enough fruit and vegetables
    • don't do enough exercise
    • drink a lot of coffee (or other caffeine-based drinks)
    • drink a lot of alcohol
    • are aged over 65

    If you fall into any of the groups listed above, consider making changes to your lifestyle to lower your risk of high blood pressure. Also consider having your blood pressure checked more often, ideally about once a year.

    Prevention and treatment

    You can take steps to prevent high blood pressure by:

    • losing weight if you need to
    • exercising regularly
    • eating a healthy diet
    • cutting back if you drink a lot of alcohol
    • stopping smoking
    • cutting down on salt and caffeine

    Find out more about how to prevent high blood pressure.

    If your blood pressure is found to be high, it will need to be closely monitored until it is brought under control. Your doctor will usually suggest changes to your lifestyle and, sometimes, medication to achieve this. Find out more about how blood pressure is treated.



    Blood pressure (low)

    introduction of blood pressure (low)...

    Low blood pressure, also known as hypotension, is where blood pressure in your arteries is abnormally low.

    It's usually the case that the lower your blood pressure, the healthier you are. 

    Naturally low blood pressure is unlikely to cause any symptoms and is normally nothing to worry about. However, if your blood pressure drops too low, it can restrict the amount of blood flowing to your brain and other vital organs, which can cause fainting or dizziness and lightheadedness.  

    See your GP if you experience any symptoms of low blood pressure and are concerned.  

    All adults should have their blood pressure checked at least every five years. If you haven't had yours measured or don't know what your reading is, ask your GP to check it.

    What is low blood pressure?

    The heart pumps a constant supply of blood around the body through arteries, veins and capillaries.   

    Blood pressure is a measure of the force of the blood on the walls of the arteries as the blood flows through them.

    It is measured in millimetres of mercury (mmHg) and recorded as two measurements:

    • systolic pressure: the pressure when your heart beats and squeezes blood into your arteries
    • diastolic pressure: the pressure when your heart rests between beats 

    For example, if your systolic blood pressure is 120 mmHg and your diastolic blood pressure is 80 mmHg, your blood pressure is 120 over 80, which is commonly written as 120/80.

    A blood pressure reading below 130/80 is generally considered normal. If you have a reading of 140/90 or more, you have high blood pressure (hypertension), which puts you at greater risk of developing serious health conditions, such as heart attack or stroke.

    People with a blood pressure reading of around 90/60 or less are usually regarded as having low blood pressure.

    Why do I have low blood pressure?

    You can have blood pressure for many reasons, including the time of day, age, the temperature, any medication you may be on, an injury and some illnesses. Find out more about the causes of low blood pressure.

    Treatment and self-help

    Naturally low blood pressure does not usually need to be treated unless it is causing symptoms such as dizziness or recurrent falls. If it is causing you to have symptoms, your GP will look at what the cause might be.

    There are various things you can do to help limit symptoms of low blood pressure, including:

    • standing up gradually
    • wearing support stockings 
    • avoiding caffeine at night and limiting your alcohol intake
    • including more salt in your diet
    • eating smaller meals, more often

    Find out more about treating low blood pressure.

    treatment of blood pressure (low)...

    If you have naturally low blood pressure, it does not usually need treating.

    But if your low blood pressure is causing symptoms, your GP will try to find the underlying cause to determine what treatment is necessary. 

    Medication

    If your GP suspects your medication is causing low blood pressure, they may change it or alter your dose. This includes medication to treat high blood pressure (hypertension), and Parkinson’s disease.

    Your blood pressure should be monitored while you're taking medication and changes noted. Tell your GP if you are experiencing side effects from taking medication.

    Underlying illnesses or conditions

    If your GP suspects your low blood pressure is being caused by a health condition, you may be referred to hospital for further tests and treatment.

    Fluids and salt

    Dehydration can cause low blood pressure. This can be easily treated by increasing your fluid and salt intake. Ensuring you drink enough fluid will help by increasing the volume of your blood. Having more blood in your arteries will also increase your blood pressure.

    People who have high blood pressure are usually advised to restrict their salt intake. If you have low blood pressure, you may be advised to include more salt in your diet. Your GP will be able to advise how much additional salt you need and whether you can add salt to your usual food or if you need to take salt tablets.

    General advice

    The advice outlined below will help to limit your symptoms of hypotension, particularly postural or orthostatic hypotension (where blood pressure falls after a sudden movement).

    • Stand up gradually: particularly first thing in the morning. It may also be useful to try other physical movements first to increase your heart rate and the flow of blood around your body. For example, stretching in bed before you get up or crossing and uncrossing your legs if you are seated and about to stand. 
    • Wear support stockings: sometimes called compression stockings, these are tight-fitting elastic socks or tights. They provide extra pressure to feet, legs, and abdomen, which will help stimulate circulation and increase blood pressure.
    • Raise the head of your bed or use extra pillows under your head: this will increase the flow of blood in your body and will also make it easier when you need to get up. 
    • Avoid caffeine at night, and limit your alcohol intake: this will help you to avoid becoming dehydrated, which can also cause low blood pressure.
    • Eat small, frequent meals rather than large ones: this will help to prevent postprandial hypotension (low blood pressure after eating). Lying down after eating or sitting still for a while may also help.

    Very few people are prescribed medication for low blood pressure. The symptoms of hypotension can be usually be treated by making these changes to your lifestyle and, in particular, by increasing your fluid and salt intake.

    If medication is necessary, it will usually be medicines to expand the volume of your blood or to constrict (narrow) your arteries. By increasing your blood, or decreasing your arteries, your blood pressure will increase because there will be more blood flowing through a smaller space.

    diagnosis of blood pressure (low)...

    Low blood pressure (hypotension) can be easily diagnosed by measuring your blood pressure.

    A blood pressure reading is taken using two measurements. The first is known as systolic, which is the pressure in your arteries when your heart contracts and pushes the blood around your body.

    The second measurement is known as diastolic, which is the pressure in your arteries when your heart refills with blood in between heartbeats. Both systolic and diastolic blood pressures are measured in millimetres of mercury (mmHg).

    How blood pressure is measured

    Blood pressure is often measured using a sphygmomanometer, a device which consists of a stethoscope, arm cuff, dial, pump and valve.

    The cuff is placed around your arm and pumped up to restrict the blood flow. The pressure is then slowly released as your pulse is checked using the stethoscope.

    Hearing how your pulse beats after the cuff is released allows a measurement to be taken on the mercury scale, giving an accurate reading of your blood pressure.

    Many GP surgeries now use digital sphygmomanometers, which measure your pulse using electrical sensors.

    Before having your blood pressure taken, you should rest for at least five minutes and empty your bladder.

    To get an accurate blood pressure reading, you should be sitting down and not talking when the reading is taken.

    After you have had your blood pressure taken, your GP or nurse will give you your systolic reading first followed by your diastolic reading. If your systolic blood pressure is 120 mmHg, and your diastolic blood pressure is 80 mmHg, you will be told that your blood pressure is 120 over 80, written as 120/80.

    Low blood pressure

    As a general guide, low blood pressure is a reading below 90/60. 

    If you have low blood pressure according to this guide, you do not need to worry. Naturally low blood pressure rarely causes symptoms or needs treating. Having low blood pressure is considered healthy because it protects you from the risks and diseases of high blood pressure.

    Postural or orthostatic hypotension

    If your symptoms of low blood pressure mostly occur when you change position (postural or orthostatic hypotension), your blood pressure may be measured before and after you move. For example, your blood pressure may be measured while you are sitting down and again while you are standing up.

    Depending on what your seated blood pressure is, if your systolic reading falls by between 15 to 30 mmHg when you stand up, you may have orthostatic hypotension.

    Underlying causes

    Your GP or practice nurse will usually be able to diagnose low blood pressure very easily. However, determining the reason for low blood pressure can often be more difficult.

    If you have an underlying condition causing low blood pressure, it is likelyyou will have other symptoms as well. You should discuss these with your GP, who may recommend further tests.

    Bone cancer (sarcoma)

    introduction of cancer of the bone...

    Primary bone cancer is a tumour that starts growing inside a bone, as opposed to secondary bone cancer which is when cancer spreads from another part of the body into surrounding bone.

    The most common symptom of bone cancer is bone pain that usually gets worse over time and can feel more painful during the night time.

    Read more about the symptoms of bone cancer.

    If you or your child is experiencing persistent bone pain that lasts for more than three days, visit your GP. While it is highly unlikely to be the result of bone cancer it does require further investigation.

    Types of bone cancer

    All types of bone cancer are very rare. The four most common types (although still very rare in general terms) are described below.

    Osteosarcoma

    Osteosarcoma is the most common type of bone cancer, with an estimated 150 cases a year in the UK. Most cases develop in children and young people who are between the ages of 5 and 20, making it the third most common cancer in young people (after leukaemia and brain tumours).

    Osteosarcoma usually develops in the larger bones, such as the thigh bone (femur) or the shin bone (tibia).

    Ewing's sarcoma

    Each year, in the UK, there are an estimated 100 cases of Ewing's sarcoma. Ewing's sarcoma usually develops in children and young people aged between 10 and 20, although 1 in 10 cases develop in people who are over 20.

    Ewing's sarcoma usually develops in the pelvis, thigh bone or shin bone.

    Chondrosarcoma

    There are an estimated 80 cases of chondrosarcoma in the UK each year. This type of bone cancer usually develops in adults who are between the ages of 40 and 50.

    The most common sites for chondrosarcoma to develop are the pelvis, thigh bone, upper arm bone, shoulder blade (scapula) and the ribs.

    Spindle cell sarcoma

    There are an estimated 80 cases of spindle cell sarcoma every year. Spindle cell sarcoma is very similar to osterosarcoma in terms of its symptoms and treatment, but it affects older adults aged 40 or over.

    Treatment

    The treatment plan for most cases of bone cancer is to use a course of chemotherapy to shrink the tumour and then use surgery to remove the affected area of bone.

    In the past this often meant that a section of a limb, such as the lower leg, had to be surgically removed (in an amputation), but today it is often possible to retain the limb by replacing the affected bone with a metal implant . This is known as limb-sparing surgery.

    Read more about the treating bone cancer.

    Causes

    The reason why a small minority of people develop bone cancer is still unclear.

    Known risk factors include:

    • previous exposure to radiation, such as radiotherapy
    • a condition known as Paget’s disease of the bone, where the normal cycle of bone growth is disrupted – however, less than 1% of people with Paget’s disease will actually develop bone cancer

    Read more about the causes of bone cancer.

    Outlook

    One important factor in determining the likely outlook for cases of bone cancer is whether the cancer has spread from the bone to other parts of the body. It is easier to achieve a cure if the cancer has not spread (known as localised bone cancer). If it has spread (most commonly to the lungs or bone marrow), it can be harder to treat. This is known as metastatic bone cancer.

    Read more about the outlook for people with bone cancer.

    Blood
    Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
    Bone marrow
    Bone marrow is the soft, spongy tissue in the centre of bones that produces blood cells.
    Joint
    Joints are the connection point between two bones that allow movement.
    Malignant
    Malignant is a term used to describe a life-threatening or worsening condition. In the case of tumours, malignant means cancerous.
    Prognosis
    A prognosis is a prediction of the possible outcome of a disease or condition.
    Spine
    The spine supports the skeleton, and surrounds and protects the delicate spinal cord and nerves. It is made up of 33 bones called the vertebrae.
    Tissues
    Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.

    treatment of cancer of the bone...

    Your care team

    If you are diagnosed with bone cancer, it's likely that you will be referred to a specialist centre with experience in treating bone cancer.

    At specialist bone cancer centres there are teams of specialist health professionals who work together to treat bone cancer. These types of teams are known as multi-disciplinary teams (MDTs).

    Members of the MDT may include:

    • an orthopaedic surgeon (a surgeon who specialises in bone and joint surgery)
    • a clinical oncologist (a specialist in the non-surgical treatment of cancer)
    • a pathologist (a specialist in diseased tissue)
    • a radiologist (a specialist in radiotherapy)
    • a palliative care specialist (a specialist in pain relief)
    • a social worker
    • a psychologist 
    • a specialist cancer nurse, who will usually be your first point of contact between yourself and the rest of the team

    Your treatment plan

    Different types of bone cancer are usually treated in a similar way.

    First, chemotherapy is given to try to shrink the tumour and to treat any cancer cells that may have spread.
    .
    Following chemotherapy, surgery may be carried out to remove the section of cancerous bone. In many cases, it is possible to reconstruct the bone that has been removed. This is known as     limb-sparing surgery.

    In some cases – for example, if the cancer has spread beyond the bone into the surrounding blood vessels – reconstruction may not be possible and it may be necessary to amputate some, or all, of the limb. However, due to advances in diagnosis and treatment, only a minority of patients (around one-in-seven cases) need an amputation.

    If cancer has spread to the lungs, surgery can also be used to remove the affected portion of the lungs. Read more about the treatment of lung cancer.

    Following surgery, further chemotherapy treatment may be given to destroy any remaining cancerous cells.

    Radiotherapy may also be used for treatment and is particularly helpful for some types of cancer (such as Ewing’s sarcoma, for example).

    Chemotherapy

    Chemotherapy uses powerful cancer-killing medication to treat cancer.

    There are four ways that chemotherapy can be used to treat bone cancer. It can be used:

    • before surgery to shrink the tumour, making it more likely that you will only require limb-sparing surgery
    • in combination with radiotherapy before surgery (chemoradiation); this approach works particularly well in the treatment of Ewing sarcoma
    • after surgery in order to prevent the cancer returning
    • to control symptoms in cases where a cure is not possible (this is known as palliative chemotherapy)

    Chemotherapy treatments are usually given in cycles. A cycle involves taking the chemotherapy medication for several days, and then having a break for a few weeks to allow your body to recover from the effects of the treatment.

    The number of cycles that you require will depend on the type and the grade of your bone cancer.

    Chemotherapy for bone cancer involves taking a combination of different medications. The medications are usually delivered via a drip into your vein, or into a tube that is connected to one of the blood vessels in your chest.

    Side effects of chemotherapy include:

    Most of the side effects associated with chemotherapy should resolve once your treatment has finished. However, there is a risk that you will be permanently infertile. Your care team will be able to provide more detailed information about the specific risk to your fertility.

    If you want to have children, it may be possible to take samples of your sperm (men) or eggs (women) so that they can be used later in fertility treatments such as IVF.

    Chemotherapy can also weaken your immune system, making you more vulnerable to infection. Inform your care team or your GP as soon as possible if you experience the possible signs of an infection, such as:

    • a high temperature (fever) of 38C (100.4F) or above
    • coughs
    • sore throat
    • a feeling of being generally unwell

    Read more about chemotherapy.

    Radiotherapy

    Radiotherapy is a type of treatment that uses pulses of radiation to destroy cancerous cells.

    As with chemotherapy, radiotherapy can be used before and after surgery to treat bone cancer, or it can be used to control the symptoms and slow the spread of cancer when a cure is not possible.

    Radiotherapy is usually given five days a week with a break from treatment over the weekend. Each session of radiotherapy usually lasts around 10 to 15 minutes. Most people require between two and five weeks of treatment.

    Common side effects of radiotherapy include:

    • reddening and irritation of the skin (this can feel much like sunburn)
    • joint pain in the part of the body that is being treated
    • feeling sick
    • hair loss in the body part being treated
    • tiredness

    These side effects will pass once the radiotherapy has been completed, although feelings of tiredness may persist for several weeks.

    Read more about radiotherapy.

    Surgery

    Limb-sparing surgery  

    Limb-sparing surgery is usually possible when the cancer has not spread beyond the bone, and the affected bone itself is in an easily accessible position, such as:

    Limb-sparing surgery is usually possible when the cancer has not spread beyond the bone, and the affected bone itself is in an easily accessible position, such as:

    • the arm
    • the leg
    • the shoulder
    • the pelvis
    • the hip

    The most common type of limb-sparing surgery involves removing the section of affected bone as well as some of the surrounding tissue (in case any cancerous cells have spread into the tissue).

    The removed section of bone is then replaced with a metal implant called a prosthesis.
    In some cases, it may be possible to take a sample of bone from another part of the body and use it as an alternative to prosthesis. This type of operation is known as a bone graft.

