The ear wax story…

It is well known that we all make and therefore have ear wax in our ears. In normal instances the wax moves from inside the ear canal to the outside of your ear where it falls out or you are able to wash it away. Unfortunately in some instances the wax can build up and block your ear or ears. In some cases a wax build up can cover your eardrum. The eardrum also known as the tympanic membrane is a fragile structure which separates the outer and middle ear and kind of looks like a circular piece of foggy glass. In normal hearing the sound waves come into the ear through the outer ear canal and hit the eardrum which causes bones to vibrate and then these vibrations are turned into signals by your brain that allow us to hear. If your outer ear canal is occluded with wax then the sound waves are unable to get to your eardrum and this process cannot take place. Hearing loss of this nature is usually not serious and can be restored by removing the wax. Ear wax tends to be more of a problem in those who wear hearing aids or ear plugs and who do not allow the natural flow of wax out of the ear canal. It is important to note that having lots of wax in your ears has nothing to do with hygiene, cleaning and trying to remove the wax will not help the situation. In fact using cotton buds can be harmful as you can push the wax further into your ear and even in some instances cause major damage by pushing wax through the eardrum itself.

Symptoms?

Having a wax build up in an ear will often make you feel as though you have lost most of the hearing in that ear and can be really frustrating. Having a build up of wax in both of your ears can make it difficult to even hold a conversation. Other things that may occur include pain in your ear, feeling dizzy and you may experience a ringing in your ear known as tinnitus. You should visit your doctor if you experience any of the above symptoms and they can look and see whether there is wax blocking your ear or if in fact there is something else going on.

Do the treatments work?

Ear drops are probably the most common form of treatment when dealing with a build up of ear wax. These work by softening the wax in such a way as to aid the ear canal to break it up and push it out. There is however not much evidence to suggest that wax softeners actually helps to get rid of the wax. You can also try more natural remedies such as olive oil or sodium bicarbonate ear drops.

Ear syringing or aural toilet is another treatment option that is conducted by a doctor or nurse. This involves squirting warm water into the blocked ear through a tube which will act to weaken and move the wax. A small basin will be held under the ear for the water and wax that comes out. It is important to note that this process may take a few minutes before you are able to begin to move the wax. In many cases you may be given ear drops first to soften the wax which will aid in the process of softening the wax. This process should not hurt but is often uncomfortable and can make you feel dizzy. Sometimes this procedure needs to be repeated as it may not work the first time. In rare cases this can cause damage to the ear canal or eardrum and care must be taken when performing the task.

In very waxy ears the doctor may remove the wax with a special metal prong or via a suction device. These are effective but require a good operator and are usually only completed by specialist trained in ear surgery.

In conclusion:

One out of every three people with ear wax plugs will notice that the ears will clear themselves at around the five day mark without any treatment. Ear syringing is usually done if the ear wax is not cleared with ear drops. If it is found out that the ear wax is not the cause of your hearing loss then your doctor will do more investigations to find out what the cause is and help you to treat the problem.

Sinusitis is a condition that for many is very painful and terribly inconvenient, but fortunately in most cases it will go away without any medical intervention. For those people who suffer from sinusitis that does not go away on its own there are treatments that are available and this article looks at the latest research to help you decide what treatments actually work.

What is Sinusitis?

There are small air filled spaces in your face and skull that we call sinuses. They connect directly with your nose passage and are situated between your eyes and in your forehead. The sinuses are responsible for making mucus and because the sinuses connect directly to your nose passage the mucus usually passes into your nose and then mouth. The sinuses are covered with a type of tissue that can become swollen and inflamed and this is what happens in sinusitis. When this tissue becomes inflamed and swollen the openings that usually drain into your nasal passage can become blocked which stops the mucus from draining out of the sinuses. The sinuses that are located in your cheeks are affected the most, these are also known as your maxillary sinuses. Sinusitis can both happen quite suddenly and get better on its own, or can last a long time and you may require medical help to clear them. If a short attack lasts for four weeks or less then it is called acute sinusitis, whereas sinusitis that lasts for a longer period of time is known as chronic sinusitis. Acute sinusitis is the most common of the two types and this article aims to focus on treatments to deal with this. Sinusitis often occurs as a result of, or when you obtain a cold, flu, or viral illness. If your sinusitis lasts for longer than a week you may have a bacterial infection.

Symptoms include…

As mentioned earlier, sinusitis can be very painful. Symptoms can be very similar to the onset of any flu like illness and include things such as:

-Generally feeling unwell.

-A sore throat.

-Pain in your upper jaw, teeth, cheeks, around your eyes, or forehead.

-A raised temperature.

-You may lose your sense of smell.

-A headache, this may become worse when you sit forward.

-Pain upon eating, or toothache.

-Lots of green or yellow mucus in your nose.

If you have symptoms such as those above you should visit your doctor and when you do this they should be able to tell you if you have sinusitis or not. Depending on how bad your symptoms are your doctor may refer you to a specialist or send you off for an appropriate scan such as a CAT scan or X-ray.

Do treatments actually work?

The first and most important thing to note is that most sinusitis gets better on its own and no intervention is usually necessary. Because this is a painful condition you will usually find that simple pain relief such as paracetamol should be sufficient until the pain goes away.

In some cases pain persists and does not get better, when this is the case and you have had the symptoms for over a week then you should go and visit your family doctor.

