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Abdominal aortic aneurysm,"Abdominal aortic aneurysm | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Heart and blood vessels Conditions Abdominal aortic aneurysm Abdominal aortic aneurysm About abdominal aortic aneurysms Symptoms of an abdominal aortic aneurysm Causes of an abdominal aortic aneurysm Diagnosing an abdominal aortic aneurysm Treating an abdominal aortic aneurysm Preventing an abdominal aortic aneurysm About abdominal aortic aneurysms An abdominal aortic aneurysm (AAA) is a swelling (aneurysm) of the aorta  the main blood vessel that leads away from the heart, down through the abdomen to the rest of the body. The abdominal aorta is the largest blood vessel in the body and is usually around 2cm wide  roughly the width of a garden hose. However, it can swell to over 5.5cm  what doctors class as a large AAA. Large aneurysms are rare, but can be very serious. If a large aneurysm bursts, it causes huge internal bleeding and is usually fatal. The bulging occurs when the wall of the aorta weakens. Although what causes this weakness is unclear, smoking and high blood pressure are thought to increase the risk of an aneurysm. AAAs are most common in men aged over 65. A rupture accounts for more than 1 in 50 of all deaths in this group. This is why all men are invited for a screening test when they turn 65. The test involves a simple ultrasound scan , which takes around 10-15 minutes. Symptoms of an AAA In most cases, an AAA causes no noticeable symptoms. However, if it becomes large, some people may develop a pain or a pulsating feeling in theirabdomen (tummy)or persistent back pain. An AAA doesnt usually pose a serious threat to health, but theres a risk that a larger aneurysm could burst (rupture). A ruptured aneurysm can cause massive internal bleeding, which is usually fatal. Around 8 out of 10 people with a rupture either die before they reach hospital or dont survive surgery. The most common symptom of a ruptured aortic aneurysm is sudden and severe pain in the abdomen. If you suspect that you or someone else has had a ruptured aneurysm, call 999 immediately and ask for an ambulance. Read more about the symptoms of an AAA . Causes of an AAA Its not known exactly what causes the aortic wall to weaken, although increasing age and being male are known to be the biggest risk factors. There are other risk factors you can do something about, including smoking and having high blood pressure and cholesterol level. Having a family history of aortic aneurysms also means that you have an increased risk of developing one yourself. Read more about the causes of an AAA . Diagnosing an AAA Because AAAs usually cause no symptoms, they tend to be diagnosed either as a result of screening or during a routine examination  for example, if a GP notices a pulsating sensation in your abdomen. The screening test is an ultrasound scan ,which allows the size of your abdominal aorta to be measured on a monitor. This is also how an aneurysm will be diagnosed if your doctor suspects you have one. Read more about diagnosing an AAA . Treating an AAA If a large AAA is detected before it ruptures, most people will be advised to have treatment, to preventit rupturing. This is usually done with surgery to replace the weakened section of the blood vessel with a piece of synthetic tubing. If surgery is not advisable  or if you decide not to have it  there are a number of non-surgical treatments that can reduce the risk of an aneurysm rupturing. They include medications to loweryour cholesterol and blood pressure , and quitting smoking . You will also have the size of your aneurysm checked regularly with ultrasound scanning. Read more about treating AAAs . Prevention The best way to prevent getting an aneurysm  or reduce the risk of an aneurysm growing bigger and possibly rupturing  is to avoid anything that could damage your blood vessels, such as: smoking eating a high-fat diet not exercising regularly being overweight or obese Read more about preventing aneurysms . Screening Read more about screening for an AAA . Symptoms of an abdominal aortic aneurysm In most cases, an unruptured abdominal aortic aneurysm (AAA) will cause no symptoms, unless it becomes particularly large. Symptoms of an unruptured AAA may include: a pulsating feeling in your stomach (abdomen), usually near your belly button, thats usually only noticeable when you touch it persistent back pain persistent abdominal pain If you have any of the symptoms above, you should see your GP as soon as possible. Ruptured AAA If your aortic aneurysm ruptures, you will feel a sudden and severe pain in the middle or side of your abdomen. In men, the pain can also radiate down into the scrotum. Other symptoms include: dizziness sweaty and clammy skin rapid heartbeat (tachycardia) shortness of breath feeling faint loss of consciousness Medical emergency A ruptured aortic aneurysm is a medical emergency, and its important to get to hospital as soon as possible. Around 80% of people with a rupture die before they reach hospital or dont survive emergency surgery. This is why the NHS AAA Screening Programme was introduced, so dangerously large aneurysms can be treated before they burst. If you suspect that you or someone in your care has had a ruptured aneurysm, call 999 immediately and ask for an ambulance. Causes of an abdominal aortic aneurysm The aorta is the largest blood vessel in the body. It transports oxygen-rich blood away from the heart to the rest of the body. An abdominal aortic aneurysm (AAA) occurs when part of the aorta wall becomes weakened and the large amount of blood that passes through it puts pressure on the weak spot, causing it to bulge outwards to form an aneurysm. The abdominal aorta is usually around 2cm wide  about the width of a garden hosepipe  but can swell to over 5.5cm, which is what doctors classify as a large aneurysm. Risk factors for an AAA Its not known exactly what causes the aortic wall to weaken, although increasing age and being male are known to be the biggest risk factors. One study found that people aged over 75 are seven times more likely to be diagnosed with an AAA than people under 55 years old. Men are around six times more likely to be diagnosed with an AAA than women. However, there are other risk factors that you can do something about  described below  the most important of which is smoking. Smoking Research has found that smokers are seven times more likely to develop an AAA than people who have never smoked. The more you smoke, the greater your risk of developing an AAA. People who regularly smoke more than 20 cigarettes a day may have more than 10 times the risk of non-smokers. The risk may increase because tobacco smoke contains harmful substances that can damage and weaken the wall of the aorta. Atherosclerosis Atherosclerosisis a potentially serious condition where arteries become clogged up by fatty deposits, such as cholesterol. An AAA is thought to develop because these deposits (called plaques) cause the aorta to widen in an attempt to keep blood flowing through it. As it widens, it also gets weaker. Smoking, eating a high-fat diet and high blood pressure all increase your risk of developing atherosclerosis. High blood pressure As well as contributing to atherosclerosis, high blood pressure (hypertension) can place increased pressure on the aortas wall. Family history Having a family history of AAAs means that you have an increased risk of developing one. One study found that people who had a brother or sister with an AAA were eight times more likely to develop one than people whose siblings were unaffected. This suggests that certain genes you inherit from your parents may make you more vulnerable to developing an AAA. However, no specific genes have yet been identified. Read about how to reduce your risk of developing an AAA . Diagnosing an abdominal aortic aneurysm An abdominal aortic aneurysm (AAA) usually causes no symptoms. Therefore, they tend to be diagnosed as a result of screening, or during a routine physical examination when a GP notices a distinctive pulsating sensation in your abdomen. A diagnosis can be confirmed using an ultrasound scan. Ultrasound can also determine the size of the aneurysm, which is an important factor in deciding on a course of treatment. Screening All men in the UK who are 65 or over are offered an ultrasound scan to check for AAAs. All men should receive an invitation in the year they turn 65 years old. Men who are older than 65 can refer themselves for screening by contacting their local NHS AAA screening service . For more information, visit our page on AAA screening . Treating an abdominal aortic aneurysm Treatment for an abdominal aortic aneurysm (AAA) depends on several factors, including the aneurysms size, your age and general health. In general, if you have a large aneurysm (5.5cm or larger) you will be advised to have surgery, either to strengthen the swollen section of the aorta or to replace it with a piece of synthetic tubing. This is because the risk of the aneurysm rupturing is usually greater than the risk of having it repaired. If you have a small (3.0-4.4cm) or medium (4.5-5.4cm) aneurysm, you will be offered regular scans to check its size. You will also be given advice on how to slow its growth and reduce the risk of it rupturingfor example, stopping smoking  and perhaps medications to reduce your blood pressure and cholesterol level. If you have a large AAA If you are diagnosed with an AAA that is 5.5cm or larger, you will be referred to a vascular surgeon (a surgeon who specialises in diseases of the blood vessels), who may recommend an operation. The surgeon will discuss treatment options with you, taking into account your general health and fitness, as well as the size of your aneurysm. If its decided that surgery isnt suitable for you, its still possible to reduce the risk of the aneurysm bursting, and you will have regular scans to check its size  in the same way people with small or medium aneurysms are treated. See below for more information on treating small and medium aneurysms. There are two surgical techniques used to treat a large aneurysm: endovascular surgery open surgery Although both techniques are equally effective at reducing the risk of the aneurysm bursting, each has its own advantages and disadvantages. The surgeon will discuss with you which is most suitable. Endovascular surgery Endovascular surgery is a type of keyhole surgery where the surgeon makes small cuts in your groin. A small piece of tubing called a graft made of metal mesh lined with fabric  is then guided up through the leg artery, into the swollen section of aorta, and sealed to the wall of the aorta at both ends. This reinforces the aorta, reducing the risk of it bursting. This is the safest of the two types of surgery available. Around 98-99% of patients make a full recovery, and recovery time from the operation is shorter than if you have open surgery. There are also fewer major complications, such as wound infection or deep vein thrombosis (DVT). However, the way the graft is attached is not as secure as open surgery. Youll need regular scans to make sure the graft hasnt slipped, and in some patients, the seal at each end of the graft starts to leak and will need to be resealed. You will need to have surgery again if either of these occurs. Open surgery In open surgery, the surgeon cuts into your stomach (abdomen) to reach the abdominal aorta and replaces the enlarged section with a graft. This type of graft is a tube made of a synthetic material. Because the graft is stitched (sutured) into place by the surgeon, its more likely to stay in place, and will usually work well for the rest of your life. The risk of complications linked to the graft after surgery is lower than in people who have endovascular surgery. Open surgery isnt usually recommended for people who are in poor health as it is a major operation. It is slightly more risky than endovascular surgery, with 93-97% of patients making a full recovery. The main risk of open surgery is death or heart attack, and recovery time is longer than with endovascular surgery. There is also a greater risk of complications, such as wound infection, chest infection and DVT. If you have a small or medium AAA If you are diagnosed with a small (3.0-4.4cm) or medium (4.5-5.4cm) aneurysm, you wont be referred to see a vascular surgeon, as its unlikely youd benefit from surgery. Youll be invited back for regular scans to check the size of the aneurysm, in case it gets bigger  every year if you have a small aneurysm and every three months if you have a medium aneurysm. You will also be given advice on how to prevent the aneurysm from getting bigger, including: stopping smoking eating a balanced diet ensuring you maintain a healthy weight taking regular exercise If you smoke, the most important change you can make is to quit. Aneurysms have been shown to grow faster in smokers than in non-smokers. Read more about stopping smoking and nicotine replacement therapies (NRTs) that can make it easier to stop smoking. Your GP will be sent your test result and may decide to change your current medication or start you on a new one, especially if you have: high blood pressure  which you will probably be treated for with a medication called an angiotensin-converting enzyme (ACE) inhibitor high cholesterol which you will probably be treated for with a medication called a statin Treating a ruptured AAA Emergency treatment for a ruptured AAA is based on the same principle as preventative treatment. Grafts are used to repair the ruptured aneurysm. The decision on whether to perform open or endovascular surgery is made on a case-by-case basis by the surgeon carrying out the operation. Preventing an abdominal aortic aneurysm The best way to prevent getting an aneurysm, or reduce the risk of an aneurysm growing bigger and possibly rupturing, is to avoid anything that could damage your blood vessels. This includes: smoking eating a high-fat diet not exercising regularly being overweight or obese If your GP finds out you have high blood pressure or a high cholesterol level, you may be prescribed medication for both. This will reduce the risk of developing an abdominal aortic aneurysm (AAA). Smoking Smoking is a major risk factor for aneurysms because it causes atherosclerosis (hardening of the arteries) and raises your blood pressure. Tobacco smoke contains substances that can damage the walls of the arteries. It is known that smokers are seven times more likely than non-smokers to develop an AAA. The more you smoke, the greater your risk. People who regularly smoke more than 20 cigarettes a day may have more than 10 times the risk of non-smokers. If you want to stop smoking, your GP will be able to refer you to an NHS Stop Smoking Service, which will give you dedicated help and advice about the best ways to quit. You can also call or chat online with Quit Your Way Scotland .The specially trained helpline staff can offer you free expert advice and encouragement. Read more about stopping smoking and nicotine replacement therapies (NRTs) , which can make it easier to quit. Diet Eating a high-fat diet increases your risk of atherosclerosis. Its especially important to limit the amount of foods you eat that are high in saturated fat, such as biscuits, cakes, butter, sausages and bacon. This is because eating too much saturated fat can lead to high cholesterol, which can build up in the artery walls. Read more about high cholesterol . Find out more about healthy eating and how to reduce the amount of saturated fat you eat . Exercise Being active and doing regular exercise lowers blood pressure by keeping your heart and blood vessels in good condition. Regular exercise can also help you lose weight, which will also help lower your blood pressure. Adults should do at least 150 minutes (two hours and 30 minutes) of moderate-intensity aerobic activity every week. Examples of moderate intensity activity include cycling or fast walking. For it to count, the activity should make you feel warm and slightly out of breath. Someone who is overweight may only have to walk up a slope to get this feeling. Physical activity can include anything from sport to walking and gardening. Get more ideas on being active . Weight Being overweight forces your heart to work harder to pump blood around your body. This can raise your blood pressure, which in turn puts pressure on your arteries. Use a BMI healthy weight calculator to find out if you need to lose weight. If you need to shed some weight, its worth remembering that losing just a few pounds will make a big difference to your blood pressure and overall health. Get tips on losing weight safely and read more about preventing high blood pressure ",,,,,,,,,,,,,
Acne,"Acne symptoms & treatments - Illnesses & conditions  Illnesses and conditions Skin, hair and nails Acne Acne About acne Causes of acne Diagnosing acne Treating acne Complications of acne About acne Acne is a common skin condition that affects most people at some point. It causes spots, oily skin and sometimes skin thats hot or painful to touch. Acne most commonly develops on the: face  this affects almost everyone with acne back  this affectsmore thanhalf of people with acne chest  this affectsabout 15% ofpeople with acne Types of spots There are 6main types of spot caused by acne: blackheads small black or yellowish bumps that develop on the skin;theyre not filled with dirt, but are black because the inner lining of the hair follicle produces pigmentation (colouring) whiteheads  have a similar appearance to blackheads, butmay be firmer and wont empty when squeezed papules small red bumps that may feel tender or sore pustules similar to papules, but have a white tip in the centre, caused by a build-up of pus nodules large hard lumps that build up beneath the surface of the skin and can bepainful cysts the most severe type of spot caused by acne; theyre large pus-filled lumps that look similar to boilsand carry the greatest risk of causing permanent scarring Papules are small red bumps that may feel tender or sore. Source: https://dermnetnz.org/ Blackheads are small black or yellow lumps that form on the skin. Source: https://dermnetnz.org/ What can I do if I have acne? The self-help techniques below may be useful: Dont wash affected areas of skin more than twice a day. Frequent washing can irritate the skin and make symptoms worse Wash the affected area witha mild soap or cleanser and lukewarm water. Very hot or cold water can make acne worse Dont try to clean out blackheads or squeeze spots.This can make them worse and cause permanent scarring Avoid using too much make-up and cosmetics. Use water-based products that are described as non-comedogenic (this means the product is less likely to block the pores in your skin) Completely remove make-up before going to bed If dry skin is a problem, use a fragrance-free, water-based emollient Regular exercise cant improve your acne, but it can boost your mood and improve your self-esteem.Shower as soon as possible once you finish exercising, as sweat can irritate your acne Wash your hair regularlyand try to avoid lettingyour hair fall across your face Although acne cant be cured, it can be controlled with treatment. Several creams, lotions and gelsfor treating spots are available at pharmacies. If you develop acne, its a good idea to speak to your pharmacist for advice. Treatments can take up to 3months to work, so dont expect results overnight. Once they do start to work, the results are usually good. When to get professional advice Pharmacy First Scotland: Acne treatment from your pharmacy If you have acne you can get advice and treatment directly from a pharmacy. Find your local pharmacy on Scotlands Service Directory. Search for a pharmacy near you Acne isnt usually serious and can be treated by a pharmacist. If your acne is severe or appears on your chest and back,it may need to be treated with antibiotics or stronger creams that are onlyavailable on prescription. Your pharmacist can advise on whether you need to see your GP for further treatment. If you develop nodules or cysts, they need to be treated properly through your GP to avoid scarring.Try to resist the temptation to pick or squeeze the spots, as this can lead to permanent scarring. Why do I have acne? Acne is most commonlylinked to the changes in hormone levels during puberty, but can start at any age. Certain hormones causethe grease-producing glands next to hair follicles in the skin to produce larger amounts of oil (abnormal sebum). This abnormal sebum changes the activity of a usually harmless skin bacterium called P. acnes, which becomes more aggressive and causes inflammation and pus. The hormones also thicken the inner lining of the hair follicle, causing blockage of the pores (opening of the hair follicles). Cleaning the skin doesnt help to remove this blockage. Other possible causes Acne is known to run in families. If both your mother and father had acne, its likely that youll also have acne. Hormonal changes, such as those that occur during the menstrual cycle or pregnancy, can also lead to episodes of acne in women. Theres no evidence that diet, poor hygiene or sexual activity play a role in acne. Read more about the causes of acne ,including some common acne myths. Whos affected? Acne is very common in teenagers and younger adults. About 80% of people aged 11to 30are affected by acne. Acne is most common in girls from the ages of 14to 17, and in boys from the ages of 16to 19. Most people have acne on and off for several years before their symptoms start to improve as they get older. Acne often disappears when a person is in their mid-twenties. In some cases, acne can continue into adult life. About5% ofwomen and 1% of men have acne over the age of 25. Further information You can find support and information from organisations like: Changing Faces  a charity for people who have a visible difference or facial disfigurement, who can be contacted on 0300 012 0275 for counselling and advice Causes of acne Acne is caused when tiny holes in the skin, known as hair follicles, become blocked. Sebaceous glands are tiny glands found near the surface of your skin. The glands are attached to hair follicles, which are small holes in your skin that an individual hair grows out of. Sebaceous glands lubricate the hair and the skin to stop it drying out. They do this by producing an oily substance called sebum. In acne, the glands begin to produce too much sebum. The excess sebum mixes with dead skin cells and both substances form a plug in the follicle. If the plugged follicle is close to the surface of the skin, it bulges outwards, creating a whitehead. Alternatively, the plugged follicle can be open to the skin, creating a blackhead. Normally harmless bacteria that live on the skin can then contaminate and infect the plugged follicles, causing papules, pustules, nodules or cysts. Testosterone Teenage acneis thought to be triggered by increased levels of a hormone called testosterone, which occurs during puberty. The hormone plays an important role in stimulating the growth and development of the penis and testicles in boys, and maintaining muscle and bone strength in girls. The sebaceous glands are particularly sensitive to hormones.Its thought that increased levels oftestosterone cause the glands to produce much more sebum than the skin needs. Acne in families Acnecan run in families. If your parents had acne, its likely that youll also develop it. One study has found that if both your parents had acne, youre more likely to get more severe acne at an early age. It also found that if one or both of your parents had adult acne, youre more likely to get adult acne too. Acne in women More than80% ofcases of adult acneoccur in women. Its thought that many cases of adult acne arecaused bythe changes in hormone levels that many women have at certain times. These timesinclude: periods some women have a flare-up of acne just before their period pregnancy  many women have symptoms of acne at this time, usually during the first 3months of their pregnancy polycystic ovary syndrome a common condition that can cause acne, weight gain and the formation of small cysts inside the ovary Other triggers Other possible triggers of an acne flare-up include: some cosmetic productshowever, this is less common as most products are now tested,so they dont cause spots(non-comedogenic) certain medicationssuch as steroid medications , lithium(used to treat depression and bipolar disorder ) andsome anti-epileptic drugs (used to treat epilepsy ) regularly wearing items that place pressure on an affected area of skin, such asa headband or backpack smoking  which can contribute to acne in older people Acne myths Despite being one of the most widespread skin conditions, acne is also one of the most poorly understood.There aremany myths and misconceptions about it: Acne is caused by a poor diet So far, research hasnt found any foods that cause acne. Eating a healthy, balanced diet is recommended because its good for your heart and your health in general. Acne is caused by having dirty skin and poor hygiene Most of the biological reactions that trigger acne occur beneath the skin, not on the surface, sothe cleanliness of your skinhasno effect on your acne. Washing your face more than twice a day could just aggravate your skin. Squeezing blackheads, whiteheads and spots is the best way to get rid of acne This could actually make symptoms worse and may leave you with scarring. Sexual activity can influence acne Having sex or masturbating wont make acne any better or worse. Sunbathing, sunbeds and sunlamps help improve the symptoms of acne Theres no conclusive evidence that prolonged exposure to sunlight or using sunbeds or sunlamps can improve acne. Many medications used to treat acne can make your skin more sensitive to light, so exposure could cause painful damage to your skin, and also increase your risk of skin cancer. Acne is infectious You cant pass acne on to other people. Diagnosing acne Your pharmacist can diagnose acne by looking at your skin. This involves examining your face and possibly your chest and back for different types of spot, such as blackheads or sore, red nodules. How many spots you have and how painful and inflamed they are will help determine how severe your acne is. This isimportant in planning your treatment. 4grades can be used to measure the severity of acne: grade 1 (mild)  acne is mostly confined to whiteheads and blackheads, with just a few papules and pustules grade 2 (moderate)  there are multiple papules and pustules, which are mostly confined to the face grade 3 (moderately severe)  theres a large number of papules and pustules, as well as the occasional inflamed nodule, and the back and chest are also affected by acne grade 4 (severe)  theres a large number of large, painful pustules and nodules More severe acne can affect the back and neck. Source: https://dermnetnz.org/ Acne in women If acne suddenly startsin adult women, itcan be a sign of a hormonal imbalance, especially if its accompanied by other symptoms such as: excessive body hair (hirsutism) irregular or light periods The most common cause of hormonal imbalances in women ispolycystic ovary syndrome (PCOS). PCOS can be diagnosed using a combination of ultrasound scans and blood tests . Treating acne Treatment for acne depends on how severe it is. It can take several months of treatment before acne symptoms improve. The various treatments for acne are outlined below. If you just have a few blackheads, whiteheads and spots, you should be able to treat them successfully with over-the-counter gels or creams (topical treatments) that contain benzoyl peroxide. Treatments from your GP See your GP if your acne is more widespread,as you probably need prescription medication.For example, if: you have a large number of papules and pustules over-the-counter medication hasnt worked Prescription medications that can be used to treat acne include: topical retinoids topical antibiotics azelaic acid antibiotic tablets in women, the combined oral contraceptive pill isotretinoin tablets If you have severe acne,your GP can refer you to an expert in treating skin conditions (dermatologist). For example, if you have: a large number of papules and pustules on your chest and back, as well as your face painful nodules A combination ofantibiotic tablets and topical treatments is usually the first treatment option for severe acne. If this doesnt work, a medication calledisotretinoin may be prescribed. Hormonal therapies or the combined oral contraceptive pill can also be effective in women who have acne. However, the progestogen-only pill or contraceptive implant can sometimes make acne worse. Many of these treatments can take 2to 3months before they start to work. Its important to be patient and persist with a recommended treatment, even iftheres no immediate effect. Topical treatments (gels, creams and lotions) Benzoyl peroxide Benzoyl peroxide works as an antiseptic to reduce the number of bacteria on the surface of the skin. It also helps to reduce the number of whiteheads and blackheads, and has an anti-inflammatory effect. Benzoyl peroxide is usually available as a cream or gel. Its used either once or twice a day. It should be applied 20 minutes after washing to all of the parts of your face affected by acne. It should be used sparingly, as too much can irritate your skin. It also makes your face more sensitive to sunlight, so avoid too much sun and ultraviolet (UV) light, or wear sun cream. Benzoyl peroxide can have a bleaching effect, so avoid getting it on your hair orclothes. Common side effects of benzoyl peroxide include: dry and tense skin a burning, itching or stinging sensation some redness and peeling of the skin Side effects are usually mild and should pass once the treatment has finished. Most people need a 6 week course of treatment to clear most or all of their acne. You may be advised to continue treatment less frequently to prevent acne returning. Topical retinoids Topical retinoids work byremoving dead skin cells from the surface of the skin (exfoliating)which helpsto prevent them building up within hair follicles. Tretinoin and adapalene are topical retinoids used to treat acne. Theyre available in a gel or cream and are usually applied once a day before you go to bed. Apply to all the parts of your face affected by acne 20 minutes after washing your face. Its important to apply topical retinoids sparingly and avoid excessive exposure to sunlight and UV. Topical retinoids arent suitable for use during pregnancy, as theres a risk they might cause birth defects. The most common side effects of topical retinoids are mild irritation and stinging of the skin. A 6 week course is usually required, but you may be advised to continue using the medication less frequently after this. Topical antibiotics Topical antibiotics help kill the bacteria on the skin that can infect plugged hair follicles. Theyre available as a lotion or gel that is applied once or twice a day. A 6 to 8week course is usually recommended. After this, treatment is usually stopped, as theres a risk that the bacteria on your face could become resistant to the antibiotics. This could make your acne worse and cause additional infections. Side effects are uncommon, but can include: minor irritation of the skin redness and burning of the skin peeling of the skin Azelaic acid Azelaic acid is often used as an alternative treatment for acne if the side effects of benzoyl peroxide or topical retinoids are particularly irritating or painful. Azelaic acid works by getting rid of dead skin and killing bacteria. Its availableas acream or gel and is usually applied twice a day (or once a day if your skin is particularly sensitive). The medication doesnt make your skin sensitive to sunlight, so you dont have to avoid exposure to the sun. Youll usually need to use azelaic acid for a month before your acne improves. The side effects of azelaic acid are usually mild and include: burning or stinging skin itchiness dry skin redness of the skin Antibiotic tablets Antibiotic tablets (oral antibiotics) are usually used in combination with a topical treatment to treat more severe acne. In most cases, a class of antibiotics called tetracyclines is prescribed, unless youre pregnant or breastfeeding. Pregnant or breastfeeding women are usually advised to take an antibiotic called erythromycin, which is known to be safer to use. It usually takes about 6weeks before you notice an improvement in your acne. Depending on how well you react to the treatment, a course of oral antibiotics can last 4to 6months. Tetracyclines can make your skin sensitive to sunlight and UV light, and can also make the oral contraceptive pill less effective during the first few weeks of treatment. Youll need to use an alternative method of contraception, such as condoms , during this time. Hormonal therapies Hormonal therapies can often benefit women with acne, especially if the acne flares up aroundperiods oris associated with hormonal conditions such as polycystic ovary syndrome. If you dont already use it, your GP may recommend the combined oral contraceptive pill , even if youre not sexually active. This combined pill can often help improve acne in women, but may take up to a year before the full benefits are seen. Co-cyprindiol Co-cyprindiol is a hormonal treatment that can be used for more severe acnethat doesnt respond to antibiotics. It helps to reduce the production of sebum. Youll probably have to use co-cyprindiol for 2to 6months before you notice a significant improvement in your acne. Theres a small riskthat women taking co-cyprindiol may develop breast cancer in later life. For example, out of a group of 10,000 women who havent taken co-cyprindiol, you would expect 16 of them to develop breast cancer by the time they were 35. This figure rises to 17 or 18 for women who were treated with co-cyprindiol for at least 5years in their early twenties. Theres also a very small chance of co-cyprindiol causing a blood clot. The riskisestimated tobe around 1 in 2,500 in any given year. Its not thought to be safe to take co-cyprindiol if youre pregnant or breastfeeding.Women may need to have a pregnancy test before treatment can begin. Other side effects of co-cyprindiol include: bleeding and spotting between your periods, whichcan sometimes occur for the first few months headaches sore breasts mood changes loss of interest in sex weight gain or weight loss Isotretinoin Isotretinoinhas a number of beneficial effects: it helps to normalise sebum and reduce how much isproduced it helps to prevent follicles becoming clogged it decreases the amount of bacteria on the skin it reduces redness and swelling in and around spots However,the drugcan also cause a wide range of side effects. Its only recommended for severe cases of acne that havent responded to other treatments. Because of the risk of side effects, isotretinoin can only be prescribed by a specially trained GP or adermatologist. Isotretinoin is takenas atablet. Most people take a 4to 6 month course. Your acne may get worse during the first 7 to 10 days of treatment. However, this is normal and soon settles. Common side effects of isotretinoin include: inflammation, dryness and cracking of the skin, lips and nostrils changes in your blood sugar levels inflammation of your eyelids (blepharitis) inflammation and irritation of your eyes (conjunctivitis) blood in your urine Rarer side effects of isotretinoin include: inflammation of the liver (hepatitis) inflammation of the pancreas (pancreatitis) kidney disease Because of the risk of these rarer side effects, youll need a blood test before and during treatment. Isotretinoin and birth defects Isotretinoin will damage an unborn baby. If youre a woman of childbearing age: dont use isotretinoin if yourepregnant or you think youre pregnant use 1, or ideally 2, methods of contraception for 1month before treatment begins, during treatment and for 1month after treatment has finished have a pregnancy test before, during and after treatment Youll be asked to sign a form confirming that you understand the risk of birth defects and are willing to use contraceptives to prevent this risk, even if youre not currently sexually active. If you think you mayhave become pregnant when taking isotretinoin, contact your dermatologist immediately. Isotretinoin is also not suitable if youre breastfeeding. Isotretinoin and mood changes There have been reports of people experiencing mood changes while taking isotretinoin. Theres no evidence that these mood changes were the result of the medication. However, as a precaution, contact your doctor immediately if you feel depressed or anxious, have feelings of aggression or suicidal thoughts. Non-pharmaceutical treatments Several treatments for acne dont involve medication. These include: comedone extractor  a small pen-shaped instrument that can be used to clean out blackheads and whiteheads chemical peels  where a chemical solution is applied to the face, causing the skin to peel off and new skin to replace it photodynamic therapy  where light is applied to the skin in an attempt to improve symptoms of acne However, these treatments may not work and cant be routinely recommended. Complications of acne Acne scarring can sometimes develop as a complication of acne. Any type of acne spot can lead to scarring, but its more common when the most serious types of spots (nodules and cysts) burst and damage nearby skin. Scarringcan also occur if you pick or squeeze your spots, so its important not to do this. There are 3main types of acne scars: ice pick scars  small, deep holes in the surface of your skin that look like the skin has been punctured with a sharp object rolling scars  caused by bands of scar tissue that form under the skin, giving the surface of the skin a rolling and uneven appearance boxcar scars  round or oval depressions, or craters, in the skin Treating acne scarring Treatments for acne scarring are regarded as a type of cosmetic surgery, which isnt usually available on the NHS. However, in the past, exceptions have been made when its been shown that acne scarring has caused serious psychological distress. See your GP if youre considering having cosmetic surgery. Theyll be able to discuss your options with you and advise you about the likelihood of having the procedure carried out on the NHS. Many private clinics offer treatment for acne scarring. Prices can vary widely (from 500 tomore than10,000) depending on the type of treatment needed. The British Association of Plastic, Reconstructive and Aesthetic Surgeons website has more information about private treatment available in your area. Its important to have realistic expectations about what cosmetic treatment can achieve. While treatment can certainly improve the appearance of your scars, it cant get rid of them completely. After treatment for acne scarring, most people notice a 50-75% improvement in their appearance. Some of the available treatments for acne scarring are explained below. Dermabrasion Dermabrasion involves removing the top layer of skin, either using lasers or a specially made wire brush. After the procedure, your skin will look red and sore for several months, but as it heals you should notice an improvement in the appearance of your scars. Laser treatment Laser treatment can be used to treat mild to moderate acne scarring. There are 2types of laser treatment: ablative laser treatment  where lasers are used to remove a small patch of skin around the scar to produce a new, smooth-looking area of skin non-ablative laser treatment  where lasers are used to stimulate the growth of new collagen (a type of protein found in skin), which helps to repair some of the damage caused by scarring, and improves the appearance Punch techniques Punch techniques are used to treat ice pick scars and boxcar scars. There are 3types of punch technique: punch excision used to treat mild ice pick scars. The scar is surgically removed and the remaining wound is sealed. After the wound heals, it leaves a smoother and more even area of skin. punch elevation used to treat boxcar scars. The base of the scar is surgically removed, leaving the sides of the scar in place. The base is then reattached to the sides, but lifted up so its level with the surface of the skin. This makes the scar much less noticeable. punch grafting used to treat very deep ice pick scars. As with a punch excision, the scar is removed, but the wound is plugged with a sample of skin taken from elsewhere on the body (usually from the back of the ear). Subcision Subcision is a surgical treatment that can be used to treat rolling scars. During surgery, the upper layer of the skin is removed from the underlying scar tissue. This allows blood to pool under the affected area. The blood clot helps form connective tissue, which pushes up the rolling scar so its level with the rest of the surface of the skin. Once subscision has been completed, additional treatment, such as laser treatment and dermabrasion, can be used to further improve the appearance of the scar. Depression Acne can often cause intense feelings of anxiety and stress, which can sometimes make people with the condition become socially withdrawn. This combination of factors can lead to people with acne becoming depressed . You may be depressed if during the last month youve often felt down, depressed or hopeless, and have little interest or pleasure in doing things. If you think that you or your child may have depression, its important to speak to your GP. Treatments for depression include: talking therapies such as cognitive behavioural therapy (CBT) a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs) ",,,,,,,,,,,,,
Acute cholecystitis,"Acute cholecystitis Illnesses and conditions Stomach, liver and gastrointestinal tract Acute cholecystitis Acute cholecystitis Acute cholecystitis is swelling (inflammation) of the gallbladder. It is a potentially serious condition that usually needs to be treated in hospital. Themain symptomof acute cholecystitis is a sudden sharp pain in the upper right side of your tummy (abdomen) that spreads towards your right shoulder. The affected part of the abdomen is usually extremely tender, and breathing deeply can make the pain worse. Unlike some others types of abdominal pain , the pain associated with acute cholecystitis is usually persistent, and doesnt go away within a few hours. Some people may additional symptoms, such as: a high temperature (fever) nausea and vomiting sweating loss of appetite yellowing of the skin and the whites of the eyes (jaundice) a bulge in the abdomen When to seek medical advice Contact your GP practice if: you develop sudden and severe abdominal pain, particularly if the pain lasts longer than a few hours or you have other symptoms, such as jaundice and a fever If your GP practice is closed, phone 111. Its important for acute cholecystitis to be diagnosed as soon as possible, because there is a risk that serious complications could develop if the condition is not treated promptly. What causes acute cholecystitis? The causes of acute cholecystitis can be grouped into 2main categories: calculous cholecystitis and acalculous cholecystitis. Calculous cholecystitis Calculous cholecystitis is the most common, and usually less serious, type of acute cholecystitis. It accounts for around 95% of all cases. Calculous cholecystitis develops when the main opening to the gallbladder, called the cystic duct, gets blocked by a gallstone or by a substance known as biliary sludge. Biliary sludge is a mixture of bile (a liquid produced by the liver that helps digest fats) and small crystals of cholesterol and salt. The blockage in the cystic duct results in a build-up of bile in the gallbladder, increasing thepressure inside it and causing it tobecome inflamed. In around 1in every 5cases, the inflamed gallbladder also becomes infected by bacteria. Acalculous cholecystitis Acalculous cholecystitis is a less common, but usually more serious, type of acute cholecystitis. Itusually develops as a complication of a serious illness, infection or injury that damages the gallbladder. Acalculous cholecystitis is often associated with problems such as accidental damage to the gallbladder during major surgery, serious injuries or burns , blood poisoning (sepsis) , severe malnutrition or AIDS . Who is affected Acute cholecystitis is a relatively common complication of gallstones. Its estimated that around 10%to 15% of adults in the UK have gallstones. Thesedont usually cause any symptoms, but in a small proportion of people they can causeinfrequent episodes of pain (known as biliary colic) or acute cholecystitis. Diagnosing cholecystitis To diagnose acute cholecystitis, your GP will examine your abdomen. They will probably carry out a simple test called Murphys sign. You willbe asked to breathe in deeply with your GPs hand pressed on your tummy, just below your rib cage. Your gallbladder will move downwards as your breathe in and, if you have cholecystitis, you will experience sudden pain as your gallbladder reaches your doctors hand. If your symptoms suggest you have acute cholecystitis, your GPwill refer you to hospital immediately for further tests and treatment. Tests you may have in hospital include: blood tests to check for signs of inflammation in your body an ultrasound scan of your abdomen to check for gallstones or other signs of a problem with your gallbladder Other scans  such as an X-ray , a computerised tomography (CT) scan or a magnetic resonance imaging (MRI) scan  may also be carried out to examine your gallbladder in more detail if there is any uncertainty about your diagnosis. Treating acute cholecystitis If you are diagnosed with acute cholecystitis, you will probably need to be admitted to hospital for treatment. Initial treatment Initial treatment will usually involve: fasting (not eating or drinking) to take the strain off your gallbladder receiving fluids through a drip directly into a vein (intravenously) to prevent dehydration taking medication to relieve your pain If you have a suspected infection, you will also be given antibiotics . Theseoften need to be continued for up to a week, during which time you may need to stay in hospital or you may be able to go home. With this initial treatment, any gallstones that may have caused theconditionusually fall back into the gallbladder and the inflammationoften settles down. Surgery In order to prevent acute cholecystitis recurring, and reduce your risk of developing potentially serious complications, the removal of your gallbladder will often be recommended at some pointafter the initial treatment.This type of surgeryis known as a cholecystectomy . Although uncommon, an alternative procedure called a percutaneous cholecystostomy may be carried out if you are too unwell to have surgery. This is where a needle is inserted through your abdomen to drain away the fluid that has built up in the gallbladder. If you are fit enough to have surgery, your doctors willneed to decide when the best time to remove your gallbladder may be. In some cases, you may need to have surgery immediately or in the next day or 2, while in other cases you may be advised towait for the inflammation to fully resolve over the next few weeks. Surgery can be carried out in two main ways: laparoscopic cholecystectomy a type of keyhole surgery where the gallbladder is removed using special surgical instruments inserted through a number of small cuts (incisions) in your abdomen open cholecystectomy where the gallbladder is removed through a single, larger incision in your abdomen Although some people who have had their gallbladder removed have reported symptoms of bloating and diarrhoea after eating certain foods, youcan lead a perfectly normal life without a gallbladder. The organ can be useful but its not essential, as your liver will still produce bile to digest food. Possible complications Without appropriate treatment, acute cholecystitis can sometimes lead to potentially life-threatening complications. The main complications of acute cholecystitis are: the death of the tissue of the gallbladder, called gangrenous cholecystitis, which can cause a serious infection that could spread throughout the body the gallbladder splitting open, known as a perforated gallbladder, which can spread the infection within your abdomen (peritonitis) or lead to a build-up of pus (abscess) In about 1in every 5cases of acute cholecystitis, emergency surgery to remove the gallbladder is needed to treat these complications. Preventing acute cholecystitis Its not always possible to prevent acute cholecystitis, but you can reduce your risk of developing the condition by cutting your risk of gallstones. One of the main steps you can take to help lower your chances of developing gallstones isadopting ahealthy, balanced diet and reducing the number of high-cholesterol foods you eat, as cholesterol is thought to contribute to the formation of gallstones. Being overweight, particularly being obese, also increases your risk of developing gallstones. You should therefore control your weight by eating a healthy diet and exercising regularly. However, low-calorie, rapid weight loss diets should be avoided, because there is evidence they can disrupt your bile chemistry and actually increase your risk of developing gallstones. A more gradual weight loss plan is best. ",,,,,,,,,,,,,
Acute lymphoblastic leukaemia,"Acute lymphoblastic leukaemia  Illnesses and conditions Cancer Cancer types in adults Acute lymphoblastic leukaemia Acute lymphoblastic leukaemia About acute lymphoblastic leukaemia Symptoms of acute lymphoblastic leukaemia Causes of acute lymphoblastic leukaemia Diagnosing acute lymphoblastic leukaemia Treating acute lymphoblastic leukaemia Complications of acute lymphoblastic leukaemia About acute lymphoblastic leukaemia Leukaemia is cancer of the white blood cells. Acute leukaemia means the condition progresses rapidly and aggressively and requires immediate treatment. Acute leukaemia is classified according to the type of white blood cells affected by cancer. There are 2 main types: lymphocytes, which are mostly used to fight viral infections neutrophils, which perform several functions, such as fighting bacterial infections, defending the body against parasites and preventing the spread of tissue damage These pages focus on acute lymphoblastic leukaemia, which is cancer of the lymphocytes. The following other types of leukaemia are covered elsewhere: chronic lymphocytic leukaemia chronic myeloid leukaemia acute myeloid leukaemia Warning signs of acute leukaemia Symptoms of acute lymphoblastic leukaemiausually begin slowly before rapidly getting severe as the number of immature white blood cells in your blood increases. Symptomsinclude: pale skin tiredness breathlessness having repeated infections over a short space of time unusual and frequent bleeding Read more about the symptoms of acute lymphoblastic leukaemia What happens in acute leukaemia All of the blood cells in the body are produced by bone marrow  a spongy material found inside bones. Bone marrow produces specialised cells called stem cells which have the ability to develop into three important types of blood cells: red blood cells, which carry oxygen around the body white blood cells, which help fight infection platelets, which help stop bleeding The bone marrow usually produces stem cells which are allowed to fully develop before being released into the blood. But in acute leukaemia, bone marrow starts releasing large numbers of immature white blood cells known as blast cells. As the number of blast cells increases there is a drop in the number of red blood cells and platelet cells. This drop causes the symptoms of anaemia, such as tiredness, and increases the risk of excessive bleeding. Also, blast cells are less effective than mature white blood cells at fighting bacteria and viruses, making you more vulnerable to infection. Despite being uncommon overall, acute lymphoblastic leukaemia is the most common type of cancer to affect children. The cause or causes of acute leukaemia are uncertain, but known risk factors include: exposure to high levels of radiation exposure to benzene, a chemical used in manufacturing that is also found in cigarettes Read more information about the causes of acute lymphoblastic leukaemia Symptoms of acute lymphoblastic leukaemia Symptoms of acute lymphoblastic leukaemia usually begin slowly before rapidly getting severe as the number of blast cells (immature white blood cells) in your blood increases. Most of the symptoms are caused by the lack of healthy blood cells in your blood supply. Symptoms of acute lymphoblastic leukaemia include: pale skin feeling tired and breathless having repeated infections over a short space of time unusual and frequent bleeding, such as bleeding gums or nose bleeds high temperature (fever) of 38C (100.4F) or above night sweats bone and joint pain easily bruised skin swollen lymph nodes (glands) abdominal pain  caused by a swollen liver or spleen unexplained weight loss a purple skin rash (purpura) In some cases of acute lymphoblastic leukaemia, the affected cells can spread from your bloodstream into your central nervous system. This can cause a series of neurological symptoms (related to the brain and nervous system), including: headaches seizures (fits) vomiting blurred vision dizziness When to seek medical advice If you or your child has some or even all of these symptoms, it is still highly unlikely that acute leukaemia is the cause. However, see your GP as soon as possible because any condition that causes these symptoms needs to be promptly investigated and treated. Causes of acute lymphoblastic leukaemia Acute lymphoblastic leukaemia is caused by a DNA mutation in the stem cells causing too many white blood cells to be produced. The white blood cellsare also released from the bone marrow before they are matureand able to fight infection like fully developed white blood cells. As the number of immature cells increases,the number ofhealthy red blood cells and platelets fall, and its thisfallwhich causes many of thesymptoms of leukaemia. It is not known exactly what causes this DNA mutation to occur, but there area fewfactors which may increase therisk ofdeveloping acute lymphoblastic leukaemia. Risk factors Genetic disorders A small numberof childhood acute lymphoblasticleukaemia cases are thought to be caused by related genetic disorders. For example, rates of leukaemia tend to be higher in children with Downs syndrome . Radiation exposure Exposure to very high levels of radiation, either before birth or afterwards, is a known risk factor. However, it would require a significant level of radiation, such as the amount released during the nuclear reactor accident at Chernobyl. Due to the potential risk of radiation to unborn babies, medical techniques and equipment that use radiation, such as X-rays , are rarely used on pregnant women. Most cases of childhood leukaemia occur in children with no history of genetic disorders or exposure to radiation. Possible environmental factors Experts have also carried out extensive research to determine whether the following environmental factors could be a trigger for leukaemia: living near a nuclear power station living near a power line living near a building or facility that releases electromagnetic radiation, such as a mobile phone mast At the moment there is no evidence to confirm that any of these environmental factors increase the risk of developing leukaemia. Benzene Exposure to the chemical benzene is a known risk factor for adult acute leukaemia. Benzene is found in petrol and is also used in the rubber industry. However, there are strict controls to protect people from prolonged exposure. Benzene is also found in cigarettes, which could explain why smokers are three times more likely to develop acute leukaemia than non-smokers. People who have had chemotherapy and radiotherapy to treat earlier, unrelated cancers also have an increased risk of developing acute leukaemia. Other risk factors There is some evidence to show an increased risk ofacute lymphoblasticleukaemia in people who: are obese have a weakened immune system  due to HIV or AIDS or taking immunosuppressants after an organ transplant Diagnosing acute lymphoblastic leukaemia The first step in diagnosing acute lymphoblastic leukaemia is for your GP to check for physical signs of the condition, such as swollen glands, and to take a blood sample. A high number of abnormal white blood cells in the blood sample could indicate the presence of acute leukaemia and you will then be referred to a haematologist (a specialist in treating blood conditions). Bone marrow biopsy To confirm a diagnosis of acute leukaemia, the haematologist will take a small sample of your bone marrow to examine under a microscope. The haematologist will use a local anaesthetic to numb the skin over a bone  usually the hip bone  and then use a needle to remove a sample of bone marrow. You may experience some pain once the anaesthetic wears off and some bruising and discomfort for a few days afterwards. The procedure takes around 15 minutes to complete and you shouldnt have to stay in hospital overnight. The bone marrow will be checked for cancerous cells and  if found  the type of acute leukaemia will be determined at the same time. Further tests There are various additional tests that can be used to help reveal more information about the progress and extent of the leukaemia. They can also provide an insight into how the leukaemia should be treated. These tests are described below. Cytogenetic testing Cytogenetic testing involves identifying the genetic make-up of the cancerous cells. There are specific genetic variations that can occur during leukaemia, and knowing what these variations are can have an important impact on treatment. Immunophenotyping Immunophenotyping is a test to help identify the exact type of acute lymphoblastic leukaemia. A sample of blood, bone marrow or another type of fluid is studied. This testing is important as the treatment needed may be slightly different for each type. Polymerase chain reaction (PCR) A polymerase chain reaction (PCR) test can be done on a blood sample. This is an important test to diagnose and monitor the response to treatment. The blood test is repeated every three months for at least two years after starting treatment, then less often once remission is achieved. Lymph node biopsy If you have been diagnosed with acute leukaemia, further biopsies may be carried out on any enlarged lymph nodes that you have. These will be able to establish how far the leukaemia has spread. CT scans If you have acute leukaemia, a computerised tomography scan (CT scan) may be used to check that your organs, such as your heart and lungs, are healthy. Chest X-ray An X-ray may be performed to examine the chest for any swollen lymph nodes. Lumbar puncture If it is felt that there is a risk that acute leukaemia has spread to your nervous system, a lumbar puncture may be carried out. A lumbar puncture is a test where a needle is used under local anaesthetic to extract a sample of cerebrospinal fluid (fluid that surrounds and protects your spine) from your back. The fluid is tested to determine whether the leukaemia has reached your nervous system. Treating acute lymphoblastic leukaemia Treatment for acute lymphoblastic leukaemia usually begins a few days after diagnosis as its an aggressive condition that develops rapidly. Stages of treatment Treatment for acute lymphoblastic leukaemia is carried out in stages: induction  the aim of the initial stage of treatment is to kill the leukaemia cells in your bone marrow, restore the balance of cells in your bloodand resolve any symptoms you may have consolidation  this stage aims to kill any remaining leukaemia cells in your central nervous system maintenance  the final stage involves taking regular doses of chemotherapy tablets to prevent the leukaemia returning Maintenance only seems to be effective in treating acute lymphoblastic leukaemia; its not usually used in the treatment of acute myeloid leukaemia . Induction The induction stage of treatment is carried out in hospital or in a specialist centre. This is because you will probably need to have regular blood transfusions as its likely that your blood will not contain enough healthy blood cells. You will also be vulnerable to infection, so it is important that you are in a sterile environment where your health can be carefully monitored and any infection that you have can be promptly treated. You may also be prescribed antibiotics to help prevent further infection. Chemotherapy You will be given chemotherapy to kill the leukaemia cells in your bone marrow. Although some medications may be given as pills, you will need more than one medication given as an injection. To make things easier and avoid repeated injections, they can all be given via one flexible tubeinto a vein in your chest (called a central line). Some chemotherapy medication may also be directly administered into your cerebrospinal fluid to kill any leukaemia cells that may have spread to your nervous system. Thisis given using a needle that is placed into your spine, in a similar way to a lumbar puncture . Side effects that occur following chemotherapy are common. They can include: nausea vomiting diarrhoea loss of appetite mouth ulcers tiredness skin rashes infertility hair loss The side effects should resolve once treatment has finished. Your hair will usually take between three to six months to grow back. Steroid therapy You may also be given corticosteroid injections or tablets to help improve the effectiveness of chemotherapy. Imatinib If you have a type of leukaemia known as Philadelphia chromosome-positiveacute lymphoblastic leukaemia, you will also be given a medicine called imatinib. Imatinib works by blocking the signals in the cancerous cells that cause them to grow and reproduce. This kills the cancerous cells. Imatinib is taken orally (as a tablet). The side effects of imatinib are usually mild and should improve over time. They include: nausea vomiting swelling in the face and lower legs muscle cramps rash diarrhoea Depending on how well you respond to treatment, the induction phase can last from two weeks to several months. In some cases, you or your child may be able to leave hospital and receive treatment on an outpatient basis if your symptoms improve. Consolidation Leukaemia can return if just one cancerous cell remains in your body. Therefore the aim of consolidation treatment is to ensure that any remaining leukaemia cells are killed. Treatment involves receiving regular injections of chemotherapy medication. This is usually done on an outpatient basis, which means you will not have to stay in hospital overnight. However, you may require some short stays in hospital if your symptoms suddenly get worse or if you develop an infection. The consolidation phase of treatment lasts several months. Maintenance The maintenance phase is designed to act as further insurance against the possibility of the leukaemia returning. It involves taking regular doses of chemotherapy tablets while undergoing regular check-ups to monitor how effective your treatment is proving. The maintenance phase can often last for two years. Other treatments As well as chemotherapy and imatinib, other treatments are used in some circumstances. These are described below. Dasatinib Dasatinib is a new type of medication used to treat Philadelphia chromosome-positive acute lymphoblastic leukaemia, when all other treatments have proved unsuccessful. Dasatinib blocks a protein called tyrosine kinase that helps stimulate the growth of cancer cells. Dasatinib cannot cure acute leukaemia but it can slow its growth, helping to relieve symptoms and prolong life. The National Institute for Health and Care Excellence (NICE) has not yet made a decision about whether the NHS should provide treatment with dasatinib for people with acute lymphoblasticleukaemia. This means it will be at the discretion of your localclinical commissioning groupas to whether you will be offered the drug. Radiotherapy Radiotherapy involves using high doses of controlled radiation to kill cancerous cells. There are two main reasons why radiotherapy is usually used to treat acute leukaemia: to sometimes treat advanced cases of acute lymphoblastic leukaemia that have spread to the nervous system or brain to prepare the body for a bone marrow transplant (see below) Side effects of both types of radiotherapy include: hair loss nausea fatigue The side effects should pass once your course of radiotherapy has been completed. However, your skin may be very sensitive to the effects of light for several months after the treatment has finished. If this is the case, avoid sunbathing or exposure to sources of artificial light, such as sunbeds, for several months. Many younger children treated with radiotherapy will go on to have restricted physical growth during puberty. A small number of people develop cataracts several years after radiotherapy. Cataracts are cloudy patches in the lens (the transparent structure at the front of the eye) that can make your vision blurred or misty. Cataracts can usually be successfully treated using surgery. Read more about cataracts Bone marrow and stem cell transplants If you or your child do not respond to chemotherapy, a possible alternative treatment option is bone marrow or stem cell transplantation. Transplantations are more successful if the donor has the same tissue type as you, so the ideal donor is usually a brother or sister. Before transplantation can take place, the person receiving the transplant will need to have aggressive high-dose chemotherapy and radiotherapy to destroy any cancerous cells in their body. This can put a bigstrain on the bodyso transplantations are usually only successful when they are carried out in children and young people, or older people who are in good health, and when there is a suitable donor, such as a brother or sister. Readabout bone marrow transplantation for more information Complications of acute lymphoblastic leukaemia Being immunocompromised (having a weakened immune system) is a possible complication for some patients with acute leukaemia. There are 2 reasons for this: the lack of healthy white blood cells means that your immune system is less able to fight infection many of the medicines used to treatacute leukaemiacan weaken the immune system This means thatyou are more vulnerable to developing an infection, and that any infection you have has an increased potential to cause serious complications. You may be advised to take regular doses of antibiotics to prevent infections occurring. You should immediately report any possible symptoms of an infection to your GP orcare teambecause prompt treatment may be required to prevent serious complications. Symptoms of infection include: high temperature (fever) of 38C (101.4F) or above headache aching muscles diarrhoea tiredness Avoid contact with anyone who is known to have an infection, even if it is a type of infection that you were previously immune to, such as chickenpox or measles. This is because your previous immunity to these conditions will probably be lower. While it is important to go outside on a regular basis, both for exercise and for your psychological wellbeing, avoid visiting crowded places and using public transport during rush hour. Also ensure that all of your vaccinations are up-to-date. Your GP or care team will be able to advise you about this. You will be unable to have any vaccine containing activated particles of viruses of bacteria such as: themumps, measles and rubella (MMR) vaccine the polio vaccine the oral typhoid vaccine the BCG vaccine (used to vaccinate against tuberculosis) the yellow fever vaccine Bleeding If you have acute leukaemia, you will bleed and bruise more easily due to the low levels of platelets (clot-forming cells) in your blood. Bleeding may also be excessive when it does occur. Bleeding can occur: inside the skull (intracranial haemorrhage) inside the lungs (pulmonary haemorrhage) inside the stomach (gastrointestinal haemorrhage) The symptoms of an intracranial haemorrhage include: severe headache stiff neck vomiting change in mental state, such as confusion The most common symptoms of a pulmonary haemorrhage are: coughing up blood from your nose and mouth breathing difficulties a bluish skin tone (cyanosis) The 2 most common symptoms of a gastrointestinal haemorrhage are: vomiting blood passing stools (faeces) that are very dark or tar-like All 3 types of haemorrhages should be regarded as medical emergencies. Phone 999 to request an ambulance if you suspect that you or your child is experiencing a haemorrhage. Infertility Many of the treatments that are used to treat acute leukaemia can cause infertility. Infertility is often temporary, although in some cases it may be permanent. People who are particularly at risk of becoming infertile are those who have received high doses of chemotherapy and radiotherapy in preparation for bone marrow or stem cell transplantation. It may be possible to guard against any risk of infertility before you begin your treatment. For example, men can have samples of their sperm stored. Similarly, women can have fertilised embryos stored, which can then be placed back into their womb following treatment. Read more about infertility Psychological effects of leukaemia Receiving a diagnosis of leukaemia can be very distressing, particularly if it is unlikely that your condition can be cured. At first, the news may be difficult to take in. The situation can be made worse if you are confronted with the knowledge that even though your leukaemia may not currently be causing any symptoms, it could be a serious problem in later life. Having to wait many years to see how the leukaemia develops can be immensely stressful and can trigger feelings of stress, anxiety and depression . If you have been diagnosed with leukaemia, talking to a counsellor or psychiatrist (a doctor who specialises in treating mental health conditions) may help you to combat feelings of depression and anxiety. Antidepressants or medicines that help to reduce feelings of anxiety may also help you cope better with the condition. You may find it useful to talk to other people who are living with leukaemia. Your GP or multidisciplinary team may be able to provide you with details of local support groups. Another excellent resource is Macmillan Cancer Support . Their helpline number is 0808 808 00 00 and is open Monday to Friday, 9am8pm. Further information You can read more information on all aspects of living and coping with cancer at the following links: living with cancer  including information on treatment, support and personal experiences of cancer living with acute lymphoblastic leukaemia  Cancer Research ",,,,,,,,,,,,,
Acute lymphoblastic leukaemia: Children,"Acute lymphoblastic leukaemia: Children | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in children Acute lymphoblastic leukaemia: Children Acute lymphoblastic leukaemia: Children Acute lymphoblastic leukaemia (ALL) is a type of blood cancer. One third of all childhood cancers are leukaemia. Approximately, 3 out of 4 of these are acute lymphoblastic (ALL). ALL can affect children of any age but is more common in children aged 1 to 4 years old. More children than ever are surviving childhood cancer. There are new and better drugs and treatments, and we can now also work to reduce the after-effects of having had cancer in the past. Its devastating to hear that your child has cancer. At times it can feel overwhelming but there are many healthcare professionals and support organisations to help you through this difficult time. Understanding more about the cancer your child has and the treatments that may be used can often help parents to cope. Your childs specialist will give you more detailed information, and if you have any questions its important to ask the specialist doctor or nurse who knows your childs individual situation. Leukaemia Leukaemia is a cancer of the white blood cells. All blood cells are made in the bone marrow, the spongy substance at the core of some bones in the body. Bone marrow contains: red blood cells, which carry oxygen around the body platelets, which help the blood to clot and control bleeding white blood cells, which help fight infection There are 2 different types of white blood cells: lymphocytes and myeloid cells (including neutrophils). These white blood cells work together to fight infection. Normally, white blood cells develop, repair and reproduce themselves in an orderly and controlled way. In leukaemia, however, the process gets out of control and the cells continue to divide in the bone marrow, but do not mature. These immature dividing cells fill up the bone marrow and stop it from making healthy blood cells. As the leukaemia cells are not mature, they cannot work properly. This leads to an increased risk of infection. There are 4 main types of leukaemia: acute lymphoblastic (ALL) acute myeloid (AML) chronic lymphocyte (CLL) chronic myeloid (CML) Chronic leukaemias usually affect adults and each type of leukaemia has its own characteristics and treatment. ALL is a cancer of immature lymphocytes, called lymphoblasts or blast cells. There are two different types of lymphocytes; T-cells and B-cells. Often, leukaemia occurs at a very early stage in the immature lymphocytes, before they have developed into either T-cells or B-cells. However, if the cells have developed this far before becoming leukaemic, the type of leukaemia may be known as T-cell or B-cell leukaemia. This page is about acute lymphoblastic leukaemia (ALL). Causes The exact cause of ALL is unknown. Research is going on all the time into possible causes of this disease. Children with certain genetic disorders, such asDowns syndrome, are known to have a higher risk of developing leukaemia. Brothers and sisters of a child with ALL (particularly identical twins) have a slightly increased risk of developing ALL themselves, althoughthis risk is still small. Like all cancers, ALL is not infectious and cannot be passed on to other people. Signs and symptoms As the leukaemia cells multiply in the bone marrow, the production of normal blood cells is reduced. Children may therefore become tired and lethargic because of anaemia, which is caused by a lack of red blood cells. Children may develop bruises, and bleeding may take longer to stop because of the low number of platelets present in their blood (which help blood to clot). Sometimes, children suffer from infections because of low numbers of normal white blood cells. A child is likely to feel generally unwell and may complain of aches and pains in the limbs or may have swollen lymph glands. At first, the symptoms are just like those of a viral infection, but when they continue for more than a week or two, the diagnosis usually becomes clear. How ALL is diagnosed A blood test usually shows low numbers of normal white blood cells and the presence of the abnormal leukaemia cells. A sample of bone marrow is usually needed to confirm the diagnosis. A sample is also sent to the genetics department to look for any abnormal chromosomes, and for a test called MRD (minimal residual disease) analysis. A test called a lumbar puncture is done to see if the spinal fluid contains any leukaemia cells. A chest X-ray is also done, which will show if there are any enlarged glands in the chest. Other tests may be necessary, depending on your childs symptoms. These tests will help to identify the precise type of leukaemia and help doctors decide on the best treatment. Treatment The aim of treatment for ALL is to destroy the leukaemia cells and enable the bone marrow to work normally again. Chemotherapy is the main treatment for ALL and is given according to a treatment plan (often called a protocol or regimen). The treatment is given in several phases, or blocks. Induction This phase involves intensive treatment, aimed at destroying as many leukaemia cells as possible and is usually started within days of being diagnosed. The induction phase lasts 4 to 6 weeks. A bone marrow test is taken at the end of induction treatment to confirm whether or not the child still has leukaemia. The sample that is taken is looked at under a microscope and when there is no evidence of leukaemia, the childs condition is referred to as being in remission. Consolidation and central nervous system (CNS) treatment The next phase of treatment is aimed at maintaining the remission and preventing the spread of leukaemia cells into the brain and spinal cord (the central nervous system, or CNS). CNS treatment involves injecting a drug, usually methotrexate lumbar puncture. After this consolidation treatment there is a recovery period which is called interim maintenance. This is when more drugs will be given to try to keep the leukaemia in remission. The exact details will depend on which arm of treatment your child follows and will be discussed in detail by your childs doctor as it depends on your childs response to treatment so far. Further doses of chemotherapy treatment, called delayed intensification, are given to kill off any remaining leukaemia cells. Maintenance treatment This phase of treatment lasts for 2 years from the start of interim maintenance for girls and 3 years from the start of interim maintenance for boys. It involves the child taking daily and weekly tablets, some children also have monthly injections of chemotherapy and oral pulses of steroids and 3-monthly intrathecal treatment. Children will be able to take part in their normal daily activities as soon as they feel able to. Most children return to school before beginning maintenance treatment. Bone marrow transplantation Bone marrow treatment is only needed by a minority of patients and is used for children with ALL that is likely to come back following standard chemotherapy. Testicular radiotherapy In some situations, it may be necessary for boys to have radiotherapy to their testicles. This is because leukaemia cells can survive in the testicles despite chemotherapy. Central nervous system (CNS) radiotherapy Children who have leukaemia cells in their CNS when they are first diagnosed with ALL need more frequent lumbar punctures with intrathecal chemotherapy. Your childs specialist will discuss with you which treatment and how much of it your child needs, and will answer any questions you have. Side effects of treatment Many cancer treatments will cause side effects . This is because while the treatments are killing the cancer cells, they can also damage some normal cells. Some of the main side effects of chemotherapy are: hair loss reduction in the number of blood cells produced by the bone marrow, which can cause anaemia (increased risk of bruising, bleeding and infection loss of appetite feeling sick (nausea) and being sick (vomiting) Steroid medicines can also cause side effects such as: increased appetite mood changes and irritability weight gain muscle weakness (especially in the legs) Most side effects are temporary, and there are ways of reducing them and supporting your child through them. Your childs doctor or nurse will talk to you about any possible side effects. Its important to discuss any side effects your child is having with the team treating them, so that they know how your child is feeling. Late side effects of treatment A small number of children may develop late side effects, sometimes many years later. These include possible problems with puberty and fertility, a change in the way their heart works and a small increase in the risk of developing another cancer later in life. Your childs doctor or nurse will talk to you about any possible late side effects. Clinical trials Many children have their treatment as part of a clinical research trial. Trials aim to improve our understanding of the best way to treat an illness, usually by comparing the standard treatment with a new or modified version. Specialist doctors carry out trials for ALL. If appropriate, your childs medical team will talk to you about taking part in a clinical trial and will answer any questions you have. Written information is provided to help explain things. Taking part in a research trial is completely voluntary, and youll be given enough time to decide if it is right for your child. Treatment guidelines Sometimes, clinical trials are not available for your child. This may be because a recent trial has just finished, or because the condition is very rare. In these cases, you can expect your doctors and nurses to offer treatment which is agreed to be the most appropriate, using guidelines which have been prepared by experts across the UK. The Childrens Cancer and Leukaemia Group (CCLG) is an important organisation which helps to produce these guidelines. Follow-up care Most children with ALL are cured. If the leukaemia recurs after initial treatment, it usually does so within the first three years. Further treatment can then be given. Long-term side effects (late side effects) are rare, and most children with ALL grow and develop normally. If you have specific concerns about your childs condition and treatment, its best to discuss them with your childs doctor, who knows the situation in detail. Your feelings As a parent, the fact that your child has cancer is one of the worst situations you can be faced with. You may have many emotions, such as fear, guilt, sadness, anger and uncertainty. These are all normal reactions and are part of the process that many parents go through at such a difficult time. Its not possible to address here all of the feelings you may have. However, the CCLG booklet Children & Young Peoples Cancer; A Parents Guide talks about the emotional impact of caring for a child with cancer and suggests sources of help and support. Your child may have a variety of powerful emotions throughout their experience with cancer. The Parents Guide discusses these further and talks about how you can support your child.",,,,,,,,,,,,,
Acute lymphoblastic leukaemia: Teenagers and young adults,"Acute lymphoblastic leukaemia Illnesses and conditions Cancer Cancer types in teenagers and young adults Acute lymphoblastic leukaemia: Teenagers and young adults Acute lymphoblastic leukaemia: Teenagers and young adults Introduction Leukaemia, blood tests and bone marrow Tests for ALL Treating ALL Introduction This section is for teenagers and young adults and is about a type of cancer called acute lymphoblastic leukaemia (ALL). The other main type of leukaemia that can affect teenagers and young adults is acute myeloid leukaemia. If youre looking for information about ALL in people of all ages, please see our general ALL section. Leukaemia is a cancer of the white blood cells. In leukaemia, the process for making new white blood cells gets out of control.Immature white blood cells (called blasts) keep being made and build up in the bone marrow until there isnt enough room for the bone marrow to make healthy white blood cells, red blood cells and platelets. The body needs these cells to: help fight infection (white cells) carry oxygen from the lungs aroundthe body (red blood cells) stop cuts bleeding by clotting blood (platelets) Symptoms Many of the symptoms of ALL are caused by having fewer than normal healthy blood cells in the body. Symptoms can include: looking paler than usual and feeling tired  because of too few red blood cells (anaemia) bruises you may bruise more easily and it could take longer for bleeding to stop, if you have less blood clotting cells (platelets) than normal infections  because there are too few mature white blood cells to fight infection aches and pains in your bones swollen glands (lymph nodes) in your neck, under your arm or in your groin feeling unwell and run down fever and sweats  you may have a high temperature without any obvious cause, such as an infection headaches and visual disturbance There can be other reasons you may have these symptoms. But if you are worried that you may have ALL, you should speak to your GP. Theyll examine you and refer you to a hospital if they think you need to see a specialist doctor. Causes Its not known exactly what causes ALL. Research is going on to try to find out. Young people with some genetic conditions, such as Downs syndrome or Li-Fraumeni syndrome, are at an increased risk of developing ALL. A genetic condition is something you are born with. If youre worried about ALL If you think you have some of the symptoms of ALL you should speak to your GP. They can talk to you about your symptoms and arrange any tests they think you might need. Leukaemia, blood tests and bone marrow To understand leukaemia, it can help to know a little about the blood and bone marrow. Leukaemia is a cancer of the white blood cells. All blood cells are made in the bone marrow, which is like a blood cell factory inside bones. A type of cell in the bone marrow, called a stem cell, can make any kind of blood cell your body needs. There are 3 main types of blood cells: white blood cells  which help fight infection red blood cells  which carry oxygen from the lungs around the body platelets  which clot blood to stop cuts bleeding The bone marrow normally makes millions of blood cells every day. To begin with, these new blood cells, called blasts, are not fully developed (theyre immature). The main job of blast cells is to make more blood cells like themselves. They cant do any of the jobs that mature blood cells can do, like carrying oxygen or fighting infection. Blast cells normally stay inside the bone marrow until theyve matured into fully-developed blood cells. Once blood cells are mature, theyre ready to do their jobs. They leave the bone marrow and go into the bloodstream, where they can be carried to wherever theyre needed. How leukaemia develops In leukaemia, the process for making new white blood cells gets out of control and immature white blood cells (blasts) keep being made. They build up in the bone marrow until there isnt enough room for the bone marrow to make healthy white cells, red cells and platelets. Types of leukaemia Leukaemia is a cancer of the white blood cells. Healthy white blood cells are made from two types of blood cells: lymphoblasts that make lymphocytes myeloid cells (myeloblasts) that make other types of white blood cells such as neutrophils Leukaemias are named after the type of white blood cell that has become abnormal and started growing out of control. The most common types in teenagers and young adults are AML and ALL: acute myeloid leukaemia (AML) is leukaemia that starts from abnormal myeloid cells acute lymphoblastic leukaemia (ALL) is leukaemia that starts from abnormal lymphoblasts There are other types of leukaemia that are more common in older people. The information in this section is about ALL, but if you have a different type of leukaemia and want to know more,contact Macmillan . We also have more information about: symptoms and causes of ALL having tests for ALL being treated for ALL If youre looking for information about ALL in people of all ages, read our general ALL section. Tests for ALL Its important to remember that the symptoms of ALL can be caused by lots of different things. But you should go to your GP if youre worried. They can talk to you about your symptoms and arrange any tests they think you might need. Visiting your GP Your GP will examine you and arrange for you to have blood tests. There can be different reasons for your symptoms, so youll need a blood test to help diagnose acute lymphoblastic leukaemia (ALL). If you have ALL, a blood test will usually find leukaemia cells and youll be referred to a specialist at the hospital. This specialist is called a haematologist and is a doctor who treats people with blood problems. At the hospital The haematologist will examine you and ask you about your symptoms and any recent illnesses. They will also arrange for you to have some more tests. These may include: blood tests  youll need more blood tests even if youve had some alreadyto look at the changes in the leukaemia cells and helpthe doctors decide on the best treatment for you bone marrow testto count the numbers of leukaemia cells in the bone marrowand get samples for cytogenetic and immunophenotyping testing lumbar puncture a small sample of the fluid that surrounds your brain and spinal cord is taken to check for leukaemia cells chest X-ray  this may also be done to see if there are any swollen lymph nodes (glands) in your chest If you have ALL, you might need a few more tests to check how your body is working in general. These could be blood tests, or an ultrasound scan of the tummy (abdomen) to look at your liver, spleen and kidneys, and an echocardiogram (an ultrasound of the heart). This may seem like a lot of tests, but they give the doctors important information that will help them give you the right treatment. Waiting for test results can be a scary time, but understanding a little about them what will happen, how youll feel and when youll get the results  can help you cope. Thinking about how you feel and getting support from family, friends or your specialist nurse and doctor can also make it a bit easier. You could also talk to a Macmillan cancer support specialist ontheir free helpline. We also have more information about: symptoms of ALL being treated for ALL leukaemia, blood cells and bone marrow If youre looking for information about ALL in people of all ages, readour general ALL section. Treating ALL The main treatment for acute lymphoblastic leukaemia (ALL) is chemotherapy . This means having anti-cancer drugs to destroy the leukaemia cells. Youll also have drugs called steroids , which help the chemotherapy to work. The treatment for ALL is pretty intensive at times and can cause unpleasant side effects. But youll be in close contact with the hospital when youre most likely to feel unwell and the staff will be able to help if things get tough. Dont feel you have to be brave. Be honest about how you are feeling with your doctors and nurses. They can give you medicines that can help you feel better. ALL is treated in3phases: getting rid of the leukaemia remission induction keeping the leukaemia away consolidation and delayed intensification therapy keeping the leukaemia away long-term continuing or maintenance therapy You usually start chemotherapy pretty quickly after finding out that you have ALL. Youll be in hospital for your treatment to begin with.If youre 18 or younger, youll be treated in a specialist Principal Treatment Centre (PTC) for teenagers and young adults (TYA).If youre 19 or older, youll be offered the choice of having treatment at the PTC or another hospital closer to home called a TYA designated hospital. Youll be given chemotherapy as tablets, by injection and into your bloodstream (intravenously). Youll also be given chemotherapy into the fluid around the spinal cord to make sure the leukaemia cells cant hide there. This is called central nervous system (CNS) therapy. Its also known as intrathecal therapy. Youll have a line put in to one of your main veins to make it easier for you to have intravenous treatment. Your nurses and doctors can also use the line to take blood samples for blood tests. There are different kinds of lines. Having chemotherapy can be hard. But the staff looking after you will give you medicines to help you cope with any side effects so you can stay strong enough to have treatment. And youll be given medicines to stop you feeling sick and antibiotics to help prevent infections. There will probably be times when you feel rough and other times when youll feel better. You might also feel upset, down or irritable. Talking to someone you trust can help you cope with these feelings. Being in hospital or coming up to hospital for clinics and treatment can be frustrating, especially when you miss out on stuff happening at school, college, university or work, or on things your friends are doing. You could try talking to your friends and family about this and see what they can do to help you. It can also help to talk to any new friends youve made who are going through similar experiences to you. We have more information about chemotherapy that has been written for people of all ages, not just teens and young adults. Getting rid of the leukaemia (remission induction) The first phase of your treatment is about getting rid of the leukaemia. Youll be given chemotherapy to kill as many leukaemia cells as possible. Remission means there is no sign of leukaemia cells in your blood or bone marrow. This type of treatment involves: chemotherapy to kill the leukaemia cells (including CNS therapy) steroids to help the chemotherapy work drugs (allopurinol or rasburicase) to help protect your kidneys from problems that can happen when lots of leukaemia cells are destroyed at once another tablet (for example ranitidine or lansoprazole) to stop indigestion or ulcers You need to stay in hospital during this phase of your treatment so the doctors can check how things are going. Treatment to get you into remission takes about5 weeks, sometimes a bit longer. Being in hospital that long can be really difficult at times. If youre struggling to cope, try and talk to your friends, family, doctors and nurses. Its important not to bottle up your feelings otherwise your might end up finding it hard to cope. Drugs you may be given include: vincristine asparaginase daunorubicin mercaptopurine methotrexate Side effects Different chemotherapy can cause different side effects. There is information about the specific ones inMacmillans chemotherapy section . Central nervous system therapy Chemotherapy given as tablets or into the blood can reach most places in your body. But it isnt good at getting into the brain or spinal cord (called the central nervous system or CNS). So youll be given treatment into the fluid that goes around the CNS to target any leukaemia cells that might be hiding there. This is called CNS therapy. CNS therapy is given during remission induction treatment (to get rid of the leukaemia) and continues right until the end of maintenance therapy. Chemotherapy is given into the fluid, called cerebrospinal fluid or CSF, around your spinal cord. Drug treatment given into the CSF is called intrathecal therapy. Its a bit like having a lumbar puncture but with chemotherapy added. A doctor puts a needle into the space between 2 small bones (vertebrae) near the bottom of your spine. Then they inject chemotherapy into the CSF. The CSF will carry the chemotherapy around your CNS so it can reach any leukaemia cells that might be there. The chemotherapy drug used for CNS therapy is called methotrexate. Side effects Most people dont have side effects after having intrathecal methotrexate. But occasionally it can cause headaches, dizziness, tiredness or blurry vision for a few hours. Rarely other side effects like seizures (fits), weakness of your arms or legs and changes in how awake you are can happen. But these almost always go away completely and you can still have the intrathecal injections in the future. Keeping leukaemia away This treatment is called consolidation and delayed intensification therapy. When youre in remission, it means the doctors cant see any leukaemia cells in your blood or bone marrow samples when they check them under the microscope. But there may still be leukaemia cells hiding in your body, so you need further treatment to get rid of these cells. Youll be given different types of chemotherapy drugs. This is so the leukaemia cells dont have a chance to get used to them (which is called drug resistance). This phase of treatment takes about 5 to 6 months. Most of the treatment can be given as an outpatient but you might need to stay in hospital for some parts of it. Drugs you may be given include: cyclophosphamide cytarabine (ara-C) mercaptopurine methotrexate vincristine asparaginase doxorubicin Side effects Chemotherapy does cause side effects. There is information about the specific ones inMacmillans chemotherapy section . Keeping the leukaemia away long term (maintenance therapy) This treatment is given to prevent the leukaemia from returning (known as relapse). The chemotherapy is given in low doses. You have it as an outpatient so you can keep doing all your normal, everyday activities when youre having maintenance therapy. Maintenance therapy is given in 12-week cycles. Youll have: mercaptopurine tablets each day methotrexate tablets once a week steroid tablets for 5 days every4weeks vincristine chemotherapy every 4 weeks methotrexate chemotherapy into your cerebrospinal fluid (CSF) every 12 weeks At the moment, boys have just over3 years of maintenance therapy and girls have just over2 years. This is because it takes a bit longer in boys to get rid of any remaining leukaemia cells. During this time, youll have regular check-ups usually every week or two to check if your drug doses need to be adjusted and to make sure youre OK. Very often, things like blood tests can be done at your GP practice or at home by a district nurse.",,,,,,,,,,,,,
Acute myeloid leukaemia,"Acute myeloid leukaemia Illnesses and conditions Cancer Cancer types in adults Acute myeloid leukaemia Acute myeloid leukaemia About acute myeloid leukaemia Symptoms of acute myeloid leukaemia Causes of acute myeloid leukaemia Diagnosing acute myeloid leukaemia Treating acute myeloid leukaemia Complications of acute myeloid leukaemia About acute myeloid leukaemia Leukaemia is cancer of the white blood cells. Acute leukaemia means it progresses rapidly and aggressively, and usually requires immediate treatment. Acute leukaemia is classified according to the type of white blood cells affected. The 2 main types of white blood cells are: lymphocytes  mostly used to fight viral infections myeloid cells  which perform a number of different functions, such as fighting bacterial infections, defendingthe body against parasites and preventing the spread of tissue damage This topic focuses on acute myeloid leukaemia (AML), which is an aggressivecancer of the myeloid cells. The following types of leukaemia are covered separately: acute lymphoblastic leukaemia chronic myeloid leukaemia chronic lymphocytic leukaemia Signs and symptoms of AML The symptoms of AML usually develop over a few weeks and become increasingly more severe. Symptoms can include: pale skin tiredness breathlessness frequent infections unusual and frequent bleeding, such as bleeding gums or nosebleeds In more advanced cases, AML can make you extremely vulnerable to life-threatening infections or serious internal bleeding. Read more about the complications of AML Seeking medical advice You should see your GP if you or your child have possible symptomsof AML. Although its highly unlikely that leukaemia is the cause,these symptoms should be investigated. If your GP thinks you may have leukaemia, theyll arrange blood tests to check your blood cell production. If the tests suggest theres a problem, youll be urgently referred to a haematologist (a specialist in treating blood conditions) for further tests and any necessary treatment. Read more about diagnosing AML What causes AML? AMLoccurs when specialised cells called stem cells, which are found in the bone marrow (a spongy material inside the bones),produce too many immature white blood cells. These immature cells are known as blast cells. Blast cells dont have the infection-fighting properties of healthy white blood cells, and producing too many canlead to adecrease in the number of red blood cells (which carry oxygen in the blood) and platelets (cells that help the blood to clot). Its not clear exactly why this happens and, in most cases, theres no identifiable cause. However,a number of factors that can increase your risk of developing AML have been identified. These include: previous chemotherapy or radiotherapy exposure to very high levels of radiation(including previous radiotherapytreatment) exposure to benzene  a chemical used in manufacturing thats also found in cigarette smoke having an underlying blood disorder or genetic disorder, such as Downs syndrome Read more about the causes of AML Whos affected AMLis a rare type of cancer.The risk of developing AML increases withage. Itsmost common in people over 65. How AML is treated AML is an aggressive type of cancer that can develop rapidly, so treatment usually needs to begin soon after a diagnosis is confirmed. Chemotherapy is the main treatment for AML. Its used to kill as many leukaemia cells in your body as possible and reduce the risk of the condition coming back (relapsing). In some cases, intensive chemotherapy and radiotherapy may be needed, in combination with a bone marrow or stem cell transplant , to achieve a cure. Read more about treating AML Symptoms of acute myeloid leukaemia The symptoms of acute myeloid leukaemia (AML) usually develop over a few weeks, becoming more severe as the number of immature white blood cells (blast cells) in your blood increases. Symptoms of AML caninclude: pale skin tiredness breathlessness a high temperature (fever) excessive sweating weight loss frequent infections unusual and frequent bleeding, such as bleeding gums or nosebleeds easily bruised skin flatred or purple spots on the skin (petechiae) bone and joint pain a feeling of fullness or discomfort in your tummy (abdomen), caused by swelling of the liver or spleen Inrare cases of AML, the affected cells can spread into the central nervous system. This can cause symptoms such as headaches , fits (seizures), vomiting, blurred vision and dizziness. When to seek medical advice See your GP if you or your child have these symptoms. Although its highly unlikely that AML is the cause, these symptoms need to be investigated and treatedpromptly. Causes of acute myeloid leukaemia Acute myeloid leukaemia (AML) is caused by a DNA mutation in the stem cells in your bone marrow that produce red blood cells, platelets and infection-fighting white blood cells. The mutationcauses the stem cellsto produce many more white blood cells that are needed. The white blood cells produced are still immature, so they dont have the infection-fighting properties of fully developed white blood cells. These immature cells are known as blast cells. As the number of immature cells increases, the amount of healthy red blood cells and platelets decrease, and its this fall that causes many of the symptoms of leukaemia . Increased risk Its not known what triggers the genetic mutationin AML, although a number of different factors thatcan increase your risk of developing the condition have been identified. The main risk factors for AML areoutlined below. Radiation exposure Being exposed toa significant level of radiationcan increase your chances of developing AML, although this usually requires exposureat very high levels. For example, rates of AML are higher in people who survivedthe atomic bomb explosions in Japan in 1945. In the UK, most peopleare unlikely to be exposed to levels of radiation high enough to cause AML.However, some people who have had radiotherapy as part of their treatment for previous cancer (see below) can be the exception. Benzene and smoking Exposure to the chemical benzene is a known risk factor for AML in adults. Benzene is found in petrol, and its also used in the rubber industry, although there are strict controls to protect people from prolonged exposure. Benzene is also found in cigarette smoke, which could explain why people who smoke have an increased risk of developing AML. Previous cancer treatment Treatment with radiotherapy and certain chemotherapy medications foran earlier, unrelated cancer can increase your risk of developing AML many years later. Leukaemia that develops as a result of previous cancer treatment is called secondary leukaemia or treatment-related leukaemia. Blood disorders People with certain blood disorders  such as myelodysplasia, myelofibrosis or polycythaemia vera (PCV)  have an increased risk of developing AML. Genetic disorders People with certain genetic disorders, including Downs syndrome and Fanconis anaemia, have an increased risk of developing leukaemia. Other suggested triggers A number of other environmental factors that could trigger AML have also been suggested, including childhood vaccinations and living near a nuclear power station or a high-voltage power line. However, theres no clearevidence to suggest that these can increase your risk of developing AML. Diagnosing acute myeloid leukaemia In the initial stages of diagnosing acute myeloid leukaemia (AML), your GP will check for physical signs of the condition and arrange for you to have blood tests . A high number of abnormal white blood cells, or a very low blood count in the test sample, could indicate the presence of leukaemia. If this is the case, youll be urgently referred to a haematologist (a specialist in treating blood conditions). A haematologist may carry out further blood tests, in addition to some of the tests outlined on this page. Bone marrow biopsy To confirm a diagnosis of AML, the haematologist will take a small sample of your bone marrow to examine under a microscope. This procedure is known as a bone marrow biopsy, which is usually carried out under a local anaesthetic . The haematologist will numb an area of skin at the back of your hip bone, before using a thin needle to remove a sample of liquid bone marrow. In some cases, a larger needle may also be used to remove a small amount of bone and bone marrow together. You wont feel any pain during the procedure, but you may experience some bruising and discomfort for a few days afterwards. The procedure takes around 15 minutes to complete, and you shouldnt have to stay in hospital overnight. The bone marrow sample will be checked for cancerous cells. If cancerous cells are present, the biopsy can also be used to determine the type of leukaemia you have. Further tests Additional tests can be used to reveal more information about the progress and extent of your AML. They can also provide insight into how the condition should be treated. These tests are described below. Genetic testing Genetic tests can be carried out on blood and bone marrow samples to identify the genetic makeup of the cancerous cells. There are many specific genetic variations that can occur in AML, and knowing the exact type of AML you have can help doctors make decisions about the most appropriate treatment. For example, people who have a type of AML known as acute promyelocytic leukaemia (APML) are known to respond well to a medicine called All Trans-Retinoic Acid (ATRA). Scans If you have AML, a computerised tomography (CT) scan , X-ray or echocardiogram (an ultrasound scan of the heart) may be used to check that your organs, such as your heart and lungs, are healthy. These tests are carried out because its important for doctors to assess your general health before they can decide on the most appropriate treatment for you. Lumbar puncture In rare situations where its thought theres a risk that AML has spread to your nervous system, a lumbar puncture may be carried out. In this procedure, a needle is used to extract a sample of cerebrospinal fluid (which surrounds and protects your spine) from your back, so it can be checked for cancerous cells. If cancerous cells are found in your nervous system, you may need to have injections of chemotherapy medication directly into your cerebrospinal fluid as part of your treatment. Treating acute myeloid leukaemia Acute myeloid leukaemia (AML) is an aggressive condition that develops rapidly, so treatment will usually begin a few days after a diagnosis has been confirmed. As AML is a complex condition, its usually treated by a multidisciplinary team (MDT)  a group of different specialists working together. Your treatment plan Treatment for AML is often carried out in 2 stages: induction  the aim of this initial stage of treatment is to kill as many leukaemia cells in your blood and bone marrow as possible, restore your blood to proper working order and treat any symptoms you may have consolidation  this stage aims to prevent the cancer returning (relapsing), by killing any remaining leukaemia cells that may be present in your body The induction stage of treatment isnt always successful and sometimes needs to be repeated before consolidation can begin. If you have a relapse after treatment, both re-induction and consolidation may need to be carried out. This may be the same as your first treatment, although its likely to involve different medications or a stem cell transplant. If youre thought to have a high risk of experiencing complications of AML treatment  for example, if youre over 75 years of age or have another underlying health condition  less intensive chemotherapy treatment may be carried out. This is less likely to successfully kill all of the cancerous cells in your body, but it can help control your condition. Induction The initial treatment you have for AML will largely depend on whether youre fit enough to have intensive chemotherapy , or whether treatment at a lower dosage is recommended. Intensive chemotherapy If you can have intensive induction chemotherapy, youll usually be given a combination of chemotherapy medication at a high dose to kill the cancerous cells in your blood and bone marrow. This stage of treatment will be carried out in hospital or in a specialist centre, as youll need very close medical and nursing supervision. Youll have regular blood transfusions because your blood wont contain enough healthy blood cells. Youll also be vulnerable to infection, so its important that youre in a clean and stable environment where your health can be carefully monitored and any infection you have can be promptly treated. You may also be prescribedantibiotics to help prevent further infection. Depending on how well you respond to treatment, the induction phase can last from four weeks to a couple of months. You may be able to leave hospital and receive treatment on an outpatient basis if your symptoms improve. For intensive treatment, the chemotherapy medications will be injected into a thin tube thats inserted either into a blood vessel near your heart (central line) or into your arm (a peripherally inserted central catheter, or PICC). In very rare cases, chemotherapy medication may also be directly administered into your cerebrospinal fluid to kill any leukaemia cells that may have spread to your nervous system. This is done using a needle thats placed into your spine, in a similar way to a lumbar puncture . Side effects of intensive chemotherapy for AML are common. They can include: nausea vomiting diarrhoea loss of appetite sore mouth and mouth ulcers (mucositis) tiredness skin rashes hair loss infertility  which may be temporary or permanent (see complications of AML for more information) Most side effects should resolve once treatment has finished. Tell a member of your care team if side effects become particularly troublesome, as there are medicines that can help you cope better with certain side effects. Read more about the side effects of chemotherapy Non-intensive chemotherapy If your doctors dont think youre fit enough to withstand the effects of intensive chemotherapy, they may recommend non-intensive treatment. This involves using an alternative type of chemotherapy to the standard intensive therapy, whichis designed more to control leukaemia rather than cure it. The main aim of this treatment is to control the level of cancerous cells in your body and limit any symptoms you have, while reducing your risk of experiencing significant side effects of treatment. The medications used during non-intensive chemotherapy may be given through a drip into a vein, by mouth or by injection under the skin, and can often be given on an outpatient basis. All Trans-Retinoic Acid (ATRA) If you have the sub-type of AML known as acute promyelocytic leukaemia, youll usually be given capsules of a medicine called ATRA, in addition to chemotherapy. ATRA works by changing the immature white blood cells (blast cells) into mature healthy cells, and can reduce symptoms very quickly. Side effects of ATRA can include headaches , nausea, bone pain, and dry mouth , skin and eyes. Consolidation If induction is successful, the next stage of treatment will be consolidation. This often involves receiving regular injections of chemotherapy medication that are usually given on an outpatient basis, which means that you wont have to stay in hospital overnight. However, you may need some short stays in hospital if your symptoms suddenly get worse or if you develop an infection. The consolidation phase of treatment lasts several months. Other treatments Many other treatments are used for AML. Radiotherapy Radiotherapy involves using high doses of controlled radiationto kill cancerous cells. There are 2 main reasons why radiotherapy is usually used to treat AML: to prepare the body for a bone marrow or stem cell transplant to treat advanced cases that have spread to the nervous system and/or brain, although this is uncommon Side effects of radiotherapy can include hair loss, nausea and fatigue. The side effects should pass once your course of radiotherapy has been completed. Bone marrow and stem cell transplants If chemotherapy doesnt work, a possible alternative treatment option is a bone marrow or stem cell transplant . Before transplantation can take place, the person receiving the transplant will need to haveintensive high-dose chemotherapy and possibly radiotherapy to destroy the cells in their bone marrow. The donated stem cells are given through a tube into a blood vessel, in a similar way to chemotherapy medication. This process can put an enormous amount of strain on the body and cause significant side effects and potential complications, so youll usually need to stay in hospital for a few weeks. Transplantations have better outcomes if the donor has the same tissue type as the person receiving the donation. The best candidate to provide a donation is usually a brother or sister with the same tissue type. Transplantations are most successful when theyre carried out on children and young people, or older people who are otherwise in good health, and when theres a suitable donor, such as a brother or sister. Readabout bone marrow donation Azacitidine Azacitidine is a possible alternative treatment for adults with AML who cant have a stem cell transplant. Its recommended by the National Institute for Health and Care Excellence (NICE) for usein certain circumstances for example, depending on the characteristics of the persons blood and bone marrow. Azacitidine is a chemotherapy medication thats given by injection under the skin. It interferes with the growth of cancer cells and destroys them, and also helps bone marrow to produce normal blood cells. NICE hasmore information about azacitidine for the treatment of AML Clinical trials andnewer unlicensed treatments In the UK, a number of clinical trialsare currently underway that aim to find the best way of treating AML. Clinical trials are studies that use new and experimental techniques to see how well they work in treating, and possibly curing, AML. As part of your treatment, your care team may suggest taking part in a clinical trial to help researchers learn more about the best way to treat yourAML, and AML in general. Search for clinical trials for AML . If you take part in a clinical trial, you may be offered medication that isnt licensed for use in the UK and isnt normally available. However, theres no guarantee that the techniques being studied in the clinical trial will work better than current treatments. Your care team can tell you whether there are any clinical trials available in your area, and can explain the benefits and risks involved. Complications of acute myeloid leukaemia If you have acute myeloid leukaemia (AML), you may experience a number of complications. These can be caused by the condition itself, although they can also occur as a side effect of treatment. Weakened immune system Having a weakened immune system  being immunocompromised  is a common complication of AML. Even if your blood is restored to normal working order with treatment, many of the medications that are used to treatAML can temporarily weaken your immune system. This means youre more vulnerable to developing an infection, and any infection you develop could be more serious than usual. Complications arising from infection are the leading cause of death in people with AML. However, if treated early, nearly all infections respond to appropriate treatment. Therefore, you may be advised to: take regular doses of antibiotics to prevent bacterial infections maintain good personal and dental hygiene avoid contact with anyone whosknown to have an infection  even if its a type of infection that you were previously immune to, such as chickenpox or measles check with your GP to ensure that all of your vaccinations are up to date, althoughyou wont be able to have any vaccine that contains live viruses or bacteria, such as the shingles vaccine and MMR vaccine (against measles, mumps and rubella) Report any possible symptoms of an infectionto yourtreatment unit immediately because prompt treatment may be needed to prevent complications. Symptoms of an infection caninclude: a high temperature (fever) a headache aching muscles diarrhoea tiredness Bleeding If you have AML, youll bleed and bruise more easily due to the low levels of platelets (clot-forming cells) in your blood. Bleeding may also be excessive. People with advanced AML are morevulnerable to excessive bleeding inside their body, which is the second most common cause of death in people with the condition. Serious bleeding can occur: insidethe skull (intracranial haemorrhage)  causing symptoms such as asevere headache, stiff neck, vomiting and confusion inside the lungs (pulmonary haemorrhage)  causingsymptoms such as coughing up blood,breathing difficulties and abluish skin tone (cyanosis) inside the stomach (gastrointestinal haemorrhage)  causing symptoms such asvomiting blood andpassing stools (faeces) that are very dark or tar-like in colour All these types of haemorrhage should be regarded as medical emergencies. Dial 999 immediately and ask for an ambulance if you think a haemorrhage is occurring. Infertility Many of the treatments that are used to treat AML can cause infertility .This is often temporary, but in some cases can be permanent. People who are particularly at risk of permanent infertility, are those who have received high doses of chemotherapy and radiotherapy in preparation for a bone marrow or stem cell transplant . Your treatment team can give a good estimation of the risk of infertility in your specific circumstances. It may be possible to guard against any risk of infertility before you begin your treatment. For example, men can have their sperm samples stored. Similarly, women can have eggs orfertilised embryos stored, which can then be placed back into their womb, following treatment. However, as AML is an aggressive condition that develops rapidly, there may not always be time to do this before treatment needs to start. ",,,,,,,,,,,,,