    If the cancer is near a joint, such as the knee joint, it may be necessary to remove the joint and replace it with an artificial one, which is made from a combination of plastic, metal, and ceramics.

    Read more about knee joint and hip joint replacement.

    Amputation

    Amputation may be required if:

    • The cancer has spread beyond the bone into major blood vessels or nerves.
    • The cancer has spread beyond the bone into your skin.
    • You develop a serious infection after limb-sparing surgery.
    • The cancer has developed in a part of the body where limb-sparing surgery is not technically possible, such as in the ankle.

    Being told that you need to have an amputation can be devastating, particularly for children. Your care team will understand the shock and fear that you, or your child, may be feeling and will be able to provide you with counselling and other support.

    In some cases, your care team may be able to introduce you or your child to someone who has already had an amputation, and they will be able to give you advice and support about living with an amputation.

    Artificial limbs are now very advanced and convenient to use. For example, people with an artificial leg are able to walk, run and play sport. In many cases, an artificial limb allows a wider range of movement than a limb repaired with limb-sparing surgery.

    Research has also found that most people who have an amputation are able to enjoy the same quality of life as people who have limb-sparing surgery.

    Once your stump has healed and the swelling has settled after surgery, you can be fitted with an artificial limb. These are usually custom-made to make wearing it and using it as comfortable as possible.

    When you are able to leave hospital, you will be referred to a local limb centre. Limb centres provide advice, support and treatment for people with artificial limbs.

    At the limb centre, you will be given physiotherapy and occupational therapy (therapy to improve the skills you'll need for day-to-day living) so that you can make the best use of your artificial limb.

    Any adjustments to your limb that may be required as you grow older can also be carried out at the limb centre.

    Read more about living with an amputation.

    Mifamurtide

    A new medication called mifamurtide has recently been approved for the treatment of high-grade osteosarcoma.

    Mifamurtide is what is known as an immune macrophage stimulant. This means it works by encouraging the immune system to produce specialised cells which are known to kill cancerous cells.

    Mifamurtide is given after surgery, in combination with chemotherapy, to kill any remaining cancerous cells and to help prevent the cancer from returning.  

    Mifamurtide is given using a process known as infusion, which means that it is slowly pumped into one of your veins over the course of an hour. This is usually done at your local hospital (you will be able to go home once the infusion has been completed) or possibly at your GP’s surgery.

    The recommended course of treatment is usually twice a week for 12 weeks and then once a week for a further 24 weeks after that.

    Mifamurtide can cause a wide range of side effects, but they are usually mild to moderate.

    They include:

    Read the leaflet that comes with your medication for a full list of side effects.

    It's unclear whether it is safe to take mifamurtide during pregnancy, so as a precaution it's important to use an effective method of contraception if you are a sexually active woman. You will need to tell your MDT as soon as possible if you think you're pregnant and avoid breastfeeding while taking mifamurtide.

    Follow up

    If tests have shown that your body is now free of cancerous cells, your various treatments will come to an end. But you'll still need to attend regular follow-up appointments to check that the cancer hasn't returned.

    Followup appointments usually involve using X-rays and computerised tomography (CT) scan.

    You will be asked to attend frequent appointment in the first two years after treatment has finished – possibly every two to four months depending on the grade of the cancer – and then these become less frequent as the years go on.

    Your MDT will be able to provide more detailed information about the schedule of your follow-up appointments.

    Outlook

    The expected outlook for people with bone cancer is outlined below.

    Five-year survival rates

    Health professionals use a general measurement of a "five-year survival rate" when describing cancer statistics. However, it's important to make clear that the five-year measurement is not an absolute measurement and it does not mean that people with bone cancer only have a five-year life expectancy.

    Osteosarcoma

    Six out of 10 people with localised osteosarcoma will live for at least five years after diagnosis and most of these people will be completely cured.

    The outlook for metastatic osteosarcoma is much poorer as only 1 in 10 people will live for at least five years after being diagnosed.

    Ewing's sarcoma

    Seven out of 10 people with localised Ewing’s sarcoma will live for at least five years after diagnosis, and again, most of them will be completely cured.

    Only 3 out of 10 people with metastatic Ewing’s sarcoma will live for at least five years after diagnosis.

    Chondrosarcoma

    In cases of chondrosarcoma, the grade of the cancer is the most important factor in determining the outlook.

    The outlook for low-grade chondrosarcoma is generally good, with 8 out of 10 people living for at least five years after a diagnosis.

    The outlook for high-grade chondrosarcoma is poorer, with only 3 out of 10 people living for at least five years after diagnosis.

    Spindle cell sarcoma

    Six out of 10 people with localised spindle cell sarcoma will live for at least five years after diagnosis.

    Only one-in-four people with metastatic spindle cell sarcoma will live for at least five years after diagnosis.
    Chemotherapy
    Chemotherapy is a treatment of an illness or disease with a chemical substance, e.g. in the treatment of cancer.
    Joint
    Joints are the connection point between two bones that allow movement.
    Radiotherapy
    Radiation therapy uses x-rays to treat disease, especially cancer.
    Spine
    The spine supports the skeleton, and surrounds and protects the delicate spinal cord and nerves. It is made up of 33 bones called the vertebrae.
    Veins
    Veins are blood vessels that carry blood from the rest of the body back to the heart.

    medicine-guides of cancer of the bone...

    The list below is a combination of the and brand names of medicines available in the UK. Each name provides a link to a separate website (Medicine Guides) where you can find detailed information about the medicine. The information is provided as part of an on-going medicine information project between NHS Direct, Datapharm Communications Ltd and other organisations.

    The medicines listed below hold a UK licence to allow their use in the treatment of this condition. medicines are not included.

    The list is continually reviewed and updated but it may not be complete as the project is still in progress and guides for new medicines may still be in development.

    If you are taking one of these medicines for a different condition, or your medicine for this condition is not mentioned here at all, speak to your prescriber, GP or pharmacist, or contact NHS Direct on 0845 46 47.

    Bone cyst

    treatment of bone cyst...

    Many bone cysts heal without treatment. However, treatment is sometimes necessary to prevent the bone fracturing, or if the cyst is painful.

    Unicameral bone cyst

    If the cyst is small and the affected bone is strong, a policy of watchful waiting may be recommended. This means your child will not receive any immediate treatment, but they will be given regular check-ups to make sure the cyst is not getting larger. About 1 in 4 unicameral bone cysts heal by themselves without the need for treatment.

    Surgical treatment may be recommended if the cyst does not show any signs of healing or if the bone is thought to have a high risk of fracture. There are three main types of surgical treatment:

    • steroid injection
    • bone marrow injection
    • curettage and bone grafting

    All three techniques are carried out under general anaesthetic, which means that your child will be asleep during the surgery and will not feel any pain.

    In some cases, a combination of two, or all three, techniques may be used. Each technique is discussed in more detail below.

    Steroid injection

    A type of steroid called methylprednisolone acetate is the preferred steroid for this type of treatment. It is thought that methylprednisolone acetate encourages the stimulation of a chemical called prostaglandin, which helps to prevent the cyst from growing.

    The surgeon will drain the fluid out of the cyst before injecting the steroids into it. Repeated injections may be required every few months over the course of a year before the cyst fully heals.

    As steroid injection is a relatively straightforward type of treatment, it is often the first treatment to be used. Additional treatment options will only be used if the cyst shows no sign of healing.

    Bone marrow injection

    Bone marrow injection is similar to a steroid injection. The surgeon injects the cyst with bone marrow that has been removed from another part of your child’s body, usually their pelvis.

    Bone marrow contains specialised cells which should encourage the cyst to heal. In most cases, a single injection of bone marrow is required.

    Curettage and bone grafting

    During this procedure a surgeon cuts into the bone to gain access to the cyst.

    The fluid inside the cyst is drained and the lining of the cyst scraped out using a tool called a curette. The resulting cavity inside the bone is filled with chips of bone, either from other parts of your child’s body or from donated bone tissue.

    Follow-up

    In around 10-20% of cases, bone cysts may reoccur during the first two years following treatment, especially with young people or with larger cysts. Therefore, it is likely your child will have regular X-rays to assess the condition of the previously affected bone.

    It is impossible to predict the reoccurrence rates of bone cysts that do not cause any symptoms because most go undiagnosed.

    Aneurysmal bone cyst

    Aneurysmal bone cysts are typically treated using curettage and bone grafting, as described above.

    In some cases, additional treatments, such as liquid nitrogen (a very cold substance) may be used to damage the tissue of the cyst.

    Some aneurysmal bone cysts will heal spontaneously following a simple biopsy. About one in five aneurysmal bone cysts will reoccur following treatment, almost always within the first 18 months after treatment.

    diagnosis of bone cyst...

    Bone cysts can usually be diagnosed by looking at an X-ray of your child’s bone. This will highlight any hollow cavities or fractures in the bone.

    In many cases, a bone cyst will only be discovered by chance when X-rays are used to diagnose an unrelated condition. Alternatively, a diagnosis may be confirmed after the affected bone has been fractured.

    Further testing

    Further testing is usually only required if:

    • the cyst has developed on the end of a long bone that is still growing (an area of the bone  known as the growth plate) and there is concern that it may affect normal physical development.
    • there are additional symptoms, such as unexplained weight loss, which mean a diagnosis of bone cancer needs to be ruled out - it should be stressed that bone cancer is very rare, with only 600 new cases occurring in the UK each year
    • the cyst is so large that the affected bone is at risk of fracturing (breaking)

    In these circumstances, two tests may be used:

    causes of bone cyst...

    The cause or causes of both unicameral and aneurysmal bone cysts are unclear, although several theories have been suggested.

    These are described below.

    Unicameral bone cyst

    A leading theory is that unicameral bone cysts are caused by a build-up of fluid, resulting in high pressure and obstruction. This is thought to happen when rapid bone growth during childhood occasionally disrupts the workings of the cells.

    There is some limited evidence to suggest there may be certain     genetic mutations that can make a person more likely to develop a unicameral bone cyst.

    A genetic mutation occurs when the normal instructions carried in certain genes (single units of genetic material) become scrambled. This means some of the functions and processes of the body will not work in the normal way.

    Aneurysmal bone cyst

    Blood is the fluid that forms inside an aneurysmal bone cyst. This suggests some sort of underlying abnormality with the blood vessels inside an affected bone is responsible. However, it is unclear exactly what type of abnormality is involved or what causes it.

    One theory is that a previous injury to the bone may damage the blood vessels, leading to a build-up of blood inside the bone. Another theory is that other non-cancerous growths (benign tumours) inside the bone may disrupt the blood supply, resulting in the formation of an aneurysmal bone cyst.

    Bowel cancer

    living-with of cancer of the colon rectum or ...

    Emotional effects

    Having cancer can cause a range of emotions. These may include shock, anxiety, relief, sadness and depression. Different people deal with serious problems in different ways. It is hard to predict how knowing you have cancer will affect you. However, you and your loved ones may find it helpful to know about the feelings that people diagnosed with cancer have reported.

    Want to know more?

    Recovering from colon or rectal surgery

    Surgeons and anaesthetists have found that using an “enhanced recovery programme” after bowel cancer surgery helps patients recover more quickly.

    Most hospitals now use this programme. It involves giving you more information before the operation about what to expect, avoiding giving you strong laxatives to clean the bowel before surgery, and in some cases giving you a sugary drink two hours before the operation to give you energy. 

    During and after the operation, the anaesthetist controls the amount of IV fluid you need very carefully, and after the operation you will be given painkillers that allow you to get up and out of bed by the next day.

    Most people will be able to eat a light diet the day after their operation.

    To reduce the risk of deep vein thrombosis (blood clots in the legs), you may be given special compression stockings that help prevent blood clots, or a regular injection with heparin until you are fully mobile.

    A nurse or physiotherapist will help you get out of bed and regain your strength so you can go home again within a few days.

    With the enhanced recovery programme, most people are well enough to go home within five to six days of their operation. The timing depends on when you and the doctors and nurses looking after you agree you are well enough to go home.

    Want to know more?

    Coping with a colostomy

    If you need a colostomy, you may feel worried about how you look and how others will react to you. Information and advice about living with a stoma (including stoma care, stoma products and ‘stoma-friendly’ diets) is available via the ileostomy and colostomy topics.

    Want to know more?

    Diet after bowel surgery

    If you have had part of your colon removed, it is likely that your stools (faeces) will be looser because one of the functions of the colon is to absorb water from the stools. This may mean that you experience repeated episodes of diarrhoea.

    You should inform your care team if diarrhoea becomes a problem because medication is available to help control symptoms.

    You may find some foods upset your bowels, particularly during the first few months after your operation.

    Different foods can upset different people, but food and drink that is commonly known to cause problems include:

    • rich and fatty food
    • fruit and vegetables that are high in fibre, such as beans, cabbages, apples and bananas
    • fizzy drinks, such as cola and beer

    You may find it useful to keep a food diary to record the effects of different foods on your bowel.

    If you find that you are having continual problems with your bowels as a result of your diet, and/or you are finding it difficult to maintain a healthy diet, you should contact your care team. You may need to be referred to a dietitian for further advice.

    Want to know more?

    Sex and bowel cancer

    Having cancer and its treatment may affect how you feel about relationships and sex. Although most people are able to enjoy a normal sex life after bowel cancer treatment, if you have had a colostomy you may feel self-conscious or uncomfortable.

    Talking about how you feel with your partner may help you both to support each other. Or you may feel you’d like to talk to someone else about your feelings. Your doctor or nurse will be able to help.

    Want to know more?

    Financial concerns

    A diagnosis of cancer can cause money problems because you are unable to work or someone you are close to has to stop working to look after you. There is financial support available for carers and for you if you have to stay off work for a while or have to stop work because of your sickness. 

    Free prescriptions

    People being treated for cancer are entitled to apply for an exemption certificate giving free prescriptions for all medication, including that which treats unrelated conditions.

    The certificate is valid for five years and you can apply for a certificate by speaking to your GP or cancer specialist.

    Want to know more?

    Dealing with dying

    If you are told there is nothing more that can be done to treat your bowel cancer, your GP will still provide you with support and pain relief. This is called palliative care. Support is also available for your family and friends.

    Want to know more?

    treatment of cancer of the colon rectum or bo...

    Surgery - colon cancer

    If the cancer is at a very early stage, it may be possible to remove just a small piece of the lining of the colon wall. This is known as local excision.

    If the cancer spread into muscles surrounding the colon, it will usually be necessary to remove an entire section of your colon. Removing some of the colon is known as a colectomy.

    Depending on the location of the cancer, possible surgical procedures include:

    • left-hemi colectomy – where the left half of your colon is removed
    • transverse colectomy – where the middle section of your colon is removed
    • right-hemi colectomy – where the right half of your colon is removed
    • sigmoid colectomy – where the lower section of your colon is removed

    There are two ways a colectomy can be performed:

    • In an open colectomy, the surgeon makes a large incision in your abdomen and removes a section of your colon.
    • A laparoscopic colectomy is a type of ‘keyhole surgery’, where the surgeon makes a number of small incisions in your abdomen and uses special instruments guided by a camera to remove a section of colon.

    Both techniques are thought equally effective in removing cancer and have similar risks of complications. Laparoscopic colectomies have the advantage of a faster recovery time and less post-operative pain.

    Laparoscopic colectomies should now be available in all hospitals carrying out bowel cancer surgery, although not all surgeons perform this type of surgery. If you are considering having your bowel cancer surgery done using keyhole surgery, discuss this with your surgeon.

    During surgery, nearby lymph nodes may also be removed. It is usual to join the ends of the bowel together after bowel cancer surgery, but very occasionally this is not possible and a stoma is needed. 

    Enhanced recovery programmes

    Enhanced recovery surgical programmes should be used for most bowel cancer patients. These programmes differ from traditional surgery by:

    • ensuring patients are in the best possible physical condition before surgery
    • minimising the trauma patients go through during surgery - for example, minimally invasive surgery when possible and better pain control
    • ensuring patients experience the best possible rehabilitation after surgery

    Want to know more?

    Stoma surgery

    In some cases, the surgeon may decide the colon needs to heal before it can be reattached, or that too much of the colon has been removed to make reattachment possible.

    In this case, it will be necessary to find a way of removing waste materials from your body without stools passing through your anus. This is done using stoma surgery.