One of the things that your doctor might prescribe for you is antibiotics. If you are given these you must take all of the tablets that have been prescribed for you even if your symptoms resolve beforehand. This is because although sometimes your symptoms are gone the bugs may still be present and can come back in force. All of the different types of antibiotics that are used to treat sinusitis are all shown to be effective and so it does not matter so much if your doctor prescribes one over another. Side effects do occur as a result of taking antibiotics and some of the things that you may get are an upset stomach and diarrhoea. How long you should take them for varies but most of the research now shows that short courses i.e. three to five days is just as effective as taking them for ten days. The most important thing to remember is just to take them for as long as your doctor prescribes them for. Antibiotics only work for bacterial infection and so if your sinusitis is caused by a viral illness then they will not help, however most viral illnesses will resolve on their own with rest and good self cares. For this reason antibiotics are generally only prescribed if your symptoms are severe and last for a week or longer, thus it is advisable to wait for a week before seeing your family doctor if you are coping alright with the symptoms.

If you do not want to go to the doctor and instead want to buy something over the counter you should be wary that the research for medications that you can buy yourself is not very good. In saying this some people find them very effective and this may relieve their symptoms until the sinusitis clears. Decongestants are medicines that as the name implies aim to clear the nasal passage and relieve a blocked nose. Medications of this variety are not always suitable for people with medical conditions such as diabetes, heart disease, or a problem with your thyroid. If you are concerned that this may be you then you should consult your doctor before using these medications. Decongestants should not be used for more than one week as rebound congestion can occur; this is where the blocked nose reoccurs.

You may also have heard of medications called antihistamines, which are traditionally used to combat fever and allergies. These are a mix of medicines that you can buy yourself and that are prescribed by the doctor. You must be wary when taking these medications though as they can make you sleepy and drowsy. Nasal steroid sprays are another option in the treatment of sinusitis and some of these are available over the counter and other will require a script from the doctor. These sprays are designed to be breathed in through your nose once or twice a day.

Like with most conditions in medicine nearly everything has been tried to combat the dreaded sinusitis condition. In fact it is well known that many people attempt to relieve their symptoms by inhaling steam, which unfortunately can cause burns in some people as the tissue within the nose is fragile. A salt water spray may also be used to rinse out the passage of your nose but evidence supporting these treatments is not convincing.

Will I be OK?

Two out of every three people who have sinusitis get better without any treatment from the doctor. However you can repeat attacks and not only that but the more attacks you have the more likely it is that you may get chronic sinusitis. If you get this long lasting chronic sinusitis you may need to see a specialist who will go over treatment options with you including surgery, of which the most common type is FESS (functional endoscopic sinus surgery). It is important that you visit a doctor if your sinusitis has not resolved in one week as it can cause problems that affect the brain and eyes. You must see your doctor straight away if you get signs of a stiff neck or bad headache, or if you find light painful as this may be suggestive of a more sinister disease.

If you have ever experienced neck pain then you will know that it often begins suddenly and that it will most likely at worst last a few days. If this pain does not go away or becomes unbearable with simple pain relief then you may need treatment. This article looks at the latest research regarding the treatment of pain in the neck.

What can you expect?

There are several types of pain that one may get in their neck and the various types have differing causes. The most common type of neck pain is something that we call simple neck pain. Often with simple neck pain you will not know the cause of the pain and the doctor may not be able to help in this instance. Often this pain is the result of one having bad posture or stress. It is also possible that simple neck pain started as the result of pulling some of the ligaments or muscles in your neck, or it could even be because your head was in an awkward position during sleep. In older patients this pain may be due to the wear and tear that the joints and bones in your neck undergo as you age. Another type of neck pain comes about as the result of nerve damage. This is most commonly due to the discs pressing on the nerves as they come out of the spinal cord between the discs. A further type of neck pain can come about as the result of whiplash. This occurs most commonly on the sports field or in car crashes.

What symptoms occur with neck pain?

The majority of neck pain begins suddenly and you will most certainly know about it as it often causes much distress to the patient. More often than not the neck will be painful and moving will cause pain or discomfort. Sometimes as a result of the way that the nerves are positioned in the neck it can cause pain to spread up to your head or down into your shoulders and even arms. It is very important that you tell your doctor if your hands feel numb, weak or are tingling. Symptoms like this can occur because of a problem with a nerve or could be the result of one of the bony discs pressing on your nerve. If the pain in your neck does not feel better in a few days time, or if you feel as though it is getting worse then it is important to see your doctor. Your doctor will be able to rule out the more serious causes by taking a history and examining you or by ordering an X-ray or another type of scan. In some cases a blood test may even be done to look for inflammation or infection.

Are there treatments?

There are treatments that you can do that do not involve the use of medication and in many cases these should be tried first. Physiotherapists are experts in the field of manipulation and mobilisation and you will most likely benefit from seeing these health professionals.  The important thing to note here is that some people do get injured as a result of having their necks manipulated and it would be wise to see your doctor first to see if this form of treatment is right for you. Visiting the doctor first is essential as they will be able to rule out more serious causes of neck pain that these therapists will not be able to pick up as they do not have the tools to do so. The benefit of this therapy is that the therapist will often give you exercises that you can do in the long term to strengthen your neck muscles and stop the pain from reoccurring.

There is research coming out now which looks at the benefits of acupuncture in patients with neck pain, Unfortunately at this stage not all of the studies are reliable and so the decision to undergo this form of therapy is very much up to the patient.

Many other forms of non-medical treatments have been tried to rid ones neck pain but once again the research for these techniques is limited at best. Some things that you may try include cold and hot packs, soft collar neck braces, special pillows to help you sleep, and stimulation of your nerves with an electrical current to interfere with the pain pathway.

