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by James Thomas, Saturday, 11 March 2017 | Categories: Asthma

Around the world, concern is growing over the quality of the air that people – particularly big city dwellers – are forced to breathe. In London during January, air quality was so bad that legally mandated pollution limits for the whole of 2017 were passed in the first week of the year. The city's mayor, Sadiq Khan, spoke of what he called a "public health emergency", as toxic air hung over the central boroughs, a problem exacerbated by unusually calm weather patterns.

Everyone is at risk when conditions like these persist, but the potential health risks are even worse for anyone with respiratory or heart issues, with asthmatics often experiencing serious problems. Evidence is also mounting that cases of chronic bronchitis increase with worsening air quality. The figures for air pollution-related deaths in London alone are astonishing; every year, almost 9500 people in the city die early because of pollution-linked conditions, according to research conducted in 2015 by scientists from King's College.

Measures such as banning certain kinds of traffic in parts of a city, or restricting people from using private vehicles, can have a beneficial effect locally. But changing weather patterns or unusual conditions can result in pollution from other areas – even other countries – having a dramatic impact in distant cities. The ability of people and governments to work across borders to combat problems like this becomes immediately apparent under such conditions.

EU takes action

Around six weeks after the January pollution spike in London, the EEB (European Environmental Bureau) announced that five EU countries were consistently breaching air pollution limits. The UK, Germany, France, Spain and Italy were, the EEB claimed, failing in their duty to protect people's health, and legal proceedings would follow. Furthermore, the EEB statement pointed out that this was not a new issue; the situation had been going on for years.

One particular pollutant, nitrogen dioxide, was singled out for its likely effect on young children with asthma, and its probable contribution to increased cases of bronchitis and other lung infections. It is the job of the European Commission to ensure that EU laws regarding air quality are upheld, and recent EU legislation includes new and more stringent emissions targets. The EEB's senior air pollution policy officer, Louise Duprez, said there was "no excuse" for not meeting the targets, and that children "deserved better" than to grow up inhaling toxic air.

Bronchitis: causes and treatment

Bronchitis is frequently mentioned as one of the effects of air pollution, though of course poor environmental air quality is not the only risk factor. Bronchitis, like pneumonia, is an infection of the airways and/or lungs, and can be a mild and relatively short-lived condition – acute bronchitis – experienced by people who have simply caught a cold. When the condition becomes a long-term, more serious health problem, it's known as chronic bronchitis.

The chances of developing bronchitis are increased by a number of factors, smoking being one of the most common. Chronic bronchitis can vary in intensity throughout the year, and environmental factors can have a causative effect, and can also make the condition worse. The main symptoms of both the acute and chronic varieties of the infection are a persistent cough with chest/lung discomfort or pain, and possible breathing problems. In emphysema sufferers, chronic bronchitis can lead to COPD, which can cause permanent lung damage in the long term.

There are a number of recommended ways to avoid contracting bronchitis, and stopping smoking is, unsurprisingly, at the top of the list. Not only does smoking cause lung damage, it lowers the body's resistance to infection. Staying within alcohol consumption guidelines – currently 14 units or fewer per week – and eating a healthy diet can help the immune system to fight infections.

It's important to be aware that bronchitis can be caused by both viruses and bacteria. Viral infections are not treatable with antibiotics. Mild cases of acute bronchitis may not require treatment, and in fact, using cough medicines is generally not recommended, as the body needs to expel phlegm by coughing. You should see a GP if your symptoms get worse or the condition doesn't clear up relatively quickly. In cases where antibiotics are appropriate, you may be able to order them from The Online Clinic – see the Free Online Assessment at the link.

by James Thomas, Saturday, 11 March 2017 | Categories: Womens Health

The term cystitis is used to describe a bladder inflammation, generally caused by a UTI or urinary tract infection. It's a common mistake to believe that only women can get cystitis; in fact, men are also able to develop it. The likelihood of cystitis in men is lower for one simple reason – the relative length of the urethra in men and women. In women, the potential transfer of bacteria into the urethra is made easier as the opening of the urethra is closer to the anus. This is not the only possible cause of cystitis, but it does explain the varying rates of the condition.

The condition known as interstitial cystitis, however, is somewhat different, both in terms of symptoms and of possible treatments. The main symptoms include a sensation of pain in the bladder (it's sometimes known as bladder pain syndrome, or IC/BPS) but without a clearly identifiable infection, as might be expected with cystitis. Pain like this is experienced in the lower abdomen, and is coupled with unusually frequent, strong urges to urinate. These symptoms may come and go in cycles over a few months.

The differences between cystitis and IC have led some researchers to believe that the condition is misleadingly named, and in fact the exact causes of IC are the subject of debate. Allergies have been suggested as a possible cause, as well as problems with the lining of the bladder or the pelvic floor muscles. It's also possible that IC may sometimes be a symptom of a separate condition (e.g. irritable bowel syndrome).

Possible new treatments for interstitial cystitis

The US-based Interstitial Cystitis Association suggests that up to 8 million American women suffer from IC, with possibly half as many men. The confusion surrounding the causes of IC (as opposed to cystitis) has led some US researchers to propose a step-based programme of treatments aimed at minimising its symptoms. In the early stages of treatment, these include lifestyle and dietary changes and advice on pain management. Dietary changes may include gradual elimination of certain types of food and drink, in order to find out which may be triggers for the symptoms. Some over-the-counter medications may also be prescribed by GPs.

