Health matters
Because of the hormonal changes and the other physical pressures on the body, there are a number of common but minor problems which respond to treatment or can be minimised or avoided. With the sophistication of modern technology a close check can be kept on the development of the fetus. Tests such as amniocentesis can reveal the presence of fetal abnormalities in the middle stage of pregnancy and a blood test, the triple test, and a scan. the nuchal thickness scan, can give a more accurate estimate of risk of Down's syndrome than simply the mother's age. We have written notes on some of the commonest illnesses and health problems. Please e-mail your suggestions for additions. Allergies [Further information on many illness and conditions is available on the NHS and the Net Doctor websites]
One of the ironies of the developed countries of plenty is that some people, almost always female, literally starve themselves to death. Anorexia nervosa has the highest mortality rate of any psychiatric condition. However, with the correct treatment anorexics can and do get better. The causes of anorexia are thought to be many - the wish to look like a modern emaciated model is only one. A common factor is a dissatisfaction with what is - the present state of the victim's life - and a loss of self-esteem for whatever reason. But what at first is deliberate - the decision to eat less and less - can become over-powering. The main characteristics of an anorexic are preoccupation with being overweight and actually being at least 15% below normal weight because of self-starvation. The patient will have other physical problems of starvation, such as pain and hypersensitivity to cold, and women will cease to have periods. Many anorexics do not recognise that they have a problem and most need others to help them to recover. At the Health Centre we provide the first stage of professional help and advice, but in the more serious cases refer our patient on to more specialist advice on eating disorders. [Useful information is available on the Eating Disorders Association website] As with most medical conditions, the sooner help is sought, the better the chances of a full recovery. Machismo nervosa Not all men escape eating disorders. Of the 60,000 to 90,000 patients being treated for eating disorders only about 10% are men, but it is suspected by the experts in the field that the true number of male sufferers is much higher. The two reasons are that men are more reluctant to share their problem, and that the consequences of low testosterone, for example, in men - loss of libido or erectile disfunction - are less obvious than missing periods in women. Anorexia nervosa and bulimia in men are often linked with exercise and bodybuilding in the quest for muscular and lean bodies. For this condition the term 'machismo nervosa' has been coined. According to the Eating Disorders Association [www.gurney.co.uk /eda/] few health care professionals have adapted to meet men's needs.
Sprains For sprains, first apply a cold compress containing ice (e.g. a packet of frozen peas), for fifteen to thirty minutes, to reduce the swelling. Apply a firm crepe bandage and give the sprain plenty of rest until the discomfort has subsided. We recommend the following books about neck and back pain. Treat your own neck ) Robin McKenzie All are available at our receptio Bedwetting (nocturnal enuresis) Bedwetting, or nocturnal enuresis as it is known medically, affects up to 15-20% of five year olds at any one time. The percentage drops at 12-14 years to 2-3%. Often there is a family/genetic link. Although a large percentage of bedwetting children will grow out of it, there is a case for intervening, supporting and treating these children. bedwetting can lead to low self-esteem and can cause friction within the family. It also means a major increase in the laundry load! Some DO's and DONT's
We now have a specialist enuresis clinic run by Karen Rickeard, the staff nurse who works in the Health Visitor team. The clinic is held every Thursday from 3.30 - 5.15pm. To make an appointment, ring the usual appointments' number: 0118 972 2745. Or, if you wish to speak direct to Karen or Anna Brodie, ring them on 0118 972 2188 Children and parents are given advice and treatment - either using charts and encouragement, bedwetting alarms or medication. The medication used is desmopressin which acts on the kidneys to concentrate the urine at night, so less of it is produced. Minor burns and scalds cause redness of the skin. Immediate treatment by running cold water over a burn or scald is very important to limit the damage caused by the burn. If burns or scalds cause severe blistering or break the skin, you should contact the nurse in
the treatment room during surgery hours. At other times contact Townlands Hospital, Henley. The first indication is a rash of small red spots about 3-4mm wide. Within a few hours these develop small blisters at the centre. During the next three or four days further spots appear and the earlier ones turn crusty and fall off. Calamine lotion may be applied to soothe the itching. The most infectious period is two to three days before the rash appears, when the patient may
just seem generally unwell, and until the last crusts have formed dry centres - usually 7-10 days after the
rash started. Children may return to school as soon as the last crusts have fallen off. Colds usually start with a hot feeling in the back of the nose and, sometimes, a dry throat. You feel generally unwell and achey. After a day or two, your nose starts running with a clear liquid, and after three or four days, with a thick yellow discharge. You may have a slightly raised temperature (37.5o - 38.0o C or 99o - 100o F). The whole illness lasts 7 - 10 days. There is no magic cure for the common cold. It is caused by a virus, so antibiotics are of no use in its treatment. It is best simply to stay quietly at home and relieve your discomfort with readily available remedies. Treatment for adults: 2 tablets of soluble aspirin or paracetamol taken every four hours. If your throat is sore, dissolve the aspirin in warm water and gargle before swallowing. Ibuprofen (400mg three times a day) can be taken in addition to paracetamol, but always check the cautions on the packet. It is important to take plenty of fluids, especially if you have a high temperature. Don't worry about loss of appetite so long as you are taking liquids. You can relieve the nasal congestion and loosen the thick yellow discharge by inhaling steam.