Medications can help patients with neck pain although unfortunately there is no research that shows specifically that medicines help with neck pain. Painkillers that you can buy over the counter such as paracetamol may help in the short term. You can also try NSAIDS (Non-steroidal anti-inflammatory drugs) which reduce inflammation and are effective as reducing pain, but these have side effects if used in the long term. For stronger painkillers you will need to visit your family doctor, also if the pain persists after taking paracetamol and NSAID’s for a few days then you should visit your doctor anyway.

Interestingly antidepressants can be effective in patients that have had neck pain for a long time. This does not mean that the pain is the result of you being depressed. We do not fully understand why antidepressants have this affect on pain but they are certainly effective in many people. They do come with side effects though that include constipation, dry mouth, dizziness and nausea.

Muscle relaxants can be used in patients who have spasms or uncontrollable twitching of muscles in their neck. These can only be used in patients for a short amount of time but may give them a great sense of relief. These include drugs such as benzodiazepines. Unfortunately these drugs can make you feel drowsy, dizzy, or nauseas. They are also addictive and as such should be avoided for long periods of time.

Steroid injections can be used in some patients to reduce more severe pain that does not go away with simple pain relief. Unfortunately here there is a small risk of getting an infection or a collection of pus in your neck called an abscess following this treatment.

Surgery has not been shown to be effective in patients with neck pain and so you should not consider discussing this pathway unless recommended by your family doctor.

Final comments.

It is important to note that the majority of neck pain will go away within a couple of days to a week and can usually be managed with simple pain relief. Neck pain can come back or last for a longer period of time the second time around. If this is the case or if you are ever worried about it you should see your family doctor. Neck pain is extremely common and recent research has shown that 1 in 10 people have neck pain that lasts for a long period of time.

What is it?

This is a medical condition that affects ones ears and can cause attacks of hearing loss accompanied with dizzy spells. This can be due to having too much of a particular type of fluid called lymph in your inner ear.

Symptoms?

When you are having an attack of Meniere’s disease you can expect to have a loss of hearing and you will most likely feel as though the room is spinning, something that in medicine we call vertigo. Another symptom that may accompany these other two symptoms is something known as tinnitus which is a ringing or humming in your ear. Collectively these three symptoms make up the triad that is Meniere’s disease i.e. hearing loss, vertigo and tinnitus. But not all of these symptoms have to occur for Meniere’s disease to be present. Sometimes one may also feel pressure in their ears when they are having an attack. This is a very unpleasant experience and often people with this condition who are having an attack will feel sick and want to vomit and lie down. The attacks can last anywhere between 20 minutes to several hours and afterwards people often feel tired or unsteady. Many people get around 12 or more attacks per year, but others have them far less frequently.

Those with this condition have variable amounts of hearing loss and some people do not have any hearing deficit in between attacks, whereas others may have little or no hearing. The symptoms associated with this condition can start in one ear but after a while the symptoms may spread to the other ear also. These symptoms are not always caused by meniere’s disease and other causes may include an ear infection or anemia. You should see your doctor right away if you get hearing loss or dizziness. Your doctor may do various tests on you to ensure that you have meniere’s disease and not any other condition.

Treatments?

The treatments of meniere’s disease are not well researched and as such there is not very good evidence to support them. As always in medicine there are things that you can try and these may or may not work. Some of the treatments are aimed at the period when you are having an attack and others are used for the prevention of another attack.

The treatments that try to prevent attacks include changing the way in which one lives. In this treatment method patients will be directed to eat a low salt diet, give up smoking, exercise, avoid foods that are high in caffeine and stop drinking alcohol. This is obviously a big ask for patients and there is not even very good research to back this method up. The only real thought is that a low salt diet may help lower the amount of fluid in the inner ear, but even this is not certain.

Balance training is a form of physiotherapy, which uses head and body exercises in the attempt to alleviate symptoms. Diuretics are drugs that assist in getting rid of excess fluid in your body and two of these drugs in combination are found to be relatively effective in meniere’s disease. The combination is called co-triamterzide however this does have some side effects including rashes, dizziness or stomach upsets. Betahistine is another fluid lowering medication but this one focuses more specifically on the fluid within the inner ear. Unfortunately the evidence and research is not very good on this medication and thus it is not widely used. Trimetazidine is a relatively new medication that is used in people with heart disease and some believe that it may help in meniere’s disease. When you visit the doctor they may prescribe for you an anticholinergic drug such as hyoscine. This is a medication that is used in sea-sickness and some research has shown that it helps with the dizziness but unfortunately this was not a great study and thus we can’t be sure of the actual benefits. Also they have side effects including blurred vision, drowsiness, dry mouth and light sensitivity. Benzodiazepines may be recommended during an attack but these can have serious side effects and you can become addicted to them.

In some instances surgery is considered in those with very severe disease. This may include an injection of antibiotics into your inner ear or an operation involving the inner ear, but this surgery is awfully uncommon and risky if hearing is to be preserved.

In conclusion:

Symptoms in this condition as a rule generally come and go and many get better without any treatment. Because most people get better spontaneously it is hard to day just how much the various treatment methods help. Attacks usually occur with the highest frequency during the early stages of the disease but after a number of years two out of every three people find that their dizziness disappears. Unfortunately even though you may get rid of the dizziness it is likely that you may have some hearing loss or continue to have ringing in the ears. Hearing aids can often restore the hearing loss and your doctor can help you with the ear ringing. Because this can cause dizziness you must ensure that you tell your doctor about it as this can affect your safety at home or whilst driving or operating heavy machinery.

What is sleep apnea?