Acute myeloid leukaemia: Children,"Acute myeloid leukaemia: Children Illnesses and conditions Cancer Cancer types in children Acute myeloid leukaemia: Children Acute myeloid leukaemia: Children Acute myeloid leukaemia (AML) is a type of blood cancer. A third of all childhood cancers are leukaemia. Less than a quarter of these are acute myeloid leukaemia (AML). AML can affect children of any age. Girls and boys are equally affected More children than ever are surviving childhood cancer. There are new and better drugs and treatments, and we can now also work to reduce the after-effects of having had cancer in the past. Its devastating to hear that your child has cancer. At times it can feel overwhelming but there are many healthcare professionals and support organisations to help you through this difficult time. Understanding more about the cancer your child has and the treatments that may be used can often help parents to cope. Your childs specialist will give you more detailed information and if you have any questions its important to ask the specialist doctor or nurse who knows your childs individual situation. Leukaemia Leukaemia is a cancer of the white blood cells. All blood cells are produced in the bone marrow, the spongy substance at the core of some of the bones in the body. Bone marrow contains: red blood cells, which carry oxygen around the body platelets, which help the blood to clot and control bleeding white blood cells, which help to fight infection There are 2 different types of white blood cells: lymphocytes and myeloid cells (including neutrophils). These white blood cells work together to fight infection. Normally, white blood cells develop, repair and reproduce themselves in an orderly and controlled way. In leukaemia, however, the process gets out of control and the cells continue to divide in the bone marrow, but do not mature. These immature dividing cells fill up the bone marrow and stop it from making healthy blood cells. As the leukaemia cells are not mature, they cannot work properly. This leads to an increased risk of infection. There are 4 main types of leukaemia: acute lymphoblastic (ALL) acute myeloid (AML) chronic lymphocytic (CLL) chronic myeloid (CML) Chronic leukaemias occur mostly in adults. CLL is exclusively an adult condition, whereas CML does occur rarely in children and young people. Each type of leukaemia has its own characteristics and treatment. This page is about acute myeloid leukaemia (AML). Acute myeloid leukaemia (AML) Acute myeloid leukaemia is an overproduction of immature myeloid white blood cells (blast cells). Cells that have started to show some of the features of myeloid cells are said to show differentiation. Cells that do not show signs of becoming a particular type of white blood cell are known as undifferentiated. There are different sub-types of AML, depending on exactly which type of cell has become leukaemic, the stage of development (maturation) the cells are at, and whether the cells are differentiated. Knowing the sub-type of AML is important, as it helps doctors decide on the best treatment. There are several classification systems for the sub-types of AML. The most commonly used system in the UK is the French-American-British (FAB) system. FAB classification of AML M0  AML with minimal evidence of myeloid differentiation M1  AML without maturation M2  AML with maturation M3  Acute promyelocytic leukaemia (APL) M4  Acute myelomonocytic leukaemia M5  Acute monocytic/monoblastic leukaemia M6 Acute erythroleukaemia M7  Acute megakaryoblastic leukaemia A newer system known as the WHO (World Health Organization) classification system is also sometimes used. Causes The exact cause of AML is unknown. Research into possible causes of this disease is ongoing. Children with certain genetic disorders, such as Downs syndrome or Li-Fraumeni syndrome, are known to have a higher risk of developing leukaemia. Brothers and sisters of a child with AML have a slightly increased risk of developing it, although this risk is still small. Other non-cancerous conditions, such as aplastic anaemia or the myelodysplastic syndromes (MDS), may increase a childs risk of developing AML. AML, like all types of cancer, is not infectious and cannot be passed on to other people. Signs and symptoms As the leukaemia cells multiply in the bone marrow, the production of normal blood cells is reduced. Children may therefore become tired and lethargic because of anaemia, which is caused by a lack of red blood cells. Children may develop bruises, and bleeding may take longer to stop because of the low number of platelets present in their blood. Sometimes they may suffer from infections because of low numbers of normal white blood cells. A child is likely to feel generally unwell and may complain of aches and pains in the limbs or may have swollen lymph glands. At first, the symptoms are just like those of a viral infection, but when they continue for more than a week or two, the diagnosis usually becomes clear. How AML is diagnosed A blood test usually shows low numbers of normal white blood cells and the presence of abnormal leukaemia cells. A sample of bone marrow is needed to confirm the diagnosis. The bone marrow sample is also examined to check for any abnormalities in the chromosomes of the leukaemia cells. A test called a lumbar puncture is done to see if the spinal fluid contains any leukaemia cells. A chest X-ray is also done, which will show if there are any enlarged glands in the chest. Other tests may be necessary, depending on your childs symptoms. These tests will help to identify the precise type of leukaemia, and help doctors to decide on the best treatment. Treatment The aim of treatment for AML is to destroy the leukaemia cells and enable the bone marrow to work normally again. Chemotherapy is the main treatment for AML. Usually a combination of chemotherapy drugs is given, according to a treatment plan (often called a protocol or regimen). The treatment usually has different phases. Induction This phase involves intensive treatment, aimed at destroying as many leukaemia cells as possible. It usually involves 2 courses (cycles) of a combination of chemotherapy drugs. A bone marrow test is taken at the end of induction treatment to confirm whether or not the child still has leukaemia. When there is no evidence of leukaemia, the childs condition is referred to as being in remission. Post-remission treatment When there are no signs of the leukaemia in the blood or bone marrow, further treatment is often given. This phase of the treatment aims to destroy any leukaemia cells that may be left and to help stop the AML from coming back. This treatment usually involves 2 more courses of chemotherapy. Bone marrow transplant This treatment is usually only used for children with AML that is likely to come back or has come back (recurred) following standard chemotherapy. Central nervous system (CNS) treatment AML may sometimes develop in the brain and spinal cord. This can be prevented by injecting chemotherapy drugs directly into the spinal fluid during a lumbar puncture (intrathecal chemotherapy). Intrathecal chemotherapy is usually given after each of the first 2 courses of chemotherapy. Sometimes a more intensive treatment is needed, and the intrathecal drugs are given more frequently until all the regular chemotherapy has been completed. Occasionally, radiotherapy to the brain is also necessary. Side effects of treatment Many cancer treatments will cause side effects . This is because while the treatments are killing the cancer cells, they can also damage some normal cells. Some of the main side effects are: hair loss reduction in the number of blood cells produced by the bone marrow, which can cause anaemia (increased risk of bruising, bleeding and infection) loss of appetite and weight feeling sick (nausea) and being sick (vomiting) Most side effects are temporary, and there are ways of reducing them and supporting your child through them. Your childs doctor or nurse will talk to you about side effects. Late side effects of treatment A small number of children may develop late side effects, sometimes many years later. These include possible problems with puberty and fertility, a change in the way the heart works, and a small increase in the risk of developing a second cancer in later life. Your childs doctor or nurse will talk to you about any possible late side effects. Clinical trials Many children have their treatment as part of a clinical research trial. Trials aim to improve our understanding of the best way to treat an illness, usually by comparing the standard treatment with a new or modified version. Specialist doctors carry out trials for AML. If appropriate, your childs medical team will talk to you about taking part in a clinical trial and will answer any questions you have. Written information is often provided to help explain things. Taking part in a research trial is completely voluntary, and youll be given plenty of time to decide if its right for your child. Treatment guidelines Sometimes, clinical trials are not available for your childs cancer. This may be because a recent trial has just finished, or because the cancer is very rare. In these cases, you can expect your doctors and nurses to offer treatment which is agreed to be the most appropriate, using guidelines which have been prepared by experts across the country. The Childrens Cancer and Leukaemia Group (CCLG) is an important organisation which helps to produce these guidelines. Follow-up care Many children with AML are cured. If the leukaemia comes back after initial treatment, it usually does so within the first 3 years. Most children with AML grow and develop normally. If you have specific concerns about your childs condition and treatment, its best to discuss them with your childs doctor, who knows the situation in detail. Your feelings As a parent, the fact that your child has cancer is one of the worst situations you can be faced with. You may have many emotions, such as fear, guilt, sadness, anger and uncertainty. These are all normal reactions and are part of the process that many parents go through at such a difficult time. Its not possible to addresshere all of the feelings you may have. However, the CCLG booklet Children & Young Peoples Cancer; A Parents Guide talks about the emotional impact of caring for a child with cancer and suggests sources of help and support. Your child may have a variety of powerful emotions throughout their experience of cancer. The Parents Guide discusses these further and talks about how you can support your child.",,,,,,,,,,,,,
Acute myeloid leukaemia: Teenagers and young adults,"Acute Myeloid Leukaemia in young adults Illnesses and conditions Cancer Cancer types in teenagers and young adults Acute myeloid leukaemia: Teenagers and young adults Acute myeloid leukaemia: Teenagers and young adults Introduction Leukaemia, blood tests and bone marrow Tests for AML Treating AML Introduction This section is for teenagers and young adults and is about a type of cancer called acute myeloid leukaemia (AML). The other main type of leukaemia that can affect teenagers and young adults is acute lymphoblastic leukaemia . For information about AML in people of all ages,read our general AML section. Leukaemia is a cancer of the white blood cells. In leukaemia, the process for making new white blood cells gets out of control. Immature white blood cells (called blasts) keep being made and build up in the bone marrow until there isnt enough room for the bone marrow to make healthy white blood cells, red blood cells and platelets. The body needs these cells to: help fight infection (white cells) carry oxygen from the lungs around the body (red blood cells) stopcuts bleeding by clotting blood (platelets) Symptoms Many of the symptoms of AML are caused by having fewer than normal healthy blood cells in the body. Symptoms can include: looking paler than usual and feeling tired because of too few red blood cells (anaemia) bruises or bleeding you may bruise more easily and it could take longer for bleeding to stop, if you have less blood clotting cells (platelets) than normal infections because there are too few mature white blood cells to fight infection aches and pains in your bones swollen glands (lymph nodes) in your neck, under your arm or in your groin feeling unwell and run down fever and sweats you may have a high temperature without any obvious cause, such as an infection headaches and blurred vision because of too many white blood cells breathlessness because of too many white blood cells. Causes Its not knownexactly what causes AML. Research is going on to try to find out. We do know some things might increase the risk of AML: some genetic conditions, like Downs Syndrome (agenetic condition is something you are born with) some non-cancerous conditions of the bone marrow, such as aplastic anaemia or myelodysplastic syndromes If youre worried about AML If you think you might have any of the symptoms of AML, you should go to your GP. Theyll talk to you about your symptoms, examine you and can arrangetests or refer you to see a specialist.Remember that the symptoms can be caused by other things, but its important to go and get checked if you are worried. Leukaemia, blood tests and bone marrow To understand leukaemia, it can help to know a little about the blood and bone marrow. Leukaemia is a cancer of the white blood cells. All blood cells are made in the bone marrow, which is like a blood cell factory inside bones. A type of cell in the bone marrow, called a stem cell, can make any kind of blood cell your body needs. There are3 main types of blood cells: white blood cells which help fight infection red blood cells  which carry oxygen from the lungs around the body platelets  which clot blood to stop cuts bleeding The bone marrow normally makes millions of blood cells every day. To begin with, these new blood cells, called blasts, are not fully developed (theyre immature). The main job of blast cells is to make more blood cells like themselves. They cant do any of the jobs that mature blood cells can do, like carrying oxygen or fighting infection. Blast cells normally stay inside the bone marrow until theyve matured into fully-developed blood cells. Once blood cells are mature, theyre ready to do their jobs. They leave the bone marrow and go into the bloodstream, where they can be carried to wherever theyre needed. How leukaemia develops In leukaemia, the process for making new white blood cells gets out of control and immature white blood cells (blasts) keep being made. They build up in the bone marrow until there isnt enough room for the bone marrow to make healthy white cells, red cells and platelets. Types of leukaemia Leukaemia is a cancer of the white blood cells. Healthy white blood cells are made from2 types of blood cells: lymphoblasts that make lymphocytes myeloid cells (myeloblasts) that make other types of white blood cells such as neutrophils Leukaemias are named after the type of white blood cell that has become abnormal and started growing out of control. The most common types in teenagers and young adults are AML and ALL: acute myeloid leukaemia(AML) is leukaemia that starts from abnormal myeloid cells acute lymphoblastic leukaemia (ALL) is leukaemia that starts from abnormal lymphoblasts There are other types of leukaemia that are more common in older people. The information in this section is about ALL, but if you have a different type of leukaemia and want to know more,contact Macmillan . We also have more information about: symptoms and causes of AML having tests for AML being treated for AML If youre looking for information about ALL in people of all ages, read general AML section. Tests for AML You should speak to your GP as soon as possible if you think you have some of the symptoms of AML. But remember that the symptoms of AML can be caused by other things. Visiting your GP Your GP will examine you and arrange for you to have blood tests. There can be different reasons for your symptoms, so youll need to have a blood test to help diagnose acute myeloid leukaemia (AML). If you have AML, a blood test will usually find leukaemia cells and youll be referred to a specialist at the hospital. This specialist is called a haematologist and is a doctor who treats people with blood disorders. At the hospital The haematologist will examine you and ask you about your symptoms and any recent illnesses. They will also arrange for you to have some more tests. These may include: blood tests  youll need more blood tests even if youve had some already tolook at the changes in the leukaemia cells and help the doctors decide on the best treatment for you; these tests may be called cytogenetics and immunophenotyping bone marrow test to count the numbers of leukaemia cells in the bone marrowand get send samples for cytogenetic and immunophenotyping testing lumbar puncture a small sample of the fluid that surrounds your brain and spinal cord is taken to check for leukaemia cells chest X-ray  this may also be done to see if there are any swollen lymph nodes (glands) in your chest If you have AML, you might need a few more tests to check how your body is working in general. These could be blood tests, an ultrasound scan of the tummy (abdomen) to look at your liver, spleen and kidneys, or an echocardiogram (which is an ultrasound of the heart). This may seem like a lot of tests, but they give the doctors important information that will help them give you the right treatment. Waiting for test results can be a scary time, but understanding a little about them what will happen, how youll feel and when youll get the results can help you cope. Thinking about how you feel and getting support from family, friends or your specialist nurse and doctor can also make it a bit easier. You could also talk to a cancer support specialist on Macmillans free helpline . We also have more information about: symptoms and causes of AML being treated for AML leukaemia, blood cells and bone marrow If youre looking for information about AML in people of all ages, read our general AML section. Treating AML The main treatment for acute myeloid leukaemia (AML) is chemotherapy. This means having anti-cancer drugs to destroy the leukaemia cells. Youll also have drugs called steroids, which help the chemotherapy to work. The treatment for AML is pretty intensive at times and can cause unpleasant side effects. But youll be in hospital when youre most likely to feel unwell, and the staff can help if things get tough. Dont feel you have to be brave. Be honest about how youre feeling with your doctors and nurses. They can give you medicines to help you feel better. There are different phases of treatment for AML: getting rid of the leukaemia  remission induction keeping the leukaemia away consolidation and delayed intensification therapy central nervous system (CNS) therapy (mainly for teenagers under 16) Very often, treatment is given as part of a clinical trial or research study, but it will be your decision whether to take part in the trial or not. Clinical trials help doctors to keep improving treatment for leukaemia. You usually start chemotherapy pretty quickly after finding out that you have AML. Youll be in hospital for your treatment to begin with.If youre 18 or younger, youll be treated in a specialist Principal Treatment Centre (PTC) for teenage and young adults (TYA).If youre 19 or older, youll be offered the choice of having treatment at the PTC or another hospital closer to home called a TYA designated hospital. Most chemotherapy for AML is given into the bloodstream (intravenously). So youll have a line put into one of your main veins to make it easier for you to have intravenous chemotherapy. There are different kinds of lines. Youll also be given chemotherapy into the fluid around your spinal cord and brain. This is to get rid of any leukaemia cells that might be hiding there. This type of treatment is called central nervous system (CNS) therapy. Having chemotherapy can be hard, but the staff looking after you will give you medicines to help you cope with any side effects so you can stay strong enough to have treatment. And youll be given medicines to help you feel less sick and antibiotics to help prevent infections. There will probably be times when you feel rough and other times when youll feel better. You might also feel upset, down or irritable. Talking to someone you trust can help you cope with these feelings. Being in hospital for long periods can be frustrating, especially when you miss out on stuff happening at school, college, university or work or on things your friends are doing. You could try talking to your friends and family about this and see what they can do to help you. Getting rid of the leukaemia (remission induction) The first phase of your treatment is about getting rid of the leukaemia. Youll be given chemotherapy to kill as many leukaemia cells as possible. Remission means there is no sign of leukaemia cells in your blood or bone marrow. You have chemotherapy over a few days, then you have a few weeks off so that your body can recover from any side effects. The days you have the chemotherapy and the rest period afterwards is called a cycle. Youll usually have4 cycles of chemotherapy overall with2 courses in the induction phase. Some people might also need to have a bone marrow transplant. This normally happens after 2 cycles of chemotherapy. Youll probably need to stay in hospital most of the time that youre having remission induction. This is so that the doctors can check how things are going. Chemotherapy drugs Drugs you may have include: cytarabine (Ara-C) daunorubicin, doxorubicin or idarubicin etoposide thioguanine Side effects Different chemotherapy can cause different side effects. There is information about the specific ones inMacmillans chemotherapy section . As well as the chemotherapy drugs, youll be given other drugs to: help prevent you from feeling sick or being sick help prevent infections protect your kidneys as sometimes when lots of leukaemia cells are destroyed at once it can cause kidney problems Youll probably also need blood and platelet transfusions to top up the numbers of red cells and platelets in your blood. Chemotherapy can cause side effects. Most of them are short-term (temporary) and gradually disappear once treatment stops. The most common side effects are: being more at risk of infections feeling sick hair loss a sore mouth Sometimes side effects can be long-term. For example, some chemotherapy treatments can affect fertility (your ability to have a baby). If you are a young man, you will be offered the chance to store sperm before chemotherapy is started. There may be other late effects of treatment and your specialist can talk to you about this. Remission induction is pretty intense treatment and youll probably feel a bit wiped out sometimes. Youll need to stay in hospital for most of the time and you might not have the energy to do much. You might feel fed up, tearful or irritable. Its normal to feel like this. Its hard to be in hospital and you might worry about losing touch with your friends or falling behind at school or college. It can help to talk about this with a friend, doctor, nurse or counsellor. Keeping the leukaemia away (post-remission treatment) This phase of treatment is sometimes also called consolidation or intensification treatment. Its given to prevent the leukaemia from returning (known as a relapse). When youre in remission, it means the doctors cant see any leukaemia cells in your blood or bone marrow samples under the microscope. But there may still be leukaemia cells hiding in your body, so further treatment is needed to get rid of these cells. You start post-remission treatment soon after you complete remission induction. Youll usually have2 courses of treatment. You might be given the same chemotherapy drugs youve had before (perhaps at similar or higher doses) or you might be given different chemotherapy drugs. When your doctors decide what chemotherapy treatment plan to give you, they will take into account: how well your leukaemia responded to the first lot of treatment (remission induction) the results of the tests that were done when you were diagnosed The following drugs may be used to treat you: cytarabine (ara-C) methotrexate Central nervous system therapy (CNS) You usually wont need this treatment if youre 16 or over. But if youre under 16, youll probably have it. CNS therapy is given to get rid of any leukaemia cells that might be in the brain or spinal cord. (The CNS or central nervous system is the name for the brain and spinal cord.) CNS therapy involves giving chemotherapy into the fluid, called cerebrospinal fluid or CSF, around the spinal cord and brain. Its a bit like having a lumbar puncture but with chemotherapy added. A doctor puts a needle into the space between two small bones (vertebrae) near the bottom of your spine. Then they inject chemotherapy into the CSF. The CSF will carry the chemotherapy around your CNS so it can reach any leukaemia cells that might be there. Youll have a lumbar puncture before you start treatment to check for leukaemia cells in the CSF. If there is no sign of leukaemia cells, youll have2 lots of CNS therapy,1 after each cycle of remission induction therapy. If there are leukaemia cells in the CSF, youll have CNS therapy twice a week until all traces of leukaemia cells in your CSF have gone. Youll then have2 more lots of CNS therapy just to make sure. For CNS therapy for AML, youll have chemotherapy drugs called methotrexate and cytarabine and a steroid called hydrocortisone. Side effects The most common side effect is feeling sick but you can be given anti-sickness treatment to help this. Rarer side effects include a headache, dizziness, tiredness or blurry vision for a few hours afterwards. We also have more information about: symptoms and causes of AML having tests for AML leukaemia, blood cells and bone marrow If youre looking for information about AML in people of all ages, read our general AML section.",,,,,,,,,,,,,
Acute pancreatitis,"Acute pancreatitis  Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Acute pancreatitis Acute pancreatitis About acute pancreatitis Symptoms of acute pancreatitis Causes of acute pancreatitis Diagnosing acute pancreatitis Treating acute pancreatitis Complications of acute pancreatitis Preventing acute pancreatitis About acute pancreatitis Acute pancreatitis is a serious condition where the pancreas becomes inflamed over a short period of time. The pancreas is a small organ located behind the stomach and below the ribcage. Most people withacute pancreatitis improve within a week and experience no further problems, but severe cases can have serious complications and can even be fatal. Acute pancreatitis is different to chronic pancreatitis , where the inflammation of the pancreas persists for many years. The most common symptoms of acute pancreatitis include: suddenly getting severe pain in the centre of your abdomen (tummy) feeling or being sick diarrhoea Read more about the symptoms of acute pancreatitis and diagnosing acute pancreatitis . When to seek medical help Contact your GP immediately if you suddenly develop severe abdominal pain. If this isnt possible, contact NHS 24s 111service or your local out-of-hours service for advice. Why it happens Its thought that acute pancreatitis occurs when a problem develops with some of the enzymes (chemicals) in the pancreas, which causes them totry to digestthe organ. Acutepancreatitisis most often linked to: gallstones  which accounts for around half of all cases alcohol consumption  which accounts for about a quarter of all cases By reducing your alcohol intake and altering your diet to make gallstones less likely, you canhelp to reduce your chances of developing acute pancreatitis. Read more about the causes of acute pancreatitis and preventing acute pancreatitis . Who is affected? Acute pancreatitisis more common in middle-aged and elderly people, but it can affect people of any age. Men are more likely to develop alcohol-related pancreatitis, while women are more likely to develop it as a result of gallstones. How its treated Treatment for acute pancreatitis focuses on supporting the functions of the body until the inflammation has passed. Thisusually involves admission to hospital so you can be given fluids into a vein (intravenous fluids), as well as pain relief, nutritional support and oxygen through tubes into your nose. Most people with acute pancreatitis improve within a week and are well enough to leave hospital after 5 to 10 days. However, recovery takes longer in severe cases, as complicationsthat require additional treatmentmay develop. Read more about treating acute pancreatitis . Complications About 4out of 5cases of acute pancreatitis improve quickly anddont cause any serious further problems. However, 1in 5cases are severe andcan result in life-threatening complications, such asmultiple organ failure. In severe cases wherecomplications develop, theres a highrisk ofthe conditionbeing fatal. If a person survives the effects of severe acute pancreatitis, its likely to be several weeks or months before theyre well enough to leave hospital. Read more about the possible complications of acute pancreatitis . Symptoms of acute pancreatitis The main symptom of acute pancreatitis is a severe, dull pain around the top of your stomach that develops suddenly. This aching pain often gets steadily worse and can travel along your back or below your left shoulder blade. Eating or drinkingmay also make you feel worse very quickly, especially fatty foods. Leaning forward or curling into a ball may help to relieve the pain, but lying flat on your back often increases the pain. Acute pancreatitis caused by gallstones usually develops after eating a large meal. If the condition is caused by alcohol, the pain often develops 6 to 12 hours after drinking a significant amount of alcohol. Other symptoms Other symptoms of acute pancreatitis can include: nausea (feeling sick) or vomiting diarrhoea indigestion a high temperature (fever) of 38C (100.4F) or above jaundice  yellowing of the skin and the whites of the eyes tenderness or swelling of the abdomen (tummy) When to seek medical advice Contact your GP immediately if you suddenly develop severe abdominal pain. If this isnt possible,contact NHS 24 111 Service or your local out-of-hours service for advice. Causes of acute pancreatitis Most cases of acute pancreatitis are closely linked to gallstones or to alcohol consumption, although the exact cause isnt always clear. Gallstones Gallstones are hard pieces of stone-like material that form in your gallbladder. They can trigger acute pancreatitis if they move out of the gallbladder and block the opening of the pancreas. The blockage can disrupt some of the enzymes (chemicals) produced by the pancreas. These enzymes are normally used to help digest food in your intestines, but theycanstart to digest the pancreas instead ifthe opening isblocked. However, not everyone with gallstones will develop acute pancreatitis. Most gallstones dont cause any problems. Alcohol consumption Its not fully understood how alcohol causes the pancreas to become inflamed. One theory is that it interferes with the normal workings of the pancreas, causing the enzymes to start digesting it. Whatever the cause, there is a clear link between alcohol use and acute pancreatitis. A very large study found that people who regularly drank more than 35 units of alcohola week were 4times more likely to develop acute pancreatitis than people who never drank alcohol (35 units is the equivalentof drinking around 16 cans of strong lager or 4bottles of wine a week). Binge drinking ,which is drinking a lot of alcohol in a short period of time, is also thought to increase your risk of developing acute pancreatitis. Other causes Less common causes of acute pancreatitis include: accidental damage or injury to the pancreas  for example, duringa procedureto remove gallstones or examine the pancreas certain types of medication,such as some antibiotics or chemotherapy medication  acute pancreatitis can bean unexpected side effect of these in a small number of people a viral infection  such as mumps or measles a complication of cystic fibrosis certain rare conditions  including hyperparathyroidism, Reyes syndromeand Kawasaki disease Severe pancreatitis Little is known about why some people develop severe acute pancreatitis. Factors thought to increase your risk include: being 70 years of age or over being obese (a person is considered obese if they have a body mass index (BMI) of 30 or above) having 2or more alcoholic drinks a day smoking Researchers have also discovered that people with a specific genetic mutation, known as the MCP-1 mutation, are 8times more likely to develop severe acute pancreatitis than the general population. A genetic mutation is where the instructions (DNA) found in all living cells become scrambled, resulting in a genetic disorder or a change in characteristics. Diagnosing acute pancreatitis Most cases of acute pancreatitis are diagnosed in hospital because of the risk of serious complications. The doctor in charge of your care will ask you about the history of your symptoms. They may also carry out a physical examination. If you have acute pancreatitis, certain areas of your abdomen will be very tender to touch. A blood test will be carried out to help confirm a diagnosis. Thiscan detect signs of acute pancreatitis,such asa high level of 2chemicals called lipase and amylase. At first, it can be difficult to tell whether your acute pancreatitis is mild or severe. Youll be monitored closely for signs of serious problems, such as organ failure. People with mild acute pancreatitis tend to improve within a week and experience either no further problems or problems that resolve within 48 hours. People with severe acute pancreatitis develop persistent serious problems. Further testing Several tests may be used to help determine the severity of your condition andassess your risk of developing more serious complications. You may have any of the following tests: a computerised tomography (CT) scan  where a series of X-rays are taken to build up a more detailed, 3D image of your pancreas a magnetic resonance imaging (MRI) scan  where strong magnetic fields and radio waves are used to produce a detailed image of the inside of your body an ultrasound scan  where high-frequency sound waves are used to create an image of part of the inside of the body endoscopic retrograde cholangiopancreatography (ERCP) An ERCP uses a narrow, flexible tube known as an endoscope, which has a camera on one end. The endoscope will be passed through your mouth and towards your stomach. A special dye that shows up on X-rays is then injected through the endoscope into your bile and pancreatic ducts. After the dye has been injected, X-rays will be taken. This test can be useful in cases of gallbladder-associated acute pancreatitis, because it can pinpoint exactly where the gallstone is located. In some cases, it may be possible to pass surgical instruments down the endoscope, so the gallstone can be removed. Treating acute pancreatitis Acute pancreatitis is treated in hospital, where youll be closely monitored for signs of serious problems and given supportive treatment, such as fluids and oxygen. Many people are well enough to leave hospital after 5 to 10 days. In severe cases, complications can develop that require specific additional treatment and youll need to be admitted to a high dependency unit or intensive care unit (ICU). In these cases, recoverymay take much longer, and the condition can be fatal. Read about the potential complications of acute pancreatitis for more informationon severe cases. Fluids Your body can become dehydrated during an episode of acute pancreatitis, so fluids are provided through a tube connected to one of your veins (this is known as intravenous, or IV, fluid). In severe cases of acute pancreatitis, IV fluids can help to prevent a serious problem called hypovolemic shock, which occurs when a drop in your fluid levels lowers the amount of blood in your body. Nutritional support Although the diet of many people with mild acute pancreatitis isnt restricted, somepeople are advised not toeat. This is because trying to digest solid food could place too much strain on your pancreas. Depending on the severity of the condition, you may not be able to eat solid foodsfor a few days or longer. If youneed to avoid solid food, a feeding tube may beused to provide your body with nutrients. This is known as enteral feeding andoften involves usinga tube inserted into your stomach through your nose (nasogastric tube). Oxygen To ensure your vital organs have enough oxygen, it will usually be supplied through tubes into your nose. The tubes can be removed after a few days, once your condition is improving. In severe cases, ventilation equipment may also be used to assist with your breathing. Painkillers Acute pancreatitis often causes severe abdominal (tummy) pain, so strong painkilling medication will probably be required, such as morphine. Some of the painkillers used can make you feel very drowsy. If youre visiting someone who is in hospital with acute pancreatitis, dont be alarmed or concerned if they appear drowsy or unresponsive. Treating the underlying cause Oncethe condition is under control, the underlying cause may need to be treated. Gallstones If a gallstone is responsible for the pancreatitis,you may needa procedure calledendoscopic retrograde cholangiopancreatography (ERCP),or your gallbladder may need to be removed. Gallbladder removal surgery may be done while youre in hospital, or itmay be planned for several weeks time. Having your gallbladder removed should have no significant effect on your health, other than making it more difficult to digest certain foods, such as fatty or spicy foods. An ERCP procedure is an alternative treatment for gallstones. It involves using a narrow, flexible tube known as an endoscope, which has a camera on one end. X-rays guide the endoscope into your digestive system, andsurgical instrumentsare passeddown the endoscopeto removethe gallstones. Alcohol consumption After recovering from acute pancreatitis, alcohol should be completely avoidedif this was the cause of the condition. If you find this difficult, youll probably need additional treatment. Treatment options for alcohol dependence include: one-to-onecounselling self-help groups  such as Alcoholics Anonymous a medication called acamprosate  which helps to reduce your alcohol cravings Complications of acute pancreatitis Although most people with acute pancreatitis recover without experiencing further problems, severe cases can have serious complications. Pseudocysts Pseudocysts are sacs of fluid that can develop on the surface of the pancreas. Theyre a common complication of acute pancreatitis, thought to affect around 1 in 20 people with the condition. Pseudocysts usually develop 4 weeks after the symptoms of acute pancreatitis start. In many cases, they dont cause any symptoms and are only detected during a computerised tomography (CT) scan . However, in some people, pseudocysts can cause bloating, indigestion and a dull abdominal (tummy) pain. If the pseudocysts are small and not causing any symptoms, there may be no need for further treatment, as they usually go away on their own. Treatment is usually recommended if youre experiencing symptoms or ifthe pseudocysts are large. Larger pseudocysts are at risk of bursting, which could cause internal bleeding or trigger an infection. Pseudocysts can be treated by draining the fluid out of the cyst by inserting a needle intoit through your skin. This can also be done by carrying out an endoscopy, wherea thin, flexible tube called an endoscope is passed down your throat, and tiny tools are used to drain away the fluid. Infected pancreatic necrosis In around 1in 3severe cases of acute pancreatitis,a serious complication called infected pancreatic necrosis occurs. In infected pancreatic necrosis, high levels of inflammation cause an interruption to the blood supply of your pancreas. Without a consistent supply of blood, some of the tissue of your pancreas will die. Necrosis is the medical term for the death of tissue. The dead tissue is extremely vulnerable to infection from bacteria. Once an infection has occurred, it can quickly spread into the blood ( blood poisoning ) and cause multiple organ failure. If left untreated, infected pancreatic necrosis is almost always fatal. Infected pancreatic necrosis usually develops 2to 6weeks after thesymptoms of acute pancreatitis starts. Symptoms include increased abdominal pain and a high temperature. The infectionis treated with injections of antibiotics , and the dead tissue needs to be removed to prevent the infection returning. In some cases, it may be possible to drain away the dead tissue using a thin tube called a catheter, which is placed through the skin. Alternatively, laparoscopic surgery (keyhole surgery) can be used.A small cutis made in your back and an endoscope is inserted to wash away any dead tissue. If laparoscopic surgeryisnt possible, a cutcan bemade in your abdomen to allow the dead tissue to be removed. Infected pancreatic necrosis is a very serious complication. Even with the highest standards of medical care, the risk of dying from organ failure is estimated to be around 1in 5. Systemic inflammatory response syndrome (SIRS) Another common complication of severe acute pancreatitis is systemic inflammatory response syndrome (SIRS). SIRS develops in an estimated 1 in 10 severe cases of acute pancreatitis. In SIRS, the inflammation affecting the pancreas spreads throughout the body, which can cause one or more organs to fail. It usually develops during the first week after thesymptoms start, with most cases developing on the same day. Symptoms of SIRS include: a rise in body temperature to above 38C (100.4F) or a fall in body temperature to below 36C (96.8F) a rapid heartbeat of more than 90 beats a minute an unusually fast breathing rate (more than 20 breaths a minute) Theres currently no cure for SIRS, so treatment involves trying to support the bodys functions until the inflammation has passed. The outcome depends on how many organs fail. The higher the number of organs affected, the greater the risk of death. Chronic pancreatitis If you have repeated episodes of acute pancreatitis, the damage to your pancreas may lead to chronic pancreatitis . Chronic pancreatitis is a long-term condition that can have a serious impact on your quality of life. Preventing acute pancreatitis As acute pancreatitis is often caused by gallstones or excessive alcohol consumption, a healthy lifestyle can reduce your chances of developing the condition. Gallstones The most effective wayof preventing gallstones is eating a healthy, balanceddiet that includes plenty of fresh fruit and vegetables (at least 5portions a day). Your diet should also include wholegrains, found in wholemeal bread, oats and brown rice. This helps lower the amount of cholesterol in your body. There is also evidence that regularly eating nuts, such as peanuts or cashews, can help reduce your risk of developing gallstones. Because of the role cholesterol appears to play in the formation of gallstones, its advisable to avoid eating too many fatty foods with a high cholesterol content. Foods high in cholesterol include: meat pies sausages and fatty cuts of meat butter and lard cakes and biscuits Being overweight also increases your chances of developing gallstones, so maintaining a healthyweight by eating abalanced diet and taking plenty of regular exercise can alsohelp reduce your risk of developingthe condition. Read more information and advice about exercise , healthy eating and losing weight . Alcohol Limiting the amount of alcohol you drink can help prevent your pancreas being damaged, andreduce your risk of developing acute pancreatitis. It can also lower your chances of developing other serious conditions, such as liver cancer . Read the pages on drinking and alcohol for more information and advice. ",,,,,,,,,,,,,
Adenomyosis,"Adenomyosis  Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Healthy living Women's health Girls and young women (puberty to around 25) Periods and menstrual health Adenomyosis Adenomyosis  |  | Polski |  |  | British Sign Language (BSL) | Easy Read Adenomyosis is a condition that causes the lining of the womb (the endometrium) to bury into the muscular wall of the womb. It can affect the whole womb or just one part of the womb. Adenomyosis is not a life-threatening condition, but the symptoms can have a big impact on your day-to-day life so its important to get the support you need. Symptoms Its possible to have adenomyosis and have no symptoms. Symptoms you might experience include: heavy periods that last for a long time severe period pain a feeling of pressure in your tummy bloating (your tummy sticks out more than normal) Causes Its not known exactly why adenomyosis happens. Adenomyosis is not an infection and its not contagious. It is benign (not cancerous). Diagnosis When you see your doctor about your symptoms, theyll carry out what is called a pelvic examination. Theyll look at your vulva, vagina and cervix (the opening between the vagina and the womb) to see if there is something that could be causing your symptoms. Sometimes other tests might be needed. Your doctor will discuss this with you and you can ask any questions that you might have. As this is an intimate examination, the doctor who performs it will have another person (chaperone) present. You can ask for a female doctor to carry it out. If there isnt a female doctor available, you can ask if theres a female health professional who could carry out the examination. You might be referred to a specialist wholl carry out more tests. This might include an ultrasound or an MRI, which will allow a doctor to look at your womb. This can also help rule out any other health conditions. Treatment Depending on your symptoms, there are different options to treat adenomyosis, including: anti-inflammatory medication to help relieve mild pain treatment during your period to help reduce the amount of menstrual blood loss hormone therapy such as the contraceptive pill, to help control heavy or painful periods a hysterectomy (removal of the womb)  this would only be considered in extreme cases, where other treatments do not work and if you do not wish to become pregnant Your doctor will discuss this with you and you can ask any questions that you might have. ",,,,,,,,,,,,,
Addisons disease,"Addison's disease  Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Glands Addisons disease Addisons disease About Addisons disease Symptoms of Addisons disease Causes of Addisons disease Diagnosing Addisons disease Treating Addisons disease About Addisons disease Addisons disease (also known as primary adrenal insufficiency or hypoadrenalism) is a rare disorder of the adrenal glands. The adrenal glands are 2 small glands that sit on top of the kidneys. They produceessential hormones: cortisol,aldosterone and adrenaline. In Addisons disease, the adrenal gland is damaged, and not enough cortisol and aldosterone are produced. About 8,400 people in the UK have Addisons disease. It can affect people of any age. Its most common between the ages of 30 and 50.Its also more common in women thanmen. Early-stage symptoms of Addisons disease are similar to other more common health conditions, such as depression or flu .You may experience: fatigue (lack of energy or motivation) muscle weakness low mood loss of appetite and unintentional weight loss increased thirst Over time, theseproblems may become more severe and you may experience further symptoms, such as dizziness, fainting,crampsand exhaustion. You may also develop small areas of darkened skin, or darkened lips or gums. Although these symptoms arent always caused by Addisons disease, you shouldsee your GP, so they can be investigated. Read more about the symptoms of Addisons disease and diagnosing Addisons disease Why it happens The conditionisusually the result of a problem with the immune system, which causes it to attack the outer layer of the adrenal gland (the adrenal cortex), disrupting the production of steroid hormones aldosterone and cortisol. Its not clear why this happens, but its responsible for 70% to 90% of cases in the UK. Other potential causes include conditions that can damage the adrenal glands, such as tuberculosis (TB) , although this is uncommon in the UK. Read more about the causes of Addisons disease Treating Addisons disease Addisons disease is treated with medication to replace the missing hormones. Youll need to take the medication for the rest of your life. With treatment, symptoms of Addisons disease can largely be controlled. Most people with the condition live a normal lifespan andare able tolive an active life, with few limitations. However,many people with Addisons disease also find they must learn to managebouts of fatigue and there may be associated health conditions, such as diabetes or an underactive thyroid . People with Addisons disease must be awareof the risk of a sudden worsening of symptoms, called an adrenal crisis. Thiscan happenwhen the levels of cortisolin your body fallsignificantly due to not taking your medicines, or during another illness. An adrenal crisis is a medical emergency and warning signs include severe nausea, confusion, fever, headache and weakness. If left untreated, it can be fatal. If you or someone you know has Addisons disease and is experiencing severe symptoms, phone 999 for an ambulance. Read more about treating Addisons disease Information about you If you have Addisons disease, your clinical team will pass information about you on to the National Congenital Anomaly and Rare Diseases Registration Service (NCARDRS). This helps scientists look for better ways to prevent and treat this condition. You can opt out of the register at any time. Find out more about the register Symptoms of Addisons disease Addisons disease can be difficult to detect at first, because early symptoms are similar to symptoms of many other health conditions. Initial symptoms of Addisons disease caninclude: fatigue (lack of energy or motivation) lethargy (abnormal drowsiness or tiredness) muscle weakness low mood (mild depression ) or irritability loss of appetite and unintentional weight loss the need to urinate frequently increased thirst craving for salty foods Dehydration can also be an early sign of Addisons disease. Its caused by lack of the hormone aldosterone in your body, which is used to regulate the balance of salt and water. Later symptoms Furthersymptoms of Addisons disease tend to develop gradually over months or years. However,additional stress, caused by another illness or an accident, for example, may cause your symptoms to suddenly get worse. You may go on to develop: low blood pressure when you stand up, which can cause dizziness and fainting feeling sick (nausea) vomiting diarrhoea abdominal,joint or back pain muscle cramps chronic exhaustion, which may cause depression brownish discolouration of the skin, lipsand gums (hyperpigmentation), particularly in the creases on your palms, on scars or on pressure points, such as your knuckles or knees a reduced libido (lack of interest in sex) , particularly in women Some women may also have irregular periodsor miss some periods completely.Children with Addisons disease may experience pubertylater than usual. Some people with Addisons disease also develop low blood sugar (hypoglycaemia) . This can cause symptoms such asdifficulty concentrating, confusion, anxiety and even unconsciousness (particularly in children). If youre experiencingsymptoms of Addisons disease, see your GP so they can diagnose or rule out the condition.These symptomswill usually improve withappropriate treatment. Read more about diagnosing Addisons disease and treating Addisons disease Adrenal crisis If Addisons disease is left untreated, the levels of hormones produced by the adrenal glandgradually decrease in the body. This causes your symptoms to get progressively worse and eventually lead to a life-threatening situationcalledan adrenal or Addisonian crisis. During an adrenal crisis, the symptoms of Addisons disease appear quickly andseverely. This could happen whenyoure already experiencing initial symptoms or without any symptoms at all. Signs of an adrenal crisis include: severe dehydration pale, cold, clammy skin sweating rapid, shallow breathing dizziness severe vomiting and diarrhoea severe muscle weakness headache severe drowsiness or loss of consciousness An adrenal crisis is a medical emergency. If left untreated, it can be fatal. If you think you or someone you knowwith Addisons diseaseis having an adrenal crisis, phone 999 for an ambulance. If an adrenal crisis isnt treated, it can lead to a coma and death. Theres also a risk your brain wont get enough oxygen if treatment is delayed, whichcan cause permanent disability. Causes of Addisons disease Addisons disease develops when the outer layer of your adrenal glands (your adrenal cortex) is damaged, reducing the levels of hormones it produces. Problems with the immune system In the UK, a problem with the immune system is the most common cause of Addisons disease, accounting for 70% to 90% of cases. Theimmune system is your bodys defence against infection and disease. If youre ill, your immune system produces antibodies (a special type of protein that destroys disease-carrying organisms and toxins). These antibodies attack the cause of the illness. However, if you develop a problem with your immune system, it can start to attack your own healthy tissues and organs. This is known as an autoimmune disorder. Addisons disease can develop if your immune system attacks your adrenal glands and severely damages your adrenal cortex. When 90% of the adrenal cortex is destroyed, your adrenal glands wont be able to produce enough of the steroid hormones cortisol and aldosterone. Once levels of these start decreasing, youll experience symptoms of Addisons disease . Its not clear why some people develop this problem with their immune system, although it can run in families. Genetics Research has shown that some people withcertain genesare more likely to develop autoimmune disorders. Its not clear how these genes lead to Addisons diseaseandsimilar conditions, but it does meanyour risk of developing Addisons disease is increased if you or aclose family memberhave another autoimmune condition, such as: vitiligo  a chronic (long-term) condition that causes pale, white patches to develop on the skin type 1 diabetes  a chronic condition caused by too much glucose in the blood underactive thyroid gland (hypothyroidism) Other causes Tuberculosis (TB) is the most common cause of Addisons disease worldwide, but is rare in the UK. TB is a bacterial infection that mostly affects the lungs, but can also spread to other parts of your body.It can cause Addisons disease if it damages your adrenal glands. Other possible causes of Addisons disease include: infections  such as those linked to AIDS , or fungal infections a haemorrhage  very heavy bleeding into the adrenal glands, sometimes associated with meningitis or other types of severe sepsis cancer  if cancer cells from elsewhere in your body spread to your adrenal glands amyloidosis  a disease where amyloid, a protein produced by your bone marrow cells, builds up in your adrenal glands and damages them surgical removal ofboth adrenal glands (adrenalectomy)  for example, to remove a tumour adrenoleukodystrophy (ALD)  a rare, life-limiting, inherited condition affecting the adrenal glands and nerve cells in the brain thatmost oftenaffects young boys certain treatments needed for Cushings syndrome  a collection of symptoms caused by very high levels of cortisol in the body Diagnosing Addisons disease To help diagnose Addisons disease, your GP will first ask about your symptoms and review your medical history. Theyre also likely to ask if anyone in your family hasan autoimmune disorder (a condition caused by a problem with their immune system). Your GP will examine your skin for any evidence of brownish discolouration (hyperpigmentation), particularly in certain areas, such as: where skin creases on your palm in your elbow crease on any scars your lips and gums However, hyperpigmentation doesnt occur in all cases of Addisons disease. Youll also be tested for low blood pressure (hypotension) while youre lying down and again shortly after you stand up. This is to see whether you have postural or orthostatic hypotension (low blood pressure when you change position). Blood tests If Addisons disease is suspected, blood tests will be carried out to measure the levels ofsodium, potassium and cortisolin your body. A low sodium, high potassium or low cortisol level may indicateAddisons disease. You may need to see a hospital hormone specialist (endocrinologist) for your bloodto be tested for the following: a low level of the hormone aldosterone a high level of adrenocorticotrophic hormone (ACTH) a low level of glucose (sugar used for energy) positive adrenal antibodies (antibodies designed to attack the adrenal gland) Any of these could be a sign of Addisons disease. Synacthen stimulation test If cortisolin your bloodislow, or your symptoms strongly suggest Addisons disease, youll need to have a synacthen stimulation test to confirm the diagnosis. Your GP may refer you to an endocrinology unit (a unit that specialises in the study of hormones) for the test. How urgently youre referred depends on how severe your symptoms are. Synacthen is a man-made (synthetic) copy of the adrenocorticotrophic hormone (ACTH). ACTH is naturally produced by the pituitary gland (a pea-sized gland below the brain) to encourage the adrenal glands to release the hormones cortisol and aldosterone. When synacthen is administered, the adrenal glands should respond in the same way as they would to ACTH, and release cortisol andother steroid hormonesinto the blood. A blood sample will be taken and tested for cortisol, before an injection ofsynacthen is given into your arm. After 30 and 60 minutes, a furtherblood sample will be taken for cortisol measurement. If the ACTH level is high, but the cortisol and aldosterone levels are low, its usually confirmation of Addisons disease. Thyroid function test As well as a synacthen stimulation test, your thyroid gland may also be tested to see if its working properly. Your thyroid gland is found in your neck. It produces hormones that control your bodys growth and metabolism. People with Addisons disease often have an underactive thyroid gland (hypothyroidism) , where the thyroid gland does not produce enough hormones. By testing the levels of certain hormones in your blood, your endocrinologist (a specialist in hormone conditions) can determine whether you have hypothyroidism. Scans In some cases, yourspecialist may refer you for a scan of your adrenal glands. This could be a computerised tomography (CT) scan or a magnetic resonance imaging (MRI) scan . Diagnosis during an adrenal crisis If Addisons disease is left untreated, it eventually leads to an adrenal crisis. This is wherethe symptoms of Addisons disease appear quickly and severely. During an adrenal crisis, theres not enough time to perform a synacthen stimulation test to confirm Addisons disease. If possible, blood will be taken and tested for any of the abnormalities listed above. While youre waiting for the results, treatment may be started with steroid injections, and fluids containing salt and glucose. Read more about treatingAddisons disease Driving If youre diagnosed with Addisons disease andhave a bus, coach or lorry licence, its your legal obligation to inform the Driver and Vehicle Licensing Agency (DVLA). Readabout driving andAddisons disease on the GOV.UK website. Treating Addisons disease If you have Addisons disease, youll need to take daily medication to replace the lost hormones. This should help you to live an active life, although many people find they still need to manage their fatigue. Insome cases, the underlying causes of Addisons disease can be treated. For example, tuberculosis (TB) is treated with a course of antibiotics over a period of at least 6 months. However, most cases are caused by a problem with the immune system that cant be cured. Medication forAddisons disease Treatment usually involves corticosteroid (steroid) replacement therapy for life. Corticosteroid medication is used to replace the hormones cortisol and aldosterone thatyour body no longer produces.Its usually taken in tablet form 2 or 3 times a day. In most cases, a medication calledhydrocortisoneis used to replace the cortisol. Other possible medicines areprednisolone or dexamethasone, though these are less commonly used. Aldosterone is replaced with a medication called fludrocortisone. Your GP may also ask you to add extra salt to your daily diet, although if youre taking enough fludrocortisone medicine thismay not be necessary.Unlike most people, if you feel the urge to eat something salty, then you should eat it. In general, the medications used for Addisons disease dont have side effects, unless your dose is too high. If you take a higher dose than necessary for a long time, theres a risk of problems such as weakened bones (osteoporosis) , mood swings and difficulty sleeping (insomnia) . Living with Addisons disease Many people with Addisons disease findthat taking their medication enables them to continuewith theirnormal diet and exercise routines. However, bouts of fatigue are also common, and it cantake some time to learn how to manage these periods of low energy. Some people find that needing to take regular doses of medication is restrictive and affects their daily life or emotional health.Missing a dose of medication, or taking it late,can also lead to exhaustion or insomnia. Some people can develop associated health conditions, such as diabetes or an underactive thyroid , which require extra treatment and management. Youll usually need to have appointments with an endocrinologist every 6 to 12 months, so they can review your progress and adjust your medication dose, if necessary.Your GP can provide support and repeat prescriptions in between these visits. Failing to take your medication could lead to a serious condition called an adrenal crisis, soyou must: remember to collect your repeat prescriptions keep spare medication as necessary  for example, in the car or at work, and always carry some spare medication with you take your medication every day at the right time pack extra medication if you are going away  usually double what you would normally need, plus your injection kit (see below) carry your medication in your hand luggage if you are travelling by plane, with a note from your doctor explaining why it is necessary You could also inform close friends or colleagues of your condition. Tell them about the signs of adrenal crisis and what they should do if you experience one. Medical alert bracelets Its also a good idea to wear a medical alert bracelet or necklace that informs peopleyou have Addisons disease. After a serious accident, such as a car crash, a healthy person produces morecortisol. This helps you cope with the stressful situation and additional strain on your body that results from serious injury. As your body cannot produce cortisol, youll need a hydrocortisone injection to replace it and prevent an adrenal crisis. Wearing a medical alert bracelet will inform any medical stafftreating you about your condition, and what medication you require. Medical alert bracelets or necklaces are pieces of jewellery engraved with your medical condition and an emergency contact number. They are available from a number of retailers. Ask your GP if theres one they recommend, or go to the MedicAlert website. If you need to stay in hospital, the healthcare professionals responsible for your care will also need to know you need steroid replacement medication throughout your stay. Its important to note that this advice still applies if youre not supposed to eat or drink (nil by mouth) for any reason. Adjusting your medication At certain times, your medication may need to be adjusted to take into account any additional strain on your body. For example, you may need to increase the dosage of your medication if you experience any of the following: an illness or infection  particularly if you have a high temperature of 37.5C (99.5F) an accident, such as a car crash an operation, dental or medical procedure (such as a tooth filling or endoscopy) youre taking part in strenuous exercisenot usually part of your daily life This will help your body cope with the additional stress. Your endocrinologist will monitor your dosage and advise about any changes. Over time, as you get used to the condition and learn what can trigger your symptoms, you may learn how to adjust your medication yourself. However, always consult your GP or specialist if youre unsure. Emergency treatment You and a partner or family member may be trained to administer an injection of hydrocortisone in an emergency. This could be necessary if you go into shockafter an injury, or if you experience vomiting or diarrhoea and are unable to keep down oral medication. This may occur if youre pregnant and have morning sickness. Yourendocrinologist will discuss with you when an injection might be necessary. If you need to administer emergency hydrocortisone, always phone your GP immediately afterwards. Check what out-of-hours services are available in your local area, in case the emergency is outside normal working hours. You can alsoregister yourself with your local ambulance service , so they have a record of your requirement for a steroid injection or tablets, if you need their assistance. Treating adrenal crisis Adrenal crisis, or Addisonian crisis, needs urgent medical attention. Phone 999 for an ambulance if you or someone you know are experiencing adrenal crisis. Signs of an adrenal crisis include: severe dehydration pale, cold, clammy skin sweating rapid, shallow breathing dizziness severe vomiting and diarrhoea severe muscle weakness headache severe drowsiness or loss of consciousness In hospital, youll be given lots of fluid through a vein in your arm to rehydrate you. This will contain a mixture of salts and sugars (sodium, glucose and dextrose) to replace those that your body is lacking. Youll also be injected with hydrocortisone to replace the missing cortisol hormone. Any underlying causes of the adrenal crisis, such as an infection, will also be treated. ",,,,,,,,,,,,,
Alcohol-related liver disease,"Alcohol-related liver disease  Illnesses and conditions Stomach, liver and gastrointestinal tract Alcohol-related liver disease Alcohol-related liver disease About alcohol-related liver disease Symptoms of alcohol-related liver disease Causes of alcohol-related liver disease Diagnosing alcohol-related liver disease Treating alcohol-related liver disease Complications of alcohol-related liver disease About alcohol-related liver disease Alcohol-related liver disease (ARLD) refers to liver damage caused by excess alcohol intake. There are several stages of severity and a range of associated symptoms. ARLDdoesnt usually cause any symptoms until the liver has been severely damaged. When this happens, symptoms can include: feeling sick weight loss loss of appetite yellowing of the eyes and skin (jaundice) swelling in the anklesand tummy confusionor drowsiness vomiting blood or passing blood in your stools This means ARLD is frequently diagnosed during tests for other conditions, or at a stage of advanced liver damage. If youregularly drink alcohol to excess, tell your GP so they can check if your liver is damaged. Read more about: symptoms of ARLD diagnosing ARLD Alcohol and the liver With the exception of the brain, the liver is the most complex organ in the body.Its functions include: filtering toxins from the blood aiding digestion of food regulating blood sugar and cholesterol levels helping fight infection and disease The liver is very resilient and capable of regenerating itself. Each time your liver filters alcohol, some of the liver cells die. The liver can develop new cells, but prolonged alcohol misuse (drinking too much)over many years can reduce its ability to regenerate. This canresult in serious andpermanent damage to your liver. ARLD isvery common in the UKthe number of people with the condition has been increasing over the last few decadesas a result ofincreasing levels of alcohol misuse. Read more about the causes of ARLD . Stages of ARLD There are 3main stages ofARLD, although theres often an overlap between each stage.These stages are explained below. Alcoholic fatty liver disease Drinking a large amountof alcohol, even for just a few days, can lead to a build-up of fats in the liver. This iscalled alcoholic fatty liver disease, and is the first stage of ARLD. Fatty liver disease rarely causes any symptoms, but its an important warning sign that youre drinking at a harmful level. Fatty liver disease is reversible. If you stop drinking alcohol for 2weeks, your liver should return to normal. Alcoholic hepatitis Alcoholichepatitis which is unrelated to infectious hepatitisis a potentially serious condition that can be caused by alcohol misuse over a longer period. When this develops, it may be the first time a person is aware theyre damaging their liver through alcohol. Less commonly, alcoholic hepatitis can occur if you drink a large amount of alcohol in a short period of time (binge drinking) . The liver damage associated with mild alcoholic hepatitis is usually reversible if you stop drinking permanently. Severe alcoholic hepatitis, however, is a seriousand life-threatening illness. Many people die from the condition each year in the UK, and some people only find out they have liver damage when their condition reaches this stage. Cirrhosis Cirrhosis is a stage ofARLD where the liver has become significantly scarred.Even at this stage, there may not be any obvious symptoms. Its generally not reversible, but stopping drinking alcohol immediately can prevent further damage and significantly increase your life expectancy. A person who hasalcohol-related cirrhosis and doesnt stop drinking has a less than 50% chance of living for at least 5more years. How ARLD is treated Theres currently no specific medical treatment for ARLD. The main treatment is to stop drinking, preferably for the rest of your life. This reduces the risk offurther damage to your liver andgivesit the best chance of recovering. Ifa person isdependent on alcohol, stopping drinking can be very difficult. However, support, advice and medical treatment may be available through local alcohol support services . A liver transplant may be required in severe cases where the liver has stopped functioning and doesnt improve when you stop drinking alcohol. Youll only be considered for a liver transplant if youve developed complications of cirrhosis , despite having stopped drinking. All liver transplant units require a person to not drink alcohol while awaiting the transplant, and for the rest oftheir life. Read more about treating ARLD . Complications Death rates linked to ARLD haverisen considerably over the lastfew decades. Alcohol is now one of the most common causes of death in the UK, along with smoking and high blood pressure . Life-threatening complications of ARLD include: internal (variceal) bleeding build-up of toxins in the brain (encephalopathy) fluid accumulation in the abdomen (ascites) with associated kidney failure liver cancer Read more about the complications of ARLD . Preventing ARLD The most effective way to preventARLD is to stop drinking alcohol or stick to the low-risk drinking guidelines . Even if youve been a heavy drinker for many years, reducing or stopping your alcohol intake will have important short- and long-term benefitsfor your liver and overall health. Read our drinking and alcohol pages for more information and advice. Symptoms of alcohol-related liver disease In many cases, people with alcohol-related liver disease (ARLD) dont have any noticeable symptoms until their liver is badly damaged. Early symptoms If you do experience early symptoms of ARLD, theseare often quite vague, such as: abdominal pain loss of appetite fatigue feeling sick diarrhoea feeling generally unwell Advanced symptoms Asthe liver becomes more severely damaged, more obvious and serious symptoms can develop, such as: yellowing of the skin and whites of the eyes (jaundice) swelling in the legs, ankles and feet, due toa build-up of fluid (oedema) swelling in your abdomen, due toa build-up of fluid known as ascites a high temperature (fever)and shivering attacks very itchy skin hair loss unusually curved fingertips and nails (clubbed fingers) blotchy redpalms significant weight loss weakness and muscle wasting confusion and memory problems, trouble sleeping ( insomnia ) and changes in your personality due to a build-up of toxins in the brain vomiting blood and black, tarry stools due tointernal bleeding a tendency to bleed and bruise more easily, such as frequent nosebleeds and bleeding gums increased sensitivity to alcohol and drugs (because the liver cant process them) When to seek medical advice ARLDdoesnt often cause symptoms until its reached an advanced stage. If you misuse alcohol, you may have liver damage, even though you have none of these symptoms. Read about alcohol misuse (drinking too much) . Contact your GP for adviceif you have a history of regular alcohol misuse. A good way to assess your history and pattern of drinking is to use a short test known as the CAGE test, which consists of 4questions: Have you ever thought you should cut down on your drinking? Have people annoyed you by criticising your drinking? Have you ever felt guilty about your drinking? Have you ever drunk an eye-opener, which means: have you ever drunk alcohol first thing in the morning to get over a hangover and steady your nerves? If you answer yes to 1or more of the questions, you may have an alcohol problem and are advised to see your GP. See your GP as soon as possibleif you have symptoms of advanced ARLD. Read more about how ARLD is diagnosed . Causes of alcohol-related liver disease Alcohol-related liver disease (ARLD) is caused by drinking too much alcohol. The more you drink above the recommended limits, the higher your risk of developing ARLD. There are 2ways alcohol misuse (drinking too much)can cause ARLD. These are: drinking a large amount of alcohol in a short amount of time (binge drinking) can cause fatty liver disease and, less commonly, alcoholic hepatitis drinking more than the recommended limits of alcohol over many years can causehepatitis and cirrhosis , the more serious types of ARLD Evidence suggests people whoregularly drink more than the recommended maximum amounts are most at risk of developing ARLD. Read more about alcohol units and how to calculate them. Additional factors As well as drinking excessive amounts of alcohol, other factors can increase your chances of developing ARLD. Theseinclude: being overweight or obese being femalewomen appear to be more vulnerable than men to the harmful effects of alcohol having a pre-existing liver condition, such as hepatitis C geneticsalcohol dependence and problems processing alcohol often run in families Diagnosing alcohol-related liver disease Alcohol-related liver disease (ARLD) is often first suspected when tests for other medical conditions show a damaged liver. This is becausethe conditioncauses few obvious symptoms in the early stages. If a doctor suspects ARLD, theyll usually arrange a blood test to check how well your liver is working. They may also ask about your alcohol consumption. Its important to be totally honest about how much and how often you drink alcohol to avoid further unnecessary testing. This could lead to a delay in the treatment you need. Blood tests Blood tests used to assess the liver are known as liver function tests. However, liver function tests can be normalat many stages of liver disease. Blood tests can also detect if you have low levels of certain substances, such as a protein called serum albumin, which is made by the liver. A low level of serum albumin suggests your liver isnt functioning properly. A blood test may also look for signs of abnormal blood clotting, which can indicate significant liver damage. Lab Tests Online has more information on liver function tests . Further testing If your symptoms or liver function test suggest an advanced form of ARLD  eitheralcoholic hepatitis or cirrhosis  you may need further tests. Imaging tests Scans may be needed toproduce detailed images of your liver. This may include: an ultrasound scan a computerised tomography (CT) scan a magnetic resonance imaging (MRI) scan Some scans may also measure the stiffness of the liver, which is a good indication of whether your liver is scarred. Liver biopsy During a liver biopsy ,afine needle is inserted into your body (usually between your ribs). A small sample of liver cells is taken and sent to a laboratory to be examined under a microscope. Thebiopsy is usually carried out under local anaesthetic , either as a day case or with an overnight stay in hospital. Specialist doctors will examine the liver biopsy tissue under the microscope to determine the degree of scarring in the liver and the cause of the damage. Endoscopy An endoscope is a long, thin, flexible tube with a light and a video camera at one end.During an endoscopy,the instrument ispassed down your oesophagus (the long tube that carries food from the throat to the stomach) and into your stomach. Pictures of your oesophagus and stomach are transmitted to an external screen. The doctor will be looking for swollen veins (varices), which are a sign of cirrhosis. Treating alcohol-related liver disease Successful treatment for alcohol-related liver disease (ARLD) often depends on whether someone is willing to stop drinking alcohol and make changes to their lifestyle. Stopping drinkingalcohol Treatment forARLD involves stopping drinking alcohol. This is known as abstinence, which can be vital, depending on what stage the condition is at. If you have fatty liver disease, the damage may be reversed if you abstain from alcohol for at least 2weeks. After this point, its usually safe to start drinking again if you stick to the NHS guidelines on alcohol consumption . If you have a more serious form of ARLD  alcoholic hepatitisor cirrhosis  life-long abstinence is recommended.This is because stopping drinking is the only way to prevent your liver damage getting worse and potentially stop you dying of liver disease. Stopping drinking isnt easy, especially as an estimated 70% of people with ARLD have an alcohol dependency problem. Nevertheless, if you have alcohol-related cirrhosis or alcoholic hepatitis and dont stop drinking, no medical or surgical treatment can prevent liver failure. Withdrawal symptoms If youre abstaining from alcohol, you may suffer withdrawal symptoms. These will be at their worst for the first 48 hours, but should start to improve as your body adjusts to being without alcohol. This usually takes 3to 7days from the time of your last drink. Many people initially experiencedisturbed sleep when abstaining from alcohol, butin most cases their sleep pattern returns to normal within a month. In some cases,you may be advised to reduce your alcohol intake in a gradual and planned way to help avoid withdrawal problems. You may also be offereda medication called a benzodiazepine and psychological therapy, such as cognitive behavioural therapy (CBT), to help you through the withdrawal process. Some peopleneed to stay in hospital or a specialist rehabilitation clinic during the initial withdrawal phases, sotheirprogress can be closely monitored. If yourestaying at home, youll regularly see a nurse or other health professional. You might see them at home, at your GP surgery or at a specialist NHS service. Preventing relapses Once youve stoppeddrinking, you mayneed furthertreatment to help ensure you dontstart drinking again. The first treatment usually offeredis psychological therapy. This involvesseeing a therapist to talk about your thoughts and feelings, and how these affect your behaviour and wellbeing. If psychological therapy alone isnt effective, you may also need medication to help you abstain from alcohol, such as: acamprosate naltrexone disulfiram Read our page on treating alcohol misuse formore information on the treatments offered. Self-help groups Many people with alcohol dependence find it useful to attend self-help groups to help them stop drinking. One of the most well-known is Alcoholics Anonymous , but there aremany other groups that can help. Read the alcohol support page for more information about the help available. Diet and nutrition Malnutrition is common in people with ARLD, so its important to eat a balanced diet to help ensure you get all the nutrients you need. Avoiding salty foods and not adding salt to foods you eat can reduce your risk of developing swelling in your legs, feet and abdomen (tummy) caused by a build-up of fluid. The damage to your liver can also mean its unable to store glycogen  acarbohydrate that provides short-term energy. When this happens, the body uses its own muscle tissue to provide energy between meals, which leads to muscle wasting and weakness. Therefore, you may need extra energy and protein in your diet. Healthy snacking between meals can top up your calories and protein. It may also be helpful to eat 3or 4small meals a day, rather than 1or 2large meals. Your GP can advise you on a suitable diet or, in some cases, refer you to a dietitian. In the most serious cases of malnutrition, nutrients may need to be provided through a feeding tubeinserted through the nose and into the stomach. Medicationforsymptoms The use of medication to directlytreatARLD is controversial. Many experts have arguedtheres limited evidence for its effectiveness. For people with severe alcoholic hepatitis, treatment in hospital may be necessary. Specific treatment withcorticosteroidsor pentoxifylline medication may be used to reduce inflammation of the liver in some people with this condition. Nutritional support is also an important part of treatment in these cases. Other medications that have been used to treat liver damage include: anabolic steroids (a more powerful type of steroid medication) ropylthiouracil (a type of medicine originally designed to treat overactive thyroid glands ) However, theres a lack of good evidence that these help and theyre no longer used for severe alcoholic hepatitis. Liver transplants In the most serious cases of ARLD, the liver loses its ability to function, leading toliver failure. A liver transplant is currently the only way to cure irreversible liver failure. A liver transplant may be considered if: you develop progressive liver failure, despite not drinking alcohol youre otherwise well enough to survive such an operation you commit to not drinking alcohol for the rest of your life Complications of alcohol-related liver disease A number of serious complications can develop if you have alcohol-related liver disease (ARLD). Portal hypertension and varices Portal hypertension is a common complication of cirrhosis and, less commonly, alcoholic hepatitis.It occurs whenthe blood pressure inside your liver has risen to a potentially serious level. When the liver becomes severely scarred, its harder for blood to move through it. This leads to an increase in the pressure of blood around the intestines. The blood must also find a new way to return to your heart. It does this by opening up new blood vessels, usually along the lining of your stomach or oesophagus (the long tube that carries food from the throat to the stomach). These new blood vessels are known as varices. If the blood pressure rises to a certain level, it can become too high for the varices to cope with, causing thewallsof the varicesto split and bleed. This can cause long-term bleeding, which can lead to anaemia . Alternatively, the bleeding can be rapid and massive, causing you to vomit blood and pass stools that are very dark or tar-like. Split varices can be treated by using anendoscope to locate the varices. A tiny band can then be used to seal the base of the varices. Ascites A person with portal hypertension may also develop a build-up of fluid in their abdomen (tummy) and aroundthe intestines. This fluid is known as ascites. Initially, this can be treated with water tablets (diuretics). If the problem progresses, many litres of fluid can build up, which needs to be drained. This is a procedure known as paracentesis and involves a long, thin tube being placed into the fluid through the skin under local anaesthetic . One of the problems associated with the development of ascites is the risk of infection in the fluid (spontaneous bacterial peritonitis). This is a potentially very serious complication and is linked to an increased risk of kidney failure and death. Hepatic encephalopathy One of the most important functions of the liver is to remove toxins from your blood. Ifthe liver is unable to do this due to hepatitis or cirrhosis, the levels of toxins in theblood increase. A high level of toxins in the blood due to liver damage is known as hepatic encephalopathy. Symptoms of hepatic encephalopathy include: agitation confusion disorientation muscle stiffness muscle tremors difficulty speaking in very serious cases, a coma Hepatic encephalopathymay require hospital admission. In hospital, body functions are supported and medication is used to remove toxins from the blood. Liver cancer Liver damage due to heavy drinking over many years can also increase your risk of developing liver cancer . Over the past few decades, rates of liver cancer in the UK have risen sharply due to increased levels of alcohol misuse . Its estimated that, every year, 3-5% of people with cirrhosis will develop liver cancer.",,,,,,,,,,,,,
Allergic rhinitis,"Allergic rhinitis Illnesses and conditions Ears, nose and throat Allergic rhinitis Allergic rhinitis Allergic rhinitis is inflammation (redness and swelling) of the inside of the nose. Its caused by an allergen, such as pollen, dust, mould, or flakes of skin from certain animals. Its a very common condition. For most people its easy to treat with medicines from a pharmacist. Symptoms of allergic rhinitis Allergic rhinitis usually causes cold-like symptoms , such as: sneezing itchiness a blocked or runny nose These symptoms usually start soon after coming into contact with something youre allergic to. Some people only get allergic rhinitis seasonally because theyre allergic to things like tree or grass pollen. Other people get allergic rhinitis all year round. When to get medical advice Speak to your GP practice if: you have allergic rhinitis and your symptoms get worse you also have asthma and its getting worse your symptoms are affecting your sleep and everyday life youre not sure whats causing your symptoms treatments from a pharmacist are not working Diagnosing allergic rhinitis Your GP will usually be able to diagnose allergic rhinitis from your symptoms and any triggers you may have noticed. If the cause of your condition is uncertain, you may be referred for allergy testing. Treatment for allergic rhinitis Treatment for allergic rhinitis depends on how severe your symptoms are. Things you can do to help your symptoms If you have mild allergic rhinitis, you can often treat the symptoms yourself. Do take over-the-counter medications, such as antihistamines clean your nasal passages with a salt water solution avoid triggers if you can Always read the leaflet that comes with your medicine before taking it. Follow the recommended dosage instructions. If youre not sure which treatments are suitable for you or your child, speak to a pharmacist for advice. How to clean your nose with a homemade salt water solution Boil a pint of water, then leave it to cool. Mix 1 teaspoon of salt and 1 teaspoon of bicarbonate of soda into the water. Wash your hands. Stand over a sink, cup the palm of 1 hand and pour a small amount of the solution into it. Sniff the water into 1 nostril at a time. Breathe through your mouth and allow the water to pour back into the sink. Try not to let the water go down the back of your throat. Repeat the first 5 steps up to 3 times a day until your nose feels more comfortable. You do not need to use all of the solution, but make a fresh solution each time you clean your nose. Medication Medication wont cure your allergy, but it can be used to treat the symptoms. Speak to your GP practice if your symptoms do not improve 2 weeks after starting medicine. They may prescribe a stronger medication such as a nasal spray containing corticosteroids . What causes allergic rhinitis? Allergic rhinitis is caused by breathing in tiny particles that youre allergic to. The most common allergens in the air that cause rhinitis are: house dust mites pollen and spores flakes of animal skin wood dust flour dust latex Youre more likely to develop an allergy if theres a history of allergies in your family. Complications of allergic rhinitis Allergic rhinitis can lead to complications in some cases. These include: nasal polyps  abnormal but non-cancerous (benign) growths inside the nose and sinuses sinusitis  inflammation that blocks the sinuses so mucus cannot drain into your nose as usual blockage of the middle ear  due to a build-up of fluid behind the eardrum These problems can often be treated with medication. Surgery is sometimes needed in severe or long-term cases. ",,,,,,,,,,,,,
Allergies,"Allergies - Illnesses & conditions Illnesses and conditions Immune system Allergies Allergies About allergies Symptoms of allergies Testing for allergies Treating allergies Preventing an allergic reaction About allergies An allergy is a reaction the body has to a particular food or substance. Allergies are very common. Theyre thought toaffect more than 1in 4people in the UK at some point in their lives. Theyare particularly common in children. Some allergies go away as a child gets older, althoughmany are lifelong. Adults can develop allergies to things they werent previously allergic to. Having an allergy can be a nuisance and affect your everyday activities, but most allergic reactions are mild and can be largely kept under control. Severe reactions can occasionally occur, but these are uncommon. Common allergies Substances that cause allergic reactions are called allergens.The more common allergensinclude: grass and tree pollen an allergy to theseis known as hay fever (allergic rhinitis) dust mites animal dander (tiny flakes of skin or hair) food  particularlynuts, fruit, shellfish, eggs and cows milk insect bites and stings medication including ibuprofen , aspirin, and certain antibiotics latex used to makesome gloves and condoms mould these can release small particles into the air that you can breathe in household chemicals including those in detergents and hair dyes Most of theseallergensare generally harmless to people who arent allergic to them. Symptoms of an allergic reaction Allergic reactions usually happen quickly within a few minutes of exposure to an allergen. They can cause: sneezing a runny or blockednose red, itchy, watery eyes wheezing and coughing a red, itchy rash worsening of asthma or eczema symptoms Most allergic reactions are mild, but occasionally a severe reaction called anaphylaxis or anaphylactic shock can occur. This isa medical emergency and needs urgent treatment. Read more about the symptoms of allergies . When to get professional advice Pharmacy First Scotland: Allergies treatment from your pharmacy If you have allergies you can get advice and treatment directly from a pharmacy. Find your local pharmacy on Scotlands Service Directory. Search for a pharmacy near you Getting help for allergies If your pharmacist thinks you might have amild allergy, they can offer advice and treatment to help manage the condition. See your pharmacist if you think you or your child might have had an allergic reaction to something. The symptoms of an allergic reactioncan alsobe caused by other conditions. Your pharmacist can help determine whether its likely you have an allergy. If your allergy is particularly severe or its not clear what youre allergic to, the pharmacist may advise you see your GPwho may refer you to an allergy specialist for testing and advice about treatment. Read more about allergy testing . How to manage an allergy Inmany cases, the most effective way of managingan allergy is to avoid the allergen that causes the reaction whenever possible. For example, if you have a food allergy, you should check a foods ingredients list for allergens before eating it. The Food Standards Agency has more information about food allergen labelling . There are also several medications available tohelp control symptoms of allergic reactions, including: antihistamines these can be taken when you notice the symptoms of a reaction, or before being exposed to an allergen to stop a reaction occurring decongestants  tablets, capsules, nasal sprays or liquids that can be used as a short-term treatment for a blocked nose lotions and creams, such asmoisturising creams (emollients) these canreduce skin redness and itchiness steroid medication  sprays, drops, creams, inhalers and tablets that can help reduce redness and swelling caused by an allergic reaction For some people with very severe allergies, a treatment called immunotherapy may be recommended. This involves being exposed to the allergen in a controlled way over a number of years, so your body gets used to it and doesnt react to it so severely. Read more about treating an allergy and avoiding allergic reactions . What causes allergies? Allergiesoccur when the bodys immune system reacts to a particular substance as though its harmful. Its not clear why this happens, but most people affected have a family history of allergies or have closely related conditions such as asthma or eczema. The number of people with allergies is increasing every year. The reasons for this are not understood, but one of the main theories is its the result of living in a cleaner, germ-free environment, which reduces the number of germs our immune system has to deal with. Its thought this maycause it to overreact when it comes into contact with harmless substances. Symptoms of allergies Symptoms of an allergic reaction usually develop within a few minutes of being exposed to something youre allergic to, although occasionally they can develop gradually over a few hours. Althoughallergic reactionscan be a nuisance and hamper your normal activities, most are mild. Very occasionally, a severe reaction called anaphylaxis can occur. Mainallergy symptoms Common symptoms of an allergic reaction include: sneezing and an itchy, runny or blocked nose ( allergic rhinitis ) itchy, red, watering eyes ( conjunctivitis ) wheezing,chest tightness, shortness of breath and a cough a raised, itchy, red rash ( hives ) swollenlips, tongue, eyesor face tummy pain , feeling sick, vomiting or diarrhoea dry, red and cracked skin The symptoms vary depending on what youre allergic to and how you come into contact with it. For example, youmayhave a runny noseif exposed to pollen, developa rash if you have a skin allergy, or feel sickif you eat something youre allergic to. See your pharmacist if you or your child might have had an allergicreaction to something. They can help determine whether the symptoms are caused by an allergy or another condition. Read more about diagnosing allergies . Severe allergic reaction (anaphylaxis) In rare cases, an allergy can lead to a severe allergic reaction, called anaphylaxis or anaphylactic shock, which can be life-threatening. This affects the whole body and usuallydevelops within minutes of exposure to something youre allergic to. Signs of anaphylaxis include any of the symptoms above, as well as: swelling of the throat and mouth difficulty breathing lightheadedness confusion blue skin or lips collapsing and losing consciousness Anaphylaxis is a medical emergency that requires immediate treatment. Read more about anaphylaxis for information about what to do if it occurs. Testing for allergies If you think you have an allergy, tell your pharmacist about the symptoms youre having, when they happen, how often they occur and if anything seems to trigger them. Your pharmacist can offer advice and treatment for mild allergies with a clear cause. If your allergy is more severe or its not obvious what youre allergic to, your pharmacist may advise you to see your GP as you may need referredfor allergy testing at a specialist allergy clinic. The tests that may be carried out are described below. Skin prick testing Skin prick testing is one of the most common allergy tests. It involves putting a drop of liquid onto your forearm that contains a substance you may be allergic to. The skin under the drop is then gently pricked with a needle. If you are allergic to the substance, an itchy, red bump will appear within 15 minutes. Skin prick testing is painless and very safe. Make sure you dont take antihistamines before the test, as they can interfere with the results. Blood tests Blood tests may be used instead of, or alongside, skin prick tests to help diagnose common allergies. A sample of your blood is removed and analysed for specific antibodies produced by your immune system in response to an allergen. Patch tests Patchtestsare used to investigate a type of eczema known as contact dermatitis, which can be caused by your skin being exposed to an allergen. A small amount of the suspected allergen is added to special metal discs, which are then taped to your skin for 48 hours and monitored for a reaction. Elimination diet If you have a suspected food allergy , you may be advised to avoid eating a particular food to see if your symptoms improve. After a few weeks, you may then be asked to eat the food again to check if you have another reaction. Dont attempt to do thisyourself without discussing it with a qualified healthcare professional. Challenge testing In a few cases, a test called afood challenge may also be usedto diagnose a food allergy. During the test, youre given the food you think youre allergic to in gradually increasing amounts, to see how you react under close supervision. This test is riskier than other forms of testing, as it could cause a severe reaction, but is the most accurate way to diagnose food allergies. And challenge testing is always carried out in a clinic where a severe reaction can be treated if it does develop. Treating allergies The treatment for an allergy depends on what youre allergic to. In many cases your pharmacist will be able to offer advice and treatment. Theyll advise you about taking steps to avoid exposure to the substance youre allergic to, andcan recommend medication to control your symptoms. Avoiding exposure to allergens The best way to keep your symptoms under control is often to avoid the things youre allergic to,although this isnt always practical. For example, youmay be able to helpmanage: food allergies by being careful about what you eat animal allergies by keeping pets outside as much as possible and washing them regularly mould allergies bykeeping your home dry and well-ventilated, and dealing with any damp and condensation hay fever bystaying indoors and avoiding grassy areas when the pollen count is high dust mite allergies byusing allergy-proof duvets and pillows, and fitting wooden floors rather than carpets Read more about preventing allergic reactions . Allergy medications Medications for mild allergies are available from pharmacies on the Pharmacy First Scotland service without a prescription, but always ask your pharmacist for advice before starting any new medicine, as theyre not suitable for everyone. Antihistamines Antihistaminesare the main medicines for allergies. Theycan be used: as and when you noticethe symptoms ofan allergic reaction to prevent allergic reactions for example, you may take them in the morningif you have hay fever and you know the pollen count is high that day Antihistaminescan be takenas tablets, capsules, creams, liquids, eye drops or nasal sprays, depending on which part of your body is affected by your allergy. Decongestants Decongestants can be used as a short-term treatment for a blocked nose caused by an allergic reaction. Theycan be taken as tablets, capsules, nasal sprays or liquids. Dont use them for more than a week at a time, as using them for long periods can make your symptoms worse. Lotions and creams Red and itchy skin caused by an allergic reaction can sometimes be treated with over-the-counter creams and lotions, such as: emollients (moisturising creams)to keep the skin moist and protect it from allergens calamine lotion to reduce itchiness steroids to reduce inflammation (see below) Steroids Steroid medications can help reduce inflammation caused by an allergic reaction.Theyre available as: nasal sprays and eye drops for an inflamednose and eyes creams for eczema andcontact dermatitis inhalers for asthma tablets for hives (urticaria) Sprays, drops and weak steroid creams are available without a prescription. Stronger creams,inhalers and tablets are available on prescription from your GP. Immunotherapy (desensitisation) Immunotherapy may be an option for a small number of people with certain severe and persistent allergies who are unable to control their symptoms using the measures above. The treatment involves being given occasional small doses of the allergen  either as an injection, or as drops or tablets under the tongue over the course of several years. The injectioncan only be performed in a specialist clinic under the supervision of a doctor, as there is a small risk of a severe reaction. The drops or tablets can usually betaken at home. The aim of treatment is to helpyour body get used to the allergen so it doesnt react to it so severely.This wont necessarily cureyour allergy, but it will make it milder and mean you can take less medication. Treating severe allergic reactions (anaphylaxis) Some people with severe allergies may experience life-threatening reactions,known as anaphylaxis or anaphylactic shock. If youre at risk of this, youll be given special injectors containing a medicine called adrenaline to use in an emergency. If you develop symptoms of anaphylaxis, such as difficulty breathing, you should inject yourself in the outer thigh before seeking emergency medical help. Read more about the treating anaphylaxis . Preventing an allergic reaction The best way to prevent an allergic reaction is to avoid the substance that youre allergic to, although this isnt always easy or practical. Below is some practical advice that should help you avoid the most common allergens. House dust mites One of the biggest causes of allergies are dust mites, which are tiny insects found in household dust. You can limit the number of mites in your home by: choosing wood or hard vinyl floor coverings instead of a carpet fitting roller blinds that can be easily wiped clean choosingleather, plastic or vinyl furniture instead of upholstered furniture cleaning cushions, soft toys, curtains and upholstered furniture regularly, either by washing (at a high temperature) or vacuuming using tested allergy-proof covers on mattresses, duvets and pillows using a vacuum cleaner fitted with a HEPA (high-efficiency particulate air) filter, because it can trap more dust mites than ordinary vacuum cleaners regularly wiping surfaces with a damp, clean cloth avoid dry dusting, as this can spread dust into the air Concentrate your efforts of controlling dust mites in the areas of your home where you spend the most time, such as the bedroom and living room. You can find more information on indoor allergies in the home on the Allergy UK website. Pets Its not the pet fur that causes an allergic reaction. Instead, its flakes of their dead skin, saliva and dried urine. If you cant permanently remove a pet from the house, you could try: keeping pets outside as much as possible, or limiting them to a particular area of the house, preferablyan areawithout carpet not allowing pets in bedrooms washing pets at least once aweek regularly groomingpets outside regularly washing all bedding and soft furnishings on which a pet has lain using an air filter in rooms where you spend most of your time increase ventilation with fans, air-conditioning or by opening windows If youre visiting a friend or relative with a pet, ask them not to dust or vacuum on the day youre visiting, as this will stir up the allergens into the air. Taking an antihistamine medicine about an hour before entering a pet-inhabited house can also help reduce your symptoms. The Allergy UK website has more information about domestic pet allergies . Mould spores Tiny particles released by moulds can cause an allergic reaction in some people. You can help prevent this by: keeping your home dry and well-ventilated removing any indoor pot plants from your home not drying clothes indoors, store clothes in damp cupboards or packing clothes too tightly in wardrobes dealing with any damp and condensation in your home avoiding damp buildings, damp woods and rotten leaves, cut grass and compost heaps Food allergies By law, food manufacturers must clearly label any foods that contain something thats known to cause allergic reactions in some people. By carefully checking the label for the list of ingredients, you should be able to avoid an allergic reaction. People with food allergiesmost often experience an allergic reaction while eating out at a restaurant. You can avoid this by: not relying on the menu description alone (remember, many sauces or dressings could contain allergens) communicating clearly with the waiting staff and asking for their advice avoiding places where theres a chance that different types of food could come into contact with each other, such as buffets or bakeries let restaurant staff you know your dietary requirements, including how severe your food allergy or intolerance is always check what allergens are in the dish even if you have eaten it before, as recipes and ingredients can change Remember, simple dishes are less likely to contain hidden ingredients. If youre not sure about a dish, dont risk it Read more about living with a food allergy and advice from the Food Standards Agency onfood allergenlabelling . Hay fever Pollen allergies  more commonly known as hay fever  are caused when trees and grasses release pollen into the air. Doctors often call hay fever allergic rhinitis. Different plants pollinate at different times of the year, so the months that you get hay fever will depend on what sort of pollen(s) you are allergic to. Typically, people are affected during spring (trees) and summer (grasses). Tohelpkeep your hay fever under control,you can: check weather reports for the pollen count and stay indoors when its high, if possible avoid drying clothesand bedding outside when the pollen count is high wear wraparound sunglasses to protect your eyes keep doors and windows shut when possible shower and change your clothes after being outside avoid grassy areas, such as parks and fieldsparticularly in the early morning, evening or night, when the pollen count is highest if you have a lawn,try asking someone else to cut the grass for you Insect bites and stings If youve ever suffered a bad reaction to an insect bite or sting, its important to take precautions to minimise your risk. When youre outdoors, particularly in the summer, you could: cover exposed skin wear shoes apply insect repellent avoid wearing strong perfumes or fragrances, as these can attract insects Read more about preventing insect bites and stings . Preventing severe allergies (anaphylaxis) If youreat risk of experiencing asevere allergic reaction ( anaphylaxis ), make sure you carry two adrenaline auto-injectorswith youeverywhere. Wearing a MedicAlert or Medi-Tag medallion or bracelet can make others aware of your allergy in an emergency. Consider telling your teachers, work colleagues and friends, so they can give you your adrenaline injection in an emergency, while waiting for an ambulance. Read more about preventing anaphylaxis .",,,,,,,,,,,,,