    Stoma surgery involves the surgeon making a small hole in your abdomen, which is known as a stoma. There are two ways that stoma surgery can be carried out.

    • An ileostomy is where a stoma is made in the right-hand side of your abdomen. Your small intestine is separated from your colon and connected to the stoma, and the rest of the colon is sealed. You will need to wear a pouch connected to the stoma to collect waste material.
    • A colostomy is where a stoma is made in your lower abdomen and a section of the colon is removed and connected to the stoma. As with an ileostomy, you will need to wear a pouch to collect waste material.

    In most cases, the stoma will be temporary and can be removed once your colon has recovered from the effects of the surgery. This will usually take at least nine weeks. Specialist stoma nurses are available to advise on the best site for a stoma, and about the best sort of pouch to cover the stoma and collect the waste material.

    Before you have a colectomy, your care team will tell you whether they think stoma surgery will be necessary and the likelihood that you will need to have a temporary or permanent ileostomy or colostomy.

    Want to know more?

    Surgery - rectal cancer

    Two common surgical procedures can be used to treat rectal cancers:

    • low anterior resection
    • abdominoperineal resection

    Low anterior resection

    Low anterior resection is a procedure used to treat cases where the cancer is in the upper section of your rectum. The surgeon will make an incision in your abdomen and remove the upper section of your rectum, as well as some surrounding tissue to make sure any lymph glands containing cancer cells are also removed. They will then attach your colon to the lowest part of your rectum or upper part of the anal canal. Sometimes, they turn the end of the colon into an internal pouch to replace the rectum. You will probably require a temporary stoma to give the join-up time to heal.

    Abdominoperineal resection

    Abdominoperineal resection is used to treat cases where the cancer is in the lowest section of your rectum. In this case, it will be necessary to remove the whole of your rectum and surrounding muscles to reduce the risk of the cancer regrowing in the same area. This involves removing the anus and its sphincter muscles too, so there is no option except to have a permanent stoma after the operation. Bowel cancer surgeons always do their best to avoid giving people permanent stomas wherever possible.

    Side effects of surgery

    Bowel cancer operations carry the same risks as other major operations, including the risks of bleeding, infection, developing blood clots or heart or breathing problems. 

    One risk is that the join-up in the bowel may not heal properly and may leak inside your abdomen. This is usually only a risk in the first few days after the operation. 

    Another risk is for patients having rectal cancer surgery. The nerves controlling passing urine and sexual function are very close to the rectum, and sometimes an operation to remove a rectal cancer can damage these nerves. 

    After bowel cancer surgery, the bowel is shorter than it used to be. This results in some patients needing to go to the toilet to open their bowels more often than before. This usually settles down within three to six months of the operation.

    Radiotherapy

    There are two main ways that radiotherapy can be used to treat bowel cancer. It can be:

    • given before surgery, in cases of rectal cancer
    • used to control symptoms and slow the spread of cancer, in cases of advanced bowel cancer (called palliative radiotherapy)

    Radiotherapy given before surgery for rectal cancer can be performed in two ways:

    • external radiotherapy, where a machine is used to beam high-energy waves at your rectum to kill cancerous cells
    • internal radiotherapy (also known as brachytherapy), where a radioactive tube is inserted into your anus and placed next to the tumour to shrink it

    External radiotherapy is usually given daily, five days a week, with a break at the weekend. Depending on the size of your tumour, you may need one to five weeks of treatment. Each session of radiotherapy is short and will only last for 10-15 minutes.

    Internal radiotherapy can usually be performed in one session before surgery is carried out a few weeks later.

    Palliative radiotherapy is usually given in short, daily sessions, with a course ranging from 2-3 days to 10 days.

    Short-term side effects of radiotherapy include:

    • nausea
    • fatigue
    • diarrhoea
    • burning and irritation of the skin around the rectum and pelvis (this looks and feels like sunburn)
    • a frequent need to urinate
    • a burning sensation when passing urine

    These side effects should pass once the course of radiotherapy has finished. Tell your care team if the side effects of treatment become particularly troublesome. Additional treatments are often available to help you cope better with the side effects.

    Long-term side effects of radiotherapy include:

    • a more frequent need to pass urine or stools
    • blood in your urine and stools
    • infertility
    • impotence in men

    If you want to have children, it may be possible to store a sample of your sperm or eggs before treatment begins so they can be used in fertility treatments in the future.

    Want to know more?

    Chemotherapy

    There are three ways chemotherapy can be used to treat bowel cancer. It can be:

    • given before surgery for rectal cancer in combination with radiotherapy
    • given after surgery to prevent the return of cancer
    • given to slow the spread of advanced bowel cancer and help control symptoms (palliative chemotherapy)

    Chemotherapy for bowel cancer usually involves taking a combination of medications that kill cancer cells. They can be given as a tablet (oral chemotherapy), through a drip in your arm or chest (intravenous chemotherapy), or as a combination of both.

    Depending on the stage and grade of your cancer, a single session of intravenous chemotherapy can last from several hours to several days.

    Most people have regular daily sessions of chemotherapy over the course of one or two weeks before having a break from treatment for another week.

    A course of chemotherapy can last up to six months depending on how well you respond to the treatment.

    Side effects of chemotherapy include:

    • fatigue
    • nausea
    • vomiting
    • diarrhoea
    • mouth ulcers
    • hair loss
    • redness and soreness on the palms of your hands and the soles of your feet
    • a sensation of numbness, tingling or burning in your hands, feet and neck

    These side effects should gradually pass once your treatment has finished. It usually takes three to six months for your hair to grow back.

    Chemotherapy can also weaken your immune system, making you more vulnerable to infection. Inform your care team or GP as soon as possible if you experience possible signs of an infection, including:

    • a high temperature (fever) of 38ºC (100.4ºF) or above
    • a sudden feeling of being generally unwell

    Medications used in chemotherapy can cause temporary damage to men's sperm and women's eggs. This means that for women who become pregnant or for men who father a child, there is a risk to the unborn baby’s health. Therefore, it is recommended you use a reliable method of contraception while having chemotherapy treatment and for a further year after your treatment has finished.

    Want to know more?

    Biological treatments

    Biological treatments, including cetuximab, bevacizumab and panitumumab, are a newer type of medication known as monoclonal antibodies. Monoclonal antibodies are antibodies that have been genetically engineered in a laboratory. They target special proteins found on the surface of cancer cells, known as epidermal growth factor receptors (EGFR). As EGFRs help the cancer to grow, by targeting these proteins, biological treatments can help prevent the cancer spreading.

    Biological treatments are usually used in combination with chemotherapy and radiotherapy.

    These treatments are not available to everyone with bowel cancer. The National Institute for Health and Clinical Excellence (NICE) has determined specific criteria which need to be met before they can be prescribed.

    Cetuximab is only available on the NHS when:

    • bowel cancer has spread to the liver and cannot be removed using surgery
    • surgery to remove the cancer in the colon or rectum has been carried out or is possible
    • a person is fit enough to undergo surgery to remove the cancer from the liver if this becomes possible after treatment with cetuximab

    Bevacizumab and panitumumab are not available on the NHS. All these medications are available privately but are very expensive. The medication is usually given in combination with chemotherapy.

    Want to know more?

    mapofmedicinepage of cancer of the colon rect...

    Brain tumour, benign (non-cancerous)

    introduction of brain tumour...

    A benign (non-cancerous) brain tumour is a mass of cells that grows slowly in the brain. It usually stays in one place and does not spread.

    Generally, brain tumours are graded from 1 to 4 according to their behaviour, such as how fast they grow and how likely they are to spread. Grade 1 tumours are the least aggressive and grade 4 are the most harmful and cancerous. Cancerous tumours are described as malignant. 

    Low-grade brain tumours – grades 1 or 2 – tend to be slow growing and unlikely to spread, so they're usually classed as benign.

    Read about high-grade (malignant) tumours.

    What are the symptoms?

    The symptoms of a low-grade or benign brain tumour depend on how big it is and where it is in the brain. Some slow-growing tumours may not cause any symptoms at first.

    Eventually, the tumour can put pressure on the brain and may cause headaches and seizures (fits). The tumour can also prevent an area of the brain from functioning properly. For example, a tumour in the occipital lobe (at the back of the brain) may cause loss of vision on one side. See Benign brain tumour - symptoms for more information.

    Who is affected?

    Brain tumours can affect people of any age, including children.

    There are about 4,500 new cases of primary brain tumours in the UK each year (tumours that start in the brain). About 20% of these are low-grade gliomas, a type of tumour that starts in the supportive tissue of the brain. Doctors don't know what causes these.

    See Benign brain tumour - causes for information about the possible causes of other types of benign brain tumour.

    Treatment and outlook

    Benign brain tumours can be serious if they are not diagnosed and treated early. Although they remain in one place and do not usually spread, they can cause harm by pressing on and damaging nearby areas of the brain. 

    Many benign brain tumours can be surgically removed and don't come back once they have been removed, causing no further problems. However, grade 2 gliomas will often grow back after treatment and have the potential to change into high-grade or malignant (cancerous) tumours, which are fast-growing and likely to spread. This change is called mutation.

    See Benign brain tumour - treatment for more information on your treatment options.

    In summary, your treatment will depend on the type and location of the tumour, and your outlook will depend on whether the tumour grows back and whether it mutates (changes).

    causes of brain tumour...

    Benign brain tumours that are congenital (present at birth) are caused by abnormal development of the baby in the womb. It is not fully understood what causes non-congenital tumours.

    Some genetic conditions can increase your risk of a benign brain tumour. These conditions include:

    These conditions tend to cause gliomas (see Benign brain tumour - introduction) that appear in childhood or early adulthood, whereas most gliomas start later in adulthood.

    Other possible causes

    Radiotherapy to the brain increases your risk of a brain tumour, although this is still uncommon.

    It is also thought that family history of brain tumours and exposure to chemicals (such as formaldehyde) may be risk factors.

    joannes-story of brain tumour...

    Joanne Glazier Reitano is 43. In September 2003 she was diagnosed with an inoperable brain tumour. She talks about how living with a brain tumour has affected her.

    "The first sign I had that things weren’t right was when I kept ‘zoning out’. At first I wasn’t really aware that it was happening – but it was like I was just switching off from the real world. The incidents probably only lasted a minute, and I wouldn’t lose consciousness, but I’d ‘come back’ to the real world and would have completely lost track of what I was saying and doing. 

    “I put it down to stress. There had been lots of redundancies at work and it had generally been an incredibly stressful year. But I began to be quite concerned when I 'zoned out' in the middle of a presentation I was giving. It was obvious to everyone who was there that something was wrong.  

    “I went to my GP about it and he diagnosed stress, so I didn’t worry too much and got on with my normal life. 

    “By the following Easter I wasn’t feeling well at all. I’d started a new job and had no energy and was taking lots of antidepressants. I was putting on weight rapidly and wasn’t feeling at all good.

    “I was also having a number of mysterious accidents. I banged my head badly when I was at work and am not sure exactly how I did it. Once I took the dog for a walk and when I came back I was covered in mud. I still don't know how that happened. I was having memory problems too.

    “My doctor referred me for an MRI scan and I was also sent to London for an ECG. While I was waiting for the results, I went away on holiday. But I was grumpy, didn’t want to join in with anything and just didn’t behave like I usually did.

    "On my return, there was a letter waiting for me that told me I had epilepsy. It was such a shock. I was devastated. I made an appointment with my consultant and had a huge list of questions to ask him, but when I got there, he said, ‘Jo, epilepsy is the least of your problems. You have a brain tumour.’ 

    "I didn’t know what to think. It was such a shock to hear those words. There was just this whole mess of thoughts in my head. The consultant couldn’t tell me much as he didn’t know if the tumour was benign or malignant. Two weeks later, I was sent for a biopsy.

    "I was in hospital for a week and was a complete wreck. They discovered that I had a slow-growing grade 2 oligodendroglioma tumour. But because the tumour was deep-set in the left temporal lobe, it was too dangerous to operate on. 

    "It was a very delicate period. I hadn’t been told where to go for support and I was very down and angry. Although it was good news that it was slow growing, I just didn’t want to deal with it. I didn’t want it in my head and I didn’t want to be in this situation. Eventually, I was put in touch with a support group and that did help. It made me realise that I wasn’t the only one in this situation and that did give me some comfort.

    "I started having radiotherapy three months after my diagnosis. I had it five days a week for six weeks. I was warned that I’d lose all my hair, which I did, and I was left with a circle of hair at the top of my head. But the radiotherapy helped. After I’d finished the course, I got the news that the tumour was lying dormant. 

    "In September 2006 a scan showed that the tumour was growing again. I went into shock when I heard the news. 

    "I started chemotherapy in October 2006 and had six cycles. I had 11 days of chemo with a four- to five-week gap in between. I felt so ill while it was going on. But while I was in the middle of chemotherapy, I got married to my boyfriend Salvo. Afterwards, my scan showed that the tumour was dormant again.

    "My life will definitely be shortened by this tumour but I’m living it to the best of my ability. I have bad pains that move around my body and my balance is quite badly affected. I fall over really easily.

    "My writing and spelling is appalling these days and my memory is ruined because the tumour is pressing against that part of my brain. My reading is also affected. I get stuck on certain words, just like a child. 

    "But I have to be positive. It’s hard but I’ve had to learn to live with it. I didn’t, and still don’t, want to be defeated by it. I have a very loving and supportive husband and family. I also discovered that keeping my mind occupied has really helped and I’ve developed a strong interest in gardening, which I find very therapeutic.

    "Practical help has been invaluable. A friend filled in all my benefit forms for me and I’ve nominated her to have power of attorney, so she always deals with that side of things. When you have something wrong with your brain, you really need that kind of help."

    This case history was provided by Brain Tumour UK.

    Brain tumour, malignant (cancerous)

    introduction of brain tumour malignant...

    A malignant brain tumour is a fast-growing cancer that spreads to other areas of the brain and spine.

    Most malignant brain tumours are secondary cancers, which means they started in another part of the body and spread to the brain. Primary brain tumours are those that started in the brain.

    There are different types of malignant brain tumour, depending on the type of brain cells they have grown from. The most common type is a glioma, which accounts for more than half of all primary brain tumours.

    Generally, brain tumours are graded from 1 to 4 according to their behaviour, such as how fast they grow and how likely they are to spread. A malignant brain tumour will be either grade 3 or 4, whereas grade 1 or 2 tumours are usually classed as benign or non-cancerous brain tumours.

    What are the symptoms?

    The symptoms of a malignant brain tumour depend on how big it is and where it is in the brain.

    The tumour can put pressure on the brain and may cause headaches and seizures (fits). It can also prevent an area of the brain from functioning properly. See Malignant brain tumour - symptoms for more information.

    Who is affected?

    Brain tumours can affect people of any age, including children.

    There are about 4,500 new cases of primary brain tumours in the UK each year. The exact cause of these is unknown, although an underlying genetic disease, such as neurofibromatosis, can increase your risk of developing one (see Malignant brain tumour - causes for more information). 

    Treatment and outlook

    A primary malignant brain tumour must be treated as soon as possible because it can spread to and damage other parts of the brain and spinal cord.

    The tumour is usually operated on and as much of it removed as possible. This may be followed with chemotherapy and radiotherapy. However, malignant tumours will often return.

    The outcome for malignant primary brain tumours depends on many factors, such as the type and location of the tumour and how ill you were when diagnosed. For more information, go to Cancer Research UK's page on Statistics and outlook for brain tumours.

    Secondary brain tumours are serious as they have already spread throughout the body. Treatment aims to improve symptoms and prolong life.

    For more information on the treatment options, see Malignant brain tumour - treatment.

    causes of brain tumour malignant...

    Most malignant brain tumours are caused by a cancer that started somewhere else in the body and spread to the brain through the bloodstream.

    The cause of primary malignant brain tumours (cancerous tumours that start in the brain) is not fully understood.

    Underlying disease

    Some genetic conditions can increase your risk of a primary malignant brain tumour. These conditions include:

    These conditions tend to cause malignant gliomas (see Malignant brain tumour - introduction) that appear in childhood or early adulthood, whereas most gliomas start later in adulthood.

    Other possible causes

    Radiotherapy to the brain increases your risk of brain tumour, although this is still uncommon.