People with sleep apnea will experience times throughout the night where they will stop breathing for a few seconds at a time. This is a very scary thought for many people and can in fact be quite dangerous if left untreated. Breathing stops because the muscles in your neck relax and cause the contents of your throat to fall over the airway and block it. The airway only stays blocked for a few seconds because your clever brain recognizes that something is going wrong and forces the body to start breathing again. This process may even cause you to wake up and when you do so you may notice that you are making a gasping or choking sound. Your breathing may stop like this several times an hour for as long as you are asleep. This means that it is very hard to stay in the deep sleep that is necessary to feel fully refreshed in the morning.

What are the symptoms?

Now the periods of waking with associated gasping and choking may or may not be noticed by yourself or your partner. In fact it is most common for another family member such as the partner to notice periods of absent breathing, also you may hear complaints that you snore. Things that you will most likely notice are feeling drowsy during the day, feeling tired when you wake up, or finding it hard to concentrate on your normal daily activities. If you do experience a very bad degree of sleep apnea then you may notice that you fall asleep, or at least want to fall asleep in situations that you must be awake. These symptoms are quite non-specific and so it is important to see your doctor as many other things can cause disruption to a good sleep.

What treatments work?

Sleep apnea is not something that goes away on its own. This is an unfortunate fact but on the bright side there are a number of things that can be done to help. The number one thing that is recommended is avoidance of alcohol and cigarettes. Some people also find that sleeping on their side will help a lot. But the treatment method that most people are familiar with is a machine with a mask that attaches to your face and that blows air in through your nose and/or mouth. This form of treatment is known as continuous positive airway pressure or CPAP and the theory is that by forcing air into your windpipe the muscles wont have a chance to collapse. There are lots of studies that support the use of the CPAP machine. These studies claim that CPAP can improve your sleep and make you feel more awake in the daytime. Unfortunately CPAP is not without its disadvantages in the sense that the mask can cause dry mouth, sneezing and a runny nose. Also the wearing of the mask is said by many to be uncomfortable and makes some patients feel claustrophobic. Some people like to use a mouthpiece that looks a little like a gum shield that is used in contact sports such as football or hockey. These mouthpieces can be used to stop people from snoring and work by pushing the lower jaw forwards to keep the airway open. These have also been shown to make people less sleepy during the day. They are also said to improve the quality of these patients’ lives but the research on mouthpieces is limited.

Patients with sleep apnea who are overweight will more than likely be told to lose weight by their doctor. Interestingly although this has major health benefit, in the realm of sleep apnea there is not much evidence to suggest that it helps. If however you are very obese and are able to lose a large amount of weight in the region of 30-70% then this may lead to big improvements in the number of times they wake at night.

Surgery is another option for those suffering from sleep apnea. This is good for people who have large tonsils or adenoids that are causing their sleep apnea. There is also another operation that aims to remove some tissue from the top of your throat. Surgery is not the most widely accepted option of treatment here and many believe that there is no quick fix when it comes to sleep apnea. In fact in many people who undergo surgery for sleep apnea, their sleep apnea returns not longer after.

Some people are tried on medications to reduce their sleep apnea. This occurs most commonly in those who cannot tolerate a mask and they are tried on medicines used for other breathing problems, sedatives, antidepressants, or sleep pattern altering medications. The research on medication based treatment is not good and says that for the most part ‘the drugs don’t work.’

What will happen to me?

Untreated sleep apnea will adversely affect the quality of life that one lives. They will feel tired and run down and be unable to concentrate or even stay awake during the day. One of the most important things to remember if you think you may have sleep apnea is driving. Because you are at risk of falling asleep at the wheel a person with sleep apnea must notify the appropriate vehicle-licensing agency to discuss the matter with them. Those with sleep apnea are at increased risk of having other health problems and thus regular visits to your family doctor are advised.

What happens in the menopause?
As one gets closer to menopause, your body begins to make less of two important reproductive hormones known as estrogen and progesterone. These hormones are responsible for a number of reproductive functions including controlling a woman’s periods. The closer to menopause you get the more likely it is that you will notice more irregularity in your periods. They may be lighter or heavier, last longer or for only a few days. Some of the symptoms that women suffer from when they go through menopause include hot flushes, a dry and itchy vagina, decreased desire for sex, trouble with sleeping, weight gain, feelings of depression and painful sexual intercourse. Some of these symptoms are caused by the decreased levels of hormones but others are caused by lifestyles stressors and anxiety associated with menopause. Not everyone requires treatment as some people find that the symptoms hardly bother them at all, but other women fond the symptoms very distressing. If the above list of symptoms are bothering you and you think they may be related to menopause then you should see your doctor and ask about treatments.

What is HRT?
As mentioned earlier HRT stands for hormone replacement therapy. This is a medical treatment that contains one of the hormones that your body no longer makes a good amount of, estrogen. The goal of this treatment is to replace some of the estrogen that the body stops making when you reach menopause. Symptoms that are specifically related to a lack of estrogen are vaginal dryness and hot flushes. With HRT most women take a combination of both estrogen and progesterone. It is shown that adding progesterone reduces the risk of getting endometrial cancer of the womb that has an increased risk in women taking estrogen alone. This type of HRT is called not surprisingly combined HRT. In women who have already had their womb removed (hysterectomy) do not need to take a progesterone as they do not have a womb to get cancer in.

HRT can be taken in such a way so that you can still have a period every month. This is known as cyclical HRT and is often prescribed for women who are still have periods but are suffering from menopausal symptoms. Alternatively you can take HRT everyday without taking breaks, which is known as continuous HRT and is more appropriate in women who have not had periods for a year or longer. HRT can be taken via a tablet, skin patch, an implant, a gel, or a vaginal ring or cream. Some products are more appropriate for different symptoms and you and your doctor can talk about which one will work best.