Alzheimers disease,"Alzheimer's disease Illnesses and conditions Brain, nerves and spinal cord Alzheimers disease Alzheimers disease About Alzheimers disease Symptoms of Alzheimers disease Causes of Alzheimers disease Diagnosing Alzheimers disease Treating Alzheimers disease Preventing Alzheimers disease About Alzheimers disease Alzheimers disease is the most common type of dementia, affecting an estimated 850,000 people in the UK. Dementia is a progressive neurological disease which affects multiple brain functions, including memory. The exact causeof Alzheimers disease is unknown, although a number of things are thought to increase your risk of developing the condition. These include: increasing age a family history of the condition previous severe head injuries lifestyle factors and conditions associated with cardiovascular disease Its becoming increasingly understood that its very common to have both changes of Alzheimers and vascular dementia together (mixed dementia). Read more about the causes of Alzheimers disease Signs and symptoms of Alzheimers disease Alzheimers disease is a progressive condition, which means the symptoms develop gradually and become more severe over the course ofseveral years. It affects multiple brain functions. The first sign of Alzheimers disease is usually minor memory problems. For example, this could beforgetting about recent conversations or events, and forgetting the names of places and objects. As the condition develops, memory problems become more severe andfurther symptoms can develop, such as: confusion, disorientation and getting lost in familiar places difficulty planning or making decisions problems with speech and language problems moving around without assistance or performing self-care tasks personality changes, such as becoming aggressive, demanding and suspicious of others hallucinations(seeing or hearing things that arent there) and delusions (believing things that are untrue) low moodor anxiety Read more about the symptoms of Alzheimers disease Who is affected? Alzheimers disease is most common in people over the ageof65, and affects slightly more women than men. The risk of Alzheimers disease and other types of dementiaincreases with age,affecting an estimated 1 in 14 people over the age of 65 and 1 in every 6 people over the age of 80. However, around1 in every 20 cases of Alzheimers disease affects people aged 40 to 65. Receivinga diagnosis As the symptoms of Alzheimers disease progress slowly, it can be difficult to recognise that theres a problem. Many people feel that memory problems are simply a part of getting older. However,a timely diagnosis of Alzheimers disease can give youthe best chance to prepare and plan for the future, as well as receive any treatment or supportthat may help. If youre worried about your memory or think you may have dementia, its a good idea to see your GP. If youre worried about someone else, you should encourage them to make an appointment and perhaps suggest that you go along with them. Theres no single test that can be used to diagnose Alzheimers disease. Your GP will ask questions about any problems you are experiencing and may do some tests to rule out other conditions. If Alzheimers disease is suspected, you may be referred to a specialist memory service to: discuss the process of making the diagnosis organise testing create a treatment plan Read more about diagnosing Alzheimers disease How Alzheimers disease is treated Theres no cure for Alzheimers disease,but medication is available that can helprelieve some of the symptoms and slow down the progression of the condition in some people. Various other types of support are also available to help people with Alzheimers live as independently as possible, such as making changes to your home environment so its easier to move around and remember daily tasks. Psychological treatments such as cognitive stimulation therapy may also be offered tohelpsupport your memory, problem solving skills and language ability. Read more about treating Alzheimers disease Outlook On average, people with Alzheimers disease live for around8 to 10 years after they start to develop symptoms. However, this can vary considerably from person to person. Some people with the condition will live longer than this, but others will not. Alzheimers disease is a life-limiting illness, although many people diagnosed with the condition will die from another cause. AsAlzheimers disease is a progressive neurological condition, it can cause problems with swallowing. This can lead to aspiration (food being inhaled into the lungs) which can cause frequent chest infections. Its also common for people with Alzheimers disease to eventually have difficulty eating and to have a reduced appetite. Theres increasing awareness that people with Alzheimers disease need palliative care . This includes support for families, as well as the person with Alzheimers. Can Alzheimers disease be prevented? As the exact cause of Alzheimers disease isnt clear, theres no known way to prevent the condition. However, there are things you can do that may reduce your risk or delay the onset of dementia, such as: stoppingsmoking and cutting down on alcohol eating a healthy, balanced diet and maintaining a healthy weight staying physically fit and mentally active These measures have other health benefits, such as lowering your risk of cardiovascular disease and improving your overall mental health. Read more about preventing Alzheimers disease Symptoms of Alzheimers disease The symptoms of Alzheimers disease progress slowly over several years. Sometimes these symptoms are confused with other conditions and may initially be put down to old age. The rate at which the symptoms progress is different for each individual and its not possible to predict exactly how quickly it will get worse. In some cases,infections, medications, strokes or deliriumcan be responsible for symptoms getting worse. Anyone with Alzheimers disease whose symptoms are rapidly getting worse should be seen by a doctor, so these can be managed. Stages of Alzheimers disease Generally, the symptoms of Alzheimers disease are divided intothree main stages. Early symptoms In the early stages, the main symptom ofAlzheimers disease is memory lapses. For example, someone with early Alzheimers disease may: forget about recent conversations or events, or misplace items forget the names of places and objects, or have trouble thinking of the right word repeat themselves regularly, such as asking the same question several times show poor judgement or find it harder to make decisions become less flexible and more hesitant to try new things There are often signs ofmood changes, such as increasing anxiety or agitation, or periods of confusion. Middle-stage symptoms As Alzheimers disease develops, memory problems will get worse. Someone with the condition may find it increasingly difficult to rememberthe names of people they know and may struggle to recognise their family and friends. Other symptoms may also develop, such as: increasing confusion and disorientation for example, getting lost, or wandering and not knowing what time of day it is obsessive, repetitive or impulsive behaviour delusions (believing things that are untrue) or feeling paranoid and suspicious about carers or family members problems with speechorlanguage (aphasia) disturbed sleep changes inmood, such as frequent mood swings, depression and feelingincreasingly anxious, frustrated or agitated difficulty performingspatial tasks, such asjudging distances hallucinations By this stage, someone with Alzheimers disease usually needs support to help them with their everyday living. For example, they mayneed help eating, washing, getting dressed and using the toilet. Later symptoms In the later stages of Alzheimers disease, the symptoms become increasingly severe and distressing for the person with the condition, as well as their carers, friends and family. Hallucinations and delusions may come and go over the course of the illness, but can getworse as the condition progresses. Sometimes people with Alzheimers disease can beviolent, demanding and suspicious of those around them. A number of other symptoms may also develop as Alzheimers disease progresses, such as: difficulty eating and swallowing (dysphagia) difficulty changing position or moving around without assistance considerable weight loss  although some people eat too much and put on weight unintentional passing ofurine (urinary incontinence) or stools ( bowel incontinence ) gradual loss of speech significant problems with short- and long-term memory In the severe stages of Alzheimers disease, people may need full-time care and assistance with eating, moving and using the toilet. Read more about how Alzheimers disease is treated Seeking medical advice If youre worried about your memory or think you may have dementia, its a good idea to see your GP. If youre worried about someone else, you should encourage them to make an appointment and perhaps suggest that you go along with them. Memory problems are not just caused by dementia  theycan also be caused by depression, stress, medications or other health problems. Your GP can carry out some simple checks to try to find out what the cause may be, and they can refer you to a specialist for more tests, if necessary. Read more about diagnosing Alzheimers disease Causes of Alzheimers disease Alzheimers disease is caused by parts of the brain shrinking (atrophy), which affects the structure and function of particular brain areas. Its not known exactly what causes this process to begin. However,in the brains of people with Alzheimers disease, scientistshave foundamyloid plaques (abnormal deposits of protein), neurofibrillary tangles (containing tau) and imbalances in a chemical called acetylcholine. Its also common to have a degree of vascular damage in the brain. Thesereduce the effectiveness ofhealthy neurons (nerve cells that carry messages to and from the brain), gradually destroying them. Over time, this damage spreads toseveral areas of the brain. The first areas affected are responsible for memories. Increased risk Although its still unknown what triggersAlzheimers disease,several factors are known to increase your risk of developing the condition. Age Age is the single most significant factor in the development of Alzheimers disease. The likelihood of developing the condition doubles every five years after you reach 65 years of age. However, its not just older people who are at risk of developing Alzheimers disease. Around1 in20people with the condition are under 65.This is called early onset Alzheimers disease andit can affect people from around the age of 40. Family history The genes you inherit fromyour parents can contribute to your risk of developing Alzheimers disease, although the actual increase in risk is small if you have aclose family member with the condition. However, in a few families, Alzheimers disease is caused by the inheritance of a single gene, and the risks of the conditionbeing passed on are much higher. If several of your family members have developed dementia over the generations, it may be appropriate to seek genetic counsellingfor information and advice about your chances of developing Alzheimers disease when you are older. The AlzheimersSociety website has more information about the genetics of dementia . Downs syndrome People with Downs syndrome are at a higher risk of developing Alzheimers disease. This is because the genetic fault that causes Downs syndrome can also cause amyloid plaques to build up in the brain over time, which can lead to Alzheimers disease in some people. Head injuries People who have had a severe head injury have been found to be at higher risk of developing Alzheimers disease. Cardiovascular disease Research shows that several lifestyle factors and conditions associated with cardiovascular disease can increase the risk of Alzheimers disease. These include: smoking obesity diabetes high blood pressure high cholesterol You can help reduce your risk by: stopping smoking eating a healthy, balanced diet leading an active life, both physically and mentally losing weight if you need to drinking less alcohol havingregular health checks as you get older Read more about reducing your risk of Alzheimers disease Diagnosing Alzheimers disease Its best to see your GP if youre worried about your memory or think you may have dementia. If youre worried about someone else, encourage them to make an appointment and perhaps suggest going with them. Its often very helpful having a friend or family member there. A timelydiagnosis gives you the best chance to adjust, prepare and plan for the future, as well as accessing treatments and support that may help. Seeing your GP Memory problems arent just caused by dementia they can also be caused by: depression or anxiety stress medications alcohol or drugs other health problems  such as hormonal disturbances or nutritional deficiencies Your GP can carry out some simple checks to try to find out what the cause may be. Theycan then refer you to a specialist for assessment, if necessary. Your GP will ask about your concerns and what you or your family have noticed. Theyll also checkother aspects of your health, and carry out a physical examination. They may also organise some blood tests and ask about any medication youre taking to rule out other possible causes of your symptoms. Youll usually be asked some questionsand carry outsomememory, thinking, and pen and paper tasks to check how different areas of your brain are functioning. This can help your GP decide if youneed tobe referred to a specialist for more assessments. Referral to a specialist Your GP may refer you to a specialist memory assessment service to help with your diagnosis. Memory clinics are staffed by professionals from multiple disciplines who are experts in diagnosing, caring for and advising people with dementia and their families. Memory clinic staff can include the following, depending on your local area: a nurse  usually a trained mental health nurse who specialises in diagnosing and caring for people with dementia a psychologist  a healthcare professional who specialises in the assessment and treatment of mental health conditions a psychiatrist  a qualified medical doctor who has training in treating mental health conditions a neurologist  a specialist in treating conditions that affect the nervous system (the brain and spinal cord) a geriatrician  a physician with specialist training in the care of older people a social worker  a trained member of staff able to advise and assist with accessing social services within the local area an occupational therapist  a member of staff with specialist skills in assessing and supporting people with dementia and their families with adjusting to disabilities Theres no simple and reliable test for diagnosing Alzheimers disease,butthe staff will listen to the concerns of both you and your family about your memory or thinking. They will assess your skills and arrange more tests to rule out other conditions. Assessing your mental abilities A specialist will usually assess your mental abilities using a special series of questions. One widely used test is the mini mental state examination (MMSE). This involves being asked to carry out activities such as memorising a short list of objectscorrectly and identifying the current day of the week, month and year. Different memory clinics may also use other, longer tests. The MMSE isnt used to diagnoseAlzheimers disease,but its useful to initially assess areas of difficulty that a person withthe condition may have. This helps specialists to make decisions about treatment and whether more tests are necessary. Tests To rule out other possible causes of your symptoms and look for possible signs of damage caused by Alzheimers disease, your specialist may recommend having a brain scan. This could be a: computerised tomography (CT) scan  where several X-rays of your brain are taken at slightly different angles and a computer is used to put the images together magnetic resonance imaging (MRI) scan  where a strong magnetic field and radio waves are used to produce detailed images of the inside of your brain Some specialist centres offer scans which look at brain function and particular protein deposits. However, at the moment, these are mostly experimental and only used if the diagnosis is unclear. Afterdiagnosis It may take severalappointments and tests over months, or even years, before a diagnosis of Alzheimers disease can be confirmed. For some people, a diagnosis ofAlzheimers disease is a huge shock, especially as its not unusual for people with dementia to have less awareness of their difficulties. For others, the diagnosis can be very important in helping them and their families to make sense of symptoms theyve been concerned about for a long time. If youve just been given a diagnosis of dementia, you may be feeling numb, scared and unable to take everything in. It may be helpful to have the diagnosis explained again to help make sense of the idea over time. It might help to talkthings through with family and friends. It takes time to adapt to a diagnosis of dementia, for both you and your family. Some people find it helpful to seek information and plan for the future, but others may need a longer period to process the news. However, as dementia is a progressive illness, the weeks to months after a diagnosis is often a good time to think about legal, financial and healthcare matters for the future. Read more about what to do if youve just been diagnosed with dementia Treating Alzheimers disease Theres currently no cure for Alzheimers disease, although medication is available that can temporarily reduce some symptoms or slow down the progression of the condition in some people. Support is also available to help someone with the condition cope with everyday life. Care plan If youre diagnosed withAlzheimers disease, its helpful if your health and social care needs are assessed and plans made forthe future. A care plan is a way of ensuring you receive the right treatment for your needs. It involves identifying areas where you may need some assistance, such as: what support you or your carer need for you to remain as independent as possible whether there are any changes that need to be made to your home to make it easier to live in whether you need any financial assistance Healthcare professionals (such as your GP or psychiatrist) and social care services (which is normally your local council working with the NHS), will usually both be involved in helping draw up and carry out care plans. Medication Anumber of medicationsmay be prescribed for Alzheimers disease to help temporarily improve some symptoms and slow down the progression of the condition. Donepezil,galantamineand rivastigmine (known as AChE inhibitors)can be prescribed for people with early to mid-stage Alzheimers disease. Memantine may be prescribed for people with mid-stage disease who cannot take AChE inhibitors, orfor those withlate-stage disease. Theres no difference in how well each of the three different AChE inhibitors work, althoughsome peoplerespond bettertocertain types or have fewer side effects. All of these medications can only be prescribed by specialists such as psychiatrists, neurologists and geriatricians. They may be prescribed by your GP on the advice of a specialist. If youre caring for someone with Alzheimers disease, your views should be taken into account when prescribing medication, as well as at regular assessments. These assessments take place to ensure the medication is having a worthwhile effect and to identify and monitor side effects. Read guidance from the National Institute for Health and Care Excellence (NICE) on donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimers disease . Side effects Donepezil, galantamine and rivastigminecan cause side effectssuch as: feeling and being sick dizziness diarrhoea headache agitation insomnia muscle cramps more rarely, slowing of the heartbeatwhich can cause issues if you already have problems with your heart rhythm. These side effects are more likely to occur at the beginning of therapy or when the dose is increased. Your doctor should review your medical history and your other medications to check the suitability and risk of interactions. Common side effects of memantine include: dizziness headaches high blood pressure tiredness constipation shortness of breath more rarely, problems with walking or increased confusion very rarely, seizures For more information about the possible side effects of your specific medication, refer to the patient information leaflet that comes with it or speak to your doctor. Supportive measures and treatments In addition to medication, treatment for Alzheimers disease involves a wide range of other measures and treatments to helppeople with dementialive as independently as possible. For example, an occupational therapist can identify problems or unsafe areasin your everyday life and help you to develop strategies or use alternative tools to manage these. They may suggest: ways of prompting and reminding yourself of important taskssuch as using diaries or calendars assistive technologydevices or systems to help maintain the independence andsafety of people living with dementia adding grab bars and handrails to your home to help you move around safely other professionals visiting you at home and assisting with daily tasks to maintain your independence in the community Psychological treatments, such as cognitive stimulation,may be offered tohelp improve your memory, problem solving skills and language ability. Medication, other psychological therapies, such as cognitive behavioural therapy (CBT), music and art therapy, reminiscence and relaxation therapies may also be offered. These may help with managing depression , anxiety, agitation, hallucinations, delusions and challenging behaviour that can occur with Alzheimers disease. Read more about how dementia is treated Practical tips for people with Alzheimers If you have Alzheimers disease, you may find it useful to: keep a diary and write down things you want to remember pin a weekly timetable to the wall put your keys in an obvious place, such as in a large bowl in your living room have a daily newspaper delivered to remind you of the day and date put labels on cupboards and drawers keep useful telephone numbers by the phone write yourself remindersfor example, put a note on the front door to remind you to take your keys with you if you go out programme peoples names and numbers into your telephone set the alarm on your watch to act as a reminder install safety devices such as gas detectors and smoke alarms throughout your home It may also be helpful toget in touch with a local or national Alzheimers or dementia support group, such as the Alzheimers Society , for more information and advice about living with Alzheimers disease. Read more about living well with dementia Future care planning People with dementia often live for many years after their diagnosis. However, as its a progressive condition, it can be helpful and reassuring for both you and your family if you make plans for the future. Future care planning means considering, discussing and possibly recording your wishes and decisions for future care. Its about planning for a time when you may not be able to make some decisions for yourself. In the earlier stages of the disease, you should have the opportunity to discuss with health professionals and your family about the future. This may involve the use of: advance statements advance decisions to refuse treatment lasting power of attorney preferred prioritiesfor care Palliative care Although the outlook is variable, dementia is a life-limiting illness and can begin to affect multiple body systems in the later stages. End of life care, or palliative care, provides support for people with an incurable illness, so theyre able to live as well and as comfortably as possible until their death. It also involves support for family members. Caremay be provided at home, a hospice, a care home or hospital. For people nearing the end of life, their care team should assess their needs, make them feel comfortable and allow them to die with dignity in a place of their choosing. Read more about palliative care Telecare Self-Check online tool Visit the Telecare Self-Check online tool to find the right support for you in your area.This easy to use online tool allows you to find helpful information on telecare services that could help you live independently at home for longer. Preventing Alzheimers disease As the exact cause of Alzheimers disease is still unknown, theres no way to prevent the condition. However, there are steps you can take that may help to delay the onset of dementia. Reducing your risk of cardiovascular disease Cardiovascular disease has been linked with an increased risk of Alzheimers disease and vascular dementia. You may be able to reduceyour risk of developing these conditions as well as other serious problems, such as strokes and heart attacks  by taking steps to improve your cardiovascular health, including: stopping smoking not drinking large amounts of alcohol eating a healthy, balanced diet , including at least five portions of fruit and vegetables every day exercising for at least 150 minutes (2 hours and 30 minutes) every week bydoing moderate-intensity aerobic activity (such as cycling or fast walking) this will improve both your physical and mental health make sure your blood pressure is checked and controlled through regular health tests if you have diabetes , make sure you keep to the diet and takeyour medication Read more about preventing dementia Staying mentally active Theres some evidence to suggest that rates of dementia are lower in people who remain as mentally, physically and socially active as possible throughout their lives, as well as among those who enjoy a wide range of different activities and hobbies. It may be possible to reduce your risk of Alzheimers disease and other types of dementia by: reading writing for pleasure learning foreign languages playing musical instruments taking part in adult education courses playing tennis playing golf swimming group sports, such as bowling walking Interventions such as brain training computer games have been shown to improve cognition over a short period, but research hasnt yet demonstrated whether this can prevent dementia. Future research Research into Alzheimers disease is continuing.As more is revealed about the condition, other ways to treat or prevent it may be found. Participation in research is important and helps to improve dementia care and support for people with dementia, plus their carers and families. You can read about ongoing dementia researchon the Alzheimers Research UK website. You can also ask your local memory clinic about projects taking place. The National Institute for Health and Care Excellence (NICE) has advised that there isnt evidence to support the use of the following to prevent dementia: statins hormone replacement therapy  when chemicals are taken to replace those that your body no longer produces vitamin E  found in a variety of foods, such as olive oil, nuts and seeds non-steroidal anti-inflammatory drugs (NSAIDs) ",,,,,,,,,,,,,
Anal cancer,"Anal cancer- Illnesses and conditions Cancer Cancer types in adults Anal cancer Anal cancer Anal cancer is a rare type of cancer that affects the very end of the large bowel. Symptoms of anal cancer The symptoms of anal cancer are often similar to more common and less serious conditions affecting the anus, such as piles (haemorrhoids) and anal fissures (small tears or sores). Symptoms of anal cancer can include: bleeding from the bottom (rectal bleeding) itching and pain around the anus small lumps around the anus a discharge of mucus from the anus loss of bowel control (bowel incontinence) However, some people with anal cancer dont have any symptoms. Speak to your GP if you develop any of the above symptoms. While theyre unlikely to be caused by anal cancer, its best to get them checked out. Diagnosing anal cancer Your GP will usually ask about your symptoms and carry out some examinations. They may feel your tummy and carry out a rectal examination. This involves your doctor inserting a gloved finger into yourbottom so they canfeel any abnormalities. Your GP will refer youto hospital if they think further tests are necessary. TheNational Institute for Health and Care Excellence (NICE) recommends in its 2015 guidelines that GPs should consider referring someone with an unexplained anal lumporanal ulcer. The person should receive an appointment within 2 weeks. If youre referred tohospital, a number of different tests may be carried out to check for anal cancer and rule out other conditions. Some of the tests you may have include a: sigmoidoscopy where a thin, flexible tube with a small camera and light is inserted into your bottom to check for any abnormalities proctoscopy where the inside of your rectum is examined using a hollow tube-like instrument (proctoscope) with a light on the end biopsy where a small tissue sample is removed from your anus during a sigmoidoscopy or proctoscopy so it can be examined in a laboratory under a microscope If these tests suggest you have anal cancer, you may have some scans to check whether the cancer has spread. Once these are complete, your doctors will be able to stage the cancer. This means giving it a score to describe how large it is and how far it has spread. You can read more about the stages of anal cancer on theCancer Research UK website. How anal cancer is treated If youre diagnosed with anal cancer, youll be cared for by a multidisciplinary team. This is a team of different specialists who work together to provide the best treatment and care. The main treatments used for anal cancer are: chemoradiation  a combination of chemotherapy and radiotherapy surgery  to remove a tumour or a larger section of bowel In cases where the cancer has spread and cant be cured, chemotherapy alone may be considered to help relieve symptoms. This is known as palliative care . Chemoradiation Chemoradiation is a treatment that combines chemotherapy (cancer-killing medication) and radiotherapy (whereradiationis used to kill cancer cells). Its currently the most effective treatment for anal cancer. You dont usually need to stay in hospital when youre having chemoradiation. Chemotherapy for anal cancer is usually given in 2 cycles, each lasting 4 to 5 days, with a 4-week gap between the cycles. In many cases, part of the chemotherapy is delivered through a small tube called a peripherally inserted central catheter (PICC) in your arm, which can stay in place until yourtreatment has finished. The tube means you dont need to stay inhospital during each of the cycles of chemotherapy. However, youll be attached to a small plastic pump, which you take home with you. A few hospitals now offer tablet chemotherapy for anal cancer, which avoids the need for the pump and PICC. Read more about how chemotherapy is carried out Radiotherapy is usually given in short sessions, once a day from Monday to Friday, with a break at weekends. This is usually carried out for 5 to 6 weeks. To prepare for radiotherapy, additional scans will be required. Read more about how radiotherapy is carried out Both chemotherapy and radiotherapy often cause significant side effects, including: tiredness sore skin around the anus sore skin around the penis and scrotum in men or vulva in women hair loss  limited hair loss from the head, but total loss from the pubic area feeling sick diarrhoea These side effects are usually temporary, but theres also a risk of longer-term problems, such as infertility . If youre concerned about the potential side effects of treatment, you should discuss this with your care team before treatment begins. Other possible long-term side effects can include: bowel control problems long-term (chronic)diarrhoea erectile dysfunction vaginal pain when having sex dry and itchy skin around the groin and anus bleeding from the anus, rectum, vagina or bladder Tell your doctor if you develop any of these symptoms so they can be investigated and treated. Surgery Surgery is a less common treatment optionfor anal cancer. Its usually only considered if the tumour is small and can be easilyremoved, or if chemoradiation hasnt worked. If the tumour is very small and clearly defined,it may be cut out during a procedure called a local excision. This is a relatively simple procedure, carried out under general anaesthetic , that usually only requires astay in hospital of a few days. If chemoradiation has been unsuccessful or the cancer has returned after treatment, a more complex operation called an abdominoperineal resection may be recommended. As with a local excision, this operation is carried out under general anaesthetic. Anabdominoperineal resection involves removing your anus, rectum, part of the colon, some surrounding muscle tissue, and sometimes some of the surrounding lymph nodes (small glands that form part of the immune system) to reduce the risk of the cancer returning. Youll usually need to stay in hospital for up to 10 days after this type of surgery. During the operation,apermanent colostomy will also be formed to allow you to pass stools. This is where asection of the large intestine is diverted through an opening made in the abdomen called a stoma. The stoma is attached to a special pouch that will collect your stools after the operation. Before and after the operation, youll see a specialist nurse who can offer support and advice to help you adapt to life with a colostomy. Adjusting to life with a colostomy can be challenging, but most people become accustomed to it over time. Read more about living with a colostomy Follow-up After your course of treatment ends, youll need to haveregular follow-up appointments to monitor your recovery and check for any signs of the cancer returning. To start with, these appointments will be every few weeks or months, but theyll graduallybecome less frequent over time. What causes anal cancer? The exact cause of anal cancer is unknown, although a number of factors can increase your risk of developing the condition. These include: infection with human papilloma virus (HPV)  a common and usually harmless group of viruses spread through sexual contact, which can affect the moist membranes lining your body having anal sex or lots ofsexual partners  possibly because this increases your risk ofdeveloping HPV having a history of cervical , vaginal or vulval cancer smoking having a weakened immune system  for example, if you have HIV Your risk of developing anal cancer increases as you get older, with half of all cases diagnosed in people aged 65 or over. The condition is also slightly more common in women than men. Further informationabout anal cancer Cancer Research UK: anal cancer Macmillan: anal cancer ",,,,,,,,,,,,,
Anaphylaxis,"Anaphylaxis - Illnesses & conditions  Immune system Anaphylaxis Anaphylaxis About anaphylaxis Causes of anaphylaxis Treating anaphylaxis Preventing anaphylaxis About anaphylaxis Anaphylaxis is a severe, potentially life-threatening allergic reaction that can develop rapidly. It is also known as anaphylactic shock. Signs of anaphylaxis include: itchy skin or a raised, red skin rash swollen eyes, lips, hands and feet feeling lightheaded or faint swelling of the mouth, throat or tongue, which can cause breathing and swallowing difficulties wheezing abdominal pain, nausea and vomiting collapse and unconsciousness What to do Anaphylaxis should always be treated as a medical emergency. If available, an injection of a medicine called adrenalineshould be given as soon as possible. Some people with a previous history of anaphylaxis will have an auto-injector of adrenaline. This should be injected into their outer thigh muscle and held in place for 5 to 10 seconds. Instructions for how to use these auto-injectors can be found on the side of each device. You should call 999 for an ambulance whether adrenaline has been given or not. If after 5 to 10 minutes the person still feels unwell, a second injection should be given. This should be given in the opposite thigh. A second dose may also be needed if the person improves and then becomes unwell again. The person should lie flat, with their legs raised on a chair or a low table. If they are having difficulty breathing, they should sit up to make breathing easier. If the person is unconscious, you should move themto therecovery position on their side, supported by one leg and one arm, with the head tilted back and the chin lifted. If the persons breathing or heart stops, cardiopulmonary resuscitation (CPR) should be performed. Further treatment will be carried out in hospital. Read more about treating anaphylaxis . Causes and triggers Anaphylaxis is the result of your bodys immune system overreacting to a harmless substance, such as food. Substances that trigger allergic reactions are known as allergens. Anaphylaxis usually develops within minutes of contact with an allergen, but sometimes the reaction can happen up to 4hours later. The most widely reported triggers of anaphylaxis are: insect stings  particularly wasp and bee stings peanuts and tree nuts other types of foodssuch as milk and seafood certain medicinessuch as antibiotics Read more about the causes of anaphylaxis . Preventing further episodes If you know what has triggered anaphylaxis, its important to take steps to avoid exposure to similar triggers. You should be referred to a specialist allergy clinic to either find out your allergy triggers or, if you already know what causes it, for further assessment and advice about how to avoid allergens in the future. You may be given two adrenaline auto-injectors to use during any future episodes of anaphylaxis. Read more about preventing anaphylaxis . Who is affected? Anaphylaxis is not common, but people of all ages can be affected. People with other allergic conditions, such as asthma or the allergic skin condition atopic eczema , are most at risk of developing anaphylaxis. Although the condition is life threatening, deaths are rare. There are around 20 deaths in the UK each year. With prompt and proper treatment, most people make a full recovery. Causes of anaphylaxis Anaphylaxis is caused by a problem with the immune system, which is the bodys natural defence against illness and infection. In the case of anaphylaxis, your immune system overreacts to a harmless substance and releases a number of different chemicals, such as histamine, to deal with the mistaken threat. Triggers Some of the more common triggers for anaphylaxis are shown below. Insect stings Most cases of anaphylaxis are caused by wasp and bee stings, although potentially any insect bite or sting can cause anaphylaxis. Its estimated around1 in 100 people will experience an allergic reaction after a wasp or bee sting, but only a small number of these people will go on to develop severe anaphylaxis. Foods More than half of all cases of food-related anaphylaxis are caused by peanuts. Other foods known to trigger anaphylaxis include: nuts such as walnuts, cashew nuts, almonds, brazil nuts and hazelnuts milk fish and shellfish eggs some types of fruit such as bananas, kiwi fruit, grapes and strawberries Medicines Medicines known to trigger anaphylaxis in a small amount of people include: antibiotics  particularly penicillin-like antibiotics general anaesthetic muscle-relaxant medicines used during surgery non-steroidal anti-inflammatory drugs (NSAIDs)  a type of painkiller that includes ibuprofen andaspirin People sensitive to these types of medicines will usually develop anaphylaxis as soon as they begin a course of treatment, although they may have safely received them in the past. The risk of anaphylaxis using these types of medicines is very small, so in most cases the benefits of treatment outweigh the potential risk. For example, the risk of developing anaphylaxis is around: 1 in 1,480after taking a NSAID-type painkiller 1 in 5,000 after taking penicillin 1 in 10,000 after being given a general anaesthetic Contrast agents Contrast agents are a group of special dyes used in some medical tests to help certain areas of your body show up better on scans such as X-rays . For example, a contrast agent injected into a blood vessel will help show up any problems in the vessel, such as a blockage, on the X-ray. This is known as angiography . The risk of developing anaphylaxis after being injected with a contrast agent is thought to be less than1 in 10,000. Rubber latex Less than 1 in 100 people in the population has anatural rubber latex allergy. Healthcare, hair, beauty, catering and motor industry workers are more likely to have a latex allergy. Those with a history of hayfever, asthma, eczema, and certain medical conditions, like spina bifida, are more likely to be affected. Idiopathic anaphylaxis Sometimes, despite extensive testing, no trigger can be found for anaphylaxis, and the cause remains unknown. This is known as idiopathic anaphylaxis. Treating anaphylaxis If you think somebody is experiencing symptoms of anaphylaxis, you should use an adrenaline injector if one is available. Dial 999 immediately afterwards. Call 999 straight away if an adrenaline injector is not available. If you can see a potential trigger, such as a wasp or bee sting stuck in their skin, carefully remove it. Adrenaline injections Adrenaline causes the blood vessels to become narrower, which raises your blood pressure and reduces swelling. It also causes the airways to open, relieving breathing difficulties. An adrenaline injection should be given as soon as a serious reaction is suspected. The signs of suspected anaphylaxis are: problems breathing feeling faint or dizzy loss of consciousness The injectioncan be done by the person with anaphylaxis, but sometimes if its a young child or someone who is unconscious, for example another person may need to do it. Before attempting the injection, make sure you know what to do. You should read all of the instructions carefully when you, or the person you are responsible for, are first prescribed the injector. After injecting, the syringe should be held in place for 5 to 10 seconds. Injections can be given through clothing. After injecting the adrenaline, you should immediately dial 999 for an ambulance, even if the person is starting to feel better. Most people should experience a rapid improvement in symptoms once the adrenaline has been used. If theres no improvement after 5 to 10 minutes, you should inject a second dose of adrenaline, if one is available. This should be injected into the opposite thigh. Read Medicines and Healthcare products Regulatory Agency (MHRA) 2014guidelines on how to use an adrenaline auto-injector (PDF, 188kb) . Positioning and resuscitation In most cases, the person should lie flat, with their legs raised on a chair or a low table, to help maintain bloodflow to the head and heart. Pregnant women should lie down on their left side to avoid putting too much pressure on the large vein that leads to the heart. If the person is conscious but having trouble breathing, they should sit up to make breathing easier. If the person is unconscious, check thattheir airways are open and clear, and also check their breathing. Then put them in the recovery position to make sure they dont choke on their vomit. Place the person on their side, making sure they are supported by one leg and one arm. Open the airway by tilting the head and lifting the chin. If the persons breathing or heart stops, cardiopulmonary resuscitation (CPR) should be performed. Admission to hospital Even if adrenaline is given, the person will need to go to hospital for observation usually for6 to 12 hours  as symptoms can occasionally return during this period. While in hospital, an oxygen mask can be used to help breathing, and fluids given by an intravenous drip directly into a vein can help increase blood pressure. As well as adrenaline, additional medications such asantihistamines and corticosteroids can be used to help relieve symptoms. Blood tests may also be carried out while youre in hospital to confirm anaphylaxis. You should be able to leave hospital when the symptoms are under control and its thought they will not return quickly. This may be after a few hours, but you may have to stay in hospital for a few days if the symptoms were severe. You may be asked to take antihistamines and corticosteroid tablets 2to 3days after leaving hospital to help stop your symptoms returning. You will probably be asked to attend a follow-up appointment so you can be given advice about how you can avoid further episodes of anaphylaxis. An adrenaline auto-injector may be given to you for emergency use between leaving hospital and attending the follow-up appointment. Read more about preventing anaphylaxis . Preventing anaphylaxis If you have anaphylaxis, you should be offered advice and medication to help prevent further episodes. Allergy clinic You should be referred to a specialist allergy clinic for tests to find out what caused the anaphylaxis. Knowing what allergen triggered the allergic reaction can help you avoid further episodes of anaphylaxis. Some of the tests commonly used to determine allergies include: a skin prick test  your skin is pricked with a tiny amount of a suspected allergen to see if it reacts by becoming red, raised and itchy a blood test  a sample of your blood is taken to test its reaction to a suspected allergen Read more about diagnosing allergies . Adrenaline auto-injectors You may be prescribed an adrenaline auto-injector if youve had a previous episode of anaphylaxis and theres a risk of you having another episode in the future. There are 3types of auto-injector: EpiPen Jext Emerade Each type is slightly different, and you should make sure you know how to use your auto-injector correctly. You can also ask for a trainer kit so you can practise giving yourself or your child injections. The following points are important: Carry your auto-injector(s) at all times  there should be no exceptions. It may also be recommended that you get an emergency card or bracelet with full details of your allergy and doctors contact details to alert others. Extremes of heat can make adrenaline less effective, so dont leave your auto-injector inthe fridge or your cars glove compartment. Check the expiry date regularly. An out-of-date injector will offer limited protection. The manufacturers offer a reminder service, where you can be contacted near the expiry date. Check the information leaflet that comes with your medicine for more information. If your child has an auto-injector, they will need to change over to an adult dose once they reach 30kg (approximately4.5 stone). Dont delay injecting yourself if you think you may be experiencing the beginning of anaphylaxis, even if your initial symptoms are mild. Its better to use adrenaline early and then find out it was a false alarm than delay treatment until youre sure you are experiencing severe anaphylaxis. Avoid triggers If a trigger has been identified as causing your episode of anaphylaxis, you will need to take steps to avoid it in the future. Food You can reduce the chances of being exposed to a food allergen by: checking food labels letting staff at a restaurant know what youre allergic to, so its not included in your meal remembering that some types of food may contain small traces of potential allergens  for example, some sauces contain wheat and peanuts Seeour page on living with a food allergy for more information. Insect stings You can reduce your risk of being stung by an insect by taking basic precautions, such as: moving away from wasps, hornets or bees slowly without panicking  dont wave your arms around or swat at them using an insect repellent if you spend time outdoors, particularly in the summer Some specialist allergy centres also offer special treatment to help desensitise you to insect stings if you are at a particularly high risk of a further sting for example, if you area beekeeper or gardener. Read more about preventing insect stings . Medicines If youre allergic to certain types of medicines, there are normally alternatives that can be safely used. For example, if youre allergic to: penicillin  you can normally safely take a different group of antibiotics known asmacrolides non-steroidal anti-inflammatory drugs (NSAIDs) , such as ibuprofen and aspirin  you can normally safely take paracetamol , but read the ingredients of things like colds medicines carefully to make sure they dont contain NSAIDs one type of general anaesthetic  others are available, or it may be possible to perform surgery using a local anaesthetic or anepidural injection angiotensin-converting enzyme (ACE) inhibitors  alternative blood pressure medications, such as calcium channel blockers, can be used Always tell any healthcare professional about medicine allergies you have, as they may not be aware of them. Contrast agents There may be times when its necessary to use contrast agents  for example, if you had bleeding inside your brain  even if this places you at risk of anaphylaxis. In such circumstances, you can be given injections ofantihistamines and corticosteroids before the contrast agents, which may help prevent symptoms occurring or at least make them less severe. ",,,,,,,,,,,,,
Angina,"Angina- Illnesses and conditions Heart and blood vessels Conditions Angina Angina About angina Treating angina About angina Angina is chest pain which occurs when the blood supply to the heart becomes restricted because of narrowing or blockages in the blood vessels around the heart. Symptoms of angina The main symptom of angina is chest pain. This can: feel like a dull pain, ache, heavy or tight feeling in your chest spread to your arms, neck, jaw or back be triggered by physical exertion Angina itself is not life threatening, but prolonged chest pain can be a symptom of a heart attack. Phone 999 immediately if: You or someone else has symptoms like: central chest pain or discomfort in the chest that doesnt go away  it may feel like pressure, tightness or squeezing pain that radiates down the left arm, or both arms, or to the neck, jaw, back or stomach unconsciousness seizures or fitting difficulty breathing (snoring or rasping) chest pain alongside breathlessness, nausea and sweating Speak to your GP if you: do not have a diagnosis of angina and experience chest pain on exercise that eases after a few minutes of resting have an angina diagnosis and your symptoms are becoming more frequent or occur at rest If your GP is closed, phone 111. Diagnosing angina To diagnose angina, you will be assessed and you may need to have several tests. You will also be asked some questions about: the symptoms you experienced if there were any triggers for the pain your familys medical history lifestyle risk factors (like smoking, for example) Tests for angina You might also be given some tests to determine if you already have heart disease or youre at risk of it. measuring your weight measuring blood pressure taking blood to check cholesterol levels, diabetes or anaemia If its thought that you have angina, you might be referred to the hospital for some more tests. These might include: electrocardiogram (ECG)  measures the rhythms and electrical activity of the heart exercise tolerance test (ETT)  measures the activity of the heart during exercise myocardial perfusion scan (MPS or MYoview)  measures how well blood is reaching the heart coronary angiography  shows whether your coronary arteries are narrow and how severe any blockages are blood tests  help to identify increased enzyme levels (troponin) which are released when the heart is damaged Types of angina The 2 main types of angina are stable angina and unstable angina. Stable angina is more common. Attacks are more likely to have a trigger (like physical activity or stress). Symptoms of stable angina usually only last for a few minutes after exercise or stress. They can improve with rest and by taking a medication called Glyceryl trinitrate (GTN). Attacks of unstable angina can be unpredictable and develop without any clear triggers. They might also last longer and continue even when resting. Sometimes, when chest pain occurs suddenly, its unclear if its due to unstable angina or a heart attack. Until tests confirm the diagnosis, doctors sometimes call this Acute Coronary Syndrome (ACS). Treating angina There are various ways to treat and manage angina. Stable angina If you have stable angina you may be given medicine to: prevent and treat angina attacks reduce your risk of a heart attack Preventing and treating angina attacks Nitrates You may be given nitrates if you have stable angina. These work by relaxing the muscles in the blood vessels so that blood can pass through more easily. You might be given nitrates as: slow release tablets a fast acting spray or tablet Glyceryl trinitrate (GTN) is usually given in a fast acting spray or tablets. You should keep this with you at all times. If you experience an episode of angina you can use the spray or tablet under your tongue. The pain should then ease within a few minutes. You can repeat the dose after 5 minutes if the pain has not gone away. If the pain has still not gone 5 minutes after you take the second dose you should call an ambulance. Beta blockers Beta blockers work mainly by slowing down the heart. Calcium channel blockers Calcium channel blockers relax the arteries, increasing blood supply to the heart muscle. If you cannot have beta blockers or calcium channel blockers, you may be given another medicine. Your doctor will discuss this with you. Reducing your risk of a heart attack or stroke To reduce your risk of more serious cardiovascular problems, your doctor might give you: a low dose of aspirin to prevent blood clots statins to reduce your cholesterol (blood fats) level ACE inhibitors to reduce your blood pressure Unstable angina Worsening angina symptoms over a short period of time can be a sign of a more acute coronary syndrome and you should seek urgent medical advice by phoning 999. If you have unstable angina (where symptoms develop unpredictably), youll need certain medicines. These will prevent blood clots and reduce your risk of having a heart attack. You may be given: low-dose aspirin clopidogrel Ticagrelor Surgery may be recommended if you continue to have angina attacks despite medical treatment. It may also be recommended if tests show that youre at a high risk of having a heart attack. Surgery for angina There are 2 types of procedures that are used to treat angina. These are a: coronary artery bypass graft (CABG) percutaneous coronary intervention (PCI) The best option for you depends on your circumstances. You should discuss the different options with your doctor. Its likely that you will need to continue taking some medicines after surgery. Coronary artery bypass graft (CABG) A CABG is where a section of a blood vessel is taken from another part of the body. This is then used to re-route the flow of blood past a blocked or narrow section of artery. Percutaneous coronary intervention (PCI) PCI is where a narrowed section of artery is widened using a balloon and a tiny tube called a stent. Its also known as a coronary angioplasty. ",,,,,,,,,,,,,
Angioedema,"Angioedema - Illnesses and conditions Skin, hair and nails Angioedema Angioedema About angioedema Symptoms of angioedema Causes of angioedema Diagnosing angioedema Treating angioedema About angioedema Angioedema is the swelling of the deeper layers of the skin, caused by a build-up of fluid. The symptoms of angioedema can affect any part of the body, butswelling usuallyaffects the: eyes lips genitals hands feet Many people with angioedema also experience urticaria (hives) . This is a raised, red and itchy rash that appears on the skin. Angioedema can cause swelling in any part of the body, including the lips. Source: https://dermnetnz.org/ Angioedema can cause swelling around the eye. Source: https://dermnetnz.org/ Why does angioedema happen? The cause of angioedema depends on the type you have. There are 4main types of angioedema: allergic angioedema the swelling is caused by an allergic reaction, such as a reaction to peanuts, and sometimes occurs in combination with anaphylaxis idiopathic angioedema there is no known cause for the swelling (although certain factors, such as stress or infection, may trigger the symptoms) drug-induced angioedema the swelling is a side effect of certain medications,most oftenangiotensin-converting enzyme (ACE) inhibitors hereditary angioedema the swelling is caused by faulty genes that are inherited from a persons parents Read more about the causes of angioedema . Who is affected Angioedema is a common condition, affecting about 10-20% of people during their life, althoughsome types are more common than others. Hereditary angioedema is rare, only affecting between 1 in 10,000and 1 in 50,000 people worldwide. Diagnosis Your doctor candiagnose angioedema by examining the affected skin anddiscussing symptoms. However, further tests, such as blood tests or allergy tests,may be required to determine the type of angioedema. Idiopathic angioedema is only diagnosed if no cause can be found. Read more about diagnosing angioedema . How is angioedema treated? Although most cases of angioedema get better without treatment after a few days, medication is often used. For cases of allergic and idiopathic angioedema, antihistamines and oral steroids (steroid tablets) can be used to relieve the swelling. Drug-induced angioedema can usually be treated byusing an alternative medication to treat whatever underlying condition you have. Although the condition cannot be cured, regular drug treatment can prevent attacks in people with hereditary angioedema. Read more about treating angioedema . Symptoms of angioedema The main sign of angioedema is swelling that develops below the skins surface. Swollen skin The swelling is caused by a collection of fluid in the deep layers of the skin. It most often affects the hands, feet, eyes, lips, or genitals. In severe cases, the inside lining of the throat and bowel can be affected (see below). The swellingusually appears suddenly, and is more severe than normal hives (nettle rash). It commonly lasts 1to 3days. There may be a prickling sensation in the affected area before swelling is visible. The swelling is not itchy and the skin may look a normal colour; however, many people with allergic or idiopathic angioedema also develop urticaria (hives) , which is red and itchy. Swelling caused by angioedema often affects the hands and feet. Source: https://dermnetnz.org/ Other symptoms As well as visible swellings, angioedema can cause other symptoms, including: a hot or painfulsensation in the swollen areas swelling of the inside of the throat, thewindpipe and the tongue, making breathing difficult swelling of the conjunctiva (the transparent layer of cells that cover the white part of the eye), which affectsvision People with hereditary angioedema may also experience: abdominal (stomach) pain caused by swelling in the stomach and bowel, which can cause nausea, vomiting and diarrhoea swelling of the bladder or urethra (the tube that connects the bladder to the genitals), which can cause bladder problems and difficulty passing urine When to seek medical advice Contact your GP if you have an episode of angioedema that does not affect your breathing and you have not previously been diagnosed with the condition. You will need to have tests to determine what type of angioedema you have. When to seek emergency medical advice Dial 999 to request an ambulance if you suspect that you, or someone you know, is experiencing anaphylaxis (a severe allergic reaction) . Tell the operator that you suspect anaphylaxis. Initial symptoms of anaphylaxis include: a feeling of tightness in the chest that leads tobreathing problems swelling of the tongue and throat If you, or the person in your care, has previously been prescribed an adrenaline auto-injector pen, you should use it while waiting for the ambulance to arrive. Causes of angioedema Angioedema is often caused by a problem with the immune system, although there are many cases where no cause can be identified. Allergic angioedema Normally, your immune system protects your body from illness and infection by attacking germs in your body. In allergic angioedema, your immune system mistakenly attacks harmless substances in your blood. Your body produces the chemical histamine, which causes the blood vessels in the area to expand, leading to swelling of the skin. Substances known to trigger allergic angioedema include: certain types of food  particularly nuts, shellfish, milk and eggs some types of medicationsuch as penicillin, aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) , such as ibuprofen insect bites and stings  particularly wasp and bee stings latex  a naturally occurring rubber used to make medical gloves, balloons and condoms Idiopathic angioedema Cases of angioedema without an identifiable cause are known as idiopathic angioedema. It may be that a problem with the immune system sometimes causes it to misfire. In cases ofidiopathic angioedema, certain triggers may lead to swelling, such as: anxiety or stress minor infections hot or cold temperatures exercise Avoiding these triggers whenever possible may improve your symptoms. Drug-induced angioedema Some medications can cause angioedema. Angiotensin-converting enzyme (ACE) inhibitors, which are used to treat high blood pressure (hypertension) , are usually responsible. Its estimated that around1-5% ofpeople taking ACE inhibitors will develop drug-induced angioedema. Black people being treated with ACE inhibitors are 3to 4times more likely to develop this side effect than white people. Around 1in 4cases of drug-induced angioedema occurs during the first month of taking an ACE inhibitor. The remaining cases develop many months or even years after treatment begins. While they are useful in lowering blood pressure, ACE inhibitors can sometimes disrupt the chemical balance and trigger an episode of severe swelling. Less common causes of drug-induced angioedema include: bupropion a medication that helps people to give up smoking vaccines selective serotonin reuptake inhibitors (SSRIs)  a type of antidepressant COX-II inhibitors  a type of painkiller used to treat chronic pain conditions such as arthritis NSAIDs  a type of painkiller, such as aspirin or ibuprofen angiotensin-2 receptor antagonists another medication used to treat high blood pressure statins used to treat people with high cholesterol levels proton pump inhibitors (PPIs) used to treat stomach ulcers Hereditary angioedema Hereditary angioedema is caused by a genetic mutation (a change in the DNA) in the C1 esterase inhibitor (C1-inh) gene. Genes are single units of genetic material that code for characteristics such as eye and hair colour. As a result of the mutated C1-inhgene, the body does not make enough C1-inhprotein. This protein plays an important role in regulating the immune system. Without enough C1-inhprotein, the immune system can misfire and trigger the symptoms of angioedema. Certainthings are thought to trigger hereditary angioedema, such as: traumaincluding surgery or infection the oral contraceptive pill pregnancy The mutated C1-inh gene is passed down through families. If you have hereditary angioedema, you have a50% chance of passing it on to your children. Diagnosing angioedema Angioedema is usually diagnosed by your doctor examining the affected skin and discussing your symptoms. It can be difficult to find the exact cause and identify which type of angioedema you have. There is no single test available, but you may have allergy tests orblood tests if a specific cause is suspected. Allergic angioedema Youre likely to be asked ifyou have recently been exposed to any allergy-causing substances, such as nuts or latex.You may also be asked whether you have a history of other allergic conditions, such as urticaria (hives) or asthma . People with an allergic condition often develop other allergic conditions. Tell your doctor about any medications you are taking, including over-the-counter medication, such as painkillers, herbal supplements and vitamins. Your GP may recommend that you keep a diary of your exposure to possible irritants  or a food diary, if a food allergy is suspected. If allergic angioedema is suspected, you arelikely to be referred to a specialist allergy or immunology clinic for further testing. Tests may include: a skin prick test your skin is pricked with a tiny amount of the suspected allergen to see whether there is a reaction a blood test  a sample of your blood is tested to determine whether your immune system reacts to a suspected allergen Read more about diagnosing allergies . Drug-induced angioedema If you are taking a medication known to cause drug-induced angioedema, your GP will withdraw that medication and prescribe an alternative. You should not stop taking any prescribed medication without advice from a health professional. If you dont have any further episodes of angioedema, a diagnosis of drug-induced angioedema can be made. Hereditary angioedema Hereditary angioedema can be diagnosed using a blood test to check the level of proteins regulated by the C1-inh gene. A very low level would suggest hereditary angioedema. The diagnosis and management of hereditary angioedema is highly specialised and should be carried out in a specialist immunology clinic. Idiopathic angioedema Idiopathic angioedema is usually confirmed by a diagnosis of exclusion. This means a diagnosis of idiopathic angioedema can only be made after all the above tests have been carried out and a cause has not been found. As angioedema can be associated with other medical problems  such as an iron deficiency, liver diseases and problems with the thyroid gland  your doctor or specialist will undertake some simple blood tests to check for these conditions. Treating angioedema Medication is the main treatment for angioedema, although many cases get better after a few days without treatment. Allergic angioedema and idiopathic angioedema are usually treated in the same way, using a combination of antihistamines and corticosteroids to help relieve the swelling. Drug-induced angioedema can usually be treated by using an alternative medication to the one causing your symptoms. If you also had symptoms of anaphylaxis during an episode of angioedema, you will probably be given an adrenaline auto-injector pen in case your symptoms return. Read more about treating anaphylaxis . Hereditary angioedema cannot be cured and does not respond to adrenaline, antihistamines or steroids, so a preventative approach is taken.A number of different medications are used to stabilise the protein levels in your blood to help prevent symptoms developing. Antihistamines Antihistamines work by blocking the effects of a protein called histamine, which is one of the chemicals responsible for causing your skin to swell. A 2-week course ofa non-sedating type of antihistamine (which does not cause drowsiness) is usually recommended  these include fexofenadine and cetirizine. Cetirizine can be bought over the counter in pharmacies and supermarkets without a prescription. Antihistamines can also be given by injection at hospital or your GP surgery. If you also have urticaria (hives) and are being kept awake at night by itchy skin, your GP may prescribe an older type of antihistamineto take before going to bed. These typescause drowsiness and should help you sleep. A minority of people will still experience drowsiness after taking the newer type of antihistamines. If you find yourself feeling drowsy, you should avoid: driving drinking alcohol operating complex or heavy machinery Other side effects of the newer antihistamines include: headache dry mouth dry nose These side effects are usually short-lived and should pass quickly. Corticosteroids Corticosteroids (steroids) work by blocking many of your immune systems actions. In most cases, a 3to 5day course of steroid tablets is recommended. A steroid called prednisolone is the preferred choice. Side effects of prednisolone include: nausea abdominal (stomach) pain tiredness oral thrush a fungal infection inside your mouth dizziness If you feel dizzy after taking prednisolone, avoid driving and operating heavy machinery. These side effects should pass once you finish the course of treatment. Steroid injections may be needed for more severe cases of angioedema. These are usually administered in hospitals or at specialist clinicsby an allergy specialist or immunologist (a doctor who specialises in treating conditions that affect the immune system). Medication for hereditary angioedema The medication used to treat hereditary angioedema falls into 1of 2categories: medication used to prevent angioedema medication used to relieve symptoms Danazol Danazol is a synthetic hormone that is effective in preventing the symptoms of angioedema because it helps boost levels of the C1-inh protein. However, danazol can cause a number of unpleasant side effects if used on a long-term basis. For example, it may cause: weight gain depression disruption to the menstrual cyclesuch asirregular periods orabsent periods high blood pressure in women, changes to the body that are usually associated with mensuch as excessivebody hair growth, flattening of the chest, deepening of the voice and an increase in muscle tone liver problems Due tothese side effects, many people with hereditary angioedema are uneasy about using danazol on a long-term basis. Stanozolol is a similar medication that is slightly better tolerated. Tranexamic acid Tranexamic acid is also an alternative medication to danazol. It can be as effective as danazol, but does not cause as many side effects and is preferred for use in women. Icatibant Icatibant is a relatively new medication used to treat acute (short-lasting) episodes of swelling. It works by blocking the effects of some of the chemicals that are responsible for causing the swelling in cases of hereditary angioedema. Icatibant is given by injection under the skin, and asecond injection is often required. Common side effects of icatibant include: adverse skin reactions at the site of the injectionsuch as pain, redness, swelling or itchiness itchiness in other areas of the skin dizziness C1-inhibitors Purified C1-inhibitor concentrate is widely used to replace the missing protein in the blood. Its needed for patients undergoing surgery, to prevent attacks caused by surgical trauma. Its used to treat acute attacks and is injected directly into the vein. Many patients will keep supplies of their concentrate at home for emergency use. Icatibant and C1-inhibitor concentrate will be prescribed by the specialist immunology unit caring for the patient with hereditary angioedema.",,,,,,,,,,,,,
Ankylosing spondylitis,"Ankylosing spondylitis (AS) - Illnesses and conditions Muscle, bone and joints Conditions Ankylosing spondylitis Ankylosing spondylitis About ankylosing spondylitis Symptoms of ankylosing spondylitis Causes of ankylosing spondylitis Diagnosing ankylosing spondylitis Treating ankylosing spondylitis Complications of ankylosing spondylitis About ankylosing spondylitis Ankylosing spondylitis (AS) is a long-term (chronic) condition in which the spine and other areas of the body become inflamed. Thesymptoms of AS can vary but usually involve: back pain and stiffness that improves with exercise and isnt relieved by rest pain and swelling in other parts of the body, such as the hips, knees and ribs fatigue (extreme tiredness) These symptoms tend to develop gradually, usually over several months or years, and may come and go over time. In some people, the condition gets better with time, but for others it can get slowly worse. Read more about the symptoms of ankylosing spondylitis When to seek medical advice You should see your GP if you have persistent symptoms of AS. If your GP thinks you may have the condition, theyshould refer you to a rheumatologist (a specialist in conditions affecting muscles and joints) for further tests and any necessary treatment. Read more about diagnosing ankylosing spondylitis . What causes ankylosing spondylitis? In AS, various areas of the spine and other joints become inflamed. As well as causingpain, stiffness and swelling, this inflammation can damage affected areas of the body over time, and in some cases can lead tosome of the individual bones of the spine fusing (joining together). This fusing of the spine is known as ankylosis. It is not known what causes the condition, but there is thought to be a link with a particular gene known as HLA-B27. Read more about the causes of ankylosing spondylitis . Who is affected AS tends to first develop in teenagers and young adults. Most cases first start in people aged 20-30, with only a minority of cases first affecting adults over 45. AS is around three times more common in men than in women. There are around 200,000 people in the UK who have been diagnosed with the condition. How ankylosing spondylitis is treated There is no cure for AS and it is not possible to reverse the damage caused by the condition. However, treatment is available to relieve the symptoms and help prevent or delay its progression. In most cases, treatment will involve a combination of: exercises carried out individually or in groups to reduce pain and stiffness physiotherapy  where physical methods, such as massage and manipulation, are used to improve comfort and spinal flexibility medication to help relieve pain and reduce inflammation  such aspainkillers anda type of medicine calledanti-TNF medication Surgery is sometimes needed to repair significantly damaged joints or correct severe bends in the spine, but this is uncommon. Read more about treatingankylosing spondylitis . Outlook The outlook for AS is highly variable. For some people, the condition improves after an initial period of inflammation, whereas for others the condition can get progressively worse over time. Around 70-90% of people with ASremain fully independent or minimally disabled in the long term. However,some people eventually become severely disabled due to the bones in their spine fusing in a fixed position and damage to other joints, such as the hips or knees. With modern treatments, AS doesnt normally affect life expectancy significantly, although the condition is associated with an increased risk of other potentially life-threateningproblems. For example, AS can lead to osteoporosis (weakening of the bones), spinal fractures and cardiovascular disease (a group of conditions affecting the heartand blood vessels). Readmore about the complications of ankylosing spondylitis . Information about you If you have AS, your clinical team will pass information about you on to the National Congenital Anomaly and Rare Diseases Registration Service (NCARDRS). This helps scientists look for better ways to prevent and treat this condition. You can opt out of the register at any time. Find out more about the register . Symptoms of ankylosing spondylitis The symptoms of ankylosing spondylitis (AS) can vary from person to person, but usually develop slowly, over several months or years. ASusually first starts to developduringlater teenage years or early adulthood. The symptoms maycome and go, and improve or get worse over many years. Main symptoms The main symptoms ofAS are described below, although you may not develop all of these if you have the condition. Back pain and stiffness Back painand stiffness are usually the main symptoms of AS.You may find: thepain gets better with exercise but doesnt improve, or gets worse, with rest the pain and stiffness is worse in the morning and at night  you may wake up regularly during the night because of the pain you have pain inthe area around yourbuttocks Arthritis As well as causing symptoms in your back and spine, AS canalso cause inflammation of the joints ( arthritis ) in other parts of your body, such as your hips and knees. The main symptoms associated with arthritis are: pain on moving the affected joint tenderness when the affected joint is examined swelling and warmth in the affected area Enthesitis Enthesitis is painful inflammation where a bone is joined to a tendon (a tough cord of tissue that connects muscles to bones) or a ligament (a band of tissue that connects bones to bones). Common sites for enthesitis are: at the top of the shin bone behind the heel (Achilles tendon) under the heel wherethe ribs join to the breast bone If your ribs are affected, you may experience chest pain, and you may find it difficult to expand your chest when breathing deeply. Fatigue Fatigue is a common symptom of untreated AS. It can make you feel tired and lacking in energy. When to seek medical advice You should see your GP if you have persistent symptoms of AS. If your GP thinks you may have the condition, they should refer you to a rheumatologist (a specialist in conditions affecting muscles and joints) for further tests and any necessary treatment. Read more about diagnosing ankylosing spondylitis . Causes of ankylosing spondylitis In ankylosing spondylitis (AS), several parts of the lower spine become inflamed, including the vertebrae (bones in the spine) and spinal joints. Over time, this can damage the spine and lead to the growth of new bone, which in some cases can cause parts of the spine to join up (fuse) and lose flexibility. This is known as ankylosis. It is not known exactly what causes AS, but in many cases there seems tobe a link with a particular gene known as HLA-B27. HLA-B27 gene Research has shown that more than 9 out of 10 peoplewith AS carry a particular gene known as human leukocyte antigen B27 (HLA-B27). Having this gene does not necessarily meanyou will develop AS. It is estimated that 8 in every 100 people in the general population have the HLA-B27 gene, but most do not have AS. It is thought that having this gene may make you more vulnerable to developing AS, and the condition is triggered by one or more environmental factors  although it is not known what these are. Testing for this gene may be carried out if AS is suspected. However, this testis not a very reliable method of diagnosing the condition because some people can have the HLA-B27 gene but not have ankylosing spondylitis. Read about how ankylosing spondylitis is diagnosed . Can ankylosing spondylitis be inherited? AScan run in families, and the HLA-B27 gene can be inherited from another family member. If youhaveAS and tests have shown you carry the HLA-B27 gene, the chance ofany children you have developing the condition is less than 20%. If you have AS but dont carry the HLA-B27 gene,the chance of any children you have developing the condition is less than 10%. If you have a close relative who has AS, such as a parent or a sibling (brother or sister), you are three times more likely to develop the condition compared with someone who does not have a relative with the condition. Diagnosing ankylosing spondylitis Ankylosing spondylitis (AS) can be difficult to diagnose because the condition develops slowly and there is no definitive test to confirm a diagnosis. The first thing you should do if you think you have AS is to see your GP. They will ask about your symptoms, including what symptoms you are experiencing, when they started and how long you have had them. Back pain associated withAS can bequite distinctive. For example, it usually doesnt improve with rest and may wake you up during the night. Blood tests If your GP suspects AS, they may arrange blood tests to check for signs of inflammation in your body.Inflammation in your spine and joints is one of the main symptoms of the condition. If yourresultssuggest you do have inflammation, youwill be referred to a rheumatologist for further tests. A rheumatologist is a specialist in conditions that affect muscles and joints. Further tests Your rheumatologist will carry out imaging tests to examine the appearance of your spine and pelvis, as well as further blood tests. These are described below. X-rays An X-ray of your lower back can showdamage to the joints at the base of your spine (the sacroiliac joints) andnew bone forming between the vertebrae (bones in your spine), which are common signs of advanced AS. MRI scan A magnetic resonance imaging (MRI) scan may highlight changes in your sacroiliac joints that might not show up on an X-ray. It may also show any inflammation of ligaments in the spinal region. Ultrasound scan An ultrasound scan can pick up inflammation of the tissues (tendons and ligaments) attached to your bones. Genetic testing A genetic blood testmay sometimesbe carried out to see if you carry theHLA-B27 gene, which is found in most people with AS. This can contribute towards a diagnosis of AS, but it is not entirely reliable as not everyone withthe conditionhas this gene, and some people have the gene without ever developing AS. Confirming ankylosing spondylitis Although scans can sometimes show spinal inflammation and fusing of the spine (ankylosis), damage to the spine cannot always be picked up in the early stages of AS. This is whydiagnosis is often difficult. In many cases, confirming a diagnosis is a long process that can take years. A diagnosis of AS canusuallybe confirmed if an X-ray shows sacroiliitis (inflammation of the sacroiliac joints) and you have at least one of the following: at least three months of lower back pain that gets better with exercise and doesnt improve with rest limited movement in your lumbar spine (lower back) limited chest expansion compared to what is expected for your age and sex If you have all three of these features but do not have sacroiliitis  or if you only have sacroiliitis  you will be diagnosed with probable ankylosing spondylitis. Treating ankylosing spondylitis There is no cure for ankylosing spondylitis (AS), but treatment is available to help relieve the symptoms. Treatment can also help delay or prevent the process of the spine fusing (joining up) and stiffening. In most cases, treatment will involve a combination of exercise, physiotherapy and medication, which are described below. Physiotherapy and exercise Keeping active can improve your posture and range of spinal movement, along with preventing your spine from becoming stiff and painful. As well as keeping active, physiotherapy is a key part of treating AS. A physiotherapist (a healthcare professional trained in using physical methods of treatment) can advise about the most effective exercises and draw up an exercise programme that suits you. Types of physiotherapy recommended for AS include: a group exercise programme  where you exercise with others an individual exercise programme  you are given exercises to do by yourself massage  your muscles and other soft tissues are manipulated to relieve pain and improve movement (the bones of the spine should never be manipulated as this can cause injury in people with AS) hydrotherapy  exercise in water (usually a warm, shallow swimming pool or a special hydrotherapy bath); thebuoyancy ofthe water helps make movement easierby supporting you, and the warmth can relax your muscles Some people prefer to swim or play sport to keep flexible. This is usually fine, although some daily stretching and exercise is also important. If youre ever in doubt, speak to your physiotherapist or rheumatologist before taking up a new form of sport or exercise. The National Ankylosing Spondylitis Society (NASS) provides detailed information about different types of exercise to help you manage your condition. Painkillers You may need painkillers to manage your condition while you are being referred to a rheumatologist. The rheumatologist may continue prescribing painkillers, although not everyone needs them all the time. Non-steroidal anti-inflammatory drugs (NSAIDs) The first type of painkiller usually prescribed is a non-steroidal anti-inflammatory drug (NSAID) . As well as helping to ease pain, NSAIDs can help relieve swelling (inflammation) in your joints. Examples of NSAIDs include ibuprofen , naproxen and diclofenac. When prescribing NSAIDs, your GP or rheumatologist will try to find the one that suits you, and the lowest possible dose that relieves your symptoms. Your dose will be monitored and reviewed as necessary. Paracetamol If NSAIDs are unsuitable for you, an alternative painkiller, such as paracetamol , may be recommended. Paracetamol rarely causes side effects and can be used in women who are pregnant or breastfeeding. However, paracetamol may not be suitable for people with liver problems or those dependent on alcohol. Codeine If necessary, as well as paracetamol, you may also be prescribed a stronger type of painkiller called codeine. Codeine can cause side effects includingfeeling sick, vomiting, constipation and drowsiness. Anti-TNF medication If your symptoms cannot be controlled using painkillers or exercising and stretching, anti-TNF (tumour necrosis factor) medication may be recommended. TNF is a chemical produced by cells when tissue is inflamed. Anti-TNF medications are given by injection and work by preventing the effects of TNF, as well as reducing inflammation in your joints caused by ankylosing spondylitis. Examples of anti-TNF medication include adalimumab, etanercept and golimumab. These are relatively new treatments for AS, and their long-term effects are unknown. However, they have been used for longer in people with rheumatoid arthritis ,and this is providing clearer information about their long-term safety. If your rheumatologist recommends using anti-TNF medication, the decision about whether they are right for you must be discussed carefully and your progress will be closely monitored. This is because anti-TNF medication can interfere with the immune system (the bodys natural defence system), increasing your risk of developing potentially serious infections. NICE guidelines The National Institute for Health and Care Excellence (NICE) has produced guidance about the use ofanti-TNF medication for AS. NICE states that adalimumab, etanercept and golimumab may only be used if: your diagnosis of ankylosing spondylitis has been confirmed your level of pain is assessed twice (using a simple scale that you fill in) 12 weeks apart and confirms your condition has not improved your Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) is tested twice, 12 weeks apart, and confirms your conditionhas not improved  BASDAI is a set of measures devised by experts to evaluate your condition, by asking a number of questions about your symptoms treatment with two or more NSAIDs for four weeks at the highest possible dose has not controlled your symptoms After 12 weeks of treatment with anti-TNF medication, your pain score and BASDAI will be tested again to see whether they have improved enough to make continuing treatment worthwhile. If they have, treatment will continue and you will be tested every 12 weeks. If there is not enough improvement after 12 weeks, you will be testedagain at a later dateor the treatment will be stopped. Corticosteroids Corticosteroids have a powerful anti-inflammatory effect and can be taken as tablets or injections by people with AS. If a particular joint is inflamed, corticosteroids can be injected directly into the joint. After the injection, you will need to rest the joint for up to 48 hours. It is usually considered wise to have a corticosteroid injection up to three times in one year, with at least three months between injections in the same joint. This is because corticosteroids injections can cause a number of side effects, such as: infection in response to the injection the skin around the injection may change colour (depigmentation) the surrounding tissue may waste away a tendon (cord of tissue that connects muscles to bones) near the joint may rupture (burst) Corticosteroids may also calm down painful swollen joints when taken as tablets. Disease-modifying anti-rheumatic drugs (DMARDs) Disease-modifying anti-rheumatic drugs (DMARDs) are an alternative type of medication often used to treat other types of arthritis. DMARDs may be prescribed for AS, although they are only beneficial in treating pain and inflammation in joints in areas of the body other than the spine. Two DMARDs sometimes used to treat inflammation of joints other than the spine include sulfasalazine and methotrexate. Surgery Most people with AS will not need surgery. However, in cases where a joint has become severely damaged,joint replacement surgery may be recommended to improve pain and movement in the affect joint. For example, if thehip joints are affected, a hip replacement may be carried out. In rare cases, corrective surgery may be neededif the spine becomes badly bent. Follow-up As the symptoms ofAS develop slowly and tend to come and go, you will need to see your rheumatologist or GP for regular check-ups. They will make sure your treatment is working properly and may carry out physical assessments to assess how your condition is progressing. This may involve further sets of the same blood tests or X-rays you had at the time of your diagnosis. Any complications of ankylosing spondylitis that arise will be treated as they develop. Complications of ankylosing spondylitis Ankylosing spondylitis (AS) is a complex condition that can affect many parts of your body. It can cause complications in your day-to-day life and lead to additional health conditions. Some complications associated with AS are outlined below. Reduced flexibility Although most people with AS remain fully independent or minimally disabled in the long term, around4 in every 10 people with the condition will eventually have severely restricted movement in their spine. This usually only affects the lower back and isthe result of the bones in the spine fusing (joining up). Fusing of the spine can make it difficult to move your back and can mean yourposture becomes fixed in one position,although it doesntlead to severe disability in most cases. In rare cases, surgery may be recommended to correct severe bends in the spine. Joint damage AS can cause joints such as the hips and knees to become inflamed.This can damagethe affected joints over time, making them painful and difficult to move. If a joint becomes particularly damaged, you may need surgery to replace it with an artificial one. Iritis Iritis, also known as anterior uveitis, is a condition sometimes associated with AS where the front part of the eye becomes red and swollen. It usually only affects one eye, rather than both. If you have iritis, your eye may become red, painful and sensitive to light (photophobia). Your vision may also become blurred or cloudy. You should visit your GP as soon as possible if you have AS and think you may have developed iritis, as the condition can cause the loss of some or all of your vision if not treated promptly. If your GP thinks you have iritis, they will refer you urgently to an ophthalmologist (a medical doctor who specialises in eye problems) for treatment. Iritis can usually be treated with corticosteroid eye drops. Osteoporosis and spinal fractures Osteoporosis is where the bones become weak and brittle. In AS, osteoporosis can develop in the spine and can increase your risk of fracturing the bones in your backbone.The longer you have the condition, the more this risk increases. If you do develop osteoporosis, you will usually need to take medication to help strengthen your bones. There are a number of medications that can be used to treat osteoporosis, which can be taken by mouth (orally) as tablets or given by injection. Read moreabout treating osteoporosis . Cardiovascular disease If you have AS, you may also have an increased risk of developing cardiovascular disease (CVD) .CVD is a general term that describes a disease of the heart or blood vessels, such as heart disease and stroke . Due to this increased risk, it is important to take steps to minimise your chances of developingCVD. Your rheumatologist (a specialist in treating muscle and joint conditions) can advise about lifestyle changes you should make to minimise your risk of developing a CVD. These changes may include: stopping smoking  if you smoke losing weight  if you are overweight or obese taking regular exercise  150 minutes of exercise per week can greatly increase your health making changes to your diet to keep other conditions you may have under control  such as diabetes or high blood pressure You may also be prescribed medication to reduce your blood pressure or blood cholesterol level. Cauda equina syndrome Cauda equina syndrome is a very rare complication of AS that occurs when nerves at the bottom of your spine become compressed (compacted). Cauda equina syndrome causes: pain or numbness in your lower back and buttocks weakness in your legs  which can affect your ability to walk urinary incontinence orbowel incontinence (when you cannot control your bladder or bowels) See your GP as soon as possible if you have AS and you develop any of these symptoms. Amyloidosis In very rare cases, it is possible to develop a condition calledamyloidosis as a complication of AS. Amyloid is a protein produced by cells in your bone marrow (the spongy material found in the centres of some hollow bones). Amyloidosis is a condition where amyloid builds up in organs such as your heart, kidneys and liver. Amyloidosis can cause a wide range of symptoms, includingfatigue, weight loss, fluid retention (oedema), shortness of breath and numbness or tingling in the hands and feet. Problems with employment Over time,AScan increasingly affect your ability to work. Some people with the condition may beunable to work at all and othersmay need changes to their working life, such as working part-time, working from homeor avoiding physically demanding work. When at work, it is important to maintain a good posture when sitting or standing for long periods of time. You should get up, stretch and move around regularly. This could mean adjusting your work station or ensuring you take regular breaks.",,,,,,,,,,,,,
Anorexia nervosa,"Anorexia nervosa - Illnesses and conditions Mental health Anorexia nervosa Anorexia nervosa Anorexia nervosa is an eating disorder. Its a serious, potentially life-threatening, mental health condition. People who have anorexia are very anxious about their weight and body shape. They try to keep their weight as low as possible by strictly controlling what they eat. Many people with anorexia will also exercise excessively. They may also use other methods to try to control their weight, like using laxatives , vomiting after eating, and taking stimulant drugs. Symptoms of anorexia Signs and symptoms of anorexia include: fear of being fat or gaining weight problems with self-esteem and body image when it comes to food and weight restricting food intake keeping your body weight low, to the point its unhealthy Restricting your food intake means your body isnt getting enough energy or nutrition. This can lead to other physical symptoms. Other signs of anorexia Eating too little for a long time can cause physical symptoms, like: fine downy hair (lanugo) growing on the body more hair on the face pubic hair becoming sparse and thin slow or irregular heartbeat People with anorexia may also: have pain in their abdomen (tummy) feel bloated or constipated have swelling in their feet, hands or face feel very tired have low blood pressure ( hypotension ) feel cold or have a low body temperature feel light-headed or dizzy In children with anorexia, puberty and the associated growth spurt may be delayed. They may gain less weight than expected for someone going through puberty. They might be shorter than other people of the same age. If you get periods and you have anorexia, your periods may stop. Anorexia can also lead to infertility, for both men and women. Getting help for anorexia Speak to your GP if you think you have: an eating problem anorexia Beat has more information about treatment for anorexia Helping someone else with anorexia If someone close to you is showing signs of anorexia, you can offer help and support. You could try talking to them about how they feel, and encourage them to think about getting help. Try not to put pressure on them or be critical of them, as this could make things worse. You could also offer to help by going with the person to see their GP. If youd like to get some advice on how to help, a healthcare professional, such as your own GP, can provide information on: how to help the person recognise that they have a problem the treatments available how you can support them during their treatment You could also get help from a support group for people who have loved ones with eating disorders. Beat has more information about how to support someone with anorexia Diagnosing anorexia When making a diagnosis, your GP will probably ask questions about your weight and eating habits. For example, they might: ask if youve lost a lot of weight recently or quite quickly ask how you feel about your weight, and if youre concerned about it ask if you make yourself vomit regularly check if you have periods, whether your periods have stopped and if so, for how long check your weight check your pulse and blood pressure do a blood test Its important to answer these questions honestly. Your GP isnt trying to judge you. They just need to accurately assess your symptoms. Referral to a specialist If your GP thinks you may have anorexia, theyll refer you to a specialist in eating disorders for a more detailed assessment. Your GP sometimes carries out this assessment. Treatment for anorexia Treatment for anorexia usually involves a combination of: talking therapy , and supervised weight gain Its important to start treatment as early as possible to reduce the risk of serious complications. Treatment for anorexia is slightly different for adults and those under 18 years old. Complications of anorexia If someone has anorexia for a long time, it can lead to severe complications and health problems. These can sometimes be permanent. People with anorexia have an increased risk of: poor circulation and cardiovascular problems heart conditions, like coronary heart disease and irregular heartbeat (arrhythmia) health problems caused by malnutrition  a lack of vitamins and minerals Anorexia can cause an imbalance of minerals in the blood, like potassium, calcium and sodium. These minerals help keep you healthy. When theres an imbalance, it can cause symptoms like: tiredness weakness dehydration fits irregular heartbeat (arrhythmia) muscle spasms confusion Health conditions Other conditions that can be caused by anorexia and malnutrition can include: low blood pressure ( hypotension ) anaemia dental problems, like tooth decay caused by regular vomiting low blood sugar levels ( hypoglycaemia ) acute kidney (renal) failure liver damage heart failure osteoporosis (fragile bones) and loss of muscle strength, particularly in women and girls loss of sex drive (libido) and impotency in men Misuse of laxatives can damage the bowels and cause permanent constipation. Anorexia and pregnancy Anorexia can lead to irregular menstrual cycles (periods), or cause your periods to stop altogether. This doesnt mean anorexia makes you infertile. If you have anorexia, even if your periods are irregular or have stopped, you should continue to use birth control if you arent planning a pregnancy. If you have anorexia and are trying to become pregnant, you should discuss this with your GP and care team. Anorexia during pregnancy can increase the risk of complications, like: miscarriage giving birth early (premature birth) having a baby with a low birth weight Youre also likely to need extra care and support during pregnancy if you have previously had anorexia and recovered from it. ",,,,,,,,,,,,,
Anxiety,"Anxiety - Illnesses and conditions Mental health Anxiety Anxiety Anxiety is a feeling of unease, like worry or fear, that can be mild or severe. Generalised anxiety disorder GAD is a long-term condition. It causes you to feel anxious about a wide range of issues, rather than 1 specific event. People with GAD feel anxious most days. They often struggle to remember the last time they felt relaxed. As soon as 1 anxious thought is resolved, another may appear about a different issue. Speak to your GP if anxiety is: affecting your daily life causing you distress Your GP will ask you about your symptoms and your worries, fears and emotions. Everyone has feelings of anxiety at some point in their life. For example, you may feel worried and anxious about sitting an exam, or having a job interview. During times like these, feeling anxious can be perfectly normal. But some people find it hard to control their worries. Their feelings of anxiety are more constant and often affect their daily lives. Anxiety is the main symptom of several conditions, including: panic disorder phobias post-traumatic stress disorder (PTSD) social anxiety disorder (social phobia) The information on this page is about a specific condition called generalised anxiety disorder (GAD). Symptoms of generalised anxiety disorder GAD can cause a change in your behaviour and the way you think and feel about things. It can also cause physical changes. This results in symptoms like: restlessness a sense of dread feeling constantly on edge difficulty concentrating irritability dizziness tiredness a noticeably strong, fast or irregular heartbeat ( palpitations ) muscle aches and tension trembling or shaking dry mouth excessive sweating shortness of breath stomach ache feeling sick headache pins and needles difficulty falling or staying asleep ( insomnia ) Your symptoms may cause you to withdraw from social contact to avoid feelings of worry and dread. You may also find going to work difficult and stressful and may take time off sick. These actions can make you worry even more about yourself and increase your lack of self-esteem. Anxiety triggers If youre anxious as a result of a specific phobia or because of panic disorder , youll usually know what the cause is. For example, if you have claustrophobia (a fear of enclosed spaces), you know that being confined in a small space will trigger your anxiety. However, if you have GAD, it may not always be clear what youre feeling anxious about. Not knowing what triggers your anxiety can intensify it. You may start to worry that therell be no solution. Causes of generalised anxiety disorder The exact cause of GAD is not fully understood. Its likely that a combination of several factors plays a role, like: overactivity in areas of the brain involved in emotions and behaviour an imbalance of the brain chemicals serotonin and noradrenaline, which are involved in the control and regulation of mood the genes you inherit from your parents  youre estimated to be 5 times more likely to develop GAD if a close relative has it having a history of stressful or traumatic experiences, like domestic violence, child abuse or bullying having a painful long-term health condition, like arthritis having a history of drug or alcohol misuse However, many people develop GAD for no apparent reason. Treating generalised anxiety disorder GAD can have a significant effect on your daily life. There are several different treatments are available that can help. These include: talking therapies  like cognitive behavioural therapy (CBT) medication  like a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs) There are also many things you can do yourself to help reduce your anxiety, like: trying a self-help course exercising regularly stopping smoking cutting down on alcohol drinking less caffeine With treatment, many people are able to control their levels of anxiety. However, some treatments may need to be continued for a long time. There may be periods where your symptoms worsen. Self help for anxiety Our mental health self-help guides are based on Cognitive Behavioural Therapy (CBT) . Theyve proven highly successful in helping people with anxiety and other mental health issues. Try the anxiety self help guide Daylight Daylight is a digital programme to improve anxiety based on Cognitive Behavioural Therapy (CBT). Its clinically proven to help people improve their anxiety symptoms by using it for just a few minutes each day. You can use Daylight via the app for iOS and Android devices. To access this course, you need to provide the first half of your postcode and your email address. Sign up for Daylight Contact support groups Support groups can give you useful advice about how to effectively manage your anxiety. Theyre also a good way to meet other people with similar experiences. Examples of support groups you may find useful include: Anxiety UK Mind Rethink Mental Illness Support groups can often arrange face-to-face meetings, where you can talk about your feelings with other people. Many support groups also provide support and guidance over the phone or in writing. Ask your GP about local support groups for anxiety in your area. Or search our support service directory for mental health information and support services near you. Referral to a specialist If treatments youve tried arent helping, you may want to discuss with your GP whether you should be referred to a mental health specialist. Youll usually be referred to your community mental health team. These teams include a range of specialists, including: psychiatrists psychiatric nurses clinical psychologists occupational therapists social workers A mental health specialist from your local team will carry out a reassessment of your condition. Theyll ask you about your previous treatment and how effective you found it. Your specialist will then be able to devise a treatment plan for you. As part of this plan, you may be offered a treatment youve not tried before. Or you may be offered a combination of a psychological treatment with medication.",,,,,,,,,,,,,
Anxiety disorders in children,"Anxiety disorders in children - Illnesses and conditions Mental health Anxiety disorders in children Anxiety disorders in children Its normal for children to feel worried or anxious from time to time, like when theyre starting school or nursery, or moving to a new area. Anxiety is a feeling of unease, like worry or fear. Its an understandable reaction in children to change or a stressful event. But for some children, anxiety affects their behaviour and thoughts on a daily basis. This can interfere with their school, home and social life. If your child is anxious for a period of time and its impacting on day to day life you may need to speak to a healthcare professional to help support your child. For example, if they feel they cannot go to school or see their friends anymore. So how do you know when your childs anxiety has reached this stage? What are the signs of anxiety in children? Anxiety can make a child feel scared, panicky, embarrassed or ashamed. Some of the signs to look out for in your child are: finding it hard to concentrate not sleeping, or waking in the night not eating properly quickly getting angry or irritable, and being out of control during outbursts constantly worrying or having negative thoughts feeling tense and fidgety, or using the toilet often always crying being clingy all the time (when other children are ok) complaining of tummy aches and feeling unwell being withdrawn and not wanting to do things they used to enjoy Your child may not be old enough to recognise why theyre feeling this way. The reason for the anxiety (if there is one) will differ depending on the age of the child. Separation anxiety is common in younger children. Older children and teenagers tend to worry more about school performance, relationships or health. What types of anxiety do children and teenagers experience? The common types of anxiety in children and teenagers are : A fear or phobia about something specific Young children are commonly afraid of things like the dark or imaginary things like monsters. This is a normal part of growing up, but has the potential to become a phobia (a type of anxiety disorder) when the fear becomes overwhelming and affects your childs day-to-day life. Read about phobias Feeling anxious for most of the time for no apparent reason Its normal for children to frequently have fears and worries. Some anxious children may develop a condition called generalised anxiety disorder when they get older. Generalised anxiety disorder causes you to feel anxious about a wide range of situations and issues, rather than one specific event. Its a feeling of constant fear or dread all the time that makes doing daily tasks hard because of feelings of anxiety. People affected by it feel anxious most days and often struggle to remember the last time they felt relaxed. Separation anxiety Separation anxiety means a child worrying about not being with their parent or regular carer. Its common in young children, and normally develops at about 6 months of age. It can make settling into nursery or school or with a child minder very difficult. Separation anxiety in older children may be a sign that theyre feeling insecure about something. They could be reacting to changes at home or at school, for example. Social anxiety Social anxiety is not wanting to go out in public, see friends or take part in activities. Social shyness is perfectly normal for some children and teenagers. However it becomes a problem  social anxiety disorder  when everyday activities like shopping or speaking on the phone cause intense, overwhelming fear. Children affected by it tend to fear doing or saying something they think will be humiliating. Social anxiety disorder tends to affect older children whove gone through puberty. School-based anxiety Some children become anxious about going to school. This could also be about schoolwork, friendships or bullying, especially if theyre changing school or moving up a level. They may not always share these worries with you, and instead they may say they have a tummy ache or are feeling sick. One of the signs is crying or seeming tired in the morning. This may be a problem that needs tackling if it is significantly affecting their daily life. Less common anxiety disorders Post-traumatic stress disorder and obsessive compulsive disorder are other anxiety disorders that can occasionally affect children, but are usually seen in adults. When is anxiety a disorder that needs treating? You should seek help for your childs anxiety if: you feel its not getting better or is getting worse, and efforts to tackle it yourself have not worked you think its slowing down their development or having a significant effect on their schooling or relationships it happens very frequently or they feel anxious all the time its making them feel physically unwell a lot of the time like feeling sick or having constant headaches your child becomes very withdrawn and is anxious about doing things they used to enjoy How serious can it be? Long-term anxiety can severely interfere with a childs personal development, family life and schooling. Anxiety disorders that start in childhood often persist into the teenage years and early adulthood. Teenagers with an anxiety disorder can also: experience clinical depression feel hopeless misuse drugs What can I do to help my child? If a child is experiencing anxiety, theres plenty parents and carers can do to help. First, its important to listen to your child about their anxiety or worries. YoungMinds has advice and resources for parents. YoungScot has advice and support for young people. Where should I go for help? You can talk to your GP or someone at your childs school like the school nurse. You might want to do this on your own or with your child, or your child might be able to have an appointment without you. The healthcare professional should listen to your concerns and offer some advice about what to do next. Your child may be referred to the local child and adolescent mental health service (CAMHS). CAMHS staff are trained to help young people with a wide range of problems. Professionals who work in CAMHS services include: psychologists psychiatrists nurses occupational therapists physiotherapists and other specially trained professionals They should offer help and support to parents and carers as well as the child. More about CAMHS Youth counselling services If your child doesnt want to see a doctor, they may be able to get help from a local youth counselling service. Youth counselling services are specially set up for young people to talk about whats worrying them, and get advice. For more information, search Scotlands Service Directory for mental health and wellbeing services in your area. Counselling may also be available in your local school. Telephone or online help Telephone helplines or online services can be helpful for children and young people. They might feel its easier to talk to someone who doesnt know them. YoungScot has information about support organisations. YoungMinds has information about where to get support. How do you treat anxiety disorders? The type of treatment offered will depend on what is causing your childs anxiety. It can be helpful for your child to talk in confidence about whats worrying them to a trained person, especially as its someone they dont know. If your child is being seen at CAMHS, they might see a child and adolescent psychotherapist or a clinical psychologist. If theyre at a youth counselling service, it might be a trained youth counsellor or psychotherapist. These sessions can help them work out what is making them anxious and how they can work through the situation. Psychological therapies Psychological therapies can really help with anxiety. Theyre evidence based talking treatments, like cognitive behavioural therapy, that are proven to help. Cognitive behavioural therapy (CBT) is a talking therapy that can help your child manage their problems by changing the way they think and behave. Its been proven to help with anxiety and is commonly offered to young people who are anxious. Your child will work with the psychological therapist to find ways to change the way they think. Theyll help your child to find strategies for coping in situations that make them anxious. The psychological therapies matrix describes the most helpful talking therapies for anxiety. What is psychological therapy? Medication If your childs anxiety problem has not got better, your doctor may talk to you about trying medication. A type of antidepressant , called a selective serotonin reuptake inhibitor (SSRI), may help your child feel calmer and differently about things. Antidepressants usually take around 2 to 4 weeks to work properly, so you or your child may not notice the difference immediately. Its natural to be concerned about side effects. Your child should be aware of any possible adverse effects and should tell you or their doctor if they happen. Why are some children affected and others not? Some children are simply born more nervous and anxious and less able to cope with stress than other children. Sometimes traumatic life events like an illness, or an accident, can cause anxiety. This can happen even if your child was previously confident by nature before. A childs anxious personality may be partly determined by the genes theyve inherited from their parents. Parents of anxious children may recognise the signs and remember feeling and behaving the same when they were younger. Life events Some children can also develop anxiety after a series of difficult life events. They may be able to cope with one of these events, but several difficult events together, or a traumatic single event, may be too much for them to cope with. Examples are: frequently moving house and school  it can be hard to settle when youre always expecting change divorce or separation of parents death of a close relative or friend becoming seriously ill or injured in an accident having someone in the family who is ill or disabled school-related issues like homework or exams, or bullying or friendship problems becoming involved in crime being abused or neglected Medical conditions Children with certain conditions such as attention deficit hyperactivity disorder (ADHD) and autistic spectrum disorders may experience anxiety as part of the symptoms of their condition. This is because of differences in the way their brain functions. ",,,,,,,,,,,,,