    It is also thought that family history of brain tumours and exposure to chemicals (such as formaldehyde) may be risk factors.

    mapofmedicinepage of brain tumour malignant...

    Breast cancer

    diagnosis of cancer of the breast female...

    Tests at the breast cancer clinic

    If you have suspected breast cancer, either due to your symptoms or because your mammogram has shown an abnormality, you will be referred to a specialist breast cancer clinic for further tests.

    Mammogram and breast ultrasound

    If you have symptoms and have been referred by your GP, you will have a mammogram to produce an X-ray of the breasts. You may also need an ultrasound scan. If your cancer was detected through the NHS Screening Programme, you may need another mammogram or ultrasound scan.

    If you are under 35, your doctor may suggest you have a breast ultrasound scan only. Younger women have denser breasts, which means a mammogram is not as effective as ultrasound in detecting cancer.

    Ultrasound uses high-frequency sound waves to produce an image of the inside of your breasts. The image produced will show any lumps or abnormalities present in your breasts. Your doctor may also suggest a breast ultrasound if they need to know whether a lump in your breast is solid or contains liquid.

    Biopsy

    A biopsy involves taking a sample of tissue cells from your breast and testing them to see if they are cancerous. You may also need a scan and a needle test on lymph nodes in your armpit (axilla) to see if these are also affected. Biopsies can be taken in different ways and the type you have will depend on what your doctor knows about your condition. Different methods of carrying out a biopsy are outlined below.

    • Needle aspiration may be used to test a sample of your breast cells for cancer or to drain a benign cyst (a small fluid-filled lump). Your doctor will use a small needle to extract a sample of cells, without removing any tissue.
    • Needle biopsy is the most common type of biopsy. A sample of tissue is taken from a lump in your breast using a large needle. You will have a local anaesthetic, which means you will be awake but your breast will be numb. Your doctor may suggest you have a guided needle biopsy (usually this is guided by ultrasound or X-ray but sometimes MRI is used) to obtain a more precise and reliable diagnosis of cancer and to distinguish it from any non-invasive change, in particular ductal carcinoma in situ (DCIS).
    • Vacuum-assisted biopsy (mammotome biopsy). The needle may be attached to a gentle suction tube which helps to obtain the sample and clear any bleeding from the area.

    Want to know more?

    Further tests for breast cancer

    If the diagnosis of breast cancer is confirmed, more tests will be needed to determine the stage and grade of the cancer, and to work out the best method of treatment.

    Scans and X-rays

    Computerised tomography (CT) scans, or chest X-ray and liver ultrasound scans, may be needed to check whether the cancer has spread to the lungs or liver. An MRI scan of the breast may be needed to clarify or to assess the extent of disease within the breast.

    If your doctor thinks that the cancer could have spread to your bones, you may need a bone scan. Before you have a bone scan, a substance containing a small amount of radiation, known as an isotope, will be injected into a vein in your arm. This will be absorbed into your bone if it has been affected by cancer. The affected areas of bone will show up as highlighted areas on the bone scan, which is carried out using a special camera.

    Tests to determine specific types of treatment

    You will also need to have tests that show whether the cancer will respond to specific types of treatment. The results of these tests can give your doctors a more complete picture of the type of cancer you have and how best to treat it.

    • Hormone receptor test. In some cases, breast cancer cells can be stimulated to grow by hormones that occur naturally in your body, such as oestrogen and progesterone. If this is the case, the cancer may be treated by stopping the effects of the hormones or by lowering the level of these hormones in your body. This is known as hormone therapy. A sample of cancer cells will be taken from your breast and tested to see if they respond to either oestrogen or progesterone. If the hormone is able to attach to the cancer cells (using a hormone receptor) then they are known as hormone receptor positive
    • HER2 test. While hormones can encourage the growth of some types of breast cancer, other types are stimulated by a protein called human epidermal growth factor receptor 2 (HER2). These types of cancer may be treated using drugs to block the effects of HER2. This is known as biological therapy or targeted therapy

    Want to know more?

    Breast Cancer Care: Diagnosis.

    Stage and grade of breast cancer

    Stage of breast cancer

    When your breast cancer is diagnosed, the doctors will give it a stage. The stage describes the size of the cancer and how far it has spread. Sometimes, ductal carcinoma in situ (DCIS) is described as Stage 0. Other stages of breast cancer describe invasive breast cancer.

    • Stage 1. The tumour measures less than 2cm and the lymph nodes in the armpit are not affected. There are no signs that the cancer has spread elsewhere in the body
    • Stage 2. The tumour measures between 2cm and 5cm or the lymph nodes in the armpit are affected, or both. There are no signs that the cancer has spread elsewhere in the body
    • Stage 3. The tumour measures between 2cm and 5cm and may be attached to structures in the breast, such as skin or surrounding tissues. The lymph nodes in the armpit are affected. However, there are no signs that the cancer has spread elsewhere in the body
    • Stage 4. The tumour is of any size and the cancer has spread to other parts of the body (metastasis)

    This is a simplified guide. Each stage is divided into further categories called A, B and C. If you are not sure what stage you have, ask your doctor.

    TNM staging system

    The TNM staging system may also be used to describe breast cancer. It can provide accurate information about the diagnosis. T describes the size of the tumour, N describes whether cancer has spread to the lymph nodes and M gives an indication of whether the cancer has spread to other parts of the body.

    Grade of breast cancer

    The grade describes the appearance of the cancer cells.

    • Low grade (G1) – the cells, although abnormal, appear to be slow growing
    • Medium grade (G2) – cells look more abnormal than low-grade cells
    • High grade (G3) – cells look even more abnormal and are more likely to grow more quickly

    Want to know more?

    treatment of cancer of the breast female...

    Treatment overview

    The first type of treatment for breast cancer is usually surgery. The type of surgery depends on the type of breast cancer you have. Surgery is usually followed by chemotherapy or radiotherapy or, in some cases, hormone or biological treatments. Again, the treatment you will have depends on your type of breast cancer. Your doctor will discuss the best treatment plan with you. Sometimes, chemotherapy or hormone therapy will be the first treatment.

    Secondary breast cancer

    Most breast cancers are discovered in the early stages of the disease. However, a small proportion of women discover that they have breast cancer after it has spread to other parts of the body (metastasis). If this is the case, the type of treatment you have may be different. Secondary cancer, also called advanced or metastatic cancer, is not curable and treatment aims to achieve a remission, where the cancer shrinks or disappears, making you feel normal and able to enjoy life to the full.

    Want to know more?

    Surgery

    There are two types of surgery for breast cancer. These are surgery to remove just the cancerous lump (tumour), known as breast-conserving surgery, and surgery to remove the whole breast, which is called a mastectomy. In many cases, a mastectomy can be followed by reconstructive surgery to recreate the breast that was removed.

    Studies have shown that breast-conserving surgery followed by radiotherapy is as successful as total mastectomy at treating early-stage breast cancer.

    Breast-conserving surgery

    Breast-conserving surgery ranges from a lumpectomy or wide local excision, in which just the tumour and a little surrounding breast tissue is removed, to a partial mastectomy or quadrantectomy, in which up to a quarter of the breast is removed.

    If you have breast-conserving surgery, the amount of breast tissue you have removed will depend on:

    • the type of cancer you have 
    • the size of the tumour and where it is in your breast
    • the amount of surrounding tissue that needs to be removed
    • the size of your breasts

    Your surgeon will always remove an area of healthy breast tissue around the cancer, which will be tested for traces of cancer. If there is no cancer present in the healthy tissue, there is less chance that the cancer will recur. If cancer cells are found in the surrounding tissue, you may need to have more tissue removed from your breast.

    After breast-conserving surgery, you will usually be offered radiotherapy to destroy any remaining cancer cells.

    Mastectomy

    A mastectomy is the removal of all the breast tissue, including the nipple. If there are no obvious signs that the cancer has spread to your lymph nodes, you may have a mastectomy, in which your breast is removed, along with a sentinel lymph node biopsy (SLNB).

    If the cancer has spread to your lymph nodes, you will probably need more extensive removal (clearance) of lymph nodes from the axilla (under your arm).

    Reconstruction

    Breast reconstruction is surgery to make a new breast shape that looks as much as possible like your other breast. Reconstruction can be carried out at the same time as a mastectomy (immediate reconstruction) or it can be carried out later (delayed reconstruction). It can be done either by inserting a breast implant or by using tissue from another part of your body to create a new breast.

    Lymph node surgery

    To find out if the cancer has spread, a procedure called a sentinel lymph node biopsy (SLNB) may be carried out. The sentinel lymph nodes are the first lymph nodes that the cancer cells reach if they spread. They are part of the lymph nodes under the arm (axillary lymph nodes). The position of the sentinel lymph nodes varies, so they are identified using a combination of a radioisotope and a blue dye.

    The sentinel lymph nodes are examined in the laboratory to see if there are any cancer cells present. This provides a good indicator of whether the cancer has spread.

    If there are cancer cells in the sentinel nodes, you may need further surgery to remove more lymph nodes from under the arm.

    Want to know more?

    Radiotherapy

    Radiotherapy uses controlled doses of radiation to kill cancer cells. It is generally given after surgery and chemotherapy to kill any remaining cancer cells.

    If you need radiotherapy, your treatment will begin about a month after your surgery or chemotherapy to give your body a chance to recover. You will probably have radiotherapy sessions three to five days a week, for three to six weeks. Each session will only last a few minutes.

    The type of radiotherapy you have depends on the type of cancer and the type of surgery you have. Some women may not need to have radiotherapy at all.

    • Breast radiotherapy. After breast-conserving surgery, radiation is applied to the whole of the remaining breast tissue
    • Chest wall radiotherapy. After a mastectomy, radiotherapy is applied to the chest wall
    • Breast boost. Some women may be offered a boost of high-dose radiotherapy in the area where the cancer was removed. However, the boost may affect the appearance of the breast, especially if you have larger breasts, and can sometimes have other side effects, including hardening of the breast tissue (fibrosis)
    • Radiotherapy to the lymph nodes. Radiotherapy is aimed at the armpit (axilla) and the surrounding area to kill any cancer that may be present in the lymph nodes

    The side effects of radiotherapy include:

    • irritation and darkening of the skin on your breast, which may lead to sore, red, weepy skin
    • fatigue (extreme tiredness)
    • lymphoedema (excess fluid build-up in your arm caused by blockage of the lymph nodes under your arm)

    Want to know more?

    Chemotherapy

    Chemotherapy involves using anti-cancer (cytotoxic) drugs to kill the cancer cells. Chemotherapy is usually used after surgery to destroy any cancer cells that have not been removed. This is called adjuvant chemotherapy. In some cases, you may have chemotherapy before surgery, which is generally used to shrink a large tumour. This is called neo-adjuvant chemotherapy.

    Several different drugs are used for chemotherapy and often three are given at once. The choice of drugs and the combination depends on the type of breast cancer and how much it has spread.

    Chemotherapy is usually given as an outpatient treatment, which means you will not have to stay in hospital overnight. The drugs are usually given through a drip straight into the blood through a vein. In some cases, you may be given tablets that you can take at home. You may receive chemotherapy sessions once every two to three weeks, over a period of four to eight months, to give your body a rest in between treatments.

    The main side effects of chemotherapy are caused by their influence on normal, healthy cells, such as immune cells. Side effects include:

    • infections
    • loss of appetite
    • nausea and vomiting
    • tiredness
    • hair loss
    • sore mouth

    Many side effects can be prevented or controlled with medicines that your doctor can prescribe.

    Chemotherapy drugs can also stop the production of oestrogen in your body. Oestrogen is known to encourage the growth of some breast cancers. If you have not been through the menopause, your periods may stop while you are undergoing chemotherapy treatment. After you have finished the course of chemotherapy, your ovaries should start producing oestrogen again. However, in some cases this does not happen and you will enter an early menopause. This is more likely in women over the age of 40, as they are closer to menopausal age. Your doctor will discuss with you the impact that any treatment will have on your fertility.

    Chemotherapy for secondary breast cancer

    If your breast cancer has spread beyond the breast and lymph nodes to other parts of the body, chemotherapy will not cure the cancer but it may shrink the tumour, relieve your symptoms and help lengthen your life.

    Want to know more?

    Hormone treatment

    Some breast cancers are stimulated to grow by the hormones oestrogen or progesterone, which are found naturally in your body. These types of cancer are known as hormone-receptor-positive cancers. Hormone therapy works by lowering the levels of hormones in your body or by stopping their effects.

    The type of hormone therapy you have will depend on the stage and grade of your cancer, which hormone it is sensitive to, your age, whether you have been through the menopause and what other type of treatment you are having. You will probably have hormone therapy after surgery and chemotherapy, but it is sometimes given before surgery to shrink a tumour, making it easier to remove.

    Hormone therapy may be used as the only treatment for breast cancer if your general health prevents you from having surgery, chemotherapy or radiotherapy.

    In most cases, you will need to take hormone therapy for up to five years after your surgery.

    If your breast cancer is not sensitive to hormones, hormone therapy will have no effect.

    Tamoxifen

    Tamoxifen stops oestrogen from binding to oestrogen-receptor-positive cancer cells. Tamoxifen is taken every day as a tablet or liquid. It can cause several side effects, including:

    • tiredness
    • changes to your periods
    • nausea and vomiting
    • hot flushes
    • aching joints
    • headaches
    • weight gain

    Aromatase inhibitors

    If you have been through the menopause, you may be offered an aromatase inhibitor. This drug works by blocking aromatase, a substance that helps to make oestrogen in the body after the menopause. Before the menopause, oestrogen is made by the ovaries.

    Three aromatase inhibitors may be offered. These are anastrozole, exemestane and letrozole. These are taken as a tablet once a day. Side effects include:

    • hot flushes and sweats
    • loss of interest in sex
    • nausea and vomiting
    • tiredness
    • aching joints and bone pain
    • headaches
    • skin rashes

    Ovarian ablation or suppression

    In women who have not been through the menopause, oestrogen is produced by the ovaries. Ovarian ablation or suppression stops the ovaries from working and from producing oestrogen.

    Ablation can be carried out using surgery or radiotherapy. This stops the ovaries working permanently and means that you will go through the menopause early.

    Ovarian suppression involves using a drug called goserelin, which is a luteinising hormone-releasing hormone agonist (LHRHa). Your periods will stop while you are taking it, although they should start again once your treatment is complete. If you are approaching the menopause (around the age of 50), your periods may not start again once you stop taking goserelin.

    Goserelin is taken as an injection once a month and can cause menopausal side effects, including:

    • hot flushes and sweats
    • mood swings
    • trouble sleeping

    Want to know more?

    Biological therapy (targeted therapy)

    Some breast cancers are stimulated to grow by a protein called human epidermal growth factor receptor 2 (HER2). These cancers are called HER2-positive. Biological therapy works by stopping the effects of HER2 and by helping your immune system to fight off cancer cells.

    If you have high levels of the HER2 protein and are able to have biological therapy, you will probably be prescribed a medicine called trastuzumab. Trastuzumab, also known by the brand name Herceptin, is usually used after chemotherapy.

    Trastuzumab

    Trastuzumab is a type of biological therapy known as a monoclonal antibody. Antibodies occur naturally in your body and are made by your immune system to destroy harmful cells, such as viruses and bacteria. The trastuzumab antibody targets and destroys cancer cells that are HER2-positive.

    Trastuzumab is given intravenously, through a drip, and you will have the treatment in hospital. Each treatment session takes up to one hour and the number of sessions you need will depend on whether you have early or more advanced breast cancer. On average, you will need a session once every three weeks for early breast cancer and weekly sessions if your cancer is more advanced.

    Trastuzumab can cause side effects, including heart problems. This means that it is not suitable if you have a heart problem, such as angina, uncontrolled high blood pressure (hypertension) or heart valve disease. If you need to take trastuzumab, you will need regular tests on your heart to make sure it is not causing any problems. Other side effects of trastuzumab may include:

    • an initial allergic reaction to the drug, which can cause nausea, wheezing, chills and fever
    • diarrhoea
    • tiredness
    • aches and pains

    Want to know more?

    Clinical trials

    A great deal of progress has been made in breast cancer treatment and more women now live longer and have fewer side effects of treatment. These advances were discovered in clinical trials, where new treatments and treatment combinations are compared with standard ones.