How can it help?
HRT tablets will decrease the number of hot flushes that a women experiences after about three weeks of use. Some of the other forms of HRT may also reduce the number of hot flushes but comparisons have not been doe for this symptom. What is known is that women who have the worst symptoms will get the most benefit from treatment. It has also been shown that high doses of estrogen are most effective in reducing the number of hot flushes.

Vaginal dryness can be relieved with a tablet, cream, or a patch. As a result of taking this medication for dryness most couples find that sex becomes less painful as a result. Relief from this symptom can be achieved with only a small dose of the estrogen. Creams with estrogen in them and estrogen vagina tablets (pessaries) are most effective at reducing urinary infections. Also taking HRT is likely to make you feel less depressed, although it may not help women with severe depression. HRT can also help you to sleep a bit better and some studies say that HRT improves overall wellbeing, although this is not proven fro sure. HRT reduces your risk of getting weak bones, a condition known as osteoporosis.

Can it be harmful?
Unfortunately all good things are not without their trade offs and HRT is no exception. There are risks associated with taking HRT and for this reason benefits must be weighed up against risks. Most women only have a very small risk of adverse effects but you should still discuss these with your doctor. Doctors are advised that the smallest effective dose should be prescribed to women who are to be tried on HRT. They are also told only to keep women on HRT for as long as necessary. The risks associated with HRT are outlined below although it is important to note that most studies refer to combined HRT (with both estrogen and progesterone).

With most of the creams and tablets that are available to be put into your vagina, doctors think that the side effects are less because less of the hormone gets into your blood supply.

Taking combined HRT has been shown in one big study to slightly increase your chance of getting breast cancer. This risk is a little bit higher in women who take HRT over the age of 60. If you use HRT for a long period of time then your risk will be higher than those who use it for short periods of time. Five years after stopping the HRT your risk of breast cancer goes back to that of the normal population.

There is also evidence that women who take HRT are more likely to get blood clots than women who don’t take it, although this risk is very small for most women. Now having clots in your bloodstream is bad news because they can get stuck in smaller blood vessels and cause them to get blocked up. This means that blood cannot get to some organs. The risk of getting a blood clot in your lungs is two times that of the general population. If you have had blood clots in the past be sure to mention this to your doctor, as you will be at further increased risk. Also women who take HRT are at slightly higher risk of having a stroke. Women over the age of 60 and take HRT more than ten years after going through menopause have a small increased risk of heart disease. There was a recent study that found that HRT might slightly increase your risk of ovarian cancer. Fortunately this increased risk of ovarian cancer seems to disappear when one stops using HRT.

Taking HRT for a year or more may increase your risk of gallbladder disease (gallstones) or urinary incontinence. There are some other side effects that you can get when you start HRT but these usually disappear after a few months of treatment. Often a change of HRT product helps control the symptoms. The side effects that one may encounter include unexpected bleeding, tender breasts, headaches and mood swings. Women may find that they gain some weight when they first try HRT, however after a few months this should correct itself and no long-term weight gain is expected.

What are the alternatives?
Tibolone is an additional form of hormone treatment, which does not contain estrogen or progesterone. This medication does not affect the lining of your womb and so if you start taking it at least one year following your periods ending, you should not get any monthly periods. Those on Tibolone are likely to have half as many hot flushes, improved sexual satisfaction, more sexual arousal and less vaginal dryness. Sex drive is said to increase in women who take Tibolone compared with combined HRT. Tibolone may increase ones risk of breast cancer, but is still less than if you take combined HRT. The most common side effect of note is spotting and bleeding from the vagina. Unfortunately researchers have found that good cholesterol levels (HDL) can fall by around a third on those taking Tibolone.

Phyto-estrogens are a type of chemicals that are found in various plants. These can be said to act like a rare form of estrogen and soya products such as tofu and miso are rich in these chemicals. Other things that are rich in these are beans, lentils, celery and certain fruits. Over the counter supplements such as red clover pills can be purchased. The research for these is not as good as HRT. Phyto-estrogens are most effective in reducing the symptoms of hot flushes and not so good at combating vaginal symptoms.

There are other treatments that have been tried for HRT, however the evidence is not complete for these treatments. Some of these include clonidine (this is a medication that is used for high blood pressure), antidepressants may also show some merit and testosterone (the male hormone) may also be effective. More research is required to know whether or not these treatments are effective and one should always consult their doctor before starting on any of these.

What happens in the menopause?

Your doctor will tell you that you have been through menopause when you have not had a period for one year. But you can get symptoms that are associated with menopause well before you actually got through it. The reason for this is that your body goes through very important hormonal changes that will prepare it for life after your period. Changes can begin as early as ten years before you actually go through menopause. When you get closer to the age of menopause (average of 53 years of age) your ovaries begin to make less estrogen and progesterone hormone. As a result of this in the years leading up to menopause you may notice that your periods are not as regular as usual. Your ovaries continue to make less of these two hormones, until eventually they make such a small amount that you stop having your periods. At this point it can be said that you have reached menopause. Once you have officially been through menopause you can no longer get pregnant, but it is important that you use contraception in the years leading up to menopause. This is especially important because you will not know that your periods have completely stopped until you have been without one for a year. Although most women go through menopause within the ages of 45-55, some have early menopause. This is said to occur when it occurs before the age of 40 years. Also menopause may occur late and some women can still be having periods when they are over 55 years. Late menopause often occurs throughout families, but may also occur if you are overweight.

What are the symptoms?