Appendicitis,"Appendicitis- Illnesses and conditions Stomach, liver and gastrointestinal tract Appendicitis Appendicitis About appendicitis Symptoms of appendicitis Diagnosing appendicitis Treating appendicitis Complications of appendicitis About appendicitis Appendicitis is a painful swelling of the appendix. The appendix is a small, thin pouch about 5 to 10cm (2 to 4 inches) long. Its connected to the large intestine, where stools (faeces) are formed. Nobody knows exactly why we have an appendix, but removing it isnt harmful. Appendicitis typically starts with a pain in the middle of your tummy (abdomen) that may come and go. Within hours, the pain travels to the lower right-hand side, where the appendix usually lies, and becomes constant and severe. Pressing on this area, coughing, or walking may all make the pain worse. You may lose your appetite, feel sick, and occasionally experience diarrhoea . Read more about the symptoms of appendicitis . When to get medical help If youre experiencing abdominal pain thats gradually getting worse, contact your GP or localout-of-hours service immediately. If these options arent available, phone NHS 24s 111 service for advice. You should phone 999 for an ambulance if you have sudden pain that continues to get worse and spreads across your abdomen. These are signs your appendix may have burst, which can lead to potentially life-threatening complications. Read more about: diagnosing appendicitis complications of appendicitis How appendicitis is treated In most cases of appendicitis, the appendix needs to be surgically removed as soon as possible. Removal of the appendix, known as an appendectomy or appendicectomy, is one of the most common operations in the UK and its success rate is excellent. The operation is most commonly performed as keyhole surgery (laparoscopy), which involves making several small cuts in your abdomen, through which special surgical instruments are inserted. Open surgery, where a larger, single cut is made in the abdomen, is usually carried out if the appendix has burst or access is more difficult. Most people make a full recovery from an appendectomy in a couple of weeks, although strenuous activities may need to be avoided for up to 6weeks after open surgery. Read moreabout treating appendicitis . What causes appendicitis? Its not exactly clear what the causes of appendicitis are. Most cases are thought to occur when somethingblocks the entrance of the appendix. For example, a blockage may be formed by a small piece offaeces or an upperrespiratory tract infectioncould lead toa swollen lymph node within the wall of the bowel. This obstruction leads to the development of inflammation and swelling. The pressure caused by the swelling can then lead to the appendix bursting. As the causes arent fully understood, theres no guaranteed way of preventing appendicitis. Whos affected? Appendicitis is a common condition. Its estimated around1 in every 13 people develop it at some point in their life. Appendicitis can develop at any age, but its most common in young people aged from 10 to 20 years old. Symptoms of appendicitis Appendicitis typically starts with a pain in the middle of your tummy (abdomen) that may come and go. Within hours, the pain travels to your lower right-hand side, where the appendix is usually located, and becomes constant and severe. Pressing on this area, coughing, or walking may all make the pain worse. If you have appendicitis, you may also have other symptoms, including: feeling sick (nausea) being sick loss of appetite diarrhoea a high temperature (fever) and a flushed face When to get medical help If youre experiencingabdominal pain thats gradually getting worse, contact your GP or localout-of-hours service immediately. If these options arent available, phone NHS 24 111 Service for advice. Appendicitis can easily be confused with something else, such as: gastroenteritis severe irritable bowel syndrome (IBS) constipation bladder or urine infections Crohns disease pelvic infection In young women, these symptoms can sometimes have a gynaecological cause, such as an ectopic pregnancy or menstrual pain. However, any condition that causes constant stomach pain requires urgent medical attention. You should phone 999 for an ambulance if you get a pain that suddenly becomes worse and spreads across your abdomen. These are signs your appendix may have burst. If the appendix bursts, it can causeperitonitis, a potentially serious infection of the inner lining of the abdomen. Read more about the complications of appendicitis . Diagnosing appendicitis Appendicitis can be tricky to diagnose unless you have the typical symptoms, which are only present in about half of all cases. Also, some peoples appendixes may be located in a slightly different part of their body, such as: the pelvis behind the large intestine around the small bowel near the right lower part of the liver Some people develop pain similar to appendicitis, but its caused by something else, such as: gastroenteritis severe irritable bowel syndrome (IBS) constipation a bladder or urine infection Your GP will ask about your symptoms, examine your abdomen, and see if the pain gets worse when pressure is applied to the appendix area (your lower right-hand side). If your symptoms are typical of appendicitis, this is normally enough for your GP to make a confident diagnosis. Inthis case, youll immediately be referred to hospital for treatment. Further tests If your symptoms arent typical, further tests may be required in hospital to confirm the diagnosis and rule out other conditions. Further tests may involve: a blood test to look for signs of infection a pregnancy testfor women a urine test to rule out other conditions, such as a bladder infection an ultrasound scan to see if the appendix is swollen a computerised tomography (CT) scan It can sometimes taketime to get test results. Your surgeon may recommend a laparoscopy to inspect your appendix and pelvic organs if the diagnosis is still uncertain. Youll usuallybe advised to have your appendix removed if appendicitis is suspected, rather than run the risk of it bursting. This means some people will have their appendix removed even though its eventually found to be normal. In some cases where a diagnosis is not certain, a doctor may recommend waiting up to 24 hours to see if your symptoms improve, stay the same, or get worse. If your doctor suspects your appendix has burst, youll be sent to hospital immediately for treatment. Read more about treating appendicitis . Treating appendicitis If you have appendicitis, your appendix usually needs to be removed as soon as possible. This operation is known as an appendectomy or appendicectomy. Surgery is usuallyalso recommended if theres a chance you have appendicitis but its not been possible to make a clear diagnosis. This is because its considered safer to remove the appendix than run the risk of the appendix bursting. In humans, the appendix doesnt perform any important function and having it removed doesnt cause any long-term problems. The procedure Appendectomies are carried out under general anaesthetic using either a keyhole or open technique. Keyhole surgery Keyhole surgery (laparoscopy) is usually the preferred method of removing the appendix because the recovery tends to be quicker than with open surgery. This operation involves making 3or 4small cuts (incisions) in your tummy (abdomen). Special instruments are then inserted, including: a tube that gas is pumped throughto inflate your abdomen  this allows the surgeon to see your appendix more clearly and gives them more room to work a laparoscope a small tube containing a light source and a camera, which relays images of the inside of the abdomen to a television monitor small surgical tools used to remove the appendix Once the appendix has been removed, the incisions will usually be closed with dissolvablestitches.Regular stitchesmay also be used, which need to be removed at your GP surgery 7 to 10 days later. Open surgery In some circumstances, keyhole surgery isnt recommended and open surgery is performed instead. These include: when the appendix has already burst and formed a lump called an appendix mass when the surgeon isnt very experienced in laparoscopic removal people who have previously had open abdominal surgery In these cases, the operation involves making a single larger cut in the lower right-hand side of your abdomen to remove the appendix. When theres widespread peritonitisinfection of the inner lining of the abdomenits sometimes necessary to operate through a long cut along the middle of the abdomen in a procedure called a laparotomy. As with keyhole surgery, the incisionis closed using either dissolvable stitches or regular stitchesthat need to be removed at a later date. After both types of surgery, the removed appendix is routinely sent to a laboratory to check there are no signs of cancer. This is a precautionary measure, although its rare for a serious problem to be found. Recovery One of the main advantages of keyhole surgery is the recovery time tends to be short and most people can leave hospital a few days after the operation. If the appendix is operated upon promptly, most patients can go home within 24 hours. With open or complicated surgery for example, if you have peritonitis it maytake up toa week before youre well enough to go home. For the first few days after the operation youre likely to experience some pain and bruising. This improves over time, but you can take painkillers if necessary. If you had keyhole surgery, you may experience pain in the tip of your shoulder for about a week. This is caused by the gas that was pumped into the abdomen during the operation. You may also experience some short-term constipation . You can help reduce this by not taking codeine painkillers, eating plenty of fibre, andstaying well hydrated. Your GP can prescribe medication if the problem is particularly troublesome. Before leaving hospital, youll be advised about caring for your wound and what activities you should avoid. In most cases, you can return to normal activities in a couple of weeks, although more strenuous activities may need to be avoided for 4to 6weeks after open surgery. When to seek medical advice While you recover, its important to keep an eye out for signs of any problems. Contact the hospital unit where the appendectomy was performed or your GP for advice if you notice: increasing pain and swelling you start vomiting repeatedly a high temperature (fever) any discharge coming from the wound the wound is hot to touch These symptoms could be a sign of infection. Risks Appendectomies are one of the most commonly performed operations in the UK, and serious or long-term complications are rare. However, like all types of surgery, there are some risks. These include: antibiotics may be given before, during, or after the operation to minimise the risk of serious infections bleeding under the skin that causes a firm swelling (haematoma)  this usually gets better on its own, but you should see your GP if youre concerned scarring  both surgical techniques will leave some scarring where the incisions were made a collection of pus (abscess)  in rare cases, an infection caused by the appendix bursting can lead to an abscess after surgery hernia  at the site of the open incision or any of the incisions used in the laparoscopic approach The use of general anaesthetic also carries some risks, such as the risk of an allergic reaction or inhaling stomach contents, leading to pneumonia . However, serious complications like this are very rare. Alternatives to emergency surgery In some cases, appendicitis can lead to the development of a lump on the appendix called an appendix mass. This lump, consisting of appendix and fatty tissue, is an attempt by the body to deal with the problem and heal itself. If an appendix mass is found during an examination, your doctors may decide its not necessary to operate immediately. Instead, youll be given a course of antibiotics and an appointment will be made for an appendectomy a few weeks later, when the mass has settled. Another possible alternative to immediate surgery is the use of antibiotics to treat appendicitis. However, studies have looked into whether antibiotics could be an alternative to surgery and as yet there isnt enough clear evidence to suggest this is the case. Complications of appendicitis If appendicitis isnt treated, the appendix can burst and cause potentially life-threatening infections. Phone 999 for an ambulance if you have abdominal (tummy) pain that suddenly gets much worse and spreads across your abdomen. These are signs your appendix may have burst. Peritonitis If your appendix bursts, it releases bacteria into other parts of the body. This can cause a condition called peritonitis if the infection spreads to the peritoneum, the thin layer of tissue that lines the inside of the abdomen. Symptoms of peritonitis can include: severe continuous abdominal pain feeling sick or being sick a high temperature (fever) a rapid heartbeat shortness of breath with rapid breathing swelling of the abdomen If peritonitis isnt treated immediately, it can cause long-term problems and may even be fatal. Treatment for peritonitis usually involves antibiotics and the surgical removal of the appendix (appendectomy). Abscesses Sometimes anabscess forms around a burst appendix. This is a painful collection of pus that occurs as a result of the bodys attempt to fight the infection. It can also occur as a complication of surgery to remove the appendix in about 1 in 500 cases. Abscesses can sometimes be treated using antibiotics, but in the vast majority of cases the pus needs to be drained from the abscess. This can be carried out under ultrasound or computerised tomography (CT) guidance using local anaesthetic and a needle inserted through the skin, followed by theplacement of a drain. If an abscess is found during surgery, the area is carefully washed out and a course of antibiotics is given.",,,,,,,,,,,,,
Arterial thrombosis,"Arterial thrombosis - Illnesses & conditions- Illnesses and conditions Heart and blood vessels Conditions Arterial thrombosis Arterial thrombosis About arterial thrombosis Symptoms of arterial thrombosis Causes of arterial thrombosis Diagnosing arterial thrombosis Treating arterial thrombosis Preventing arterial thrombosis About arterial thrombosis Arterial thrombosis is a blood clot that develops in an artery. Its dangerous as it can obstruct or stop the flow of blood to major organs, such as the heart or brain. If a blood clot narrows one or more of the arteries leading to the heart, muscle pain known as angina can occur. If a blood clot blocks the arteries leading to part of the heart muscle, it will cause a heart attack. If it blocks an artery in the brain, it will cause a stroke . Symptoms therefore depend on where the blood clot has formed. Find out more about the symptoms of arterial thrombosis Whos at risk of arterial thrombosis? Most cases of arterial thrombosis are caused when a process called atherosclerosisdamages an artery. Fatty deposits build up on the walls of the arteries and cause them to harden and narrow. Find out more about the causes and risk factors for developing arterial thrombosis Treating arterial thrombosis There are two main types of treatment for arterial thrombosis. Medication Medication can help dissolve clots and restore the flow of the blood to the brain or heart. Surgery Surgery involves a surgeon accessing the affected artery. They will either: unblock it re-route the blood flow via another blood vessel graft the blood vessel to travel around, or past, the section thats blocked Find out more about the treatment of arterial thrombosis Preventing arterial thrombosis If youve had a blood clot in an artery, you may need to take medication to prevent it from happening again. Its also vital that you live a healthy lifestyle. This includes: stopping smoking (if you smoke) doing some physical activity reducing the amount of salt and saturated fat that you eat Find out more about preventing arterial thrombosis Symptoms of arterial thrombosis Depending on where the clot is in your body, a bloodclot in an artery (arterial thrombosis) can cause: angina heart attack stroke peripheral vascular disease Find out about each of these below. Heart attack A heart attackcan happen when a blood clot completely blocks an artery that pumps blood to your heart muscle. You may experience: a crushing central chest pain or mild chest discomfort shortness of breath a clammy, sweaty and grey complexion dizziness nausea and vomiting If you suspect you or someone you know is having a heart attack, dial 999 immediately. Its important that you dont wait and do treat these symptoms as an emergency. Find out more about the symptoms of a heart attack Stroke Arterial thrombosis can cause a stroke if a blood clot is blocking an artery that supplies blood to your brain. The symptoms of a stroke can come on suddenly and may include: numbness or weakness down one side, ranging in severity from weakness in your hand to complete paralysis of the whole side of your body weakness in your face, which can make you drool saliva dizziness difficulty talking and understanding what others are saying problems with balance and co-ordination difficulty swallowing If you suspect that you or someone else is having a stroke, dial 999 immediately. Its important that you dont wait and do treat these symptoms as an emergency. Further information on a stroke Peripheral vascular disease If you have a narrowing of an artery in one or both of your legs (peripheral vascular disease) you may: be more susceptible to developing a clot have pain when exercising, usually in the lower half of your legs have pain that may affect both legs, but develops in one leg before the other have pale, cold skin and numbness in one of your legs Peripheral vascular disease can also cause other problems such as impotence ( erectile dysfunction ). If you have any of these symptoms, its important to talk to your GP. If one of your legs is a very different colour from the other, and you have other symptoms, you should treat this as an emergency and call 999 . Causes of arterial thrombosis Arterial thrombosis occurs when a blood clot forms within an artery, slowing or stopping the flow of blood. How it happens Your blood contains cells called platelets and proteins (clotting factors). Together they make up the blood-clotting mechanism. When a blood vessel is cut, the platelets and clotting factors in your blood mesh together to form a solid clot at the site of the wound. This clot acts as a plug to stop the wound from bleeding. Normally, the blood-clotting mechanism is triggered when a blood vessel is damaged and bleeds, such as when you cut yourself. However, the blood may sometimes begin to clot even when a blood vessel has not been damaged. If this happens, a blood clot can form within a vein or artery (thrombosis). What causes it to happen Most cases of arterial thrombosis are caused when an artery is damaged byatherosclerosis. Fatty deposits build up on the walls of the arteries and cause them to harden and narrow. The risk factors for a blood clot in an artery include: eating a high-fat diet smoking alcohol misuse obesity lack of exercise diabetes (both type 1 diabetes and type 2 diabetes ) high blood pressure (hypertension) Diagnosing arterial thrombosis The tests used to diagnose blood clots in the arteries (arterial thrombosis) will depend on what medical condition the blood clot has triggered. Electrocardiogram (ECG) Suspected cases of unstable angina and heart attacks are diagnosed using an electrocardiogram (ECG). Every time your heart beats, it produces tiny electrical signals that will show on paper. This allows your doctor to see how well your heart is functioning or if there are any areas not receiving blood as in a heart attack. Find out more about having an ECG Blood test Blood may also be taken to measure levels of a protein called troponin. This is released when the heart muscle is damaged by a heart attack. Find out more about blood tests Scans Suspected cases of stroke are diagnosed by producing a scan of the brain using a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan . Treating arterial thrombosis There are two main types of treatment for a blood clot that develops in an artery (arterial thrombosis): medication surgery Medication Medication can help dissolve clots and restore the flow of the blood to the brain or heart. Surgery You may need a heart procedure if the blood clot is in an artery that supplies blood to your heart. Coronary angioplasty A coronary angioplasty is the most common type of procedure for a heart attack. A hollow metal tube called a stent is inserted to widen the artery and stop it from blocking again. Find out more about having a coronary angioplasty Coronary artery bypass graft (CABG) Occasionally, a coronary artery bypass graft (CABG) may be carried out after a heart attack. A blood vessel that is taken from another part of the body is used to bypass where the blockage is. Find out more about having a CABG Carotid endarterectomy Another type of surgery for arterial thrombosis is called carotid endarterectomy, which you may have if you have had a blood clot in an artery in your neck (causing a stroke). The surgeon makes a cut in your neck to open up the artery and remove the fatty deposits. Preventing arterial thrombosis Its not possible to prevent blood clots altogether, but there are a number of ways to reduce the risks of developing a blood clot in an artery. Medication If youve had blood clot in an artery before, you might need to take medication to prevent it from happening again. Medication can include: statins  used to lower your blood cholesterol levels anticoagulant medicines- such as warfarin antiplatelet medicines  such as low-dose aspirin or angiotensin-converting enzyme (ACE) inhibitors (used to treat high blood pressure) Lifestyle In addition to medication, its vital that you look after your health and take steps to improve your lifestyle. Most cases of arterial thrombosis are associated with atherosclerosis(the furring up of your arteries with fatty deposits). This can lead to a blood clot in an artery and cause a heart attack or stroke. Making healthy changes to your lifestyle can greatly reduce the effects of this condition, and others such a heart disease. Things you could do include: stopping smoking (if you smoke) reduce your alcohol intake to recommended limits reduce salt intake eat at least 5 portions of fruit and vegetables and 2 portions of fish per week (1 oily) do a minimum of 30 minutes of moderate exercise such as walking or cycling at least 5 times a week ",,,,,,,,,,,,,
Arthritis,"Arthritis  Illnesses and conditions Muscle, bone and joints Conditions Arthritis Arthritis About arthritis Living with arthritis About arthritis Arthritis is a common condition that causes pain and inflammation in a joint. In the UK, around 10 million people have arthritis. It affects peopleof all ages, including children (see below). Types of arthritis The two most common types of arthritis are: osteoarthritis rheumatoid arthritis Osteoarthritis Osteoarthritis is the most common type of arthritis in the UK, affecting around 8 million people. It most often develops inadults who are in their late 40s or older. Its also more common in women andpeople with a family history ofthe condition.However, it can occur at any age as a result of an injury or be associated with otherjoint-related conditions, such as gout or rheumatoid arthritis. Osteoarthritis initially affects the smooth cartilage lining of the joint. This makes movement more difficult than usual, leading to pain and stiffness. Once the cartilage lining starts to roughen and thin out, the tendons and ligaments have to work harder. This can cause swelling and the formation of bony spurs, called osteophytes. Severe loss of cartilage can lead to bone rubbing on bone, altering the shape of the joint and forcing the bones out of their normal position. The most commonly affected jointsare those in the: hands spine knees hips Rheumatoid arthritis In the UK, rheumatoid arthritis affects more than 400,000 people. It often starts when a person is between 40 and 50 years old. Women are three times more likely to be affected than men. Rheumatoid and osteoarthritis are two different conditions. Rheumatoid arthritis occurs when the bodys immune system targets affected joints, which leads to pain and swelling. The outer covering (synovium) of the joint is the first place affected. This can then spread across the joint, leading to further swelling and a change in the joints shape. Thismay cause thebone and cartilage to break down. People with rheumatoid arthritis can also develop problems with other tissues and organs in their body. Other types of arthritis and related conditions Ankylosing spondylitis  a long-term inflammatorycondition that mainly affects the bones, muscles and ligaments of the spine, leading to stiffness and joints fusing together.Other problems can include the swelling of tendons, eyes and large joints. Cervical spondylosis  also known as degenerative osteoarthritis, cervical spondylitis affects the joints and bones in the neck, which can lead to pain and stiffness. Fibromyalgia  causes pain in the bodys muscles, ligaments and tendons. Lupus  an autoimmune condition that can affect many different organs and the bodys tissues. Gout  a type of arthritis caused by too much uric acid in the body. This can be left in joints (usually affecting the big toe) but can develop in any joint. It causes intense pain, rednessand swelling. Psoriatic arthritis  an inflammatory joint condition that can affect people with psoriasis . Enteropathic arthritis  a form of chronic, inflammatory arthritis associated with inflammatory bowel disease (IBD), the two best-known types being ulcerative colitis and Crohns disease . About one infive people with Crohns or ulcerative colitis will develop enteropathic arthritis. The most common areas affected by inflammation arethe peripheral (limb) joints and the spine. Reactive arthritis  this can cause inflammation of the joints, eyes and urethra (the tube that urine passes through).It develops shortly after an infection of the bowel, genital tract or, less frequently, after a throat infection. Secondary arthritis  a type of arthritis that can develop after a joint injury and sometimes occurs many years afterwards. Polymyalgia rheumatica  a condition that almost always affects people over 50 years of age, where the immune system causes muscle pain andstiffness, usually across the shoulders and tops of the legs. It can also causejoint inflammation. Symptoms of arthritis Thesymptoms of arthritis you experience will vary depending on the type you have. This is why its important to have an accurate diagnosis if you have: joint pain, tenderness and stiffness inflammation in and around the joints restricted movement of thejoints warm, red skin over the affected joint weakness andmuscle wasting Arthritis and children Arthritis is often associated with older people, butit can alsoaffect children. In the UK, about 15,000 children and young people are affected by arthritis. Most types of childhood arthritis are known as juvenile idiopathic arthritis (JIA). JIA causes pain andinflammation in one or more joints for at least six weeks. Although the exact cause of JIA isunknown, the symptoms often improve as a child gets older, meaning they can lead a normal life. The main types of JIA are discussed below. Arthritis Research UK has more information about the different types of juvenile idiopathic arthritis . Oligo-articular JIA Oligo-articular JIA is the most common type of JIA. It affects fewer than five joints in the bodymost commonly in the knees, ankles and wrists. Oligo-articular JIA has good recovery rates and long-term effects are rare. However, theres a risk that childrenwith the condition may develop eye problems, so regulareyetests with an ophthalmologist (eye care specialist) are recommended. Polyarticular JIA (polyarthritis) Polyarticular JIA, or polyarthritis, affects five or more joints. It can develop at any age during childhood. The symptoms of polyarticular JIA are similar to the symptoms of adult rheumatoid arthritis . The condition is often accompanied by a rash and a high temperature of 38C (100.4F) or above. Systemic onset JIA Systemic onset JIA begins with symptoms such as a fever, rash, lethargy (a lack of energy) and enlarged glands. Later on, joints canbecome swollen and inflamed. Like polyarticular JIA, systemic onset JIA can affect children of any age. Enthesitis-related arthritis Enthesitis-related arthritis is a type of juvenile arthritis that affects older boys or teenagers. It can cause pain in the soles of the feet and around the knee and hip joints, where the ligaments attach to the bone. Treating arthritis Theres no cure for arthritis, but there are many treatments that can help slow down the condition. For osteoarthritis, medications are often prescribed, including: painkillers non-steroidal anti-inflammatory drugs (NSAIDs) corticosteroids In severe cases, the following surgical procedures may be recommended: arthroplasty (joint replacement) arthodesis (joint fusion) osteotomy (where abone is cut and re-aligned) Treatment forrheumatoid arthritis aimsto slow down the conditions progress and minimise joint inflammation or swelling. This isto try and prevent damage to the joints. Recommended treatments include: analgesics (painkillers) disease modifying anti-rheumatic drugs (DMARDs)a combination of treatments is often recommended physiotherapy regular exercise Read moreabout how rheumatoid arthritisis treated . Living with arthritis Living with arthritis isnt easy and carrying out simple, everyday tasks can often be painful and difficult. However, there are many things you can do to make sure you live a healthy lifestyle.A range of services and benefits are also available. Work Many people with arthritis want to continue working for many reasons, including betterfinancial security and higher self-esteem. Better treatment options have helped to ensure that many people return to work after being diagnosed with arthritis.This is particularly the case if arthritis is diagnosed and treated at an early stage. You may find work challenging, but your employer should help you with the training and support you need. Help is also available if your arthritis is so severe that youre unable to work. Find out more about the Personal Independence Payment (formerly known as the Disability Living Allowance). Healthy eating Its very important to eat ahealthy, balanceddiet if you have arthritis. Eating healthily will give you all the nutrients you need and help you maintain a healthy weight. Your diet should consist of a variety of foods from all5 foodgroups. These are: fruit and vegetables starchy foods  like bread, rice, potatoes and pasta meat, fish,eggs and beans milk and dairy foods foods containing fat and sugar Further informationabout how to have a healthy, balanced diet . Weight If youre overweight, losing weight can really help you cope with arthritis. Too much weight places excess pressure on the joints in your hips, knees, ankles and feet, leading to increased pain and mobility problems. Further informationabouthow you can lose weight. Exercise If your arthritis is painful, you may not feel like exercising. However, being active can help reduce and prevent pain. Regular exercisecan also: improve your range of movement and joint mobility increase muscle strength reduce stiffness boost your energy As long as you do the right type and level of exercise for your condition, your arthritis wont get any worse. Combined with a healthy, balanced diet (see above), regular exercise willhelp you lose weight and place less strain on your joints. Your GP can advise about the type and level of exercise thats right for you. Versus Arthritis also has further information about exercising with arthritis . Joint care If you have arthritis, its important to look after your joints so theres no further damage. For example, try to reduce the stress on your joints while carrying out everyday tasks like moving and lifting. Sometips for protecting your joints,particularly if you have arthritis, include: use larger, stronger joints as levers for example,take the pressure of opening a heavy door on your shoulder rather than on your hand use several joints to spread the weight of an object for example, use both hands to carry your shopping or distribute the weight evenly in a shoulder bag or rucksack dont grip too tightly grip as looselyas possible or use a padded handleto widen your grip Its also important toavoid sitting in the same position for long periods of time and to take regular breaks so you can move around. At home If you have arthritis, carrying out tasks around the home can be a challenge. However, making some practical changes to your home and changing the way you work should make things easier. Practical tips that could help include: keeping things in easyreach using a hand rail to help you get up and down the stairs using long-handled tools to pick things up or to clean fitting levers totaps to make them easier to turn using electric kitchen equipment,like tin openers, when preparing food Versus Arthritis has further information and tips for living with arthritis . Occupational therapy An occupational therapist can help if you have severearthritis thats affecting your ability to move around your home and carry out everyday tasks,like cooking and cleaning. They can advise about equipment you may need to help you live independently. Depending on the exact nature of your condition, your GP may be able to refer you to an NHS occupational therapist. However, you may need to access this type of therapy through your local council. Find your local council Further information about occupational therapy . Telecare Self-Check online tool Visit the Telecare Self-Check online tool to find the right support for you in your area. This easy to use online tool allows you to find helpful information on telecare services that could help you live independently at home for longer. ",,,,,,,,,,,,,
Asbestosis,"Asbestosis - Illnesses and conditions Lungs and airways Asbestosis Asbestosis About asbestosis Causes of asbestosis Diagnosing asbestosis Treating asbestosis Preventing asbestosis About asbestosis Asbestosis is a chronic (long-term) lung condition caused by prolonged exposure to asbestos. Asbestos is a general term for a group of minerals made of microscopic fibres. In the past, it was widely used in construction. Asbestos canbe very dangerous.It does not present a health risk if it is undisturbed, but if material containing asbestosis chipped, drilled, broken or allowed to deteriorate,it can release a fine dust that contains asbestos fibres. When the dust is breathed in, the asbestos fibres enter the lungs and can gradually damagethem over time. For asbestosis to develop, prolonged exposure to relatively high numbers of the fibres is necessary.However, it is not the only factor, as many people avoid getting asbestosis, despite heavy exposure. Read more about the causes of asbestosis . Symptoms of asbestosis Breathing in asbestos fibres may eventually scar the lungs of some people, which can lead to a number of symptoms, including: shortness of breath  this may only occur after physicalactivity at first, but itcan eventually become a more constant problem a persistent cough wheezing fatigue (extreme tiredness) chest pain in more advanced cases,clubbed (swollen) fingertips Nowadays, most people who are diagnosed with asbestosis were exposed many years ago, before there were effective controls on exposure to asbestos fibres in the workplace. See your GP if you have the above symptoms and you think you may have been exposed to asbestos in the past. Read more about diagnosing asbestosis . Treating asbestosis There is no cure for asbestosis once it has developed, because it is not possible to reverse the damage to the lungs. One of themost important things someone with the condition can do is to stop smoking ,if they smoke. This is becausethe symptomsare morelikely to get worse in people who smoke, andsmoking also increases the risk of lung cancer in people with asbestosis. If necessary, treatments such as oxygen therapycan improve the quality of life of someone with asbestosis. Read more about treating asbestosis . Outlook The outlook for asbestosis can vary significantly, depending on the extent of damage to the lungs and whether any other conditions are present. Asbestosis can get worse over time and severe cases can place a significant strain on a persons health and shorten their life expectancy,but in many cases the condition progresses very slowly or not at all. However, people with asbestosis have a higher risk of developing other serious and potentially life-threatening conditions, such as: pleural disease  where the membrane covering the lungs (pleura) becomes thicker, which can further contribute to breathlessness and chest discomfort mesothelioma  a type of cancer that affects the membrane that covers the lungs, heart and gut lung cancer Overall, more people with asbestosis die as a result of one of the cancers mentioned above, or from natural causes, than from asbestosis itself. Compensation If you have been diagnosed with asbestosis, you may be able to claim compensation. This can be done through: industrial injuries disablement benefit  this isa weekly benefit that may be paid to people with asbestosis who were exposed to asbestos while in employment (but not self-employed) a civil claim for compensation through the courts you will need to obtain legal advice about how to do this a claim for a lump compensation sum under thePneumoconiosis etc. (Workers Compensation) Act 1979 if you have asbestosis, or you are the dependant of someone who has died from the condition, andyou havent been able to get compensation through the courts because the employer who exposed you (or the person on whose behalf you are claiming) has ceased trading Read more about industrial injuries disablement benefit on the GOV.UK website . Preventing asbestosis There are three main types of asbestos that were used in construction. Two of these  called crocidolite and amosite  were banned in 1985 (although voluntary bans came into force earlier than this) and the use of the third type (chrysotile) was widely banned in 1999. However, despite these strict regulations having been in place for a number of years, large amounts of asbestos are still found in many older buildings. Its thereforeimportant to take precautions to reduce your risk of inhaling asbestos fibres if you live or work in a building that may contain asbestos. If you are concerned that your house may contain asbestos,you can seek advice from an environmental health officer at your local authority or council. Do not attempt to remove any materials that you think may contain asbestos yourself. If your job meansyou could potentially be exposed to asbestos fibres, make sure you are fully aware of what you can do to reduce your risk. Do notattempt to remove any asbestos you come across, unless you have been trained in how to do this safely. Read about preventing asbestosis . Who is affected Asbestosis is a relatively rare condition, because it takes a considerable degree of asbestos exposure to cause it, and regulations to restrict exposure have been in place for many years. However, in 2011 there were 178 deaths directly caused by asbestosis and 429 where the condition was thought to have played a role. 980 new cases were assessed for industrial injuries disablement benefit during 2012. Causes of asbestosis Asbestosis is caused by breathing in asbestos fibres. People working in certain trades are more likely to have been exposed to asbestos in the past. What is asbestos? Asbestos is a general termfor a group of minerals made of microscopic fibres.Materials containing asbestos used to be widely used in construction, because they are strong, durable and fire-resistant. There were three main types of asbestos in commercial use: crocidolite (blue asbestos) amosite (brown asbestos) chrysotile (white asbestos) All these types of asbestos are hazardous if a material containing them becomes damaged and the fibres are released into the air. No crocidolite was imported into the UK after 1970, and both amosite and crocidolite were banned in 1985 (although voluntary bans on the industrial use of both these materials came into force earlier than this). Chrysotile was not banned until 1999. This means that, although asbestos is no longer used, materials containing asbestos are still found in many older buildings. How asbestos fibres affect the lungs When you inhale a foreign body, such as a dust particle, cells in the lungs called macrophagesusually hunt and break the particle down before it gets into your lung tissues and bloodstream. However, asbestos fibres are too difficult for the macrophages to break down. In an attempt to break down the fibres, the macrophages release substances that are intended to destroy the fibres, but actually cause the tiny air sacs in your lungs (alveoli) to become damaged and permanently scarred over time. This scarring is what is known as asbestosis. Alveoli are crucial in transferring oxygen from the air into your bloodstream and removing carbon dioxide from your bloodstream. If they become damaged and scarred, these processes will be affected, resulting in symptoms such as breathlessness. For asbestosis to develop, prolonged exposure  usually over many years  to relatively high numbers ofasbestosis fibres is necessary. Occupations associated with asbestos exposure The use of asbestos increased significantly after World War II. Itpeaked during the 1970s, before declining during the 1980s and 1990s. You may have been exposed to asbestos if you worked in an industry such as building or construction, where asbestos was used during this time period. Occupations particularly associated with exposure to asbestos during this periodinclude: insulation workers boilermakers plumbers, pipefitters and steamfitters shipyard workers sheet metal workers plasterers chemical technicians heating, air-conditioning and refrigeration mechanics Now that asbestos isno longer used,those most at risk of being exposed to asbestos fibres include people whose jobs put them at risk of damaging any asbestos remaining in older buildings, such as caretakers,electricians and demolition workers. The Health and Safety Executive (HSE) website has further information about when you are most likely to be at risk of asbestos exposure. Diagnosing asbestosis When diagnosing asbestosis, your GP will first ask about your symptoms and listen to your lungs with a stethoscope (a medical instrument used to listen to the heart and lungs). If your lungs have been affected by asbestos, they will usually make a crackling noise when you breathe in. Your GP will also ask about your work history, particularlyabout periods when you may have been exposed to asbestos, how long you may have been exposed, and whether you were issued with any safety equipment, such as a face mask, when you were working. Referral to a specialist Ifasbestosis issuspected,youwill be referred to a specialist in lung diseases for tests to confirm any lung scarring. These may include: a chest X-ray  to detect abnormalities in the structure of your lungs that could be caused by asbestosis a computerised tomography (CT) scan of the lungs  which produces more detailed images ofthe lungs and the membrane covering the lungs and can help identify less obvious abnormalities lung function tests  to assess the impact of damage of the lungs, determine how much air your lungs can hold and assesshow well oxygen crosses the membrane of the lungs into your bloodstream Before confirming a diagnosis of asbestosis, the chest specialist will also consider and rule out other possible causes of lung inflammation and scarring, such as rheumatoid arthritis . Treating asbestosis There is no cure for asbestosis, as the damage to the lungs is irreversible. However, you can take steps to reduce your symptoms and improve your quality of life. Not smoking If you have been diagnosed with asbestosis and you smoke, its very important to stop as soon as possible. Smoking can make your symptoms ofbreathlessness worse and significantly increase your risk of developing lung cancer at a later stage. Speak to your GP for help with giving up smoking. They can advise about nicotine replacement therapies and prescription medicines thatcan greatly increase your chances of quitting successfully. Your GP can alsoput you in touch with local support groups in your area. You can also phone Quit Your Way Scotlandon 0800 84 84 84 to get more help and advice about quitting smoking. Read more about stopping smoking . Vaccinations If you have asbestosis, your lungs will be more vulnerable to infection. Its recommended that you have theinfluenza (flu) vaccination to protect against flu , and the pneumococcal vaccination to protect you from the bacteria that can cause serious conditions, such as pneumonia . Your GPcan arrange for you to have these vaccinations. You will need the flu vaccine every year to ensure you stay protected. Most people only require one dose of the pneumococcal vaccine, although additional booster shots may be recommended if your general health is poor. Long-term oxygen therapy If you have severe asbestosis, your body may not be getting allthe oxygen it needs to function properly. Oxygen therapy may be recommendedif you have low levels of oxygen in your blood. Oxygen therapyis supplied through a machine called an oxygen concentrator, which purifies oxygen from the air in the room and produces a more oxygen-rich supply of air. This oxygen-rich air is breathed in through a mask or a small, soft plastic tubeplaced just inside your nostrils (nasal cannula). You may be given a small, portable oxygen tank and mask, to be used when youre out of the house. This is known as ambulatory oxygen. Its very important not to smoke when you are using an oxygen concentrator. This is because high concentrations of oxygenare highly flammable, and a lit cigarette or flame could cause a fire or an explosion. Medication Most people with asbestosis will not benefit from any specific medication for the condition, unless you have another condition also affecting the lungs,such as chronic obstructive pulmonary disease (COPD) . More severe cases may benefitfrom medicines, such as small doses ofmorphine to reduce breathlessness and a cough . Serious side effects are uncommon, because the dose is so small. The most common problem is constipation ,and a laxative will usually be given at the same time to help you pass stools. Preventing asbestosis Although asbestos is no longer widely used in the UK, its still important to take precautions to reduce your risk of exposure, because its still found in many old buildings. Strict regulations were introduced in 1970 to regulate the use of asbestos in the workplace. However, the import, supply and use of brown (amosite) and blue (crocidolite) asbestos was not banned in the UK until 1985. White asbestos (chrysotile) was banned in 1999, except for a small number of specialist uses of the material. This means that buildings that were built or refurbished before the year 2000 could still contain asbestos. Asbestos in your home If you are concerned that your house may contain asbestos, you can seek advice from an environmental health officer at your local authority or council. In these circumstances, it may be best to leave any asbestos-containing materialswhere they are  especially if they are in good condition and unlikely to get damaged. You should check the condition of the materials from time to time to make sure they havent been damaged or started to deteriorate. Slightly damaged asbestos-containing materials can sometimes be repaired by sealing or enclosing them. However, this should only be done by someone with the necessary training. Any badly-damaged asbestos material that cannot be protected should be removed by someone who is appropriately trained. Your local environmental health officer can advise you about this. If you are planning any home improvements, repairs or maintenance, and you intend to bring in any additional workers or contractors, you should inform them of any asbestos materials in your home before they start work. This will help reduce the risks of anyasbestos-containing materialbeing disturbed. You can search for who to contact about asbestos in your home on the GOV.UK website. Asbestos in your workplace If your job doesnt directly put you at risk of asbestos exposure, but you are concerned about asbestos in your workplace, speak to the building duty holder about what they are doing to monitor and manage the situation. A duty holder is someone who is responsible for maintaining and repairing non-domestic premises. If any asbestos-containing materials in your workplace are assessed as being in good condition, and not in a position where they are likely to be damaged, they will usually be left in place and monitored. However,asbestos-containing materials that are in a poor condition orare likely to be damaged during the normal use of the building should be sealed, enclosed or removed as appropriate. Working with asbestos If your job means that you could potentially be exposed to asbestos fibres, make sure the appropriate precautions are taken before and during any work you do. The Health and Safety Executive (HSE) has drawn up the following checklist for employers,managers and traders to go through before carrying out work on a building that may contain asbestos: Identify whether asbestos is present and determine its type and condition  this may mean checking with the building manager or having the area surveyed. Carry out a risk assessment to determine whether its possible to carry out the work, while avoiding the risk of asbestos exposure completely. Decide if the work needs to be carried out by a licensed contractor  the removal of certain types of asbestos-containing material will need to be done by a contractor holding a licence from the HSE. If the work is not licensable, decide if the work needs to be notified  somejobs requirethe relevant enforcing authority to be notified of what you are doing Ensure that those carrying out the work are suitably trained  any worker who may disturb asbestos during their daily work needs to receive appropriate training, so that they can protect themselves and others. Steps that may help reduce your exposure to asbestos during your work include wearing protective equipment (such as a suitable face mask),cleaning up as you go (using avacuum cleaner or wet rags, rather than sweeping) and not using power tools whenever possible. Want to know more? The HSE website has more information about: managing and working with asbestos dos and donts when working with asbestos task sheetsoutlininghow to carry out non-licensed work with asbestos You may also find it useful to read theControl of Asbestos Regulations (2012), which outline the measures that should be in place to reduce the risk of asbestos exposure. Read the full Control of Asbestos Regulations 2012 (PDF, 143 KB) .",,,,,,,,,,,,,
Asthma,"Asthma - Illnesses and conditions Lungs and airways Asthma Asthma About asthma Symptoms of asthma Causes of asthma Diagnosing asthma Treating asthma Living with asthma About asthma Asthma is a common long-term condition that can cause coughing, wheezing, chest tightness and breathlessness. The severity of these symptoms varies from person to person. Asthma can be controlled well in most people most of the time, although some people may have more persistent problems. Occasionally, asthma symptoms can get gradually or suddenly worse. This is known as an asthma attack, although doctors sometimes use the term exacerbation. Severeattacks may require hospital treatment and can be life threatening, although this is unusual. Read more about the symptoms of asthma and diagnosing asthma What causes asthma? Asthma is caused by inflammation of the small tubes, called bronchi, which carry air in and out of the lungs. If you have asthma, the bronchi will be inflamed and more sensitive than normal. When you come into contact with something that irritates your lungs  known as a trigger  your airways become narrow, the muscles around them tighten, and there is an increase in the production of sticky mucus (phlegm). Common asthma triggers include: house dust mites animal fur pollen cigarettesmoke exercise viral infections Asthma may also be triggered by substances (allergens or chemicals) inhaled while at work. Speak to your GP if you think your symptoms are worse at work and get better on holiday. The reason why some people develop asthma is not fully understood, although it is known that you are more likely to develop it if you have a family history of the condition. Asthma can develop at any age,including in young children and elderly people. Read more about the causes of asthma Who is affected? In the UK, around 5.4 million people are currently receiving treatment for asthma. Thats the equivalent of 1 in every 12 adults and1 in every 11 children. Asthma in adults is more common in women than men. Howasthma is treated While there is no cure for asthma, there are a number of treatments that can help control the condition. Treatment is based on two important goals, which are: relieving symptoms preventing future symptoms and attacks For most people, this will involve the occasional  or, more commonly, daily  use of medications, usually taken using an inhaler. However, identifying and avoiding possible triggers is also important. You should have a personal asthma action plan agreed with your doctor or nurse that includes information about the medicines you need to take, how to recognise when your symptoms are getting worse, and what steps to take when they do so. Read more about treating asthma and living with asthma Outlook For many people, asthma is a long-term condition  particularly if it first develops in adulthood. Asthma symptoms are usually controllable and reversible with treatment, although some people withlong-lasting asthma maydevelop permanent narrowing of their airways and more persistent problems. For children diagnosed with asthma, the condition may disappear or improve during the teenage years, although it can return later in life. Moderate or severe childhood asthma is more likely to persist or return later on. Symptoms of asthma The symptoms of asthma can range from mild to severe. Most people will only experience occasional symptoms, although a few people will have problems most of the time. The main symptoms of asthma are: wheezing (a whistling sound when you breathe) shortness of breath a tight chest  which may feel likea band is tightening aroundit coughing These symptoms are often worse at night and early in the morning, particularly if the condition is not well controlled. They may also develop or become worse in response to a certain trigger, such as exercise or exposure to an allergen. Read our page on the causes of asthma for more information about potential triggers. Speak to your GP if you think you or your child may have asthma. You should also talk to your doctor or asthma nurse if you have been diagnosed with asthma and you are finding it difficult to control the symptoms. Asthma attacks When asthma symptoms get significantly worse, it is known as an asthma attack or acute asthma exacerbation. Asthma attacks often develop slowly, sometimes taking a couple of days or more to become serious, although some people with asthma are prone to sudden, unexpected severe attacks. It is important to recognise attacks early and take appropriate action. During an asthma attack, the symptoms described above may get worse and  if youre already on treatment  your inhaler medication may not workas well as it normally does. You might be monitoring your asthma using a device called a peak flow meter, and theremay be a drop in your peak expiratory flow. Read about diagnosing asthma for more information. Signs of a particularly severe asthma attack can include: your reliever inhaler (which is usually blue) is not helping symptoms as much as usual, or at all wheezing, coughing and chest tightness becoming severe and constant being too breathless to eat, speak or sleep breathing faster a rapid heartbeat feeling drowsy, exhausted or dizzy your lips or fingersturning blue (cyanosis) Phone 999 to seek immediate help if you or someone else has symptoms of a severe asthma attack. Causes of asthma Its not clear exactly what causes asthma, although it is likely to be a combination of factors. Some of these may be genetic. However, a number of environmental factors are thought toplay a role in the development of asthma. These include air pollution, chlorine in swimming pools and modern hygiene standards (known as the hygiene hypothesis). There is currently not enough evidence to be certain whether any of these can cause asthma, although a variety of environmental irritants, such as dust, cold air and smoke, may make it worse. Who is at risk? Although the cause of asthma is unknown, a number of things that can increase your chances of developing the condition have been identified. These include: a family history of asthma or other related allergic conditions (known as atopic conditions) such as eczema, food allergy or hay fever havinganother atopic condition having bronchiolitis (a common childhood lung infection) as a child childhood exposure to tobacco smoke, particularly if your mother also smoked during pregnancy being born prematurely, especially if you needed a ventilator to support your breathing after birth having a low birth weight as a result of restricted growth within the womb Some people may also be at risk of developing asthma through their job. Asthma triggers In people with asthma, the small tubes (bronchi) that carry air in and out of the lungs become inflamed and more sensitive than normal. This means that when you come into contact with something that irritates your lungs (a trigger), your airways become narrow, the muscles around them tighten, and there is an increase in the production of sticky mucus (phlegm). Asthma symptoms can have a range of triggers, such as: respiratory tract infections  particularly infections affecting the upper airways, such as colds and the flu allergens  including pollen, dust mites, animal fur or feathers airborne irritants  including cigarette smoke, chemical fumes and atmospheric pollution medicines  particularly the class of painkillers called non-steroidal anti-inflammatory drugs (NSAIDs) , which includes aspirin and ibuprofen , and beta-blockers sometimes given for high blood pressure or some types of heart disease emotions  including stress or laughing foods containing sulphites  naturally occurring substances found in some food and drinks, such as concentrated fruit juice, jam, prawns and many processed or pre-cooked meals weather conditions  includinga sudden change in temperature, cold air, windy days, thunderstorms, poor air quality and hot, humid days indoor conditions  including mould or damp, house dust mites and chemicals in carpets and flooring materials exercise food allergies  including allergies to nuts or other food items Once you know your asthma triggers, youmay be able tohelp control your condition by tryingto avoid them. Further information Asthma UK: asthma triggers A-Z Occupational asthma In some cases, asthma isassociated with substancesyou may be exposed toat work. This is known as occupational asthma. Some of the most commonly reportedcauses of occupational asthma include exposure to: isocyanates (chemicals often found in spray paint) flour and grain dust colophony (a substanceoften found in solder fumes) latex animals wood dust You may be at an increased risk of developing occupational asthma if you are regularly exposed to substances such as these throughyour work. Occupations that are commonly associated with the condition include paint sprayers, bakers and pastry makers, nurses, chemical workers, animal handlers, welders, food processing workers and timber workers. Further information Asthma UK:occupational asthma Health and Safety Executive: asthma Diagnosing asthma If you have typical asthma symptoms, your GP will often be able to make a diagnosis. Theywill want to know whenthe symptoms happen and how often, and if you have noticed anything that might trigger them. Your GP may also ask whetheryou have any allergic (atopic) conditions such as eczema and hay fever , which often occur alongside asthma. A number of tests can be carried out to confirm the diagnosis. These are described below. In children, asthma can be difficult to diagnose because many other conditions can cause similar symptoms in infants. The tests outlined below are also not always suitable forchildren. Your GP therefore may sometimes suggestthat your child usesan asthma inhaler as a trial treatment. If this helps improve your childs symptoms, it is likelythey have asthma. Spirometry A breathing test calledspirometry will often be carried out to assess how well your lungs work. This involves taking a deep breath and exhaling as fast as you can through a mouthpiece attached to a machine called a spirometer. The spirometer takes two measurements  the volume of air you can breathe out in the first second of exhalation (the forced expiratory volume in one second, or FEV1) and the total amount of air you breathe out (the forced vital capacity or FVC). You may be asked to breathe into the spirometer a few times to get an accurate reading. The readings are then compared with average measurements for people your age, sex and height, which can show if your airways are obstructed. Sometimes an initial set of measurements is taken, and you arethen given a medicine to open up your airways (a reliever inhaler) to see if this improves your breathing when another reading is taken. This is known as reversibility testing, and it can be useful in distinguishing asthma from other lung conditions, such as chronic obstructive pulmonary disease (COPD) . Peak expiratory flow test A small hand-held device known as a peak flow meter can be used to measure how fast you can blow air out of your lungs in one breath. This is your peak expiratory flow (PEF) and the test is usually called a peak flow test. This test requires a bit of practise to get it right, so your GP or nurse will show you how to do it and may suggest you take the best of two or three readings. You may be given a peak flow meter to take home and a diary to record measurements of your peak flow over a period of weeks. This is because asthma is variable and your lung function may change throughout the day. Your diary may also have a space to record your symptoms. This helps to diagnose asthma and, once diagnosed, will help you recognise when your asthma is getting worse and aid decisions about what action to take. To help diagnose asthma that may be related to your work (occupational asthma), your GP may ask you to take measurements of your peak expiratory flow both at work and when you are away from work. Your GP may then refer you to a specialist to confirm the diagnosis. Other tests Some people may also need anumber of more specialised tests. The tests may confirm the diagnosis of asthma or help diagnose a different condition. This will help you and your doctor to plan your treatment. Airways responsiveness This test is sometimes used to diagnose asthma when the diagnosis is not clear from the more simple tests discussed above. It measures how your airways react when they come into contact with a trigger. You will be asked to breathe in a medication that deliberately irritates or constricts your airways slightly if you have asthma, causing a small decrease in your FEV1 measured using spirometry and possibly triggering mild asthma symptoms. If you do not have asthma, your airways will not respond to this stimulus. The test often involves inhaling progressively increasing amounts of the medication at intervals, with spirometry measurement of FEV1 in between to see if it falls below a certain threshold. In some cases, however, exercise may be used as a trigger. Testing airway inflammation It may also be useful in some cases to carry out tests to check for inflammation in your airways. This can be done in two main ways: amucus sample  the doctor may take a sample of mucus (phlegm)so it can be tested for signs ofinflammation in the airways nitric oxide concentration  as you breathe out, the level of nitric oxide in your breath is measured using a special machine;a high level of nitric oxide can be a sign of airway inflammation Allergy tests Skin testing or a blood test can be used to confirm whether your asthma is associated with specific allergies,such asdust mites, pollen or foods. Tests can also be carried out to see if you are allergic or sensitive to certain substances known to cause occupational asthma. Read more about diagnosing allergies Treating asthma Reliever inhalers Reliever inhalersusually blueare taken to relieve asthma symptoms quickly. The inhaler usually contains a medicine called a short-acting beta2-agonist, which works by relaxing the muscles surrounding the narrowed airways. This allows the airways to open wider, making it easier to breathe again. Reliever inhalers do not reduce the inflammation in the airways, so they do not make asthma better in the long term  they are intended only for the relief of symptoms. Examples of reliever medicines include salbutamol and terbutaline. They are generally safe medicines with few side effects, unless overused. However, they should rarely, if ever, be necessary if asthma is well controlled, and anyone needing to use them three or more times a week should have their treatment reviewed. Everyone with asthma should be given a reliever inhaler, also known simply as a reliever. Read further information: Asthma UK: relievers Preventer inhalers Preventer inhalersusually brown, red or orangework over time to reduce the amount of inflammation and sensitivity of the airways, and reduce the chances of asthma attacks occurring. They must be used regularly (typically twice or occasionally once daily) and indefinitely to keep asthma under control. You will need to use the preventer inhaler daily for some time before you gain the full benefit. You may still occasionally need the blue reliever inhaler to relieve yoursymptoms, but your treatment should be reviewedif you continue to need them often. The preventer inhaler usually contains a medicine called an inhaled corticosteroid. Examples of preventer medicines include beclometasone, budesonide, fluticasone, ciclesonide and mometasone. Preventer treatment should be taken regularly if you have anything more than occasional symptoms from your asthma, and certainly if you feel the need to use a reliever inhaler more than twice a week. Some inhaled corticosteroids can occasionally cause a mild fungal infection (oral thrush) in the mouth and throat, so make sure you rinse your mouth thoroughly after inhaling a dose. The use of a spacer device also reduces this risk. Smoking can reduce the effects of preventer inhalers. Read further information: Asthma UK:preventer inhalers Other treatments and add-on therapy Long-acting reliever inhalers If your asthma does not respond to initial treatment, the dose of preventer inhaler you take may be increased in agreement with your healthcare team. If this does not control your asthma symptoms, you may be given an inhaler containing a medicine called a long-acting reliever (long-acting bronchodilator/long-acting beta2-agonist, or LABA) to take as well. These work in the same way as short-acting relievers. Although they take slightly longer to work, their effects can last for up to 12 hours. This means that taking them regularly twice a day provides 24-hour cover. Regular use of long-acting relievers can also help reduce the dosage of preventer medication needed to control asthma. Examples of long-acting relievers include formoterol and salmeterol, and recently vilanterol, which may last up to 24 hours. However, like short-acting relievers, long-acting relievers do not reduce the inflammation in the airways. If they are taken without a preventer, this may allow the condition to get worse while masking the symptoms, increasing the chance of a sudden and potentially life-threatening severe asthma attack. You should therefore always use a long-acting reliever inhaler in combination with a preventer inhaler, and never by itself. In view of this, most long-acting relievers are prescribed in a combination inhaler, which contains both an inhaled steroid (as a preventer) and a long-acting bronchodilator in the one device. Examples of combination inhalers include Seretide, Symbicort, Fostair, Flutiform and Relvar. These are usually (but not always) purple, red and white, or maroon. Other preventer medicines If regular efficient administration of treatment with a preventer and a long-acting reliever still fails to control asthma symptoms, additional medicines may be tried. Two possible alternatives include: leukotriene receptor antagonists tablets that block part of the chemical reaction involved in the swelling (inflammation) of the airways theophyllines tablets that help widen the airways by relaxing the muscles around them, and are also relatively weak anti-inflammatory agents Oral steroids If your asthma is still not under control, you may be prescribed regular steroid tablets. This treatment is usually monitored by a respiratory specialist (an asthma specialist). Oral steroids are powerful anti-inflammatory preventers, which are generally used in two ways: to regain control of asthma when it is temporarily upsetfor example, by a lapse in regular medication or an unexpected chest infection; in these cases, they are typically given for one or two weeks, then stopped when long-term control of asthma remains a problem, despite maximal dosages of inhaled and other medicationsin these cases, oral steroids may be given for prolonged periods, or even indefinitely, while maintaining maximum treatment with inhalers asthis maximises the chance of being able to stop the oral steroids again in the future Long-term use of oral steroids has serious possibleside effects, so they are only used once other treatment options have been tried, and after discussing the risks and benefits with your healthcare team. Omalizumab (Xolair) Omalizumab, also known as Xolair, is the first of a new category of medication that binds to one of the proteins involved in the immune response and reduces its level in the blood. This lowers the chance of an immune reaction happening and causing an asthma attack. It is licensed for use in adults and children over six years of age with asthma. The National Institute for Heath and Care Excellence (NICE) recommends that omalizumab can be used in people with allergy-related asthma whoneed continuous or frequent treatment with oral corticosteroids. Omalizumab is given as an injection every two to four weeks. It should only be prescribed in a specialist centre. If omalizumab does not control asthma symptoms within 16 weeks, the treatment should be stopped. Read further information: Asthma UK:other treatments and add-on therapies Asthma UK:steroid tablets NICE: omalizumab for severe persistent allergic asthma Bronchial thermoplasty Bronchial thermoplasty is a relatively new procedurethat can be usedin some cases of severe asthma. It worksby destroying some of the muscles surrounding the airways in the lungs, which canreduce their ability to narrow the airways. The procedure is carried out either with sedation or under general anaesthetic . A bronchoscope (a long, flexible tube) containing a probe is inserted into the lungs through the mouth or noseso it touches the airways. The probe then uses controlled heat to damage the muscles around the airways. Three treatment sessions are usually needed, with at leastthree weeks between each session. There is some evidence to showthis procedure may reduce asthma attacks and improve the quality of life of someone with severe asthma. However, the long-term risks and benefits are not yet fully understood. There is a small risk it will trigger an asthma attack, which sometimes requires hospital admission. You should discuss this procedure fully with your clinician if the treatment is offered. Read further information: NICE:bronchial thermoplasty for severe asthma Side effects of treatments Side effects of relievers and preventers Relievers are a safe and effective medicine, and havefew side effects as long as they are not used too much. The main side effects include a mild shaking of the hands (tremors), headaches and muscle cramps. These usually only happen with high doses of reliever inhaler and usually only last for a few minutes. Preventers arevery safe at usual doses, although they can cause a range of side effects at high doses, especially with long-term use. The main side effect of preventer inhalers is a fungal infection of the mouth or throat (oral candidiasis) . You may also develop a hoarse voice and sore throat . Using a spacer can help prevent these side effects, as can rinsing your mouth or cleaning your teeth afterusingyour preventer inhaler. Your doctor or nurse will discuss with you the need to balance control of your asthma with the risk of side effects, and how to keepside effects to a minimum. Side effects of add-on therapy Long-acting relievers may cause similar side effects to short-acting relievers. You should be monitored at the beginning of your treatment and reviewed regularly. If you find there is no benefit to using the long-acting reliever, it should be stopped. Theophylline tablets have been known to cause side effects in some people, including nausea, vomiting, tremors and noticeable heartbeats (palpitations). These can usually be avoided by adjusting the dose according to periodic measurement of the theophylline concentration in the blood. Side effects of leukotriene receptor agonists can include tummy (abdominal) pain and headaches. Side effects of steroid tablets Oral steroids carry a risk if they are taken for more than three months or if they are taken frequently (more than three or four courses of steroids a year). Side effects can include: osteoporosis (fragile bones) high blood pressure (hypertension) diabetes increased appetite, leading to weight gain cataracts andglaucoma (eye disorders) thinning of the skin easy bruising muscle weakness With the exception of increased appetite, which is very commonly experienced by people taking oral steroids, most of these unwanted effects are uncommon. However, it is a good idea to keep an eye out for them regularly, especially side effects that are not immediately obvious, such as high blood pressure, thinning of the bones, diabetes and glaucoma. You will need regular appointments to check for these. Read further information: Asthma UK:side effects of asthma medicines Asthma attacks Apersonal asthma action plan will help you recognise the initial symptoms of an asthma attack, know how to respond, and when to seek medical attention. In most cases, the following actions will be recommended: Take one to two puffs of your reliever inhaler (usually blue) immediately. Sit down and try to take slow, steady breaths. If you do not start to feel better, take two puffs of your reliever inhaler (one puff at a time) every two minutes(you can take up to 10 puffs)this is easier using a spacer, if you have one. If you do not feel better after taking your inhaler as above or if you are worried at any time, phone 999. If an ambulance does not arrive within 10 minutes and you are still feeling unwell, repeat step three. If your symptoms improve and you do not need to phone 999, you still need to see a doctor or asthma nurse within 24 hours. If you are admitted to hospital, you will be given a combination of oxygen, reliever and preventer medicines to bring your asthma under control. Your personal asthma action plan will need to be reviewed after an asthma attack, so reasons for the attack can be identified and avoided in future. Read further information: Asthma UK: what to do in an asthma attack Personal asthma action plan As part of your initial assessment, you should be encouraged to draw up a personal asthma action plan with your GP or asthma nurse. If youve been admitted to hospital because of an asthma attack, you should be offered an action plan (or the opportunity to review an existing action plan) before you go home. The action plan should include information about your asthma medicines, and will help you recognise when your symptoms are getting worse and what steps to take. You should also be given information about what to do if you have an asthma attack. Your personal asthma action plan should be reviewed with your GP or asthma nurse at least once a year, or more frequently if your symptoms are severe. As part of your asthma plan, you may be given a peak flow meter . This will give you another way of monitoring your asthma, rather than relying only on symptoms, so you can recognise deterioration earlier and take appropriate steps. Read further information: Asthma UK: personal asthma action plan What is good asthma care? Your doctor or nurse will tailor your asthma treatment to your symptoms. Sometimes you may need to be on higher levels of medication than at others. You should be offered: care at your GP surgery provided by doctors and nurses trained in asthma management full information about your condition and how to control it involvement in making decisions about your treatment regular checks to ensure your asthma is under control and your treatment is right for you (this should be at least once a year) a written personal asthma action plan agreed with your doctor or nurse It is also important that your GP or pharmacist teaches you how to properly use your inhaler, as this is an important part of good asthma care. Occupational asthma If it is possible you have asthma associated with your job (occupational asthma), you will be referred to a respiratory specialist to confirm the diagnosis. If your employer has an occupational health service, they should also be informed, along with your health and safety officer. Your employer has a responsibility to protect you from the causes of occupational asthma. It maysometimes be possible to substitute or remove the substance triggering your occupational asthma from your workplace, to redeploy youto another role within the company, or to wear protective breathing equipment. However, you may need to consider changing your job or relocating away from your work environment, ideally within 12 months of your symptoms developing. Some people with occupational asthma may be entitled to Industrial Injuries Disablement Benefit. Read further information: Asthma UK: occupational asthma GOV.UK: Industrial Injuries Disablement Benefit Health and Safety Executive: asthma Complementary therapies A number of complementary therapies have been suggested for the treatment of asthma, including: breathing exercises traditional Chinese herbal medicine acupuncture ionisersdevices that use an electric current to charge (ionise) molecules of air manual therapiessuch as chiropractic hypnosis homoeopathy dietary supplements However, there is little evidence that any of these treatments, other than breathing exercises, are effective. There is some evidence that breathing exercisescan improve symptoms and reduce the need for reliever medicines in some people. These includebreathing exercises taught by a physiotherapist, yoga and the Buteyko method (a technique involving slowed, controlled breathing). Read further information: Asthma UK: complementary therapies Living with asthma With the right treatment and management, asthma shouldnt restrict your daily life (including your sleep) in any way. You should work with your healthcare professionals and strive to achieve this goal. You should also be confident about how to recognise when your asthma is getting out of control, and what to do if it does. Sleeping Asthma symptoms are often worse at night. This means you might wake up some nights coughing or with a tight chest. If your child has asthma, poor sleep can affect their behaviour and concentration, as well as their ability to learn. Effectively controlling asthma with the treatment your doctor or nurse recommends will reduce the symptoms, so you or your childshould sleep better. Read about living with insomnia for more tips on getting better sleep. Exercise Very occasionally, people with asthma develop symptoms only during exercise. However, usually this is a sign that your asthma could be better controlled generally. If you or your child have asthma symptoms during or after exercise, speak to your doctor or asthma nurse. It is likely they will review your general symptoms and personal asthma plan to make surethe conditionis under control. Your doctor or asthma nurse may also advise that: you make sure the people you are exercising with know you have asthma you increase your fitness levels gradually you always have your reliever inhaler (usually blue) with you when you exercise you use your reliever inhaler immediately before you warm up you ensure that you always warm up and down thoroughly if you have symptoms while you are exercising, stop what youre doing, take your reliever inhaler and wait until you feel better before starting again Read about health and fitness for more information on simple ways to exercise. Diet Most people with asthma can eat a normal, healthy diet. Occasionally, people with asthma may have food-based allergic triggers and will need to avoid foods such as cows milk, eggs, fish, shellfish, yeast products, nuts, and some food colourings and preservatives. However, this is uncommon. Read more about eating well Read further information: Asthma UK: exercise Asthma UK: diet and food Know your triggers Its important to identify possible asthma triggers by making a note of any worsening symptoms or by using yourpeak flow meter during exposure to certain situations. Read our page on the causes of asthma for more information about potential triggers. Some triggers, such as air pollution, illnesses and certain weather conditions, can be hard to avoid. However, it may be possible to avoid other triggers, such as dust mites, fungal spores, pet fur and certain medications that trigger your symptoms. Make sure your healthcare team knows about and investigates triggers for your symptoms that you may have noticed yourself. Read further information: Allergy prevention Asthma UK: asthma triggers A-Z Complications of asthma Quality of life Badly controlled asthma can have an adverse effect on your quality of life. The condition can result in: fatigue (extreme tiredness) underperformance or absence from work or school psychological problems  including stress, anxiety and depression disruption of your work and leisure because of unexpected visits to your GP or hospital in children, delays in growth or",,,,,,,,,,,,,
puberty Children may also feel excluded from their school friends if they cannot take part in games, sports and social activities. Respiratory complications In rare cases,,,,,,,,,,,,,
Atopic eczema,"Atopic eczema - Illnesses and conditions Skin, hair and nails Atopic eczema Atopic eczema About atopic eczema Symptoms of atopic eczema Causes of atopic eczema Diagnosing atopic eczema Treating atopic eczema Complications of atopic eczema About atopic eczema Atopic eczema, also known as atopic dermatitis, is the most common form of eczema. It mainly affects children, but can also affect adults. Eczema is a condition that causes the skin to become itchy, red, dry and cracked. It is a long-term (chronic) condition in most people, although it can improve over time, especially in children. Atopic eczemacan affect any part of the body,but the most common areas to be affected are: backs or fronts ofthe knees outside or inside of the elbows around the neck hands cheeks scalp People with atopic eczema usuallyhave periods when symptoms are less noticeable, as well as periods when symptoms become more severe (flare-ups). Read more about the symptoms of atopic eczema and diagnosing atopic eczema . Atopic eczema causes itchy, red, dry and cracked skin. Source: https://dermnetnz.org/ What causes atopic eczema? The exact cause of atopic eczema is unknown, but its clear its not down to one single thing. It often occurs in people who get allergies  atopic means sensitivity to allergens. Itcan run in families, and oftendevelops alongside other conditions, such as asthma and hay fever . The symptoms of atopic eczemaoften have certaintriggers, such assoaps, detergents, stress and the weather.Sometimes food allergies can play a part, especially in young children with severe eczema. Readmore about the causes of atopic eczema . Treating atopic eczema There is currently no cure for atopic eczema, but treatment canhelp relieve the symptoms and many cases improve over time. However, severe eczema often has a significant impact on daily life and may be difficult tocope with physically and mentally. There is also an increased risk of skin infections. Many different treatments can be used to control symptoms and manage eczema, including: self care techniques,such as reducing scratching and avoiding triggers emollients(moisturising treatments)used on a daily basis for dry skin topical corticosteroids used to reduce swelling, redness and itching during flare-ups When to get professional advice Pharmacy First Scotland: Atopic eczema treatment from your pharmacy If you have atopic eczema or symptoms of atopic eczema you can get advice and treatment directly from a pharmacy. Find your local pharmacy on Scotlands Service Directory. Search for a pharmacy near you Atopic eczema isnt usually serious and can be treated by a pharmacist. Your pharmacist may recommend that you contact your GP practice if required. Read more about treatingatopic eczema and the complications of atopic eczema . Who is affected? About 1in 5children in the UK has atopic eczema. In 8 out of 10 cases, the condition develops before a child reaches the age of 5. Many children develop it before their first birthday. Atopic eczema can improve significantly, or even clear completely, in some children as they get older. About half of all cases improve a lot by the time a child reaches 11 years, and around two-thirds improveby the age of 16. However, the condition can continue into adulthood and can sometimes develop for the first time in adults. Symptoms of atopic eczema Atopic eczema causes areas of skin to become itchy, dry, cracked, sore and red. There will usually be periods where the symptoms improve, followed by periods where they get worse (flare-ups). Flare-ups may occur as often as 2or 3times a month. Atopic eczema can occur all over the body, but is most common on the hands (especially fingers), the insides of the elbows or backs of the knees, and the face and scalp in children. The face is more commonly involved in adults. The severity of atopic eczema can vary a lot from person to person. People with mild eczema may only have small areas of dry skin that are occasionally itchy. In more severe cases, atopic eczema can cause widespread red, inflamed skin all over the body and constant itching. Scratching can disrupt your sleep, make your skin bleed, and cause secondary infections. It can also make itching worse, and a cycle of itching and regular scratching may develop. This can lead to sleepless nights and difficulty concentrating at school or work. Areas of skin affected by eczema may also turn temporarily darker or lighter after the condition has improved. This is more noticeable in people with darker skin. Its nota result ofscarring or a side effect of steroid creams, but more of a footprint of old inflammationand will eventually return to its normal colour. Atopic eczema often occurs on the insides of the elbows. Source: https://dermnetnz.org/ Atopic eczema can occur on the face. Source: https://dermnetnz.org/ Signs of an infection Occasionally, areas of skin affected by atopic eczema can become infected. Signs of an infection can include: your eczema getting a lot worse fluid oozing from the skin a yellow crust on the skin surface or small yellowish-white spots appearing in the eczema the skin becoming swollen and sore a high temperature (fever) and generally feeling unwell See your doctor as soon as possible if you think your or your childs skin may have become infected. Read more about infections and other complications of atopic eczema . Causes of atopic eczema Atopic eczema is likely to be caused by a combination of things. People with atopic eczema often have very dry skin because their skin is unable to retainmuch moisture. This dryness may makethe skin more likely to react to certain triggers, causing it to become red and itchy. You may be born with an increased likelihood of developing atopic eczema because of the genes you inherit from your parents. Research has shown children who have 1or both parents with atopic eczema, or who have other siblings with eczema, are more likely to develop it themselves. Atopic eczema is not infectious, so it cannot be passed on through close contact. Eczema triggers There are a number of things that may trigger your eczema symptoms. These can vary from person to person. Commontriggers include: irritants such assoaps and detergents, including shampoo, washing up liquidand bubble bath environmental factors or allergens  such as cold and dry weather, dampness, and more specific things such as house dust mites, pet fur, pollen and moulds food allergies  such as allergies tocows milk, eggs, peanuts, soya or wheat certainmaterials worn next to the skin  such as wool and synthetic fabrics hormonal changes  women may find their symptoms get worse in the days before their period or during pregnancy skin infections Some people also report their symptoms get worse when the air is dry or dusty, or when they are stressed,sweaty, or too hot or too cold. If you are diagnosed with atopic eczema, your pharmacist or GP will work with you to try to identify any triggers for your symptoms. Read more about diagnosing atopic eczema . Diagnosing atopic eczema Your GP will usually be able to diagnose atopic eczema by looking at your skin and asking questions about your symptoms. These questions may include asking: whether the rash is itchy and where it appears when the symptoms first began whether it comes and goes over time whether there is a history of atopic eczema in your family whether you have any other conditions, such as allergies or asthma You should tell your pharmacist or GP if your condition is affecting your quality of life for example, if youhave difficulty sleeping because of itching, oryour eczema limits your everydayactivities. Checklist for diagnosing atopic eczema Typically, to be diagnosed with atopic eczema you should have had an itchy skin condition in the last 12 months and 3or more of the following: visibly irritated red skin in the creases of your skin, such as the insides of your elbows or behind your knees (or on the cheeks, outsides of elbows, or fronts of the knees in children aged 18 months or under) at the time of examination by a health professional a history of skin irritation occurring in the same areas mentioned above generally dry skin in the last 12 months a history of asthma or hay fever  children under 4must have an immediate relative, such as a parent, brother or sister, who has one of these conditions the condition started before the age of 2(this does not apply to children under the age of 4) Establishing triggers Your pharmacist should work with you to establish if any triggers make your eczema worse. You may be asked about your diet and lifestyle to see if something obvious may be contributing to your symptoms. For example, you may have noticed some soaps or shampoos make the eczema worse. You may also be asked to keep a food diary to try to determine whether a specific food makes your symptoms worse. A food diary involves writing down everything you eat and making a record of any eczema flare-ups you have. Your pharmacist can then use the diary to see if there is a pattern between your symptoms and what you eat. Allergy tests are not usually needed to identify triggers, although they are sometimes helpful in identifying food allergies that may be triggering symptoms in young children or in those where a food allergy is suspected. Read more about triggers and causes of atopic eczema . Treating atopic eczema There is no cure for atopic eczema, but treatments can ease the symptoms. Many children find their symptoms naturally improve as they get older. The main treatments for atopic eczema are: emollients(moisturisers)  used every day to stop the skin becoming dry topical corticosteroids creams and ointments used to reduce swelling and redness during flare-ups Other treatments include topical pimecrolimus or tacrolimus for eczema in sensitive sites not responding to simpler treatment,antihistamines for severe itching, bandages or special body suits to allow the body to heal underneath, or more powerful treatments offered by a dermatologist (skin specialist). The various treatments foratopic eczema are outlined below. Self care As well as the treatments mentioned above, there are thingsyou cando yourself to help easeyour symptoms and prevent further problems. Try to reduce the damage from scratching Eczema is often itchy and it can be very tempting to scratch the affected areas of skin. But scratching usually damages the skin, which can itself cause more eczema to occur. The skin eventually thickens into leathery areas as a result of chronic scratching. Deep scratching also causes bleeding and increases the risk of your skin becoming infected or scarred. Try to reduce scratching whenever possible. You could try gently rubbing your skin with your fingers instead. If your baby has atopic eczema, anti-scratch mittens may stop them scratching their skin. Keep your nails short and clean to minimise damage to the skin from unintentional scratching. Keep your skin covered with light clothing to reduce damage from habitual scratching. Avoid triggers Your pharmacist will work with you toestablish what mighttrigger the eczema flare-ups, althoughit may get better or worse for no obvious reason. Once you knowyour triggers, you can try to avoid them.For example: if certain fabrics irritate your skin, avoid wearing these and stick to soft, fine-weave clothing or natural materials such as cotton if heat aggravates your eczema, keep the rooms in your home cool, especially the bedroom avoid using soaps or detergents that may affect your skin use soap substitutes instead Althoughsome people with eczema are allergic to house dust mites, trying to rid your home of them isnt recommendedas it can be difficult and there is no clear evidence that it helps. Read more about preventing allergies . Dietary changes Some foods, such as eggs and cows milk, can trigger eczema symptoms. However, you should not make significant changes to your diet without first speaking to your pharmacist or GP. It may not be healthy to cut these foods from your diet, especially in young children who need the calcium, calories and protein from these foods. If your GP suspects you have a food allergy , you may be referred to a dietitian (a specialist in diet and nutrition), who can help work out a way to avoid the food youre allergic to while ensuring you still get all the nutrition you need. Alternatively, you may be referred to a hospital specialist such as an immunologist, dermatologist or paediatrician. If you are breastfeeding a baby with atopic eczema, get medical advice before making any changes to your regular diet. Emollients Emollients are moisturising treatments applied directly to the skin to reduce water loss and cover it with a protective film. They are often used to help manage dry or scaly skin conditions such as atopic eczema. In addition to making the skin feel less dry, they may also have a mild anti-inflammatory role, and can help reduce the number of flare-ups you have. Choosing anemollient Several different emollients are available. You may need to try a few to find one that works for you. You may also be advised to use a mix of emollients, such as: an ointment for very dry skin a cream or lotion for less dry skin an emollient to use instead of soap an emollient to add to bath water or use in the shower one emollient to use on your face and hands, and a different one to use on your body The difference between lotions, creams and ointments is the amount of oil they contain. Ointments contain the most oil so they can be quite greasy, but are the most effective at keeping moisture in the skin. Lotions contain the least amount of oil so are not greasy, but can be less effective. Creams are somewhere in between. If you have been using a particular emollient for some time, it may eventually become less effective or may start to irritate your skin. If this is the case, your pharmacist will be able to recommend another product that suits you better. The best emollient is the one you feel happy using every day. How to use emollients Use your emollient all the time, even if you are not experiencing symptoms. Many people find it helpful to keep separate supplies of emollients at work or school, or a tub in the bathroom and one in a living area. To apply the emollient: use a large amount dont rub it in smooth it into the skin in the same direction the hair grows instead after a bath or shower, gently pat the skin dry andapply the emollient while the skin is still moist to keep the moisture in You should use an emollient at least twice a day if you can, or more often if you have very dry skin. During a flare-up, apply generous amounts of emollient more frequently, but remember to treat inflamed skin with a topical corticosteroidas emollients usedon their ownare not enough to control it. Dont put your fingers into an emollient pot  use a spoon or pump dispenser instead, as this reduces the risk of infection. And never share your emollient with other people. Topical corticosteroids If your skin is sore and inflamed, your pharmacist may recommend a topical corticosteroid (applied directly to your skin), which can reduce the inflammation within a few days. Topical corticosteroids can be prescribed in different strengths, depending on the severity of your atopic eczema and the areas of skin affected. They can be very mild (such as hydrocortisone), moderate (such as clobetasone butyrate), or even stronger (such as mometasone). If you need to use corticosteroids frequently, see your GP regularly so they can check the treatment is working effectively and you are using the right amount. How to use topical corticosteroids Dont be afraid to apply the treatment to affected areas to control your eczema. Unless instructed otherwise by your doctor, follow the directions on the patient information leaflet that comes with your medication. This will give details of how much to apply. Most people will only have to apply it once a day as there is no evidence there is any benefit to applying it more often. When using a topical corticosteroid: apply your emollient first and ideally wait around 30 minutes until the emollient has soaked into your skin, or apply the corticosteroid at a different time of day (such as at night) apply the recommended amount of the topical corticosteroid to the affected area continue to use it until 48 hours after the flare-up has cleared so the inflammation under the skin surface is treated Occasionally, your doctor may suggest using a topical corticosteroid less frequently, but over a longer period of time. This is designedto help prevent flare-ups. This is sometimes called weekend treatment, where a person who has already gained control of their eczema uses the topical corticosteroid every weekend on the trouble sites to prevent them becoming active again. Side effects Topical corticosteroids may cause a mild stinging sensation for less than a minute as you apply them. In rare cases, they may also cause: thinning of the skin especially if the strong steroids are used in the wrong places, such as the face, for too long (for example, several weeks) changes in skin colour usually, skinlightening after many months of using very strong steroids, but most lighteningafter eczema is a footprint of old inflammation and nothing to do with treatments acne (spots) especially when used on the face in teenagers increased hair growth Most of these side effects will improve once treatment stops. Generally, using a strong topical corticosteroid for many months,using them in sensitive areas such as theface, armpits or groin, or using a large amount will increase your risk of side effects. For this reason, you should be prescribed the weakest effective treatment to control your symptoms. Antihistamines Antihistamines are a type of medicine that blocks the effects of a substance in the blood called histamine. Theycan help relieve the itching associated with atopic eczema. They can eitherbe sedating, which cause drowsiness,ornon-sedating. If you have severe itching, your pharmacist may suggest tryinga non-sedating antihistamine. If itching during a flare-up affects your sleep, your pharmacist may suggest taking a sedatingantihistamine. Sedatingantihistamines can cause drowsiness into the following day, so it may be helpful to let your childs school know they may not be as alert as normal. Bandages and wet wraps In some cases, your GP may prescribe special medicated bandages, clothing or wet wraps to wear over areas of skin affected by eczema. These can either be used over emollients or with topical corticosteroids to prevent scratching, allow the skin underneath to heal, and stop the skin drying out. Corticosteroid tablets Corticosteroid tablets are rarely used to treat atopic eczema nowadays, but may occasionally be prescribed for short periods of 5to 7days to help bring particularly severe flare-ups under control. Longer courses of treatment are generally avoided because of the risk of potentially serious side effects. If your GP thinks your condition may be severe enough to benefit from repeated or prolonged treatment with corticosteroid tablets, they will probably refer you to a specialist. Seeing a specialist In some cases, your GP may refer you to a specialist in treating skin conditions (dermatologist). You may be referred if your GP is not sure what type of eczema you have, normal treatment is not your eczema, your eczema is affecting your daily life, or its not clear what is causing it. A dermatologist may be able to offer the following: a thorough review of your existing treatment  to make sure you are using enough of the right things at the right times topical calcineurin inhibitors  creams and ointments that suppress your immune system, such aspimecrolimus and tacrolimus very strong topical corticosteroids bandages or wet wraps phototherapy  ultraviolet (UV) light that reduces inflammation immunosuppressant tablets  to suppress your immune system, such as azathioprine, ciclosporin and methotrexate alitretinoin  medicine to treat severe eczema affecting the hands in adults A dermatologist may also offer additional support to help you use your treatments correctly, such as demonstrations from nurse specialists, and they may be able to refer you for psychological support if you feel youneed it. Complications of atopic eczema People with atopic eczema can sometimes develop further physical and psychological problems. Bacterial skin infections As atopic eczema can cause your skin to become cracked and broken, there is a risk of the skin becoming infected with bacteria. The risk is higher if you scratch your eczema or do not use your treatments correctly. Signs of a bacterial infection can include: fluid oozing from the skin a yellow crust on the skin surface small yellowish-white spots appearing in the eczema the skin becoming swollen and sore a high temperature (fever) and generally feeling unwell Your normal symptoms may also get rapidly worse and your eczema may not respond to your regular treatments. You should see your doctor as soon as possible if you think your or your childs skin may have become infected. They will usually prescribe antibiotic tablets, capsules or cream to treat the infection, as well as making sure the skin inflammation that led to the infection is well controlled. Speak to your pharmacist or GP if these dont help or your symptoms get worse. Once your infection has cleared, your GP should prescribe new supplies of any creams and ointments youre using to avoid contamination. Old treatments should be disposed of. Viral skin infections Its also possible for eczema to become infected with the herpes simplex virus, which normally causes cold sores . This can develop into a serious condition called eczema herpeticum. Symptoms of eczema herpeticum include: areas of painful eczema that quickly get worse groups of fluid-filled blisters that break open and leave small, shallow open sores on the skin a high temperature and generally feeling unwell, in some cases Contact yourdoctor immediately if you think you or your child may have eczema herpeticum. If you cannot contact your GP, call NHS 111 or go to your nearest hospital. If you are diagnosed witheczema herpeticum, you will be given an antiviral medication called aciclovir. Psychological effects As well as affecting you physically, atopic eczema may also affect you psychologically. Preschool children with atopic eczema may be more likely to have behavioural problems such as hyperactivity than children who do not have the condition. They are also more likely to be more dependent on their parents. Bullying Schoolchildren may experience teasing or bullying if they have atopic eczema. Any kind of bullying can betraumatic and difficult for a child to deal with. Your child maybecome quiet and withdrawn. Explain the situation to your childs teacher and encourage your child to tell you how they are feeling. The National Eczema Society provides information about regional support groups , where you may be able to meet other people living with atopic eczema. Problems sleeping Sleep-related problems are common among people with eczema. A lack of sleep may affect mood and behaviour. It may also make it more difficult to concentrate at school or work. If your child has problems sleepingbecause of theireczema,they may fall behind with their schoolwork. Itmight helpto lettheir teacher know about their condition so it can be taken into consideration. During a severeeczema flare-up, your child may need time off from school. This may also affect their ability to keep up with their studies. Self-confidence Atopic eczema can affect the self-confidence of both adults and children. Children may find it particularly difficult to deal with their condition, which maylead tothem having a poor self-image. If your child is severely lacking in confidence, it may affect their ability to develop social skills. Support and encouragement will help boost your childs self-confidence and give them a more positive attitude about their appearance. Speak to your GP if you are concerned your childs eczema is severely affecting their confidence. They may benefit from specialist psychological support. ",,,,,,,,,,,,,