The "steps" in this kind of approach to treating IC are ordered by risk factor; if the least risky strategies provide acceptable relief, there's no need to proceed to the next level. As an example, the fourth proposed stage of treatment may include Botox injections, while the following stages could involve surgery.

Cystitis: symptoms and treatment options

Cystitis itself is easier to treat than IC, and in fact some over-the-counter medications, as well as antibiotics in some cases, are available from The Online Clinic. While milder instances of cystitis often clear up without treatment, if you experience frequent symptoms, or the condition doesn't get better after a few days, you should see a doctor. Men with cystitis symptoms should always seek medical advice, and children complaining of similar symptoms should also be taken to a doctor. More severe symptoms may include fever and/or passing blood during urination.

Preventative measures are centred around avoiding bacteria entering the urethra (allowing bladder infections to develop) as well as certain lifestyle changes. While cranberry juice has long been thought of as a cure or prevention, there's very little scientific evidence that this is the case. Making sure you've completely emptied your bladder when you urinate is recommended, as well as wearing looser underwear made from natural fibres (e.g. cotton). Drinking plenty of water in order to flush out the urinary system is also a good idea.

It's also possible that irritants in certain kinds of shower gels, shampoos, bubble baths and similar products could be a problem; avoid perfumed varieties, and if possible take a shower rather than a bath. If you suffer from cystitis, try avoiding any drinks containing caffeine. These will not cause cystitis in themselves, but may aggravate the symptoms. Some medical professionals believe that the use of a bidet could be a risk factor for cystitis, as bacteria can be washed upwards towards the urethra.

It is important to see a doctor if cystitis symptoms don't clear up, as there is a possibility of contracting a kidney infection in some cases. However, cystitis is generally simple both to diagnose and to treat.

by James Thomas, Saturday, 25 February 2017 | Categories: Obesity

The older we get, the better care we have to take of ourselves – that’s the message drummed into us by everyone from doctors to TV personalities. But, while it’s well known that your risk for serious conditions such as cancer and cardiovascular disease increases as you age, it’s also a universally acknowledged fact that getting older goes hand in hand with putting on weight, slowing down and finding it harder to get energised and motivated.

Obviously, this isn’t the case for every person in middle age – especially if you’re someone who has always had an interest in exercise, healthy eating and fitness – but according to recent statistics, it does affect a worryingly large percentage of the population.

As reported by The Guardian here, eight out of 10 Brits aged between 40 and 60 are not taking good enough care of themselves. To be more specific, 87% of men and 79% of women in this age range have been found to weigh too much, drink too much or be too physically inactive.

Perhaps most concerning is the high percentage of middle-aged adults who are overweight or obese (77% of men and 63% of women). Being overweight or obese is a high risk factor for serious conditions like type 2 diabetes, heart disease, breast cancer, bowel cancer and stroke. It’s often closely linked to an inactive lifestyle and drinking too much – but the experts also believe there may be some other factors at play.

Reasons for the Middle Age Health Crisis

In the past 20 years, obesity in adults has increased by 16%, which is something that flags it up as a general health crisis, not solely specific to older age categories. One of the worrying effects this has had is that it has warped the average person's ability to distinguish between a healthy and an unhealthy weight – a particular problem for parents with overweight children.

Another factor to consider is that more and more people work in jobs requiring them to sit in front of a computer screen all day; as detailed by the NHS here, a sedentary lifestyle is associated with all kinds of health risks.

Generally speaking, we also live in a fairly ageist society that often devalues or ignores people over a certain age. As a result, many older people who are looking to get fit may find it more difficult to start exercising than those from younger generations; gyms and fitness classes tend to be populated with young people, and this can be really alienating if you do feel you are "too old" and out of shape to be there.

How to Lose Weight and Get Healthy in Middle Age

Whatever age and weight you are, there is always a way to get fitter, healthier and happier. For most people, this will involve three simple things:

  • Eating a healthier diet
  • Starting to take more exercise
  • Cutting down your alcohol intake

Many people will read those words and assume that means cutting out carbs, joining and gym and going teetotal. But in fact, getting healthier is often about making a series of small, manageable changes that can be easily adopted into your daily routine.

The first step is to take a look at what you eat and drink every day, and whether it largely adheres to the recommended guidance from the NHS. The second step is to start exercising a little more each day. This can mean taking the stairs instead of the escalator, getting off the bus or train one stop early and walking the rest of the way, and even standing up from your desk chair once every hour to stretch your legs.

From there, you can implement bigger changes, like taking up an exercise class; there are many tailored specifically towards older people. If you’re struggling to control your eating, consider signing up for a healthy diet programme or visiting a nutritionist.

If you find that these tactics aren’t effective, you can also talk to a doctor about getting a prescription for weight loss medication such as Orlistat or Saxenda. As part of a healthy lifestyle, this can be a very effective tool for gradual weight loss. Learn more by visiting The Online Clinic’s Weight Loss Tips page.

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.

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