As with the onset of the age of menopause the symptoms are also incredibly variable from person to person. In fact some women have no symptoms when they go through menopause and others find it one of the hardest things they will ever have to face in their lives. There are some symptoms that are directly related to the hormone changes occurring in your body. But there are other changes that might be caused by emotional changes or changes associated with aging. Irregular periods are often a sign that menopause is about to occur and you may find that periods are either heavier or lighter. They may be increased or decreased in frequency and may last longer or only a few days. Once again these things vary from person to person and it is normal to expect these changes. However if you experience very heavy bleeding such that you need to change pads or tampons every hour or if you get mid cycle spotting or bleeding after sex then see your doctor.

Some of the more common symptoms of menopause include:

• Hot flushes, this is where you go red in the face and feel hot all of a sudden. You may find that certain things trigger these hot flushes such as caffeine, alcohol or spicy foods.

•Night sweats, usually caused by hot flushes at night.

•Your vagina becomes dryer as the lining inside becomes thinner. This can make sex painful and may cause vaginal itching.

•A loss of interest in sexual activity.

• Many people experience mood swings and may feel depressed or often find they are in a bad mood. These are negative feelings that can include being panicky, forgetful, irritable and anxious.

.Problems sleeping.

• Weight gain can be a problem as well as a loss of muscle tone and an increase in the amount of fat surrounding your stomach.

In most cases your doctor will be able to tell you if what you are experiencing is menopause. However if you are younger (<40 years) then the doctor may ask you to take a blood test that can determine if it is definitely menopause or not.

What will happen to me?

As mentioned before the way in which women experience menopause is highly variable and differs greatly between individuals. Some women have very little problems and others find it a significant challenge. If you do really struggle with menopause please note that this is not because there is anything wrong with your body but is simply because all of our bodies react differently to the process. A large survey was done in women aged between 45 and 54 years that found that most of them had at least one symptom of menopause. Although more than half of these women said that these symptoms were not a problem for them.

In most cases experience of menopause is related to other things that are going on in a women’s life. Women who are under lots of stress may find it more difficult to cope. Some women see menopause as a positive step in life and this is associated with better outcomes in terms of symptom management. Women who feel anxious or depressed about menopause tend to do much worse. After you have been through menopause you must take extra care of your health, especially looking after your heart and your bones. There are several ways to do this including eating a healthy well balanced diet, cutting down on alcohol, maintaining a healthy weight, not smoking and having a regular exercise schedule.

What treatments work?

Symptoms of menopause can vastly interfere with the lives of many women around the world. Fortunately there are treatments available and things that you can do to reduce these symptoms and make menopause a smooth transition into elderly womanhood. Hormone replacement therapy is one option and is covered in another article; also herbal and other medicinal treatments are available.

Things that you can do yourself are listed below and seem to help many women significantly but do bear in mind that there is no scientific evidence for them.

If you are having hot flushes then it may help to breathe deeply and relax. You should also aim to avoid triggers if you think that this will help. Running your wrists or body under cool water in the shower may help, as will sleeping in a cool bedroom and avoiding many layers of bedding, using cotton sheets and having a cold drink of water handy may also be beneficial.

If you experience pain during sex or have a dry and itchy vagina then the first thing that you should do is visit your doctor and make sure that you don’t have an infection. If this is not the case then you should try a lubricant or moisturizer from your chemist. Also if you have lost interest in sex then you should talk to your partner about this, sometimes a councilor may be able to help you.

If you are feeling depressed of low in energy then you should focus on doing things that you find enjoyable. It is important to visit friends and maintain lots of social contact. You should eat a healthy diet and exercise on a regular basis. Sometimes going to yoga or Pilates may help. Also ensure that you get lots of sleep and learn about relaxation techniques.

Ensure the child has a regular skin care routine.

A regular skin care routine is undoubtedly the best way to address your child’s eczema. The number one key tip is to use plenty of moisturizer. There should be no times during the day when your child is allowed to get dry skin. The secret to keeping the skin well moisturized is to apply lots of thick and gooey moisturizer to the skin, not aqueous cream. Aqueous cream will simply wash off in a matter of minutes and be almost entirely ineffective. It is important to note that the skin is easily damaged in dry and winter climates and thus extra care must be taken here to be extremely vigorous with moisturizing. Also it is vital to keep using the moisturizer even when you believe the skin has healed. This is because the skin in those suffering from eczema has more holes in it than people without eczema and so moisture can escape easily.

Triggers may make things worse.

Every child will have things that make their eczema worse and we call these things triggers. Sometimes it gets worse after they have been running around and are hot and sweaty. Or perhaps it gets worse with various types of soap care products. The best thing to do is to look out for the things that you think may be making it worse and simply avoid them. This simple step can often make a world of difference for your child.

Please stop itching.

One of the worse things for young children with eczema is that it can be extremely itchy. So if you can stop them from itching all the time this will greatly relieve their symptoms and make them more comfortable. One of the ways to do this is by not allowing them to get to hot and sweaty. This can be difficult in active children, but encouraging showering and moisturizing straight after exercise can help. The problem with getting hot and sweaty is that the sweat can make the skin itchier and so even things like keeping the child’s bedroom cool may help.

It is important to avoid clothes and bedding made from synthetic or rough fabrics. Fabrics made from nylon and wool may irritate a childs skin more than cotton bedding and clothes. Although it sounds bizarre it is important to not wash with soap and instead use a soap substitute. You should advise the child to avoid hot baths and tell them to instead take long warm or even cool baths. Fingernails should be kept short so that scratching does minimal damage, when despite your best efforts the child continues to scratch. Babies may be able to use anti scratch mittens depending on how well they tolerate them. Non-biological washing powders should be used when laundering and fabric softeners should be avoided. It is also important to note that routine vaccinations make children’s eczema symptoms worse and can cause flare-ups.