Atrial fibrillation,"Atrial fibrillation - Illnesses & conditions  Heart and blood vessels Conditions Atrial fibrillation Atrial fibrillation About atrial fibrillation Symptoms of atrial fibrillation Causes of atrial fibrillation Diagnosing atrial fibrillation Treating atrial fibrillation Complications of atrial fibrillation About atrial fibrillation Atrial fibrillation (AF)is a condition that causes an irregular heart rate. Most commonly, the heart rate will be unusually fast with this condition;butit is possible for the heart rate to be within accepted limitsor slower and still be in atrial fibrillation. You can measure your heart rate by feeling the pulse in your wrist or neck. A normal heart rate, when you are resting, should be between 60 and 100 beats a minute. In atrial fibrillation, it may be over 140 beats a minute. How is atrial fibrillation defined? Atrial fibrillation is defined in various ways, depending on how it affects you: paroxysmal atrial fibrillation  this comes and goes, usually stopping within 48 hours without any treatment. persistent atrial fibrillation  this lasts for longer than seven days, or less when it is treated. longstanding persistent atrial fibrillation  this means you have had continuous atrial fibrillation for a year or longer. permanent atrial fibrillation  this is when atrial fibrillation is present all the time and no more attempts to restore normal heart rhythm will be made What happens in atrial fibrillation? When the heart beats normally, its muscular walls contract (tighten and squeeze) to force blood out and around the body. They then relax, so the heart can fill with blood again. This process is repeated every time the heart beats. Atrial fibrillation occurs when abnormal electrical impulses suddenly start firing in the atria (upper chambers of the heart). These impulses override the hearts natural pacemaker, which can no longer control the rhythm of the heart. The atria contract randomly and sometimes so fast that the heart muscle cannot relax properly between contractions. This reduces the hearts efficiency and performance and causes a highly irregular pulse rate. What are the symptoms of atrial fibrillation? Atrial fibrillation can lead to a number of problems, including: dizziness feeling faint shortness of breath fast and irregular heartbeat (palpitations) feeling very tired Some people with atrial fibrillation have no symptoms and are completely unaware that their heart rate is irregular. Find out more about the symptoms of atrial fibrillation Why does atrial fibrillation happen and how common is it? Atrial fibrillation is the most common heart rhythm disturbance and affects up to 800,000 people in the UK. The cause of atrial fibrillation is not fully understood, but it tends to occur in certain groups of people and may be triggered by certain situations, such as drinking excessive amounts of alcohol or smoking. The condition can affect adults of any age or gender but: is more common the older you get affects about 10% of people over 75 more common in men than women Atrial fibrillation is more likely to occur in people with other conditions, like: high blood pressure diabetes coronary heart disease Find out more about the causesof atrial fibrillation and how its diagnosed What is the outlook with atrial fibrillation? Atrial fibrillation is generally not life threatening, many people live normal healthy lives with this condition, but it can be uncomfortable and often needs treatment. This condition increases your risk by about fourto five times of having a transient ischaemic attack (TIA) or stroke . This is because when the atria in the heart do not contract properly there is a risk ofblood clot formation. Clots from the atria may break off and go to other parts of the body. A blood clot passing up to the arteries supplying the brain may cause a stroke. For this reason, treatment may involve medication to control the heart rate or rhythm, and medication to prevent clots from forming in the blood. Find out how to treatatrial fibrillation and possible complicationsof having AF Symptoms of atrial fibrillation The most obvious symptom of atrial fibrillation (AF)is palpitations caused by a fast and irregular heartbeat. A normal heart rate, when you are resting, should be between 60 and 100 beats a minute. In atrial fibrillation, it may be over 140 beats a minute. If you notice an irregular heartbeat and/or have chest pain, see your doctor immediately. How to check your heart rate You can check your heart rate by pressing gently on the pulse in your wrist or neck. Other symptoms As well as a fast and irregular heartbeat, you may also experience: tiredness (inability to carry out normal exercise for you) breathlessness dizziness feeling faint palpitations chest discomfort or pain Some people have no symptoms Some people with atrial fibrillation have no symptoms and it is only discovered during routine tests or investigations for another condition. Causes of atrial fibrillation The exact cause of atrial fibrillation (AF) is unknown, but it becomes more common with age and affects certain groups of people more than others. People with other heart conditions Atrial fibrillation is common in people with other heart conditions, such as: high blood pressure coronary heart disease heart valve disease congenital heart disease(heart defects at birth) heart failure (from any cause) People with other medical conditions Atrial fibrillation isalso associated with other medical conditions such as: hyperthyroidism (overactive thyroid gland) heavy alcohol consumption pneumonia chronic obstructive pulmonary disease pulmonary embolism(a blockage in a blood vessel in your lungs) Cause is unknown Not everyone with atrial fibrillation falls into one of the above groups. Sometimes the cause can be idiopathic (no known cause) and can affect extremely athletic people. Triggers Sometimes there is a trigger to an episode of atrial fibrillation, including: drinking excessive amounts of alcohol, particularly binge drinking being overweight taking illegal drugs, particularly amphetamines or cocaine smoking heightened emotional stress Diagnosing atrial fibrillation Feeling your pulse to check if you have an irregular heartbeat can give a strong indication of whether you have atrial fibrillation (AF). However,a complete diagnosis requires a full medical investigation. If you notice your heartbeat is irregular and/or you have chest pain, see your GP straight away. If your GP thinks you have atrial fibrillation after assessing your symptoms, you will be asked to have an electrocardiogram (ECG) and referred to a heart specialist, known as a cardiologist. Electrocardiogram (ECG) An ECG is a test that records the rhythm and electrical activity of your heart. Small stickers called electrodes are attached to your arms, legs and chest and connected by wires to an ECG machine. Every time your heart beats, it produces tiny electrical signals. An ECG machine traces these signals on paper. An ECG is usually carried out in a hospital or GP surgery. It takes about five minutes and is painless. If you have the test during an episode of atrial fibrillation, the ECG will record your abnormal heart rate. This will confirm the diagnosis of atrial fibrillation and rule out other conditions. However, it may be difficult to capture an episode, as the irregular rhythm may come and go, therefore, to capture this your GP or cardiologist, may ask you to wear a small, portable ECG recorder for a longer period of time away from the hospital or GP surgery. Find out more about having an ECG Echocardiogram (Echo) An echocardiogram, sometimes called an echo, is an ultrasound scan of the heart. It can help identify any other heart problems and assess the structure and function of your heart and valves. Find out more about having an echocardiogram Chest X-ray A chest X-ray may be performed and will identify any lung problems that may have caused the atrial fibrillation. Blood tests Blood tests can also be useful in the diagnosis of atrial fibrillation. They may showanaemia, which could be complicating the situation, problems with kidney function or hyperthyroidism (overactive thyroid gland). Treating atrial fibrillation The treatment of atrial fibrillation (AF)varies from person to person and depends on: the type of atrial fibrillation symptoms treatment of any underlying cause age overall health Some people may be treated by their GP, whereas others may be referred to a cardiologist. Finding an underlying cause The first step is to try to find out the cause of the atrial fibrillation. If a cause is found, treatment for this may be enough. For example,medication to correct hyperthyroidism (an overactive thyroid gland) may cure atrial fibrillation. If there is no underlying cause found If no underlying cause of the atrial fibrillation can be found, the treatment options are: medicines to control atrial fibrillation restoring a normal heart rhythm medicines to reduce the risk of a stroke cardioversion (a controlled electrical shock to reset the heart rhythm) catheter ablation having a pacemaker fitted You can find out more about each of these below. Medicines to control atrial fibrillation Medicines called anti-arrhythmics can control atrial fibrillation by: restoring a normal heart rhythm controlling the rate at which the heart beats The choice of anti-arrhythmic medicine depends on: the type of atrial fibrillation any other medical conditions you have side effects of the medicine chosen how well the atrial fibrillation responds. Some people with atrial fibrillation may need more than one anti-arrhythmic medicine to control it. Restoring a normal heart rhythm There are a number of drugs that can be used to try to restore a normal heart. The best option for you will be decided by your cardiologist and /or GP. Commonly, these drugs include: flecainide beta-blockers amiodarone Dronedarone may also be used for certain people. It is important you know what side effects to look out for if taking such medication and seek medical advice if you experience any of them. To find out about side effects, read the patient information leaflet that comes with your medicine for more details. Medicines to reduce the risk of a stroke The way the heart beats in atrial fibrillation means that there is a risk of blood clots forming in the heart chambers. If these get into the bloodstream, they can cause a stroke (our complications of atrial fibrillation section has more information on this). Your doctor will assess your risk to minimise your chance of a stroke. They will consider your age and whether you have a history of any of the following: stroke orblood clots heart valve problems heart failure high blood pressure diabetes heart disease You will be classed as having a high, moderate or low risk of a stroke and will be given medication according to your risk. Depending on your level of risk, you may be prescribed warfarin . Anticoagulants Anticoagulants help to reduce the risk of stroke in patients with atrial fibrillation. Newer anticoagulants like apixaban, dabigatran, edoxaban and rivoroxaban are now more commonly used than warfarin. They do not require dose changes and continuous blood test monitoring. Warfarin may still be used in patients who cant be treated with a newer anticoagulant, or in those patients with other conditions where treatment with warfarin is preferred. Cardioversion Cardioversion may be tried in some people with atrial fibrillation. The heart is given a controlled electric shock to try to restore a normal rhythm. The procedure normally takes place in hospital with heavy sedation or anaesthetic and careful monitoring. In people who have had atrial fibrillation for more than two days, cardioversion is associated with an increased risk of clot formation. If this is the case, warfarin is given for three to four weeks before cardioversion and for at least four weeks afterwards to minimise the chance of having a stroke. If the cardioversion is successful, warfarin may be stopped. However, some people may need to continue with warfarin if there is a high chance of their atrial fibrillation returning and they have a moderate to high risk of a stroke. Catheter ablation Catheter ablation is a procedure that very carefully interrupts abnormal electrical circuits. It is an option if medication has not been effective or tolerated. Catheters (thin, soft wires) are guided through one of your veins into your heart where they record electrical activity. When the source of the abnormality is found, an energy source (such as high-frequency radiowaves that generate heat) is transmitted through one of the catheters to destroy the tissue. This procedure commonly takes two to three hours, so it may be done under general anaesthetic , where you are put to sleep. Find out more about catheter ablation for atrial fibrillation on the Arrhythmia Alliance website Having a pacemaker fitted A pacemaker is a small, battery-operated device that is implanted in your chest, just below your collarbone. It will not cure, reverse or actively treat your atrial fibrillation. A pacemaker provides beats where your heart is not supplying its own. If your heart beatis very slow the pacemaker will override this and pace at a set rate.If there are significant pauses between your heart beats beats, the pacemaker will supply a beat, acting as a safety net. Having a pacemaker fitted is usually a minor surgical procedure performed under a local anaesthetic (where the area is numbed). Complications of atrial fibrillation When the upper chambers of the heart, called the atria, do not pump efficiently then there is a risk of blood clots forming. These blood clots may move into the lower chambers of the heart, called the ventricles, and get pumped into the blood supply to the lungs or the general blood circulation. Stroke Clots in the general circulation can block arteries in the brain, causing a stroke . The risk of a stroke in people with atrial fibrillation (AF)is four to five times greater than the general population. However, the risk depends on a number of factors, including age, whether you have high blood pressure, heart failure, diabetes and a previous history of blood clots. Heart failure If your atrial fibrillation is persistent, it may start to weaken your heart muscle. In extreme cases, it can lead to heart failure , where your heart cannot pump blood around your body as efficiently as before. ",,,,,,,,,,,,,
Attention deficit hyperactivity disorder (ADHD),"Attention deficit hyperactivity disorder (ADHD) - Illnesses and conditions Mental health Attention deficit hyperactivity disorder (ADHD) Attention deficit hyperactivity disorder (ADHD) Attention deficit hyperactivity disorder (ADHD) is a group of behavioural symptoms that include: difficulty concentrating and paying attention hyperactivity impulsiveness Symptoms of ADHD in children and teenagers Symptoms of ADHD tend to be noticed at an early age. They may become more noticeable when a childs circumstances change, like when they start school. The main symptoms of ADHD in children and teenagers are: Inattentiveness The main signs of inattentiveness are: having a short attention span being easily distracted making careless mistakes appearing forgetful losing things being unable to stick at tedious or time-consuming tasks appearing to be unable to listen to or carry out instructions constantly changing activity or task having difficulty organising tasks Hyperactivity and impulsiveness The main signs of hyperactivity and impulsiveness are: being unable to sit still, especially in quiet surroundings constantly fidgeting being unable to concentrate on tasks excessive physical movement excessive talking being unable to wait their turn acting without thinking interrupting conversations little or no sense of danger Symptoms of ADHD in adults If youre an adult with ADHD, you may find that: you get easily distracted and find it hard to notice details, particularly with things you find boring its hard to listen to other people  you may find yourself finishing their sentences for them or interrupting them its hard to follow instructions you find it hard to organise yourself  you start a lot of things without ever finishing them you find it hard to wait you fidget and cant sit still when theres nothing much going on youre forgetful and tend to lose or misplace things you easily get irritable, impatient or frustrated and lose your temper quickly you feel restless or edgy, have difficulty turning your thoughts off you find stress hard to handle you tend to do things on the spur of the moment, without thinking, which gets you into trouble Some people with ADHD have problems with inattentiveness, but not with hyperactivity or impulsiveness. This form of ADHD is also known as attention deficit disorder (ADD). ADD can sometimes go unnoticed because the symptoms may be less obvious. Related conditions Some people might have other conditions alongside ADHD. Related conditions in children and teenagers with ADHD Some children may also have signs of other problems or conditions alongside ADHD, like: anxiety disorder oppositional defiant disorder (ODD)  this involves negative and disruptive behaviour, particularly towards figures of authority conduct disorder  this often involves antisocial behaviour, like stealing and harming people or animals depression sleep problems autistic spectrum disorder (ASD) epilepsy Tourettes syndrome learning difficulties, like dyslexia The symptoms of ADHD can improve with age. Although many adults diagnosed with the condition at a young age continue to experience problems. Related conditions in adults with ADHD ADHD in adults can occur alongside several related problems or conditions. One of the most common conditions is depression. Other conditions that adults may have alongside ADHD include: personality disorders bipolar disorder obsessive-compulsive disorder (OCD) ADHD can also cause problems like difficulties with relationships and social interaction. Causes of ADHD The exact cause of ADHD isnt fully understood. A combination of the following factors might be responsible: Genetics ADHD tends to run in families. The genes you you inherit from your parents are a factor in developing the condition. The way ADHD is inherited is complex and isnt thought to be related to a single gene. Brain function and structure Research has identified some possible differences in the brains of people with ADHD. Some studies involving brain scans have suggested that certain areas of the brain may be a different size in people with ADHD. Other studies have suggested that people with ADHD may have a chemical imbalance in the brain. Or that some chemicals may not work properly. Groups at risk Certain people are also believed to be more at risk of ADHD, including people: who were born prematurely (before the 37th week of pregnancy) or with a low birthweight with epilepsy with brain damage  which happened either in the womb or after a severe head injury later in life Diagnosing ADHD Speak to your GP if you think that you or your child may have ADHD. If youre worried about your child, it may help to speak to their teachers before seeing your GP. This means you can find out if they have any concerns about your childs behaviour. Your GP cant formally diagnose ADHD. They can discuss your concerns with you and refer you for a specialist assessment, if necessary. Treating ADHD Treatment for ADHD can help relieve the symptoms. ADHD can be treated using medication or therapy. A combination of both is often best. Treatment is usually arranged by a specialist, like a paediatrician or psychiatrist. Treatment of ADHD might include: Medication Medication might help you or your child concentrate better, be less impulsive and feel calmer. Therapy You might be offered therapy. This might be: psychoeducation behaviour therapy parent training education programmes cognitive behavioural therapy social skills training There are other treatments that involve altering your diet or taking supplements.",,,,,,,,,,,,,
Autistic spectrum disorder (ASD),"Autism spectrum disorder (ASD) - Illnesses and conditions Brain, nerves and spinal cord Autism spectrum disorder (ASD) Autism spectrum disorder (ASD) About autism Characteristics of autism Diagnosing autism Living with autism Facts and myths about autism About autism Autism spectrum disorder (ASD), usually called autism, is something youre born with. Autism means that the way you think about and experience the world is different to most people. This means you can behave differently to most people, and have different strengths and difficulties. For example, some autism characteristics (things you think, feel and do) can make it hard to express yourself in social situations, but you may also be particularly knowledgeable and passionate about topics that interest you. Read more about characteristics of autism here Autism is highly variable  the word spectrum refers to how autism is experienced differently by different people. Autism is considered a spectrum because its different for every autistic person  some autistic people might need more support than others to live the lives they want to lead. The way autism affects you can change as you grow and develop, and experience different environments. Read more about support here Talking about autism Many people who have been diagnosed with autism prefer using the term autistic to describe themselves  this is known as identity-first language (for example, Im autistic). They consider autism to be part of their identity, not a condition to be treated. For a long time people used the term person on the autism spectrum, known as person-first language (for example, Im on the autism spectrum), and some people still prefer this. In this guide, well mostly use the term autistic. If in doubt, you can always ask an autistic person what term theyd prefer. In the past, autism was broken down into several different diagnoses, including: Aspergers Syndrome autistic disorder Kanners Syndrome childhood autism atypical autism Pervasive Development Disorder Not Otherwise Specified (PDD-NOS) Because these diagnoses all had the characteristics of autism, they were removed and replaced with autism spectrum disorder (ASD), or autism for short. People also use the term autism spectrum condition (ASC). Learn more about autism from autistic people How common is autism? At least 1 in 100 people in Scotland are autistic. Currently, between 1 in 3 and 1 in 4 people diagnosed with autism are assigned female at birth (AFAB). Read more about autism and gender Autism is always present from birth, but it might not be recognised or diagnosed until adulthood. Early intervention, in the form of support for their individual needs, can be helpful for autistic children. Even if you arent diagnosed until adulthood, getting a diagnosis can be very helpful for identifying your strengths and the things you struggle with, and finding support. Read more about characteristics of autism Characteristics of autism Every autistic person is different and has different experiences. However, there are some characteristics that are common in autistic people. The way these characteristics show themselves can change with age, and also with the situation youre in. For example: the way you use language and talk might be different to most people you may use facial expressions, tone of voice, and gestures (hand and body movements) differently to most people making and maintaining friendships might be difficult for you you may be good at seeing patterns or solutions, and be good at seeing solutions to problems that other people might not you might have set ways of doing things, and find it difficult to do them differently autistic people are often very good at understanding and working with structured systems, for example languages, music, and computers you may have good attention to detail, and be good at spotting mistakes you might be passionately interested in certain things, and as a result learn a large amount about them in a short time  these interests can change throughout your life you might avoid or seek out certain sensations, like loud noises or specific textures, more than most people, and experience them more strongly there might be some foods you particularly enjoy and eat a lot of, and others that you cant be around due to their texture or smell when working on projects, you might find it difficult to think about the project as a whole  you may do a great job on your part of a group project, but struggle to imagine how it fits in with everyone elses part while autistic people can be good at paying attention to detail, you might find it difficult to leave out details that are accurate but not needed when talking to people or working on projects autistic people can be very determined and driven, and keep going with tasks or problems when other people may give up you might find youre always determined to make sure things are perfect, and sometimes forget to eat or sleep if youre working on something it can be difficult for autistic people to work in groups where there isnt clear communication about what theyre expected to do There are a number of other possible signs that a healthcare professional will look for when assessing if someone is autistic. Read more about diagnosing autism here Autism and gender At the moment, men and those assigned male at birth are diagnosed with autism more often than women and those assigned female at birth. As more healthcare professionals now know what characteristics to look for, its becoming more common for women and those assigned female at birth to receive an autism diagnosis. However, recognising autism can take longer for women and those assigned female at birth. This is because the characteristics healthcare professionals look for are the same for everyone, but women and those assigned female at birth can often show these in slightly different ways. For example, theyre more likely to mask autism  hiding autism characteristics and copying what other people without autism do  in order to fit into groups. This can make it harder to recognise that they might be autistic, and to receive a diagnosis. Autism and environment Some environments can be very difficult for autistic people, due to the way they experience and interact with the world. Every autistic person finds different things difficult, but common examples are: social situations with no timetable or clear rules on things like who speaks when  for example, parties and nights out busy environments like concerts, supermarkets, and school playgrounds, where there might be a lot of different loud noises at once Many environments allow autistic people to feel more comfortable and be themselves. When autistic people are in an environment with people who understand their individual needs and characteristics, theyre likely to: feel more relaxed perform better at tasks find it easier to learn use less time and energy trying to fit in with their environment Because every autistic person is different, it can take time to understand how you experience different environments. It may also take time to find the environments that suit your needs, and to learn which ones to avoid. If theres an autistic person in your life, its important to ask them what theyd prefer and if theres anything you can do to make a new environment more comfortable for them. If youre the parent or caregiver of an autistic child, you can ask how they felt in situations, or look for signs that theyre uncomfortable during or after being in different environments. Autistic children are often able to communicate best with those closest to them about what they enjoy and dont enjoy. Read more about finding the right environment Diagnosing autism The signs of autism can be different depending on the person and how old they are. Because autism is present from birth, it can usually be diagnosed in childhood. However, it may only be recognised later in life. Understanding of autism has grown over time, so more people are now being diagnosed when theyre older if the signs werent recognised when they were children. These are signs of autism that health professionals look for when making a diagnosis, but an autistic person may not have all of these signs. For example, delayed speech (learning to speak later than most children), or a child not speaking at all, can be a sign of autism. However, many autistic children talk at the same age a child without autism would. Its also possible that these signs are there, but they arent caused by autism. If you think you or your child might be autistic, talk to your GP or health visitor. Signs of autism in children The signs of autism can change as children grow  babies and toddlers show different signs of autism than children aged 4 and older. Babies and toddlers Signs of autism in babies and toddlers can include a number of things that affect different parts of their life and behaviour. Talking and showing emotions Autistic babies and toddlers might: start talking later than most children seem less aware of others around them  for example, they might not respond to their name being called make repetitive movements when excited or upset  for example flapping their hands, rocking back and forth, or making the same noise repeatedly Autistic babies and toddlers might not: smile back when you smile at them point to show when they want something point to show you something they find interesting share when theyre feeling happy  for example, they might be having fun playing, but they might not turn around and smile at you Playing Autistic babies and toddlers might: spend a long time setting up toys in a certain way, and set them up the same way every time enjoy lining toys up in order, or watching parts of them move Autistic babies and toddlers might not: seem interested in playing with other children their age seem to use their toys to make up stories or pretend  they might also start pretend play at a later age than most children Sensory (sights, smells, sounds, touch, and tastes) Autistic babies and toddlers might: react strongly to sounds, smells, touch, tastes, or things they can see  for example, if they like the way a stuffed toy feels, they want to spend a lot of time stroking the toy become upset if given something to eat or drink thats new to them eat a limited range of foods Children aged 4 and up As children grow and experience different environments, such as nursery and school, the characteristics of autism can appear differently. Communicating Autistic children might: speak differently to most children  for example, they might use an unusual accent, talk slowly or quickly compared to others, speak in a flat tone that doesnt change, or use a sing-song voice use longer or more complicated words than most children, even in relaxed situations struggle to ask other people questions about themselves find it hard to keep a conversation going Relationships Autistic children might: show a great deal of enthusiasm for talking about subjects that interest them, but experience significant difficulty when talking about other peoples interests find it difficult to make and keep friends want to play with other children, but find it hard to ask if they can join in have 1 or 2 good friends that they spend a lot of time with spend free time, such as school break times, by themselves find it hard to tell the difference between someone being friendly or joking and someone trying to bully them or hurt their feelings get on better with adults than other children their age get on better with children who are younger or older than them spend time with a group of children, but find it hard to join in with other childrens play, and so spend a lot of time on the edge of the group have friends at school, but show little to no interest in seeing them outside of school Different situations and routine Autistic children might: accidentally make social mistakes, for example correcting a teacher about classroom rules find some social situations, like parties or busy places, overwhelming and difficult to cope with be passive around other children or adults, agreeing to everything and doing everything people ask often tell others what to do, including while playing struggle with social situations with no timetable or clear rules, such as free play or school break times find it difficult to cope with changes to their routine, especially if the change is unexpected  for example, having a different teacher for a day or having plans change due to bad weather Sensory (sights, smells, sounds, touch, and tastes) Autistic children might: react strongly to sounds, smells, touch, tastes, or things they can see  for example, being unable to cope with seams in their socks or the noises in supermarkets find certain sounds, smells, feelings or tastes particularly calming or enjoyable  for example, coloured lights or being tucked tightly into bed make repetitive movements when excited or upset  for example flapping their hands, rocking back and forth, or making the same noise repeatedly Signs of autism in teenagers and adults The characteristics of autism can affect you differently as you get older  you may also recognise some of the signs of autism in children in yourself as an adult. Many people are diagnosed with autism as teenagers or adults based on noticing that they think and behave differently from most other people. Signs of autism in teenagers As you age and experience different environments, you might notice different signs of autism. Communicating As an autistic teenager, you might: find it hard to be understood in conversations, find it hard to work out when to talk in conversations  you might never get to say what you want to say, or find yourself talking over other people find it easier to communicate with other autistic people be able to talk for a long time about the subjects that particularly interest you show a great deal of enthusiasm for talking about subjects that interest you, but experience significant difficulty when trying to talk about other peoples interests be able to answer other peoples questions, but struggle to know what questions to ask or how to answer when someone tells you something about themselves find other people say you use a lot of long words, or use longer or more complicated words than most people often use the same phrases when youre talking struggle with hidden meanings when other people are talking to you  it might be difficult for you to understand a hint, or notice when someone is flirting with you find people can take the wrong meaning from your words or behaviour  for example, if you make a lot of eye contact, they might think youre flirting with them Behaviour and different situations As an autistic teenager, you might: find eye contact uncomfortable, or struggle to know how much eye contact to use do well when youre in your routine, but find it difficult when routines change  changes might make you feel anxious, make it hard to concentrate, or mean you have to work harder on things itd normally be easy to do struggle to imagine things that you havent experienced before  for example, if youre going to a party for the first time, it might be hard for you to imagine what will happen and what youll be expected to do find yourself making social mistakes without realising why  for example, during conversations you might not realise there are things other people would rather not talk about, or dont think are important to talk about Learning and hobbies As an autistic teenager, you might: have a lot of knowledge on particular topics, and spend a lot of time learning about them and telling others about them have a hobby you feel very passionate about and spend a lot of time on find it hard to start a new activity but get very focused on it once you get started  you might be able to focus on it better than most people find it difficult to stop doing an activity youre very focused on, even if you need to move on to something else  you might forget to eat or sleep Emotions and relationships As an autistic teenager, you might: spend a lot of time being careful to avoid making social mistakes, or trying to make sure you dont accidentally hurt anyones feelings find that other people struggle to understand your feelings from your face or tone of voice find that your friends are often older or younger than you find that your friends tend to be autistic people have to ask people to explain idioms (phrases that say one thing, when theyre actually talking about something else), for example: well cross that bridge when we come to it, which means well talk about that problem later have a clear idea of right and wrong, and strong views on issues that are important to you  you might struggle to understand exceptions to rules, or grey areas find a lot of people dont understand your sense of humour, and you might not understand why their jokes are funny be trusting, and find people can often take advantage of you find it hard to work out when someone is being unkind Sensory (sights, smells, sounds, touch, and tastes) As an autistic teenager, you might: have a strong negative reaction to sounds, smells, sights, and things you can touch  for example, being unable to wear certain types of clothing or find it overwhelming being in places with a lot of different noises, like gyms have a strong positive reaction to sounds, smells, sights, and things you can touch  for example, enjoying flashing, multi-coloured lights in nightclubs or how loud the music is at a concert seek out certain sounds, smells, feelings or tastes because you find them particularly calming  for example, coloured lights or soft clothing and blankets find making repetitive movements (often with your hands, fingers or legs) or sounds calming or enjoyable Signs of autism in adults As you age and experience different environments, life events, and circumstances, you might notice different signs of autism. You might also have developed coping strategies for environments you find difficult, changing the way you manage them. Work and education As an autistic adult, you might: find it more difficult than most people to communicate in interviews  for example, talking about your skills  which can make it hard to get a job find it more difficult than most people to keep a job  you may be good at your work, but it might be hard to have good relationships with colleagues and managers have a lot of knowledge or feel very passionate about a subject thats useful for your work or studies find it difficult or frustrating when rules or ways of doing things dont make sense to you find it more difficult than most people would to work on a project or task that has unclear instructions for how to complete it Relationships and being social As an autistic adult, you might: find socialising hard work  when others seem to have a lot of energy after meeting a group of friends, for example, you might feel exhausted have had relationships with friends or partners end because you couldnt understand how each other thought, behaved, and communicated find dating challenging prefer to be alone during breaks at work find it difficult to make small talk  meaning conversation about day-to-day things such as the weather  or understand the reasons for making small talk enjoy spending time with other people, but find activities that dont have clear rules or a schedule  for example, going to parties or nightclubs  difficult because you arent sure what to do prefer meeting up with people to do structured activities, like cooking or taking part in a shared hobby or interest Hobbies and skills As an autistic adult, you might: have a lot of detailed knowledge about a particular topic or hobby and feel very passionate about it find that the hobbies or topics youre particularly passionate about have changed several times in your life Communication and emotions As an autistic adult, you might: find other people often misunderstand you, or seem upset by things you say even if you dont mean to upset them find it hard to understand why people around you see a situation one way, and not the way you understand it find change more difficult than most people do  things that disrupt your daily routine, like changes to your job or going on holiday, can make you feel stressed and anxious Sensory (sights, smells, sounds, touch, and tastes) As an autistic adult, you might: have a strong negative reaction to sounds, smells, sights, and things you can touch  for example, being unable to wear certain types of clothing or find it overwhelming being in places with a lot of different noises, like busy buses or trains have a strong positive reaction to sounds, smells, sights, and things you can touch  for example, enjoying lying under a weighted blanket, or the loudness of the music at a concert seek out certain sounds, smells, feelings or tastes because you find them particularly calming  for example, coloured lights or soft clothing and blankets find making repetitive movements (often with your hands, fingers or legs) or sounds calming or enjoyable Autistic traits and diagnosis Autistic traits  meaning things that autistic people often do, think, and feel  are often shared by people who dont have autism too. This doesnt mean that everyone is a little bit autistic, or that autistic people dont need support. To be diagnosed with autism, a person has to have a lot of autistic traits from birth, and those traits need to have a big effect on their life. In order to be diagnosed with autism, those traits must cause what a healthcare professional would call clinically significant difficulties in their day-to-day life. This means that they have difficulties with day-to-day life due to their autistic traits and need to use their own ways of overcoming those difficulties, or the people in their life need to help them to overcome them, or both. Being in a supportive environment makes a big difference to an autistic persons wellbeing and quality of life. Learn more about how autism is diagnosed Other health conditions People who have these conditions can be more likely to also have autism: developmental disorders such as Attention Deficit Hyperactivity Disorder (ADHD) or learning disability muscular dystrophy Downs syndrome cerebral palsy epilepsy neurofibromatosis  a number of genetic conditions that cause tumours to grow along the nerves (the main types are neurofibromatosis type 1 and neurofibromatosis type 2) rare genetic conditions, including fragile X syndrome, tuberous sclerosis and Rett syndrome Causes of autism The exact cause of autism is unknown, but researchers think its at least partly genetic  that autism can run in the family. However, autism can also develop when theres no family history. Theres no way to predict whether a child will be autistic, even if one or both of their parents are autistic. More research is being done to find out which genes cause autism  its thought to be caused by more than one. Living with autism Like everyone else, autistic people can be happy and healthy in the right environment  however, the right environment for an autistic person can be different to the right environment for a non-autistic person. Autism doesnt mean that a person will need additional support to work, have relationships, or enjoy hobbies. However, many autistic people do need additional understanding or support to overcome the challenges caused by having autistic characteristics in a society where most people dont have them. Therapies for autistic people Theres no cure for autism, and most autistic people wouldnt want to be cured even if it was possible. Many autistic people feel autism is part of their identity, and not something to be cured or treated. Related conditions Because of the difficulties they can experience, autistic people may need treatment or support for other conditions, including: low mood anxiety sleep problems Psychological therapies like cognitive behavioural therapy (CBT) are often used to treat depression, anxiety, and sleep problems, both in people who have autism and people who dont. Psychological therapies can help to manage conditions linked with autism, like anxiety, but psychological therapies arent a treatment for autism itself. Therapy techniques might need to be adapted to work for an autistic person. Challenges in daily living Depending on whats offered by your NHS board and local organisations, there are therapies to help overcome the challenges that autistic people can experience. Possible therapies include: help with communicating, both for autistic people and the people in their lives groups for autistic people to share experiences and advice sensory assessments and support with an occupational therapist to help find ways of managing and improving your environment and how you experience the world training courses for loved ones, to help them understand autism and offer the best possible support Finding the right therapies Interventions that aim to train out behaviours (like repetitive movements, for example) or force autistic people to behave like non-autistic people are unethical and often harmful. However, many autistic people can benefit from support in learning skills to overcome some of the difficulties they experience  this is different to forcing someone to change their behaviour. For example, an autistic adult might want to learn extra social skills to improve their relationships at work, or a therapist may work with a child and parent to help them to develop their communication skills. These therapies dont aim to change a persons autism, but to give them skills they can use. If youre an autistic adult, the decision to have therapies for things like social skills should be yours. If you have an autistic child, any therapy they have should be with the aim of meeting their needs. Learn about avoiding harmful and unhelpful therapies for autism Autism and your environment Sometimes, when a situation is too much to cope with due to sensory input (things you see, hear, feel, smell or taste), or being asked to do things that cause stress or distress, an autistic person can become overwhelmed. Meltdowns and shutdowns When an autistic person becomes overwhelmed and isnt able to use or benefit from their coping strategies, they might have meltdowns or shutdowns. Its important, for parents of autistic children in particular, to be aware that a meltdown isnt a tantrum. A tantrum is something that a child can control, and tantrums often happen because a child wants something. A meltdown or shutdown isnt something an autistic person can control, and its caused by being overwhelmed. During a meltdown, an autistic person might try to make themselves feel less overwhelmed. This can include doing things like: trying to get away from people  for example by running away or hiding trying to get people away from them  for example by shouting, screaming, hitting, or acting aggressively During a shutdown, an autistic person might try to block everything out  for example by not responding to anything or anyone around them. Read more about meltdowns Challenging behaviour Like everyone else, autistic people can display challenging behaviour if theyre in the wrong environment. While it can be challenging for the people around them, this behaviour is often a result of distress or frustration, particularly if an autistic person has difficulty with communicating. Behaviour that challenges others is usually a way for someone to get their needs met when they dont have any other way to do so. Its not bad behaviour, or intended to cause harm. This kind of behaviour is most common in children, or people who find it hard to communicate their needs  for example, people with a learning disability. If youre autistic, effective communication about your needs, and finding ways to have those needs met, can be helpful in reducing the distress that can lead to behaviour that challenges. If someone in your life is autistic, or youre the parent or caregiver of an autistic child, finding the right strategies for supporting their needs is important and helpful, and can be done if theres effective support for everyone involved. Behaviour that challenges can also be caused by: trying to meet sensory needs  for example, wanting to do something because it feels nice, like rubbing soaps and creams all over themselves and the walls wanting something  for example, being hungry or wanting to play with a toy needing assistance or attention  for example, because theyre bored or want help with a project at school trying to escape an environment or the people around them, but doing so in a way that can be dangerous or harmful, such as running into the road Behaviour that people can find challenging includes: being destructive  breaking things, for example being disruptive  making noise in class or throwing things, for example self-harm aggression Help is available for anyone experiencing distress that might result in behaviour that challenges. Finding support can help you identify the reasons behind this behaviour and find other ways of communicating and meeting needs. Contact your GP or the healthcare professional who usually supports you for advice. Getting the right environment Environment is important to quality of life for autistic people. There are ways you can adapt (change) and improve your environment to make it as comfortable and supportive as possible for you or your child. The social model of disability is a way of looking at the world that treats the difficulties people with disabilities have as being caused by barriers in society, rather than just the disabilities themselves. These barriers can be physical  for example, buildings not having accessible toilets. Barriers can also be caused by peoples attitudes  for example, many people will assume someone is lying because they dont make eye contact while talking. The social model of disability can be a helpful way of considering the difficulties someone faces, and how to adapt their environment so it works for them. Learn more about the social model of disability Autism is covered by the Equality Act (2010), which means that schools and employers are required to make reasonable adjustments to ensure autistic people are comfortable in their environment and able to learn or work. Learn more about the Equality Act (2010) Common changes to an environment that can help autistic people include: sensory changes  for example, being given a quiet space to work, being able to use sensory toys like fidget spinners, or being allowed to make noises while working communication changes  for example, using email or apps to communicate, using very clear language, allowing additional time to ask questions, or using visual communication such as photos or pictures as well as written words routine  keeping to a regular routine and giving warning of any changes as far in advance as possible Every autistic person is likely to benefit from different changes  the best way to find the right ones is to ask an autistic person, or in the case of a child, their parents or caregivers. Learn more about autism from autistic people Facts and myths about autism There are many incorrect beliefs about autism, particularly the causes of autism or the best ways to overcome the challenges often faced by autistic people. Causes These things do not cause autism: bad parenting vaccines, or any ingredients in vaccines trauma or distress at a young age diet infections Fake treatments Theres no cure for autism, but many people incorrectly believe there are ways to cure it, or to change the way autistic people experience and interact with the world. Some fake treatments are dangerous  even the ones that arent dangerous are unethical, and none of them are helpful. Harmful and dangerous fake treatments include: any treatment that aims to train out autistic behaviour like forcing someone to stop making repetitive movements any treatment that aims to train autistic people to do things that cause them distress",,,,,,,,,,,,,
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Bacterial vaginosis,"Bacterial vaginosis- Illnesses and conditions Sexual and reproductive Bacterial vaginosis Bacterial vaginosis Bacterial vaginosis is not a sexually transmitted infection. Its an imbalance of the usual bacteria found in the vagina. Symptoms of bacterial vaginosis Often there are no symptoms of bacterial vaginosis. Some women may notice a change in the normal discharge from the vagina. This discharge will usually be white or grey, thin or watery and have a strong, unpleasant fishy smell. This can be more noticeable during and after sex, and during periods. Bacterial vaginosis does not usually cause itching or irritation. What to do if you think you may have bacterial vaginosis Check if you could be triggering it with toiletries . Consider over the counter treatments from your pharmacy . Contact your GP practice for an appointment or book an appointment at your local sexual health service . What does a bacterial vaginosis test involve? Sometimes treatment is given based on symptoms without the need for an examination or test. Sometimes a diagnosis can be made straightaway because of how the discharge looks. Sometimes the sample will be sent to a lab for testing. You are more likely to need a test if you have frequent episodes of discharge. Your nurse or doctor may perform an internal examination to check your vagina for signs of bacterial vaginosis. They may use a swab to collect a sample of the discharge from your vagina. A swab looks a bit like a cotton bud and collecting a sample only takes a few minutes. Its not painful, but it may be a little uncomfortable for a moment. If your nurse or doctor suspects you are at risk of an STI they may do more tests. Treatment for bacterial vaginosis Bacterial vaginosis is treated with antibiotics. Antibiotics must be prescribed by a doctor or nurse. You may be given an antibiotic cream or gel to use in your vagina, instead of antibiotic tablets by mouth. While youre there, make sure you tell the doctor or nurse if you: are pregnant think you might be pregnant are breastfeeding These may affect the type of treatment youre given. You can still have sex while being treated for bacterial vaginosis as its not sexually transmitted. However antibiotics and creams can affect condoms and other forms of contraception. Speak to your doctor or pharmacist who can give you further information. Partners do not usually need treatment. Non-antibiotic treatment is also available to buy in pharmacies . What causes bacterial vaginosis? Bacteria called lactobacilli naturally live in your vagina and stop other bacteria from growing there. Sometimes the balance of these bacteria changes. If this happens you can develop bacterial vaginosis. Bacterial vaginosis cant be passed on. But its more common in sexually active people. Other things that may increase the risk of getting it include: having a new sexual partner having multiple sexual partners smoking using scented soaps or perfumed bubble bath putting antiseptic liquids in the bath douching (washing or cleaning out the vagina with water or other fluids) using vaginal washes or deodorant using strong detergents to wash your underwear receiving oral sex How to prevent bacterial vaginosis The causes of bacterial vaginosis are not fully understood, so it may not be possible to completely prevent it. However, you may be able to lower your risk of developing it by following our genital washing advice . ",,,,,,,,,,,,,
Benign prostate enlargement,"Benign prostate enlargement - Illnesses & conditions  Kidneys, bladder and prostate Benign prostate enlargement Benign prostate enlargement About benign prostate enlargement Symptoms of benign prostate enlargement Causes of benign prostate enlargement Diagnosing benign prostate enlargement Treating benign prostate enlargement Complications of benign prostate enlargement About benign prostate enlargement Benign prostate enlargement (BPE), also known as benign prostatic hyperplasia (BPH), is a condition that affects older men and anyone with a prostate. Its particularly common in men and anyone with a prostate over 50 years of age and isnt usually a serious threat to health. Prostate gland The prostate is a small gland, located in the pelvis, between the penis and bladder. Its involved in the production of semen. The prostate produces a thick, white fluid thats made into a thinnerliquid by a protein called prostate-specific antigen (PSA). The liquid is then mixed with sperm, produced by the testicles, to create semen. If the prostate becomes enlarged, it can place pressure on the bladder and urethra (the tube through which urine passes). This canaffect how you pass urine and may cause: difficulty starting urination a frequent need to urinate difficulty fully emptying the bladder In some men and anyone with a prostate, the symptoms are mild and dont require treatment. In others, the symptoms can be very troublesome and have a major impact on a persons quality of life. Read more about the symptoms of benign prostate enlargement Many people worry that having an enlarged prostate means they have an increased risk of developing prostate cancer .This isnt the case. The risk of prostate cancer is no greater for people with an enlarged prostate than it is for those without anenlarged prostate. What causes benign prostate enlargement? The cause of prostate enlargement is unknown, but most experts agree that its linked to hormonal changes that occur as a man gets older. Read more about the causes of benign prostate enlargement How is benign prostate enlargement diagnosed? If your GP suspects that you have an enlarged prostate, youll be asked to complete a questionnaire to assess your symptoms. Each question has 5 possible answers that carry a score, and your overall score indicates the severity of your symptoms. Your GP will also want to rule out other conditions that cause similar symptoms to prostate enlargement. You may have a number of standard tests, such as urine tests, plus some more specific tests, such as ablood test that measures PSA. Read more about diagnosing benign prostate enlargement Treating benign prostate enlargement Treatment for an enlarged prostate is determined by the severity of your symptoms. If you have mild to moderatesymptoms, you wont receive any immediate medical treatment, but youll have regular check-ups to carefully monitor your prostate. Youll probably also be advised to makelifestyle changes, such as limiting your caffeine and alcohol intake, and exercising regularly ,to see if they improve your symptoms. As well aslifestyle changes, medication is usually recommended to treat moderate to severe symptoms of benign prostate enlargement.Finasteride and dutasteride are medicationsthat are commonly used. They block the effects of a hormone called dihydrotestosterone (DHT) on the prostate gland, which can reduce the size of the prostate and improve associated symptoms. Alpha blockers may also be prescribed. They help to relax your bladder muscles, making it easier to pass urine. Tamsulosin and alfuzosin are two alpha blockers commonly used to treat benign prostate enlargement. Surgery is usually only recommended for moderate to severe symptoms of benign prostate enlargement that have failed to respond to medication. Read more about treating benign prostate enlargement Complications of benign prostate enlargement Benign prostate enlargement can sometimes lead to complications such as a urinary tract infection (UTI) or acute urinary retention. Serious complications are rare. Read more about the complications of benign prostate enlargement How common is benign prostate enlargement? Benign prostate enlargement is a condition associated with ageing and is common in men and anyone with a prostate over 50 years of age. Symptoms of benign prostate enlargement The symptoms of benign prostate enlargement are caused by the enlarged prostate placing pressure on the bladder and urethra (which carries urine from the bladder to the penis). This can affect urination in a number of ways. For example, it can: make it difficult for you to start urinating weaken theflow of urine or cause stopping and starting cause you to strain to pass urine cause you to need to urinatefrequently cause you to wake up frequently during the night to urinate cause a sudden urge to urinate, which can result in urinary incontinence if you cant find a toilet quickly enough cause you to not be able to empty your bladder fully cause blood in the urine (haematuria) In the later stages, benign prostate enlargement can cause urine retention and other complications such asbladder stones,bladder infections and kidney damage. When to seek medical advice Seeyour GP if you notice any problems with, or changes to,your usual pattern of urination. Even if the symptoms are mild, they could be caused by a condition that needs to be investigated. Anyblood in the urine must be investigated by your GP to rule out other more serious conditions. Causes of benign prostate enlargement The exact cause of benign prostate enlargement is unknown, but research suggests that hormones probably play an important role in the conditions development. Hormones are powerful chemicals that can have a wide range of effects on the cells of the body. One theory is that as some men and anyone with a prostate gets older, the levels of a type of hormone called dihydrotestosterone (DHT) increases, which may stimulate the growth of the prostate. Another theory suggests that two hormones, testosterone and oestrogen, play a role. Younger men and anyone with a prostate produce high levels of testosterone and much smaller levels of oestrogen. But as they get older, levels of testosterone decrease, which means they then have a higher proportion of oestrogen in their body. Its been suggested that the relative increase in oestrogen may stimulate prostate growth. Risk factors Research has shown that rates of benign prostate enlargement are higher among men and anyone with a prostate with high blood pressure and diabetes . However, both diabetes and high blood pressure are associated with the natural ageing process, so there may not be a direct connection between the three conditions. Diagnosing benign prostate enlargement To find out whether your prostate gland is enlarged, youll need to have a few tests. Some tests will be carried out by your GP and others will be carried out by a urologist (a doctor who specialises in urinary problems). First, your GP will ask about your symptoms. If it seems that you have symptoms of benign prostate enlargement , the next stage is to calculate yourInternational Prostate Symptom Score (IPSS). International Prostate Symptom Score (IPSS) Youll be asked to completeaquestionnaireto assess your symptoms. Each question has5 possible answers that carry a score, andyour overall scoreis used to assess the severity of your symptoms. The checklist includes the following questions. Over the past month, how often: have you had the sensation of not completely emptying your bladder after urinating? have you had to urinate again less than 2 hours after finishing urinating? have you found that you stopped and started again when urinating? have you found it difficult to postpone urination? have you had a weak stream of urine? have you had to push or strain to begin urinating during the course of one night? haveyou had toget up during the night to urinate? After your GP has assessed the severity your symptoms, theyll aim to ruleout other conditionswith similar symptoms using certain tests. Ruling out other conditions Thesymptoms of benign prostate enlargement are similar to those of other conditions, including prostate cancer . Therefore, your GP will need to be completely sure that your symptoms arent caused by cancer. Urine tests A urine test can be used to check whether your symptoms are caused by an infection in your urinary system, such as a kidney infection or bladder infection. Rectal examination You may needarectal examination to check whether you might have prostate cancer. Prostate cancer can cause the prostate gland to become hard and bumpy. Your GP will put on a glove and lubricate one of their fingers, before gently pushing this finger into your bottom and up into your rectum. As the rectum is close to the prostate gland, theyll be able to check whether the surface of the gland has changed. The procedure will feel a little uncomfortable, but it isnt usually painful. Prostate cancer doesnt always cause changes to the prostate gland, so you may need to have some more specialised tests to rule it out. You will probably be referred to a urologist for these tests. Prostate-specific antigen (PSA) test A blood test can be used to measure the amount of the PSA protein thats produced by the prostate. A raised PSA level indicates enlargement of the prostate, and a significantly raised level may indicate prostate cancer. However, as with a rectal examination, a PSA test cant provide a definitive diagnosis of prostate cancer. Transrectal ultrasound (TRUS) A TRUS is a type of ultrasound scan specifically designed to study the prostate and the surrounding area. An ultrasound probe is placed into your rectum and uses soundwaves to build a detailed image of your prostate. This type of scan measures the size of your prostate and can be used to either confirm or rule out a diagnosis of prostate cancer. Computer tomographic (CT) urogram A CT urogram is used to study the urinary tract (the bladder and the tubes through which urine passes, also known as the ureter and urethra). A CT urogram can be used to check for blockages in your urinary system that could be causing your symptoms, such as a kidney stone or bladder stone. It can also be used to detect any damage in the urinary tract. During a CT urogram, youll be injected with a harmless radioactive dye, which will be visible on X-rays . After 30-60 minutes, the dye should have passed into your urinary tract and a series of X-rays will be taken. In some cases, you may be asked to pass urine before the final X-ray is taken. Voiding charts A voiding chart is a urination diary, which you may be asked to keep for 24 hours. Youll be asked to record how often you urinate, as well as details about how you urinate  for example, whether your urination is stopping and starting, or whether its difficult to start urinating. A voiding chart is a good way of finding out more information about your symptoms and can be used to determine the type of treatment that would be most effective in controlling your symptoms. Uroflowmetry Uroflowmetry measures the pressure of your bladder and how well your bladder works when you urinate. Youll be given a local anaesthetic and a small flexible tube (catheter) will be inserted into your urethra and moved up into your bladder. Water will then be injected through the catheter and into your bladder. A computer connected to the catheter measures the pressure inside your bladder and can assess how well your bladder is working. As with voiding charts, uroflowmetry is a good way of determining what type of treatment will help to control your symptoms. Treating benign prostate enlargement The treatment for an enlarged prostate gland will depend on how severe your symptoms are. The 3 main treatments are: lifestyle changes medication surgery If your symptoms are mild to moderate, you may not receive any immediate medical treatment, but youll have regular check-ups to carefully monitor your prostate gland. This is often referred to as watchful waiting. You may also be advised to make lifestylechanges to see whether they improve your symptoms. Lifestyle changes If your prostate gland is enlarged, you may be advised to: avoid drinking any liquids for 1 to 2 hours before going to bed  this will reduce your chances of waking up during the night to pass urine (nocturia) experiment with the time you take prescribed medication  for example, taking itat 7pm may help prevent nocturia stop drinking alcohol and caffeine, or limit your consumption of them  these drinkscan irritate your bladder and make your symptoms worse exercise regularly  research shows moderate exercise, such as walking for 30 to 60 minutes a day, can improve symptoms, although its unclear exactly why this is the case join a patient support group  your doctor should be able to recommend one, whichmay help you manage mild symptoms without the need for medication Bladder training Bladder training is an exercise programme that aims to increase the time between urination and the amount of urine your bladder can hold. Youll be given a target, such as waiting at least 2 hours between each time you urinate. Its a good idea to use a bladder training chart, which allows you to record each time you pass urine and the volume of urine passed youll need a plastic jug to measure this. Your doctor should give you a chart to take home. Youll also be taught a number of exercises, such as breathing, relaxation and muscle exercises, to help take your mind off the need to urinate. Over time your target time will be increased, and at the end of the programme you should find that youre able to go for longer without urinating. Bladder training should only be carried out under medical supervision. Medication Medication, in combination with the lifestyle changes above, is usually recommended to treat moderate to severe symptoms of benign prostate enlargement. Finasteride or dutasteride Finasterideanddutasteride are widely used to treat benign prostate enlargement. They block the effects of a hormone called dihydrotestosterone (DHT) on the prostate gland, which can reduce the size of the prostate and improve your associated symptoms. Find out about the causes of prostate enlargement If youre prescribed one of these medications, you may experience an immediate improvement in symptoms. However, youll need to take it for at least six months to get the maximum benefit, and your doctor will need to monitor you every year. Use condoms if youre sexually activeboth finasteride and dutasteride can have an adverse effect on your sperm. If you get a woman pregnant, theres a risk the baby could develop birth defects. Other possible side effects can alsoinclude impotence and little or nosperm when you ejaculate. In many cases, these side effects will improve as your body gets used to the medication. See your GP if the side effects are troubling you. Alpha blockers Alpha blockers help relax the muscles of your bladder, making it easier to pass urine. You may be prescribed alpha blockers as your primary treatment or in combination with finasteride. Tamsulosinandalfuzosin are 2 alpha blockers commonly used to treat benign prostate enlargement. Side effects of tamsulosin and alfuzosin are uncommon and usually mild. They include: dizziness headaches weakness little or no sperm when you ejaculate You should only begin taking alpha blockers over a restful weekend when youre not planning to drive, as theres a risk they could cause low blood pressure (hypotension) and fainting. Generally, if you experience dizziness while taking this medication, avoid driving or operating heavy machinery until its passed. Surgery Surgery is usually only recommended for moderate to severe symptoms of benign prostate enlargementthat have failed to respond to medication. Various procedures can be used to reduce the pressure on your bladder. Transurethral resection of the prostate (TURP) Transurethral resection of the prostate (TURP)involves inserting a small instrument called a resectoscope into your urethra, thetube that carries urine from the bladder to the penis. A wire loop heated by an electric currentis used to remove excess tissue from your prostate. TURP is carried out using either a general anaesthetic , where youre asleep, or a spinal anaesthetic, where youre awake, but the lower half of your body is numbed. The procedure can take up to an hour, depending on how much tissue needs to be removed. Most people are well enough to leave hospital 2 to 3 days after the operation. Aftersurgery, youll be unable to urinate normally at firstbecause of your swollen urethra. A thin tube called acatheter will be inserted into your urethra and up into your bladder to allow urine to drain away. This will usually be removed 24 to 48 hours after surgery. A common complication of TURP is youll no longer produce semen when you ejaculate. This is known as retrograde ejaculation. It causes sperm to go into your bladder rather than out of your penis during ejaculation. However, youll still experience the physical pleasure associated with ejaculation (the climax). Bladder neck incision(TUIP) Bladder neck incisioninvolves widening the urethra so it is easier to pass urine. It is also known astransurethral incision of the prostate (TUIP). Like TURP, the surgeon will insert a resectoscope into your urethra. The resectoscope has a heated wire loop at the end and is used to make small cuts (incisions) in the muscle where the prostate meets the bladder. This type of surgery relaxes the opening to the bladder, helping urine flow out of it. As with TURP, TUIPis carried out under a spinal or general anaesthetic. After surgery, you may not be able to urinate and a catheter may be needed to empty your bladder. Like TURP, youll only need to use a catheter for a short time until youre able to urinate normally. Theres less of a risk of retrograde ejaculation with TUIP compared with TURP, although it can sometimes still occur. Holmium laser enucleation of the prostate(HoLEP) Holmium laser enucleation of the prostate (HoLEP) is similar to a TURP. Excess prostate tissue is removed using an instrument inserted through the urethra. However, it usesa laser, rather than a wire loop. There are some advantages to using this technique rather than a TURP, but also some disadvantages. If you have been offered a HoLEP, you may want to ask your surgeon to explain why this was chosen for you, and the risks and benefits comparedwith TURP. Insertion of prostatic urethral lift implants The insertion of prostatic urethral lift implants is a new surgical procedure that can help relieve urinary symptoms. The procedure can be carried out underlocal anaesthesia or general anaesthesia. It involves inserting tiny implants through the urethra.The implants are then positioned to hold the enlarged prostate away from the urethra so it isnt blocked. One of the big advantagesof prostatic urethral lift implants compared with TURPand TUIP is a reduced risk to your sexual function there is less chance of erectile dysfunction and ejaculation problems. Theres also less tissue injury, which means your recovery will be quicker and you wont need to stay in hospital as long. However, prostatic urethral lift implantsare unlikely to provide permanent symptom relief in all cases. And as its a new procedure, the long-term outcomes are unknown and availability may be limited. Read more about the use of prostatic urethral lift implants to relieve symptoms ofprostateenlargement. Transurethral vaporisation of the prostate (TUVP) Transurethral vaporisation of the prostate (TUVP)is similar to a TURP, but parts of the prostate are destroyed (vaporised) rather than cut away. Studies have shown that TUVP is as effective as TURP at improving symptoms. But some men and anyone with a prostate may need more treatment in the future. Greenlight laser surgery (PVP) A laser can sometimes be used to destroy the prostate tissue. This particular form of TUVP is called photoselective vaporisation of the prostate (PVP), or Greenlight laser surgery. A thin, flexible instrument called a cytoscope is inserted into the urethra. A laser fibre is then passed through thecytoscope to destroy the excess prostate tissue that is blocking the urine flow. The procedure is recommended for thosewho dont have a high risk of developing complications from treatment, such as men and anyone with a prostate who: doesnt have urinary retention doesnt have an increased risk of bleeding has a prostate smaller than 100ml In these low-risk groups,Greenlight laser surgery is thought to be as effective as TURP, but also has several benefits. These include: a shorter hospital stay the procedure is often carried out as a day case the catheter can be removed sooner recovery is quicker theres a lower risk of complications The National Institute for Health and Care Excellence (NICE) website has more information about GreenLight XPS for treating benign prostatic hyperplasia . Open prostatectomy An open prostatectomy is a procedure that may be more effective than TURP if you have severe benign prostate enlargement. However, its now rarely used, even for larger prostates,because other techniques have beendeveloped, such as HoLEP. During an open prostatectomy, anincision will be made in your tummy and the outer portion of your prostate will be removed. The procedure carries a higher risk of complications, such as erectile dysfunction and urinary incontinence . Theres also a greater chance that these complications will become permanent than if they occur after TURP. Complications of benign prostate enlargement Benign prostate enlargement can sometimes lead to complications, such as a urinary tract infection or acute urinary retention. Urinary tract infections If youre unable to empty your bladder properly, theres a risk that bacteria in your urinary system wont get flushed out and will spread through the urine to cause a urinary tract infection (UTI) . Symptoms of a UTIinclude: cloudy, bloody or bad  smelling urine pain in your lower abdomen (tummy) nausea vomiting shaking and chills a high temperature of 38C (100.4F) or above UTIs can be treated with antibiotics . A single UTI isnt usually serious, but repeated UTIs can damage your kidneys and bladder. If you have a history of repeated UTIs, you may need to have surgery. Acute urinary retention Acute urinary retention (AUR) is the sudden inability to pass any urine. AUR should be treated as a medical emergency, because without prompt treatment urine may be passed back up into the kidneys, which can damage them. Symptoms of AUR include: the sudden inability to pass urine severe lower abdominal pain swelling of the bladder that you can feel with your hands Phone 999 and ask for an ambulance if you or someone you know experiences the symptoms of AUR. AUR can be treated using a thin tube (catheter) to drain the urine out of your bladder. In very serious cases, surgery may be required to empty the bladder. ",,,,,,,,,,,,,
Bile duct cancer (cholangiocarcinoma),"Bile duct cancer - Illnesses & conditions Cancer Cancer types in adults Bile duct cancer (cholangiocarcinoma) Bile duct cancer (cholangiocarcinoma) About bile duct cancer Symptoms of bile duct cancer Causes of bile duct cancer Diagnosing bile duct cancer Treating bile duct cancer Preventing bile duct cancer About bile duct cancer Bile duct cancer (cholangiocarcinoma) is a rare but aggressive type of cancer. The bile duct system, or biliary system, is made up of a series of tubes that begin in the liver and end in the small intestine. Bile is a fluid the digestive system uses to help break down fats and digest foods. Symptoms of bile duct cancer In most cases, there are no signs of bile duct cancer until it reaches the later stages, when symptoms caninclude: jaundice yellowing of the skin and the whites of the eyes, itchy skin, pale stools and dark-coloured urine unintentional weight loss abdominal pain Speak to your GP if you have signs of jaundice or are worried about other symptoms. While it is unlikely you have bile duct cancer, it is best to get it checked. Read more about the symptoms of bile duct cancer Why does bile duct cancer happen? The exact cause of bile duct cancer is unknown. However, some thingsmay increase your chances of developing the condition. The most commoninclude being over 65 years old or havingarare chronic liver disease called primary sclerosing cholangitis (PSC). Read more about the causes of bile duct cancer Types of bile duct cancer There are 2 main types of bile duct cancer,depending on where the cancer begins: cancer that starts in a part of the bile duct inside the liver is known as intrahepatic bile duct cancer cancer that starts in part of the bile duct outside the liver is known as extrahepatic bile duct cancer Diagnosis Cancer of the bile duct can be difficult to diagnose, so you may need several tests, including: blood tests ultrasound scans computerised tomography (CT) scans magnetic resonance imaging (MRI) scans For some of these tests, youmay need to be injected with a special dye that highlights your bile ducts. You may alsoneed a biopsy . This involves removing a small sample of tissue soit can be studied under a microscope. However, in some cases, your surgeon may prefer to remove the suspected tumour based on the results of your scans alone. Read more about diagnosing bile duct cancer How is bile duct cancer treated? Cancer of the bile ductcan usually only be cured if cancerous cells havent spread. If this is the case, some or all of the bile ductmay be removed. Only a small proportion of bile duct cancer cases are diagnosed early enough to be suitable for surgery. This isbecause symptoms usually develop at a late stage. Despite this, treatmentsuch as chemotherapy can relievethe symptoms of bile duct cancer and improve the quality of life of people in the advanced stages of the condition. Read more about treating bile duct cancer Who is affected? Most cases of bile duct cancer occur in peopleover the age of 65. The condition affects men and women almost equally. Can bile duct cancer be prevented? There are no guaranteed ways to avoid getting bile duct cancer, but you can reduce your chances of developing it. Themost effectiveways ofachieving this are reducing your alcohol intake, as cirrhosis is a risk factor,and trying to ensure that you dont become infected withhepatitis B or hepatitis C. Read more about preventing bile duct cancer Symptoms of bile duct cancer Bile duct cancer doesnt usually cause any symptoms until the flow of bile from the liver is blocked. In most cases, the condition is at an advanced stage by this time. The blockage will cause bile to move back into the blood and body tissue, resulting in symptoms such as: jaundiceyellowing of the skin and whites of the eyes, itchy skin, pale stools and dark-coloured urine unintentional weight loss abdominal pain  most people feel a dull ache in the upper right-hand side of their abdomen (stomach) high temperature (fever) of 38C (100.4F) or above and shivering loss of appetite When to seek medical advice Always visit your GP if you have jaundice. While jaundice is unlikely to be caused by bile duct cancer, it could indicate an underlying problem with the liver, such as hepatitis. Causes of bile duct cancer The exact cause of bile duct cancer is unknown, although some things can increase the risk of developing the condition. Cancerbegins with a change (mutation) in the structure of the DNA in cells, which can affect how they grow. This means that cells grow and reproduce uncontrollably, producing a lump of tissue called a tumour. If left untreated, cancer can grow and spread to other parts of your body, either directly or through the blood and lymphatic system. Increased risk Anumber offactors that increase the risk of developing bile duct cancer have been identified. Age Your chances of developing cancer of the bile duct increase as you get older. Most people with the condition are over 65 years old. Primary sclerosing cholangitis Primary sclerosing cholangitis (PSC) is a rare type of liver disease that causeslong-lasting (chronic) inflammation of the liver. Itusually occurs in peopleaged 30to 50. Up to 10% of people with ulcerative colitis (inflammation of the colon and rectum) also have PSC. Around 10to 20% of people with PSC will develop bile duct cancer.Your risk of developing bile duct cancer is thought to be higher if you have PSC and you smoke. Bile duct abnormalities Some people can have fluid-filled sacs (cysts) in their bile duct.These cysts are usually congenital, which meansthey are present frombirth. The most common types are choledochal cysts and Carolis disease, but both conditions are very rare. Up to 20%of people with choledochal cysts that are not removed will develop cancer of the bile duct. Biliary stones Biliary stones are similar to gallstones , except they form inside the liver rather than inside the gallbladder. Biliary stones are rare in western Europe, but are relatively common in parts of Asia, such as Japan and Taiwan. Its estimated that approximately 10% of people with biliary stones will develop bile duct cancer. Parasitic infection Liver flukes are a type of parasitic insect known to increase the risk of developing bile duct cancer. You can become infected with liver flukes by eating undercooked fish that has been contaminated with fluke eggs. Liver fluke infections are usually only a problem in Asia (especially Thailand) and Africa, where liver flukes are more widespread. Exposure to toxins Exposure to certain chemical toxins is known to increase the risk of developing bile duct cancer. For example, if you are exposed to a chemical called thorotrast, your chances of developing bile duct cancer rises. Thorotrast was widely used in radiography until it was banned during the 1960s after its dangerous properties were fully understood. Other toxins that may increase your chances of developing cancer of the bile duct include: asbestos a fire-resistant materialthat was widely used in construction and manufacturing, but is now banned in this country polychlorinated biphenyls (PCBs) a chemical that was used in manufacturing and building but, like asbestos, has now been banned Other factors The following factorsare linked with an increased risk of developing bile duct cancer, but more research is still needed: hepatitis B and hepatitis C cirrhosis (a scarred liver) as a result of drinking excessive amounts of alcohol HIV diabetes obesity smoking Diagnosing bile duct cancer Bile duct cancer can be a challenging condition to diagnose. You usually need several different tests before an accurate diagnosis can be made. Blood tests In bile duct cancer, the cancerous cells may release certainchemicals that can be detected using blood tests . These are known as tumour markers. However, tumour markers can also be caused by other conditions.A positive blood test does not necessarily mean you have bile duct cancer, and a negative blood test does not always meanyou dont. Scans A number of scans can be used to examine your bile ducts in more detail and check for lumps or other abnormalities that could be the result of cancer. These scans include: ultrasound scan high-frequency sound waves are used to build up a picture of the inside of your body computer tomography (CT) scan a series of X-rays of your liver are taken and a computer is used to assemble them into a more detailed three-dimensional image magnetic resonance imaging (MRI) scan  this uses a strong magnetic field and radio waves to produce a picture of the inside of your liver Endoscopic retrograde cholangio-pancreatography (ERCP) Endoscopic retrograde cholangio-pancreatography (ERCP) allows your bile ducts show up more clearly on an X-ray scanner. A special dye is injected and the X-ray scanner is used to guide an endoscope (a small, flexible tube with a camera at the end) down your throat and into your bile duct. The endoscope can detect blockages in your bile ductthat could be the result of bile duct cancer. A short wire-mesh tube, called a stent, may also be inserted into the artery during the procedure. The stent is left in place permanently to allow blood to flow more freely. Spyglass An advanced form of ERCP is a special test called a spyglass. This involves passing a specialised endoscope into the bile duct to detect abnormalities. It also enables a biopsyto be taken. While this test can help confirm bile duct cancer in uncertain cases, it is very expensive and requires specialist training. Therefore, it is only available at a limited number of centres. Percutaneous transhepatic cholangiography (PTC) Percutaneous transhepatic cholangiography is carried out to obtain a detailed X-ray image of your bile duct. The side of your abdomen (tummy)is numbed using local anaesthetic , anda special dyethat shows up on X-rays is injected through your skin and into your liver duct. As with ECRP, a stent may be inserted during the procedure. PTC and ECRPare bothuseful ways of detecting any blockages in your bile duct that could be caused by bile duct cancer. Biopsy If scans indicatethat you may have bile duct cancer, a biopsy may becarried out to confirm a diagnosis. Duringa biopsy, a small sample of tissue is taken from the body and checked under a microscope forcancerous cells. A biopsy is usually performed while ERCP or PTC is being carried out. As well as taking bile and tissue samples from your bile duct, samples may be taken from nearby lymph nodes. This is to check whether the cancer has spread from your bile duct into your lymphatic system. Staging A widely used method of staging bile duct cancer is a number staging system. The stages are: stage 1A the cancer is contained inside the bile duct stage 1B  the cancer is beginning to spread beyond the walls of the bile duct, but has not spread into the surrounding tissue or lymph nodes stage 2  the cancer has spread into nearby tissue, such as the liver, but has not spread into the lymph nodes stage 3 the cancer has spread into the lymph nodesandmajor blood vessels that supply the liver stage 4 the cancer has spread into distant organs, such as the lungs Read more about staging bile duct cancer on the Cancer Research UK website Cancer support If you are diagnosed with cancer, the Alan Morement Memorial Fund (AMMF) is currently the only dedicated UK charity that provides support for people affected by bile duct cancer. Treating bile duct cancer Most cases of bile duct cancer cannot be cured. Instead, treatment is most commonly used to relieve symptoms. Cancer treatment team Due to the rarity of bile duct cancer, you are likely to be referred to a specialist hepatobiliary unitwith experience in treating the condition. A multidisciplinary team (MDT) made up of different specialistswill help you decide on your treatment, but the final decision will be yours. Your MDTmayinclude: a liver surgeon  a specialist in treating cancers of the liver a medical or clinical oncologist  a specialist in the non-surgical treatment of cancer using techniques such as radiotherapy and chemotherapy a pathologist  a specialist in diseased tissue a radiologist  a specialist inradiological diagnosis and intervention a cancer nurse who usually acts as the first point of contact between you and the rest of the care team a gastroenterologist  a specialist in the medical management of liver and biliary disease Before going to hospital to discuss your treatment options, you may want to write a list of questions to ask the specialist. For example, you may want to find out theadvantages and disadvantages of particular treatments. Your treatment plan Your recommended treatment plan will be determined by your general health and the stage the cancer has reached . In cases of stage 1 and stage2 bile duct cancer, a cure may be possible by surgically removing the affected part of the bile duct, and possibly some of the liver or gallbladder. In cases of stage 3 bile duct cancers, the chances of achieving a successful cure will depend on how many lymph nodes have been affected. A cure may be possible if only a few nodes have cancerous cells in them, or it may be possible to slow the spread of the cancer by surgically removing the lymph nodes. In cases of stage4 bile duct cancer, achieving a successful cure is highly unlikely. However, stenting, chemotherapy, radiotherapy and surgery can often be used to help relieve the symptoms. Your treatment plan may also be different if you have intrahepatic bile duct cancer, as this is usually treated in a similar way to liver cancer. Read more about treating liver cancer . A number of experimental treatments may be available as part of a clinical trial. Surgery If your MDT thinks it is possible to cure your bile duct cancer, surgery will be needed to remove any cancerous tissue. Depending on the extent of the cancer, it may be necessary to remove: the part of your bile duct that contains cancerous cells your gallbladder nearby lymph nodes a large partof your liver After surgery, it is usually possible to reconstruct what remains of the bile duct so that bile can stillflow into the intestine. Similarly, it is often possible for the liver to resume normal function after surgery because we do not need all of our liver. The liver can also regenerate itself after surgery. You may need to stay in hospital for up to two weeks or more after having bile duct cancer surgery before you are well enough to go home. Success rates of bile duct surgery depend on individual circumstances, such as whether nearby lymph nodes are free of cancer and whether it was possible to remove all of the cancerous cells during surgery. Unblocking the bile duct If your bile duct becomes blocked as a result of cancer, treatment to unblock it may be recommended. This will help resolve symptoms such as: jaundice yellowing of the skin and the whites of the eyes itchy skin abdominal (tummy) pain Unblocking the bile duct is sometimes necessary if the flow of bile back into your liver starts to affect the normal functioning of your liver. The bile duct can be unblocked by using a small tube called a stent.The stent widens the bile duct, which should help to get the bile flowing again. A stent can be inserted using either: avariation of the endoscopic retrograde cholangiopancreatography (ERCP) procedure, which uses an endoscope to guide the stent into the bile duct avariation of the percutaneous transhepatic cholangiography (PTC) procedure, which involves making a small incision (under local anaesthetic) in your abdominal wall Occasionally, an implanted stent can become blocked. If this occurs, it will need to be removed and replaced. Radiotherapy Radiotherapy is not a standard treatment for bile duct cancer, butmay help to relieve the symptoms, slow the spread of the cancer and prolong life. The types of radiotherapy are used to treat bile duct cancer: external beam radiotherapy  a machine is used to target radioactive beams at your bile duct internal radiotherapy (brachytherapy)  a radioactive wire is placed inside your bile duct next to the tumour Radiotherapy works by damaging the cancerous cells. However, it can also damage healthy cells and cause side effects. Side effects of radiotherapy include: nausea (feeling sick) vomiting fatigue (severe tiredness) Read more about radiotherapy Chemotherapy Chemotherapy is used in a similar way to radiotherapy to relieve the symptoms of cancer, slow down the rate it spreads and prolong life. It is sometimes used in combination with radiotherapy. Medicines used in chemotherapy can sometimes damage healthy tissue as well as cancerous tissue, and adverse side effects are common. Side effects of chemotherapy can include: nausea vomiting fatigue hair loss However, these side effects should stop once the course of treatment has finished. Chemotherapy can also weaken your immune system, making you more vulnerable to infection. Read more about chemotherapy Clinical trials and experimental treatments The treatments for bile duct cancer are not as effective as treatments for other types of cancer. Therefore, a number of clinical trials are being conducted to find better ways of treating the condition. For example, ongoing trials are looking at new combinations of chemotherapy medicines, which may helpextend the lifespan of someone with bile duct cancer. Targeted therapies Another promising field of research involves using targeted therapies to treat bile duct cancer. Targeted therapies are medicationsthat target the processes that cancerous cells need to grow and reproduce. In studies for some cancers, a medication called sorafenib has proved reasonably effective. Sorafenib works by blocking a protein that cancerous cells need to create a blood supply. However, sorafenib is not currently used as a routine treatment for bile duct cancer. As bile duct cancer is a rare condition, there is a possibility you may be invited to take part in a clinical trial lookingat the use of these types of experimental treatments. All clinical trials are carried out under strict ethical guidelines based on the principles of patient care. However, there is no guarantee that the treatment you receive during a clinical trial will be more effective, or even as effective, as existing treatments. Read more about clinical trials and clinical trials for bile duct cancer Preventing bile duct cancer There are no guaranteed ways to avoid getting bile duct cancer, although itis possible to reduce your chances of developing the condition. The 3 most effective steps to reduce your chances of developing bile duct cancer are: giving up smoking (if you smoke) drinking alcohol in moderation minimising your exposure to the hepatitis B and hepatitis C viruses Stopping smoking Not smokingis the most effective way of preventing bile duct cancer, as well as other serious health conditions, such as stroke , heart attack and lung cancer . It is particularly important tostop smoking if you have the liver condition known as primary sclerosing cholangitis (PSC). If you have PSC, smoking will significantly increase your chances of developing bile duct cancer. Your GP can adviseon how to give up smoking. They canalso recommend and prescribe suitable medication. You can get more information and advice from the Quit Your Way Scotland advice and support service. Read more about stopping smoking Alcohol If you are a heavy drinker, reducing your alcohol intake will help prevent liver damage (cirrhosis) . This may, in turn, reduce your risk of developing bile duct cancer. Reducing your alcohol consumption is particularly important if you have a pre-existing liver condition, such as PSC or hepatitis B or C. Read low-risk drinking guidelines Visit your GP if you are finding it difficult to moderate your alcohol consumption. Counselling and medication are available to help reduce the amount you drink. Read more about alcohol Hepatitis C If you regularly inject drugs, the best way to avoid getting hepatitis C is to never share any of your drug-injecting equipment with others. You should also avoid sharing any object that could be contaminated with blood, such as razors and toothbrushes. There is less risk of getting hepatitis C by having sex with someone who is infected. However, as a precaution it is best to use a barrier method of contraception, such as a condom, with a new partner. Read more about preventing hepatitis C Hepatitis B A vaccine is available that provides immunisation against hepatitis B . Vaccination would usually only be recommended for people in high-risk groups, such as: people who inject drugs or have a sexual partner who injects drugs people who change their sexual partner frequently people travelling to or from a part of the world where hepatitis B is widespread healthcare workers who may have come into contact with the virus Pregnant women are also screened for hepatitis B. If they are infected, their baby can be vaccinated shortly after birth to prevent them also becoming infected. Read more detailed information about hepatitis B vaccination The liver fluke The liver fluke is a major cause of bile duct cancer in Asia. It is a parasite which, after infection, damages the tissue of the bile duct and in some cases triggers the onset of bile duct cancer. The liver fluke is widespread in Thailand. Other countries where the liver fluke can be found include: Cambodia Laos Vietnam Infection occurs after eating raw or undercooked fish contaminated by fluke eggs. Always ensure any fish you eat is cooked thoroughly when travelling in these countries.",,,,,,,,,,,,,
Binge eating,"Binge eating disorder -llnesses and conditions Mental health Binge eating disorder Binge eating disorder Binge eating is an eating disorder where a person feels they have to overeat through regular binges. Symptoms of binge eating disorder The main sign of binge eating disorder is someone bingeing on a regular basis. Signs that an episode of overeating is actually a binge, include: eating much faster than normal eating until you feel uncomfortably full eating a large amount of food when youre not hungry eating alone or secretly due to being embarrassed about the amount of food youre consuming having feelings of guilt, shame or disgust afterwards If you feel like you have to purge what youve eaten after a binge to avoid gaining weight, you may have symptoms of bulimia . If binges dont happen regularly, and your weight is very low, you may have symptoms of anorexia . Treating binge eating disorder There are some treatments available for binge eating disorder. Guided self-help The main type of psychological treatment for binge eating disorder is guided self-help. Guided self-help is where you work through information and activities on your own. Youll also have regular support sessions with a professional (usually a psychologist). Cognitive behavioural therapy (CBT) Another treatment is cognitive behavioural therapy (CBT), either individually or as part of a group. CBT starts with the idea that thoughts, feelings, and behaviour are linked and affect one another. If problems in your life are causing you to binge eat, CBT helps you to reduce bingeing. It helps to identify the underlying issues so youre less likely to binge in the future. Learn more about talking therapies Antidepressants Antidepressants may be used alongside other treatments for binge eating disorder. Long term physical effects of binge eating Binge eating often leads to weight gain. Being overweight or obese can put you at risk of a number of physical health problems, some of which can be life threatening. These include: high cholesterol high blood pressure diabetes osteoarthritis some types of cancer, like breast cancer and bowel cancer If you think you might have a binge eating problem, help is available. You can get support to tackle both the physical and mental effects of binge eating. Getting help for binge eating disorder If you have eating problems or think you may have an eating disorder, its important to seek help as soon as possible. You could: talk to someone you trust, like a friend or member of your family see your GP  you may find it helpful to bring someone with you for support Helping someone else If someone close to you is showing signs of an eating disorder, you can offer help and support. You could try talking to them about how they feel, and encourage them to think about getting help. Try not to put pressure on them or be critical of them, as this could make things worse. You could also offer to help by going with the person to see their GP. Your GP or a healthcare professional can give you advice on how to help someone. This includes information on: the treatments available how you can support them during their treatment Support for binge eating disorder Beat is a leading charity for people with eating disorders. They have a range of information on the help and support available for people with eating disorders, and their friends and families. Your GP and care team can recommend other helpful resources.",,,,,,,,,,,,,