    All cancer trials in the UK are carefully overseen to ensure the trial is worthwhile and safely conducted. In fact, participants in clinical trials can do better overall than those in routine care.

    If you are asked to take part in a trial, you will be given an information sheet and, if you want to take part, you will be asked to sign a consent form. You can refuse or withdraw from a clinical trial without it affecting your care.

    Want to know more?

    Psychological help

    Dealing with cancer can be a huge challenge, for both patients and their families. It can bring emotional and practical difficulties. Many women have to cope with the removal of part or all of a breast, which can be very upsetting.

    It often helps to talk about your feelings or other difficulties with a trained counsellor or therapist. You can ask for this kind of help at any stage of your illness. There are various ways to find help and support:

    • Your hospital doctor, specialist nurse or GP can refer you to a counsellor. If you are feeling depressed, talk to your GP. A course of antidepressant drugs may help or your GP can arrange for you to see a counsellor or psychotherapist
    • It can help to talk to someone who has been through the same thing as you. Many organisations have helplines and online forums. They can also put you in touch with other people who have had cancer treatment

    Want to know more?

    Complementary therapies

    Complementary therapies are holistic therapies that can promote physical and emotional wellbeing. They are given alongside conventional treatments and include relaxation techniques, massage, aromatherapy and acupuncture.

    Complementary therapy can help some women cope with diagnosis and treatment and provide a break from the treatment plan.

    Your hospital or breast unit may be able to provide access to complementary therapies or suggest where you can get them. It is important to speak to your breast cancer specialist nurse about any complementary therapy you wish to use to make sure it does not interfere with your conventional treatment.

    Want to know more?

    copingwithcancer of cancer of the breast fema...

    In this video, people who have been through cancer treatment talk about what kept them going and the practicalities of treatment.

    Breast cancer (male)

    introduction of cancer of the breast male...

    Breast cancer is often thought of as a condition that only affects women, but men can also develop it.

    However, breast cancer in men is much less common than breast cancer in women, affecting just one in every 100,000 men in England.

    The most common symptom of breast cancer in men is a hard, painless lump that the develops on one of the breasts.

    Read more about the symptoms of breast cancer in men.

    When to see your GP

    You should always visit your GP if you notice a lump in your breast, or you have symptoms that affect your nipples, such as retraction or discharge.

    While these symptoms are unlikely to be the result of breast cancer, they should be investigated further.

    Treating breast cancer in men

    In most cases of breast cancer, surgery is used to remove a section of the breast. This is usually followed by a long-term course of hormone therapy using a medication called tamoxifen.

    Tamoxifen helps to block the effects of hormones on breast tissue that are known to stimulate the growth of cancerous cells. It should help to prevent the cancer from returning.

    In some cases, radiotherapy and/or chemotherapy may be used for the same purpose.

    Read more about treating breast cancer in men.

    Causes

    The causes of breast cancer in men are unclear, but a number of risk factors for the condition have been indentified. These include:

    • age - most cases of male breast cancer affect men who are over 70 years of age
    • having a family history of breast cancer (both male or female)
    • obesity - a body mass index (BMI) of 30 or more
    • alcohol consumption

    Read more about the potential risk factors and possible causes of breast cancer in men.

    Who is affected?

    It is estimated that around 300 new cases of breast cancer in men are diagnosed each year in England. The average age of diagnosis is 71 years of age.

    Rates of breast cancer are slightly higher in Jewish men. This is thought to be due to genetic reasons.

    Outlook

    The outlook forbreast cancer in men is less favourable than for breast cancer in women. This is because there is less awareness of the condition, so it often takes longer to diagnose.

    Healthcare professionals assess the outlook for cases of cancer by measuring how many people survive for five years following the initial diagnosis. This is known as ‘the five year survival rate’. However, many men who are diagnosed with breast cancer survive for much longer than five years.

    The estimated five year survival rate for:

    • stage 1 breast cancer is 75-100%
    • stage 2 to 3 breast cancer is 50-80%,
    • stage 4 breast cancer is 30-60%

    Read more about diagnosing breast cancer in men, including how the condition is staged.

    Tissue


    Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.

    symptoms of cancer of the breast male...

    The most common symptom of breast cancer in men is usually a hard, painless lump in one of your breasts. However, in around 1 in 20 cases, the lump can be painful.

    The lump is usually located underneath the nipple and areola (the circle of dark coloured skin that surrounds the nipple).

    Less common symptoms of male breast cancer usually affect the nipple. These can include:

    Additional symptoms usually only develop if the cancer spreads from your breast to other parts of the body, such as your bones, liver or lungs. This is known as metastatic breast cancer.

    Symptoms of metastatic breast cancer include:

    • bone pain
    • swelling of the lymph nodes (glands) near your breast; usually in, or around, the armpit
    • shortness of breath
    • feeling unusually tired all the time
    • feeling sick (nausea)
    • itchy skin

    When to seek medical advice

    You should always visit your GP if you notice a lump in your breast or if you have symptoms that affect your nipples, such as retraction, ulceration or discharge. While symptoms such as these are unlikely to be of the result of breast cancer, it is important that they are investigated further.

    treatment of cancer of the breast male...

    Many hospitals use multidisciplinary teams (MDTs) to treat breast cancer in men. MDTs are teams of specialists that work together to make decisions about the best way to proceed with your treatment.

    Members of your MDT may include:

    • a surgeon
    • a clinical oncologist (a specialist in the non-surgical treatment of cancer)
    • a pathologist (a specialist in diseased tissue)
    • a radiologist (a doctor who specialises in analysing the results of imaging tests such as X-rays and ultrasound scans)
    • a dietitian
    • a social worker
    • a psychologist

    As well as having a specialist MDT, you may also be assigned a key worker who will usually be a specialist nurse. They will be responsible for co-ordinating your care.

    Deciding what treatment is best for you can often be confusing. Your cancer team will recommend what they think is the best treatment option but the final decision will be yours.

    Before visiting hospital to discuss your treatment options, you may find it useful to write a list of questions that you would like to ask the specialist. For example, you may want to find out the advantages and disadvantages of particular treatments.

    Your treatment plan

    Your recommended treatment plan will depend on how far the cancer has spread. If the cancer has not spread significantly beyond your breast (stage 3 or below), a complete cure may be possible.

    Surgery to remove the affected breast is usually recommended followed by radiotherapy, hormone therapy and /or chemotherapy to help prevent the cancer returning.

    If the cancer has spread beyond your breast into other parts of your body, such as your lungs (stage 4 breast cancer), a complete cure will not be possible. However, hormone therapy and chemotherapy can be used to relieve symptoms, slow down the spread of the cancer  and prolong lifespan.

    Surgery

    Surgery is the first treatment option that is often recommended for breast cancer and usually involves an operation called a modified radical mastectomy. This is where the surgeon removes the entire breast as well as the lymph nodes (glands) in the armpit.

    Once surgery has been completed there will be a scar where your nipple used to be and an indentation in your chest where the breast tissue was.

    It is possible to have reconstructive surgery after having a modified radical mastectomy. Tissue can be taken from other parts of your body, such as your lower abdomen or buttocks, and be used to recreate the shape of the breast.

    An alternative option is to use breast implants that are similar to those that are used in cosmetic surgery. However, they are obviously much smaller. In many cases, reconstructive surgery can be carried out immediately after a mastectomy has been performed.

    It is also possible to restore the appearance of a nipple by having a tattoo on your chest. ‘Nipple tattoos’ can be created in around 30 to 40 minutes and have a very realistic appearance.

    You should discuss the various options for reconstructive surgery with your MDT.

    After surgery

    Most men are well enough to leave hospital three to five days after having surgery for breast cancer. After the operation, it is likely that you will feel very tired and it may take several weeks before you are well enough to start carrying out relatively strenuous activities, such as lifting objects or driving.

    Your MDT will be able to give you a more precise recommendation.

    The wound at the site of the surgery will take about two to three weeks to heal. It is important to keep the wound clean during this time using unscented soap. You should look out for any signs that the wound may have become infected, such as redness and swelling around the wound or a discharge of pus.

    Inform your MDT as soon as possible if you suspect that the wound may have become infected.

    It is difficult to predict when you will feel able to return to work. Some people choose to remain off work until other treatments, such as radiotherapy, have been completed. Others prefer to return to work in between treatments. Your MDT will be able to provide you with advice but the final decision will be yours.

    It can take several months to fully recover from the effects of a mastectomy. A structured exercise programme  where the intensity and amount of time spent exercising  is gradually increased  will probably be recommended.

    Your MDT will be able to provide you with more advice or refer you to physiotherapist (a specialist with training in rehabilitation using exercise).

    The Royal College of Surgeons have produced a useful leaflet for people who are recovering after having a mastectomy.

    Complications of surgery

    Following surgery, you may experience numbness or tingling at the site of the scar and in your upper arm. This is common and is caused by nerve damage that occurs during surgery. The numbness and tingling should pass within a few weeks or months although it can occasionally be permanent.

    Another common complication that can occur after a mastectomy is painful swelling in the arms and legs and, occasionally, in other parts of the body, such as the head and chest. This is called lymphoedema and it is caused by the disruption of the lymphatic system (a series of channels and lymph nodes which is normally responsible for removing excess fluid from tissue).

    If multiple lymph nodes are surgically removed, as in the case of a modified radical mastectomy, it can disrupt the lymphatic system’s ability to drain fluid which can lead to swelling.

    There is no cure for lymphoedema, but it is possible to control the symptoms using a combination of different techniques, such as massage and compression garments.

    Read more about treating lymphoedema.

    Radiotherapy

    Radiotherapy is a type of treatment that uses a machine that releases high energy waves to destroy cancerous cells. It can be given a few weeks after surgery to prevent the cancerous cells returning.

    A course of radiotherapy usually involves five sessions a week over the course of six weeks. The sessions are short and usually only last for 10 to 15 minutes.

    Radiotherapy is not usually painful although you will probably experience some side effects. This is because the energy that is released during radiotherapy can also damage healthy cells.

    Common side effects of radiotherapy include:

    • extreme tiredness (fatigue)
    • feeling sick (nausea)
    • sore, red, and irritated skin on the breast (similar in appearance to sunburn)

    The side effects of radiotherapy should pass after your course of treatment has finished, although some men experience prolonged fatigue for several months.

    Radiotherapy can also be used in cases of advanced breast cancer to slow down the spread of the cancer and to relieve the symptoms of pain. This is known as palliative radiotherapy. Palliative radiotherapy is usually given in just one or two doses and does not usually cause any side effects

    Read more about radiotherapy.

    Hormone therapy

    About 90% of cases of breast cancers in men are oestrogen receptor positive or ER+ (E is used because the American spelling of oestrogen is ‘estrogen’). This means that the cancerous cells require oestrogen to grow. Oestrogen is a type of hormone that is found in low levels in men and in  much higher levels in women.

    Therefore, the aim of hormone therapy is to block the effects of oestrogen on the breast tissue to prevent the cancer reoccurring after surgery.

    Hormone therapy can also be used in cases of advanced breast cancer in order to slow down the spread of the cancer.

    Tamoxifen

    Tamoxifen is a medication that is widely used during hormone therapy for breast cancer.

    It prevents oestrogen from entering the breast tissue cells which helps prevent breast cancer reoccurring. Tamoxifen is available in tablet or liquid form.

    It is unclear what the ideal length of a course of tamoxifen should be. Studies in women with breast cancer suggest that a five year course of treatment is the most effective in preventing the return of cancer and extending survival rates. However, it is not known whether this also applies to men.

    Tamoxifen can cause unpleasant side effects, so you will need to balance the potential advantages of taking the medication with the possible disadvantages. You should discuss the pros and cons of long-term treatment with tamoxifen with your MDT.

    Side effects of tamoxifen include:

    • reduced interest in sex (low libido)
    • inability to obtain or maintain an erection (erectile dysfunction)
    • headache
    • feeling sick - taking your medication with food may help to alleviate this side effect
    • changes in mood, such as feeling irritable or depressed

    You should inform your MDT if you experience side effects that become particularly troublesome because alternative medications are available.

    Aromatase inhibitors

    Aromatase inhibitors are a type of medication that are an alternative hormone treatment to tamoxifen.  They may be used if tamoxifen proves to be unsuccessful or if the side effects of tamoxifen are particularly troublesome. Aromatase inhibitors can also be used to slow the spread of advanced breast cancer.

    In men, oestrogen is created when a protein called aromatase converts another hormone called androgens. Aromatase inhibitors block the effects of aromatase which, in turn, lowers the amount of oestrogen in the body.

    Aromatase inhibitors are usually given in tablet form and are taken daily for two to five years. As with tamoxifen, there is very little available evidence (compared with female breast cancer) regarding what the most effective length of dosage is.

    Side effects of aromatase inhibitors include:

    • joint pain
    • lack of energy
    • hot flushes
    • skin rashes
    • feeling sick
    • being sick
    • thinning of the hair

    The side effects are usually mild to moderate. It is also unlikely that you will experience all of the side effects that are listed above.

    Chemotherapy

    Chemotherapy is used to treat cases of breast cancer where the cancerous cells are not oestrogen receptor positive (ER+), which meaning that hormone therapy would be mostly ineffective. Chemotherapy is usually given after surgery to help prevent the cancer returning or it is used to treat the symptoms of incurable cancer.

    Chemotherapy for breast cancer usually involves taking a combination of cancer-killing medications. Treatment is usually given every two to three weeks, over the course of six months.

    You may be given chemotherapy tablets (oral chemotherapy) or chemotherapy injections (intravenous chemotherapy) or a combination of both.

    The side effects of chemotherapy include:

    However, the side effects should resolve once your treatment has finished. Following treatment, your hair should take between three to six months to grow back.

    Chemotherapy can also weaken your immune system, making you more vulnerable to infection.

    It is therefore important to report any symptoms of a potential infection to your MDT such as:

    • a high temperature of 38C (100.4F) or above
    • flu-like symptoms, such chills or joint pain
    • a general sense of feeling unwell

    You should also avoid close contact with people who are known to have an infection.

    If you are sexually active, you should use a condom for 48 hours after receiving a dose of chemotherapy medication. This is because the medication used in chemotherapy could pass into your semen and cause irritation in the tissue of your partner’s genitals.

    You should avoid having children while receiving chemotherapy because many of the medications can damage your sperm and increase your chances of having a baby with a birth defect. Again, using a reliable method of contraception, such as a condom, is recommended

    Depending on the medications that are used, it may be several months after your course of chemotherapy has ended before you can safely have children. Your MDT will be able to give you a more detailed recommendation.

    Read more about chemotherapy.

    Biological therapy

    As with oestrogen receptor positive (ER+) types of cancer, some cases of breast cancer can be stimulated by a type of protein called human epidermal growth factor receptor 2 (HER2).

    Biological therapy uses medication to block the effects of HER2 on breast tissue.

    Biological therapies are sometimes referred to as targeted therapies because they are designed to target biological processes that cancers rely on to grow and reproduce.

    If you have high levels of the HER2 protein and you are able to have biological therapy, you will probably be prescribed a medicine called trastuzumab. Trastuzumab, also known by the brand name Herceptin, is usually used after radiotherapy and/or chemotherapy to prevent cancerous cells returning.

    Trastuzumab

    Trastuzumab is a type of biological therapy known as a monoclonal antibody. Antibodies occur naturally in the body and are created by the immune system to destroy harmful cells, such as viruses and bacteria. The trastuzumab antibody targets and destroys cancer cells that are designed to respond to the HER2 protein.

    Trastuzumab is given intravenously (directly in to a vein) through a drip. You will receive the treatment in hospital. Each treatment session takes up to one hour and the number of sessions that you need to have will depend on whether your breast cancer is in its early or more advanced stages. On average, for early breast cancer you will need to have a session once every three weeks, and for cancer that is more advanced you will need to have weekly sessions.

    Trastuzumab can cause side effects, including heart problems. This means that it is not suitable if you have a heart problem, such as angina, uncontrolled high blood pressure (hypertension) or heart valve disease. If you need to take trastuzumab, you will need to have regular tests on your heart to ensure that it is not causing any problems.

    Other side effects of trastuzumab may include:

    • an initial allergic reaction to the medication, which can cause nausea, wheezing, chills and fever
    • diarrhoea
    • tiredness
    • aches and pains

    Read more about trastuzumab.