Should I change my child’s diet?

Many people believe that if their child has eczema they need to radically change what they are feeding the child, well this is not usually the case. You should always talk to your doctor before considering a change in diet. It is not proven that some foods are related to eczema and to date there is poor evidence supporting those who believe that there is. Because children require many important nutrients to ensure that they are growing well, diet should never be changed without consulting your doctor or dietician.

There have been many studies on the topic of diet and eczema and although the evidence is not good. Some studies have shown that taking vitamin E supplements can help with symptoms. However there are just as many studies saying that they show no difference. Cutting cows mil out of the diet only improves symptoms in those children who are allergic to cows milk and does not help in other children with eczema. Other supplements such as probiotics, which contain good bacteria, may have some positive effect. Many parents have tried diets where they cut out all but a few key foods and see of this improves symptoms. There is no evidence for this approach and this may prove to be harmful for the child, as they may not get the nutrients that they need.

What about complementary medicine?

Many complimentary medicines have been tried in the treatment of eczema. This is not evidence based and more studies are needed to know whether these treatments have any effect or not. It is important to talk to your doctor before trying a complementary medical treatment as these treatments do have side effects and can react with other medicines. Studies were done to see of Chinese herbal medicine was useful in the treatment of eczema and 2 studies found that it helped and the other two found that it did not help. In one small study massage was found to help children with eczema cope better with their illness. It did not make any difference what particular massage oil was used.

If you’re pregnant

So if you happen to be pregnant (first of all congratulations), but you know that eczema runs in your family, you may wonder if there is anything you can do to prevent it. Well one study has shown that eating foods containing ‘good bacteria’ in the last few weeks of pregnancy and then giving them to your baby when it is born (via breastfeeding) may reduce the risk of the child getting eczema. Unfortunately this was a small study and more research needs to be done to confirm the findings. No studies have been done looking at whether breastfeeding your baby can help reduce their risk of obtaining eczema. As well as this there has been little research looking at what you eat during pregnancy as a cause or preventer of you’re child getting eczema.

What is rheumatoid arthritis?

Those who have rheumatoid arthritis know how painful and swollen joints in the body become. This condition happens as a result of a problem with your immune system, that is the system that fights off infection. The problem in those with this form of arthritis is that as well as fighting off the infection that you want to fight off, your body makes a mistake and also attacks your own joints.

What are the symptoms?

The symptoms that affect those with rheumatoid arthritis are usually slow to come on and get worse over a long period of time. The first thing that some people notice is that their joints begin to feel a little bit stiff, especially in the mornings. The joints that are usually affected first are the small ones, usually in your hands and feet. As time goes on your joints may become stiff and painful. Pain is often worse after you wake up from sleep or if you have been sitting still for a while and get better when you get active and move around. Another thing people notice is that they get swelling in their joints and some people even notice lumps or swellings under their skin. These are usually noticed on the back of your elbows or finger joints and they can be removed via surgery if they cause you problems.

What treatments work?

Fortunately there are a number of treatments that have been proven to be very effective in those with rheumatoid arthritis. It is important to note that there is not one standard treatment and so many people are on a number of medications to help fight off the disease. Also treatment will not cure your arthritis, but it will certainly help with pain and halt the bad effects on your joints. There is strong evidence to suggest that the sooner you start taking the drugs for rheumatoid arthritis, the better your outcome will be. It is most likely that you will have to take these medications for your entire life and so forming good habits early on is very important.

Drugs that protect your joints are called disease-modifying drugs. These may in fact take a few months to begin working and so it important to persist with taking them. Most of these drugs are in tablet form and some of the more common ones are:

• methotrexate

• sulfasalazine.

• azathioprine

• ciclosporin

• leflunomide

It is quite likely that you will be put on methotrexate or sulfasalazine first. In fact your doctor may suggest that you take several of these disease modifying drugs at the same time, so be aware that this is not unusual. Also note that your doctor may change your treatment over time depending on how well it is going.

Unfortunately al of the above medications can have side effects. When you are first prescribed them your doctor will go through these and warn you of what to expect. If you do get bad side effects it is important to visit your doctor and get a check up. As there are a wide range of medications to be on it is likely that changing these medications will be no problem. If you get continued problems despite changing your medications, your doctor may decide to put you on a medication called a tumour necrosis factor antagonist. These are given as injections or on a drip and include:

• Etanercept

• Infliximab

• Adalimumab

Once again your doctor will inform you of side effects that you can expect on these medications.

Also low doses of steroids may be used to help reduce the swelling and pain associated with rheumatoid arthritis in the short term. It is important to note that these are not the same steroids that are used by body builders and are similar to chemicals that your body makes naturally. But steroids used for a long time can cause side effects and you will usually be given a low dose for this reason. In fact it is not known if steroids work well if given over a long time period. Rituximab is new treatment that is suitable for people who haven’t been helped by other drugs. They usually give this drug at the same time as methotrexate.

Treatments to help with pain

As mentioned earlier rheumatoid arthritis can be a very painful disease and although some of the above medications can help with pain they are often not enough. For this reason it is important to talk to your doctor about painkillers. Paracetamol can be an effective short term medication for pain but is often not effective over the long term and can be associated with overdose if too much is taken. If you need stronger painkillers then your doctor can prescribe drugs called NSAID’s, these are quite effective as they help with pain and inflammation. Some examples of these medications you may be offered include; diclofenac, ibuprofen and naproxen. If one of these drugs do not work for you then another one might.