Bipolar disorder,"Bipolar disorder  Illnesses and conditions Mental health Bipolar disorder Bipolar disorder Introduction Symptoms Causes Diagnosis Treatment Living with bipolar disorder Introduction Bipolar disorder, formerly known as manic depression, is a condition that affects your moods, which can swing from one extreme to another. People withbipolar disorder have periods or episodes of: depression  feeling very low and lethargic mania  feeling very high and overactive (less severe mania is known as hypomania) Symptoms of bipolar disorder depend on which mood youre experiencing. Unlike simple mood swings, each extreme episode of bipolar disorder can last for several weeks (or even longer), and some people may not experience a normal mood very often. Depression You may initially be diagnosed with clinical depression before having a future manic episode (sometimes years later), after whichyou may be diagnosed withbipolar disorder . During an episode of depression, you may have overwhelming feelings of worthlessness, which can potentially lead to thoughts of suicide . If youre feeling suicidal or having severe depressive symptoms, contact your GP, care co-ordinator or local mental health emergency services as soon as possible. If you want to talk to someone confidentially, call the Samaritans, free of charge,on 116 123. You can talk to them24 hours a day,7 days a week. Alternatively, visit the Samaritans website. Mania During a manic phase of bipolar disorder, you may feel very happy and have lots of energy, ambitious plans and ideas. You may spend large amounts of money on things you cant afford and wouldnt normally want. Not feeling like eating or sleeping, talking quickly and becoming annoyed easily are also common characteristics of this phase. You may feel very creative and view the manic phase of bipolar as a positive experience. However, you may also experience symptoms of psychosis , where you see or hear things that arent there or become convinced of things that arent true. Living with bipolar disorder The high and low phases of bipolar disorder are often so extreme that they interfere with everyday life. However, there are several options for treating bipolar disorder that can make a difference. They aim to control the effects of an episode and help someone with bipolar disorder live life as normally as possible. The following treatment options are available: medication to prevent episodes of mania, hypomania (less severe mania) and depressionthese are known as mood stabilisers and are taken every day on a long-term basis medication to treat the main symptoms of depression and mania when they occur learning to recognise the triggers and signs of an episode of depression or mania psychological treatmentsuch as talking therapy, which can help you deal with depression, and provides advice about how to improve your relationships lifestyle advicesuch as doing regular exercise, planning activities you enjoy that give you a sense of achievement, as well as advice on improving your diet and getting more sleep Its thought using a combination of different treatment methods is the best way to control bipolar disorder. Help and advice for people with a long-term condition or their carersis also availablefrom charities, support groups and associations. This includes self-help and self-management advice, and learning todeal with the practical aspects of a long-term condition. Find out more about living with bipolar disorder Bipolar disorder and pregnancy Bipolar disorder, like all other mental health problems, can get worse during pregnancy. However, specialist help is available if you need it. What causes bipolar disorder? The exact cause of bipolar disorder is unknown, although its believed a number of things can trigger an episode. Extreme stress, overwhelming problems and life-changing events are thought to contribute, as well as genetic and chemical factors. Whos affected? Bipolar disorder is fairly common and one in every 100 adults will be diagnosed with the condition at some point in their life. Bipolar disorder can occur at any age, although it often develops between the ages of 15 and 19 and rarely develops after 40. Men and women from all backgrounds are equally likely todevelop bipolar disorder. The pattern of mood swings in bipolar disorder varies widely between people. For example, some people only have a couple of bipolar episodes in their lifetime andare stable in between, while others have many episodes. Symptoms Bipolar disorder is characterised by extreme mood swings. These can range from extreme highs (mania) to extreme lows (depression). Episodes of mania and depression often last for several weeks or months. Depression During a period of depression, your symptoms may include: feeling sad, hopeless or irritable most of the time lacking energy difficulty concentrating and remembering things loss of interest in everyday activities feelings of emptiness or worthlessness feelings of guilt and despair feeling pessimistic about everything self-doubt being delusional, having hallucinations and disturbed or illogical thinking lack of appetite difficulty sleeping waking up early suicidal thoughts Mania The manic phase of bipolar disorder may include: feeling very happy, elated or overjoyed talking very quickly feeling full of energy feeling self-important feeling full of great new ideas and having important plans being easily distracted being easily irritated or agitated being delusional, having hallucinations and disturbed or illogical thinking not feeling like sleeping not eating doing things that often have disastrous consequences such as spending large sums of money on expensive and sometimes unaffordable items making decisions or saying things that are out of character and that others see as being risky or harmful Patterns of depression and mania If you have bipolar disorder, you may have episodes of depression more regularly than episodes of mania, or vice versa. Between episodes of depression and mania, you may sometimes have periods where you have a normal mood. The patterns arent always the same and some people may experience: rapid cyclingwhere a person with bipolar disorder repeatedly swings from a high to low phase quickly without having a normal period in between mixed statewhere a person with bipolar disorder experiences symptoms ofdepression and mania together; for example, overactivity with a depressed mood If your mood swings last a long time but arent severe enough to be classed as bipolar disorder, you may be diagnosed with cyclothymia(a mild form of bipolar disorder). Living with bipolar disorder Bipolar disorder is a condition of extremes.A person with the condition may be unaware theyre in the manic phase. After the episode is over, they may be shocked at their behaviour. However, at the time, they may believe other peopleare being negative or unhelpful. Some people with bipolar disorder have more frequent and severe episodes than others.The extreme nature of the condition meansstaying in a job may be difficult and relationships may become strained. Theres also an increased risk of suicide . During episodes of mania and depression, someone with bipolar disorder may experience strange sensations, such as seeing, hearing or smelling things that arent there (hallucinations). They may also believe things that seem irrational to other people (delusions). These types of symptoms are known as psychosis or a psychotic episode. Read more about living with bipolar disorder Causes The exact cause of bipolar disorder is unknown. Experts believe there are a number of factors that work together to make a person more likely to develop the condition. These are thought to be a complex mix of physical, environmental and social factors. Chemical imbalance in the brain Bipolar disorder is widely believed to be the result of chemical imbalances in the brain. The chemicals responsible for controlling the brains functions are called neurotransmitters and includenoradrenaline, serotonin and dopamine. Theres some evidence that if theres an imbalance in the levels of one or more neurotransmitters, a person may develop some symptoms of bipolar disorder . For example, theres evidence that episodes of mania may occur when levels of noradrenaline are too high, and episodes of depression may be the result of noradrenaline levels becoming too low. Genetics Its also thought bipolar disorder is linked to genetics, as the condition seems to run in families. The family members of a person with the condition have an increased risk of developing it themselves. However, no single gene is responsible for bipolar disorder. Instead, a number of genetic and environmental factors are thought to act as triggers. Triggers A stressful circumstance or situation often triggers the symptoms of bipolar disorder. Examples of stressful triggers include: the breakdown of a relationship physical, sexual or emotional abuse the death of a close family member or loved one These types of life-altering events can cause episodes of depression at any time in a persons life. Bipolar disorder may also be triggered by: physical illness sleep disturbances overwhelming problems in everyday life such as problems with money, work or relationships Diagnosis If your GP thinks you may have bipolar disorder, theyll usually refer you to a psychiatrist (a medically qualified mental health specialist). If your illness puts you at risk of harming yourself, your GP will arrange an appointment immediately. Specialist assessment Youll be assessed by the psychiatrist at your appointment. Theyll ask you a few questions to determine if you have bipolar disorder.If you do, theyll decide what treatments are most suitable. During the assessment, youll be asked about your symptoms and when you first experienced them. The psychiatrist will also ask about how you feel leading up to and during an episode of mania or depression, and if you have thoughts about harming yourself. The psychiatrist will also want to know about your medical background and family history, especially whether any of your relatives have had bipolar disorder. If someone else in your family has the condition, the psychiatrist may want to talk to them. However, theyll ask for your agreement before doing so. Other tests Depending on your symptoms, you may also need tests to see whether you have a physical problem, such as an underactive thyroid or an overactive thyroid . If you have bipolar disorder, youll need to visit your GP regularly for a physical health check. Treatment Treatment for bipolar disorder aims to reduce the severity and number of episodes of depression and mania to allow as normal a life as possible. Treatment options for bipolar disorder Treatment for bipolar disorder aims to reduce the length and severity of episodes. In some cases treatment can prevent bipolar episodes. Most people with bipolar disorder can be treated using a combination of different treatments. These can include one or more of the following: medication to prevent episodes of mania, hypomania (less severe mania) and depression  these are known as mood stabilisers and are taken every day on a long-term basis medication to treat the main symptoms of depression and mania when they occur learning to recognise the triggers and signs of an episode of depression or mania psychological treatment  like talking therapies, which help you deal with depression and provide advice on how to improve relationships lifestyle advice  such as doing regular exercise, planning activities you enjoy that give you a sense of achievement, and advice on improving your diet and getting more sleep Read more about living with bipolar disorder . Medication Several medications are available to help stabilise mood swings. These are commonly referred to as mood stabilisers and include: lithium carbonate anticonvulsant medicines antipsychotic medicines If youre already taking medication for bipolar disorder and you develop depression, you should speak to your healthcare professional. Learning to recognise triggers If you have bipolar disorder, you can learn to recognise the warning signs of an approaching episode of mania or depression. A community mental health worker, such as a psychiatric nurse, may be able to help you identify your early signs of relapse from your history. This may mean making some changes to your treatment. Your healthcare professional can advise you on this. Psychological treatment Most people find psychological treatment helpful when used alongside medication in between episodes of mania or depression. Pregnancy You should speak to your healthcare professional if you have bipolar disorder if youre trying to conceive or become pregnant. The National Institute for Health and Care Excellence (NICE) recommends that specialist mental health services work closely with maternity services. A written plan for managing the treatment of a pregnant woman with bipolar disorder should be developed as soon as possible. The plan should be drawn up with the patient, her partner, her obstetrician (pregnancy specialist), midwife, GP and health visitor. If you become pregnant while taking medication prescribed to treat bipolar disorder, its important that you dont stop taking it until youve discussed it with your healthcare professional. If medication is prescribed for bipolar disorder after the baby is born, it may also affect a mothers decision to breastfeed her child. Your pharmacist, midwife or mental health team can give you advice based on your circumstances. Living with bipolar disorder Although its usually a long-term condition, effective treatments for bipolar disorder , combined with self-help techniques, can limit the conditions impact on your everyday life. Staying active and eating well Eating well and keeping fitare important for everyone.Exercise can also help reduce the symptoms of bipolar disorder, particularly depressive symptoms. It may also give you something tofocus onand provide aroutine, which is important for many people. A healthy diet, combined with exercise, may also help limit weight gain, which is a common side effect of medical treatments for bipolar disorder. Some treatments alsoincrease the risk of developing diabetes, or worsen the illness in people that already have it. Maintaining a healthy weight and exercising are an important way of limiting that risk. You should have a check-up at least once a year to monitor your risk of developing cardiovascular disease or diabetes . This will include recording your weight, checking your blood pressure and having any appropriate blood tests. Read more information about losing weight and improving fitness Self-care and self-management Self-care Self-care is an essential part of daily life.It involves taking responsibility for your own health and wellbeing with support from the people involved in your care. It includes: staying fit and maintaining good physical and mental health preventing illness or accidents caring more effectively for minor ailments and long-term conditions People withlong-term conditions can benefit enormously from being helpedwith self-care.They can live longer, have less pain, anxiety, depression and fatigue, have a better quality of life, and be more active and independent. Self-management programmes Self-management programmes aim to help people with bipolar disorder take an active part in their own recovery so theyre not controlled by their condition. One course run by BipolarUK aims to teach people with bipolar disorder how to manage their illness. The programme includes information about: triggers and warning signs coping strategies and self-medication support networks and action plans maintaining a healthy lifestyle drawing up an advance decision complementary therapies action plans There are other courses, such as those run by Self Management UK , for mild to moderate mental health conditions. Coursessuch asthese help people who may feel distressed and uncertain about their bipolar disorder improve their own lives. Talking about it Some people with bipolar disorder find it easy to talk to family and friends about their condition and its effects. Other people find it easier to turn to charities and support groups. Many organisations run self-help groups that can put you in touch with other people with the condition. This enables people to share helpful ideas and helps themrealise theyre not alone in feeling the way they do. These organisations also provide online support in forums and blogs. Some useful charities, support groups and associations include: Bipolar UK Carers UK Mind Rethink Samaritans SANE Talking therapies are useful for managing bipolar disorder, particularly during periods of stability. Services that can help You may be involved with many different services during treatment for bipolar disorder. Some are accessed through referral from your GP, others through your local authority. These services may include: Community mental health teams (CMHT)  these provide the main part of local specialist mental health services. They offer assessment, treatment and social care to people withbipolar disorderand other mental illnesses. Early intervention teams these provide early identification and treatment for people who have the first symptoms of psychosis. Your GP may be able to refer you directly to an early intervention team. Crisis services  these allow people to be treated at home, instead of in hospital, for an acute episode. These are specialist mental health teams that deal with crises that occur outside normal office hours. Acute day hospital  these are an alternative to inpatient care in a hospital. You can visit every day or as often as you need. Assertive outreach teams  these deliver intensive treatment and rehabilitation in the community for people with severe mental health problems, providing rapid help in a crisis. Staff often visit people at home and liaise with other services, such as your GP or social services. They can also help with practical problems, such as helping to find housing and work, or doing your shopping and cooking. Avoiding drugs and alcohol Some people with bipolar disorder use alcohol or illegal drugs to try to take away their pain and distress. Both have well-known harmful physical and social effects and are not a substitute for effective treatment and good healthcare. Some people with bipolar disorder find they can stop misusing alcohol and drugsonce theyre using effective treatment. Others may have separate but related problems of alcohol and drug abuse, which may need to be treated separately. Avoiding alcohol and illegal drugs is an important part of recovery from episodes of manic, hypomanic or depressive symptoms, and can help you gain stability. Read more about alcohol misuse Money and benefits Its important to avoid too much stress ,including work-related stress. If youre employed, you may be able to work shorter hours or in a more flexible way, particularly if job pressure triggers your symptoms. Under the Equality Act 2010 , people are protected from discrimination in the workplace and in wider society. This can include people with a diagnosis of bipolar disorder or other mental illnesses. Arange of benefitsis available to people with bipolar disorder whocant work as a result of their mental illness. The Adult Disability Payment is managed by Social Security Scotland. Depending on your circumstances, you may qualify fromnon-devolved benefits from the UK Government . Want to know more? Care Information Scotland: Money Living with or caring for someone with bipolar disorder People living with or caring for someone with bipolar disorder can have a tough time. During episodes of illness, the personalities of people with bipolar disorder may change, and they may become abusive or even violent. Sometimes social workers and the police may become involved. Relationships and family life are likely to feel the strain. If youre the Named Person (as defined by theMental Health (Scotland) Act 2015) of a person with bipolar disorder, you havecertain rights that can be used to protect the persons interests. These include requesting that the local social services authority asks an approved mental health professional to consider whether the person with bipolar disorder should be detained in hospital (also known as sectioning). You may feel at a loss if youre caring for someone with bipolar disorder. Finding a support group and talking to other peoplein a similar situation might help. If youre having relationship or marriage difficulties, you can contact specialist relationship counsellors, who can talk things through with you and your partner. Want to know more? Care Information Scotland: Support for carers Relate: Relationship advice Dealing with suicidal feelings Having suicidal thoughts is a common depressive symptom of bipolar disorder.Without treatment, these thoughts may get stronger. Some research has shown the risk of suicide for people with bipolar disorder is 15 to 20 times greater than the general population. Studies have also shown that as many as 25-50% of people with bipolar disorder attempt suicide at least once. The risk of suicide seems to be higher earlier in the illness, so early recognition and help may prevent it. If youre feeling suicidal or youre having severe depressive symptoms, contact your GP, care co-ordinator or the local mental health emergency services as soon as possible. If you cant or dont want to contact these people, contact the Samaritans on 116 123. You can call them24 hours a day, seven days a week. Alternatively, visit the Samaritans website or email jo@samaritans.org . Self-harm Self-harm(sometimes called self-injury) is often a symptom of mental health problems such as bipolar disorder. For some people, self-harm is a way of gaining control over their lives or temporarily distracting themselves from mental distress. It may not be related to suicide or attempted suicide. Want to know more? Mind: Understanding self-harm National Self Harm Network Rethink: Suicide and self-harm Samaritans Recommended communities Online communities help you talk to people, share your experiences and learn from others. The SANESupport Forumallows people to share their feelings and provide mutual support to anyone with mental health issues, as well as their friends and family. SANE Support Forum Bipolar UK, a national charity, alsoruns an online discussion forum for people with bipolar disorder, their families and carers. Bipolar UK eCommunity Source: NHS 24 - Opens in new browser window Last updated: 04 April 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Depression Other health sites Bipolar Scotland NICE: Bipolar disorder Royal College of Psychiatrists: bipolar disorder Choice and Medication: Bipolar depression Choice and Medication: Bipolar mood disorder NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852']",,,,,,,,,,,,,
Bladder cancer,"Bladder cancer - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Bladder cancer Bladder cancer About bladder cancer Symptoms of bladder cancer Causes of bladder cancer Diagnosing bladder cancer Treating bladder cancer Complications of bladder cancer Preventing bladder cancer About bladder cancer Bladder cancer is where a growth of abnormal tissue, known as a tumour, develops in the bladder lining. In some cases, the tumour spreads into the surrounding muscles. The most common symptom of bladder cancer is blood in your urine, which is usually painless. If you notice blood in your urine, even if it comes and goes, you should speak to your GP, so the cause can be investigated. Read about the symptoms of bladder cancer Types of bladder cancer Once diagnosed, bladder cancer can be classified by how far it hasspread. If the cancerous cells are contained inside the lining of the bladder, doctors describe it as non-muscle-invasive bladder cancer.This is the most common type of bladder cancer, accounting for 7 out of 10 cases.Most people dont die as a resultofthis type of bladder cancer. When the cancerous cells spread beyond the lining, into the surrounding muscles of the bladder, its referred to as muscle-invasive bladder cancer.This is less common,but has a higher chanceof spreading to other parts of the body and can be fatal. If bladder cancer has spread to other parts of the body, its known as locally advanced or metastatic bladder cancer. Read more about diagnosing bladder cancer Why does bladder cancer happen? Most cases of bladder cancer appear to be caused by exposure to harmful substances, which lead to abnormal changes in the bladders cells over many years. Tobacco smoke is a common cause andits estimated that half of all cases of bladder cancer are caused by smoking. Contact with certain chemicals previouslyused in manufacturing is also known to cause bladder cancer. However, these substances have sincebeen banned. Read more about the causes of bladder cancer and preventing bladder cancer Treating bladder cancer In cases of non-muscle-invasive bladder cancer, its usually possible to remove the cancerous cells while leaving the rest of the bladder intact. This is done using a surgical technique called transurethral resection of a bladder tumour (TURBT).Thisis followed by a dose of chemotherapy medication directly into the bladder, to reduce the risk of the cancer returning. In cases with a higher risk of recurrence, a medication known as Bacillus Calmette-Gurin (BCG) may beinjected into the bladder to reduce the risk of the cancer returning. Treatment for high-risk non-muscle-invasive bladder cancer, or muscle-invasive bladder cancer may involve surgically removing the bladder in an operation known as a cystectomy. When the bladder is removed, youll need another way ofcollecting your urine. Possible options include making an opening in the abdomen so urine can be passed into an externalbag, or constructing a new bladder out of a section of bowel. This will be done at the same time as a cystectomy. If its possible to avoid removing the bladder, or if surgeryis not suitable, a course of radiotherapy and chemotherapy may be recommended. Chemotherapy may sometimes be used on its own before surgery or before being combined with radiotherapy. After treatment for all types of bladder cancer, youll have regular follow-up tests to check for signs of recurrence. Read more about treating bladder cancer Who is affected? Bladder canceris more common in older adults, with more than half of all newcases diagnosed in peopleaged 75 and over. Bladder cancer is also more common in men than in women, possibly because in the past, men were more likely to smoke and work in themanufacturing industry. Symptoms of bladder cancer Blood in your urine is the most common symptom of bladder cancer. The medical name for this is haematuriaand its usually painless. You may notice streaks of blood in your urine or the blood may turn your urine brown. The blood isnt always noticeable and it may come and go. Less common symptoms of bladder cancer include: a need to urinate on a more frequent basis sudden urges to urinate a burning sensation when passing urine If bladder cancer reaches an advanced stage and begins to spread, symptoms can include: pelvic pain bone pain unintentional weight loss swelling of the legs When to seek medical advice If you ever have blood in your urine even if it comes and goes you should speak to your GP, so the cause can be investigated. Having blood in your urine doesnt mean you definitely have bladder cancer. There are other, more common, causes including: a urinary tract infection ,such as cystitis a kidney infection kidney stones urethritis an enlarged prostate gland ,in men Causes of bladder cancer Bladder cancer is caused by changes to the cells of the bladder. Its often linked with exposure to certain chemicals, but the cause isnt always known. What is cancer? Cancer begins with a change (mutation)in the structure of the DNA in cells, whichcanaffect how they grow. This means that cells grow and reproduce uncontrollably, producing a lump of tissue called a tumour. Increased risk Severalfactorshave been identified that can significantly increase your risk of developing bladder cancer. Smoking Smoking is the single biggest risk factor for bladder cancer. This is because tobacco contains cancer-causing (carcinogenic) chemicals. If you smoke for many years, these chemicals pass into your bloodstream and are filtered by the kidneysinto your urine. The bladder is repeatedly exposed to these harmful chemicals, as it acts as a store for urine. This can cause changes to the cells of the bladder lining, which maylead to bladder cancer. Its estimated thatjust over a thirdof all cases of bladder cancer are caused bysmoking. People who smoke may be up tofour times more likely to develop bladder cancer than non-smokers. Exposure to chemicals Exposure to certain industrial chemicals is the second biggest risk factor. Previous studies have estimated that this may account for around 25% of cases. Chemicals known to increase the risk of bladder cancer include: aniline dyes 2-Naphthylamine 4-Aminobiphenyl xenylamine benzidine o-toluidine Occupationslinked to an increased risk of bladder cancer are manufacturing jobs involving: dyes textiles rubbers paints plastics leather tanning Some non-manufacturing jobs have also been linked to an increased risk of bladder cancer. These include taxi or bus drivers, as a result of their regular exposure to the chemicals present in diesel fumes. The link between bladder cancer and these types of occupations was discovered in the 1950s and 1960s. Since then, regulations relating to exposure to cancer-causing chemicals have been made much more rigorous and many of the chemicals listed abovehave been banned. However,these chemicals are stilllinked with cases of bladder cancer now, as it can take up to30 years after initial exposure to the chemicals before the condition starts to develop. Other risk factors Otherfactors that can increase your risk of bladder cancer include: radiotherapy to treat previous cancers near the bladder, such as bowel cancer previous treatment withcertain chemotherapy medications, such ascyclophosphamide and cisplatin previous surgery to remove part of the prostate gland, during treatment for benign prostate enlargement having diabetes  bladder cancer is thought to be linked to certain treatments for type 2 diabetes having a tube in your bladder (an indwelling catheter) for a long time, because you have nerve damage that has resulted in paralysis long-term or repeated urinary tract infections (UTIs) long-term bladder stones having an early menopause (before the age of 42) an untreated infection called schistosomiasis , which iscaused by a parasite thatlives in fresh waterthis is very rare in the UK How does bladder cancer spread? Bladder cancer usually begins in the cells of the bladder lining. In some cases, itmay spread into surrounding bladder muscle. If the cancer penetrates this muscle, itcan spread to other parts of the body, usually through the lymphatic system. If bladder cancer spreads to other parts of the body, such as other organs, its known as metastatic bladder cancer. Diagnosing bladder cancer If you have symptoms of bladder cancer, such as blood in your urine, you should speak to your GP. Your GP may ask about yoursymptoms,family history and whether youve been exposed to any possible causes of bladder cancer,such assmoking. In some cases, your GP may request a urine sample, soit can be tested in a laboratory for traces of blood, bacteria or abnormal cells. Your GPmay also carry out a physical examination of your rectum and vagina,as bladder cancersometimes causes a noticeable lump that presses against them. If your doctor suspectsbladder cancer,youll bereferred to a hospital for further tests. In 2015, the National Institute for Health and Care Excellence (NICE) published guidelines to help GPs recognise the signs and symptoms of bladder cancer and refer people for the right tests faster.Find out who should be referred for further tests for suspected bladder cancer . At thehospital Some hospitals havespecialist clinics for people withblood in their urine (haematuria), while others have specialist urology departments for people with urinary tract problems. Cystoscopy If youre referred to a hospital specialist and they think you might have bladder cancer, you should first be offered a cystoscopy . This procedure allows the specialist to examine the inside of your bladder by passing a cystoscope through your urethra (the tube through which you urinate).A cystoscope isathin tube with a camera and light at the end. Before having a cystoscopy,a local anaesthetic gel is applied to your urethra (the tube through which you urinate) soyou dont feel any pain.The gel alsohelps the cystoscope to pass into the urethra more easily. The procedure usually takes about 5 minutes. Imaging scans You may be offered a CT scan or an MRI scan if the specialist feels they need a more detailed picture of your bladder. An intravenous (IV) urogram may also be used to look at your whole urinary system before or after treatment for bladder cancer. During this procedure, dye is injected into your bloodstream and X-rays are used to study it as it passes through your urinary system. Transurethral resection of a bladder tumour (TURBT) If abnormalities are found in your bladder during a cystoscopy, you should be offered an operation known as TURBT. This isso any abnormal areas of tissuecan be removed and tested for cancer (a biopsy). TURBTis carried out under general anaesthetic . Sometimes, a sample of the muscle wall of your bladder is also taken to check whether the cancer has spread, but this may be a separate operation within 6 weeks of the first biopsy . You should also be offered a dose of chemotherapy after the operation. This may help to prevent the bladder cancer returning if the removed cells are found to be cancerous. See treating bladder cancer for more information about the TURBT procedure Staging and grading Once these tests have been completed, it should be possible to tell you the grade of the cancer and what stage it is. Staging is a measurement of how far the cancer has spread. Lower-stage cancers are smaller and have a better chance of successful treatment. Grading is a measurement of how likely a cancer is to spread.The grade of a cancer is usually described using a number system ranging from G1 to G3. High-grade cancers are more likely to spread than low-grade cancers. The most widely used staging system for bladder cancer is known as the TNM system, where: T stands for howfar into the bladder the tumour has grown N stands for whether the cancer has spread into nearby lymph nodes M stands for whether the cancer has spread into another part of the body (metastasis), such as the lungs T stages The T staging system is as follows: TIS or CIS (carcinoma in situ)  a very early high-grade cancer confined to the innermost layer of the bladder lining Ta  the cancer is just in the innermost layer of the bladder lining T1  the cancerous cells have started to grow into the connective tissue beyond the bladder lining Bladder cancer up to the T1 stage is usually called early bladder cancer or non-muscle-invasive bladder cancer. If the tumour grows larger than this, its usually called muscle-invasive bladder cancer and is categorised as: T2  the cancer has grown through the connective tissue, into the bladder muscle T3  the cancer has grown through the layer of muscles, into the surrounding layer of fat If the tumour grows larger than the T3 stage, its considered to be advanced bladder cancer and is categorised as: T4  the cancer has spread outside the bladder, into surrounding organs N stages The N staging system is as follows: N0  there are no cancerous cells in any of your lymph nodes N1  there are cancerous cells in just one of your lymph nodes in your pelvis N2  there are cancerous cells in two or more lymph nodes in your pelvis N3  there are cancerous cells in one or more of your lymph nodes (known as common iliac nodes) deep in your groin M stages There are only two options in the M system: M0  where the cancer hasnt spread to another part of the body M1  where the cancer has spread to another part of the body, such as the bones, lungs or liver The TNM system can be difficult to understand, so dont be afraid to ask your care team questions about your test results and what they mean for your treatment and outlook. Treating bladder cancer The treatment options for bladder cancer largely depend on how advanced the cancer is. Treatments usually differbetween early stage, non-muscle-invasive bladder cancer and more advanced muscle-invasive bladder cancer. Multidisciplinary teams (MDTs) All hospitals use MDTs to treat bladder cancer. These are teams of specialists that work together to make decisions about the best way to proceed with your treatment. Members of your MDT may include: a urologist a surgeon specialising in treating conditions affecting the urinary tract a clinical oncologist a specialist in chemotherapy and radiotherapy a pathologista specialist in diseased tissue a radiologist a specialist in detecting disease using imaging techniques You should be given the contact details for a clinical nurse specialist, who will be in contact with all members of your MDT.Theyll be able to answer questions and support you throughout your treatment. Deciding what treatment is best for you can be difficult. Your MDT will make recommendations, but remember that the final decision is yours. Before discussing your treatment options, you may find it useful to write a list of questions to ask your MDT. Non-muscle-invasive bladder cancer If youve been diagnosed with non-muscle-invasive bladder cancer (stages CIS, Ta and T1), your recommended treatment plan depends on the risk of the cancer returning or spreading beyond the lining of your bladder. This risk is calculated using a series of factors, including: the number of tumours present in your bladder whether the tumours are larger than 3cm (1 inch) in diameter whether youve had bladder cancer before the grade of the cancer cells These treatments are discussed in more detail below. Low-risk Low-risk non-muscle-invasive bladder cancer is treated with transurethral resection of a bladder tumour (TURBT). This procedure may be performed during your first cystoscopy when tissue samples are taken for testing (see diagnosing bladder cancer ). TURBT is carried out under general anaesthetic . The surgeon uses an instrument called a cystoscope to locate the visible tumours and cut them away from the lining of the bladder. The wounds are sealed (cauterised) using a mild electric current, and you may be given a catheter to drain any blood or debris from your bladder over the next few days. After surgery,you may be given asingle dose of chemotherapy , directly into your bladder,using a catheter. The solution is kept in your bladder for around an hour before being drained away. Most people are able to leave hospital less than 48 hours after having TURBT and are able to resume normal physical activity within 2 weeks. You should be offered follow-up appointments at 3 months and nine months to check your bladder, using a cystoscopy . If your cancer returns after 6 months and is small,you may be offered a treatment called fulguration. This involves using an electric current to destroy the cancer cells. Intermediate-risk People with intermediate-risk non-muscle-invasive bladder cancer should be offered a course of at least 6 doses of chemotherapy. The liquid is placed directly into your bladder,using a catheter, and kept there for around an hour before being drained away. You should be offered follow-up appointments at 3 months, 9 months, 18 months, then once every year.Atthese appointments, your bladder will be checked using a cystoscopy.If your cancer returns within 5 years, youll be referred back to a specialist urology team. Some residue of the chemotherapy medication may be left in your urine after treatment, which could severely irritate your skin. It helpsif you urinate while sitting down and that youre careful not to splash yourself or the toilet seat. After passing urine, wash the skin around your genitals with soap and water. If youre sexually active, its important to use a barrier method of contraception , such as a condom. This isbecause the medication may be present in your semen or vaginal fluids, which can cause irritation. You also shouldnt try to get pregnant or father a child while having chemotherapy for bladder cancer, as the medication can increase the risk of having a child with birth defects. High-risk People with high-risk non-muscle-invasive bladder cancer should be offered a second TURBT operation, within 6 weeks of the initial investigation(see diagnosing bladder cancer ). A CT scan or an MRI scan may also be required. Your urologist and clinical nurse specialistwill discussyour treatment options with you, which will either be: a course of Bacillus Calmette-Gurin (BCG) treatment  using a variant of the BCG vaccine an operation to remove your bladder (cystectomy) The BCG vaccine is passed into your bladder through a catheter and left for 2 hours before being drained away. Most people require weekly treatments over a 6-week period. Common side effects ofBCG include: a frequent need to urinate pain when urinating blood in your urine (haematuria) flu-like symptoms, such as tiredness, fever and aching urinary tract infections IfBCGtreatment doesnt work, or the side effects are too strong, youll be referred back to a specialist urology team. You should be offered follow-up appointments every 3 months for the first 2 years, then every 6 months for the next 2 years, then once a year.Atthese appointments, your bladder will be checked using a cystoscopy. If you decide to have a cystectomy, your surgeon willneed tocreate an alternative way for urine to leave your body (urinary diversion). Your clinical nurse specialist can discuss your options for the procedure and how the urinary diversion will be created. Read about the complications of bladder cancer surgery for more information about urinary diversion and sexual problems after surgery. After having a cystectomy,you should be offered follow-up appointments including a CT scan at six and 12 months, andblood tests once a year. Men require an appointment to check their urethra once a year for 5 years. Muscle-invasive bladder cancer The recommended treatment plan for muscle-invasive bladder cancer depends on how far the cancer has spread. With T2 andT3 bladder cancer, treatment aims to cure the condition if possible, or at least control it for a long time. Your urologist, oncologist and clinical nurse specialistwill discussyour treatment options with you, which will either be: an operation to remove your bladder (cystectomy)  see above radiotherapy with a radiosensitiser Your oncologistshould also discuss the possibility of having chemotherapy before eitherof these treatments (neoadjuvant therapy), if its suitable for you. Radiotherapy with a radiosensitiser Radiotherapy is given by a machine that beams the radiation at the bladder (external radiotherapy). Sessions are usually given on a daily basis for 5 days a week over the course of 4 to 7 weeks. Each session lasts for about 10 to 15 minutes. A radiosensitisershould also be given alongside radiotherapy for muscle-invasive bladder cancer. This is a medicine which affects the cells of a tumour, to enhance the effect of radiotherapy. It has a much smaller effect on normal tissue. As well as destroying cancerous cells, radiotherapy can also damage healthy cells, which means it can cause a number of side effects. These include: diarrhoea inflammation of the bladder (cystitis) tightening of the vagina (in women), which can make having sex painful erectile dysfunction (in men) loss of pubic hair infertility tiredness difficulty passing urine Most of these side effects should pass a few weeks after your treatment finishes, although theres a chance theyll be permanent. Having radiation directed at your pelvis usually means youll be infertile for the rest of your life.However, most people treated for bladder cancer are too old to have children, so this isnt usually a problem. After having radiotherapy for bladder cancer,you should be offered follow-up appointmentsevery 3 months for the first 2 years, then every 6 months for the next 2 years, and every year after that.Atthese appointments, your bladder will be checked using a cystoscopy. You may also be offered CT scans of your abdomen, pelvis and chest after 6 months, 1 year and 2 years. A CT scan of your urinary tract may be offered every year for 5 years. Surgery or radiotherapy? Your MDT may recommend a specific treatmentbecause ofyour individual circumstances. For example, someone with a small bladder ormany existing urinary symptoms is better suited to surgery. Someone who has a single bladder tumour with normal bladder function is better suited for treatments that preserve the bladder. However, your input is also important, so you should discuss which treatment is best for you with your MDT. There are pros and cons of both surgery and radiotherapy. The pros of having a radical cystectomy include: treatment is carried out in one go you wont need regular cystoscopies after treatment, although other less invasive testsmay be needed The cons of having a radical cystectomy include: it can take up to 3 months to fully recover a risk of general surgical complications, such as pain, infection and bleeding a risk of complications from the use ofgeneral anaesthetic an alternative way of passing urine out of your body needs to be created, which may involve an external bag a high risk of erectile dysfunction in men (estimated at around 90%)as a result of nerve damage after surgery, some women may find sex uncomfortable, as their vagina may be smaller a small chance of a fatal complication, such as a heart attack , stroke or deep vein thrombosis (DVT) The pros of having radiotherapy include: theres no need to have surgery, which is often an important consideration for people in poor health your bladder function may not be affected, as your bladder isnt removed theres less chance of causing erectile dysfunction (around 30%) The cons of having radiotherapy include: youll require regular sessions of radiotherapy for 4 to 7 weeks short-term side effects are common,such as diarrhoea, tiredness and inflammation of the bladder (cystitis) a small chanceof permanently damaging the bladder, which could lead to problems urinating women may experience a narrowed vagina, making sex difficult and uncomfortable Chemotherapy In some cases,chemotherapy may be used during treatment for muscle-invasive bladder cancer. Instead of medication being put directly into your bladder, its put into a vein in your arm. This is called intravenous chemotherapy and can be used: before radiotherapy and surgery to shrink the size of any tumours in combination with radiotherapy before surgery (chemoradiation) to slow the spread of incurable advanced bladder cancer (palliative chemotherapy) There isnt enough evidence to say whether chemotherapy is an effective treatment when its given after surgery to prevent the cancer returning. Its usually only used this way as part of a clinical trial .See clinical trials for bladder cancer for more information. Chemotherapy is usually given over a few consecutive days at first. Youll then have a few weeks off to allow your body to recover before the treatment begins again. This cycle will be repeated for a few months. As the chemotherapy medication is being injected into your blood, youll experience a wider range of side effects than if you were having chemotherapy directly into the bladder. These side effects should stop after the treatment has finished. Chemotherapy weakens your immune system, making you more vulnerable to infection. Its important to report any symptoms of a potential infection, such as a high temperature, persistent cough or reddening of the skin, to your MDT. Avoid close contact with people who are known to have an infection. Otherside effects of chemotherapy can include: nausea vomiting hair loss lack of appetite tiredness Locally advanced or metastatic bladder cancer The recommended treatment plan forlocally advanced or metastatic bladder cancerdepends on how far the cancer has spread. Your oncologist should discuss your treatment options with you, which may include: a course of chemotherapy treatments to relieve cancer symptoms Chemotherapy If you receive a course of chemotherapy, youll be given a combination of drugs to help relieve the side effects of treatment. Treatment may be stopped if chemotherapy isnt helping, or a second course may be offered. Relieving cancer symptoms You may be offered treatment to relieve any cancer symptoms. This may include: radiotherapy to treat painful urination, blood in urine, frequently needing to urinate or pain in your pelvic area treatment to drain your kidneys, if they become blocked and cause lower back pain Palliative care If your cancer is at an advanced stage and cant be cured, your MDT should discuss how the cancer will progress and which treatments are available to ease the symptoms. You can be referred to a palliative care team, who can provide support and practical help, including pain relief. Read more about end of life care Complications of bladder cancer A diagnosis of bladder cancer, and some treatments for the condition, can have a significant impact on your life. Emotional impact The emotional impact of living with bladder cancer can be huge. Many people report experiencing a kind of rollercoaster effect. For example, you may feel down at receiving a diagnosis,up whenthe canceris removed, and down again as you try to come to terms with the after-effects of your treatment. This type of emotional disruption can sometimes trigger feelings of depression . Signs that you may be depressed include: having continuous feelingsof sadnessor hopelessness no longer taking pleasure in the things you enjoy Contact your GP for advice if you think you may be depressed. Theres a range of relatively successful treatments for depression, including antidepressant medication andtherapies such as cognitive behavioural therapy (CBT). Read more about coping with cancer Urinary diversion Ifyour bladder is removed, an alternative way of passing urine out of yourbody will be created during the operation. This is called urinary diversion. There are various types of urinary diversion, which are described below. In some cases, you may be able to make a choice based on your personal preferences. However, certain treatment options will not be suitable for everyone. Your multidisciplinary team (MDT) can provide information on the most suitable options for you. Urostomy A urostomy iscarried out during a radical cystectomy. A small section ofthe small bowel isremoved andconnected to your ureters (the 2 tubes that normally carry urine out of the kidneys). The surgeonthen creates a small hole in the surface of your abdomen and the open end of the removed bowel is placed in this hole, creating an opening known as a stoma. Aspecial waterproofbagis placed over the stoma to collect urine. Astoma nurse will teach you how to care for your stoma, and how and when to change the bag. Continent urinary diversion Continent urinary diversion is similar to a urostomy, butwithout an external bag. Instead, a section of your bowelis used to create a pouch inside your body that stores urine. The ureters are connected to the pouch and the pouch is connected to an opening in the abdominal wall.A valve in the opening (stoma) prevents urine leaking out. The pouch is emptied using athin, flexible tube(catheter). Most people need to empty their pouch about 4 or 5 times a day. Bladder reconstruction In some cases it may be possible to create a new bladder, known as a neobladder. This involves removing a section of your bowel and reconstructing it into a balloon-like sac, before connecting it to your urethra (the tube that carries urine out of the body) at one end and your ureters at the other end. However, bladder reconstruction isnt suitable for everyone. Youll be taught how to empty your neobladder by relaxing the muscles in your pelvis, whiletightening the muscles in your abdomen at the same time. Your neobladder wont contain the same types of nerve endings as a real bladder, so you wont get the distinctive sensation that tells you to pass urine. Some people experience a feeling of fullness inside their abdomen, while others have reported they feel like they need to pass wind. Because ofthe loss of normal nerve function, most people with a neobladder experience some episodes of urinary incontinence , which usually occurs during the night, while theyre asleep. You may find it useful to empty your neobladder at set times during the day, including before you go to bed, to help prevent incontinence. Sexual problems Erectile dysfunction Contact yourMDT if you lose the ability to obtain or maintain an erection after a radical cystectomy. It may be possible for you to be treated with a type of medicine known as phosphodiesterase type 5 inhibitors (PDE5). PDE5s work by increasing the blood supply to your penis. PDE5s are sometimes combined witha device called a vacuum pump, which consists of acylinder connected to a pump. The penis is placed inside the cylinder and the air is pumped out. This creates a vacuum that causes blood toflow into the penis. A rubber ring is then placed around the base of the penis, which allows an erection to be maintained for around 30 minutes. Read more about treating erectile dysfunction Narrowing of the vagina Both radiotherapy and cystectomy can cause a womans vagina to become shortened and narrowed, which can make penetrative sex painful or difficult. There are 2 main treatment options available if you have a narrowed vagina. The first is to apply hormonal cream to the area, which should help to increase moisture inside your vagina. The second is to use vaginal dilators. These areplastic cone-shaped devices of various sizesthat are designed to gently stretchyour vagina and make it more supple. Its usually recommended that youusedilatorsfor a 5 to10-minute period every day, starting with the dilator that fits in easiest first andgradually increasing the size, as your vagina stretches over the following weeks. Many women find this an embarrassing issue to discuss, but the use of dilators is a well-recognised treatment for narrowing of the vagina. Your specialist cancer nurse should be able to provide more information and advice. You may find that themore often you have penetrative sex, the less painful it becomes. However, it may be several months before you feel emotionally ready to be intimate with a sexual partner. The Macmillan Cancer Support website has information and a video about cancer and sexuality Preventing bladder cancer Its not always possible to prevent bladder cancer, but some risk factors have been identified, which may increase your risk of developing the condition. Stopping smoking If you smoke, giving up is the best way to reduce your risk of developing bladder cancer and preventing it from recurring. If you decide to stop smoking, youcould contact the Quit Your Way .",,,,,,,,,,,,,
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Smoking and Bladder Cancer," every day). The specially trained helpline staff willoffer you free expert advice and encouragement. If youre committed to giving up smoking	 butdont want to be referred to a stop smoking service	 your GP should be able to prescribe medical treatment to help with any withdrawal symptoms you may experience after giving up. For more information and advice about giving up smoking	 have a browse through stop smoking treatments and the stop smoking home page . Workplace safety Your risk of bladder cancer could be increased if your job involves exposure to certain chemicals. Occupations linked to an increased risk of bladder cancer are manufacturing jobs involving: rubber dyes textiles plastic leather tanning diesel fumes Nowadays	 there are rigorous safety protocols in place designed to minimise your risk of exposure	 andchemicals known to increase the risk of bladder cancer have been banned. If youre uncertain about what these protocols involve	 talk to your line manager or health and safety representative. If youre concerned that your employer may be disregarding recommendations about workplace safety	 you should contact the Health and Safety Executive for advice. Diet Theres some evidence to suggest that a diet high in fruit and vegetables and low in fat can help to prevent bladder cancer. Even though this evidence is limited	 its a good idea to follow this type of healthy diet	 as it can help to prevent other types of cancer	 such as bowel cancer 	 as well as serious health conditions	 including high blood pressure (hypertension) 	 stroke and heart disease . A low-fat	 high-fibre diet is recommended	 including plenty of fresh fruit and vegetables (5 portions a day) and whole grains. Limit the amount of salt you eat to no more than 6g (0.2oz) a day (1 teaspoon) because too much can increase your blood pressure. You should try to avoid foods that contain saturated fat	 as itcan increase your cholesterol levels. Foods high in saturated fat include: meat pies sausages and fatty cuts of meat butter ghee (a type of butter often used in Indian cooking) lard cream hard cheese cakes and biscuits foods that contain coconut or palm oil However	 a balanced diet should include a small amount of unsaturated fat	 becausethis will actually help to control your cholesterol levels. Foodshigh in unsaturated fat include: oily fish avocados nuts and seeds sunflower	 rapeseed	 olive and vegetable oils Read more about healthy eating Source: NHS 24 - Opens in new browser window Last updated: 13 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name	 location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Radiotherapy Chemotherapy Other health sites Cancer Research UK: Bladder cancer Macmillan Cancer Support: Bladder cancer Penny Brohn UK Fight Bladder Cancer: What is bladder cancer? Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852']""																																																																	",,,,,,,,,,,,,
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Blood poisoning (sepsis),"Sepsis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Blood and lymph Sepsis Sepsis About sepsis Symptoms of sepsis Treating sepsis About sepsis Phone 999 immediately or go to A&E if: You or someone else has symptoms like: loss of consciousness severe breathlessness a high temperature (fever) or low body temperature a change in mental state  like confusion or disorientation slurred speech cold, clammy and pale or mottled skin a fast heartbeat fast breathing chills and shivering severe muscle pain feeling dizzy or faint nausea and vomiting diarrhoea What is sepsis? Sepsis is a serious complication of an infection. Without quick treatment, sepsis can lead to multiple organ failure and death. What causes a sepsis infection? The immune system usually keeps an infection limited to one place. This is called a localised infection. To do this, the body produces white blood cells. White blood cells travel to an infection site to destroy the germs causing the infection. This triggers tissue swelling, known as inflammation. This helps to fight the infection and prevent it from spreading. However, an infection can spread to other parts of the body if the immune system is weak or an infection is severe. Widespread inflammation can damage tissue and interfere with blood flow. When blood flow is interrupted, blood pressure can drop dangerously low. This stops oxygen from reaching the organs and tissues. Sources of infection Sepsis can be triggered by an infection in any part of the body. The most common sites of infection that lead to sepsis are the: lungs urinary tract tummy (abdomen) pelvis However, sometimes the specific infection and source of sepsis cant be identified. Infections linked to sepsis appendicitis  infection in the appendix cellulitis  a skin infection that can be caused by an intravenous catheter thats been inserted through the skin to give fluids or medication cholangitis  an infection of the bile duct cholecystitis  an infection of the gallbladder encephalitis  an infection of the brain and nervous system endocarditis  a heart infection flu  only in some cases meningitis  an infection of the brain and nervous system peritonitis  an infection of the thin layer of tissue that lines the abdomen pneumonia  a lung infection post-surgery infections osteomyelitis  a bone infection urinary tract infection  an infection of the bladder, urethra or kidneys Tests to diagnose sepsis Sepsis is often diagnosed by testing your: temperature heart rate breathing rate blood Other tests can help determine the type of infection, where its located and which parts of the body have been affected. These include: urine or stool samples a wound culture  where a small sample of tissue, skin or fluid is taken from the affected area for testing respiratory secretion testing  taking a sample of saliva, phlegm or mucus blood pressure tests imaging studies  like an X-ray , ultrasound scan or computerised tomography (CT) scan Whos at risk of sepsis? Anyone can develop sepsis after an injury or minor infection. However, some people are more vulnerable, including people who: are very young are very old are pregnant have had a urinary catheter fitted have a long term health condition like diabetes have recently had surgery are genetically prone to infections are already in hospital with a serious illness have to stay in hospital for a long time have wounds or injuries as a result of an accident have a medical condition that weakens the immune system  like HIV or leukaemia are receiving medical treatment that weakens the immune system  like chemotherapy or long-term steroids are on mechanical ventilation  where a machine is used to help you breathe Recovering from sepsis Some people make a full recovery from sepsis fairly quickly. The amount of time it takes to fully recover from sepsis varies depending on: the severity of the sepsis the persons overall health how much time was spent in hospital whether treatment was needed in an intensive care unit (ICU) Long term effects of sepsis Some people with sepsis will experience long-term physical and psychological problems. This is known as post-sepsis syndrome. Symptoms of post-sepsis syndrome include: feeling lethargic or excessively tired muscle weakness swollen limbs joint pain chest pain breathlessness Symptoms of sepsis Sepsis can cause a variety of symptoms. Sepsis symptoms in children under 5 Temperature over 38C (babies under 3 months) over 39C (babies aged 3 to 6 months) below 36C  check 3 times in a 10-minute period a high temperature in a child who cant be encouraged to show interest in anything Breathing difficulty breathing  this looks like hard work grunting with every breath struggling to speak more than a few words at once (for older children who normally talk) breathing that obviously pauses Eating and drinking no interest in feeding (child under 1 month) not drinking for more than 8 hours (when awake) black, green or bloody vomit Body a soft spot on a babys head that bulges sunken eyes a baby thats floppy a child that cant be encouraged to show interest in anything weak, whining or continuous crying in a younger child confusion in an older child irritableness unresponsive stiffness in the neck, especially when trying to look up or down not had a wee or wet nappy for 12 hours Go to A&E or call 999 if your child: is very lethargic or difficult to wake feels abnormally cold to touch is breathing very fast has a rash that does not fade when you press it has a fit or convulsion Trust your instincts and phone 111 if your childs symptoms are getting worse or they are sicker than youd expect (even if their temperature falls). Sepsis symptoms in older children and adults Early symptoms of sepsis may include: a high temperature (fever) or low body temperature chills and shivering a fast heartbeat fast breathing Symptoms of severe sepsis or septic shock In some cases, symptoms of more severe sepsis or septic shock (when your blood pressure drops to a dangerously low level) develop. These can include: feeling dizzy or faint a change in mental state  like confusion or disorientation diarrhoea nausea and vomiting slurred speech severe muscle pain severe breathlessness less urine production than normal  for example, not urinating for a day cold, clammy and pale or mottled skin loss of consciousness Phone 999 or go to A&E if: youve recently had an infection or injury and you have possible signs of sepsis you think you or someone in your care has severe sepsis or septic shock Dont be afraid to ask the healthcare professional is this sepsis?. Treating sepsis Treatment for sepsis varies, depending on the: area affected cause of the infection organs affected extent of any damage If you have the early signs of sepsis, youll usually be referred to hospital. Youll then be given a diagnosis and treatment. Emergency treatment Youll need emergency treatment, or treatment in an intensive care unit (ICU), if: the sepsis is severe you develop septic shock  when your blood pressure drops to a dangerously low level ICUs can support body functions like breathing that are affected by sepsis. This allows the medical staff to focus on treating the infection. Sepsis is treatable if its identified and treated quickly. In most cases it leads to full recovery with no lasting problems. Antibiotics The main treatment for sepsis, severe sepsis or septic shock is antibiotics . These will be given directly into a vein (intravenously). Ideally, antibiotic treatment should start within an hour of diagnosis. Intravenous antibiotics are usually replaced by tablets after 2 to 4 days. You may have to take them for 7 to 10 days or longer, depending on the severity of your condition. Types of antibiotics If sepsis is suspected, broad-spectrum antibiotics are given first. This is because there wont be time to wait until a specific type of infection has been identified. Broad-spectrum antibiotics work against a wide range of known infectious bacteria. They usually cure most common infections. Once a specific bacterium has been identified, a more focused antibiotic can be used. Viral infections If the sepsis is caused by a virus, antibiotics wont work. However, it would be too dangerous to delay treatment to find out the specific cause. This means antibiotics are usually given anyway. With a viral infection, youll need to wait until your immune system starts to tackle it. However, antiviral medication may be given in some cases. Intravenous fluids If you have sepsis, your body needs more fluid to prevent dehydration and kidney failure. If you have severe sepsis or septic shock, youll usually be given fluids intravenously for the first 24 to 48 hours. Its important that the doctors know how much urine your kidneys are making when you have sepsis. This helps them spot signs of kidney failure. If youre admitted with severe sepsis or septic shock, youll usually be given a catheter . This is inserted into your bladder to monitor your urine output. Oxygen Your bodys oxygen demand goes up if you have sepsis. If youre admitted to hospital with sepsis and the level of oxygen in your blood is low, youll usually be given oxygen. This is given through a mask or tubes in your nostrils. Treating the source of infection If a source of the infection can be identified, like an abscess or infected wound, this will also need to be treated. For example, any pus may need to be drained away. In more serious cases, surgery may be needed to remove the infected tissue and repair any damage. Increasing blood pressure Medications called vasopressors are used if you have low blood pressure caused by sepsis. Vasopressors are normally given intravenously while youre in an ICU. Extra fluids may also be given intravenously to help increase blood pressure. Other treatments You may require additional treatments like: corticosteroids insulin medication a blood transfusion mechanical ventilation  where a machine is used to help you breathe dialysis  where a machine filters your blood to copy the function of your kidneys These treatments are mostly used in ICUs. Source: NHS 24 - Opens in new browser window Last updated: 16 August 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Antibiotics Other health sites UK Sepsis Trust Nice: Sepsis: recognition, diagnosis and early management Sepsis Research NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852']",,,,,,,,,,,,,
Bone cancer,"Bone cancer - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Bone cancer Bone cancer About bone cancer Symptoms of bone cancer Causes of bone cancer Diagnosing bone cancer Treating bone cancer About bone cancer Primary bone cancer is a rare type of cancer that begins in the bones. This is a separate condition from secondary bone cancer, which is cancer that spreads to the bones after developing in another part of the body. These pages only refer to primary bone cancer. The Macmillan Cancer Support website has more information about secondary bone cancer . Signs and symptoms of bone cancer Bone cancer can affect any bone, but most cases develop in the long bones of the legs or upper arms. The main symptoms include: persistent bone pain that gets worse over time and continues into the night swelling and redness (inflammation)over a bone, which can make movement difficult ifthe affectedbone is near a joint a noticeable lump over a bone a weak bone that breaks (fractures) more easily than normal If you or your child are experiencing persistent, severe or worseningbone pain, visit your GP. While its highly unlikely to be the result of bone cancer, it does require further investigation. Read more about the symptoms of bone cancer Types of bone cancer Some of the main types of bone cancer are: osteosarcoma  the most common type, which mostly affects children andyoung adults under 20 Ewing sarcoma  which most commonly affects people aged between 10and 20 chondrosarcoma  which tends to affect adults aged over 40 Young people can be affected becausethe rapid growth spurts that occur duringpubertymay make bone tumours develop. These types of bone canceraffect different types ofcell. The treatment and outlook will depend on the type of bone cancer you have. What causes bone cancer? In most cases, its not known why a person develops bone cancer. Youre more at riskof developing it if you: have had previous exposure toradiationduring radiotherapy have a condition known as Pagets disease of the bone however, only a very small number of people with Pagets disease will actually develop bone cancer have a rare genetic condition calledLi-Fraumeni syndromepeople with this condition have a faulty version of a gene that normally helps stop the growth of cancerous cells Read more about the causes of bone cancer How bone cancer is treated Treatment for bone cancer depends on the type of bone cancer you have and how far it has spread. Most people have a combination of: surgery to remove the section of cancerous bone  its often possible to reconstruct or replace the bone thats been removed,but amputation is sometimes necessary chemotherapy treatmentwith powerful cancer-killing medication radiotherapy whereradiation is used to destroy cancerous cells In some cases ofosteosarcoma,a medication called mifamurtide may alsobe recommended. Read more about treating bone cancer Outlook The outlook for bone cancer depends onfactors such asyour age, the type of bone cancer you have, how far the cancer has spread (the stage), and how likely it is to spread further (the grade). Generally, bone cancer is much easier to cure in otherwise healthy people whose cancer hasnt spread. Symptoms of bone cancer Bone pain is the most common symptom of bone cancer. Some people experience other symptoms as well. Bone pain Pain caused by bone cancer usually begins with a feeling of tenderness in the affected bone. Thisgradually progresses to a persistent ache or ache that comes and goes, which continues at night and when resting. Any bone can be affected, although bone cancer most often develops in the long bones of the legs or upper arms. Thepain can sometimes bewrongly mistaken for arthritis in adults and growing painsin children and teenagers. Other symptoms Some peoplealso experience swelling and redness (inflammation) ornotice a lump on or around the affected bone. If the bone is near a joint, the swelling may make it difficult to use the joint. In some cases, the cancer can weaken a bone, causing it to break (fracture) easilyafter a minor injury or fall . Less common symptoms can include: a high temperature (fever) of 38C (100.4F) or above unexplained weight loss sweating, particularlyat night When to seek medical advice Speak to your GP if you or your child experiences persistent, severe or worsening bone pain, or if youre worried about any symptoms. While its highly unlikely that your symptoms are caused by cancer, its best to be sure by getting a proper diagnosis. Read more about diagnosing bone cancer Causes of bone cancer Cancer occurs when the cells in a certain area of your body divide and multiply too rapidly. This produces a lump of tissue known as a tumour. The exact reason why this happens is often not known, but certain things can increase your chance of developing the condition, including: previous radiotherapy treatment otherbone conditions, such as Pagets disease of the bone rare genetic conditions, such asLi-Fraumeni syndrome a history ofcertainotherconditions, including retinoblastomaand umbilical hernia Radiotherapy treatment Previous exposure to high doses of radiationduring radiotherapy may cause cancerous changes in your bone cells at a later stage, although this risk is thought to be small. Bone conditions Some non-cancerous (benign) conditions affecting the bones may increase your chances of developing bone cancer, although the risk is still small. In particular, a condition called Pagets disease of the bonecan increase the risk of bone cancer in people over 50to 60 years of age. Rarer conditions that cause tumours to grow in your bones, such as Olliers disease, can also increase your risk of bone cancer. Genetic conditions A rare genetic condition calledLi-Fraumeni syndrome can increase your risk of developing bone cancer, as well as several other types of cancer. People with this condition have a faulty version of a gene that usually helps stop the growth of tumours in the body. Other conditions People who had a rare type of eye cancer called retinoblastomaas a child may be more likely to develop bone cancer, because the same inherited faulty gene can be responsible for both conditions. Research has also found that babies born with an umbilical herniaare three times more likely to develop a type of bone cancer called Ewing sarcoma,although the risk is stillvery small. Diagnosing bone cancer If youre experiencing bone pain, your GP will ask about your symptoms and examine the affected area, before deciding whether you need to have any further tests. They will look for any swelling or lumps, and ask if you haveproblems moving the affected area. They may ask about the type of pain you experience  whether its constant or comes and goes, and whether anything makes it worse. After being examined, you may bereferred for an X-ray of the affected area to look for any problems in the bones. If the X-ray shows abnormal areas, youll be referred toan orthopaedic surgeon (a specialist in bone conditions) or bone cancer specialistfor a further assessment. X-rays An X-rayis a procedure where radiation is used toproduce images of the inside of the body. Its a particularly effective way of looking at bones. X-rays can often detect damage to the bones caused by cancer, or new bone thats growing because of cancer.They can also determine whether your symptoms arecaused bysomething else, such as a brokenbone (fracture). Ifan X-ray suggests you may have bone cancer, you should be referred to a specialist centre with expertise in diagnosing and treating the condition. As bone cancer israre,there are asmall number of specialist centres, so you may have to travel outside your local area for advice and treatment. Biopsy The most definitive way of diagnosing bone cancer is to take a sample of affected bone and send it to a laboratory for testing. This is known as a biopsy . A biopsy can determine exactly what type of bone cancer you have and what grade it is (see below). A biopsy can becarried outin two ways: A core needle biopsy isperformed under anaesthetic (depending on where the bone is located, this could be a local anaesthetic or general anaesthetic ).A thin needle is inserted into the bone and used to remove a sample of tissue. An open biopsy isperformed under a general anaesthetic. The surgeon makes an incision in the affected bone to remove a sample of tissue. You may need to have an open biopsy if the results of a core needle biopsy are inconclusive. Further tests If the results of the biopsy confirm or suggest bone cancer, its likely youll have further tests to assess how far the cancer has spread. These tests are described below. MRI scan A magnetic resonance imaging (MRI) scan uses a strong magnetic field and radio waves to produce detailed pictures of the bones and soft tissues. An MRI scan is an effective way of assessing the size and spread of any cancerous tumour in or around the bones. CT scan A computerised tomography (CT) scan involves taking a series of X-rays and using a computer to reassemble them into a detailed three-dimensional (3D) image of your body. CT scans are often used to check if the cancer has spread to your lungs. Chest X-rays may also be taken for this purpose. Bone scans A bone scan cangive more detailed information about the inside of your bones than an X-ray. During a bone scan,a small amount of radioactive material is injected into your veins. Abnormal areas of bone will absorb the material at a faster rate than normal bone and will show up as hot spots on the scan. Bone marrow biopsy If you have a type of bone cancer called Ewing sarcoma , you may have a test called a bonemarrow biopsy to check if the cancer has spread to the bone marrow (the tissue inside your bones). During the test,a needle is inserted into your bone to remove a sample of your bone marrow. This may be done under either local or general anaesthetic. Staging and grading Once these tests have been completed, it should be possible to tell you what stage and grade the bone cancer is. Staging is a description of how far a cancer has spread and grading is a description of how quickly the cancer is likely to spread in the future. A widely used staging system for bone cancer inthe UKuses 3 main stages: stage 1  the cancer is low-grade and has not spread beyond the bone stage 2  the cancer has still not spread beyond the bone, but is a high-grade stage 3  the cancer has spread into other parts of the body, such as the lungs Most cases of stage 1 bone cancer and some stage 2 bone cancers have a goodchance of being cured. Unfortunately, stage 3 bone cancer is more difficult to cure, although treatment can relieve symptoms and slow the spread of the cancer. Coping with a diagnosis Being toldyou have bone cancer can be a distressing and frightening experience. Receiving that type of news can be upsetting at any age, but can be particularly difficult if you are still in your teenage years, orif youre a parent of a child who has just been toldthey have bone cancer. These types of feelings can cause considerable stress and anxiety, which in some cases can trigger depression . If you think you may be depressed,your GP may be a good person to talk to about support and possiblytreatment. You may also find it useful to contact the Bone Cancer Research Trust , which is the UKs leading charity for people affected by bone cancer, if you need more information. If youre a teenager you may want to contact the Teenage Cancer Trust , which is a charity for teenagers and young adults affected by cancer. Read more about coping with a cancer diagnosis Treating bone cancer Treatment for bone cancer depends on the type of bone cancer you have, how far it has spread and your general health. The main treatments are surgery, chemotherapy and radiotherapy. Your treatment plan Your treatment should be managed by a specialist centre with experience in treating bone cancer, where youll be cared for by a team of different healthcare professionals known as a multi-disciplinary team (MDT). Members of the MDT will include an orthopaedic surgeon (a surgeon who specialises in bone and joint surgery), a clinical oncologist (a specialist in the non-surgical treatment of cancer) and a specialist cancer nurse, among others. Your MDT will recommend what they think is the best treatment for you, but the final decision will be yours. Your recommended treatment plan may include a combination of: surgery to remove the section of cancerous bone  its often possible to reconstruct or replace the bone thats been removed, although amputation is occasionally necessary chemotherapy treatmentwith powerful cancer-killing medication radiotherapy whereradiation is used to destroy cancerous cells In some cases, a medication called mifamurtide may be recommended as well. Surgery Surgery to remove the cancerous area of bone is an important part of treatment for bone cancer, although its often combined with the other treatments mentioned below. Nowadays, its usually possible to avoid removing an affected body part completely (known as limb-sparing surgery), although up to 1 in every 10 people may need to have a limb permanently removed (amputation). Limb-sparing surgery Limb-sparing surgery is usually possible when the cancer has not spread beyond the bone, and the bone can be reconstructed. The most common type of limb-sparing surgery involves removing the section of affected bone and some of the surrounding tissue (in case any cancerous cells have spread into the tissue). The removed section of bonemay then bereplaced with a metal implant called a prosthesis or a piece of bone from elsewhere in your body (bone graft). If the cancer is near a joint, such as the knee, it may bepossible to remove the joint and replace it with an artificial one. Read more about knee joint replacement and hip joint replacement. Amputation Amputationmay be necessary if limb-sparing surgery is not possible or has not worked well. For example, it may be necessary if: the cancer has spread beyond the bone into major blood vessels or nerves you developed an infection after limb-sparing surgery and the prosthesis or bone graft had to be removed the cancer has developed in a part of the body where limb-sparing surgery is not technically possible, such as the ankle Your care team will understand the shock and fear that you, or your child, may be feeling if an amputation is needed and should be able to provide you withcounselling and other support. In some cases, your care team may be able to introduce you to someone who has already had an amputation. After an amputation, most people use an artificial limb to replace the limb thats removed. These limbs are now very advanced and convenient to use. For example, people with an artificial leg are often able to walk, run and play sport, and have an excellent quality of life. Recovering from surgery After limb-sparing surgery or an amputation, youll need help to return to normal life. This is known as rehabilitation. Rehabilitation will usually involve physiotherapysessions, where you carry out exercises to help regain proper function in the treated body part, and occupational therapy , where youre taught skills to help you cope with day-to-day activities. After an amputation, you may be referred to a local limb centre for advice, support and rehabilitation treatment.Read more about living with an amputation . Chemotherapy There are 4 ways chemotherapy can be used to treat bone cancer. It can be used: before surgery, to shrink the tumour and make surgery easier in combination with radiotherapy before surgery (chemoradiation) this approach works particularly well in the treatment of Ewing sarcoma after surgery, to prevent the cancer returning to control symptoms in cases where a cure is not possible (known as palliative chemotherapy) Chemotherapy for bone cancer involves taking a combination of different medications that are usually delivered via a drip into your vein, or into a line inserted into a bigger blood vessel. Thetreatment isusually given in cycles. A cycle involves taking the chemotherapy medication for several days, then having a break for a few weeks to allow your body to recover from the effects of the treatment. The number of cyclesyouneed will depend on the type and grade of your bone cancer. Side effects Chemotherapy can damage healthy cells as well as cancerous cells, which means it often causes a number of side effects. Common side effects of chemotherapy include: nauseaand vomiting diarrhoea mouth ulcers tiredness increased risk of catching infections temporary hair loss infertility Most side effects associated with chemotherapy should resolve once your treatment has finished. However, there is a riskyou will be permanently infertile. Your care team will provide more detailed information about the specific risk to your fertility. Read more about the side effects of chemotherapy Radiotherapy As with chemotherapy, radiotherapy can be used before and after surgery to treat bone cancer, or used to control the symptoms and slow the spread of cancer when a cure is not possible. Radiotherapy for bone cancer involves beams of radiation being directed at the cancerous section of bone by an external machine. This is normally given in daily sessions, 5 days a week, with each session lasting a few minutes. The whole course of treatment will usually last a few weeks. Side effects The radiation youre exposed to during radiotherapy will mostly be focused on the cancerous cells, but healthy cells nearby can also be damaged. This can lead toside effects such as: reddening and irritation of the skin (this can feel much like sunburn) joint pain in the part of the body that is being treated feeling sick hair loss in the body part being treated tiredness These side effects will pass once the radiotherapy has been completed, although feelings of tiredness may persist for several weeks. Read more about the side effects of radiotherapy Mifamurtide For people with a type of bone cancer called osteosarcoma, a medication called mifamurtide may be used alongside other treatments. Mifamurtide is an immune macrophage stimulant. This means it works by encouraging the immune system to produce specialised cellsthat kill cancerous cells. Its normally recommended for young people withhigh-grade osteosarcomas and is givenafter surgery, in combination with chemotherapy, to help prevent the cancer returning. Mifamurtide is slowly pumped into one of your veins over the course of an hour (known as infusion). The recommended course of treatment is usually twice a week for 12 weeks, and then once a week for a further 24 weeks. Side effects Mifamurtide can cause a wide range of side effects. These can include: nausea and vomiting diarrhoea or constipation headache dizziness loss of appetite tiredness and weakness Its unclear whether its safe to take mifamurtide during pregnancy, so as a precaution its importanttouse an effective method of contraception if youre a sexually active woman. You will need to tell your MDT as soon as possible if youthink yourepregnant, and you should avoid breastfeeding while taking mifamurtide. Follow-up Once your treatment has finished, youll need to attend regular follow-up appointments to checkthe cancer hasnt returned. Youll be asked to attend frequent appointments in the first two years after treatment has finished  possibly every 3 months.These willbecome less frequent as the years go on. Contact your specialist or GP if you develop symptoms of bone cancer again and think the cancer may have come back. Source: NHS 24 - Opens in new browser window Last updated: 13 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Ewing sarcoma Radiotherapy Chemotherapy Other health sites Bone Cancer Research Trust Cancer Research UK: Bone cancer Teenage cancer trust Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852']",,,,,,,,,,,,,
Bone cancer: Teenagers and young adults,"Bone cancer: Teenagers and young adults | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in teenagers and young adults Bone cancer: Teenagers and young adults Bone cancer: Teenagers and young adults Introduction The bones Tests for bone cancer Treating bone cancer Life after treatment for bone cancer Introduction This section about bone cancer is for teenagers and young adults. There are different types of bone cancer, and most of this information applies to all types. If you have a rare type of bone cancer and want to know more, you could talk to Macmillan . If youre looking for information about bone cancer in people of all ages, read our general bone cancer section. Types of bone cancer There are different types of bone cancer. The2 most common bone cancers to affect teenagers are osteosarcoma and Ewing sarcoma. Osteosarcoma Osteosarcomas are most likely to affect bones in the leg, especially around the knee joint, but they can affect any bone. Ewing sarcoma Ewing sarcoma can affect any bone, but its most common in the pelvis (which is made up of the tail bone and the2 hip bones), or in leg bones. Ewing sarcoma can sometimes start outside the bone in the soft tissue. This is called soft tissue Ewing sarcoma, and is treated in the same way. Sarcoma is the name for a cancer that starts in any connective tissue, such as muscle, fat or cartilage. In this information we sometimes use the term bone tumour. This means the same as bone cancer. Causes The cause of bone cancer is unknown. Because its more common in young people, doctors think that it may be linked to the changes that happen when bones are growing. There is lots of ongoing research into the possible causes. People often think a knock or injury might have caused bone cancer, but theres no evidence for this. Remember that nothing youve done has caused the cancer. Signs and symptoms of bone cancer Bone cancer symptoms vary, and not everyone will feel the same. Many symptoms are similar to everyday aches and pains, so they can be mistaken for other things, like strains, sports injuries or growing pains. The main symptoms are: painor tenderness this may start as an ache that doesnt go away and may be made worse by exercise or feel worse at night swelling around the affected area of bone swelling may not show up until the tumour is quite large and it isnt always possible to see or feel a lump if the affected bone is deep inside the body reduced movement if the bone tumour is near a joint (like an elbow or knee), it can make it harder to move the joint; if its in a leg bone, it may cause a limp; if its in the backbone (spine), it may press on nerves and cause tingling and numbness in the legs or arms abroken bone a bone may break suddenly, or after only a minor fall or accident if the bone has been weakened by cancer. There might also be other symptoms including: tiredness ahigh temperature loss of appetite weight loss If you have any of these symptoms, or you are worried that you may have a bone tumour, you should get it checked by your GP. They can talk to you about your symptoms, and arrange tests if they feel theyre needed. Remember most people with these symptoms wont have bone cancer. The bones Knowing what your bones do might help you understand what bone cancer is. Bones are like human scaffolding. They help keepyou upright. The human skeleton is made up of more than 200 bones of different shapes and sizes. Bones do lots of important things: they work with joints and connective tissue so thatyou can move around they protect parts of the body from injury for example, the ribs protect the heart and lungs they store calcium some bones contain bone marrow, which make blood cells Joints Joints help bones fit together so that we can move freely. There are different types of joint. Some work as levers, like the finger joint. Others are ball-and-socket joints, such as the hip joint. There are different types of connective tissue that help bones move: ligaments are tough cords of tissue that attach bones to each other cartilage is a slippery material that covers the ends of bones to stop them rubbing together muscles are made of tough, stretchy tissueand give strength tendons are strong cords of tissue that attach muscles to bones We also have more information about: symptoms of bone cancer having tests for bone cancer treatment for bone cancer life after bone cancer If youre looking for information about bone cancer in people of all ages, read our general bone cancer section. Tests for bone cancer There are some tests you might have when you visit your GP or at the hospital. The tests will help the doctors see whether you have bone cancer. Visiting your GP If you think you might have some of the symptoms of bone cancer , you should speak to your GP. Your GP will talk to you about your symptoms, examine you and usually arrange some tests, such as X-rays and blood tests. There may be a number of reasons why youre feeling unwell, so it can be difficult to diagnose the problem straight away. If your GP cant find the cause, you may be referred to a specialist at the hospital. At the hospital The hospital youre referred to will depend on the results of the tests. You may go straight to a doctor specialising in bone cancer, or you might see doctors with more general experience first. The hospital doctor will examine you and arrange for some of the following tests: X-rays bone scans biopsies MRI and/or CT scans If youre diagnosed with bone cancer and not already seeing a specialist bone doctor, youll be referred to one. Further tests If the tests show you have bone cancer, you might need a few more tests to check how your body is working in general: blood tests tests to check your heart is healthy chest X-rays to check your lungs are healthy tests to check your kidneys are healthy you may need to give a sample ofpee (urine) to be tested This may seem like a lot of tests, but theyll help the doctors plan the best treatment for you. Having tests and waiting for the results can be an anxious time. Talking about how you feel and getting support from family, friends, your specialist nurse or your doctor can help. We have more information about: the bones symptoms of bone cancer treatment for bone cancer life after bone cancer If youre looking for information about bone cancer in people of all ages, read our general bone cancer section. Treating bone cancer The information on this page is about Ewing sarcoma and osteosarcoma. If you have a different type of bone cancer and want to know more, you can talk to Macmillan . The3 main treatments for bone cancer are chemotherapy , surgery and radiotherapy . Most people have a combination of these. Your doctors will plan your treatment based on: the type of bone cancer you have where the cancer is the stage of the cancer (this means whether it has spread outside the bone) how fast-growing the cancer is If you have any questions about your treatment, ask your doctor or nurse. Theyll be happy to help you understand whats involved. You may be offered the opportunity to take part in a clinical research trial. These trials help doctors find new and better treatments for people with bone cancer. If your doctor thinks you are suitable for a clinical trial, theyll discuss this with you. In this information we sometimes use the term bone tumour. This means the same as bone cancer. Chemotherapy Chemotherapy is when youre given anti-cancer drugs to destroy the cancer cells. Its an important treatment for bone tumours. It helps shrink the tumour before surgery or radiotherapy, and it can kill cells that have spread outside the bone. After your surgery or radiotherapy, youll usually have more chemotherapy. Chemotherapy for bone cancer is given into a vein, usually through a central line, a port or a PICC line. Youll have chemotherapy over a few days and then youll have some time off to give your body a chance to recover from any side effects. The days you have the chemotherapy and the rest period afterwards is called a cycle. Most people have several cycles of chemotherapy. Youll probably need to stay in hospital for some of the time during chemotherapy. The type of chemotherapy you have depends on whether the tumour is an Ewing sarcoma or an osteosarcoma. Chemotherapy for Ewing sarcoma For Ewing sarcoma, the drugs most often used first are vincristine, ifosfamide, doxorubicin and etoposide. Giving these drugs together is called VIDE. Youll usually have6 cycles of VIDE. After your chemotherapy you may have surgery, or, if the tumour cant be removed with an operation, youll have radiotherapy. Some people have both surgery and radiotherapy. The team looking after you will decide on the best combination for you. If you have surgery, youll have more chemotherapy afterwards to help stop the tumour coming back or spreading to other parts of the body. At the moment, there is a clinical trial called Euro-Ewing 2012 that is comparing different combinations of chemotherapy treatments before and after surgery for people with Ewing sarcomas. You can talk to your specialist doctor about whether you could take part in this trial. Chemotherapy for osteosarcoma Osteosarcoma is usually treated with3 chemotherapy drugs called methotrexate, doxorubicin (Adriamycin) and cisplatin. Giving these drugs together is called MAP. You will usually have6 cycles of chemotherapy in total. Each cycle takes about5 weeks. After the first2 cycles, youll have surgery to remove the cancer. If the cancer has spread, you may also need to have surgery on another part of your body. For example, if osteosarcoma spreads outside of the main tumour, it usually spreads to the lungs. If the cancer has spread to your lungs, you may need a second operation to remove the cancer in your lungs. If you have bone cancer thats spread, your doctors will talk to you about what will happen next. After surgery, youll have4 more cycles of MAP chemotherapy. You may also be given a new treatment called mifamurtide (Mepact), which helps your body kill tumour cells.Your doctor will tell you if you can have this drug as well as your chemotherapy. Side effects Different chemotherapy drugs cause different side effects. Some people have just a few side effects and others have more. Its hard to know how its going to be for you. Most side effects are temporary and gradually disappear once treatment stops. The most common are a sore mouth, hair loss , tiredness, sickness and being more at risk of getting an infection. The most common side effect of mifamurtide is having a high temperature or feeling cold and shivery for a few hours after its given. Surgery The surgery you have will depend on the type of bone cancer you have and where it is in the body. Your surgeon will aim to remove all of the cancer, while trying to keep as much function in the limb as possible. Limb-sparing surgery Most people with bone cancer have an operation called limb-sparing surgery. This means the surgeon removes the cancer without having to remove the arm or leg its in. Youll have all the tumour taken away from your limb, including any bone and muscle affected by the tumour. Its usually possible to remove the affected part of the bone and replace it with a custom-made metal fitting (endoprosthesis) or with a bone from another part of the body (bone graft). If the cancer affects a bone in or near a joint, the whole joint can often be replaced with an artificial one.In some cases, the surgeon can remove the affected bone without replacing it with anything and without it affecting the way you move. Before the operation If youve had chemotherapy, youll need2 or3 weeks to recover before you can have your operation. Doctors will make sure that youre well enough to have the operation. If youve lost weight or been off your food, you might need to build yourself up a bit before the operation. The hospital dietitian can help you do this. Youll probably see a physiotherapist, wholl give you exercises to strengthen your muscles. You may like to see the replacement part or endoprosthesis (often just called a prosthesis) that will be put in during your operation. If you would like to see it, your surgeon or key worker can usually arrange this. After the operation Youll have a bandage or splint on your limb to keep it supported and let it heal. Youll probably have a tube, called a drain, coming out of your wound. This stops fluid building up in your wound. A nurse will take it out after about 3 to 4 days. You wont feel like eating or drinking much for a few hours after your operation, so youll be given fluids into a vein. This is called a drip. Youll probably feel a bit sore to begin with, but youll be given strong painkillers to help. Its important to tell the nurses if you need extra pain relief. The pain usually starts to get better within 2 or 3 days. As time goes on, youll need fewer painkillers and will start to feel a lot more comfortable. Once youre home, you should start to feel a bit better and stronger every day. But if you do have any problems, its important to tell your doctor or nurse right away, so they can deal with them quickly. After your operation, you will need to do lots of physiotherapy to help you make the best possible recovery. This can feel like hard work but is really important. Your physiotherapist will tell you what exercises to do, and help you to do them regularly. If you notice any new redness, pain or swelling in the limb thats been operated on, its very important to get in touch with your doctor right away. You might have an infection that needs treatment, so youll need to see the surgeon who did your operation without delay. Theres more information about the long-term effects of limb-sparing surgery in our section on living with and after bone cancer . Amputation Sometimes the only way to get rid of the bone cancer affecting an arm or a leg is to remove the limb. This is called an amputation. Its only done if there is no alternative. This is usually needed if the cancer has spread from the bone and has grown around nearby blood vessels. These need to be removed along with the cancer. Some people choose to have an amputation rather than limb-sparing surgery. You should be given a chance to discuss the advantages and disadvantages of both types of surgery with your team. An amputation may also need to be done if theres an infection in the bone that doesnt go away with treatment, or if the cancer comes back in the bone. Every person and every tumour is different, so you might meet other people with the same type of tumour, who are having slightly different surgery. Your specialist will talk to you about your operation and make sure you understand whats involved. Before the operation Your doctor will talk things through with you so that you fully understand whats involved. Losing a limb can feel very scary and it might help to talk to your specialist nurse, key worker or a counsellor about your feelings. It might also help to talk to someone whos had an amputation your nurse or doctor can arrange this. Its really important to get support at this tough time. After the operation Youll have bandages or a plaster cast on the area thats been operated on. Therell be a tube, called a drain, coming from the wound. This stops fluid building up. A nurse will usually take it out after 3 or 4 days. Youll also have a drip to give you fluid into a vein in your arm until you feel like eating and drinking again. Youll probably feel a bit sore after your op, especially for the first 2 or 4 days, but youll be given strong painkillers to help with this. Its important to tell the nurses if you need extra pain relief. As time goes on, youll need fewer painkillers and will start to feel a lot more comfortable. You may have pain that feels like its coming from the part of the limb thats been removed. This is known as phantom pain. Let your doctor or nurse know if you have this. There are medicines that can help ease it or take it away. It usually gets better and goes away in time. A physiotherapist will visit you a day or so after your operation. Theyll show you exercises to keep your muscles strong and flexible. If youve had an arm removed, youll be able to get up and move around once youve recovered from the anaesthetic and dont feel too sore. If youve had a leg removed, the physiotherapist will show you how to move around in bed and get from your bed to a chair. Youll probably be moving around with crutches or in a wheelchair within a few days. Once youre up and about, youll go to the hospital gym for physiotherapy. This is a big part of your recovery. Your physiotherapist will give you more exercises to do as your wound heals and you get stronger. Itll take a few months for your limb to heal to its final shape after the operation, so you wont be fitted with your permanent prosthesis until this happens. In the meantime, youll be given a temporary prosthesis and learn how to use it in physiotherapy. You should be able to go home about2 weeks after your operation. Theres more information about the long-term effects of amputation in our section on living with and after bone cancer . Radiotherapy Radiotherapy treats cancer by using high-energy X-rays to destroy cancer cells. Radiotherapy is mainly used to treat Ewing sarcoma. You may have radiotherapy after your chemotherapy, or before or after having surgery. If you have osteosarcoma, youre less likely to have radiotherapy treatment. But you might have it if an operation to remove the cancer isnt possible. Occasionally, people with osteosarcoma have radiotherapy after surgery to remove their cancer. Radiotherapy is generally given every weekday (Monday to Friday) for5 weeks. Each treatment takes a few minutes. Side effects Radiotherapy isnt painful, but it can cause other side effects. After a few treatments you may begin to feel tired, and your skin may go red or get darker and feel sore or itchy around the area thats being treated. This gets better once your radiotherapy treatment is over. Other side effects depend on which part of your body is being treated. Having radiotherapy around a joint can make it feel stiff, but physiotherapy can help. We also have more information about: symptoms of bone cancer having tests for bone cancer life after bone cancer the bones If youre looking for information about bone cancer in people of all ages, read our general bone cancer section. Life after treatment for bone cancer This information is about life after having surgery for bone cancer . Life after limb-sparing surgery The long-term effects of limb-sparing surgery depend on which part of your body is affected and what kind of operation you have. The best person to ask about this is your surgeon. After limb-sparing surgery, the limb might not work as well as it used to. Physiotherapy is an important part of your recovery. Youll be given exercises to do to help you get your limb working as well as possible. These can be hard work, but its important to keep going with them. Knee joint replacement If youve had a knee joint replacement, youll be able to walk and swim, but your doctor might advise you not to play high-impact sports like hockey, football, tennis or rugby. These activities could damage or loosen the new joint. Its usuallyOK to run a short distance, for example for a bus. But running or jogging regularly wears out the new joint, so its best to avoid this. If your knee joint wears out or loosens, you might need to have it replaced after a few years. Hip joint replacements After a hip joint replacement, you should be able to do most of your usual activities, but youll probably be advised to avoid running and high-impact sports. Shoulder replacement If youve had a shoulder replacement, youll be able to move your arm below shoulder height the same as before, but you might not be able to lift your arm above your shoulder. Bone graft If youve had an implant put into your limb while youre still growing, youll need to have it lengthened as your leg or arm grows. Some types of implant can be lengthened without an operation, but with others youll need surgery. Your specialist or key worker can tell you what kind of implant you have. Life after amputation After amputation, you usually have an artificial limb fitted. This is called a prosthesis. There are artificial limbs designed to let you do all types of physical activities, including walking, swimming, running, cycling and playing sports. Different types of prosthesis let you do different things. Some people have one for wearing day-to-day, and an extra one specially designed for something like swimming or doing athletics. How will I feel? Things may be tough as you get used to living with the changes in your body, but help is available. You might have lots of different emotions. You might be tearful, angry, fed up or sad at times. You might feel like youve lost all your confidence and that youll never be able to live a normal life or be in a relationship. These feelings are normal, and its important to get support to help you cope with them. You could talk to: your specialist nurse or key worker family or friends a counsellor, which can be arranged by your nurses other young people in a similar situation Other peoples reactions can be hard to cope with too. You might be worried about what your friends think or how theyre going to treat you. The thought of going back to school, college or work can be scary. Even people in your family who you are close to might not know what to say or do. Others might say things that sound stupid or seem hurtful. Try to choose a couple of really close relatives or friends who you can talk to if things get you down. You might find it useful to talk to someone outside your close circle, like your specialist nurse, key worker or counsellor. Most people find it helps to talk about how theyre feeling or whats on their mind. Follow-up When you finish your treatment, your doctor will talk to you about what happens next. They will explain some of the long-term risks that bone cancer and its treatment could have for you. They will make arrangements to see you in a clinic to see how you are getting on. We have more info about: the bones symptoms of bone cancer having tests for bone cancer treatment for bone cancer If youre looking for information about bone cancer in people of all ages, read our general bone cancer section. Source: Macmillan - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852']",,,,,,,,,,,,,