    Glossary

    Mastectomy
    A mastectomy is an operation to remove a breast, and most of the skin covering it. It is usually done to treat or prevent breast cancer.
    Radiotherapy
    Radiation therapy uses x-rays to treat disease, especially cancer.
    Lymph nodes
    Lymph nodes are small oval tissues that remove unwanted bacteria and particles from the body. Part of the immune system.
    Liver
    The liver is the largest organ in the body. Its main jobs are to secrete bile (to help digestion), detoxify the blood and change food into energy.
    Tissue
    Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.  
    Chemotherapy
    Chemotherapy is a treatment of an illness or disease with a chemical substance, e.g. in the treatment of cancer.
    Biopsy
    A biopsy is a test that involves taking a small sample of tissue from the body so it can be examined.
    Brain
    The brain controls thought, memory and emotion. It sends messages to the body controlling movement, speech and senses.
    Lungs
    Lungs are a pair of organs in the chest that control breathing. They remove carbon dioxide from the blood and replace it with oxygen.

    Broken collarbone

    introduction of broken collarbone...

    A broken collarbone usually happens after a fall onto the shoulder. It takes about six to eight weeks to heal in adults and three to four weeks in children.

    The collarbone, or clavicle, is a long slender bone that runs from the breastbone to each of the shoulders. You should be able to feel it running across the top of your chest, just below your neck. The collarbone is connected to the breastbone and to the shoulder blade via tough bands of tissue called ligaments.

    If you think you've injured your collarbone, or you think your child has, see your GP straight away. They may be able to tell whether the bone is fractured (broken or cracked) just by feeling it. If your GP thinks it is fractured, they will refer you to hospital for an X-ray to confirm the injury and to have it treated with a sling and brace. 

    If you can't see your GP or if the injury is severe (e.g. the bone is poking through the skin or the pain is unbearable), go straight to your nearest hospital accident and emergency (A&E) department.

    This page summarises the signs of a broken or cracked collarbone, and explains what you can do while you wait to see the doctor and how this injury is treated. 

    Signs of a broken collarbone

    A cracked or broken collarbone will be extremely painful. There may also be:

    • swelling or tenderness around the injured area
    • bruising to the skin
    • bleeding, if the bone has damaged the tissue and skin (however, this is rare)

    Your shoulder may be slumped downwards and forwards under the weight of the arm, as the broken collarbone is no longer providing support.

    You may have heard a snap or a grinding noise during the accident. In very severe cases, one end of the bone may poke through the skin.

    What you should do

    While you wait to see a doctor, you can stabilise the arm by using a towel as a sling (this goes under the arm and then around the neck). Try to move the arm as little as possible.

    Take over-the-counter painkilllers, such as paracetamol or ibuprofen, to reduce the pain (note that aspirin shouldn't be given to children aged under 16).

    Hold an ice pack to the injured area – try a bag of frozen peas wrapped in a tea towel. This can help to reduce pain and swelling.

    If your child has injured their collarbone, try and get someone else to drive so that you can support and comfort your child, who may feel very distressed.

    How a broken collarbone is treated

    Most broken collarbones are left to heal naturally, using just a sling and brace to support the arm and hold the bones together in their normal positions.

    The sling and brace are usually applied in hospital, after an X-ray has confirmed that the collarbone is broken. You'll be given painkillers to relieve the pain.  

    Surgery under a general anaesthetic is only needed if the injury is severe (e.g. the bone has broken through the skin) or if the bones have failed to line up in a brace and are overlapping significantly. Many different techniques have been used to repair the collarbone, but the most common is to fix the break with a plate and screws. If you need surgery to repair your broken collarbone, ask your surgeon to explain which technique they will be using, and the advantages and disadvantages of this method.

    Being discharged

    You may need to stay in hospital overnight, depending on the extent of the injury.

    Before you're discharged, you'll be seen by a physiotherapist, who will show you some gentle arm and shoulder exercises to do at home with your arm out of its sling. These will help to reduce stiffness, relieve some of the pain and build up strength in your shoulder muscles.

    Follow-up

    You're likely to be asked to go back to the hospital outpatient department about one week later, to check that the collarbone is healing properly.

    Recovering from a broken collarbone

    In adults, it takes about six to eight weeks for a broken collarbone to heal. In children it's just three to four weeks.

    However, it will take at least the same period again to restore full strength to your shoulder.

    Avoid contact sports for at least 10-12 weeks after the injury. Your doctor will tell you when you can go back to work and resume normal activities.

    Broken wrist

    introduction of broken arm...

    A broken arm or wrist is usually caused by a fall or by force from a collision. It takes about six to eight weeks to heal in adults, and less time in children.

    Doctors refer to all breaks or cracks in bones as fractures. However, most people use the word 'fracture' to describe a crack rather than a clean break. This article will use the terms 'break' and 'crack' to describe both. 

    If you think you may have broken or cracked a bone in your arm, or you think your child has, go to your nearest hospital accident and emergency (A&E) department. If the injury is severe, dial 999 for an ambulance.

    How can I tell if the arm or wrist is broken?

    A cracked or broken arm bone will be extremely painful and there may also be:

    • swelling or tenderness around the injured area
    • bleeding, if the bone has damaged the tissue and skin

    If it's just a crack in the bone, you may think the pain and swelling have just resulted from a sprained or torn tendon (read about sprains and strains). Getting the arm X-rayed in hospital is the only way to confirm whether or not the bone has been injured.

    If it's a clean break, you may have heard a snap or a grinding noise during the accident. The bone may have broken straight across or diagonally, or may be a spiral (winding) break. In severe cases, the arm bone may stick out at an angle or poke through the skin.

    What you can do

    It's important not to eat or drink anything if you think you've broken your arm, as you may need a general anaesthetic (be put to sleep) that day.

    Before going to hospital, you can stabilise the arm by using a towel as a sling (this goes under the arm and then around the neck). Don't try to straighten the arm.

    Take an ice pack with you to hold to the injured area – try a bag of frozen peas wrapped in a tea towel. This can help to reduce pain and swelling.

    If your child has injured their arm or wrist, try and get someone else to drive so you can support and comfort them, as your child may feel very distressed.

    How a broken arm or wrist is treated

    A broken arm or wrist is usually treated in a hospital accident and emergency department. The treatment differs depending on the severity of the injury.

    First, a doctor will give you or your child painkillers and then fix a splint to the arm to secure it in position and prevent further damage.

    An X-ray will be taken of the arm to see what kind of fracture it is. Even if it's just a cracked bone (called a hairline fracture), this should still show up faintly on X-ray.

    If it's a minor break or crack, your doctor will just apply a plaster cast to the arm or wrist to hold the broken ends together while they heal. This is called closed reduction, as no incisions are needed. It may be done using a local or regional anesthetic, where the arm is numbed and you don't feel any pain (this is rarely used in children), or using a general anaesthetic, where you are put to sleep.

    For more severe fractures, an operation may be necessary to bring the bones together. This involves cutting open the skin (open reduction) using a general anaesthetic and fixing the bones using pins, rods or a plate and screws.

    Once the bones have been aligned and the arm or wrist has been bandaged and set into a plaster cast, the arm will be secured to the chest with a sling. Plaster may not be needed if the bones are held in position with a metal fixation device.

    Recovering from a broken arm or wrist

    The plaster cast will usually need to stay on for a few weeks, the time it takes for the bone to heal.

    The exact length of healing time depends on the type of fracture, whether it has damaged the surrounding tissues, and (to an extent) the age of the patient. For example, a young child who has cracked their bone at the wrist will need to wear a cast or removable splint for just two to three weeks. But in older people, a wrist injury can take a lot longer to get back to normal and stiffness is extremely common. 

    It's important not to get a plaster cast wet - read How should I care for my plaster cast? for more advice.

    When the cast comes off, the arm or wrist should have healed and it can be used normally, although it may be stiff. 

    However, children who have just come out of plaster are at risk of breaking or cracking their bone again, so it's worth keeping them away from trampolines, bouncy castles, soft play areas and contact sports for a further two to three weeks to minimise this risk.

    Physiotherapy is sometimes needed for adults after the bone has healed, to help build up strength in the arm muscles and restore full movement. However, this is rarely needed for children.

    A broken arm bone that has pierced the skin and damaged the surrounding tissue may become infected, so the wound will need to be cleansed regularly.

    Bronchiectasis

    introduction of bronchiectasis...

    Bronchiectasis is a long-term lung condition where the airways of the lungs become abnormally widened, leading to a build-up of excess mucus.

    This in turn can make the airways of the lungs more vulnerable to infection.

    The most common symptom of bronchiectasis include:

    • a persistent cough that usually brings up sputum (phlegm)
    • breathlessness
    • coughing up or spitting out blood

    Symptoms can vary widely. Some people have only a few symptoms that don't appear often, while others have wide-ranging symptoms that occur daily.

    Read more about the symptoms of bronchiectasis.

    The lungs are full of tiny branching airways, known as the bronchi, whose role is to move oxygen into even smaller sacs called alveoli, which transfer the oxygen into the blood so it can then be transported around the body.

    The lining of the bronchi are coated with a sticky fluid called mucus (the same fluid that can come out of your nose when you sneeze), which protects against particles moving down into the lungs and damaging them.

    With bronchiectasis, one or more of the bronchi become abnormally widened. This can then trigger a vicious circle of mucus gathering in the bronchi, making them prone to infection and further widening the bronchi, leading to a build-up of more mucus.

    During an infection, the symptoms of bronchiectasis will usually get worse.

    Causes

    Bronchiectasis has a wide range of possible causes. The three most commonly reported causes in England are:

    • The bronchi became damaged due to a previous childhood lung infection.
    • Underlying problems with the immune system (the body’s defence against infection) has led to the bronchi becoming damaged due to infection, or in some cases, they have mistakenly been attacked by the immune system.
    • The patient has allergic bronchopulmonary aspergillosis (ABPA) – an allergy to a certain type of fungi that damages the lungs.

    However, in over half of all cases of bronchiectasis no obvious reason can be found to explain why the bronchi became widened.

    Read more about the possible causes of bronchiectasis.

    Treatment

    Treatment for bronchiectasis involves using a number of different methods to help improve symptoms and quality of life, such as:

    • medication to help improve airflow within the lungs
    • physiotherapy and exercise to help clear the lungs of mucus
    • antibiotics, when necessary, to treat infection

    If an infection is severe you may be admitted to hospital as a precaution.

    Surgery is occasionally used when other treatments fail to improve symptoms, although not everyone is a suitable candidate for surgery.

    Read more about the treatment of bronchiectasis.

    Complications

    Complications of bronchiectasis are rare but when they do occur they can be serious. Probably one of the most serious complications is coughing up large amounts of blood which can be life-threatening and require emergency surgery to treat.  

    Read more about the complications of bronchiectasis.

    Who is affected?

    Bronchiectasis is thought to be relatively rare and can affect anyone at any age. 

    One estimate is that around 1 in every 1,000 adults and 1 in every 10,000 children have bronchiectasis in England. Around 9,000 people are admitted to hospital each year due to problems arising from bronchiectasis.

    Outlook

    The outlook can be highly variable and often depends on the underlying cause.

    For most people the outlook is good, although living with bronchiectasis can be distressing and frustrating.

    In people with very severe symptoms, bronchiectasis can disrupt normal lung function, which can sometimes be fatal.

    In 2010, there were just over 1,000 deaths reported in England and Wales where bronchiectasis was thought to be an underlying factor. 

    Lungs
    Lungs are a pair of organs in the chest that control breathing. They remove carbon dioxide from the blood and replace it with oxygen.
    Bacteria
    Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and some others are good for you.

    symptoms of bronchiectasis...

    The most common symptoms of bronchiectasis is a cough, which affects around 9 out of 10 people with bronchiectasis.

    In three out of four cases the cough will bring up sputum (phlegm), which can be clear, pale yellow or yellow-greenish in colour.

    In the remaining cases the cough may only occasionally bring up sputum, or bring up no sputum at all.

    Other symptoms include:

    • shortness of breath
    • coughing up blood or blood-stained sputum
    • chest pain

    Infection

    If you contract a lung infection then your symptoms will usually get worse. This is known as an infective exacerbation and could mean that:

    • You cough up even more sputum and often the sputum has an unpleasant smell.
    • Your shortness of breath worsens.

    You may also experience additional symptoms, such as:

    When to seek medical advice

    If you haven't previously been diagnosed with bronchiectasis and you begin to experience a persistent and unexplained cough, visit your GP for advice.

    While persistent coughing may not necessarily be the result of bronchiectasis, it will require further investigation.

    If you have been previously diagnosed with bronchiectasis and you begin to experience symptoms that suggest you have contracted a lung infection, such as worsening of your present symptoms or coughing up foul-smelling sputum, contact your GP.

    This is because it's likely that you will require treatment with antibiotics (although some people with bronchiectasis are given a stock of antibiotics as a precaution in case they suddenly develop a lung infection).

    When to seek immediate medical advice

    Some people with bronchiectasis develop a severe lung infection that may need to be treated in hospital.

    Signs and symptoms of serious lung infection include:

    • Your skin takes on a bluish tinge due to lack of oxygen – this is known as cyanosis.
    • You (or someone in your care) are mentally confused.
    • You have a high temperature of or above 38C (100.4F).
    • You are breathing rapidly, with more than 25 breaths a minute.
    • You have severe chest pains that are making it too painful to cough and to clear any mucus out of your lungs.

    If you experience any of the above, phone the healthcare professional in charge of your care for advice immediately. This may be your GP, a doctor who specialises in lung conditions (pulmonologist) or a specialist nurse.

    If this isn't possible then phone NHS Direct on 0845 46 47 or your local out-of-hours service.

    causes of bronchiectasis...

    Bronchiectasis is a progressive condition that gets worse over time in a pattern often referred to as a vicious circle.

    Your lungs are continually exposed to germs so your body has a number of sophisticated defence mechanism that are designed to keep the lungs sterile (germ free). However, occasionally these defences can be breached.

    Your immune system will attempt to stop the spread of any infection by sending infection-fighting white blood cells to the location of infection.

    These cells release chemicals that can cause surrounding tissue to become inflamed.

    In some cases, inflammation can destroy the elastic-like tissue and muscles that surround the bronchi, leading to the bronchi to becoming wider.

    This abnormal bronchi then becomes filled with an excess amount of mucus which can trigger persistent coughing and make the lung more vulnerable to infection. This in turn can result in further inflammation, and further widening of the bronchi, leading to more mucus gathering and so it continues. However, the levels of damage to the lungs can differ widely from case to case.

    In around half of all cases of bronchiectasis, no obvious cause can be found to explain what triggered the symptoms. Other triggers are described below.

    Childhood infections

    Around a third of cases of bronchiectasis currently found in adults are associated with a previous severe childhood lung infection, such as:

    As there are now vaccinations available for these types of conditions, the rates of these types of infection-related bronchiectasis are expected to fall in the future.

    Immunodeficiency

    Around 1 in 12 cases of bronchiectasis are caused because a person has a weakened immune system – the body’s defence against infection – making their lungs more vulnerable to tissue damage. The medical term for having a weakened immune system is immunodeficiency.

    Some people are born with an immunodeficiency due to problems with the genes that they inherit from their parents. It is also possible to acquire an immunodeficiency due to an infection such as HIV.

    Allergic bronchopulmonary aspergillosis (ABPA)

    Around 1 in 14 people develop bronchiectasis as a complication of an allergic condition known as allergic bronchopulmonary aspergillosis (ABPA).

    People with ABPA have an allergy to a type of fungi known aspergillus, which is found in a wide range of different environments across the world.

    If a person with ABPA breathes in fungal spores it can trigger an allergic reaction and persistent inflammation which in turn can progress to bronchiectasis.  

    Read more about allergic bronchopulmonary aspergillosis.

    Aspiration

    The medical term for accidentally swallowing the "wrong way" into your lungs rather than down into your stomach is aspiration, which is responsible for around 1 in 25 cases of bronchiectasis.

    The lungs are very sensitive to the presence of foreign objects, such as small samples of food or even stomach acids, so this can trigger inflammation leading to bronchiectasis.

    Young’s syndrome

    Young’s syndrome is a rare disorder that accounts for around 1 in 33 cases of bronchiectasis and only affects males. The condition damages little tiny, hair-like structures that cover the airways in the lung known as cilia. The cilia are designed to protect the airways of the lungs, as well as helping move away any excess mucus.