One of the problems with NSAIDs is that they can cause an upset stomach if taken for a long time and can even cause stomach ulcers. For this reason doctors will often suggest that you take an additional medication that will protect the lining of your stomach from this. Also taking increased doses of NSAID’s regularly for a long time may increase your risk of heart attack and stroke. Therefore it is advisable to only take these drugs when necessary and if pain persists see your doctor.

Things you can do to help yourself

There are things that you can do to help your symptoms as well as taking medications. There are people who find that taking a warm bath or shower may help to relieve their pain and swelling. Sometimes putting ice on a painful joint may relieve pain. Also exercise may help relieve the pain and swelling of yours joints, so long as it is not exercise that stresses your joints. Swimming and cycling are recommended, as they are softer on your joints than running. You may want to consider seeing you physiotherapist to suggest a good exercise regime for you. Some people talk about eating certain foods that they relieve symptoms and although this may be true there is no evidence to suggest that this does work.

What will happen to me?

An important thing to note is that every person with rheumatoid arthritis will experience a very different disease course. For this reason it is very hard to know exactly what will happen to you and when. Some people will suffer very little with symptoms and others will have major problems. But fortunately new treatments out there are helping those with this disease stay mobile and active for longer and consequently live happier and healthier lives. Most people do find that their symptoms become more severe over time and sometimes they can flare up and become more painful. About 1 in every 20 people will get more severe damage to their joints, which can make everyday tasks very difficult. Many find having arthritis a scary thing, however treatments today can really make a big difference so it is worth persisting with medication schedules. If pain does get worse don’t hesitate to contact your doctor, as there are often extra treatments that will help. Support is certainly important, so share your experiences with your friends and family and join one of the many support groups out there for those with rheumatoid arthritis.

As is well known in Western countries vaccines work by introducing the body to a small amount of the disease-causing organism. This allows the body to recognize these bugs in the future so that the body can mount a sufficient and effective attack against them.

What vaccines work?

Two vaccines may help protect you against pneumonia. The first of the two is known as the pneumococcal vaccine and the other is the flu vaccine. Although the flu vaccine does not directly protect you from pneumonia, it prevents you from getting the flu. It is important to prevent the flu because when you are sick your body is weakened and you are more likely to get other diseases such as pneumonia.

Evidence is becoming stronger to support that the pneumococcal vaccine helps to protect you against invasive pneumonia. Invasive pneumonia refers to a complication of pneumonia whereby the infection spreads out of the lungs and into the rest of the body. The bacterium that is used in the virus is dead and as a result cannot harm you i.e. it can not give you pneumonia or any other illness. It is also important to note that the pneumococcal vaccine is designed to protect against the most common form of pneumonia. The most common side effects include muscle and/or joint pains. Most people only require the pneumococcal vaccine once in their lifetime. However those with spleen problems or those with a weak immune system require another vaccination after five years. Make sure you ask your doctor if this vaccine is right for you.

The flu vaccine

If you get the flu then evidence shows that you have a higher chance of getting pneumonia. This means that if you have the flu vaccine you will most likely lower your risk of getting pneumonia. Along with this there is evidence, which shows that elderly people in nursing homes are less likely to get pneumonia if they have received the flu vaccination. Now the flu vaccination is not like many vaccinations that you can get once and be protected for years, with the flu vaccine you must get it every year. You usually get this in summer or fall, so that you are protected when the winter months come around. Also there is no need to worry about getting the injection as it will not give you the flu and one of the worst things that can happen is a little bit of pain associated with the needle going in. The only known side effects that some people get are a temperature and joint or muscle pains. It can also be said that you should not receive the flu vaccine if you have a severe allergy to eggs. This is because the flu vaccine is made using eggs. These kind of allergic reactions, which are known as anaphylactic reactions, are very rare. If you are concerned that you may be allergic to eggs or have had any problems with vaccinations in the past then consult your family doctor before getting a vaccination.

Do I need a flu vaccine or pneumococcal vaccine?

There are several reasons why someone should receive the pneumococcal vaccine and some of the reasons are as follows:

-You are 65 years of age or older.

-You have a lung condition such as emphysema or severe asthma.

- You have a long-term illness, such as heart disease, kidney disease, liver disease and/or diabetes, sickle cell disease, or a problem with your spleen.

-If you have a weakened immune system such that you may be getting chemotherapy or steroid treatment, or you have HIV or AIDS.

It is important to note that there is a special type of pneumococcal vaccine for children. This is suitable and recommended for all children under two years of age. This vaccine is given in two or three doses that are one or two months apart. The first of these doses is usually given at two months of age. In children who are under five years of age who may be at risk of illnesses caused by the pneumococcal bug, they should also be vaccinated even though they are not under two years of age. These bacteria can also cause meningitis or blood poisoning in children, as well as pneumonia, so this is even more reason to get your child or grandchild immunized.

The flu vaccination is especially recommended in those who are:

-65 years or older.

-Living in a nursing home.

-Suffering from a long term illness, such as heart disease, liver disease, kidney disease, diabetes, sickle cell disease, or a problem with your spleen.

-Suffering from a lung condition such as emphysema or severe asthma.

-Subject to a weakened immune system i.e. those who are undergoing chemotherapy or steroid treatment, or those with HIV or AIDS.

-Living or working with someone who could get very ill if they had the flu. This includes healthcare workers and people who work at nursing homes.

More recently some people have caught pneumonia after having the swine flu illness. So people should also be vaccinated against this new strain of flu. In fact most new flu vaccinations will include protection against this swine flu illness.