Add a teaspoon of vapour rub or one or two menthol crystals to a pint of steaming water in a bowl. Trap the
steam with a towel placed over your head and the bowl. Inhale for ten minutes, three times a day. Cot Death – the latest Guidelines The Department of Health has published revised guidelines on reducing the risk do sudden infant death, more commonly known as cot death. The new advice includes:
Those guidelines are added to existing advice which is:
Bleeding can usually be stopped by applying pressure to the cut for two or three minutes. The cut can then be carefully inspected. If it has bled freely, any bacteria will normally have been washed away by the blood. Apply a plaster dressing firmly, bringing the edges of the cut together, so that it will knit
quickly. Keep it dry for one or two days. If the cut is deep and the edges cannot be held together with a
dressing, consult the doctor or practice nurse. A tetanus injection may be needed if the wound is dirty. Unusual lumps, for example in the breast, should not be neglected, but many of them prove to be cysts and benign. There are many types of cyst but they are all a form of lump or swelling filled with fluid or semi-solid material. They may occur in any body organ or tissue and are harmless in themselves. Often no treatment is necessary, but if they are considered suspicious or are causing a problem by their presence, they may be removed surgically. In adults and older children, diarrhoea and vomiting will usually get better on their own.
Treatment consists of replacing the fluid you have lost and resting the digestive system by having nothing
solid to eat for 24 hours. Plain water in small quantities (which may be warmed) should be taken frequently. Diarrhoea in small babies and young children should be treated with caution. Your doctor will be happy to advise you over the phone and will arrange to see you if necessary. Elderly patients and those with medical conditions (e.g. diabetes) should consult the doctor. Any diarrhoea lasting more than five days should be
investigated by sending a stool sample to the lab for analysis. Earache may mean an infection of the middle ear – otitis media – and often follows a cold or other respiratory infection.. Take paracetamol to ease the pain. If it persists consult your doctor who may prescribe an antibiotic. Children quite often suffer a build up of fluid in the middle ear – chronic otitis media which is painless but causes slight deafness and may go on to leave a more permanent loss of hearing. If you suspect a problem, consult your doctor who may refer the child to an ENT specialist. Sometimes a minor operation is need ed to drain the fluid and/or plastic grommets will be inserted to allow drainage. Any suspicion of loss of hearing should be acted
upon as soon as possible.
Fainting is the commonest form of unexpected unconsciousness and can occur in normally healthy people in certain well-known circumstances: for example, the sight of blood, the guardsman standing on parade for hours on a hot day. (Is this why some parades at Sandhurst are called 'passing out parades'?)
Often blamed when the patient just has a cold, but it's not too difficult to spot which is which. SPOTTING THE DIFFERENCE
Treatment has conventionally been the same as for a cold, though the effects of 'flu are more severe, especially for older people, and last longer. The new drug Relenza may eventually change all that but, at £24 a dose, it is not available through the NHS. A 'flu jab is strongly recommended for adults and children with any of the following:
The risk from 'flu is greater for the elderly with these conditions and increases if two or more risk conditions co-exist. The recommended time for vaccination is October/November.
For this year's arrangements, click here.