    Damage to the cilia can lead to the symptoms of bronchiectasis.

    Young’s syndrome is thought to be caused by childhood exposure to mercury. As the regulations regarding the use of mercury are now much stricter than they were in the past it is expected that Young’s syndrome will become a much less common cause of bronchiectasis. 

    Cystic fibrosis

    Cystic fibrosis is a relatively common genetic disorder where the lungs become clogged up with mucus. The mucus then provides an ideal environment for a bacterial infection to take place, leading to the symptoms of bronchiectasis.

    It is estimated that cystic fibrosis is responsible for around 1 in 35 cases of bronchiectasis.

    Rheumatoid arthritis

    Rheumatoid arthritis is a common condition in which the immune system goes wrong and starts attacking healthy tissue, causing inflammation which in most cases is confined to the joints. However, in a small number of cases the inflammation can spread to the lungs, triggering the symptoms of bronchiectasis.

    It is estimated that rheumatoid arthritis is responsible for around 1 in 35 cases of bronchiectasis. 

    Bronchiolitis

    introduction of bronchiolitis...

    Bronchiolitis is a common lower respiratory tract infection that affects babies and young children under a year old. The early symptoms are similar to those of a common cold and include a runny nose and cough.

    As it develops, the symptoms of bronchiolitis can include:

    • a slight fever (raised temperature)
    • a dry and persistent cough
    • difficulty feeding

    Symptoms usually improve after three days and in most cases the illness isn’t serious.

    However, contact your GP or midwife if your child is only able to feed half the normal amount or is struggling to breathe, or if you are generally worried about them. Sometimes further testing is needed to monitor any severe symptoms or check for any underlying conditions.

    Read more about diagnosing bronchoilitis.

    Bronchiolitis is usually caused by a virus known as the respiratory syncytial virus (RSV) and spread through tiny droplets of liquid from the coughs or sneezes of someone who is infected.

    This causes the smallest airways in the lungs (the bronchioles) to become infected and inflamed (swollen). The inflammation reduces the amount of air entering the lungs, making it more difficult to breathe.

    Read more information about the causes of bronchiolitis.

    Who is affected?

    It is estimated that one-third of children in the UK develop bronchiolitis in their first year of life. The condition is most common in babies between three and six months old. By the age of two, almost all infants have been infected with RSV and 40%-50% will have had bronchiolitis.

    Bronchiolitis is most common during the winter months, from November to March. It’s also possible to get bronchiolitis more than once during the same season.

    Treating bronchiolitis

    There is no medication to kill the viruses that cause bronchiolitis, but the infection usually clears up within two weeks without any need for treatment. Most children can be cared for at home in the same way that you’d treat a cold. Make sure that your child gets enough fluid to avoid dehydration and give infants paracetamol or ibuprofen to bring down any temperature. 

    Read more information about treating bronchiolitis.

    Around 3% of babies with bronchiolitis need to go to hospital. This is because they develop more serious symptoms, such as difficulty breathing. This is more common in premature babies (babies born before week 37 of pregnancy) and those born with a heart or lung condition.

    Read more about the complications of bronchiolitis.

    Preventing bronchiolitis

    Although it is very difficult to prevent bronchiolitis, you can take steps to reduce your child's risk of catching it and help prevent the virus spreading. This includes:

    • washing both your child's hands and your hands frequently
    • washing or wiping toys and surfaces regularly
    • keeping infected children at home until their symptoms have improved
    • keeping newborn babies away from people with colds or flu
    • preventing your child being exposed to tobacco smoke

    Some children who are at high risk of severe bronchiolitis may also require monthly antibody injections, which help limit the severity of the condition.

    Read more information about preventing bronchiolitis.



    prevention of bronchiolitis...

    The viruses that cause bronchiolitis are very common and easily spread, so it's impossible to prevent the condition entirely. However, you can take steps to reduce the chance of your child catching a virus.

    If your child already has bronchiolitis, following these steps will help to prevent spreading the virus further:

    • Cover your child's nose and mouth when they cough or sneeze.
    • Use disposable tissues rather than cotton handkerchiefs and throw them away as soon as they have been used.
    • Wash both your child's hands and your hands frequently, particularly after touching their nose or mouth or after feeding.
    • Ask anyone who comes into contact with your child, such as a relative or nanny, to wash their hands first.
    • Wash and dry eating utensils after use.
    • Wash or wipe toys and surfaces regularly.
    • Keep infected children at home until their symptoms have improved (they are feeding normally and do not have any difficulty breathing).
    • Keep newborn babies away from people with colds or flu, particularly during the first two months of life or if they were born prematurely (before week 37 of pregnancy).

    Smoking

    It is important to prevent your child from being exposed to tobacco smoke.

    Children who inhale smoke passively are more at risk of developing severe bronchiolitis.

    Read up on how to quit smoking.

    High-risk children

    In some cases, it may be possible for a child with a high risk of developing severe bronchiolitis to have monthly antibody injections. The injections may help limit the severity of the condition if the child becomes infected.

    Children considered to be at high risk include those who:

    • were born very prematurely
    • were born with a heart or lung condition
    • have an immune deficiency (a weakened immune system)

    Your GP can give you more information and advice if your child is at high risk.



    symptoms of bronchiolitis...

    Although most children recover from bronchiolitis within a few days, it's important to look out for signs of more serious symptoms, such as breathing difficulties.

    The early symptoms of bronchiolitis are similar to those of a common cold. The first symptom is usually a blocked or runny nose and your child may also have a slight cough or fever (high temperature). A normal temperature is 36C-36.8C (96.8F-98.2F).

    Symptoms usually get worse during the first three days, then gradually improve. During this time, your child may experience:

    • a rasping and persistent dry cough
    • rapid or noisy breathing
    • brief pauses in their breathing
    • feeding less and having fewer wet nappies
    • vomiting after feeding
    • being irritable

    Even though most cases of bronchiolitis are not serious, these symptoms can be very worrying for parents.

    When to seek medical advice

    Contact your GP or midwife if your child has any of the symptoms of bronchiolitis described in the list above. This is particularly important if your baby is under 12 weeks old or they have an underlying health problem, such as a congenital heart or lung condition. Congenital means that the condition has been present from birth.

    In all cases, be aware of any changes to your child’s symptoms. Contact your GP again if you are worried or if your child develops any of the following symptoms:

    • increased difficulty breathing or wheezing as they breathe
    • poor feeding (if your child has taken less than half the amount that they usually do during the last two or three feeds)
    • no wet nappy for 12 hours or more 
    • a rapid breathing rate of more than 40 breaths a minute
    • a high temperature (fever) of 38C (100.4F) or above 
    • being very tired or irritable

    When to call 999

    While it is unusual for children to need hospital treatment for bronchiolitis, the symptoms can get worse very quickly.

    Call 999 for an ambulance in any of the following circumstances.

    • Your child has severe breathing difficulties or exhaustion from trying to breathe. You may see the muscles under your child's ribs sucking in with each breath, your child may be grunting with the effort of trying to breathe or they may be pale and sweaty.
    • Your child has a rapid breathing rate of more than 60 breaths a minute.
    • You are unable to rouse (wake) your child or, if roused, they do not stay awake. 
    • Your child’s breathing stops for more than 10 seconds at a time (this is known as recurrent apnoea).
    • Your child’s skin begins to turn very pale or blue, particularly around the lips or fingernails (known as cyanosis).


    Bronchitis

    introduction of bronchitis...

    Bronchitis is an infection of the main airways of the lungs (bronchi), which causes them to become irritated and inflamed.

    The main symptom is a cough which may bring up yellow-grey mucus. Bronchitis may also cause a sore throat, wheezing and a blocked nose.

    Read more about the symptoms of bronchitis.

    When to see your GP

    Most cases of bronchitis can be treated easily at home.

    You only need to see your GP if your symptoms are severe or unusual – for example, if:

    • your cough is severe or lasts longer than three weeks
    • you have a constant fever for more than three days
    • you cough up mucus streaked with blood
    • you have an underlying heart or lung condition, such as asthma or heart failure

    Treating bronchitis

    In most cases bronchitis will clear up by itself within a few weeks without the need for treatment. This type of bronchitis is known as acute bronchitis. While you are waiting for it to pass, you should drink lots of fluid and get plenty of rest.

    In some cases the symptoms of bronchitis can last much longer. If symptoms last for at least three months, this is known as chronic bronchitis. There is no cure for chronic bronchitis but there are several medications to help relieve symptoms. It is also important to avoid smoking and smoky environments, as this can make your symptoms worse.

    Read more about treating bronchitis.

    Why do I have bronchitis?

    The bronchi are the main airways in your lungs, which branch off on either side of your windpipe (trachea). They lead to smaller and smaller airways inside your lungs, known as bronchioles.

    The walls of the bronchi produce mucus to trap dust and other particles that could otherwise cause irritation.

    Most cases of acute bronchitis develop when an infection causes the bronchi to become irritated and inflamed, which causes them to produce more mucus than usual. Your body tries to shift this extra mucus through coughing.

    Smoking is the most common cause of chronic bronchitis. Over time, tobacco smoke can cause permanent damage to the bronchi, causing them to become inflamed.

    Read more about the causes of bronchitis.

    Complications

    Pneumonia is the most common complication of bronchitis. It happens when the infection spreads further into the lungs, causing air sacs inside the lungs to fill up with fluid. One in 20 cases of bronchitis leads to pneumonia.

    People more vulnerable to the effects of infection, such as the very young or people with a pre-existing health condition, may need to be admitted to hospital as a precaution if they develop pneumonia.

    Read more about the complications of bronchitis.

    Who is affected

    Acute bronchitis is one of the most common types of lung infection and one of the top five reasons for GP visits.

    Acute bronchitis can affect people of all ages but it is most common in younger children under the age of five. It is more common in winter and often develops following a cold, sore throat or flu.

    It is estimated that there are around 2 million people in the UK affected by chronic bronchitis. Most of these are adults over the age of 50.

    complications of bronchitis...

    Pneumonia

    Around one person in 20 with bronchitis goes on to develop a secondary infection inside one or both of their lungs. Specifically, the infection takes hold in tiny air sacs known as alveoli. This type of infection is called pneumonia.

    People at an increased risk of developing pneumonia include:

    • elderly people
    • people who smoke
    • people with other health conditions such as heart, liver or kidney disease
    • people with a weakened immune system

    Symptoms of pneumonia include:

    • difficulty breathing – your breathing may be rapid and shallow and you may feel breathless, even when you are resting
    • rapid heartbeat
    • fever
    • feeling generally unwell
    • sweating and shivering
    • loss of appetite
    • pain in your chest

    Mild pneumonia can usually be treated with antibiotics at home.

    More severe cases may require admission to hospital where, if necessary, a breathing machine (ventilator) can assist you with your breathing and antibiotics can be given directly into one of your blood vessels through a drip.

    Read more about the treatment of pneumonia.

    diagnosis of bronchitis...

    If you have bronchitis, you may not need to see your GP unless your symptoms are severe or persistent (read more about when to see your GP). 

    If you do see your GP, they will usually be able to make a diagnosis by asking about your symptoms and listening to your chest using a stethoscope.

    Ruling out other conditions

    Your GP may need to rule out other lung infections, such as pneumonia, which has symptoms similar to those of bronchitis. If your GP thinks you may have pneumonia, you will probably need a chest X-ray. Your GP may also take a sample of mucus for testing.

    If your GP thinks that you may have an undiagnosed underlying condition, such as asthma or emphysema (damage to the small airways in your lungs), they may also suggest a pulmonary function test. You will be asked to take a deep breath and blow into a device called a spirometer, which measures the volume of air in your lungs. A decreased lung capacity can indicate an underlying health problem.

    Bronchodilator medicines

    side-effects of bronchodilator drugs...

    Bronchodilators can sometimes cause side effects.

    Beta-2 agonists

    Beta-2 agonists can affect other muscles as well as the lungs, which can lead to side effects.

    The most common side effects are nervousness, restlessness and trembling. Some people also find they get a dry, irritated throat after using the medication.

    Less common side effects include:

    These side effects should improve and disappear completely after you have been using beta-2 agonists for a few days or weeks. Contact your GP if your side effects persist; your dosage may need to be adjusted.

    Anticholinergics

    Compared with beta-2 agonists, anticholinergics are better tolerated by most people and serious side effects are rare. A dry mouth is the most commonly reported side effect.

    Less common side effects include:

    • nausea
    • coughing
    • headaches
    • constipation 
    • palpitations
    • an inability to urinate
    • a rash
    • blurred vision

    Theophyllines

    Theophyllines can cause serious side effects if too much of the medication builds up in your body. You will need to have regular blood tests to ensure levels of theophylline in your body are safe.

    Older people are more at risk of developing side effects from theophyllines because their liver may not be able to remove the medication from their body.

    Possible side effects of theophyllines include:

    • a rapid heart beat
    • trembling and palpitations
    • restlessness and nervousness
    • nausea
    • headaches
    • dizziness
    • sleep problems
    • seizures (fits)

    Contact your GP if you have any of these side effects. Again, it may be that your dosage will need to be reviewed.



    considerations of bronchodilator drugs...

    Bronchodilators are not recommended in certain circumstances. If you have a health condition such as diabetes, heart disease, or an overactive thyroid gland, you may be advised to use beta-2 agonists and theophyllines with caution.

    When bronchodilators are not recommended

    Anticholinergics

    Anticholinergics are not recommended for use in people with prostate problems, such as prostate cancer or benign prostatic hyperplasia (a non-cancerous swelling of the prostate). In these cases, anticholinergics can cause urination problems.

    Anticholinergics are also not recommended for people with chronic glaucoma (a build-up of pressure in the eye which, if untreated, can cause blindness).

    Theophyllines

    Theophyllines are usually not recommended for people with a history of liver disease. This is because their liver may not be able to remove the medication from their body.

    Using bronchodilators with caution

    Generally, bronchodilators should be used with caution in elderly people and those with epilepsy or peptic ulcers. While using bronchodilators, these people will need to be regularly monitored by their GP.

    Further considerations are outlined below.

    Beta-2 agonists

    Beta-2 agonists should be used with caution in people with:

    • an overactive thyroid (hyperthyroidism) – the medication may stimulate the thyroid gland, making the thyroid problem worse
    • heart disease – the medication may affect blood pressure and cause an irregular heartbeat
    • diabetes – there is a risk of ketoacidosis (a serious complication of diabetes caused by a lack of insulin in the body); your blood glucose levels may need to be regularly monitored

    If you have one of these conditions, you will need to be regularly monitored by your GP while using beta-2 agonists.

    Theophyllines

    Theophyllines should be used with caution in people with:

    • overactive thyroid (hyperthyroidism) – the medication may stimulate the thyroid gland, making the thyroid problem worse
    • heart disease – the medication may affect blood pressure and cause an irregular heartbeat

    If you have one of these conditions, you will need to be regularly monitored by your GP while using theophyllines.

    Pregnancy and breastfeeding

    Speak to your GP as soon as possible if you regularly use bronchodilators and are pregnant or breastfeeding. You should ideally see your doctor before you start to try for a baby or as soon as you find out you are pregnant.

    Asthma can affect your pregnancy so it is important it is well controlled. Medication to treat asthma is usually considered safe to use during pregnancy and while breastfeeding.

    If possible, bronchodilators should be inhaled to minimise your unborn baby’s exposure to the medication.

    Read more about taking medication during pregnancy.



    how-does-it-work of bronchodilator drugs...

    Bronchodilator medicines are available in short-acting and long-acting varieties. The three most widely used bronchodilators are beta-2 agonists, anticholinergics and theophyllines.

    Beta-2 agonists

    Beta-2 agonists can be short-acting (relievers) and long-acting. They are usually taken through a small, hand-held inhaler.

    Beta-2 agonists work by relaxing muscles in the lungs, which allows the airways to dilate (widen). Long-acting beta-2 agonists can also reduce the amount of mucus in the lungs by speeding up the motion of cilia. Cilia are tiny hairs that line the airway walls and 'sweep' mucus out of the airways.

    Beta-2 agonists tend to be more effective in treating asthma than in treating chronic obstructive pulmonary disease (COPD).

