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by James Thomas, Thursday, 26 January 2017 | Categories: General Health

Diabetes & Pain Management: New Findings

Many people are familiar with diabetes; they know that there are two different types, that type 2 is related to being overweight, and that the disease is often treated with injections of insulin.

What fewer people are familiar with is the fact that there are many health complications associated with diabetes. Pregnant women are faced with a greater risk of miscarriage and stillbirth, sexual dysfunction can become a problem, and the arteries can narrow, leading to heart disease.

One symptom that can be particularly difficult to live with is nerve damage, which can happen as a result of high blood glucose levels. This nerve damage can lead to peripheral neuropathy, a condition that causes burning or tingling sensations, stabbing pain and muscle weakness in the hands and feet.

New Treatment

For certain sufferers, the neuropathy can become so severe that the slightest pressure on the skin of the hands or feet causes agonising pain. Currently, there are a number of different treatments used to manage diabetic neuropathy. However, following a recent study in Germany, it looks as though a brand new treatment is on its way.

As reported here, researchers have discovered a chemical agent that seems to block the nerve signals that channel pain. Currently, nerve damage cannot be reversed, but the research team involved hopes that this new discovery lets the medical community take a step closer towards resolving neuropathy issues in diabetic patients.

The main advantage of this potential treatment (which has been tested on mice and is now set for human trials) is that it acts directly on nerve receptors in the skin, instead of affecting the body’s central nervous system. For this reason, the researchers hope to steer clear of some of the dangerous side effects associated with other medicines used to treat neuropathy.

It’s still early days for this new treatment; until such a medicine is approved for use, diabetic patients have a number of options available to them when it comes to pain management. Read on to learn more about these treatments.

Good Diabetes Management

The first step in managing neuropathy is keeping your diabetes under control. The worse the management of your diabetes, the more likely you are to develop nerve damage.

Lifestyle changes associated with diabetes management involve losing weight, taking more exercise and eating a healthy diet. However, it’s also important to make sure you are using any prescription medication correctly. If you feel that your diabetes might be out of control, you should speak to your doctor.

Pain Relief Medication

Several different types of medication can be prescribed to treat neuropathy. The most common are:

  • amitriptyline (also used for headaches and depression)
  • duloxetine (also used for bladder issues and depression)
  • pregabalin and gabapentin (also used for epilepsy, headaches and anxiety)

If you do not respond to these medications, your doctor may prescribe a strong painkiller like tramadol. Because this medicine can become addictive, it is normally only prescribed for a short period – usually it will be used to treat bouts of particularly bad neuropathic pain, and not on a regular basis.

Topical Treatments

Topical treatments are ones applied directly to the skin, and are a good option for people who experience pain in specific areas, or who do not want/cannot take the medications listed above. Two common topical treatments for neuropathy are:

  • capsaicin cream (rubbed directly into the painful area)
  • a lidocaine plaster (applied to the painful area)

Capsaicin cream contains the chemical that gives chilli peppers their spicy heat. When applied to the skin it is an effective form of pain relief; it's thought to work by blocking pain signals to the brain.

A lidocaine plaster contains local anaesthetic, and when stuck onto the painful area of skin, works to numb that pain.

Finding the Right Treatment for You

The main thing to bear in mind when treating diabetic neuropathy is that everyone is different. It may take you some time to find the right treatment for your pain. However, you shouldn’t lose hope – there are many options out there and, as evidenced by the latest research, new developments are cropping up all the time.

To read more about pain relief, click here and visit The Online Clinic’s Pain Management page.




by James Thomas, Thursday, 26 January 2017 | Categories: General Health

Heartburn and Stroke Risk: Latest Research

Heartburn is something almost everybody can relate to, and more often than not it’s thought of as a minor annoyance, the kind of thing that might – at worst – sour a dinner party.

What many people don’t realise is that, for some sufferers, heartburn can make normal, everyday tasks a real challenge. Regular heartburn is often an indicator of a more serious condition called gastro-oesophageal reflux disease (GORD), which is often associated with other unpleasant symptoms such as acid reflux, bad breath, nausea and difficulty swallowing.

Sometimes heartburn and GORD can be managed through self-care and taking over-the-counter medication. In more extreme cases, prescription medicines are required. Currently the most popular of these is the proton pump inhibitor (PPI), a type of medicine that reduces the amount of acid produced by the stomach.