Bowel cancer,"Bowel cancer | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Bowel cancer Bowel cancer About bowel cancer Signs and symptoms of bowel cancer Causes of bowel cancer Diagnosing bowel cancer Treating bowel cancer Living with bowel cancer Preventing bowel cancer About bowel cancer Bowel cancer is a general term for cancer that begins in the large bowel. Depending on where the cancer starts, bowel cancer is sometimes called colon or rectal cancer. Cancer can sometimes start in the small bowel (small intestine), but small bowel cancer is much rarer than large bowel cancer. Bowel cancer is one of the most common types of cancer diagnosed in the UK. Signs and symptoms The 3 main symptoms of bowel cancer are blood in the stools (faeces), changes in bowel habit such as more frequent, looser stools and abdominal (tummy) pain . However, these symptoms are very common and most people with them do not have bowel cancer. For example, blood in the stools is more often caused by haemorrhoids (piles), and a change in bowel habit or abdominal pain is usuallythe result ofsomething you have eaten. As almost 9out of 10 people with bowel cancer are over the age of 60, these symptoms are more important as people get older. They are also more significant when they persist despite simple treatments. Most people who are eventually diagnosed with bowel cancer have one of the following combinations ofsymptoms: a persistent change in bowel habit that causes them to go to the toilet more often and pass looser stools, usually together with blood on or in their stools a persistent change in bowel habit without blood in their stools, but with abdominal pain blood in the stools without other haemorrhoid symptoms, such as soreness, discomfort, pain, itching or a lump hanging down outside the back passage abdominal pain, discomfort or bloating always provoked by eating, sometimes resulting in a reduction in the amount of food eaten and weight loss The symptoms of bowel cancer can be subtle and dont necessarily make you feel ill. When to seek medical advice Read about the symptoms ofbowel cancer , and when you should see your GP to discuss whether any tests are necessary. Your doctor will probably carry out a simple examination of your tummy and bottom to make sure you have no lumps. They may alsoarrange for a simple blood test to check foriron deficiency anaemia. This can indicate whether there is any bleeding from your bowel that you havent been aware of. In some cases, your doctor may decide it is best for you to have a simple test in hospital to make sure there is no serious cause for your symptoms. Make sure you return to your doctor if your symptoms persist or keep coming back after stopping treatment, regardless of their severity or your age. Read more about diagnosing bowel cancer Whos at risk? Its not known exactly what causes bowel cancer, but there are a number of things that can increase your risk. These include: age  almost9 in 10 cases of bowel cancer occur in people aged 60 or over diet  a diet high in red or processed meats and low in fibre can increase your risk weight  bowel cancer is more common in people who are overweight or obese exercise  being inactive increases the risk of getting bowel cancer alcohol and smoking  a high alcohol intake and smoking may increase your chances of getting bowel cancer family history  having a close relative (mother or father, brother or sister) who developed bowel cancerunder the age of50 puts you at a greater lifetime risk of developing the condition Some people have an increased risk of bowel cancer because they have another condition that affects their bowel, such as severe ulcerative colitis or Crohns disease , over a long period of time. Read more about the causes of bowel cancer and preventing bowel cancer Bowel cancer screening Bowel screening is offered to men and women aged 50 to 74 across Scotland to help find bowel cancer early when it can often be cured. Bowel screening involves taking a simple test at home every 2 years. The test looks for hidden blood in your poo, as this could mean a higher chance of bowel cancer. Read more about screening for bowel cancer Treatment Bowel cancer can be treated using a combination of different treatments, depending on where the cancer is in your bowel and how far it has spread. The main treatments are: surgery the cancerous section of bowel is removed; it is the most effective way of curing bowel cancer, and is all that many people need chemotherapy  where medication is used to kill cancer cells radiotherapy  where radiation is used to kill cancer cells biological treatments  a newer type of medication that increases the effectiveness of chemotherapy and prevents the cancer spreading As with most types of cancer, the chances of a complete cure depends on how farithas advanced by the time it is diagnosed. Read more about how bowel cancer is treated and living with bowel cancer Signs and symptoms of bowel cancer The 3 main symptoms of bowel cancer are blood in the stools (faeces), a change in bowel habit, such as more frequent, looser stools, and abdominal (tummy) pain . However, these symptoms are very common. Blood in the stools is usually caused by haemorrhoids (piles), and a change in bowel habit or abdominal pain is often the result ofsomething you have eaten. In the UK, an estimated 7 million people have blood in the stools each year. Even more people have temporary changes in their bowel habits and abdominal pain. Most people with these symptoms do not have bowel cancer. As the vast majority of people with bowel cancer are over the age of 60, these symptoms are more important as people get older.These symptomsare also more significant when they persist in spite of simple treatments. Most patients with bowel cancer present with one of the following symptom combinations: a persistent change in bowel habit, causing them to go to the toilet more often and pass looser stools, usually together with blood on or in their stools a persistent change in bowel habit without blood in their stools, but with abdominal pain blood in the stools without other haemorrhoid symptoms, such as soreness, discomfort, pain, itching, or a lump hanging down outside the back passage abdominal pain, discomfort or bloating always provoked by eating, sometimes resulting in a reduction in the amount of food eaten and weight loss The symptoms of bowel cancer can be subtle and dont necessarily make you feel ill. When to seek medical advice Read about the symptoms ofbowel cancer , and when you should see your GP to discuss whether any tests are necessary. Your doctor will probably perform a simple examination of your tummy and bottom to make sure you have no lumps, as well asa simple blood test to check for iron deficiency anaemia . This can indicate whether there is any bleeding from your bowel you havent been aware of. In some cases, your doctor may decide it is best to have a simple test in hospital to make sure there is no serious cause for your symptoms. Make sure you return to your doctor if your symptoms persist or keep coming back after stopping treatment, regardless of their severity or your age. Read more about diagnosing bowel cancer Bowel obstruction In some cases, bowel cancer can stop digestive waste passing through the bowel. This is known as a bowel obstruction. Symptoms of a bowel obstruction can include: severe abdominal pain, which may initially come and go not being able to pass stools when you go to the toilet noticeable swelling or bloating of the tummy vomiting A bowel obstruction is a medical emergency. If you suspect your bowel is obstructed, you should see your GP quickly. If this isnt possible, go to the accident and emergency (A&E) department of your nearest hospital. Read further information: Beating Bowel Cancer: symptoms Bowel Cancer UK: symptoms of bowel cancer Cancer Research UK: bowel cancer symptoms Causes of bowel cancer Cancer occurs when the cells in a certain area of your body divide and multiply too rapidly. This produces a lump of tissue known as a tumour. Most cases of bowel cancer first develop inside clumps of cells on the inner lining of the bowel. These clumps are known as polyps . However, if you develop polyps, it does not necessarily mean you will get bowel cancer. Exactly what causes cancer to develop inside the bowel is still unknown. However, research has shown several factors may make you more likely to develop it. Age Your chances of developing bowel cancer increase as you get older. Almost9 out of 10 cases of bowel cancer in the UK are diagnosed in people over the age of 60. Family history Having a family history of bowel cancer can increase your risk of developing the condition yourself, particularly if a close relative (mother, father, brother or sister) was diagnosed with bowel cancer below the age of 50. If you are particularly concerned that your familys medical history may mean you are at an increased risk of developing bowel cancer, it may help to speak to your GP. If necessary, your GP can refer you to a genetics specialist, who can offer more advice about your level of risk and recommend any necessary tests to periodically check for the condition. Diet A large body of evidence suggests a diet high in red and processed meat can increase your risk of developing bowel cancer. For this reason, the Department of Health advises people who eat more than 90g (cooked weight) a day of red and processed meat cut down to 70g a day. Read more about red meat and bowel cancer risk There is also evidence thatsuggests a diet high in fibre could help reduce your bowel cancer risk. Read more about eating good food and a healthy diet Smoking People who smoke cigarettes are more likely to develop bowel cancer, other types of cancer, and other serious conditions, such as heart disease . Read more about stopping smoking Alcohol Drinking alcohol has been shown to be associated with an increased risk of bowel cancer, particularly if you regularly drink large amounts. Read about alcohol for information and tips on cutting down Obesity Being overweight or obese is linked to an increased risk of bowel cancer, particularly in men. If you are overweight or obese, losing weight may help lower your chances of developing the condition. Inactivity People who are physically inactive have a higher risk of developing bowel cancer. You can help reduce your risk of bowel and other cancers by being physically active every day. Read more about health and fitness Digestive disorders Some conditions affecting the bowel may put you at a higher risk of developing bowel cancer. For example, bowel cancer is more common in people who have had severe Crohns disease or ulcerative colitis for many years. If you have one of these conditions, you will usually have regular check-ups to look for signs of bowel cancer from about 10 years after your symptoms first develop. Check-ups will involve examining your bowel with a colonoscopea long, narrow flexible tubethat containsa small camerathat is inserted into your rectum. The frequency of the colonoscopy examinations will increase the longer you live with the condition, and will also depend on factors such as how severe your ulcerative colitis is and if you have a family history of bowel cancer. Genetic conditions There are two rare inherited conditions that can lead to bowel cancer. They are: familial adenomatous polyposis (FAP)  a condition that triggers the growth of non-cancerous polyps inside the bowel hereditary non-polyposis colorectal cancer (HNPCC), also known as Lynch syndrome  an inherited gene fault (mutation) that increases your bowel cancer risk Although the polyps caused by FAP are non-cancerous, there is a high risk that, over time, at least one will turn cancerous. Most people with FAP will have bowel cancer by the time they are 50. As people with FAP have such a high risk of getting bowel cancer, they are often advised by their doctor to have their large bowel removed before they reach the age of 25. Families affected can find support and advice from FAP registries such as The Polyposis Registry provided by St Marks Hospital, London. Removing the bowel as a precautionary measure is also usually recommended in people with HNPCC because the risk of developing bowel cancer is so high. Read further information: Bowel Cancer UK: Risk factors Bowel Cancer UK: Diet Diagnosing bowel cancer When you first see your GP, they will ask about your symptoms and whether you have a family history of bowel cancer. They will then usually carry out a simple examination of your abdomen (tummy) and your bottom, known as a digital rectal examination (DRE). This is a useful way of checking whether there are any lumps in your tummy or back passage. The tests can be uncomfortable, and most people find an examination of the back passage a little embarrassing, but they take less than a minute. If your symptoms suggest you may have bowel cancer or the diagnosis is uncertain, you will be referred to your local hospital initially for a simple examination called a flexible sigmoidoscopy. In 2015, the National Institute for Health and Care Excellence (NICE) published guidelines to help GPs recognise the signs and symptoms of bowel cancer and refer people for the right tests faster. To find out if you should be referred for further tests for suspected bowel cancer, read the NICE 2015 guidelines on suspected cancer: recognition and referral . Flexible sigmoidoscopy A flexible sigmoidoscopy is an examination of your rectum and some of your large bowel using a device called a sigmoidoscope. A sigmoidoscope is a long, thin, flexible tube attached to a very small camera and light. It is inserted into your rectum and up into your bowel. The camera relays images to a monitor, and can also be used to take biopsies , where a small tissue sample is removed for further analysis. It is better for your lower bowel to be as empty as possible when sigmoidoscopy is performed, so you may be asked to carry out an enema a simple procedure to flush your bowels at home beforehand. This should be used at least two hours before you leave home for your appointment. A sigmoidoscopy can feel uncomfortable, but it only takes a few minutes and most people go home straight after the examination. More detailed tests Most people with bowel cancer can be diagnosed by flexible sigmoidoscopy. However, some cancers can only be diagnosed by a more extensive examination of the colon. The two tests used for this are colonoscopy and computerised tomography (CT) colonography. Colonoscopy A colonoscopy is an examination of your entire large bowel using a device called a colonoscope, which is like a sigmoidoscope but a bit longer. Your bowel needs to be empty when a colonoscopy is performed, so you will be advised to eat a special diet for a few days beforehand and take a laxative (medication to help empty your bowel) on the morning of the examination. You will be given a sedative to help you relax during the test, after which the doctor will insert the colonoscope into your rectum and move it along the length of your large bowel. This is not usually painful, but can feel uncomfortable. The camera relays images to a monitor, which allows the doctor to check for any abnormal areas within the rectum or bowel that could be the result of cancer. As with a sigmoidoscopy, a biopsy may also be performed during the test. A colonoscopy usually takes aboutan hour to complete, and most people can go home once they have recovered from the effects of the sedative. After the procedure, you will probably feel drowsy for a while, so you will need to arrange for someone to accompany you home. It is best for elderly people to have someone with them for 24 hours after the test. You will be advised not to drive for 24 hours. In a small number of people, it may not be possible to pass the colonoscope completely around the bowel, and it is then necessary to have CT colonography. Find out more about whata colonoscopy involves CT colonography CT colonography, also known as a virtual colonoscopy, involves using a computerised tomography (CT) scanner to produce three-dimensional images of the large bowel and rectum. During the procedure, gas is used to inflate the bowel using a thin, flexible tube placed in your rectum. CT scans are then taken from a number of different angles. As with a colonoscopy, you may need to have a special diet for a few days and take a laxative before the test to ensure your bowels are empty when the test is carried out. This test can help identify potentially cancerous areas in people who are not suitable for a colonoscopybecause ofother medical reasons. A CT colonography is a less invasive test than a colonoscopy, but you may still need to have colonoscopy or flexible sigmoidoscopy at a later stage so any abnormal areas can be removed or biopsied. Read further information: Bowel Cancer UK: Diagnosis Cancer Research UK:Getting diagnosed Macmillan Cancer Support:Symptoms of bowel cancer Further tests If a diagnosis of bowel cancer is confirmed, further testing is usually carried out to check if the cancer has spread from the bowel to other parts of the body.These tests also help your doctors decide on the most effective treatment for you. These tests can include a: CT scan of your abdomen and chest this will check if the rest of your bowel is healthy and whether the cancer has spread to the liver or lungs magnetic resonance imaging (MRI) scan  this can provide a detailed image of the surrounding organs in people with cancer in the rectum Staging and grading Once the above examinations and tests have been completed, it should be possible to determine the stage and grade of your cancer. Staging refers to how far your cancer has advanced. Grading relates to how aggressive your cancer isand howlikely it isto spread. This is important, as it helps your treatment team choose the best way of curing or controlling the cancer. A number of different staging systems are used by doctors. stage 1  the cancer is still contained within the lining of the bowel or rectum stage 2  the cancer has spread beyond the layer of muscle surrounding the bowel and may have penetrated the surface covering the bowel or nearby organs stage 3  the cancer has spread into nearby lymph nodes stage 4  the cancer has spread beyond the bowel into another part of the body, such as the liver There are 3 grades of bowel cancer: grade 1  a cancer that grows slowly and has a low chance of spreading beyond the bowel grade 2  a cancer that grows moderately and has a medium chance of spreading beyond the bowel grade 3  a cancer that grows rapidly and has a high chance of spreading beyond the bowel If you are not sure what stage or grade of cancer you have, ask your doctor. Treating bowel cancer Ifcolon cancer is at a very early stage, it may be possible to remove just a small piece of the lining of the colon wall. This is known as local excision. If the cancer spreads intomuscles surrounding the colon, it will usually be necessary to remove an entire section of your colon.This is known as a colectomy. There are 2 ways a colectomy can be performed: an open colectomy  where the surgeon makes a large cut (incision) in your abdomen and removes a section of your colon a laparoscopic (keyhole) colectomy  where the surgeon makes a number of small incisions in your abdomen and uses special instruments guided by a camera to remove a section of colon During surgery, nearby lymph nodes are also removed. It is usual to join the ends of the bowel together after bowel cancer surgery, but very occasionally this is not possible and a stoma is needed. Both open and laparoscopic colectomies are thought to be equally effective at removing cancer and have similar risks of complications. However, laparoscopic colectomies have the advantage of a faster recovery time and less postoperative pain. It is becoming the routine way of doing most of these operations. Laparoscopic colectomies should be available in all hospitals that carry out bowel cancer surgery, although not all surgeons perform this type of surgery. Discuss your options with your surgeon to see if this method can be used. Surgery for rectal cancer There are a number of different types of operation that can be carried out to treat rectal cancer, depending on how far the cancer has spread. Some of the main techniques used are described below: Local resection If you have a very small, early-stage rectal cancer, your surgeon may be able to remove it in an operation called a local resection (transanal resection). The surgeon puts an endoscope in through your back passage and removes the cancer from the wall of the rectum. Total mesenteric excision In many cases, however, a local resection is not possible. Instead, a larger area of the rectum will need to be removed. This area willinclude a border of rectal tissue free of cancer cells, as well as fatty tissuefrom around the bowel(the mesentery). This type of operation is known as total mesenteric excision (TME). Removing the mesentery can help ensure all the cancerous cells are removed, which can lower the risk of the cancer recurring at a later stage. Depending on where in your rectum the cancer is located, one of two main TME operations may be carried out. Low anterior resection Low anterior resection is a procedure used to treat cases where the cancer is in the upper section of your rectum. The surgeon will make an incision in your abdomen and remove the upper section of your rectum, as well as some surrounding tissue to make sure any lymph glands containing cancer cells are also removed. They will then attach your colon to the lowest part of your rectum or upper part of the anal canal. Sometimes they turn the end of the colon into an internal pouch to replace the rectum. You will probably require a temporary stomato give the joined section of bowel time to heal. Abdominoperineal resection Abdominoperineal resection is used to treat cases where the cancer is in the lowest section of your rectum. In this case, it will be necessary to remove the whole of your rectum and surrounding muscles to reduce the risk of the cancer regrowing in the same area. This involves removing and closing the anus and removing its sphincter muscles, so there is no option except to have a permanent stoma after the operation. Bowel cancer surgeons always do their best to avoid giving people permanent stomas wherever possible. Stoma surgery Where a section of the bowel is removed and the remaining bowel joined, the surgeon may sometimes decide to divert your stool away from the join to allow it to heal. The stool is temporarily diverted by bringing a loop of bowel out through the abdominal wall and attaching it to the skin  this is called a stoma. A bag is worn over the stoma to collect the stool. When the stoma is made from the small bowel (ileum) it is called an ileostomy , and when it is made from thelarge bowel (colon) it is called a colostomy . A specialist nurse, known as a stoma care nurse, can advise you on the best site for a stomaprior to surgery. The nurse will take into account factors such as your body shape and lifestyle, although this may not be possible where surgery is performed in an emergency. Inthe first few daysafter surgery, the stoma care nurse will advise on the care necessary to look after the stoma and the type of bag suitable. Once the join in the bowel has safely healed, which can take several weeks, the stoma can be closedduring further surgery. In some people, for various reasons, rejoining the bowel may not be possible or may lead to problems controlling bowel function, and the stoma may become permanent. Before having surgery, the care team will advise you about whether it may be necessary to form an ileostomy or colostomy, and the likelihood of this being temporary or permanent. There are patient support groups available that provide support for patients who have just had or are about to have a stoma. You canget moredetails fromyour stoma care nurse, or visit the groupsonline for further information. Ileostomy and Internal Pouch Support Group provides a unique visiting service for anyone wishing to speak with someone who has been through similar surgery Learn more about coping with a stoma after bowel cancer Side effects of surgery Bowel cancer operations carry many of the same risks as other major operations, including bleeding, infection, developing blood clots, or heart or breathing problems. The operations all carry a number of risks specific to the procedure. One risk is that the joined-up section of bowel may not heal properly and leak inside your abdomen. This is usually only a risk in the first few days after the operation. Another risk is for people having rectal cancer surgery. The nerves that control urinationand sexual function are very close to the rectum, and sometimessurgery to remove rectal cancer can damage these nerves. After rectal cancer surgery, most people need to go to the toilet to open their bowels more often than before, althoughthis usually settles down within a few months of the operation. Radiotherapy There are 2 main ways radiotherapy can be used to treat bowel cancer. It can be given before surgery to shrink rectal cancers and increase the chances of complete removal, or be used to control symptoms and slow the spread of cancer in advanced cases (palliative radiotherapy). Radiotherapy given before surgery for rectal cancer can be performed in 2 ways: external radiotherapy  where a machine is used to beam high-energy waves at your rectum to kill cancerous cells internal radiotherapy (brachytherapy)  where a radioactive tube is inserted into your anus and placed next to the cancer to shrink it External radiotherapy is usually given daily, 5 days a week, with a break at the weekend. Depending on the size of your tumour, you may need 1 to 5 weeks of treatment. Each session of radiotherapy is short and will only last for 10 to 15 minutes. Internal radiotherapy can usually be performed in one session before surgery is carried out a few weeks later. Palliative radiotherapy is usually given in short daily sessions, with a course ranging from 2 to 3 days, up to 10 days. Short-term side effects of radiotherapy can include: feeling sick fatigue diarrhoea burning and irritation of the skin around the rectum and pelvisthis looks and feels like sunburn a frequent need to urinate a burning sensation when passing urine These side effects should pass once the course of radiotherapy has finished. Tell your care team if the side effects of treatment become particularly troublesome. Additional treatments are often available to help you cope with the side effectsbetter. Long-term side effects of radiotherapy can include: a more frequent need to pass urine or stools blood in your urine and stools infertility erectile dysfunction If you want to have children, it may be possible to store a sample of your sperm or eggs before treatment begins so they can be used in fertility treatments in the future. Chemotherapy There are 3 ways chemotherapy can be used to treat bowel cancer: before surgeryused in combination with radiotherapyto shrink the tumour after surgeryto reduce the risk of the cancer recurring palliative chemotherapy to slow the spread of advanced bowel cancer and help control symptoms Chemotherapy for bowel cancer usually involves taking a combination of medications that kill cancer cells. They can be given as a tablet (oral chemotherapy), through a drip in your arm (intravenous chemotherapy), or as a combination of both. Treatment is given in courses (cycles) that are 2 to 3 weeks long each, depending on the stage or grade of your cancer. A single session of intravenous chemotherapy can last from several hours to several days. Most people having oral chemotherapy take tablets over the course of two weeks before having a break from treatment for another week. A course of chemotherapy can last up to 6 months, depending on how well you respond to the treatment. In some cases, it can be given in smaller doses over longer periods of time (maintenance chemotherapy). Side effects of chemotherapy can include: fatigue feeling sick vomiting diarrhoea mouth ulcers hair loss with certain treatment regimens, but this is generally uncommon in the treatment of bowel cancer a sensation of numbness, tingling or burning in your hands, feet and neck These side effects should gradually pass once your treatment has finished. It usually takes a few months for your hair to grow back if you experience hair loss. Chemotherapy can also weaken your immune system, making you more vulnerable to infection. Inform your care team or GP as soon as possible if you experience possible signs of an infection, including high temperature (fever) or a sudden feeling of being generally unwell. Medications used in chemotherapy can cause temporary damage to mens sperm and womens eggs. This means that for women who become pregnant or for men who father a child, there is a risk to the unborn babys health. Itis thereforerecommended you use a reliable method of contraception while having chemotherapy treatment and for a period after your treatment has finished. Find out more about chemotherapy Biological treatments Biological treatments, including cetuximab, bevacizumab and panitumumab, are a newer type of medication also known as monoclonal antibodies. Monoclonal antibodies are antibodies that have been genetically engineered in a laboratory. They target special proteins found on the surface of cancer cells, known as epidermal growth factor receptors (EGFR). As EGFRs help the cancer grow, targeting these proteins can help shrink tumours, and improve the effect and outcome of chemotherapy. Biological treatments are therefore usually used in combination with chemotherapy when the cancer has spread beyond the bowel (metastatic bowel cancer). These treatments are not available to everyone with bowel cancer. The National Institute for Health and Care Excellence (NICE) has specific criteriathat need to be met before these can be prescribed. Cetuximab is only available on the NHS when: surgery to remove the cancer in the colon or rectum has been carried out or is possible bowel cancer has spread to the liver and cannot be removed surgically a person is fit enough to undergo surgery to remove the cancer from the liver if this becomes possible after treatment with cetuximab Cetuximab, bevacizumab and panitumumab are available on the NHS through a government scheme called theCancer Drugs Fund. All these medications are also available privately, but are very expensive. Further information isavailable from: Macmillan Cancer Support:Targeted therapies and immunotherapies for bowel cancer Bowel Cancer UK: Surgery Cancer Research UK: Treatment Bowel Cancer UK:Radiotherapy Macmillan Cancer Support:Radiotherapy Living with bowel cancer Talk to others Your GP or nurse may be able to reassure you if you have questions, or you may find it helpful to talk to a trained counsellor, psychologist or specialist telephone helpline operator. Your GP surgery will have information on these. Some people find it helpful to talk to others with bowel cancer at a local support group or through an internet chat room. Beating Bowel Cancer offers support services to people with bowel cancer. They run anurse advisory line on 08450 719 301 or 020 8973 0011 available 9am to 5.30pm Monday to Thursday, and 9am to 4pm on Fridays. You can also email a nurse at nurse@beatingbowelcancer.org . The organisation also runs a national patient-to-patient network called Bowel Cancer Voicesfor people affected by bowel cancer and their relatives. Find more support from Bowel Cancer UK and cancer support groups Your emotions Having cancer cancause a range of emotions. These may include shock, anxiety, relief, sadness and depression. Different peopledeal with serious problems in different ways. It is hard to predict how knowing you have cancer will affect you. However, you and your loved ones may find it helpful toknow aboutthe feelings that people diagnosed with cancer have reported. Read aboutthe emotional effects of cancer Recovering from surgery Surgeons and anaesthetists have found using an enhanced recovery programme after bowel cancer surgery helps patients recover more quickly. Most hospitals now use this programme.It involves giving you more informationabout what to expectbefore the operation, avoiding giving you strong laxatives to clean the bowel ",,,,,,,,,,,,,
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before surgery	 and in some cases giving you a sugary drinktwo hours before the operation to give you energy. During and after the operation	 the anaesthetist controls the amount of IV fluid you need very carefully	 and after the operation you will be given painkillers that allow you to get up and out of bed by the next day. Most people will be able to eat a light diet the day after their operation. To reduce the risk ofblood clots in the legs (deep vein thrombosis) 	 you may be given special compression stockings that help prevent blood clots	 or a regular injection with a blood-thinning medication calledheparin until you are fully mobile. A nurse or physiotherapist will help you get out of bed and regain your strength so you can go home within a few days. With the enhanced recovery programme	 most people are well enough to go home within a week of their operation. The timing depends on when you and the doctors and nurses looking after you agree you are well enough to go home. You will be asked to return to hospital a few weeks after your treatment has finished so tests can be carried out to check for any remaining signs of cancer. You may also need routine check-ups for the next few years to look out for signs of the cancer recurring. Diet after bowel surgery If you have had part of your colon removed	 it is likely your stools (faeces) will be looserone of the functions of the colon is to absorb water from stools. This may mean you need to go to the toilet more often to pass loose stools. Inform your care team if this becomes a problem	as medication is available to help control it. You may find some foods upset your bowels	 particularly during the first few months after your operation. Different foods can upset different people. Food and drink known to cause problems include: fruit and vegetables that are high in fibre	 such as beans	 cabbages	 apples and bananas fizzy drinks	 such as cola and beer You may find it useful to keep a food diary to record the effects of different foods on your bowel. Contact your care team if you find you are having continual problems with your bowels as a result of your diet	 or you are finding it difficult to maintain a healthy diet. You may need to be referred to a dietitian for further advice. Read more about diet after treatment. Living with a stoma If you need a temporary or permanent stoma with an external bag or pouch	 you may feel worried about how you look and how others will react to you. Information and advice about living with a stoma including stoma care	 stoma products and stoma-friendly dietsis available on the ileostomy and colostomy topics. For thosewho want further information about living with a stoma	 there are patient support groupsthat provide support for people who may have had	 or are due to have a stoma. You canget moredetailsfrom your stoma care nurse	 or visit support groups online for further information. The Ileostomy and Internal Pouch Support Group organisation provide a unique visiting service for anyone wishing to speak with someone who has been through similar surgery. Sex and bowel cancer Having cancer andreceiving treatment may affect how you feel about relationships and sex. Although most people are able to enjoy a normal sex life after bowel cancer treatment	 you may feel self-conscious or uncomfortableif you havea stoma. Talking about how you feel with your partner may help you both support each other. Or you may feelyoud like to talk to someone else about your feelings. Your doctor or nurse will be able to help. Find more information on body image and intimate relations Financial concerns A diagnosis of cancer can cause money problems because you are unable to work	 or someone you are close to has to stop working to look after you. There is financial support available for carers and yourself if you have to stay off work for a while or stop work because of your illness. Visit Macmillan for information on your finances . The following organisations could also offer helpor information: GOV.UK: benefits Money Advice Service Dealing with dying If you are told there is nothing more that can be done to treat your bowel cancer	 your GP will still provide you with support and pain relief. This is called palliative care. Support is also available for your family and friends. Find out more about end of life care Visit the following organisations for further support: Macmillan Cancer Support:Looking after someone with cancer Macmillan Cancer Support:End of life Marie Curie Cancer Care Preventing bowel cancer There are some things that increase your risk of bowel cancer that you cant change	 such as your family history or your age. However	 there are several waysyou canlower your chances of developing the condition. Diet It may help prevent bowel cancer if you eat: less cured and processed meat	 such as bacon	 sausages and ham less red meat and more fish more fibre from cereals	 beans	 fruit and vegetables The Department of Health advises people who eat more than 90g (cooked weight) of red and processed meat a day to cut down to 70g to help reduce their bowel cancer risk. Read more about red meat and bowel cancer risk and eating good food and a healthy diet Exercise Regular exercise can lower the risk of developing bowel and other cancers. Its recommended adults exercise for at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity	 such as cycling or fast walking	 every week. Read more about keeping active Healthy weight Being overweight or obese increases your chances of developing bowel cancer	 so you should try to maintain a healthy weight if you want to lower your risk. You can find out if you are a healthy weightby usingthe BMI chart Changes to your diet and an increase in yourphysical activity will help keep your weight under control. Readmore about losing weight Stop smoking If you smoke	 stopping can reduce your risk of developing bowel and other cancers. Quit Your Way Scotland is an advice and support service for anyone trying to stop smoking in Scotland. To speak with an advisor	 phone 0800 84 84 84from8am to 10pm	 every day. Calls are free from landlines and mobiles. Your GP or pharmacist can alsoprovide help	 support and advice if you want to give up smoking. Read more about stopping smoking Cut down on alcohol Drinking alcohol has been linked to an increased risk of developing bowel cancer	 so you may be able to reduce your risk by cutting down on the amount of alcohol you drink. If you drink most weeks	 to reduce your risk of harming your health: men and women are advised not to regularly drink more than 14 units a week spread your drinking over 3 days or more if you drink as much as 14 units a week Read more about alcohol units and get tips on cutting down Bowel cancer screening Although screening cannot stop you getting bowel cancer	 it can allow the condition to be detected at an earlier stage	 when it is much easier to treat. As well as making lifestyle changes and keeping an eye out for possible symptoms of bowel cancer 	 taking part in bowel cancer screening when it is offered can help reduce your chances of dying from the condition. Bowel screening is offered to men and women aged 50 to 74 across Scotland. If youre 75 or over	 you can still take a bowel screening test every 2 years. However	 youll need to request a new test kit each time. Read more about bowel cancer screening",,,,,,,,,,,,,
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Bowel incontinence,"Bowel incontinence | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Bowel incontinence Bowel incontinence About bowel incontinence Causes of bowel incontinence Diagnosing bowel incontinence Treating bowel incontinence About bowel incontinence Bowel incontinence is an inability to control bowel movements, resulting in involuntary soiling. Its also sometimes known as faecal incontinence. The experience of bowel incontinence can vary from person to person. Some people feel a sudden need to go to the toilet but are unable to reach a toilet in time. This is known as urge bowel incontinence. Other people experience no sensation before soiling themselves, known as passive incontinence or passive soiling, or there might be slight soiling when passing wind. Some people experience incontinence on a daily basis, whereas for others it only happens from time to time. Its thought 1in 10 people will be affected by it at some point in their life. It can affect people of any age, although its more common in elderly people. Its also more common in women than men. Why bowel incontinence happens Bowel incontinence isa symptom of an underlying problem or medical condition. Many cases are caused by diarrhoea , constipation , or weakening of the muscle that controls the opening of the anus. It can also be caused by long-term conditions such as diabetes , multiple sclerosis and dementia . Read more about the causes of bowel incontinence . Seeking advice and treatment Bowel incontinence can be upsetting and hard to cope with, but treatment is effective and a cure is often possible, so make sure you see your GP. Its important to remember that: bowel incontinence isnt something to be ashamed of  its simply a medical problem thats no different fromdiabetes or asthma it can be treated  theres a wide range of successful treatments bowel incontinence isnt a normal part of ageing it wont usually go away on its own  most people need treatment for the condition If you dont want to see your GP, you can usually make an appointment at your local NHS continence service without a referral. These clinics are staffed by specialist nurses who can offer useful advice about incontinence. Read more about diagnosing bowel incontinence . How bowel incontinence is treated In many cases, with the right treatment, a person can maintain normal bowel function throughout their life. Treatment will often depend on the cause and how severe it is, but possible options include: lifestyle and dietary changes to relieve constipation or diarrhoea exercise programmes to strengthen the muscles that control thebowel medication to control diarrhoea and constipation surgery, of which there are a number of different options Incontinence products , such as anal plugs and disposable pads, can be used until your symptoms are better controlled. Even ifit isnt possible tocure yourbowel incontinence, symptomsshouldimprove significantly. Read more about treating bowel incontinence . Causes of bowel incontinence Bowel incontinence is usually caused by a physical problem with the parts of the body that control the bowel. Themost common problems are: problems with the rectum the rectum is unable to retain poo properly until its time to go to the toilet problems with the sphincter muscles  the muscles at the bottom of the rectum dont work properly nerve damage the nerve signals sent from the rectum dont reach the brain These problems are explained in more detail below. Its important to discuss any bowel problems with your GP as theres a small chance they could be a sign of a more serious condition, such as bowel cancer . Problems with the rectum Constipation Constipation is a leading cause of bowel incontinence. In cases of severe constipation, a large, solid stool can become stuck in the rectum. This is known as faecal impaction. The stool then begins to stretch the muscles of the rectum, weakening them. Watery stools can leak around the stool and out of the bottom, causing bowel incontinence. This is called overflow incontinence andhappens most commonly in elderly people. Repeated straining caused by constipation or faecal impaction can also lead to rectal prolapse, when part of your lower intestine falls out of place and protrudes from your bottom. Rectal prolapse may also lead to bowel incontinence. Diarrhoea Its difficult for the rectum to hold liquid stools (diarrhoea), so people with diarrhoea (particularly recurring diarrhoea) can develop bowel incontinence. Conditions that can cause recurring diarrhoea include: Crohns disease  inflammation of the digestive system irritable bowel syndrome  a condition that causes a range of digestive problems, such as diarrhoea and bloating ulcerative colitis  inflammation of the large bowel These conditions can also cause scarring of the rectum, which can lead to bowel incontinence. Haemorrhoids Haemorrhoids (piles) are enlarged blood vessels inside or around the bottom (the rectum and anus). Symptoms include discomfort, itching, bleeding or a lump hanging down outside of the anus. In severe cases, haemorrhoids may lead to bowel incontinence. Problems with the sphincter muscles The sphincter muscles at the bottom of the rectum control the bowel. Bowel incontinence happens if these muscles become weakened or damaged. Childbirth is a common cause of damage to the sphincter muscles and a leading cause of bowel incontinence. During a vaginal birth, the sphincter muscles can become stretched and damaged, particularly as a result of a forceps delivery. Other causes include a large baby, the baby being born with the back of their head facing the mothers back (occipitoposterior position) and a long labour. Sphincter muscles can also become damaged through injury, or damage from bowel or rectal surgery. Nerve damage Bowel incontinence can also be caused by a problem with the nerves connecting the brain and the rectum. A nerve problem can mean your body is unaware of stools in your rectum, and may make it difficult for you to control your sphincter muscles. Damage to these nerves is related to a number of conditions, including: diabetes multiple sclerosis (a condition of the central nervous system) stroke spina bifida (birth defects that affect the development of the spine and nervous system) An injury to these nerves, such as a spinal injury, can also lead to bowel incontinence. Other health conditions In some cases, bowel incontinence may result from a health condition such as dementia or a severe learning disability that causes the person to lose bowel control. A physical disability can also make it difficult to get to the toilet in time. Diagnosing bowel incontinence Your GP will begin by asking you about the pattern of your symptoms and other related issues, such as your diet. You may find this embarrassing, but its important to answer as honestly and fully as you can tomake sureyou receive the most suitable treatment. Let your doctor know about: any changes in your bowel habitslasting for more than a few weeks rectal bleeding stomach pains anychanges toyour diet any medication youre taking Your GP will usually carry out a physical examination. Theyll look at your anus and the surrounding area to check for damage and carry outa rectal examination,insertinga gloved finger into your bottom. A rectal examinationwill show whether constipation is the cause, and check forany tumours in your rectum. Your GP may ask you to squeeze your rectum around their finger to assess how well the muscles in your anus are working. Depending on the results, your GP may refer you for further tests. Further tests Endoscopy (sigmoidoscopy) During anendoscopy, the inside of your rectum (and in some cases your lower bowel) is examined using a long, thin flexible tube with a light and video camera at the end (endoscope). Images can alsobe taken of the inside of your body. The endoscopechecks whether theres any obstruction, damage or inflammation in your rectum. Anendoscopy isnt painful, butit can feel uncomfortable, so you may be given a sedative to relax you. Anal manometry Anal manometry helps to assess how well the muscles and nerves in and around your rectum are working. The test uses a device that looks like a small thermometer with a balloon attached to the end.Its inserted into your rectum and the balloon is inflated. It may feel unusual, but its not uncomfortable or painful. The device is attached to a machine, which measures pressure readings taken from the balloon. Youll be asked to squeeze, relax and push your rectum muscles at certain times. You may also be asked to push the balloon out of your rectum in the same way you push out a stool. The pressure-measuring machine gives an idea of how well your muscles are working. If the balloon is inflated to a relatively large size but you dont feel any sensation of fullness, it may mean there are problems with the nerves in your rectum. Ultrasound An ultrasound scan can be used to create a detailed picture of the inside of your anus. Ultrasound scans are particularly useful in detecting underlying damage to the sphincter muscles. Defecography Defecography is a test used to studyhow youpass stools. It can also be useful in detecting signs of obstruction or prolapse that havent been discovered during a rectal examination. During this test, a liquid called barium is placed into your rectum. The barium helps make it easier tohighlight problems using an X-ray . Once the barium is in place, youll be asked to pass stools in the usual way while scans are taken. This test is occasionally carried out using a magnetic resonance imaging (MRI) scanner instead of an X-ray. Treating bowel incontinence Treatment for bowel incontinence depends on underlying cause and the pattern of your symptoms. Trying the least intrusive treatments first, such as dietary changes and exercise programmes, is often recommended. Medication and surgery are usually only considered if other treatments havent worked. Continence products You may find it helpful to use continence products until your bowel incontinence is better controlled. Most continence products are available for free on the NHS. Anal plugs are one way to prevent involuntary soiling. An anal plug is made of foam and designed to be inserted into your bottom. However, they can be uncomfortable and theyre not really a long term solution. If the plug comes into contact with moisture from the bowel, it expands and prevents leakage or soiling. Anal plugs can be worn for up to 12 hours, after which time they are removed using an attached string. Disposable body pads are contoured pads that soak up liquid stools and protect your skin. They can be used in cases of mild bowel incontinence. Single-use silicone inserts, which form a seal around the rectum until your next bowel movement, are also being investigated as a treatment option for moderate to severe bowel incontinence. Your local NHS continence service can offer help and advice about continence products, and you dont usually need a referral from your GP to make an appointment. These clinics are staffed by nurses who specialise in continence treatment. When youre out Wear trousers or skirts that are easy to undo and have elasticated waistbands rather than buttons. Disability Rights UK offers access to 9,000 disabled toilets around the UK with a Radar NKS key .The key costs 4.50 and is only sold to people who require use of toilet facilities due to a disability or health condition. Dietary changes Bowel incontinence associated with diarrhoea or constipation can often be controlled by making changes to your diet. It may be beneficialto keep a food diary to record the effect of your diet on your symptoms. Diarrhoea The National Institute for Health and Care Excellence (NICE) has published dietary advice for managing diarrhoea in cases of irritable bowel syndrome. These guidelines can also be applied to people with diarrhoea associated with bowel incontinence. The advice from NICE includes the following: limit fibre intake from wholegrain breads, bran, cereals, nuts and seeds (except golden linseeds) avoid skin, pips and pith from fruit and vegetables limit fresh and dried fruit to 3portions a day andfruit juice to 1small glass a day (make up the recommended 5a day with vegetables) limit how often you have fizzy drinksand drinks containing caffeine avoid foods high in fat, such as chips, fast foods and burgers Constipation A high-fibre diet is usually recommended for most people with constipation-associated bowel incontinence. Your GP can tell you if a high-fibre diet is suitable for you. Fibre can soften stools, making them easier to pass. Foods that are high in fibre include: fruit and vegetables beans wholegrain rice wholewheat pasta wholemeal bread seeds, nuts and oats Drink plenty of fluids because this can help to soften your stools and make them easier to pass. Pelvic floor muscle training Pelvic floor muscle training is a type of exercise programme used to treat cases of bowel incontinence caused by weakness in the pelvic floor muscles. A therapist, usually a physiotherapist or specialist nurse, will teach you a range of exercises. The goal of pelvic floor muscle training is to strengthen any muscles that may have been stretched and weakened. Youll probably be required to carry out the exercises 3times a day, for 6to 8weeks. After this time, you should notice an improvement in your symptoms. Exercises to try Check with your health professional before trying these at home. First, pretend youre trying to hold in a bowel movement. You should feel the muscles around your anus tighten. Next, sit, stand, or lie in a comfortable position with your legs slightly apart. Squeezeyour pelvic floormuscles for as long as you can, then relax. Repeat 5times. Squeeze the muscles as hard as you can, then relax. Repeat 5times. Squeeze the muscles quickly, then relax. Repeat 5times. If you find these exercisestoo difficult, try fewer repetitions at first and build them up. If they get too easy, try doing more repetitions. You can do the exercises without anyone knowing about them, so they should be easy to fit into your daily routine. Bowel retraining Bowel retraining is a type of treatment for people with reduced sensation in their rectum as a result of nerve damage, or for those who have recurring episodes of constipation. There are 3goals in bowel retraining: to improve the consistency of your stools to establish a regular time for you to empty your bowels to find ways of stimulating your bowels to empty themselves Changes to your diet usually improve stool consistency (see above). Establishing a regular time to empty your bowels meansfinding the most convenient time when you cango to the toilet without being rushed. Ways to stimulate bowel movements can differ from person to person. Some people find a hot drink and meal can help. Others may need to stimulate their anus using their finger. Biofeedback Biofeedback is a type of bowel retraining exercise that involves placing a small electric probe into your bottom. The sensor relays detailed information about the movement and pressure of the muscles in your rectum to an attached computer. Youre then asked to perform a series of exercises designed to improve your bowel function. The sensor checks that youare performing the exercises in the right way. Medication Medication can be used to help treat soft or loose stools or constipation associated with bowel incontinence. Loperamideis amedicine widelyused to treat diarrhoea. It works by slowing down the movement of stools through the digestive system, allowing more water to be absorbed from the stools. Loperamide can be prescribed in low doses to be taken regularly over a long period of time. Laxatives are used to treat constipation. Theyre a type of medicine that helps you to pass stools. Bulk-forming laxatives are usually recommended.These help your stools to retain fluid. This means theyre less likely to dry out, which can lead to faecal impaction. Enemas or rectal irrigation Rectal irrigation or enemasare used when bowel incontinence is caused by faecal impaction and other treatments have failed to remove the impacted stool from the rectum. These procedures involvea small tube that is placed into your anus. A special solution is then used to wash out your rectum. Surgery Surgery is usually only recommended after all other treatment options have been tried. The main surgical treatments used on the NHS are sphincteroplasty and sacral nerve stimulation. Other treatments  such as tibial nerve stimulation, endoscopic heat therapy and artificial sphincter surgery  can also be used, but their availability on the NHS is limited. An operation called a colostomy is more widely available on the NHS, but its only used if other treatments are unsuccessful. Sphincteroplasty A sphincteroplasty is an operation to repair damaged sphincter muscles. The surgeon removes some of the muscle tissue and the muscle edges are overlapped and sewn back together. This provides extra support to the muscles, which makes them stronger. Sacral nerve stimulation Sacral nerve stimulation is a treatment used for people with weakened sphincter muscles. Electrodes are inserted under the skin in the lower back and connected to a pulse generator. The generator releases pulses of electricity that stimulate the sacral nerves, which causesthe sphincter and pelvic floor muscles to work more effectively. Atfirst, the pulse generator is located outside your body. If the treatment is effective, the pulse generator will be implanted deep under the skin in your back. The most commonly reported complications of the procedure are infection at the site of surgery and technical problems with the pulse generator, which require additional surgery to correct. Read the NICE guidelines on Sacral nerve stimulation for faecal incontinence . Tibial nerve stimulation Tibial nerve stimulation is a fairly new treatment for bowel incontinence. A fine needle is inserted into the tibial nerve just above the ankle and an electrode is placed on the foot.A mild electric current is passed through the needle to stimulate the tibial nerve. Its not known exactly how this treatment works, but its thought to work in a similar way to sacral nerve stimulation. NICE concludes that the procedure appears to be safe, although there are still uncertainties about how well it works. Read the NICE guidelines on Treating faecal incontinence by stimulating the tibial nerve . Injectable bulking agents Bulking agents, such as collagen or silicone, can be injected into the muscles of the sphincter and rectum to strengthen them. The use of bulking agents in this way is a fairly new technique, so theres little information about their long-term effectiveness and safety. You should discuss the possible advantages and disadvantages of this type of treatment in full with your treatment team before deciding whether to proceed. Read the NICE guidelines on Treating faecal incontinence with injectable bulking agents . Endoscopic heat therapy Endoscopic radiofrequency (heat) therapy is a fairly new treatment for bowel incontinence. Heat energy is applied to the sphincter muscles through a thin probe, to encourage scarring of the tissue. This helps tighten the muscles and helps to control bowel movements. The National Institute for Health and Care Excellence (NICE)recently produced guidelines on this procedure.NICE concluded that the procedure appears to be safe, although there are still uncertainties about how well it works. As well as the uncertainties surrounding this procedure, it is also expensive. Therefore, it is usually only used on the NHS during clinical trials. Read the NICE guidelines on Treating faecal incontinence using endoscopic radiofrequency therapy . Artificial sphincter An artificial sphincter may be implanted if you have bowel incontinence caused by a problem with your sphincter muscles. This operation involves placing a circular cuff under the skin around the anus.The cuff is filled with fluid and sits tightly around the anus, keeping it closed. A tube is placed under the skin from the cuff to a control pump. Inmen, the pump is placed near the testicles, inwomen its placed near the vagina. A special balloon is placed into the tummy, and this isconnected to the control pump by tubing that runs under the skin. Thepumpis activated by pressing a button located under the skin. This drains the fluid from the cuff into the balloon, so your anus opens and youcan pass stools. When you are finished, the fluid slowly refills the cuff and the anus closes. The use of an artificial sphincter is arelatively new procedure, so there isnt much good-quality information aboutits long-term effectiveness and safety. Possible problemsinclude infection, injury during surgery and the cuff becoming dislodged. In some cases, further surgery is required to correct problems. Read the NICE guidelines on Treating faecal incontinence with an artificial sphincter inserted through a cut in the abdomen . Colostomy A colostomy is usually only recommended if other surgical treatments are unsuccessful. A colostomy is a surgical procedure in which your colon (lower bowel) is cut and brought through the wall of your stomach to create an artificial opening. Your stools can then be collected in a bag, known as a colostomy bag, which is attached to the opening. Source: NHS 24 - Opens in new browser window Last updated: 12 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. ",,,,,,,,,,,,,
Bowel polyps,"Bowel polyps | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Bowel polyps Bowel polyps Bowel polyps are small growths on the inner lining of the colon (large bowel) or rectum. They are common, affecting 15% to 20% of the UK population, and dont usually cause symptoms. Polyps are usually less than 1cm in size, although they can grow up to several centimetres. There are various forms: some are a tiny raised area or bulge, known asa sessile polyp somelook like a grape on a stalk, known as a pedunculated polyp some take the form of many tiny bumps clustered together Bowel polypsare not usually cancerous, althoughif theyre discovered theyll need to be removed, as some will eventually turn into cancer if left untreated. Some people just develop one polyp, while others may have a few.They tend to occur in people over the age of 60. How are they caused? Bowel polyps are caused by an abnormal production of cells. The lining of the bowel constantly renews itself, and a faulty gene can cause the cells in the bowel lining to grow more quickly. There may be a family tendency towards developing bowel polyps or bowel cancer. What are the symptoms? Most people with polyps wont be aware of them as they produce no symptoms and are often discovered by accident. However, some larger polyps can cause: a small amount of rectal bleeding(blood in your stool) mucus to be produced when you open your bowels diarrhoea or constipation abdominal pain How are they discovered? Bowel polypsare usually found as a result of a bowel investigation for another reason, such as a sigmoidoscopy (examination of the last part of the bowel) or during screening for bowel cancer . If polyps are found, a colonoscopy or CT colonographyis needed to view the whole of the large bowel and remove any polyps. How are they treated? There are several methods for treating polyps, but the most common procedure involves snaring the polypduring a colonoscopy. Snaring is like cutting the polyp off with cheese wire and is painless. Both of the above methods involve passing a flexible instrument called a colonoscope through your bottom andup into your bowel. The colonoscope has a wire with an electric current to either cauterise (burn off) or snare the polyp. In rare cases, polyps may need to be treated by surgically removing part of the bowel. This is usually only done when the polyp has some cell changes or is particularly large. After the polyp or polyps have been removed, they are sent to specialists in a laboratory, who will inform your consultant if: the polyp has been completely removed there is any risk of it regrowing there is any cancerous change in the polyp If there is a cancerous change in the polyp, you may need further treatment (depending on the degree and extent of change). Your specialist will be able to advise you on this. Outlook Some people will need further colonoscopies because polyps can recur. Polyps can sometimes run in families. This is uncommon, butmeans youll need colonoscopy checks at regular intervals. You might be asked to have repeat examinations at intervals of around 3to 5years to catch any further polyps that may develop and potentially turn into bowel cancer. ",,,,,,,,,,,,,
Brain stem death,"Brain stem death - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Brain stem death Brain stem death Brain stem death is when a person no longer has any brain stem functions, and has permanently lost the potential for consciousness and the capacity to breathe. When this happens, a ventilator keeps the persons heart beating and oxygen circulating through their bloodstream. A person is confirmed as being dead when their brain stem function is permanently lost. Confirming death Confirming death used to be straightforward. Death was said to occur when the heart stopped beating and a person was unresponsive and no longer breathing. The lack of oxygen as a result of no blood flow, quickly led to the permanent loss of brain stem function. Confirming death is now more complex, because its possible to keep the heart beating after the brain stem has permanently stopped functioning. This can be done by keeping a person on a ventilator, which allows the body and heart to be artificially oxygenated. However, that person wont ever regain consciousness or start breathing again. Once the brain stem has permanently stopped functioning, theres no way of reversing it and the heart will eventually stop beating, even if a ventilator continues to be used. To save a persons family and friends from unnecessary suffering, once theres clear evidence that brain death has occurred, the person will be disconnected from the ventilator. The brain stem The brain stem is the lower part of the brain thats connected to the spinal cord (part of the central nervous system in the spinal column). The brain stem is responsible for regulating most of the bodys automatic functions that are essential for life. These include: breathing heartbeat blood pressure swallowing The brain stem also relays information to and from the brain to the rest of the body, so it plays an important role in the brains core functions, such as consciousness, awareness and movement. After brain death, its not possible for someone to remain conscious. How brain death occurs Brain death can occur when the blood and/or oxygen supply to the brain is stopped. This can be caused by: cardiac arrest  when the heart stops beating and the brain is starved of oxygen heart attack  a serious medical emergency that occurs when the blood supply to the heart is suddenly blocked stroke  a serious medical emergency thathappenswhen the blood supply to the brain is blocked or interrupted blood clot  a blockage in a blood vessel that disturbs or blocks the flow of blood around your body Brain death can also occur as a result of: a severe head injury a brain haemorrhage infections, such as encephalitis a brain tumour Vegetative state Theres a difference between brain death and avegetative state, which can occur after extensive brain damage. Someone in a vegetative state can show signs of wakefulness  for example, they may open their eyes, but not respond to their surroundings. In rare cases, a person may demonstrate some sense of response that can be detected using a brain scan, but not be able to interact with their surroundings. However, the important difference between brain death and a vegetative state is that someone in a vegetative state still has a functioning brain stem, which means that: some form of consciousness may exist breathing unaided is usually possible theres a slim chance of recovery, because the brain stems core functions may be unaffected Aperson who is brain dead has no chance of recovery, because their body is unable to survive without artificial support. Confirming brain death Although rare, a few things can make it appear as though someone is brain dead. These include drug overdoses (particularly from barbiturates) and severehypothermia (where body temperature drops below 28C). Therefore, a number of tests are carried out to check that brain death has actually occurred, like shining a torch into both eyes to see if they react to the light. Organ and tissue donation After brain death has occurred, it may be possible for the persons organs and tissue to be used in transplantations. This can often save or improve the lives of others. Only 1% of people die in a way that makes organ donation possible. This means every opportunity for donation is very precious. Specialist nurses will discuss the possibility of donation with families. Thisll be done in a sensitive way. Theyll also check the NHS Organ Donor Register to see if the person had recorded a donation decision and share this information with the family. This lets the family know what their loved one wanted. It also means that nurses can check if this was their latest view. Further information about organ and tissue donation Diagnosing brain stem death There are a number of criteria for diagnosing brain stem death. For a diagnosis of brain stem death to be made: aperson must be unconscious and fail to respond to outside stimulation apersons heartbeat and breathing can only be maintained using a ventilator there must be clear evidence that serious brain damage has occurred and it cant be cured Ruling out other conditions Before testing for brain stem death, doctors must carry out a series of checks to ensure that the symptoms arent being caused by other factors, like: an overdose of illegal drugs, tranquillisers, poisons or other chemical agents an abnormally low body temperature (hypothermia) severe under-activity of the thyroid gland Once these factors have been ruled out, tests are carried out to confirm brain death. The diagnosis of brain death has to be made by two senior doctors. Neither of them can be involved with the hospitals transplant team. The doctors will explain the tests to you and theyll keep you informed about your loved ones condition at all times. Tests The doctors will run a series of tests. Both doctors have to agree on the results for a diagnosis of brain death to be confirmed. The tests are carried out twice to minimise any chance of error. The tests used to determine whether brain stem death has occurred are outlined below: A torch is shone into both eyes to see if they react to the light. The cornea (transparent outer layer of the eye), which is usually very sensitive, is stroked with a tissue or piece of cotton wool to see if the eyereacts. Pressure is applied to the forehead and the nose is pinched to see if theres any movement in response. Ice-cold water is inserted into each ear, which would usually cause the eyes to move. A thin, plastic tube is placed down the trachea (windpipe) to see if itprovokes gagging or coughing. The person is disconnected from the ventilator for a short period of time to see if they make any attempt to breathe on their own. Brain death will bediagnosedif a person fails to respond to all of these tests. Occasionally, a persons limbs or torso (the upper part of the body) may move, even after brain stem death has been diagnosed. These spinal reflex movements are generated by the spinal cord and dont involve the brain at all. Therefore, they wont affect the diagnosis of brain death. ",,,,,,,,,,,,,
Brain tumours,"Brain tumours  Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Brain tumours Brain tumours A brain tumour is a growth of cells in the brain that multiplies in an abnormal, uncontrollable way. It can either be cancerous (malignant) or non-cancerous (benign). Brain tumours are graded from 1 to 4 according to their behaviour, such as how fast they grow and how likely they are togrow back after treatment. benign brain tumours arelow grade (grade 1 or 2), which means they grow slowlyand are less likely to return after treatment malignant brain tumours arehigh grade (grade 3 or 4) and either start in the brain (primary tumours) or spread into the brain from elsewhere (secondary tumours); theyre more likely to grow back after treatment This page gives general information relevant to both types of brain tumour. Symptoms of a brain tumour The symptoms of a brain tumour vary depending on the exact part of the brain thats affected. Common symptoms include: severe, persistent headaches seizures (fits) persistent nausea, vomiting and drowsiness mental or behavioural changes, such as memory problems or changes in personality progressive weakness orparalysis on one side of the body, vision problems, or speech problems Sometimes, you may not have any symptoms to begin with, or they may only develop very slowly over time. When to speak to your GP Speak to your GP if youhave persistent symptoms of a brain tumour. While its unlikely to be a tumour, its best to be sure by getting a proper diagnosis. If your GP is unable to identify a more likely cause of your symptoms, they may refer you to a neurologist for further assessment and tests, such as a brain scan. Who is affected Brain tumours can affect people of any age, including children, although they tend to be more common in older adults. More than 9,000 people are diagnosed with primarybrain tumours in the UK each year, ofwhich about halfare benign and half are malignant. Many othersare diagnosedwith secondary brain tumours. The exact reason why some people develop primary brain tumours is unknown,but its thought that certain genetic conditions  such asneurofibromatosis type 1and tuberous sclerosis  and previous radiotherapy to the head increaseyour risk. Treatment and outlook The main treatment for most brain tumours is surgery, which aims to remove as much of the abnormal tissue as possible. Its not always possible to remove the entire tumour, so further treatment with radiotherapy and/or chemotherapy may be necessary to kill any abnormal cells left behind. For most benign tumours, treatment is oftensuccessful and a full recovery is possible, although theres sometimes a small chance the tumour could come back.Regular follow-up appointments will normally be recommended to monitor this. The outlook for malignant tumours is generally less good, although this varies depending on things such aswhere the tumour is in the brain, your age, and your general health. Unfortunately,a cure is often not possible and most tumours will return after treatment. If a tumour does come back, treatmentwill aim to relieve your symptoms and prolong life by controlling the growth of the tumour. Support and further information As well as reading the separate pages onbenign brain tumoursand malignant brain tumours, you may find the following websites useful sources of information and support: The Brain Tumour Charity Brain Tumour Research Cancer Research UK: Brain tumours Macmillan Cancer Support: Brain tumours ",,,,,,,,,,,,,
Brain tumours: Children,"Brain tumours: Children | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in children Brain tumours: Children Brain tumours: Children Brain tumours are the most common tumours that develop in children. Children of any age may be affected. Boys are affected slightly more often than girls. More children than ever are surviving childhood cancer. There are new and better drugs and treatments, and we can now also work to reduce the after-effects of having had cancer in the past. Its devastating to hear that your child has cancer. At times it can feel overwhelming, but there are many healthcare professionals and support organisations to help you through this difficult time. Understanding more about the cancer your child has, and the treatments that may be used, can often help parents to cope. Your childs specialist will give you more detailed information and, if you have any questions, its important to ask the specialist doctor or nurse who knows your childs individual situation. Brain tumours A tumour in the brain can come from the brain itself (primary), or from another part of the body (secondary). This information is about primary brain tumours. Signs and symptoms Symptoms will depend on the size of the tumour, where it is and how it affects that part of the brain.Symptomsare caused by the pressure inside the head being higher than it should be. A growing tumour may push normal brain out of the way, or block the flow of fluid in the brain. Doctors call this raised intracranial pressure, and it can cause symptoms such as: headaches (often worse in the morning) vomiting (usually in the morning) or feeling sick fits (seizures) feeling very irritated or losing interest in day-to-day things eye problems, such as abnormal eye movements, blurring or double vision feeling very tired much more quickly than usual feeling extremely sleepy (drowsy) for no reason Brain tumours can also cause problems with balance and walking, weakness down one side of the body, or changes in behaviour. Some of these symptoms are common even without a brain tumour, and this can cause confusion in the early stages. The brain The brain is contained within the skull, which protects it. Between the brain and the skull, there are 3 layers of membrane called the meninges. These completely cover the brain and spinal cord and help to protect it. Between 2 of these layers is a space that contains a fluid called cerebrospinal fluid (CSF), which circulates around the brain and spinal cord. The main parts of the brain are: the cerebrum  this is at the top of the head and is the largest part of the brain; itsmade up of 2 halves(hemispheres), it controls thinking, learning, memory, problem-solving, emotions and touch, and it also helps us be aware of our body position the cerebellum  this is the back part of the brain, and it controls movement, balance and coordination the brain stem  this connects the brain to the spinal cord and is in the lower part of the brain just above the back of the neck; it controls breathing, body temperature, heart rate and blood pressure, eye movements and swallowing What happens when a brain tumour is suspected Knowing what a test involves can make things a bit easier. The specialist doctor and nurse will explain things but dont be afraid to ask questions. Your doctor will want to hear about the problems your child has had recently, and will examine him or her properly. This will include looking into the back of your childs eyes with an ophthalmoscope to check for swelling, which can be a sign of raised pressure in the brain. Theyll usually check other things like balance, coordination, sensation and reflexes. CT or MRI scan Most children will have a CT or an MRI scan , which looks in detail at the inside of the brain. A CT scan uses X-rays . Its quick and often is the best first-line investigation, but it does not give as detailed pictures as an MRI. It uses quite a lot of X-rays, and so it is important to make sure we do not use it on too many people if it can be avoided. An MRI scan uses no X-rays, and gives more detailed pictures, but takes much longer. Machines are noisy, and often children cannot lie still long enough to get proper images. It is sometimes necessary to have an anaesthetic for this scan. Ordinary X-rays are not usually helpful for brain tumours. Blood tests These are usually done to make sure it is safe to do an operation, and can also be used to help diagnose certain types of tumour. Biopsy Its often necessary for doctors to remove a small part of the tumour ( biopsy ) to find out exactly what type of tumour it is. It means your child will need to go into hospital for an operation under general anaesthetic. The piece of tumour removed is then examined under a microscope by a specialist doctor called a pathologist. A biopsy isnt always done; it is sometimes better to remove the whole tumour in one operation. In this case, it will be a few days before the exact type of tumour is known. Sometimes, it may be safer to do the operation in two stages. Part of the tumour might be removed in the first operation and the rest a few days later. Types of brain tumours There are different types of brain tumours and they are usually named after the type of cells they develop from. The main types are astrocytoma, ependymoma, and medulloblastoma, but there are many other, less common types. Brain tumours can be either benign (non-cancerous) or malignant (cancerous). Benign brain tumours These remain in the part of the brain that they started in and do not usually spread into other areas. Sometimes it may be difficult to remove a benign tumour, because of where it is and, in this situation, other treatments may be needed. The most common tumour of this type is a low-grade astrocytoma (also called low-grade glioma). Malignant primary brain tumours These are most likely to cause problems by causing pressure and damage to the areas around them and possibly by spreading to the normal brain tissue close by. High-grade astrocytoma and ependymoma These tumours develop from the supporting cells of the brain known as glial cells, and are sometimes also called gliomas. Medulloblastomas These usually develop in the lower part of the brain, the cerebellum. They may spread to other parts of the brain or into the spinal cord, and treatment must include the whole of this. Treatment Because there are different types of brain tumours, treatment will not be the same for everyone. The doctors will look at the type of brain tumour, its size and where it is in the brain before deciding on the best treatment. These are the main treatments used to treat brain tumours. Your child may have one treatment or a combination of treatments. Surgery Usually, a neurosurgeon will operate to remove as much of the tumour as possible. Operations can be very long. Its not uncommon for these to be more than 6 or 8 hours. Sometimes, the fluid in and around the brain does not flow freely, as a result of the tumour or brain swelling. In this case, it may be necessary to place a fine tube (shunt) to drain excess fluid from the brain and into the lining of the tummy area (abdomen). You cannot see the shunt outside the body. Another way of treating this is to create another drainage route for the fluid around the obstruction (called a ventriculostomy). After the operation, your child may spend some time in an intensive care ward or high dependency unit, so the nurses and doctors can keep a very close eye on them. Once a diagnosis is known, a plan to treat any tumour left behind can be made. For benign tumours, there may be no further treatment, but for some, radiotherapy or chemotherapy will be required. Radiotherapy Radiotherapy treats cancer by using high energy radiation beams. These are exactly the same as visible light, but instead of reflecting from the surface, the energy passes inside the body, where it causes damage to tumour cells. Radiotherapy is delivered extremely carefully, using machines linked to the MRI scans of your childs brain. The process usually takes a few minutes each time, but often needs to continue for 5 or 6 weeks. Sometimes more specialised types of radiotherapy may be used. Your childs oncologist will explain more about this. Chemotherapy Chemotherapy uses drugs to get rid of cancer cells. Chemotherapy is given into the veins, and sometimes as a liquid or tablets by mouth. Treatment is often quite prolonged, with periods of time in hospital and gaps when you will be able to return home. This part of the treatment is planned by an oncologist. The specialist doctor and nurse will explain your childs treatment and answer your questions so that you understand what is involved. Other medicines your child may need to take Your child may need to take medicines for a while to reduce or control the symptoms of the brain tumour: Steroids These are medicines that reduce swelling and inflammation in the brain and can help with symptoms. Anticonvulsants These are medicines that help prevent fits, which can be a problem before or after operations on the brain. They may only be necessary for a short period, but sometimes are needed for longer. Side effects of treatment Your childs doctor and specialist nurse will explain more about what to expect. Always let them know about any side effects your child is having. Many side effects can be well controlled or made easier. Hair loss Both radiotherapy and chemotherapy can cause hair loss . Your childs hair will usually grow back again after chemotherapy, although it may not after radiotherapy. Tiredness Tiredness is very common with both treatments and may continue for weeks after chemotherapy or radiotherapy finishes. Feeling sick Radiotherapy and chemotherapy may make your child feel sick. This can usually be controlled well with anti-sickness drugs, which the oncologist will prescribe for your child. Increased risk of an infection Chemotherapy can increase the risk of infection. Itsimportant to contact the oncologist or specialist nurse straight away if your child has a temperature, any signs of infection or suddenly feels unwell. Skin changes in the treated area if your child is having radiotherapy Radiotherapy can cause a mild form of sunburn. The skin may become red, flaky or sore if your child has fair skin and may become darker and flaky if your child has dark skin. Youll be given advice on looking after the skin in the treated area. Clinical trials Trials aim to improve our understanding of the best way to treat an illness, usually by comparing the standard treatment with a new or modified version. Its important to realise that a clinical trial is not an experiment, and your doctor will always offer you what is believed to be the best available treatment. Clinical trials are usually offered to explore ways of making new improvements to treatment, beyond what is already known. Specialist doctors carry out many trials for brain tumours. If appropriate, your childs medical team will talk to you about taking part in a clinical trial, and will answer any questions you have. Written information is often provided to help explain things. Taking part in a research trial is completely voluntary, and youll be given plenty of time to decide if it is right for your child. You can also join a trial, and then withdraw if you change your mind at a later date. Treatment guidelines Sometimes, clinical trials are not available for your childs tumour. This may be because a recent trial has just finished, or because the tumour is very rare. In these cases, you can expect your doctors and nurses to offer treatment which is agreed to be the most appropriate, using guidelines which have been prepared by experts across the country. The Childrens Cancer and Leukaemia Group (CCLG) is an important organisation which helps to produce these guidelines. Follow-up care After treatment is over, your child will be seen regularly by specialists. This is to check their progress and how well theyre recovering from treatment. It is also to check that they dont have any long-term problems from treatment. You can contact your childs specialist doctor or nurse at any time if you have any worries about their health. Long-term side effects Sometimes treatments may cause possible long-term side effects that may develop later. Your childs oncologist or specialist nurse will explain the possible risk of any long-term effects in your childs situation. Children are monitored for any long-term problems following treatment so that they can be picked up and managed early on. Your feelings As a parent, the fact that your child has cancer is one of the worst situations you can be faced with. You may have many emotions, such as fear, guilt, sadness, anger and uncertainty. These are all normal reactions and are part of the process that many parents go through at such a difficult time. Its not possible to address here all of the feelings you may have. However, the CCLG booklet Children & Young Peoples Cancer; A Parents Guide talks about the emotional impact of caring for a child with cancer and suggests sources of help and support. Your child may have a variety of powerful emotions throughout their experience of cancer. The Parents Guide discusses these further and talks about how you can support your child. ",,,,,,,,,,,,,
Brain tumours: Teenagers and young adults,"Brain tumours: Teenagers and young adults | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in teenagers and young adults Brain tumours: Teenagers and young adults Brain tumours: Teenagers and young adults The brain and brain tumours Symptoms and causes of brain tumours Having tests for brain tumours Treating brain tumours The brain and brain tumours This section is for teenagers and young adults. Its about the brain and different types of brain tumour. Any illness to do with your brain can be scary. Understanding a bit more about how the brain works might help. The brain The brain and the spinal cord make up the central nervous system (CNS). The brain is the control centre which coordinates most body functions. It is inside the skull, which protects it. The spinal cord is made up of nerves that run down the spine. It passes messages between the brain and the rest of the body. The brain and the spinal cord are covered by 3 thin layers of tissue called the meninges. Between2 of these layers is a fluid called cerebrospinal fluid (CSF). The meninges and CSF help to protect the brain and spinal cord. The main parts of the brain are the: cerebrum cerebellum brain stem pituitary gland Cerebrum This is at the top of the head and is the largest part of the brain. Its made up of2 halves called hemispheres. It controls thinking, learning, memory, problem solving, emotions, and touch. It also makes us aware of our body position. Cerebellum This is at the back of the head, near the middle. It controls movement, balance and coordination. Brain stem This connects the brain to the spinal cord. Its in the lower part of the brain, just above the back of the neck. It controls breathing, body temperature, heart rate, blood pressure, eye movements and swallowing. Pituitary gland This is in the middle of the brain. It makes hormones that control things such as growth, metabolism, periods, and sperm production. Types of brain tumour There are different types of brain tumour. They are usually named after the type of cells they develop from. Brain tumours can be either benign (non-cancerous) or malignant (cancerous). This information is about both types. Benign brain tumours often press on the brain but dont usually spread into surrounding tissue. They are also less likely to spread around the brain and spinal cord. If they can be removed with an operation they may not cause any more problems. Sometimes its difficult to remove a benign tumour because of where it is in the brain. In this case, you might need treatment with chemotherapy or radiotherapy. Some benign tumours can cause long-lasting changes. This can be because they increase the pressure inside the brain, or because they press on important areas of the brain. Malignant brain tumours can spread from where they started into surrounding brain tissue, causing pressure and problems in those parts of the brain. They can also spread through the cerebrospinal fluid (CSF) into other parts of the brain or the spinal cord. This information is about tumours that start in the brain, which are called primary brain tumours. Sometimes cancers that start in other parts of the body can spread to the brain. These are known as secondary brain tumours. The types of brain tumour most likely to affect teenagers and young adults are: pituitary tumours gliomas medulloblastomas germ cell tumours Gliomas These start in cells called glial cells. There are different types of glioma, but the ones that affect younger people are usually astrocytomas, oligodendrogliomas and ependymomas. These types of tumour can develop in the brain or in the spinal cord. Astrocytomasand oligodendrogliomas These are the most common type of glioma. Astrocytomas develop from a star-shaped cell called an astrocyte. Oligodendrogliomas look like a fried egg. Sometimes tumours are a mix of both cells. These are called oligoastrocytomas. Doctors group them by how quickly they grow (known as the grade of the tumour). They can tell the grade from how the cells look under a microscope. Ependymomas These are a rarer type of glioma. They develop from the spinal cord, and from cells that line the fluid-filled spaces (ventricles) in the brain. These tumours can spread toother parts of the brain and spine through the CSF. Pituitary tumours These are usually benign tumours that grow in the pituitary gland. They are mostly grouped into pituitary adenomas and craniopharyngiomas. Some cause too many or too few hormones to be produced in the body. They very rarely spread. Medulloblastomas These usually start in the cerebellum, at the back of the brain. Sometimes they can spread through the CSF, or very rarely to other parts of the body. They start from cells that havent properly developed yet, and are sometimes called primitive neuroectodermal tumours (PNET). Germ cell tumours of the brain This type of tumour is rare. They develop from very early cells called germ cells, which have the potential to grow into any type of tissue. Although germ cell tumours often develop in the ovaries in girls or the testicles in boys, they can also start in other parts of the body, including the brain. They may be non-cancerous or cancerous. They are called by different names depending on what the cells look like under a microscope. We also have more information about: symptoms of brain tumours having tests for brain tumours treatment for brain tumours If youre looking for information about brain tumours in people of all ages, read our general brain tumours section. We also have information about brain tumours in children . Symptoms and causes of brain tumours This section on brain tumours is for teenagers and young adults. Signs and symptoms The symptoms of a brain tumour depend on the size of the tumour and where it is. The tumour can: cause fits affect the messages sent by that part of the brain to other parts of the body cause raised intracranial pressure theres only a certain amount of space in the skull for the brain and as a tumour grows, there can be a rise in pressure in or around the brain Common symptoms of raised intracranial pressure are: headaches, which are often worse in the morning vomiting (usually in the morning) or feeling sick fits (seizures) feeling very irritated or losing interest in day-to-daythings like friends, school or going out problems with your eyes, such as blurring or seeing double feeling more sleepy or drowsy than usual changes in your balance and walking, or weakness down one side of the body problems with speech personality changes Theres often a simple explanation for many of these symptoms. But if you have any of these or if youre worried, its important to speak to your GP straight away. Causes The cause of most brain tumours is unknown. Research is looking into this all the time. Young people with rare genetic conditions that run in families, such as neurofibromatosis type 1 and neurofibromatosis type 2, have an increased chance of developing a brain tumour. Mobile phones, power lines and certain viruses have all been suggested as possible causes of brain tumours. Theres been a lot of research into these possible causes, especially mobile phones. But there has been no strong evidence for any of them. Remember nothing youve done has caused the tumour. If youre worried about brain tumours If you think you might have any of the symptoms of a brain tumour, you should go straight to your GP. Theyll be able to talk to you about your symptoms. They can arrange tests to find out more, or refer you to a specialist doctor. We also have more info about: having tests for brain tumours treatment for brain tumours the brain If youre looking for information about brain tumours in people of all ages, read our general brain tumours section. We also have information about brain tumours in children . Having tests for brain tumours This section on brain tumours is for teenagers and young adults. Seeing your GP Your GP will examine you and, depending on your symptoms, they may arrange some tests. Or they might send you to hospital straight away to see a doctor who specialises in problems to do with the brain. These doctors are called neurologists or neurosurgeons. Sometimes a brain tumour is diagnosed after someone has been taken into hospital to check out symptoms that have happened suddenly, like having a fit. At the hospital Youll usually be seen at a hospital with a centre or unit specialising in treating brain tumours. Your specialist will ask you questions about your symptoms and how youve been feeling. Theyll examine the back of your eyes using an instrument with a light on the end of it to check for swelling. Swelling can be a sign of raised pressure in your head. Theyll usually check: your balance your coordination your muscle strength your reflexes whether you can feel pinpricks on areas of your skin You might also have your eyesight and hearing tested. Tests Youll need to have some more tests before a diagnosis is made. Your doctor will select the most suitable tests for your situation. These tests are important because they help your specialist plan the best treatment for you. Your doctor and specialist nurse will explain things to you, but dont be afraid to ask questions. Macmillan Cancer Support has information on the possible tests, whichinclude: a CT scan or MRI scan  these show a detailed picture of the inside of your head blood tests  these are done to check your general health and sometimes to measure the level of certain chemicals or hormones in your blood lumbar punctures  in this test a small needle is used to collect some fluid from the base of your spine; its sometimes done to look for cancer cells in the fluid surrounding the brain and spinal cord X-rays  might be taken to check your skull and chest Having a biopsy Doctors often need to remove a small part of the tumour ( biopsy ) to find out exactly what type of tumour it is. The piece of tumour thats removed is looked at under a microscope by a doctor called a pathologist. The operation will be done under general anaesthetic . This is where you are put into a deep sleep. Youll probably be in hospital for a few days. An MRI or CT scan is used to find the exact position of the tumour. The surgeon makes a small hole in the skull and passes a fine needle through it to remove a piece of the tumour. Guided biopsy This is often used to make sure the doctor takes the biopsy from the most appropriate part of the tumour. You will have a head frame fitted that will help guide the surgeon to exactly the right place before they take the biopsy. This is called a stereotactic biopsy. Tests and waiting for results Having tests and waiting for results can be scary. Remember  you dont have to keep your worries to yourself. Talking about how you feel and getting support from family, friends or your specialist nurse and doctor can make it a bit easier. You could also talk to one of Macmillans cancer support specialists on their free helpline. This information is about having tests for brain tumours. We also have more information about: symptoms of brain tumours treatment for brain tumours the brain If youre looking for information about brain tumours in people of all ages, read our general brain tumours section. Treating brain tumours This section on brain tumours is for teenagers and young adults. A team of specialists will plan your treatment. They will talk to you about the best treatment for you. Its normal to have a combination of treatments, so you may be seen by different doctors, such as: a neurosurgeon, who specialises in brain operations a neurologist, who treats brain conditions a cancer specialist (oncologist), who treats brain tumours with radiotherapy and chemotherapy Youll usually see a specialist nurse who looks after people with conditions affecting the brain, or a specialist nurse for teenagers or young adults with cancer. If you have radiotherapy (X-ray treatment) you will be given this treatment by a radiographer. There are different types of brain tumours, so treatment wont be the same for everyone. Your doctors look at the type of brain tumour you have, its size and where it is in the brain before deciding on the best treatment for you. The main treatments for brain tumours are: surgery an operation to remove all, or as much as possible, of the tumour radiotherapy  uses high-energy x-rays to treat cancer cells chemotherapy  uses anti-cancer drugs to destroy cancer cells Your specialist doctor and nurse will explain your treatment and answer any questions you have. Its important you understand whats involved. Youll probably need some time to talk it through with your family. Medicines you may need to take You might need to take these medicines for a while to reduce or control the symptoms of the brain tumour: steroids, which can reduce swelling or inflammation in the brain and help with symptoms anticonvulsant medicines that help prevent fits (seizures) Surgery for brain tumours Your surgeon will usually try to remove all, or as much as possible, of the tumour. Before the operation, they will talk to you about whats involved and the benefits and risks of the operation. Its important you understand all this, so ask all the questions you want to. Youll usually be in hospital for a week, sometimes longer. Your doctor or nurse will tell you what to expect before and after the operation as it can be different for everyone. Before the operation youll probably need to have some of your hair shaved off. This is done in the anaesthetic room. You may prefer to have all your hair shaved off. You can cover up with a wig or hat while it grows back. For some types of brain tumours, particularly low-grade gliomas, your surgeon might suggest doing an operation while you are awake. This is called an awake craniotomy. If you need this, you will be given plenty of medication to make sure it doesnt hurt. Sometimes surgery is not needed, or its not possible to remove the tumour. Your specialist may think that another treatment would be better for you. They will discuss this with you and you can ask any questions to help you understand your options. What happens after the operation? After the operation you are monitored very closely for the first 12 to 24 hours. At first you might be attached to a machine called a ventilator that helps you breathe. Your nurse or doctor will tell you if this is likely to happen. Your head might be bandaged and youll have a tube draining any extra blood thats collected around the wound into a plastic bottle. You may also have another tube draining extra cerebrospinal fluid (fluid that surrounds the brain). This is to make sure you dont get too much pressure building up inside your brain. Your doctor will remove these tubes as soon as its safe, usually after a couple of days. Youll have a drip to give you fluids until youre eating and drinking again. There may be some swelling and bruising around your face and eyes. This will settle down after a few days. When you wake up you might have a headache. Youll be given painkillers regularly until this eases off. Tell your nurse or doctor if youre in pain so that they can give you something stronger. Radiotherapy for brain tumours Radiotherapy uses high-energy X-rays to treat cancer cells. It can be used: after the operation to treat any cells that may have been left behind instead of an operation when a brain tumour doesnt need to be or cant be removed if a brain tumour comes back after surgery For some brain tumours, its normal to treat your spinal cord (the nerves that go from your brain to your body) as well as your brain. Your doctor will tell you if this is the case. Types of radiotherapy There are3 types of radiotherapy that are used to treat brain tumours: photon radiotherapy (given at your local hospital) proton radiotherapy (until 2018/2019 this is given in Switzerland or America) stereotactic radiosurgery/radiotherapy (given at specialist hospitals in the UK) Your doctor will discuss with you which treatment would be best. Youll have your treatment in the radiotherapy department of the hospital. Its usually given Monday to Friday, with a rest at the weekend. The number of treatments you have will depend on your situation, but it can last from 1 day to 7 weeks. You will have to wear a mask or shell to keep your head as still as possible during radiotherapy treatment. This makes sure treatment is delivered to the exact area each time. Your mask is made before your treatment is planned. Youll be able to see and breathe properly, but it might feel a bit tight. You only have to wear it for a few minutes at a time. Most people find they get used to it pretty quickly. Let your nurse or radiographer know if youre worried about this. The treatment only takes a few minutes. It isnt painful, but you need to lie very still. Youll be on your own in the room but you can talk to the radiographer through an intercom. In some hospitals you can have music playing while you have your treatment. Side effects The side effects you might have will depend on the type of radiotherapy youre having and how long it lasts for. Your doctor and specialist nurse will tell you more about what to expect. Always let them know about any side effects youre having. Theres usually something they can do to make things easier. Hair loss Your hair in the treatment area will start to thin and fall out shortly after your treatment starts. Your doctor or nurse can show you where you will lose your hair . Losing your hair can be scary and really upsetting. There are lots of ways to cover up with hats, bandannas, baseball caps, scarves, or wigs until it grows back. Getting a shorter haircut before it starts to fall out sometimes makes it a little easier to cope with. It usually starts to grow back within 3 months of finishing treatment. Hair may grow back with a slightly different colour and texture and might not be as thick as before. Although hair loss is usually temporary, for some people it can be permanent. Your specialist will usually be able to tell you if this is likely. This can be hard to deal with and youll be given advice and support to help you cope. Skin changes You might get some skin changes a bit like sunburn in the area being treated, usually after 3 to 4 weeks of treatment. At first it can be dry and itchy. If youve got pale skin it might get red. If youve got darker skin it can get darker. You should wash and dry the skin gently using non-perfumed soap and use only the moisturiser that the radiographer gives you. The radiographer or specialist nurse will give you advice on looking after your skin. Tiredness You may feel really tired towards the end of your treatment and for a few weeks after it has finished. This gradually improves after a few weeks. Try to get plenty of rest. Its also a good idea to do some gentle exercise if you can, like taking short walks. This helps to give you more energy and keep your muscles toned. Feeling sick Let your doctor know if this is a problem. They can prescribe anti-sickness medicines to help. Headaches Its important to tell your doctor if you have headaches. They can prescribe painrelief for you. During and after treatment, you might find your symptoms get a bit worse before they get better. This can be scary but its usually a reaction to the radiotherapy. It doesnt mean the radiotherapy hasnt worked or that the tumour has got worse. If it happens, let your doctor or nurse know. Late effects Side effects that happen months or years after treatment has finished are called late (long-term) effects. These depend on the area of the brain treated. They can include patches of hair loss, worse concentration, memory changes and difficulty learning new things, reduced hormones, increased risk of a stroke, and a second tumour. Youll be seen regularly for follow-up appointments and your doctors will be checking you for any late effects of treatment. Your doctors will explain more about this to you. Chemotherapy for brain tumours Chemotherapy is the use of special anti-cancer drugs to destroy tumour cells. You might have chemotherapy: to shrink a tumour to make it easier to remove with surgery when its not possible to remove the tumour completely with surgery during radiotherapy to make the tumour more sensitive to radiation after radiotherapy or surgery to reduce the chance of the tumour coming back (adjuvant chemotherapy) when a brain tumour has come back after treatment. Chemotherapy drugs Macmillan has information on the different chemotherapy drugs that can be used, such as: lomustine (CCNU) procarbazine vincristine cisplatin or carboplatin temozolomide (Temodal) cyclophosphamide ifosfamide etoposide The information on these drugs is written for people of all ages, not just for young people. There are lots of other drugs that are used and your doctor or nurse can tell you more about this. You can also callMacmillans cancer support specialists for more information about chemotherapy drugs. Chemotherapy can be given as a single drug or in combination with others. They can be given by injection into a vein (intravenously) or as tablets. Occasionally chemotherapy is given directly into the spine (intrathecal chemotherapy) or into the brain through a special device (ommaya reservoir). Another way of giving chemotherapy is for the surgeon to place a wafer containing chemotherapy in the area of the brain where the tumour was removed during the surgery. As the wafer dissolves, the chemotherapy drug is slowly released into the area of the brain that needs treatment.| Side effects Chemotherapy causes side effects that usually get better when treatment is over. Being more at risk of an infection You need to let your doctor or nurse know immediately if you have signs of an infection like feeling hot and shivery. This is because you can become unwell quite quickly while you are on chemotherapy. Tiredness This is a common side effect so its important to get plenty of rest. Try to balance rest with some gentle exercise like short walks if you can. This helps give you more energy and keeps your muscles toned. Feeling sick Youll be given anti-sickness medicines to take regularly. Let your nurse or doctor know if the ones youre taking arent working for you. Hair loss If you lose your hair it will usually start to grow back again after your treatment stops. Infertility Some chemotherapy drugs can affect your fertility. Your doctor should discuss this with you before treatment begins. Your doctor and nurse will tell you more about the side effects to expect depending on the chemotherapy you have. Let your doctor or nurse know about any side effects as theres often something that can be done to control them. Supportive treatment for brain tumours As part of your treatment for a brain tumour youll probably be given drugs called steroids. You may also be given some anticonvulsant drugs to prevent fits. Steroids Steroids help reduce the swelling that often surrounds a brain tumour. Although they dont treat the tumour itself, they can improve symptoms and make you feel better. Steroids are often given before and after surgery, and sometimes during or after radiotherapy and chemotherapy. Its important to take steroids as your doctor tells you and not to suddenly stop them. If you take steroids for more than 2 weeks, its important to tell your doctor about them if you are unwell (for example an infection) over the next 6 months. This is because you may need an extra course of steroids. Side effects If you take steroids for some time, you may have some temporary side effects. These can include: weight gain a change in the shape of your face (making it more rounded) indigestion slightly more risk of getting an infection mood changes (feeling hyper or overactive or feeling low) increase in the sugar level in your blood your blood or urine may be tested to check for this Side effects can be hard to cope with, especially with all the other stuff you have to deal with. Remember the side effects will gradually get better when the steroids are stopped, and in the meantime there are lots of people who can support you. Anticonvulsants Tumours in the brain can sometimes cause fits. Anticonvulsant drugs can help prevent them. You might be prescribed these before surgery, or to take on a more long-term basis. Your doctors will tell you about any side effects of these drugs. We also have more information about: symptoms of brain tumours having tests for brain tumours the brain If youre looking for information about brain tumours in people of all ages,read our general brain tumours section. ",,,,,,,,,,,,,