    Anticholinergics

    Like beta-2 agonists, anticholinergics also relax the muscles in your lungs. Short- and long-acting varieties are available.

    Anticholinergics are mainly used to treat COPD and are usually taken through an inhaler. However, if you have severe COPD, you will need to use a nebuliser. This is a device that uses air pressure to turn the medicine into a fine mist which you breathe in through a mask.

    Theophyllines

    Theophyllines are long-acting bronchodilators that are usually used to treat COPD. It is not clear exactly how theophyllines work, but they seem to relax the muscles in the lungs, while reducing possible inflammation (swelling) in the airways.

    Theophyllines are usually taken in tablet or syrup form. Due to a risk of associated side effects, such as nausea and dizziness, theophyllines are often only used if other bronchodilators have proven ineffective.

    Read more about the side effects of bronchodilators.



    Bulimia

    diagnosis of bulimia...

    If you have an eating disorder such as bulimia, the first step is to recognise that you have a problem and visit your GP.

    This may be a very difficult step for you to take. Most people who have bulimia hide their situation for months or years before seeking help. It can often take a change of situation, such as the start of a new relationship or living with new people, to make a person with bulimia want to seek help.

    Once you have explained your situation to your GP, they will decide whether to refer you for help from a specialist mental health team. Your local team will include specialist counsellors, psychiatrists, psychologists, nurses, dietitians and other healthcare professionals.

    The course of your treatment depends on how serious your condition is and the best way to manage it. Your GP may recommend a self-help programme to start your recovery before referring you for specialist treatment.
    complications of bulimia...

    There are a number of physical complications associated with bulimia.

    These can include any of the following:

    • Dental problems. Persistent vomiting can cause your stomach acid to damage the enamel on your teeth, which may lead to tooth decay. Excessive vomiting can also cause bad breath and a sore throat.
    • Irregular periods. Your menstrual cycle can become unpredictable or even stop altogether. You may also find it difficult to become pregnant in the future.
    • Poor skin and hair. A lack of nutrients through persistent vomiting or laxative use can make your skin and hair unhealthy. Your skin and hair can become dry and your fingernails can become brittle.
    • Swollen glands. If you have bulimia, your saliva glands can become swollen from frequent vomiting. This makes your face appear rounder.
    • Chemical imbalance. Excessive vomiting and laxative use can cause chemical imbalances in your body. This can result in tiredness, weakness, abnormal heart rhythms, kidney damage, convulsions (fits) and muscle spasms.
    • Bowel problems. Excessive use of laxatives can damage your bowel muscles, resulting in permanent constipation.
    • Heart problems. Long-term complications of bulimia can include an increased risk of heart problems. 

    treatment of bulimia...

    You can recover from bulimia, but it may be a long and difficult process.

    The first step towards getting better is to recognise the problem and to have a genuine desire to get well. This may involve a big change in lifestyle and circumstances.

    Treatment usually begins with psychological treatments, aimed to help you re-establish healthy attitudes towards eating. People with bulimia need to explore and understand the underlying issues and feelings that are contributing to their eating disorder, and change their attitudes to food and weight. 

    Sometimes, your GP may suggest you try medication, usually in addition to psychological treatment.

    Psychological treatment

    Cognitive behavioural therapy

    Cognitive behavioural therapy (CBT) is the most common type of psychological treatment for bulimia. It involves talking to a therapist and looking at your emotions in detail to work out new ways of thinking about situations, feelings and food. It may also involve keeping a food diary, which will help determine what triggers your binge eating.

    Interpersonal therapy

    As with CBT, interpersonal therapy (IPT) involves meeting with a therapist to discuss your condition. However, the focus is more on your personal relationships than your problems with food.

    You are more likely to be referred for this type of psychological treatment if you have recently lost a loved one and have experienced a big change in your life. The aim of IPT is to help you establish supportive relationships. This can help draw your focus away from eating.

    Medication

    Antidepressants known as selective serotonin reuptake inhibitors (SSRIs) may be used to treat bulimia. The SSRI usually recommended to treat bulimia is called fluoxetine (brand name Prozac).

    SSRIs are mainly used to treat depression, but they are also used to treat eating disorders, obsessive compulsive disorder (OCD), anxiety and social phobia.

    As with any antidepressant, an SSRI will usually take several weeks before it starts to work. You will usually be started on a low dose, which is then gradually increased as your body adjusts to the medicine.

    When you start taking an SSRI, see your GP after two, four, six and twelve weeks to check your progress and to see if you are responding to the medicine. Not everyone responds well to antidepressant medicines, so it is important that your progress is carefully monitored.

    Very few drugs are recommended for children and young people below the age of 18. It is also best not to take SSRIs if you have epilepsy or a family history of heart, liver or kidney disease.

    Hospital treatment

    Bulimia is not usually treated in hospital. However, if you have serious health complications and your life is at risk, you may be admitted to hospital. Hospital treatment is also considered if you are at risk of suicide or self-harm.

    The recovery process

    Once diagnosed, people with bulimia can recover, but it may take a long time. It can be very difficult, both for the person affected and their family and friends.

    To recover, someone with bulimia needs to:

    • change their eating habits
    • change the way they think about food
    • gain weight safely, if necessary

    The longer someone has had bulimia, the harder it is to re-learn healthy eating habits and gain weight. It is important to start treatment as early as possible, so the person has the best chance of recovery.

    For most people, recovery goes through several stages, where progress may be involve steps forward and steps back.



    Bullying

    Why Men and Women React Differently to Workpl...

    If your boss bullies you or puts you down, would you shirk your work, quit, or work even harder? According to a joint study by Edith Cowan University and the University of New England, yet to be published, depending on your gender, you will react very, very differently to workplace incivility. According to Dr Jennifer Loh, a senior lecturer and organisational psychologist at Edith Cowan University, and one of the study's authors, ‘You can look at bullying as the far end of incivility, on a spectrum. Bullying is very obvious. But what about more subtle forms of incivility – general gossip, people rolling their eyes at your suggestions, or making derogatory comments? These things are subtle, but have very nasty consequences. We wanted to look at that.’ After asking 317 individuals at various organisations what kinds of workplace incivility they had experienced, and how they reacted to it, Loh and her colleagues found that the victims’ gender had a role to play in how the situations played out. ‘One of the things that came out is that women were subjected to more workplace incivility,’ said Loh. ‘But interestingly, they not only put up with it, but worked harder in the face of it.’ On the other hand, if men were treated badly they tended to slack off. The researchers came up with various explanations as to why this may occur. Loh surmised that women brought up to be more passive in the face of mistreatment, and to care more about what other people think, and so may decide to put their heads down and impress mean bosses. Another explanation put forward is that women are commonly lower down in a company's hierarchy, and so may not be in a position of power to kick up a fuss over the incivility shown to them. Loh said, ‘Women were far more likely to give people the benefit of the doubt. They might interpret incivility as just someone having a bad day.’ However, she noted that this doesn’t mean managers should bully their female employees to get better results. ‘It doesn't work that way,’ she said. ‘If your organisation is perceived to be an uncivil one, where people are mistreated, that sets the culture. It becomes hostile. People there aren't happy. It's important to realise that if you treat people with disrespect, in the end, the company's reputation will suffer, and those talented people will leave companies that don't show them human courtesy. You can't bully women into doing more work.’

    How to Handle Bullying in The Workplace...

    Workplace bullying has become a big topic over the past few years. Some statistics suggest that up to 35 percent of the work force have fallen victim to this some sort of intimidation or harassment while trying to do their job. It’s a fact that bullying has become an unpleasant fact of life among many workplaces. It can be even worse when it comes after someone has left a job, with the bullying employee continuing to make their life difficult by giving them a poor reference to a prospective employer.

    There are a number of workplace bullying tactics – they can range from physical abuse, to public humiliation to simply making derogatory comments. It can affect victims very seriously. Any sort of workplace bullying can cause a loss of confidence, debilitating anxiety, panic attacks, clinical depression and even physical illnesses.

    One of the most central aspects of the issue is the fact that management or supervisors are the most likely to be doing the bullying, and their bullying actions leave the recipient in a difficult position with regards to their employment. Do you stand up against your manager or employer and risk being sacked?

    Fortunately, there is a solution in place if you find yourself in such a scenario. If you find yourself being the victim of a workplace bully who is speaking out of turn when responding to an employment inquiry, employees can exercise their right to the option of a ‘cease and desist’ letter or pursue further legal action. Such tools can help to ensure that the bully will have to stop their way of acting for fear of legal reprisal.

    Could New Legislation End Bullying in The Wor...

    Many people have trouble with their boss at work. Working for a boss who treats you badly can really be a nightmare. This can even lead to a situation in which a manager or owner can because physically or mentally threatening to their employees. You hear stories about workplace bullying all the time, and unfortunately they seem to be growing in number as the effect of the recession takes hold and there is more stress in the working environment. On-the-job bullying can take a number of different forms, from a supervisor's verbal abuse and threats to cruel comments or relentless teasing by someone that you work with. And it could become the next major battleground in employment law. That is because many are considering legislation that would allow workers sue their employers or fellow members of staff for harassment that causes physical or emotional harm. Many companies already recognise the problems that workplace bullying can cause, including the fact that it can sap morale, lead to increased employee turnover and even affect the bottom line. Half of the employers in a 2011 survey by the management association reported incidents of bullying in their workplace. It was also revealed that about a quarter of human resources professionals themselves said they had been bullied. Some employers have begun to put in place anti-bullying policies, but advocacy groups want to take the matter even further. They have been urging policy makers to give legal rights to workers who do not already fit into a protected class based on race, gender or age. One reason that the issue has attracted more attention in recent years is that parents who deal with school bullying also realise that it can happen in the workplace.

    Bursitis

    treatment of bursitis...

    In most cases, bursitis can be successfully treated using a combination of self care techniques and over-the-counter painkillers.

    The pain will usually improve within a few weeks, although the swelling may take longer to completely disappear. The exact length of time it will take to fully recover may depend on:

    • where the bursitis is
    • whether it is caused by an infection (septic bursitis)

    If treated with aspiration (see below), bursitis in the elbow will usually get better in around two weeks, or in five weeks if it is infected. Septic bursitis of the knee usually gets better in three weeks if it is treated with aspiration.  

    Self care

    You should take measures to reduce the swelling in the affected joint by resting it until your symptoms improve. Avoid strenuous activities, such as running, that are likely to cause additional pain.

    You may wish to wear padding to protect the affected joint from further injury. For example, wearing knee pads may help if you have bursitis in your knee joints.

    Ice packs are also an effective method of reducing inflammation and pain. Wrap an ice pack in a towel and apply it to the affected area for 10-20 minutes. Repeat this every few hours. If you do not have an ice pack, you can use ice cubes or a bag of frozen vegetables wrapped in a towel.

    While sleeping, avoid lying on the side that has bursitis. If possible, elevating (raising) the affected body part above the level of your heart may help to reduce inflammation. For example, you can prop your foot up on a pillow to raise your ankle. 

    Painkillers, such as paracetamol or ibuprofen, are also effective ways of treating pain. Ibuprofen, or other non-steroidal anti-inflammatory drugs (NSAIDs), such as naproxen or diclofenac, can also be used to help reduce swelling.

    Always read the patient information leaflet that comes with the medicine to check that it is suitable for you and that you are taking the correct dose.

    Aspiration

    If the swelling that's caused by bursitis is particularly severe, you may want to consider having the fluid drained out in a procedure that's known as an aspiration. This can improve the range of movement in your joint and relieve pain.

    During aspiration, your GP will use a needle to draw out the fluid before covering the area with a dressing. You'll need to avoid strenuous activity for around two days afterwards.

    Corticosteroids

    If your symptoms of bursitis are particularly severe or they fail to respond to treatment, corticosteroid injections are another possible treatment option. Corticosteroids contain steroids, a type of hormone, and can reduce inflammation.

    Your GP can inject corticosteroids directly into the affected body part. Possible side effects of corticosteroid injections include:

    • the surrounding tissue wasting away
    • the skin around the injection changing colour

    Corticosteroid injections can't be used if your bursitis is caused by an infection, or if your GP is unsure whether it's caused by an infection. You also can't have another corticosteroid injection if you've already had three or more in the same area within a year.

    Antibiotics

    If testing confirms that your bursitis is caused by infection, your GP will prescribe antibiotics. Possible antibiotics that you may take include:

    • flucloxacillin
    • erythromycin
    • clarithromycin

    These will usually be taken orally (as tablets or capsules) that you take two or four times a day for seven days. After seven days, you should return to your GP so that they can check how well you're responding to the antibiotics. If you still have signs of infection you may need to take antibiotics for another seven days.

    If you're prescribed antibiotics, it's very important that you finish the entire course that you're given, even if your symptoms improve. This will help to prevent the infection from returning.

    Referral

    If your symptoms do not improve after two months of trying the above treatments, your GP may refer you to a specialist. This may be:

    • a rheumatologist - a specialist in conditions that affect the bones, muscles and joints
    • an orthopaedic surgeon - a specialist in the surgical treatment of conditions that affect the bones, muscles and joints

    You may also be referred if you have infected bursitis that does not get better after taking antibiotics, or if your infected bursitis reoccurs.

    Surgery

    In some cases, surgery to remove the affected bursa may be a possible treatment option. For example, if you keep getting septic bursitis or if other treatments don't work. 

    Incision and drainage is a surgical technique that may be recommended if your infection doesn't respond to antibiotics. This involves making an incision in your skin and through to the bursa so that the fluid can be drained out.

    introduction of bursitis...

    Bursitis is inflammation (swelling) of a bursa. A bursa is a small fluid-filled sac which forms under the skin, usually over the joints and between tendons and bones.

    A bursa can become inflamed through injury or repetitive movement. For example, runners and joggers have an increased risk of developing bursitis in their ankles. Less commonly, bursitis can occur as a result of an infection or as a complication of certain conditions, such as rheumatoid arthritis (see Bursitis - causes for more information).

    Bursitis causes pain and swelling in the affected body part. The symptoms of bursitis usually improve within a few weeks. Resting the affected body part and taking painkillers, such as ibuprofen, can help to relieve symptoms and speed up recovery.

    Bursae

    There are around 160 bursae in the human body. They can be found in any area where friction occurs.

    Bursae act as cushions between two surfaces that rub against each other, such as bones, muscles, joints and tendons, helping to reduce friction. Bursae reduce friction because they're lined with special cells called synovial cells, which produce a liquid that lubricates the moving parts of the body.

    Where bursitis occurs

    It's possible for any bursa to become inflamed, but the most common places where bursitis occurs are the:

    • shoulder
    • elbow
    • ankle
    • knee
    • hip
    • thigh

    The risk of developing bursitis is increased if you regularly do an activity that involves a lot of repetitive movement. For example, darts players who repeatedly bend and straighten their elbow may get bursitis of the elbow. People who do a lot of kneeling, such as carpet fitters and gardeners, have a high risk of developing bursitis in their knee (known as 'housemaid's knee').

    Taking precautions, such as wearing knee pads or warming up before exercise, may help to reduce your risk of getting bursitis. See Bursitis - prevention for more information.

    When to see your GP

    You should visit your GP if there's no improvement in your symptoms after two weeks.

    Joints
    Joints are the connection point between two bones that allow movement.
    Pain
    Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.

    symptoms of bursitis...

    The symptoms of bursitis include:

    • pain – usually a dull ache in the affected body part that's made worse by movement or pressure
    • tenderness in the affected body part
    • swelling of the affected body part
    • loss of movement in the affected body part

    Septic bursitis

    Septic bursitis is bursitis that's caused by infection. Additional symptoms of septic bursitis include:

    When to seek medical advice

    Always visit your GP if you have the symptoms of a fever because a fever is usually an indication that you have an infection. Otherwise, you should visit your GP if your symptoms don't improve after two weeks.

    Caesarean section

    introduction of caesarean section...

    A caesarean section is an operation to deliver a baby. It involves making a cut in the front wall of a woman’s abdomen (tummy) and womb.

    The operation can be:

    • a planned (elective) procedure, when a medical need for the operation becomes apparent during pregnancy
    • an emergency procedure, when circumstances during labour call for urgent delivery of the baby

    A caesarean section is carried out under regional anaesthetic, where the lower part of your body is numbed. It usually tak