New Study

However, it now looks as though PPIs may not be as safe to use as previously thought. A recent study by the Danish Heart Foundation has found that PPIs seems to be associated with the risk of stroke. Drawing on fifteen years of records, researchers looked at the number of ischaemic strokes occurring in people who had undergone gastric endoscopy (a technique used to diagnose GORD).

The researchers found that 9,500 of these patients had suffered an ischaemic stroke. They also found that – even when adjusted for contributing factors such as age and medical history – this seemed to bear a relationship to their use of PPIs.

The conclusion drawn was that low daily doses (e.g. 10mg) of proton pump inhibitors are safe; however, the stroke risk seems to creep up at around the 60mg mark.

This may be very concerning for people currently taking proton pump inhibitors, but it’s important to recognise that – as stated – low doses seem to pose no threat, and that there are alternative medications available. If you’re very concerned, speak to your GP. Otherwise, read on to find out more about heartburn and GORD.

What is the difference between heartburn and GORD?

Heartburn normally happens after eating, when acid from the stomach leaks into the oesophagus and causes an unpleasant burning sensation in the chest. Heartburn is often caused by consuming spicy or fatty foods, or drinks containing alcohol or caffeine (it can also be triggered by chocolate, tomatoes and citrus fruit).

In some cases, however, heartburn is a symptom of gastro-oesophageal reflux disease. GORD is different to heartburn because it is a chronic (i.e. long-term) condition, which causes regular symptoms. It's caused by stomach acid leaking into the oesophagus, usually because the muscle at the base of the oesophagus has been weakened.

What are the risk factors for heartburn and GORD?

There are several factors that can put you at risk for heartburn and GORD. These include:

  • being overweight or obese
  • being a smoker
  • pregnancy
  • stress
  • medical conditions such as hiatus hernia or gastroparesis

There is also some evidence to suggest that GORD can be inherited genetically.

Treatments for Heartburn and GORD

If your heartburn isn’t too serious and you think you can manage it without medication, try the following:

  • avoid eating three large meals a day; aim for smaller, more frequent portions over the course of the day
  • work out what triggers your heartburn and avoid it
  • don’t wear clothing that is tight on your stomach
  • raise up the head of your bed so that you sleep at a slight angle; this will help to prevent stomach acid from leaking upwards
  • if you’re stressed, start doing relaxation techniques
  • maintain a healthy weight
  • stop smoking

If you can’t manage your symptoms on your own, visit a pharmacy for over-the-counter medication such as antacids. If the condition is more serious, you can request prescription medication from your doctor.

The prescription treatments for heartburn and GORD are:

  • Proton pump inhibitors
  • H2-receptor antagonists

If you are prescribed either of these, you will be given the lowest dose to begin with; this means that for many patients, PPIs should still be safe to use. To read more, visit The Online Clinic’s Heartburn page.

In some situations, surgery may be appropriate. Click here to find out more about your surgical options for heartburn and GORD.




by James Thomas, Saturday, 07 January 2017 | Categories: General Health

Dentists Unite against Antibiotic Resistance

If there’s one health-related topic that’s been consistently grabbing headlines in recent years it’s antibiotic resistance. Antibiotic resistance is a term referring to bacterial infections that can no longer be treated effectively with existing antibiotics. It’s a huge problem facing modern medicine because simple infections that are currently treated quickly and easily may soon become unmanageable. It’s a particular issue for patients undergoing serious medical treatments such as major surgery, chemotherapy or stem cell transplant; the advent of antibiotic resistance means the simplest of surgeries could become too risky to carry out.

For medical professionals, this growing problem has demanded fresh approaches to the use of antibiotics. Resistance develops through overuse and misuse – not finishing a course of antibiotics, for instance, can lead to small amounts of bacteria surviving and, in response to the specific treatment, developing a resistance.

It’s unsurprising, then, that medical bodies like the Faculty of General Dental Practice (FGDP), the British Dental Association and the Association of Clinical Oral Microbiologists are coming together to raise awareness of antibiotic misuse, and to audit the way dentists manage oral and dental infections.

According to Dentistry.co.uk, dental treatments account for 9% of all antibiotic use in the UK. By more rigorously auditing the way in which antibiotics are prescribed for dental issues, it is hoped that we will see a decline in misuse. Bodies like the FGDP currently offer guidance for how antibiotics should be prescribed, however, going forward, British dentists are keen to do more.

One tactic is to spend more time explaining treatments to patients. It’s hoped that, with some more guidance from their dentist, patients who are prescribed antibiotics will start taking them more responsibly.

In essence, it all comes down to education, which is why we’ve pulled together a short guide to common dental issues, and how you can treat them safely – without contributing to the resistance crisis.