Dirt often enters a graze caused by falling on a hard or rough surface. It must be cleaned carefully with an antiseptic solution. After cleaning, leave the graze uncovered. Exposure to the air will cause a scab to form,
which will then gradually dry and fall off. It is not a good idea to apply a dressing, as this may stick to
the graze and make it soggy or infected. In Summer, hay fever sufferers often have symptoms caused by pollens in the air. They also
tend to sneeze and have sore, itchy eyes. All the usual treatments can be bought at the chemist's without
prescription. However, if you have predictable and long periods of symptoms, then we can prescribe
antihistamine tablets before the symptoms start. These may affect anyone but particularly children, and are not a sign of poor hygiene, as the lice actually prefer clean hair. The first sign may be of the nits - the eggs that cling to individual hairs close to the scalp. Medicated hair lotion can be bought over the counter at the chemist's. Every member of the household should be treated as the lice are passed on by contact (not necessarily of the hair). Although many head lice have become resistant to medication, daily combing with a fine 'nit comb' and the use of conditioner after washing will always work eventually. About one in seven people have a hearing loss. Deafness in a child may be caused by rubella during the mother's pregnancy or by a common disease such as measles or mumps. Many children suffer from 'glue ear' and require treatment to help them grow out of it. It is important for parents to seek help if they suspect there is a problem. However, some three quarters of the people with a hearing loss are aged over 65, so, if you are one of our older patients, have a look at the special advice on late hearing loss. Sudden intense pain, usually at one side of the back may be the first indication of a kidney stone problem. More common in men than women and typically occurring between the ages of 30 and 50.
Melanomas are the most dangerous form of skin cancer. Once thought to be fatal, they are now known to respond to treatment if diagnosed early. In addition to taking proper precautions when exposed to the sun, you should inspect any moles regularly, not forgetting your back (with the help of a second person if necessary). Remember your ABC of signs which might indicate a melanoma: Asymmetry: the mole has become irregular in shape If you are suspicious about any of your moles, consult your doctor, who may advise the surgical removal of one or more as a precaution (a quick and painless procedure carried out at the surgery). Nosebleeds are most common in children. They can seem frightening but are rarely dangerous. They
are usually caused by a blow or the dislodging of crusted mucous. Treatment is straightforward. Tilt the
head forward, mouth open. Firmly pinch the lower part of the nose for up to 15 - 20 minutes until the
bleeding stops. Apply cold compress to forehead. Seek medical help if it continues. Sexually transmitted infections It is not generally known that seventy per cent of all sexually transmitted infections do not cause any symptoms in the people infected. Chlamydia is one of these infections. It can go on to cause chronic pain and cause fertility problems in women by damaging the fallopian tubes. It has been found to affect up to one in twenty women under 25 years of age in the Slough area and up to one in ten in the inner cities. It is rather less common in rural areas like ours. Men who catch chlamydia are, however, usually aware of the problem. They develop a urethral discharge, that is worse in the morning, and pain on urinating. If you are not in a long-term, stable relationship, it is vital to practise safe sex to protect yourself and others. For anyone unfamiliar with the term 'safe sex', it basically means ALWAYS USE A CONDOM. If you are worried because you feel you could be at risk, or if you are getting symptoms such as discharge, pain on intercourse or burning on passing urine, please make an appointment with your doctor. Alternatively you can contact the Florey Unit at the Royal Berkshire Hospital Tel: (0118) 987
7202. You will, of course, be treated in absolute confidence. A squint is a condition in which one eye deviates in relation to the other, not necessarily inwards. In the first weeks of life, a baby's eyes move independently before becoming co-ordinated. All young children in our practice are screened for squints by an orthoptist. Treatment, if required, is straightforward and normally successful. It is usually a matter of developing the appropriate muscles, so a patch is put over the 'good' eye in order to encourage the other eye to work harder. There are also exercises which may be prescribed to help strengthen the muscles. If no action is taken, an operation may become necessary and, in some cases, the sight of the 'lazy' eye could be impaired. Squints in older children my be due to long-sightedness, which is corrected by glasses. In adults squints may result, for example, from a stroke, diabetes, multiple sclerosis and can be treated simply with prismatic lenses or, in some cases, surgery.
[Further information on many illness and conditions is available on the NHS and the Net Doctor websites]
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