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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, 05 November 2016 | Categories: General Health

It’s a feeling nearly everyone can relate to; you’ve just eaten a delicious meal at a posh restaurant and when you get home to bed, you find yourself clutching your chest and gulping down water to try and alleviate that horrible burning sensation.

No, you’re not having a heart attack – but heartburn (which is caused by stomach acid leaking into the oesophagus) is certainly an unpleasant thing to experience. And you’d be in the minority if you haven’t been through it at least once in your life. Unfortunately, for some Brits, heartburn is a daily reality, just one symptom of a chronic condition known as gastro-oesophageal reflux disease (or GORD, for short).

In 2011, a Norwegian study found that cases of GORD were on the rise, and suggested a link between this and rising body weights. At the time, the Daily Mail reported on this study, interpreting the results as an indication that obesity caused by a fatty diet is a direct cause of heartburn and acid reflux. As shown here, the NHS dismissed the Daily Mail’s take on the results, as the study did not show a link between diet and symptoms.

In fact, while it is true that obesity puts you at greater risk of GORD the foods that most commonly cause heartburn are not those you might expect. According to the experts at WebMD, some of our favourite healthy foods can be a high risk for triggering an attack of heartburn.

If you find yourself regularly battling with heartburn, it’s worth visiting a doctor, as you may be suffering from GORD and may require medication. If you aren’t diagnosed with GORD, or if it’s only causing moderate symptoms, you should be able to manage the condition at home by making some adjustments to your diet and lifestyle.

Foods to Avoid

There are a number of different foods and drinks that can trigger heartburn and acid reflux:

  • Acidic foods such as citrus fruits or juices, and tomatoes
  • Garlic and onion
  • Spicy food containing lots of pepper and/or chilli
  • Peppermint
  • Alcohol
  • Caffeine
  • Chocolate
  • Carbonated drinks

Though the Daily Mail’s condemnation of a fatty diet was a little slapdash, they weren’t totally wrong – as you’ll read here, foods that are high in fat (avocado, cheese, nuts and steak) can also cause heartburn. This is because high-fat foods cause the stomach to empty more slowly, meaning it is more likely to swell, putting pressure on the muscles that keep it closed and allowing for acid to leak out.

Having said that, it may not be necessary to completely cut out the foods and drinks listed above – particularly the healthier ones. However, eating them in moderation, and not in combination with one another, is advised.

Lifestyle Changes

As well as looking out for foods that can trigger your heartburn, you should avoid eating very large meals – instead, eat several small, light meals over the course of the day, and leave several hours between dining or drinking alcohol and going to bed.

Raising the head of your bed by around 20cm can also help to alleviate symptoms. This is because, for stomach acid to leak into the oesophagus, you have to be lying flat or bending over. Lying at an angle should help prevent this from happening. To raise your bed you should insert blocks underneath the bed – simply propping yourself up with pillows will not work.

Losing weight and quitting smoking are also advised.

Medical Treatment for Heartburn

If you are suffering from persistent heartburn, it may be appropriate to start using medication. There are various types available, ranging from over-the-counter antacids to prescription-only proton-pump inhibitors (PPIs) and H2-receptor antagonists (H2RAs). Antacids neutralise the effects of stomach acid, while PPIs and H2RAs actively reduce the amount of acid produced by your stomach.

In rare cases, surgery may be the most suitable course of action. Most commonly, GORD is resolved through keyhole surgery in which the ring of muscle between the oesophagus and the stomach is tightened. This prevents the leakage of stomach acid.

To find out more about medical treatments for heartburn, consult our dedicated heartburn page.




by James Thomas, Saturday, 15 October 2016 | Categories: General Health

For many people, there’s something irresistible about the idea of a midnight snack or a movie night packed with popcorn and sweet treats. But though we all know indulging in biscuits, brownies and crisps is bad for our health at any time of day, how many of us are aware of the toll these foods can take when they’re eaten after 7pm?

If recent findings are to be believed, then we all need to start making our evening binges a thing of the past. As reported here, the European Society of Cardiology has found that people who eat large meals after 7pm experience dramatic increases of blood pressure overnight.

This is worrying because high blood pressure (also known as hypertension) is associated with all kinds of health issues, including heart disease and stroke. It’s also concerning because most of us consider 7pm an ideal time to eat dinner!

If the research is accurate, and eating late really can cause problems with our blood pressure, then what is the best way to stay healthy? Well, it isn’t as simple as eating dinner at 6.30pm.

Current Guidance for Healthy Eating

According to the NHS, there are several factors that go into a healthy diet. The first recommendation is that men consume 2,500 calories and women 2,000 calories a day. This will differ slightly depending upon your age, fitness, health and weight. However, if you get into the habit of eating significantly more or less than this, you could be putting your health at risk.

The calories you consume should also be nutritious, and not simply made up of sweets and junk food. Your daily diet should include:

  • 5 portions of fruits and vegetables
  • Starchy carbohydrates, preferably wholegrain or high fibre
  • Protein in the form of lean meat, fish, eggs, pulses and/or beans
  • Low fat dairy
  • 6 to 8 glasses of water

Red meat should not be eaten too regularly; however, in small portions it does have health benefits, as it is packed with protein, iron and zinc. If you are eating more than 90g a day you are advised to cut down.

Sugary drinks, chocolate, sweets and snack foods that are oily, fatty or salty are not strictly off-limits. However, they should be restricted; eat this kind of junk food in small portions, and not on a regular basis.

The newest research also suggests that eating at the same time every day is also important. Heart expert Dr Ebru Özpelit advises that we should eat a good breakfast, avoid skipping lunch, and keep our evening meal small, light, and ideally before 7pm.

Avoiding High Blood Pressure

It’s not always easy to avoid developing high blood pressure. This is because it is related to age, genetics and family history, and even sleep deprivation.

If you think you may be at risk of high blood pressure, you should visit your doctor for a blood pressure test. A normal blood pressure measurement is anything between 90/60mmHg and 120/80mmHg. High blood pressure is considered anything over 140/90mmHg. However blood pressure between 120/80mmHg and 140/90mmHg is considered prehypertension – this means your blood pressure could continue to rise and pose a risk to your health. If your blood pressure is in this range, you may wish to start making some changes to your diet and lifestyle.

Things you can do to limit your risk of (or lower existing) high blood pressure include:

  • Eating less than 6g of salt a day (roughly one teaspoon)
  • Cutting down your alcohol intake, and avoiding alcohol "binges"
  • Losing weight
  • Exercising (the NHS recommends at least 150 minutes of moderate activity every week)
  • Cutting down on caffeine
  • Quitting smoking
  • Getting a good night’s sleep

In some cases, this won’t be sufficient, and medication will be required.

Medical Treatments for High Blood Pressure

There are several different treatments for high blood pressure. The five most common are:

These medications are prescribed depending upon your age, health and family history. Find out more about pursuing a healthy lifestyle and avoiding high blood pressure by visiting The Online Clinic’s hypertension information page.




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