Common Dental Problems

A common marker of a dental problem is toothache, which occurs when the tissue at the centre of a tooth becomes inflamed. Because some of the causes of toothache can be fairly serious, it’s important to visit a dentist if the pain doesn’t go away on its own after one or two days – particularly if it is very severe.

Causes of toothache include:

  • Tooth decay, in which acid caused by plaque build-up attacks your teeth leading to cavities, or in worse cases gum disease or abscesses
  • A cracked tooth
  • A broken or loose filling
  • Receding gums, in which the gums shrink away, exposing the more sensitive parts of the tooth
  • Periapical abscess, in which a bacterial infection causes pus to collect at the end of the tooth

Oral pain that is not strictly defined as toothache (because it does not stem from the centre of the tooth) can be caused by:

  • Periodontal abscess, in which a bacterial infection causes pus to collect in the gums
  • Sinusitis
  • Ulcers on the gums
  • Soreness around a tooth about to break through (for adults, this typically happens with wisdom teeth)

Treatments for Dental Pain

You may think that dental discomfort caused by a bacterial infection would be automatically treated with antibiotics; however, this isn’t the case. In fact, antibiotics should typically only be prescribed in emergency situations when the infection is very severe.

Usually, dental issues such as those described above should be tackled with a combination of dental procedures (for abscesses, this can involve a root canal or tooth extraction) and lifestyle changes. The current NHS guidance on dental health recommends the following:

  • Brushing your teeth with fluoride toothpaste for two minutes, at least two times a day
  • Using floss or an interdental brush once a day to clean between teeth and around the gum line
  • Reducing your intake of sugary or starchy foods and drinks
  • Visiting your dentist regularly

More guidance on good dental hygiene can be found at The Oral Health Foundation.

In the case of a severe dental abscess, The Online Clinic can prescribe emergency antibiotics. This is a good option if you cannot get access to your dentist. Click here to visit our online dental clinic and learn more.




by James Thomas, Saturday, 07 January 2017 | Categories: Womens Health

How does HRT affect dementia risk?

Hormone replacement therapy (or HRT) has long been the subject of controversy. First made available in the 1940s, it was created as a means of tackling the unpleasant – and for some women, debilitating – symptoms caused by the menopause.

In the 1990s and 2000s, studies were undertaken to study HRT’s long-term effects. When they found evidence that it could increase a woman’s risk of cancer and heart disease, the reaction was swift. Medical bodies began urging doctors to prescribe it only in its lowest effective doses, and many women stopped taking it altogether.

Today, those three letters still evoke a lot of uncertainty in patients and doctors. Many doctors feel uncomfortable prescribing it; many more menopausal women automatically rule it out as a potential treatment because of the risks it may carry.

In an interesting turn of events though, the studies that caused the initial panic have recently been challenged. According to new research, it now looks like HRT is perfectly safe for menopausal women to use. In fact, the latest studies seem to suggest that hormone replacement therapy could be seriously beneficial to post-menopausal women when it comes to staving off dementia.

The Menopause and Dementia

Earlier this year, it was reported that early menopause as caused by surgical removal of the ovaries is linked to a reduction in memory and thinking skills. The fear is that this could in turn lead to early-onset dementia and Alzheimer’s.

It isn’t understood precisely why the removal of the ovaries might have these worrying effects, but the doctor running the study, Gillian Einstein, believes that this indicates the importance of oestrogen in healthy brain function for women.

One fascinating offshoot of this study is that hormone replacement therapy (which artificially boosts oestrogen levels) could now play a seriously important role in maintaining brain health for post-menopausal women. In fact, this isn’t just speculation – in 2014, researchers at the Stanford University School of Medicine found that, when given to post-menopausal women who were at risk of dementia, HRT actively prevented brain degeneration.

While the sample size used in this study was too small to draw any definitive results, it is interesting to consider this research in conjunction with Dr Einstein’s more recent study. If oestrogen is the key to maintaining a healthy brain after the menopause, then it seems only logical that HRT would be the way forward.

All dementia-fighting powers aside, there are plenty of reasons why HRT would appeal to a menopausal woman living with unpleasant symptoms.

The Benefits of Hormone Replacement Therapy

The menopause is a natural part of ageing, which occurs when a woman’s oestrogen levels begin to decline. This predominantly causes period cessation, but other symptoms include:

  • Hot flushes, which can incorporate heart palpitations, sweating, and skin reddening

  • Night sweats and problems sleeping

  • Vaginal dryness, which can cause pain and discomfort during sex
  • Anxiety and low mood

  • Reduced sex drive
  • Difficulty concentrating

Hormone replacement therapy works by boosting oestrogen levels artificially. In turn it helps to tackle all of the symptoms listed above, as well as osteoporosis (the weakening of the bones), which is more common in post-menopausal women. HRT is usually taken for a few years, after which the doses are gradually reduced and treatment eventually ceased.

Types of HRT

There are many different types of HRT available, and the exact kind you are prescribed will depend upon your medical history, symptoms, and how advanced your menopause is.

Women who have had a hysterectomy (i.e. their womb has been removed) can safely take oestrogen on its own; women who still have their womb will have to take a combination of progesterone and oestrogen.

Cyclical HRT is recommended for women experiencing HRT but still having periods, while continuous combined HRT is recommended for post-menopausal women who are no longer having periods.

HRT treatments also come in a variety of preparations. You can take tablets, use patches that stick onto your skin, apply an oestrogen gel directly to your skin or vagina, or even have an implant fitted that gradually releases hormones into your bloodstream.

To find out more about HRT, or to obtain a safe prescription through The Online Clinic, click here.




by James Thomas, Sunday, 27 November 2016 | Categories: Asthma

According to Asthma UK, there are 5.4 million people living with asthma in the UK, 1.1 million of whom are children. That adds up to 1 in every 11 children, meaning that on average there are three with asthma in every classroom in the country.

At first glance, asthma might not seem like the worst health condition to live with, but the reality can be scary. For adults and children coping with severe asthma, living a normal life can be a daily struggle.

The good news is that asthma medications and the techniques for managing the condition effectively are constantly improving. Recent research from the American Academy of Pediatrics also looks set to make a significant contribution to the health of asthmatic children and adults.

According to the experts, the indoor environment of asthma sufferers’ homes plays a crucial role in respiratory health. In fact, controlling this environment could be as vital to asthma management as the use of medication. This discovery is particularly important for parents of asthmatic children, because air-borne pollutants can disrupt the development of young airways. Children are also more likely to be exposed to irritants and pollutants than adults because they spend more time on the floor.

Keeping your Home Safe

The new guidance recommends that parents with asthmatic children take the following precautions in their home:

  • Reduce your child’s exposure to cigarette smoke
  • Dust and clean regularly to avoid exposure to dust mites
  • Address any mould or damp issues
  • Address any issues with pests or vermin

Ultimately, the best thing you can do for your child is to keep your home very clean, dust-free and regularly vacuumed – particularly the rooms they spend the most time in.

Pets & Asthma

The report also discussed the role that family pets can play in children’s asthma. Animal dander is a common asthma trigger and it’s not always easy to control – even if you have a so-called "hypoallergenic" pet.

Giving up your dog or cat is not necessarily the only option if your child has asthma. This is because animal dander is only a problem if your child has an allergy to it – not all asthma sufferers are automatically allergic.

You’ll be able to tell if your child is allergic by monitoring their symptoms when they are around your pets. When the allergy is severe, a reaction will be instant, causing coughing, wheezing, shortness of breath and sometimes even a rash. When the allergy is only mild, a reaction may take a few days to develop.

For children with only a mild allergy, it may be possible to keep pets as long as they are not allowed into bedrooms or communal living areas. Keeping your pets well groomed and clean is also important, as is regularly cleaning and vacuuming.

For children with a severe allergy, it’s worth getting a definitive allergy test before you consider giving up your pet. It may be that your child is allergic to something else in your home.

Other Management Techniques

Keeping your home clean and safe is very important when it comes to asthma management, but there are other important techniques to keep in mind.

The first is having a written asthma action plan. This is a document which details all the vital information related to your child’s condition. It will include a list of your child’s triggers, medications, and what to do in the event of an asthma attack. To establish a comprehensive asthma action plan for your child you will need to take some time monitoring their condition, and working out what their asthma triggers are.

It’s also crucial to make sure your child is using the correct asthma medication. If they are only using a blue reliever inhaler (usually Ventolin) but experiencing symptoms more than three times a week, then it is likely that will need a preventer inhaler.

However, frequent flare-ups of symptoms could also be a sign of an unidentified trigger in the home – whether it’s cigarette smoke, animal dander, dust mites, food additives or mould. In this situation, an allergy test is recommended.

You can read more about asthma and the various medications available to treat it at The Online Clinic. Click here to view our inhalers and learn more about asthma management.





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