Breast cancer (female),"Breast cancer (female) - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Breast cancer (female) Breast cancer (female) About breast cancer Symptoms of breast cancer Causes and risk factors of breast cancer Diagnosing breast cancer Treating breast cancer Living with breast cancer Preventing breast cancer About breast cancer Breast cancer is the most common type of cancer in the UK. Most women who get it (8 out of 10) are over 50, but younger women, and in rare cases, men can alsoget breast cancer . If its treated early enough, breast cancer can be prevented from spreading to other parts of the body. The breasts The breasts are made up of fat, connective tissue and thousands of tiny glands called lobules, which produce milk. When a woman has a baby, the milk is delivered to the nipple through tiny tubes called ducts, which allow her to breastfeed. The body is made up of billions of tiny cells, which usually grow and multiply in an orderly way. New cells are only produced when and where theyre needed. In cancer, this orderly process goes wrong and cells begin to grow and multiply uncontrollably. Read more about the causes of breast cancer Symptoms of breast cancer Breast cancer can have a number of symptoms, but the first noticeable symptom is usually a lump or area of thickened breast tissue. Most breast lumps arent cancerous, but its always best to have them checked by your doctor. You should also speak to your GP if you notice any of the following: a change in the size or shape of one or both breasts discharge from either of your nipples(which may be streaked with blood) a lump or swelling in either of your armpits dimpling on the skin of your breasts a rash on or around your nipple a change in the appearance of your nipple, such as becoming sunken into your breast Breast pain alone isnt a symptom of breast cancer. Learn more about the symptoms of breast cancer After examining your breasts, your GP may refer you to a specialist breast cancer clinic for further tests.This might include a mammography (breast screening)or a biopsy . Read more about breast screening and how breast cancer is diagnosed Types of breast cancer There are several different types of breast cancer, which can develop in different parts of the breast. Breast cancer is often divided into non-invasive and invasive types. Non-invasive breast cancer Non-invasive breast cancer is also known as cancer or carcinoma in situ. This cancer is found in the ducts of the breast and hasnt developed the ability to spread outside the breast. This form of cancer rarely shows as a lump in the breast that can be felt, and is usually found on a mammogram. The most common type of non-invasive cancer is ductal carcinoma in situ (DCIS). Invasive breast cancer Invasive cancer has the ability to spread outside the breast, although this doesnt necessarily mean it has spread. The most common form of breast cancer is invasive ductal breast cancer, which develops in the cells that line the breast ducts. Invasive ductal breast cancer accounts for about 80% of allbreast cancer cases and is sometimes called no special type. Other types of breast cancer Other less common types of breast cancer include invasive lobular breast cancer, which develops in the cells that line the milk-producing lobules, inflammatory breast cancer and Pagets disease of the breast . Its possible for breast cancer to spread to other parts of the body, usually through the lymph nodes (small glands that filter bacteria from the body) or the bloodstream. If this happens, its known as secondary or metastatic breast cancer. Breast cancer screening Theres a good chance of recovery if breast cancer is detected in its early stages. For this reason, its vital that women check their breasts regularly for any changes and always get any changes examined by their GP. Mammographic screening (where X-ray images of the breast are taken) is the best available method of detecting an early breast lesion. However, you should be aware that a mammogram might fail to detect some breast cancers. It might also increase your chances of having extra tests and interventions, including surgery. Women with a higher-than-average risk of developing breast cancer may be offered screening and genetic testing for the condition. As the risk of breast cancer increases with age, all women who are 50to 70 years old are invited for breast cancer screening every 3 years. Women over 70 are also entitled to screening and can arrange an appointment through their GP or local screening unit. The NHS is in the process of extending the programme as a trial, offering screening to some women aged 47to 73. Read more about breast screening and find breast cancer screening services near you Treating breast cancer If cancer is detected at an early stage, it can be treated before it spreads to nearby parts of the body. Breast cancer is treated using a combination of surgery, chemotherapy and radiotherapy . Surgery is usually the first type of treatment youll have, followed by chemotherapy or radiotherapy or, in some cases, hormone or biological treatments. The type of surgery and the treatment you have afterwards will depend on the type of breast cancer you have. Your doctor will discuss the best treatment plan with you. In asmall proportion of women, breast cancer is discovered after its spread to other parts of the body (metastasis). Secondary cancer, also called advanced or metastatic cancer, isnt curable, so the aim of treatment isto achieve remission (symptom relief). Read more about treating breast cancer Preventing breast cancer As the causes of breast cancer arent fully understood, its not possible to know if it can be prevented altogether. If youre at increased risk of developing the condition, some treatments are available to reduce the risk. Studies have looked at the link between breast cancer and diet and, although there are no definite conclusions, there are benefits for women who maintain a healthy weight , exercise regularly and who have a low intake of saturated fat and alcohol . Its been suggested that regular exercise can reduce your risk of breast cancer by as much as a third. If youve been through the menopause, its particularly important that youre not overweight or obese. This is because being overweight or obese causes more oestrogen to be produced, which can increase the risk of breast cancer. Read more about preventing breast cancer Living with breast cancer Being diagnosed with breast cancer can affect daily life in many ways,depending on what stageits at and what treatment youre having. How women cope with their diagnosis and treatment varies from person to person. You can be reassured that there are several forms of support available, if you need it. For example: yourfamily andfriends can be a powerful support system you can communicate with other people in the same situation find out as much as possible about your condition dont try to do too much or overexert yourself make time for yourself Read more about living with breast cancer Symptoms of breast cancer The first symptom of breast cancer most women notice is a lump or an area of thickened tissue in their breast. Mostbreast lumps (90%) arent cancerous, but its always best to have them checked by your doctor. You should speak to your GP if you notice any of the following: a lump or area of thickened tissue in either breast a change in the size or shape of one or both breasts discharge from either of your nipples(which may be streaked with blood) a lump or swelling in either of your armpits dimpling on the skin of your breasts a rash on or around your nipple a change in the appearance of your nipple, such as becoming sunken into your breast Breast pain alone isnt a symptom of breast cancer. Read further information: Breast Cancer Now: Signs and symptoms of breast cancer Cancer Research UK: Breast cancer symptoms Macmillan Cancer Support: Signs and symptoms of breast cancer Breast awareness Its important to be breast aware,so you can pick up any changes as soon as possible. Get to know what is normal for you. For instance, your breasts may look or feel different at different times of your life. This will make it much easier to spotpotential problems. Read further information: Breast Cancer Now: Checking your breasts Breast Cancer Now: Signs and symptoms of breast cancer Causes and risk factors of breast cancer The causes of breast cancer arent fully understood, making it difficult to say why one woman may develop breast cancer and another may not. However, there are risk factors that areknown to affect your likelihood of developing breast cancer. Some of these you cant do anything about, but there are some you can change. Age The risk of developing breast cancer increases with age. The condition is most common among women over 50 who have been through the menopause . About 8 out of 10 cases of breast cancer occur in women over 50. All women who are 50to 70 years of age should be screened for breast cancer every 3 years as part of the NHS Breast Screening Programme. Women over the age of 70 are still eligible to be screened and can arrange this through their GP or local screening unit. Read more about breast screening Family history If you have close relatives who have had breast cancer or ovarian cancer , you may have a higher risk of developing breast cancer. However, because breast cancer is the most common cancer in women, its possible for it to occur in more than one family member by chance. Most cases of breast cancer arent hereditary (they dont run in families), but particular genes, known as BRCA1 and BRCA2, can increase your risk of developing both breast and ovarian cancer. Its possible for these genes to be passed on from a parent to their child. A third gene (TP53) is also associated with an increased risk of breast cancer. If you have, for example, 2 or more close relatives from the same side of your family, such as your mother, sister or daughter, who have had breast cancer under the age of 50, you may be eligible for surveillance for breast cancer or for genetic screening to look for the genes that make developing breast cancer more likely. If youre worried about your family history of breast cancer, discuss it with your GP. Read about predictive genetic tests for cancer risk genes Previous diagnosis of breast cancer If youve previously had breast cancer or early non-invasive cancer cell changes in breast ducts, you have a higher risk of developing it again, either in your other breast or in the same breast again. Previous benign breast lump A benign breast lump doesnt meanyou have breast cancer, but certain types of lump may slightly increase your risk of developing it. Certain benign changes in your breast tissue, such as atypical ductal hyperplasia (cells growing abnormally in ducts), or lobular carcinoma in situ (abnormal cells inside your breast lobes), can make getting breast cancer more likely. Breast density Your breasts are made up of thousands of tiny glands (lobules), which produce milk. This glandular tissue contains a higher concentration of breast cells than other breast tissue, making it denser. Women with dense breast tissue may have a higher risk of developing breast cancer because there are more cells that can become cancerous. Dense breast tissue can also make a breast scan (mammogram) difficult to read, because it makes any lumps or areas of abnormal tissue harder to spot. Younger women tend to have denser breasts. As you get older, the amount of glandular tissue in your breasts decreases and is replaced by fat, so your breasts become less dense. Exposure to oestrogen The female hormone, oestrogen,can sometimes stimulate breast cancer cells and cause them togrow. The ovaries, where your eggs are stored, begin to produce oestrogen when you start puberty , to regulate your periods. Your risk of developing breast cancer may rise slightly with the amount of oestrogenyour body is exposed to. For example, if you started your periods at a young age and experienced themenopause at a late age, youll have been exposed to oestrogen over a longer period of time. In the same way, not having children, or having children later in life, may slightly increase your risk of developing breast cancer because your exposure to oestrogen is uninterrupted by pregnancy. Being overweight or obese If youve experienced the menopause and are overweight or obese , you may be more at risk of developing breast cancer. This is thought to be linked to the amount of oestrogen in your body, because being overweight or obese after the menopause causes more oestrogen to be produced. Being tall If youre taller than average, youre more likely to develop breast cancer than someone whos shorter than average.The reason for this isnt fully understood, but it may be due to interactions between genes, nutrition and hormones. Alcohol Your risk of developing breast cancer can increase with the amount of alcohol you drink . Radiation Certain medical procedures that use radiation, like X-rays and computerised tomography (CT) scans , may slightly increase your risk of developing breast cancer. If you had radiotherapy to your chest area for Hodgkin lymphoma when you were a child, you should have already received a written invitation from the Department of Health for a consultation with a specialist to discuss your increased risk of developing breast cancer. Speak to your GP if you werent contacted, or if you didnt attend a consultation. If you currently need radiotherapy for Hodgkin lymphoma, your specialist should discuss the risk of breast cancer before your treatment begins. Hormone replacement therapy (HRT) Hormone replacement therapy (HRT) is associated with a slightly increased risk of developing breast cancer. Both combined HRT and oestrogen-only HRT can increase your risk of developing breast cancer, although the risk is slightly higher if you take combined HRT. Read further information: Breast Cancer Now: Breast cancer causes Macmillan Cancer Support: Risk factors for breast cancer Diagnosing breast cancer If you have suspected breast cancer, eitherbecause ofyour symptoms or because your mammogram has shown an abnormality, youll be referred to a specialist breast clinic for further tests. What to expect at the breast clinic The tests youll receive at the breast clinic depend on your current symptoms, your age, and the results of the initial examination youll have when you arrive. Many people dont need any further tests after the initial examination. Most of the time you can expect to spend up to 2 hours at the breast clinic. Mammogram and breast ultrasound If you have symptoms and have been referred by your GP, youll meet a specialist wholl examine you to determine if you need further tests. If youre under40 years of age, the specialistmay suggest you only have a breast ultrasound scan. This is because younger women have denser breasts, which means a mammogram isnt as effective as an ultrasoundfor diagnosing breast disease. If you have a mammogram, it will produce an X-ray of your breasts. You may also need an ultrasound scan . Ultrasound uses high-frequency sound waves to produce an image of the inside of your breasts, showing any lumps or abnormalities. Your doctor may also suggest a breast ultrasound if they need to know whether a lump in your breast is solid or contains liquid. Read more about breast screening Biopsy A biopsy is where a sample of tissue cells is taken from your breast and tested to see if its cancerous. You may also need a scan and a needle test on lymph nodes in your armpit (axilla) to see whether these are also affected. Biopsies can be taken in different ways, and the type you have will depend on what your doctor knows about your condition.Different methods ofcarrying outa biopsy are discussed below. Needle aspiration may be used to test a sample of your breast cells for cancer or to drain a benign cyst (a small fluid-filled lump). Your doctor will use a small needle to extract a sample of cells, without removing any tissue. Needle biopsy is the most common type of biopsy. A sample of tissue is taken from a lump in your breast using a large needle. Youll have a local anaesthetic , which means youll be awake during the procedure, but your breast will be numb. Your doctor may suggest that you have a guided needle biopsy (usually guided by ultrasound or X-ray, but sometimes MRI is used) to obtain a more precise and reliable diagnosis of cancer and to distinguish it from any non-invasive change, particularly ductal carcinoma in situ (DCIS). Vacuum-assisted biopsy, also known as a mammotome biopsy, is another type of biopsy. During the procedure, a needleis attached to a gentle suction tube, which helps toobtain the sample and clear any bleeding from the area. Read further information: Breast Cancer Now:What happens at a breast clinic appointment? Breast Cancer Now: Your pathology results Macmillan Cancer Support: Breast cancer Further tests for breast cancer If a diagnosis of breast cancer is confirmed, more tests will be needed to determine the stage and grade of the cancer, and to work out the best method of treatment. Ifyourcancer was detected through the NHS Breast Screening Programme, youll have further tests in the screening centre before being referred for treatment. Scans and X-rays Computerised tomography (CT) scans , or chest X-ray and liver ultrasound scans, may be needed to check whether the cancer has spread to your lungs or liver. An MRI scan of the breast may be needed to clarify or to assess the extent of the condition within the breast. If your doctor thinks that the cancer could have spread to your bones, you may need a bone scan. Before having a bone scan, a substance containing a small amount of radiation, known as an isotope, will be injected into a vein in your arm. This will be absorbed into your bone if its been affected by cancer. The affected areas of bone will show up as highlighted areas on the bone scan, which is carried out using a special camera. Tests to determine specific types of treatment Youll also need tests that show whether the cancer will respond to specific types of treatment. The results of these tests can give your doctors a more complete picture of the type of cancer you have and how best to treat it. The types of test you could be offered are discussed below. In some cases, breast cancer cells can be stimulated to grow by hormones that occur naturally in your body, such as oestrogen and progesterone. If this is the case, the cancer may be treated by stopping the effects of the hormones, or by lowering the level of these hormones in your body. This is known as hormone therapy. Duringa hormone receptor test, a sample of cancer cells will be taken from your breast and tested to see if they respond to either oestrogen or progesterone. If the hormone is able to attach to the cancer cells (using a hormone receptor), theyre known as hormone receptor positive. While hormones can encourage the growth of some types of breast cancer, other types are stimulated by a protein calledhuman epidermal growth factor receptor 2 (HER2). These types of cancer can be diagnosed using a HER2 test, and treated with medication to block the effects of HER2. This is known as biological or targeted therapy. Stage and grade of breast cancer Stage of breast cancer When your breast cancer is diagnosed, the doctors will give it a stage. The stage describes the size of the cancer and how far it has spread. Ductal carcinoma in situ (DCIS) is sometimes described as stage 0. Other stages of breast cancer describe invasive breast cancer: stage 1  the tumour measures less than 2cm, the lymph nodes in the armpit arent affected, and there are no signs that the cancer has spread elsewhere in the body stage 2  the tumour measures 2 to 5cm or the lymph nodes in the armpit are affected, or both, and there are no signs that the cancer has spread elsewhere in the body stage 3  the tumour measures2 to 5cm and may be attached to structures in the breast, such as skin or surrounding tissues, the lymph nodes in the armpit are affected butthere are no signs that the cancer has spread elsewhere in the body stage 4  the tumour is of any size and the cancer has spread to other parts of the body (metastasis) This is a simplified guide. Each stage is divided into further categories: A, B and C. If youre not sure what stage you have, ask your doctor. TNM staging system The TNM staging system may also be used to describe breast cancer, as it can provide accurate information about the diagnosis. T describes the size of the tumour, N describes whether cancer has spread to the lymph nodes, and M gives an indication of whether the cancer has spread to other parts of the body. Grade of breast cancer The grade describes the appearance of the cancer cells. low grade (G1)  the cells, although abnormal, appear to be growing slowly medium grade (G2)  the cells look more abnormal than low-grade cells high grade (G3)  the cells look even more abnormal and are more likely to grow quickly Read further information: Cancer Research UK: TNM breast cancer staging Cancer Research UK: Stages and grades of breast cancer Treating breast cancer Surgery is usually the first type of treatment for breast cancer. The type of surgery you undergo will depend on the type of breast cancer you have. Surgery is usually followed by chemotherapy or radiotherapy or, in some cases, hormone or biological treatments. Again, the treatment youll have will depend onyour type of breast cancer. Your doctor will discuss the most suitable treatmentplan with you. Chemotherapy or hormone therapy will sometimes be the first treatment. Secondary breast cancer Most breast cancers are discovered in the conditions early stages. However, a small proportion of women discover that they have breast cancer after its spread to other parts of the body (known as metastasis). If this is the case, the type of treatment you have may be different. Secondary cancer, also called advanced or metastatic cancer, isnt curable and treatment aims to achieve remission (where the cancer shrinks or disappears, and you feel normal and able to enjoy life to the full). Read further information aboutsecondary breast cancer Surgery There are 2 main types of breast cancer surgery. They are: surgery to remove the cancerous lump (tumour), known as breast-conserving surgery surgery to remove the whole breast, which is called a mastectomy In many cases, a mastectomy can be followed by reconstructive surgery to try to recreate a bulge to replace the breast that was removed. Studies have shown that breast-conserving surgery followed by radiotherapy is as successful as total mastectomy at treating early-stage breast cancer. Breast-conserving surgery Breast-conserving surgery ranges from a lumpectomy or wide local excision, wherejust the tumour and a little surrounding breast tissue is removed, to a partial mastectomy or quadrantectomy, whereup to a quarter of the breast is removed. If you have breast-conserving surgery, the amount of breast tissue you have removed will depend on the: type of cancer you have size of the tumour and where it is in your breast amount of surrounding tissue that needs to be removed size of your breasts Your surgeon will always remove an area of healthy breast tissue around the cancer, which will be tested for traces of cancer. If theres no cancer present in the healthy tissue, theres less chance that the cancer will reoccur. If cancer cells are found in the surrounding tissue, more tissue may need to be removed from your breast. After having breast-conserving surgery, you will usually be offered radiotherapy to destroy any remaining cancer cells. Mastectomy A mastectomy is the removal of all the breast tissue, including the nipple. If there are no obvious signs that the cancer has spread to your lymph nodes, you may have a mastectomy, where your breast is removed, along with a sentinel lymph node biopsy. If the cancer has spread to your lymph nodes, you will probably need more extensive removal (clearance) of lymph nodes from the axilla (under your arm). Reconstruction Breast reconstruction is surgery to make a new breast shape that looks as much as possible like your other breast. Reconstruction can be carried out at the same time as a mastectomy (immediate reconstruction), or it can be carried out later (delayed reconstruction). It can be done either by inserting a breast implant or by using tissue from another part of your body to create a new breast. Read further information aboutbreast reconstruction Lymph node surgery To find out if the cancer has spread, a procedure called a sentinel lymph node biopsymay be carried out. The sentinel lymph nodes are the first lymph nodes that the cancer cells reach if they spread. Theyre part of the lymph nodes under the arm (axillary lymph nodes). The position of the sentinel lymph nodes varies, so theyre identified using a combination of a radioisotope and a blue dye. The sentinel lymph nodes are examined in the laboratory to see if there are any cancer cells present. This provides a good indicator of whether the cancer has spread. If there are cancer cells in the sentinel nodes, you may need further surgery to remove more lymph nodes from under the arm. Radiotherapy Radiotherapy uses controlled doses of radiation to kill cancer cells. Its usually given after surgery and chemotherapy to kill any remaining cancer cells. If you need radiotherapy, your treatment will begin about a month after your surgery or chemotherapy, to give your body a chance to recover. Youll probably have radiotherapy sessions 3 to 5 days a week, for 3 to 6 weeks. Each session will only last a few minutes. The type of radiotherapy you have will depend on your cancer and surgery type. Some women may not need to have radiotherapy at all. The types available are: breast radiotherapy  after breast-conserving surgery, radiation is applied to the whole of the remaining breast tissue chest wall radiotherapy  after a mastectomy, radiotherapy is applied to the chest wall breast boost  some women may be offered a boost of high-dose radiotherapy in the area where the cancer was removed; however, the boost may affect the appearance of the breast, particularly if you have large breasts, and can sometimes have other side effects, including hardening of the breast tissue (fibrosis) radiotherapy to the lymph nodes  where radiotherapy is aimed at the armpit (axilla) and the surrounding area to kill any cancer that may be present in the lymph nodes The side effects of radiotherapy include: irritation and darkening of the skin on your breast, which may lead to sore, red, weepy skin fatigue (extreme tiredness) lymphoedema(excess fluid build-up in your arm caused by blockage of the lymph nodes under your arm) Read further information aboutradiotherapy for breast cancer Chemotherapy Chemotherapy involves using anti-cancer (cytotoxic) medication to kill the cancer cells. Its usually used after surgery to destroy any cancer cells that havent been removed. This is called adjuvant chemotherapy. In some cases, you may have chemotherapy before surgery, which is often used to shrink a large tumour. This is called neo-adjuvant chemotherapy. Several different medications are used for chemotherapy and three are often given at once. The choice of medication and the combination will depend on the type of breast cancer you have and how much its spread. Chemotherapy is usually given as an outpatient treatment, which meansyou wont have to stay in hospital overnight. The medications are usually given through a drip straight into the blood through a vein. In some cases, you may be given tablets that you can take at home. You may have chemotherapy sessions once every 2 to 3 weeks, over a period of 4 to 8 months, to give your body a rest in between treatments. The main side effects of chemotherapy are caused by their influence on normal, healthy cells, such as immune cells. Side effects include: infections loss of appetite nausea and vomiting tiredness hair loss sore mouth Many side effects can be prevented or controlled with medicines that your doctor can prescribe. Chemotherapy medication can also stop the production of oestrogen in your body, which is known to encourage the growth of some breast cancers. If you havent experienced the menopause, your periods maystop while youre undergoing chemotherapy treatment. After youve finished the course of chemotherapy, your ovaries should start producing oestrogen again. However, this doesnt always happen and you may enter an early menopause . This is more likely in women over 40 years old, becausetheyre closer to menopausal age. Your doctor will discuss with you the impact that any treatment will have on your fertility. Chemotherapy for secondary breast cancer If your breast cancer has spread beyond the breast and lymph nodes to other parts of your body, chemotherapy wont cure the cancer, but it may shrink the tumour, relieve your symptoms and help lengthen your life. Read further information aboutchemotherapy for breast cancer Hormone treatment Some breast cancers are stimulated to grow by the hormones oestrogen or progesterone, which are found naturally in your body. These types of cancer are known as hormone-receptor-positive cancers. Hormone therapy works by lowering the levels of hormones in your body or by stopping their effects. The type of hormone therapy youll have will depend on the stage and grade of your cancer, which hormone its sensitive to, your age, whether youve experiencedthe menopause and what other type of treatment youre having. Youll probably have hormone therapy after surgery and chemotherapy, but its sometimes given before surgery to shrink a tumour, making it easier to remove. Hormone therapy may be used as the only treatment for breast cancer if your general health prevents you from having surgery, chemotherapy or radiotherapy. In most cases, youll need to take hormone therapy for up to five years afterhaving surgery. If your breast cancer isnt sensitive to hormones, hormone therapy will have no effect. Tamoxifen Tamoxifen stops oestrogen from binding to oestrogen-receptor-positive cancer cells. Its taken every day as a tablet or liquid. It can cause several side effects, including: tiredness changes to your periods nausea and vomiting hot flushes aching joints headaches weight gain Aromatase inhibitors If youveexperienced the menopause, you may be offered an aromatase inhibitor. This type of medication works by blocking aromatase, a substance that helps produce oestrogen in the body after the menopause. Before the menopause, oestrogen is made by the ovaries. Three aromatase inhibitors may be offered. These areanastrozole, exemestane and letrozole. These are taken as a tablet once a day. Side effects include: hot flushes and sweats lack of interest in sex (loss of libido) nausea and vomiting tiredness aching joints and bone pain headaches skin rashes Ovarian ablation or suppression In women who haventexperienced the menopause, oestrogen is produced by the ovaries. Ovarian ablation or suppression stops the ovaries working and producing oestrogen. Ablation can be carried out using surgery or radiotherapy. Itstops the ovaries working permanently and means youll experience the menopause early. Ovarian suppression involves using a medication called goserelin, which is a luteinising hormone-releasing hormone agonist (LHRHa). Your periods will stop while youre taking it, although they should start again once your treatment is complete. If youreapproaching the menopause (around the age of 50), your periods may not start again after you stop taking goserelin. Goserelin is taken as an injection once a month and can cause menopausal side effects, including: hot flushes and sweats mood swings trouble sleeping Read further information abouthormone therapy Biological therapy (targeted therapy) Some breast cancers are stimulated to grow by a protein called human epidermal growth factor receptor 2 (HER2). These cancers are called HER2-positive. Biological therapy works by stopping the effects of HER2 and by helping your immune system to fight off cancer cells. If you have high levels of the HER2 protein and are able to have biological therapy, youll probably be prescribed a medicine called trastuzumab. Trastuzumab, also known by the brand name Herceptin,is usually used after chemotherapy. Trastuzumab Trastuzumab is a type of biologial therapy",,,,,,,,,,,,,
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Breast cancer (female),"such as viruses and bacteria. The trastuzumab antibody targets and destroys cancer cells that are HER2-positive. Trastuzumab is usually given intravenously	 through a drip. Its also sometimes available as an injection under the skin (a subcutaneous injection). You will have the treatment in hospital. Each treatment session takes up to one hour and the number of sessions you need will depend on whether you have early or more advanced breast cancer. On average	 youll need a session once every three weeks for early breast cancer	 and weekly sessions if your cancer is more advanced. Trastuzumab can cause side effects	 including heart problems. This means that its not suitable if you have a heart problem	 such as angina 	 uncontrolled high blood pressure (hypertension) or heart valve disease. If you need to take trastuzumab	 youll haveregular tests on your heart to make sure its not causing any problems. Other side effects of trastuzumab may include: an initial allergic reaction to the medication	 whichcan cause nausea	 wheezing	 chills and fever diarrhoea tiredness aches and pains Clinical trials A great deal of progress has been made in breast cancer treatment	 and more women now live longer and have fewer side effects from treatment. These advances were discovered in clinical trials 	 where new treatments and treatment combinations are compared with standard ones. All cancer trials in the UK are carefully overseen to ensure theyre worthwhile and safely conducted. In fact	 participants in clinical trials can do better overall than thosein routine care. If youre asked to take part in a trial	 youll be given an information sheet and	 if you want to take part	 youll be asked to sign aconsent form. You can refuse or withdraw from a clinical trial without it affecting your care. Read further information: Breast Cancer Now: Clinical trials Against Breast Cancer:Our research Psychological help Dealing with cancer can be a huge challenge	 for both patients and their families. It can cause emotional and practical difficulties. Many women have to cope with the removal of part or all of a breast	 which can be very upsetting. It often helps to talk about your feelings or other difficulties with a trained counsellor or therapist. You can ask for this kind of help at any stage of your illness. There are various ways to find help and support. Your hospital doctor	 specialist nurse or GP can refer you to a counsellor. If youre feeling depressed	 talk to your GP. A course of antidepressant drugs may help	 or your GP can arrange for you to see a counsellor or psychotherapist. It can help to talk to someone whos been through the same thing as you. Many organisations have helplines and online forums. They can also put you in touch with other people whove had cancer treatment. Read further information: Breast Cancer Now: Support for you Macmillan Cancer Support:Online community Complementary therapies Complementary therapies are holistic therapies that can promote physical and emotional wellbeing. Theyre given alongside conventional treatments and include relaxation techniques	 massage	 aromatherapy and acupuncture. Complementary therapycan help some women cope with diagnosis and treatment	 and providea breakfrom the treatment plan. Your hospital or breast unit may be able to provide access to complementary therapies or suggest where you canget them. Its important to speak to your breast cancer specialist nurse about any complementary therapy you wish to use	 to make sure it doesntinterfere with your conventional treatment. Read further information aboutcomplementary therapies Living with breast cancer Recovery Most women with breast cancer have an operation as part of their treatment. Getting back to normal after surgery can take some time. Its important to take things slowly and give yourself time to recover. During this time	 avoid lifting things  for example	 children or heavy shopping bags  and avoid heavy housework. You may also be advised not to drive. Read more about recovering from an operation Some other treatments	 particularly radiotherapy and chemotherapy 	 can make you very tired. You may need to take a break from some of your normal activities for a while. Dontbe afraid to ask for practical help from family and friends. Follow-up After your treatment has finished	 youll be invited for regular check-ups	 usually every 3 months for the first year. If youve had early breast cancer	 your healthcare team will agree a care plan with you after your treatment has finished. This plan contains the details of your follow-up. You will receive a copy of the plan	 which will also be sent to your GP. During the check-up	 your doctor will examine you and may carry out blood tests or X-rays to see how your cancer is responding to treatment. You should also be offered a mammogram every year for the first 5 years after your treatment. Long-term complications Although its rare	 your treatment for breast cancer may cause new problems	 such as: pain and stiffness in your arms and shoulders may occur after surgery	 and the skin in these areas may be tight lymphoedema (a build-up of excess lymph fluid which causes swelling)  this may occurif surgery or radiotherapy damages the lymphatic drainage system in the armpit Talk to your healthcare team if you experience these or any other long-term effects of treatment. Read further information: Breast Cancer Now:Life after treatment Breast Cancer Now: Lymphoedema Cancer Research UK: Follow up after breast cancer treatment Your body and breasts after treatment Dealing with changes to your body A diagnosis of breast cancer may change how you think about your body. All women react differently to the bodily changes that happen as a result of breast cancer treatment. Some women react positively	 but others find it more difficult to cope. Its important to give yourself time to come to terms with any changes to your body. Read further information: Breast Cancer Now: Coping with breast cancer emotionally healthtalk: Body image and breast cancer Macmillan Cancer Support:Changes to your appearance and body image Early menopause Although most cases of breast cancer occur in women over 50 who have experiencedthe menopause 	 some younger women have to cope with early menopause brought on by cancer treatment. Symptoms can include hot flushes	 vaginal dryness and loss of sexual desire . Talk to your healthcare team about any symptoms you have and theyll be able to help. Read further information: Breast Cancer Now: Fertility and breast cancer treatment Cancer Research UK: Breast cancer and menopausal symptoms Macmillan: Menopausal symptoms and cancer treatment Prosthesis A breast prosthesis is an artificial breast	 which can be worn inside your bra to replace the breast thats been removed. Soon after a mastectomy	 youll be given a lightweight foam breast to wear until the area affected by surgery or radiotherapy has healed. After its healed	 youll be offered a silicone prosthesis. Prostheses come in many different shapes and sizes	 and you should be able to find one that suits you. Read further information: Breast Cancer Now: Your body after breast cancer treatment Cancer Research UK: False breast shape (prosthesis) after breast cancer surgery Reconstruction If you didnt have immediate breast reconstruction (carried out at the time of a mastectomy)	 you can have reconstruction later. This iscalled a delayed reconstruction. There are 2 main methods of breast reconstruction  reconstruction using your own tissue and reconstruction using an implant. The type thats most suitable for you will depend on many factors	 including the treatment youve had	 any ongoing treatment and the size of your breasts. Talk to your healthcare team about which reconstruction is suitable for you. Read further information about breast reconstruction Relationships with friends and family Its not always easy to talk about cancer 	 either for you or your family and friends. You may sense that some people feel awkward around you or avoid you. Being open about how you feel and what your family and friends can do to help may put them at ease. However	 dont be afraid to tell them that you need some time to yourself	 if thats what you need. Read further information: Breast Cancer Now: Telling family and friends about your breast cancer Macmillan Cancer Support: Talking about your cancer Healthtalk: How breast cancer affects families Your sex life Breast cancer and its treatment can affect your sex life. Its common for women to lose interest in sex after breast cancer treatment. Your treatment may leave you feeling very tired. You may feel shocked	 confused or depressed about being diagnosed with cancer. You may be upset by the changes to your body or grieve the loss of your breasts or	 in some cases	 your fertility. Its understandable that you may not feel like having sex while coping with all this. Try to share your feelings with your partner. If you have problems with sex that arent getting better with time	 you may want to speak to a counsellor or sex therapist. Read further information: Breast Cancer Now: Sex and breast cancer treatment Cancer Research UK: Life after breast cancer surgery Macmillan Cancer Support: Sex and side effects of cancer treatment Money and financial support If you have to reduce or stop work because of your cancer	 you may find it difficult to cope financially. If you have cancer or youre caring for someone with cancer	 you may be entitled to financial support	 for example: if you have a job but cant work because of your illness	 youre entitled to Statutory Sick Pay from your employer if you dont have a job and cant work because of your illness	 you may be entitled to Employment and Support Allowance if youre caring for someone with cancer	 you may be entitled to Carers Allowance you may be eligible for other benefits if you have children living at home	 or if you have a low household income Find out what help is available to you as soon as possible. The social worker at your hospital will be able to give you the information you need. Talk to other people Your GP or nurse may be able to answer any questions you have about your cancer or treatment. You may find it helpful to talk to a trained counsellor or psychologist	 or to someone at a specialist helpline. Your GP surgery will have information on these. Some people find it helpful to talk to other people who havebreast cancer	 either at a local support group or in an internet chatroom. Read further information: Breast Cancer Now: Support for you Macmillan Cancer Support: Online community Preventing breast cancer As the causes of breast cancer arent fully understood	 its not known if it can be prevented altogether. Some treatments are available to reduce the risk in women who have a higher risk of developing the condition than the general population. Diet and lifestyle Regular exercise and a healthy	 balanceddiet are recommended for all women because they can help prevent many conditions	 including heart disease 	 diabetes and many forms of cancer . Regular exercise can reduce your risk of developing breast cancer. If you have been through the menopause 	 its particularly important that youre not overweight or obese . This is because these conditions cause more oestrogen to be produced	 which can increase the risk of breast cancer. Breastfeeding Studies have shown that women who breastfeed are statistically less likely to develop breast cancer than those who dont. The reasons arent fully understood	 but it could be because women dont ovulate as regularly while theyre breastfeeding and oestrogen levels remain stable. Treatments to reduce your risk If you have an increased risk of developing breast cancer	 treatment is available to reduce your risk. Your level of riskis determined by factors such as your age	 your familys medical history and the results of genetic tests. You will usually be referred to a specialist genetics service if its thought you have an increased risk of breast cancer.Healthcare professionals working at these servicesshould discuss treatment options with you. The 2 main treatments are surgery to remove the breasts (mastectomy) or medication. Mastectomy A mastectomy is surgery to remove the breasts. It can be usedto treat breast cancer and reduce the chances of developing the condition in the small number of women from high-risk families. By removing as much breast tissue as possible	 a mastectomy canreduceyour risk of breast cancer by up to 90%. However	 like all operations	 theres a risk of complications	 and having your breasts removed can have a significant effect on your body image and sexual relationships. If you want to	 you can usually chooseto have breast reconstruction either during the mastectomy operation	 or at a later date. During breast reconstruction surgery	 your original breast shape is recreated using eitherbreast implants or tissue from elsewhere in your body. An alternative is to usebreast prostheses. These areartificial breaststhat can be worn inside your bra. Read more about your body and your breasts after treatment Medication In 2013	 the National Institute for Health and Care Excellence (NICE) announced that 2 medications	 called tamoxifen and raloxifene	 would be available on the NHSfor women who have an increased risk of developing breast cancer. Eithertamoxifen or raloxifene can be used in women whove been through the menopause	 but only tamoxifen should be used in women who havent. Thesemedications may not be suitable if in the past youve had blood clots or womb cancer 	 or if you have an increased risk of developing these problems in the future. Women whove already had a mastectomy to remove both breastswont be offered these medications	 because their risk of developing breast cancer is very small. Acourse of treatment with tamoxifen or raloxifene will usually involve taking a tablet every day for 5 years. Raloxifene can cause side effects including flu-like symptoms 	 hot flushes and leg cramps. Side effects of tamoxifen can include hot flushes and sweats	 changes to yourperiods	 and nausea and vomiting. Your chances of giving birth to a child with birth defects increase while youre taking tamoxifen	 soyoull be advised to stop taking it at least 2 months before trying for a baby. The medication can also increase your risk of blood clots	 so you should stop taking it 6 weeks before having any planned surgery. Tamoxifen and raloxifene arent currently licensed for the purpose of reducing the risk of breast cancer in women with an increasedrisk of developing the condition. However	 they can still be used if you understand the benefits and risks	 and your doctor believes the treatment will be helpful.",,,,,,,,,,,,,
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Breast cancer (male),"Breast cancer in men - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Breast cancer (male) Breast cancer (male) About breast cancer in men Symptoms of breast cancer in men Causes of breast cancer in men Diagnosing breast cancer in men Treating breast cancer in men About breast cancer in men Breast cancer is often thought of as a condition that only affects women, but men can also develop it. Itsmuch less common in men than women. The cancer develops in the small amount of breast tissue men have behind their nipples. The most common symptom is a hard, painless lump in one of the breasts. However, the vast majority of breast lumps are caused bya condition called gynaecomastia . This is a common non-cancerous condition where male breast tissue becomes enlarged. Breast cancer in men can also cause nipple problems, such as the nipple turning in on itself (retraction) or nipple discharge. Read more about the symptoms of male breast cancer When to speak to your GP You should always talk to your GP if you notice a lump in your breast or you have problems affecting your nipples, such as discharge. While these symptoms are unlikely to be caused by breast cancer, they should be investigated further. Why it happens The cause of male breast cancer is unclear, but factors known to increase your chances of developing the condition include: age  most cases affect men over the age of60 having a family history of breast cancer (male or female) obesity  a body mass index (BMI) of 30 or more Read more about causes of breast cancer in men Treating breast cancer in men In most cases, surgery is used to remove the cancer, along with a section of the breast. This may be followed by a long-term course of hormone-blocking therapy using medication, usuallya drugcalled tamoxifen. Tamoxifen helps block the effects of hormonesknown to stimulate the growth of cancerous cells in breast tissue. It should help prevent the cancer returning. In some cases, radiotherapy or chemotherapy may be used for the same purpose. Read more about treating breast cancer in men Outlook The outlook for breast cancer is not as good in men as in women. This is because theres reduced awareness of the condition and it may take longer to diagnose. The survival rates for breast cancer in men largely depend on how far the cancer has spread before its diagnosed. Breast cancer diagnosed at an early stage can often be treated successfully, but effective treatment is more difficult if the cancer has spread beyond the breast tissue. Unfortunately, many cases are diagnosed after the cancer has already started to spread. Read more about diagnosing breast cancerin men . Reducing your risk The most effective way of reducing your risk of developing breast cancer, as well as other serious health conditions, is to: drink alcohol in moderation maintain a healthy weight  through a combination of eating a healthy diet and exercising regularly Read more about preventing cancer Symptoms of breast cancer in men The main symptom of breast cancer in men is a hard lump in one of your breasts. The lump is almost always painless. The lump is usually located underneath the nipple and areola (the circle of dark-coloured skin surrounding the nipple). However, the vast majority of breast lumps arecaused bya condition called gynaecomastia . This is a common non-cancerous condition where male breast tissue becomes enlarged. Less common symptoms of male breast cancerinclude: the nipple beginning to turn in on itself (nipple retraction) the nipple becoming hard and inflamed, and looking sore (nipple ulceration) fluid leaking from the nipple (nipple discharge) Advanced symptoms Additional symptoms usually only develop if the cancer spreads from the breast to other parts of the body, such as the bones, liver or lungs. This is known as metastatic breast cancer. Symptoms of metastatic breast cancer include: bone pain swelling of the lymph nodes (glands), usually in or around the armpit shortness of breath feeling unusually tired all the time feeling sick (nausea) itchy skinwithyellowing of the skin and whites of the eyes (jaundice) When to seek medical advice You should always visit your GP if you notice a lump in your breast or you haveproblems affecting your nipples, such as retraction, ulceration or discharge. These problemsare unlikely to be of the result of breast cancer, but theyshould beinvestigated further. Causes of breast cancer in men Its not clear exactly what causes breast cancer in men, although a number of things can increase your risk of developing the condition. Age Like many cancers, men have an increased risk of developing breast cancer as they get older. Most cases are diagnosed in men aged 60 to 70. Its rare for young men todevelop the condition. Genetics and family history A genetic mutation isa permanent alteration in the DNA sequence that makes up a gene.The result is thatone or more of the bodys processes may not work in the way they should. There are a number of genetic mutations known to increase your risk of developing breast cancer. The most significant mutation identified is known as the BRCA2 mutation. Theres also evidence that breast cancer can run in families, especially in men who have a first-degree relative who has developed breast cancer,such as a mother or sister. Routine testing for the faulty genes that cause breast cancer in men isnt usually carried out on the NHS, unless specifically requested by a specialist. However,some private clinics may offer gene testing. Tests can be expensive, with prices ranging from around 2,000 to 3,000. Oestrogen Theres evidence that high levels of the hormone oestrogen, or prolonged exposure to it, can increase the risk of breast cancer in men. Comparedwith women, men tend to have low levels of oestrogen, but there are circumstances that can increase the levels of oestrogen in men. These include: hormone treatments  man-made (synthetic) versions of oestrogen are often used to treat prostate cancer, and are also given to transgender patientsundergoing a male to female sex change obesity  obese men have higher levels of oestrogen than normal cirrhosis  this is scarring of the liver, often caused by long-term alcohol misuse There is also a rare genetic condition affecting males called Klinefelter syndrome . This is a congenital condition thatboys are born with that meansthose who areaffectedproduce less of the hormone testosterone than usual. As testosterone usually helps to limit the effect of oestrogen, men with Klinefelter syndrome are more likely to develop breast cancer than the general male population. Occupational risks Theres some evidence men who work in hot environments are twice as likely to develop breast cancer compared with men who work in cooler environments. Environments linked to an increased risk of breast cancer in men include: blast furnaces steelworks rolling mills  a factory where metal (usually steel) is shaped using rollers car manufacturing plants One hypothesis to help explain the link between working environment and the increased risk of developing breast cancer is that excessive heat may damage the testicles, which could lead to an increase in oestrogen levels. Another hypothesis is that working in hot environments usually involves exposure to certain chemicals that may increase the risk of developing breast cancer in men. Rates of breast cancer are also unusually high in men who manufacture perfumes and soaps. They are 7 times more likely to develop breast cancer than the male population at large. The reason for this increased risk is still unclear. Exposure to certain chemicals seems to be an obvious possibility, but this hasnt yet been proven. Radiation Exposure to radiation has been linked to an increased risk of developing breast cancer in men. Research has found men who received a course of radiotherapy  where high energy X-rays are used to kill cancerous cellsdirected at the upper chest were seven times more likely to develop male breast cancer comparedwith the population at large. However, even a seven-fold increase means the chance of developing breast cancer is still very low. Diagnosing breast cancer in men If you have symptoms of breast cancer, such as a hard, painless lump in one of your breasts, your GP will carefully examine you. During the examination, theyll also look for other possible signs of male breast cancer, such as swollen lymph nodes (glands). Its likely your GP will refer you for further tests if theres a possibility you may have breast cancer. Mammogram A mammogram is a type of X-ray used to help determine whether there are any changes in breast tissue that could be the result of cancer. During the mammogram procedure, a radiographer (a specialist in taking X-rays) will compress one of your breasts between two X-ray plates. This shouldnt be painful, but you should tell the radiographer if you find it uncomfortable. Once your breast has been correctly positioned, an X-ray will be taken that produces a clear image of the inside of your breast. The procedure will then be carried out on your other breast. Ultrasound An ultrasound scan uses high-frequency sound waves to produce an image of the inside of your breasts, in the same way an unborn baby can be seen in the womb. An ultrasound probe or sensor will be placed over your breasts to create an image of the inside of your breasts on a screen. The image will highlight any lumps or abnormalities that may be present in your breasts. Biopsy A biopsy may be recommended if a mammogram or ultrasound scan highlight any lumps or abnormalities in your breasts. A biopsy is a test that can either confirm or rule out a diagnosis of breast cancer in men. It involves taking a sample of suspected cancerous tissue and examining it in a laboratory for the presence of cancerous cells. A type of biopsy known as a core biopsy is usually recommended for the diagnosis of breast cancer in men. This type of biopsy can usually indicate whether the cancer has started to spread from the breast into the surrounding area. During a core biopsy, a local anaesthetic will be used to numb your breast. A hollow needle will then be used to remove a number of small tissue samples from the breast lump. If cancer is found, its also possible to check whether there are special proteins, known as oestrogen receptors, on the surface of the cancerous cells. This is important, because if oestrogen receptors are found and they are in more than halfof casesits possible to treat the cancer with hormone therapy. Read treating breast cancer in men for more information. Staging After breast cancer has been diagnosed, your care team should provide information about the stage of the cancer. Staging is a system used to describe how far a cancer has spread at the point of diagnosis. A cure may be possible if breast cancer is diagnosed at an early stage. However, treatment can only be used to control symptoms and slow the spread of the cancer if its diagnosed at a later stage. Unfortunately, more than 40% of breast cancers in men are diagnosed at a late stage. In some cases, men are diagnosed with a type of breast cancer called ductal carcinoma in situ (DCIS). This means there are cancer cells in the breast, but theyre contained within the breast ducts and cant spread. If left untreated, DCIS can lead to invasive breast cancer over a period of time. Coping with a diagnosis Being told you have breast cancer can cause a wide range of emotions, such as shock, fear, confusion and, in some cases, embarrassment. Most people assume breast cancer only affects women, so it can be difficult to come to terms with the diagnosis. Feelings of isolation and being alone are common in men with breast cancer. This may be because theres little in the way of advice and support for men with breast cancer, particularly when comparedwith the support available for women with the condition. Sometimes men who find themselves in this situation can become depressed. You may be depressed if youve felt very down and no longer interested in doing activities you used to enjoyduring the past month. If you think you may be depressed, visit your GP. There is a range of effective treatments, such as medication and counselling, that can help relieve feelings of depression. You may also find it useful to talk to other men affected by the condition. Breast Cancer Now is a breast cancer charity that provides an online forum for anyone diagnosed with breast cancer . Cancer Research UK also provides Cancer Chat , an online forum for anyone affected by cancer. Screening for breast cancer in men As breast cancer israre inmen, routine screening for the condition isnt recommended, even for men in high-risk groups, such as those with a family history of breast cancer or those who have had radiotherapy . Treating breast cancer in men Treatment for breast cancer in men largely depends on how far the cancer has spread. Most hospitals use multidisciplinary teams (MDTs) to treat men with breast cancer. These are teams of specialistswho work together to make decisions about the best way to proceed with your treatment. Deciding which treatment is best for you can often be confusing. Your cancer team will recommend what they think is the ideal treatment option, but the final decision will be yours. Before visiting hospital to discuss your treatment options, you may find it useful to write a list of questions youd like to ask the specialist. For example, you could ask aboutthe advantages and disadvantages of particular treatments. Your treatment plan Your recommended treatment plan depends on how far the cancer has spread. If the cancer hasnt spread significantly beyond your breast, a complete cure may be possible. In these cases, surgery to remove the affected breast is usually recommended. This is often followed by radiotherapy , hormone therapy, or chemotherapy to help prevent the cancer returning. If the cancer has spread beyond your breast into other parts of your body, such as your lungs, a complete cure wont be possible. However, hormone therapy and chemotherapy can be used to relieve symptoms and slow down the spread of the cancer. More information about these treatments can be found below. Surgery An operation called a mastectomy is usually recommended as the first treatment for breast cancer. A mastectomy involves removing the entire breast,sometimes with the nipple and lymph nodes (glands) in the armpit. A procedure known as asentinel lymph node biopsy may also be performed. In some cases, part of the muscle under the breast may also be removed if theres a risk the cancer has spread to this area. Once surgery has been completed, there will be a straight scar across your chest where your nipple used to be and possibly an indentation around the area where the breast tissue used to be. After surgery Most men are well enough to leave hospital 1 to 3 days after surgery. After the operation, its likely youll feel very tired and it may take a few weeks before youre well enough to start carrying out relatively strenuous activities, such as lifting objects or driving. Your specialist nurse will be able to offer more specific advice about this. The wound takes about 2 to 3 weeks to heal. Its important to keep the wound clean during this time. You should look for any signs that the wound may have become infected, such as redness and swelling around the wound or a discharge of pus. Inform your MDT as soon as possible if you suspect an infection. Its difficult to predict when youll feel able to return to work. Some people choose to remain off work until other treatments, such as radiotherapy, have been completed. Others prefer to return to work in between treatments. Your MDT will be able to advise you, but the final decision will be yours. It can take several weeks to fully recover from the effects of a mastectomy. A structured exercise programme, where the intensity and amount of time spent exercising is gradually increased, will probably be recommended. Yourtreatment teamwill be able to provide you with more advice or refer you to a physiotherapist (a specialist with training in rehabilitation using exercise). Complications of surgery Aftersurgery, you may experience numbness or tingling at the site of the scar and in your upper arm. This is common, and iscaused by nerve damage during surgery. The numbness and tingling should pass within a few weeks or months, although it can occasionally be permanent. Anotherpossible complication is painful swelling in the arms. This is called lymphoedema , which is caused by the disruption of the lymphatic system (a series of channels and lymph nodes normally responsible for removing excess fluid from tissue). If many lymph nodes are surgically removed, it can disrupt the lymphatic systems ability to drain fluid, which can lead to swelling. Theres no cure for lymphoedema, but its possible to control the symptoms using a combination of different techniques, such as massage and compression garments. See treating lymphoedema for more information Radiotherapy Radiotherapy is a type of treatment involving a machine that releases high-energy waves to destroy cancerous cells. It can be given a few weeks after surgery to prevent the cancerous cells returning. A typical course of radiotherapy involves 2 to 5 sessions a week over the course of 3 to 6 weeks. The sessions are short and usually only last for 10 to 15 minutes. Radiotherapy isnt usually painful, although youll probably experience some side effects. This is because the energy released during radiotherapy can also damage healthy cells. Common side effects of radiotherapy can include: extreme tiredness (fatigue) feeling sick (nausea) sore, red and irritated skin on the breast similar in appearance to sunburn The side effects of radiotherapy should pass after your course of treatment has finished, although some men experience prolonged fatigue for several months. Radiotherapy can also be used in cases of advanced breast cancer to slow down the spread of the cancer and relieve the symptoms of pain. This is known as palliative radiotherapy. Palliative radiotherapy is usually given in just 1 or 2 doses and doesnt usually cause any side effects. Hormone therapy Up to90% of cases of breast cancers in men are oestrogen receptor positive, or ER+. E is used because the American spelling of oestrogen is estrogen. This means the cancerous cells require oestrogen to grow. Oestrogen is a type of hormone found in low levels in men and much higher levels in women. The aim of hormone therapy is to block the effects of oestrogen on the breast tissue to prevent the cancer recurring after surgery. It can also be used in cases of advanced breast cancer to slow down the spread of the cancer. Tamoxifen Tamoxifen isone of the hormone-blockingmedications widely used for breast cancer. Its available in tablet or liquid form, and prevents oestrogen entering the breast tissue cells. The ideal length of treatment with tamoxifen is unclear. Studies in women with breast cancer suggest a five-year course of treatment is the most effective for preventing the return of cancer and extending survival rates. However, its unclear if this also applies to men. Tamoxifen can also cause unpleasant side effects, which will be taken into consideration when yourtreatment teamis deciding which treatments to recommend. You can discuss the pros and cons of long-term treatment with tamoxifen with your doctors. Side effects of tamoxifen caninclude: reduced interest in sex (loss oflibido) inability to obtain or maintain an erection (erectile dysfunction) headache feeling sicktaking your medication with food may help reduce this side effect changes in mood, such as feeling irritable or depressed You should inform yourteam if you experience side effects that become particularly troublesome, as alternative medications are available. Aromatase inhibitors Aromatase inhibitors are an alternativetype of hormone medication. They may be used if tamoxifen proves unsuccessful or the side effects of tamoxifen are particularly troublesome. Aromatase inhibitors can also be used to slow the spread of advanced breast cancer. In men, oestrogen is created when a protein called aromatase converts another hormone called androgens. Aromatase inhibitors block the effects of aromatase, which in turn lowers the amount of oestrogen in the body. Aromatase inhibitors are usually given in tablet form and taken daily for two to five years. As with tamoxifen, theres little available evidence about the most effective length of dosage in men, compared with female breast cancer. Side effects of aromatase inhibitors can include: joint pain lack of energy hot flushes skin rashes feeling sick being sick thinning of the hair However, its unlikely youll experience any or all of these side effects. Chemotherapy Chemotherapy is used to treat cases of breast cancer where hormone therapy would be largely ineffective because the cancerous cells are not oestrogen receptor positive (ER+). Its usually given after surgery to help prevent the cancer returning, or its used to treat the symptoms of incurable cancer. Chemotherapy for breast cancer involves taking a combination of cancer-killing medications. Treatment is usually given every 2 to3 weeks over the course of 6 months. You may be given chemotherapy tablets (oral chemotherapy), chemotherapy injections (intravenous chemotherapy), or a combination of both. The side effects of chemotherapy can include: feeling sick being sick diarrhoea loss of appetite mouth ulcers tiredness skin rashes infertility hair loss The side effects should resolve once your treatment has finished.Your hair should grow back about 3 to 6 monthsafter treatment. Chemotherapy can also weaken your immune system, making you more vulnerable to infection. Its important totell your MDT aboutany symptoms of a potential infection, such as: a high temperature of 38C (100.4F) or above flu-like symptoms, such as chills or joint pain a general sense of feeling unwell You should also avoid close contact with people known to have an infection. If youre sexually active, you should use a condom for 48 hours after receiving a dose of chemotherapy medication. This is because the medication used in chemotherapy could pass into your semen and cause irritation in the tissue of your partners genitals. You should avoid having children while receiving chemotherapy as many of the medications can damage your sperm and increase your chances of having a baby with a birth defect. Again, using a reliable method of contraception, such as a condom, is recommended Depending on the medications used, it may be several months after your course of chemotherapy has ended before you can safely have children. Your MDT will be able to give you a more detailed recommendation. Biological therapy Biological therapy uses medication to block the effects of a protein called human epidermal growth factor receptor 2 (HER2) in cases where HER2 is contributing to breast cancer. Biological therapies are sometimes referred to as targeted therapies because they are designed to target biological processes that cancers rely on to grow and reproduce. If you have high levels of the HER2 protein andare able to have biological therapy, youll probably be prescribed a medicine called trastuzumab.Also known by the brand name Herceptin, itis usually used after radiotherapy or chemotherapy to prevent cancerous cells returning. Trastuzumab Trastuzumab is a type of biological therapy known as a monoclonal antibody. Antibodies occur naturally in the body and are created by the immune system to destroy harmful cells, such as viruses and bacteria. The trastuzumab antibody targets and destroys cancer cells designed to respond to the HER2 protein. Trastuzumab is given through a drip, directly into a vein (intravenously). Youll receive the treatment in hospital. Each treatment session takes up to 1 hour, and the number of sessions you need depends on whether your breast cancer is in its early or more advanced stages. On average, for early breast cancer youll need to have a session once every 3 weeks, and for more advanced cancer youll need to have weekly sessions. Trastuzumab can cause side effects, including heart problems. This means its not suitable if you have a heart problem, such as angina , uncontrolled high blood pressure (hypertension), or heart valve disease. If you need to take trastuzumab, youll need to have regular tests on your heart to ensure its not causing any problems. Other side effects of trastuzumabcan include: an initial allergic reaction to the medication, which can cause nausea, wheezing, chills and fever diarrhoea tiredness aches and pains ",,,,,,,,,,,,,
Bronchiectasis,"Bronchiectasis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Lungs and airways Bronchiectasis Bronchiectasis About bronchiectasis Symptoms of bronchiectasis Causes of bronchiectasis Diagnosing bronchiectasis Treating bronchiectasis Complications of bronchiectasis About bronchiectasis Bronchiectasis is a long-term condition where the airways of the lungs become abnormally widened, leading to a build-up of excess mucus that can make the lungs more vulnerable to infection. The most common symptoms of bronchiectasis include: a persistent cough that usually brings up phlegm (sputum) breathlessness The severity of symptoms can vary widely. Some people have only a few symptoms that dont appear often, while others have wide-ranging dailysymptoms. The symptoms tend to get worse if you develop an infection in your lungs. Read more about the symptoms of bronchiectasis . When to see your GP You should see your GP if you develop a persistent cough. While this may not becaused bybronchiectasis, it requires further investigation. If your GP suspects you may have bronchiectasis, theyll refer you to a specialist in treating lung conditions (a respiratory consultant) for further tests. Read more about diagnosing bronchiectasis . How the lungs are affected The lungs are full of tiny branching airways, known as bronchi. Oxygen travels through these airways, ends up in tiny sacs called alveoli, and from there is absorbed into the bloodstream. The inside walls of the bronchi are coated with sticky mucus, which protects against damage from particles moving down into the lungs. In bronchiectasis, one or more of the bronchi are abnormally widened. This means more mucus than usual gathers there, which makes the bronchi more vulnerable to infection. If an infection does develop, the bronchi may be damaged again, so even more mucus gathers in them, and the risk of infection increases further. Over time, this cycle can cause gradually worsening damage to the lungs. Why it happens Bronchiectasis can develop if the tissue and muscles that surround the bronchi are damaged or destroyed. There are many reasons why this may happen. The three most common causes in the UKare: alung infection during childhood, such as pneumonia or whooping cough , that damages the bronchi underlying problems with the immune system (the bodys defence against infection) that make the bronchi more vulnerable to damage from an infection allergic bronchopulmonary aspergillosis (ABPA)  an allergy to a certain type of fungi that can cause the bronchi to become inflamed if spores from the fungiare inhaled However, in many cases of bronchiectasis, no obvious cause for the condition can be found (known as idiopathic bronchiectasis). Read more about the causes of bronchiectasis . Who is affected Bronchiectasis is thought to be uncommon. Its estimated that around 1 in every 1,000 adults in the UK have the condition. It can affect anyone at any age, butsymptoms dont usually develop until middle age. Over 12,000peoplewere admittedto hospital in England during 2013-14 with bronchiectasis. The majority of thesepeople were over 60 years old. How bronchiectasis is treated The damage caused to the lungs by bronchiectasis is permanent, but treatment can help relieve your symptoms and stop the damage getting worse. The main treatments include: exercises and special devicesto help you clear mucus out of yourlungs medication to help improve airflow within the lungs antibiotics to treat any lung infections that develop Surgeryis usually only considered for bronchiectasis in rare cases where other treatments havent been effective, the damage to your bronchi is confined to a small area and youre in good general health. Read more about the treatment of bronchiectasis . Possible complications Complications of bronchiectasis are rare, but they can be serious. One of the most serious complications is coughing up large amounts of blood, causedby one of the blood vessels in the lungs splitting. This problem can be life-threatening and may require emergency surgery to treat it. Read more about the complications of bronchiectasis . Outlook The outlook for people with bronchiectasis is highly variable and often depends on the underlying cause. Living with bronchiectasis can be stressful and frustrating, but most people with the condition have a normal life expectancy. For people with very severe symptoms, however, bronchiectasis can be fatal if the lungs stop working properly. Around 1,000 deaths reported in England and Wales each year are thought to becaused bybronchiectasis. Information about you If you havebronchiectasis, your clinical team may pass information about you on to the National Congenital Anomaly and Rare Diseases Registration Service (NCARDRS). This helps scientists look for better ways to prevent and treat this condition. You can opt out of the register at any time. Find out more about the register . Symptoms of bronchiectasis The most common symptom of bronchiectasis is a persistent cough that brings up a large amount of phlegm on a daily basis. The phlegmcan be clear, pale yellow or yellow-greenish in colour. Other peoplemay only occasionallycough up small amounts of phlegm, or none at all. Other symptoms may include: shortness of breath wheezing coughing up blood or blood-stained phlegm chest pain joint pain clubbing of the fingertips  the tissue beneath the nail thickens and the fingertips become rounded and bulbous Signs of a lung infection If youdevelop a lung infection, your symptoms usually get worsewithin a few days. This is known as an infective exacerbation and it can cause: coughing up even morephlegm, which may bemore green than usualor smell unpleasant worsening shortness of breath You may also: feel very tired cough up blood, if you havent already done so experience a sharp chest pain thats made worse when breathing ( pleurisy ) feel generally unwell When to seek medical advice If you havent previously beendiagnosed with bronchiectasis and you develop a persistent cough, visit your GP for advice. While persistent coughing may not necessarily be the result of bronchiectasis, it requires further investigation. If youve been previously diagnosed with bronchiectasis and you begin to experience symptoms that suggest you have a lung infection, contact your GP. Youll usually need treatment with antibiotics. Some people with bronchiectasis are given a stock of antibiotics as a precaution, in case they suddenly develop a lung infection. When to seek immediate medical advice Some people with bronchiectasis develop a severe lung infection that may need to be treated in hospital. Signs and symptoms of serious lung infection include: a bluish tinge to theskin and lips (cyanosis) confusion a high temperature of 38C (100.4F) or above rapid breathing (more than 25 breathsa minute) severe chest pain that makes it too painful to cough and clear your lungs If you experience any of the above, phone the healthcare professional in charge of your care immediately. This may be your GP, a doctor who specialises in lung conditions (pulmonologist) or a specialist nurse. If this isnt possible, then phone the NHS 24 111 serviceor your local out-of-hours service. Causes of bronchiectasis Bronchiectasis is caused by the airways of the lungs becoming damaged and widened. This can be due to an infection or another condition. Sometimes, the cause is not known. Your lungs are continually exposed to germs, soyour body has sophisticated defence mechanisms designed to keep the lungs free of infection. Ifa foreign substance (such as bacteria or a virus) gets past these defences, your immune system will attempt to stop the spread of any infection by sending white blood cells to the location of the infection. These cells release chemicals to fight the infection, which can cause thesurrounding tissue to become inflamed. For most people, this inflammation will pass without causing any further problems. However, bronchiectasis can occur if the inflammation permanently destroys the elastic-like tissue and muscles surrounding the bronchi (airways), causing them to widen. The abnormal bronchi then become filled with excess mucus, which can trigger persistent coughing and make the lungs more vulnerable to infection. If the lungs do become infected again, thiscan result in further inflammation and further widening of the bronchi. As this cycle is repeated, the damage to the lungs gets progressively worse. How quickly bronchiectasis progresses can vary significantly. For some people, the condition will get worse quickly, but for many the progression is slow. Commoncauses In around half of all cases of bronchiectasis, no obvious cause can be found. Some of the morecommon triggers that have been identified are described below. Childhood infections Around a third of cases of bronchiectasis in adults are associated with a severe lung infection in childhood, such as: severe pneumonia whooping cough tuberculosis (TB) measles However, as there are now vaccinations available for these infections, it is expected that childhood infections will become a less common cause of bronchiectasis in the future. Immunodeficiency Around 1 in 12 cases of bronchiectasis occur because a person has a weakened immune system, which makes their lungs more vulnerable to tissue damage. The medical term for having a weakened immune system is immunodeficiency. Some people are born with an immunodeficiency because of problems with the genes they inherit from their parents. Its also possible to acquire an immunodeficiencyafter an infection such as HIV . Allergic bronchopulmonary aspergillosis (ABPA) Around 1 in 14 people with bronchiectasis develop the condition as a complication of an allergic condition known as allergic bronchopulmonary aspergillosis (ABPA). People with ABPA have an allergy to a type of fungi known as aspergillus, which is found in a wide range of different environments across the world. If a person with ABPA breathes in fungal spores, it can trigger an allergic reaction and persistent inflammation, which in turn can progress to bronchiectasis. Aspiration Aspiration is the medical term for stomach contents accidentally passing into your lungs, rather than down into your gastrointestinal tract. This is responsible for around 1 in 25 cases of bronchiectasis. The lungs are very sensitive to the presence of foreign objects, such as small samples of food or even stomach acids, so this can trigger inflammation leading to bronchiectasis. Cystic fibrosis Cystic fibrosis is a relatively common genetic disorder, where the lungs become clogged up with mucus. The mucus then provides an ideal environment for a bacterial infection to take place, leading to the symptoms of bronchiectasis. It is estimated that cystic fibrosis is responsible for around 1 in 33 cases of bronchiectasis. Cilia abnormalities Cilia are the tiny, hair-like structures that line the airways in the lungs. They are designed to protect the airways and help move away any excess mucus. Bronchiectasis can develop if there is a problem with the cilia that means they are unable to effectively clear mucus from the airways. Conditions that can cause problems with the cilia include: Youngs disease  a rare condition only affecting males that is thought to be caused by exposure to mercury in childhood primary ciliary dyskinesia  a rare condition caused by inheriting faulty genes Its estimated that about 1 in every 33 cases of bronchiectasis are caused by Youngs disease and 1 or 2 in every 100 cases are caused by primary ciliary dyskinesia. However, as the regulations regarding the use of mercury are now much stricter than they were in the past, it is expected that Youngs syndrome will become a much less common cause of bronchiectasis in the future. Connective tissue diseases Certain conditions that cause inflammation in other areas of the body are sometimes associated with bronchiectasis, including: rheumatoid arthritis Sjgrens syndrome Crohns disease ulcerative colitis These conditions are usually thought to be caused by a problem with the immune system, where it mistakenly attacks healthy tissue. Diagnosing bronchiectasis You should see your GP for advice if you develop a persistent cough, so they can look for a possible cause. Your GP will ask you about your symptoms, such as how often you cough, whether you bring up any phlegm (sputum) and whether you smoke. They may also listen to your lungs with a stethoscope as you breathe in and out. The lungs of people with bronchiectasis often make a distinctive crackling noise as a person breaths in and out. Youll also probablyhave a chest X-ray to rule out other, more serious, causes of your symptoms, such as lung cancer . If your GP thinks you may have a lung infection, they may take a sample of your phlegm, so it can be checked for bacteria. Referral to a specialist If your GP suspects you could have bronchiectasis, youll be referred to a doctor who specialises in treating lung conditions (a respiratory consultant) for further testing. The maximum time you should have to wait for referral is 18 weeks, although you may not have to wait as long as this. Read more about waiting times. Some of the tests a respiratory consultant may carry out to help diagnose bronchiectasis are described below. HRCT scan Currently, the most effective test available to diagnose bronchiectasis is called a high-resolution computerised tomography (HRCT) scan. A HRCT scan involves taking several X-rays of your chest at slightly different angles.A computer is then used to put all the images together. This produces a very detailed picture of the inside of your body and the airways inside your lungs (the bronchi) should show up very clearly. In a healthy pair of lungs, the bronchi should become narrower the further they spread into your lungs, in the same way a tree branch separates into narrower branches and twigs. If the scan shows that a section of airways is actually getting wider, this usually confirms bronchiectasis. Other tests Other tests can be used to assess the state of your lungs and to try to determine what the underlying cause of your bronchiectasis may be. These tests may include: blood tests  to check how well your immune system is working and check for infectious agents, such as bacteria, viruses and fungi phlegm (sputum) testto check for bacteria or fungi a sample of your sweat can be tested to see how much salt is in it  high levels of salt can be caused by cystic fibrosis (if this test is positive, then a more detailed genetic test can be carried out; see diagnosing cystic fibrosis for further information) lungfunction test  a small, hand-held device (spirometer) that you blow into is used to measure how hard and how quickly you can expel air from your lungs; this can assess how well your lungs are working bronchoscopy  a flexible tube with a camera at one end is used to look into your lungs; this is usually only required if you think youveinhaleda foreign object Treating bronchiectasis The damage to the lungs associated with bronchiectasis is permanent, but treatment can help prevent the condition getting worse. In most cases, treatment involves a combination of medication, exercises you can learn and devices to help clear your airways. Surgery for bronchiectasis is rare. There are a number of things you can do to help relieve the symptoms of bronchiectasis and stop the condition getting worse, including: stopping smoking (if you smoke) having the flu vaccine every year making sure you have had the pneumococcal vaccine to protect against pneumonia exercising regularly keeping yourself well hydrated eating a balanced diet Exercises There are a range of exercises, known as airway clearance techniques, which can help to remove mucus from your lungs. This can often help improve coughing and breathlessness in people with bronchiectasis. You can be referred to aphysiotherpist, who can teach you these techniques. Active cycle of breathing techniques (ACBT) The most widely used technique in the UK is called active cycle of breathing techniques (ACBT). ACBT involves you repeating a cycle made up of a number of different steps. These include a period of normal breathing, followed by deep breaths to loosen the mucus and force it up; then you cough the mucus out. The cycle is then repeated for 20 to 30 minutes. Dont attempt ACBT if you havent first been taught the steps by a suitably trained physiotherapist, as performing the techniques incorrectly could damage your lungs. If youre otherwise in good health, youll probably only need to perform ACBT once or twice a day. If you develop a lung infection, you may need to perform ACBT on a more frequent basis. Postural drainage Changing your position can also make it easier to remove mucus from your lungs. This is known as postural drainage. Each technique can involve several complex steps, but most techniques involve you leaning or lying down while the physiotherapist or a carer uses their hands to vibrate certain sections of your lungs as you go through a series of huffing and coughing. Devices There are also a number of handheld devices that can help to remove mucus from your lungs. Although these devices look different, most work in a similar way. Generally, they use a combination of vibrations and air pressure to make it easier to cough out any mucus. Examples of these devicesinclude the flutter, the RC cornet and the Acapella. However, these devices arent always available on the NHS, so you may have to pay for one yourself. They usually cost 45 to 60. Medication In some cases, medications to make breathing or clearing your lungs easier may be prescribed. These are discussed below. Nebulised medications Occasionally, medication inhaled through a device called a nebuliser may be recommended to help make it easier for you to clear your lungs. Nebulisers are devices consisting of a face mask or mouthpiece, a chamber to convert the medication into a fine mist, and a compressor to pump the medication into your lungs. A number of different medications can be administered using a nebuliser, including salt water solutions. These medications help to reduce the thickness of your phlegm so its easier to cough it out. Nebulisers can also be used to administer antibiotics, if necessary (see below). However, while the medications used with a nebuliser can be provided on prescription, the nebuliser device itself isnt always available on the NHS. In some areas, a local respiratory service may provide the device without charge, but if this isnt an option, you may have to pay for a device. Bronchodilators If you have a particularly severe flare-up of symptoms, you may be prescribed bronchodilator medications on a short-term basis. Bronchodilators are inhaled medications that help make breathing easier by relaxing the muscles in the lungs. Examples of this type of medication include beta2-adrenergic agonist, anticholinergics and theophylline. Antibiotics If you experience a worsening of symptoms because of a bacterial infection (known as an infective exacerbation) then youll need to be treated with antibiotics . A sample of phlegm will be taken to determine what type of bacteria is causing the infection, although youll be initially treated with an antibiotic known to be effective against a number of different bacteria (a broad spectrum antibiotic) becauseit can take a few days to get the test results. Depending on the test results, you may be prescribed a different antibiotic, or in some cases, a combination of antibiotics known to be effective against the specific bacteria causing the infection. If youre well enough to be treated at home, youll probably be prescribed two to three antibiotic tablets a day for 10-14 days. Its important to finish the course even if you feel better, as stopping the course prematurely could cause the infection to recur quickly. If your symptoms are more severe (see symptoms of bronchiectasis for a detailed description) you may need to be admitted to hospital and treated with antibiotic injections. Preventative treatment If you have three or more infective exacerbations in any one year, or your symptoms during an infective exacerbation were particularly severe, it may be recommended that you take antibiotics on a long-term basis. This can help to prevent further infections and give your lungs the chance to recover. This could involve taking low-dose antibiotic tablets to minimise the risk of side effects, or using an antibiotic nebuliser (see above for more information about nebulisers). Using antibiotics in this way does increase the risk that one or more types of bacteria will develop a resistance to the antibiotic. Therefore, you may be asked to give regular phlegm samples to check for any resistance. If bacteria do show signs of developing a resistance, then your antibiotic may need to be changed. Surgery Surgery is usually only recommended where bronchiectasis is only affecting a single section of your lung, your symptoms arent responding to other treatment and you dont have an underlying condition that could cause bronchiectasis to recur. The lungs are made up of sections known as lobes  the left lung has two lobes and the right lung has three lobes. Surgery for focal bronchiectasis would usually involve removing the lobe affected by the bronchiectasis in a type of operation known as a lobectomy. Surgery wont be used if more than one lobe is affected, as its too dangerous to remove so much lung tissue. Complications of bronchiectasis In some cases, people with bronchiectasis can develop serious complications that require emergency treatment. Coughing up large amounts of blood A rare, but serious, complication of bronchiectasis is coughing up large amounts of blood (the medical term for this is massive haemoptysis). This can occur when a section of one of the blood vessels supplying the lungs suddenly splits open. Symptoms that may indicate massive haemoptysis include: coughing up more than 100ml of blood in a 24-hour period  100ml is roughly equivalent to a third of a can of drink breathing difficulties  caused by blood obstructing your airways feeling lightheaded, dizzy and having cold, clammy skin  caused by rapid blood loss Massive haemoptysis is a medical emergency. If you think someoneis experiencing massive haemoptysis, then phone 999 for an ambulance. A person with massive haemoptysis needs to be admitted to hospital and a tube may need to be placed into their throat to assist them with their breathing. A procedure called a bronchial artery embolisation (BAE), carried out by specialist radiology doctors, will then be required to stop the bleeding. During a BAE, a special dye is injected into your arteries so they show up clearly on X-rays . Then, using X-ray scans as a guide, the source of the bleeding is located and injected with tiny particles, around the size of a grain of sand, that will help clog the vesselup and stop the bleeding. ",,,,,,,,,,,,,
Bronchitis,"Bronchitis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Lungs and airways Bronchitis Bronchitis About bronchitis Symptoms of bronchitis Causes of bronchitis Treating bronchitis About bronchitis Bronchitis is an infection of the main airways of the lungs (bronchi), causing them to become irritated and inflamed. The main symptom is a cough , which may bring up yellow-grey mucus (phlegm). Bronchitis may also cause a sore throat and wheezing. Read more about the symptoms of bronchitis . When to see your GP Most cases of bronchitis can be treated easily at home with rest, non-steroidal anti-inflammatory drugs (NSAIDs) and plenty of fluids. You only need to see your GP if your symptoms are severe or unusual  for example, if: your cough is severe or lasts longer than three weeks you have a constant fever(a temperature of 38C100.4For above) for more than three days you cough up mucus streaked with blood you have an underlying heart or lung condition, such as asthma or heart failure Your GP may need to rule out other lung infections, such as pneumonia , which has symptoms similar to those of bronchitis. If your GP thinks you may have pneumonia, you will probably need a chest X-ray, and a sample of mucus may be taken for testing. If your GP thinks you might have an undiagnosed underlying condition, they may also suggest a pulmonary function test. You will be asked to take a deep breath and blow into a device called a spirometer, which measures the volume of air in your lungs. Decreased lung capacity can indicate an underlying health problem. Treating bronchitis In most cases, bronchitis will clear up by itself within a few weeks without the need for treatment. This type of bronchitis is known as acute bronchitis. While you are waiting for it to pass, you should drink lots of fluid and get plenty of rest. In some cases, the symptoms of bronchitis can last much longer. If symptoms last for at least three months, it is known as chronic bronchitis. There is no cure for chronic bronchitis, but there are several medications to help relieve symptoms. It is also important to avoid smoking and smoky environments, as this can make your symptoms worse. Read more about treating bronchitis . Why do I have bronchitis? The bronchi are the main airways in your lungs, which branch off on either side of your windpipe (trachea). They lead to smaller and smaller airways inside your lungs, known as bronchioles. The walls of the bronchi produce mucus to trap dust and other particles that could otherwise cause irritation. Most cases of acute bronchitisdevelop when an infection causes the bronchi to become irritated and inflamed, which causes them to produce more mucus than usual. Your body tries to shift this extra mucus through coughing. Smoking is the most common cause of chronic bronchitis. Over time, tobacco smoke can cause permanent damage to the bronchi, causing them to become inflamed. Read more about the causes of bronchitis . Complications Pneumonia is the most common complication of bronchitis. Ithappens when theinfection spreads further into the lungs, causing air sacs inside the lungs to fill up with fluid.1 in 20 cases of bronchitis leads to pneumonia. People at an increased risk of developing pneumonia include: elderly people people who smoke people with other health conditions, such as heart, liver or kidney disease people with a weakened immune system Mild pneumonia can usually be treated with antibiotics at home. More severe cases may require admission to hospital. Read more about the treatment of pneumonia . Who is affected Acute bronchitis is one of the most common types of lung infection, and is one of the top five reasons for GP visits. Acute bronchitis can affect people of all ages, but is most common in younger children under the age of five. It is more common in winter, and often develops following a cold ,sore throat or flu . It is estimated that there are around 2 million people in the UK affected by chronic bronchitis. Most of these are adults over the age of 50. Symptoms of bronchitis The main symptom of bronchitis is a hacking cough. It is likely that your cough will bring up thick yellow-grey mucus (phlegm), although this does not always happen. Other symptoms of bronchitis are similar to those of other infections, such as the common cold or sinusitis , and may include: sore throat headache runny or blocked nose aches and pains tiredness If you have bronchitis,your cough may last for several weeks after other symptoms have gone. You may also find that the continual coughing makes your chest and stomach muscles sore. Some people may experience shortness of breathor wheezing, due to inflamed airways. However, this is more common with long-term (chronic) bronchitis. Long-term (chronic) bronchitis Chronic bronchitis is often known as chronic obstructive pulmonary disease (COPD) . The symptoms of COPD can include: wheezing increasing breathlessness when exercising or moving around a persistent cough that brings up mucus (phlegm) frequent chest infections The symptoms are often worse in the winter, and it is common to have two or more flare-ups a year. A flare-up is when your symptoms are particularly bad. When to see your GP See your GP as soon as possible if: your cough is very severe or lasts longer than three weeks you have a constant fever (a temperature of 38C  100.4F  or above) for more than three days  this may be a sign of flu or a more serious condition, such as pneumonia you cough up mucus streaked with blood you develop rapid breathing (more than 30 breaths a minute) or chest pains you become drowsy or confused you have had repeated bouts of bronchitis You should also contact your GP if you have an underlying heart or lung condition, such as: asthma heart failure  weakness in the heart that leads to fluid in your lungs emphysema  damage to the small airways in your lungs Causes of bronchitis The bronchitis infection can be caused by either a virus or bacteria, although viral bronchitis is much more common. In most cases, bronchitis is caused by the same viruses that cause the common cold or flu . The virus is contained in the millions of tiny droplets that come out of the nose and mouth when someone coughs or sneezes. These droplets typically spread about 1m (3ft). They hang suspended in the air for a while, then land on surfaces where the virus can survive for up to24 hours. Anyone who touches these surfaces can spread the virus further by touching something else. Everyday items at home and in public places, such as door handles and keyboards,may have traces of the virus on them. People usually become infected by picking up the virus on their hands from contaminated objects, and then placing their hands near their nose or mouth. It is also possible to breathe in the virus if it is suspended in airborne droplets. Breathing inirritant substances Bronchitis can also be triggered by breathing in irritant substances, such as smog, chemicals in household products or tobacco smoke. Smoking is the main cause of long-term (chronic) bronchitis, and it can affect people who inhale second-hand smoke, as well as smokers themselves. Read information about treatments to quit smoking . Occupational exposure You may also be at risk of bronchitis and other forms of chronic obstructive pulmonary disease (COPD) if you are often exposed to materials that can damage your lungs, such as: grain dust textiles (fabric fibres) ammonia strong acids chlorine This is sometimes referred to as occupational bronchitis, and usually eases once you are no longer exposed to the irritant substance. Read more information about the causes of COPD . You can also readthe Health and Safety Executives report on COPD in Great Britainattributed to occupational exposure (PDF, 275 KB). Treating bronchitis Most cases of bronchitis do not require treatment from a GP, and the symptoms can be easily managed at home. There is no cure for chronic bronchitis, but healthy livingwill help. In particular,you should stop smoking ,if you smoke. Managing symptoms at home If you have bronchitis: get plenty of rest drink lots of fluids  this helps prevent dehydration and thins the mucus in your lungs, making it easier to cough up treat headaches, fever, and aches and pains with paracetamol or ibuprofen  although ibuprofen is not recommended if you have asthma There is little evidence that cough medicines work  readmore abouttreating coughs . TheMedicines and Healthcare Products Regulatory Agency (MHRA)has recommended that over-the-counter cough medicines should not be given to children under the age of six. As an alternative to anover-the-countercough medicine, try making your own mixture of honey and lemon, which can help soothe a sore throat and ease your cough. Stop smoking If you smoke, you should stop immediately. Smoking aggravatesbronchitis and increases your risk of developing a long-term (chronic) condition. Stopping smoking while you have bronchitis can also be the perfect opportunity to quit altogether. Antibiotics Although treatment from a GP is rarely necessary, there may be times when you should see one  read more about when to see your GP . Your GP will not routinely prescribe antibiotics , as bronchitis is nearly always caused by a virus. Antibiotics have no effect on viruses, and prescribing them when they are unnecessary can, over time, make bacteria more resistant to antibiotic treatment. Your GP will only prescribe antibiotics if you have an increased risk of developing complications, such as pneumonia .Antibiotics may be recommended for: premature babies elderly people over the age of 80 people with a history of heart, lung, kidney or liver disease people with a weakened immune system, which could be the result of an underlying condition or a side effect of a treatment such as steroid medication people with cystic fibrosis If you are prescribed antibiotics for bronchitis, it is likely to be a five-day course of amoxicillin, oxytetracycline or doxycycline. Possible side effects of these medicines include nausea, vomiting anddiarrhoea, but they are uncommon. Chronic bronchitis Chronic bronchitis is treated in the same way as chronic obstructive pulmonary disease (COPD). For example: a type of medication called mucolytics can be used to make mucus easier to cough up an exercise programme known as pulmonary rehabilitation can help you cope better with your symptoms Stopping smoking is also very important if you have been diagnosed with chronic bronchitis or COPD. Read more about the treatment of COPD .",,,,,,,,,,,,,
Bulimia,"Bulimia | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Mental health Bulimia Bulimia Bulimia nervosa is an eating disorder and mental health condition. People with bulimia are very anxious about their weight and focused on having the right body shape. They also spend a lot of time thinking about food. Symptoms of bulimia The main symptoms of bulimia are: bingeing  overeating in a particular pattern purging  trying to reduce the effect of binging by attempting to get calories out of your body focus on food  thinking about food all the time, even when you dont want to problems with self-esteem focussing on body image when it comes to food and weight Diagnosing bulimia When making a diagnosis, your GP will probably ask questions about your eating habits. For example, they could ask: how you feel about your weight if youre concerned about it if you make yourself vomit regularly if you binge-eat Its important to answer these questions honestly. Your GP isnt trying to judge you or catch you out. They just need to accurately assess how serious your symptoms are. Weight and BMI Your GP may check your weight and calculate your body mass index (BMI). Blood tests and other tests Your GP might check your pulse and blood pressure. Sometimes an (electrocardiogram (ECG) may be needed to check how well your heart is working. Your GP may do blood tests to check the level of: fluids in your body chemicals or minerals, like potassium in your blood Blood tests look for the complications of bulimia. Even if they come back as normal, your GP may still refer you to a specialist if youre experiencing bulimia symptoms. Treating bulimia Before your treatment begins, youll probably have an overall assessment of your health. Your GP or another healthcare professional will do this. The assessment will help your healthcare professional plan for your treatment and care. For example, they may assess: your overall health and any medical needs your social situation, like how much support you have from family and friends your mood any risks that affect you, like whether youre at risk of harming yourself whether there are any physical risks as a result of bulimia that need urgent treatment Guided self-help For many people, guided self-help can be an effective treatment for bulimia. Guided self-help is where you work through information and activities on your own. Youll have regular support sessions with a professional (usually a psychologist). Activities can include: worksheets a food diary meal plan writing about difficult thoughts and feelings Eating disorder service If guided self help is unsuccessful, your GP can refer you for treatment to an eating disorder service. An eating disorder service will usually offer a structured programme of psychological treatment. Psychological treatment The main type of psychological treatment for bulimia is cognitive behavioural therapy (CBT). CBT starts with the idea that thoughts, feelings, and behaviour are linked and affect one another. CBT helps to change the harmful behaviour while working on changing how you think about food, eating, and weight. One alternative to CBT is interpersonal therapy (IPT). IPT explores the way you interact with other people. It also looks at the relationships you have, with the goal of improving them. Learn more about talking therapies Medication Antidepressants like selective serotonin reuptake inhibitors (SSRIs) may be used to treat bulimia. They can reduce the urges to binge and vomit. The medication will usually take several weeks before it starts to work. Youll usually start on a low dose. The dose will gradually increase as your body adjusts to the medicine. Very few drugs are recommended for children and young people below the age of 18. Its best not to take SSRIs if you have epilepsy or a family history of heart, liver or kidney disease. Relapse Recovery from bulimia can take a long time. Its common for bulimia symptoms to return after treatment. This is often called a relapse, and is more likely during times of stress. If relapse happens, the approach to getting treatment is the same. The first step is going to your GP. Complications of bulimia There are physical complications associated with bulimia. These can include: dental problems  regular vomiting can cause your stomach acid to damage the enamel on your teeth, which can lead to tooth decay repeated vomiting can cause bad breath and a sore throat due to a lack of nutrients, your skin and hair can become dry and your fingernails can become brittle your saliva glands can become swollen from frequent vomiting, which makes your face appear rounder frequent use of laxatives can damage your bowel muscles, causing permanent constipation (finding it difficult to poo) an increased risk of heart problems Frequent vomiting or laxative use can cause: tiredness weakness abnormal heart rhythms kidney damage convulsions (fits) muscle spasms If you have periods, bulimia can cause them to become unpredictable, or stop altogether. This does not mean bulimia makes you infertile. While it may be harder to get pregnant, you should continue to use birth control if you arent planning a pregnancy. If you have diabetes , youll need regular health checks to help avoid problems with your eyes or other serious complications. This is particularly important if you have type 1 diabetes . Getting help for bulimia People with bulimia can be anxious about seeking treatment that might mean making changes to their eating habits. Helping yourself If you have eating problems or think you may have bulimia, its important to seek help as soon as possible. You could start by: talking to someone you trust, like a friend or member of your family going to see your GP  you may find it helpful to bring someone with you for support Helping someone else If someone close to you is showing signs of bulimia, you can offer help and support. You could try talking to them about how they feel, and encourage them to think about getting help. Try not to put pressure on them or be critical of them, as this could make things worse. You could also offer to help by going with the person to see their GP. You could speak to your own GP or a healthcare professional if youd like some advice on how to help someone. You could also get help from a support group for people who have loved ones with eating disorders. Your GP or Scotlands Service Directory can help you find services near you. Beat has a range of information on the help and support available for people with eating disorders, and their friends and families. ",,,,,,,,,,,,,
Bunion,"Bunion (hallax valgus) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Muscle, bone and joints Conditions Bunion (hallux valgus) Bunion (hallux valgus) This information is useful for those who have been diagnosed with bunions. People experiencing new or ongoing symptoms should contact a healthcare professional for assessment and diagnosis. Read more about self-managing a foot problem A bunion (hallux valgus) is a deformity caused by the base joint of the big toe developing sideways. This pushes the bones of the big toe towards the smaller toes. If you have a bunion, try to stay positive. Theres a lot you can do to help yourself. What causes a bunion? The exact cause of bunions is unknown. Contributing factors can be: a joint problem like osteoarthritis or rheumatoid arthritis poorly fitting footwear a family history Bunion symptoms Bunions can cause: pain and stiffness of the big toe joint swelling of the big toe joint  the foot may become so wide it can be difficult to find wide enough shoes difficulty walking Management of bunions Wearing the right footwear is one of the best things you can do to help. Choose well fitting shoes. Ones with laces or an adjustable strap are best as they can adjust to the width of your foot. Avoid wearing high-heeled, pointed or tight shoes. It may be helpful to use insoles and toe spacers to provide support for your foot or reduce pressure between your toes. You may see bunion padding available. The repeated use of sticky padding can cause skin irritation so is not recommended as a regular solution. Pain treatment Pain medication can help you move more comfortably, which can help with the management of this condition. More about taking painkillers Exercise It can be helpful to do exercises to strengthen the muscles in the foot. This can help in the management of the condition Work A foot problem can sometimes mean you need to take some time off work to help recovery. How long youre off will depend on the nature of your condition and your role at work. You do not need to be symptom free before you consider returning to work. Continuing to go to work, or returning to work as soon as is possible for you, will help your recovery. Gradually getting back to your normal daily activities can help to build up your strength and stamina levels Help and support Following this advice, you should see gradual improvements over time. Talk to a healthcare professional about your symptoms if youve been following this advice and: your symptoms havent improved within 12 weeks your symptoms are worsening Find out how to access MSK services in your area When dealing with any health condition its important to also look after your mental wellbeing as this can impact your recovery. ",,,,,,,,,,,,,
Carcinoid syndrome and carcinoid tumours,"Carcinoid syndrome and carcinoid tumours | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Carcinoid syndrome and carcinoid tumours Carcinoid syndrome and carcinoid tumours A carcinoid tumour is a rare cancer of the neuroendocrine system  the body system that produces hormones. The tumourusually growsin the bowels or appendix, but it can also be found in the stomach, pancreas, lung, breast, kidney, ovaries or testicles. It tends to grow very slowly. Carcinoid syndrome is the collection of symptoms some people get when a carcinoid tumour  usually one that has spread to the liver  releases hormones such as serotonin into the bloodstream. Signs and symptoms In the early stages of having a carcinoid tumour, you may not have any symptoms. You may also not have symptoms if the tumour is just in your digestive system, as any hormones it produces will be broken down by your liver. If symptomsdo develop, they tend to be fairly general and can be easily mistaken for signs of other illnesses. Symptoms may result from both the tumour itself and from any hormones it releases into the bloodstream. Symptoms caused by the tumour Symptoms will dependon where in the body the tumour develops: abowel carcinoid tumour may causetummy pain, a blocked bowel ( diarrhoea , constipation , feeling or being sick) andbleeding from the bottom (rectal bleeding) alung carcinoid tumour may cause a cough , which may make you cough up blood, and cause wheezing, breathlessness , chest pain and tiredness astomach carcinoid tumour may cause pain, weight loss, tiredness and weakness Some tumours may not cause any symptoms and are discovered by chance. For example,an appendix carcinoid tumour may only befound when the appendix is being removed for another reason. Symptoms caused by the hormones (carcinoid syndrome) Typical symptoms of carcinoid syndrome include: diarrhoea,tummy pain and loss of appetite flushingof the skin, particularly the face fast heart rate breathlessness and wheezing These symptoms may come on unexpectedly, as the hormones can be produced by the tumour at any time. Some people may also developcarcinoid heart disease, wherethe heart valves thicken andstop working properly. There is also a risk of developing a rare but serious reaction calleda carcinoid crisis, which involves severe flushing, breathlessness and a drop in blood pressure. What causes carcinoid tumours? Itsnotknown exactlywhy carcinoid tumours develop, but its thought that mostoccur by chance. Your chances of developing a carcinoid tumour may be increased if you have: a rare family syndrome called multiple endocrine neoplasia type 1 (MEN1) parents or siblings with a carcinoid tumour parents with squamous cell skin cancer , non-Hodgkins lymphoma , or cancer of the brain, breast, liver, womb, bladder or kidney conditions calledneurofibromatosisor tuberous sclerosis Diagnosing carcinoid tumours Acarcinoid tumour may be found incidentally  for example, as a surgeon is removing an appendix. In this case, the tumour will often be caught early and removed along with the appendix, causing no further problems. Otherwise, people usually speak to their GP after they have developed symptoms. A carcinoid tumour may be diagnosed after carrying out a series of scans and tests, which may include measuring theamount ofserotoninin your urine and having an endoscopy . Treating carcinoid tumours and carcinoid syndrome If the tumour is caught early, it may be possible to completely remove it and cure the cancer altogether. Otherwise, surgeons will remove as much of the tumour as possible (debulking). You can read more about thesurgery for carcinoid tumourson theCancer Research UK website. If the tumour cannot be removed, but its not growing or causing symptoms, you may not need treatment straight away  it might just be carefully monitored. If its causing symptoms, you may be offered one of thefollowing treatments: injections of medicines called somatostatin analogues, such as octreotide and lanreotide, which can slow down the growth of the tumour radiotherapy to kill some of the cancer cells a procedure to block the blood supply tothetumour (for tumours in the liver), known ashepatic artery embolisation a procedure that uses a heated probe to kill cancer cells (for tumours in the liver), calledradiofrequency ablation chemotherapy to shrink the tumour and control your symptoms Symptoms of carcinoid syndrome canbe treated with injections of octreotide and lanreotide.You may also be givenmedication to widen your airways (to relieve wheezing and breathlessness) and anti-diarrhoea medication. What can I do to help myself? There are things you can do yourself to manage some of the symptoms of carcinoid syndrome. Generally, you should avoid triggers of flushing, such as: alcohol large meals spicy foods foods containing the substance tyramine, such as aged cheese and salted or pickled meats stress Some medications, such as selective serotonin reuptake inhibitor (SSRI) antidepressants , may make symptoms worse by further increasing your levels of serotonin  but never stop taking medication without seeking medical advice. If you have diarrhoea, its important to keep drinking little and often to avoid dehydration . Outlook If the whole tumour can be removed, this may cure the cancer and symptoms altogether. But even if surgeons cannot remove the entire tumour, it usually grows slowly and can be controlled with medication. Overall,people with carcinoid tumourshave a good life expectancy compared to many other cancers. Many people remain relatively well and lead active lives, with only occasional symptoms. Butas the tumourgrows or spreads, it will produce more and more hormones, and it may eventually be difficult to completely control symptoms with medication. You may need further surgery or other treatments. Unfortunately, life expectancy is not as good for cancer that has spread to other parts of your body, because it wont usually be possible to remove all of it. However, treatment can still control your symptoms and slow down the spread of cancer. Information about you If you have carcinoid syndrome, your clinical team will pass information about you on to the National Congenital Anomaly and Rare Diseases Registration Service (NCARDRS). This helps scientists look for better ways to prevent and treat this condition. You can opt out of the register at any time. Find out more about the register Source: NHS 24 - Opens in new browser window Last updated: 13 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Neuroendocrine tumours Other health sites Cancer Research UK: Carcinoid syndrome Cancer Research UK: Neuroendocrine tumours Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Catarrh,"Catarrh | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Lungs and airways Catarrh Catarrh About catarrh About catarrh Catarrh is a build-up of mucus in an airway or cavity of the body. It usually affects the back of the nose, the throat or the sinuses (air-filled cavities in the bones of the face). Its often temporary, but some people experience it for months or years. This is known as chronic catarrh. Catarrh can be a nuisance and may be difficult to get rid of, but its not harmful and there are treatments available. Symptoms associated with catarrh Catarrh can lead to a: constant need to clear your throat feelingthat your throat is blocked blockedor stuffy nose that you cant clear runny nose feeling of mucus running down the back of your throat persistent cough headache or facial pain reduced sense ofsmell and taste crackling sensation in your ear and some temporary hearing loss These problems can be frustrating to live with and mayaffect your sleep, making you feel tired. Treatments for catarrh Catarrh will often passin a few days or weeks as the condition that causes it improves. There are things you can try at home to relieve your symptoms, such as: avoiding things that trigger your symptoms, such as allergens or smokyplaces taking sips of cold water when you feel the need to clear your throat  constantly clearing your throat may make things worse using a saline nasal rinse several times a day  these can be bought from apharmacy or made at home with half a teaspoon of salt in a pint of boiledwater thats been left to cool avoiding warm, dry atmospheres, such asplaces with air conditioning and car heating systems  placing plants or bowls of water in a roommay help to keep theair humid staying well hydrated talking to a pharmacist about suitable over-the-counter medications  including decongestants ,antihistamines or steroid nasal sprays There are also several remedies, such as herbal medicines, available from health shops and pharmacies that claim to treat catarrh. Some people find these helpful, but theres generally little scientific evidence to suggest they work. When to see your GP Speak to your GP if your catarrh persists and is becoming difficult to live with. They may want to rule out conditions that could be causing it, such asnasal polypsor allergies . This may mean youneed to be referred to a specialist for tests. If youre diagnosed with a specific underlyingcondition, treating it may help relieve your catarrh. For example, nasal polypsmay be treated with a steroid nasal spray, or in some cases surgery. If a cause for you catarrh cannot be found, the self-help techniques above may be recommended.Unfortunately, however,chronic catarrh can be hard to treat and may last for a long time. What causes catarrh? Catarrh is usually caused by the immune system reacting to an infection or irritation, which causes the lining of your nose and throat to become swollen and produce mucus. Thiscan be triggered by: a cold or other infections hay fever or other types of allergic rhinitis non-allergic rhinitis nasal polyps Itsunclear what causes chronic catarrh, but its not thought to be the result of an allergy or infection. It may be related to an abnormality in the way mucustravels withinthe nose or an increasedsensitivity to mucus in the back of thenoseand throat. Source: NHS 24 - Opens in new browser window Last updated: 10 February 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Allergic rhinitis Common cold Catarrh Decongestants Other health sites ENT UK: patient information Allergy UK NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Cellulitis,"Cellulitis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Skin, hair and nails Cellulitis Cellulitis About cellulitis Symptoms of cellulitis Causes of cellulitis Treating cellulitis About cellulitis Cellulitis is an infection of the deeper layers of skin and the underlying tissue. It can be serious if not treated promptly. The infection develops suddenly and can spread through the body quickly. Severe infections can spread deep into the body, andcanbe life threatening. Most casesare successfully treated with antibiotics at home, although sometimesit needs to be treated in hospital. Symptoms of cellulitis Cellulitis causes an area of skin to suddenly become: red hot swollen painful tender It most often affects the lower legs, but can occur anywhere. Cellulitis causes swelling, redness, pain and tenderness in the affected area. Source: https://dermnetnz.org/ In more severe cases, cellulitis can also be accompanied and often preceded by: a high temperature (fever) of 38C (100.4F) or above vigorous shaking (rigors) nausea and vomiting dizziness confusion These are signs that the infection has spread deeper into the body. Read more about the symptoms of cellulitis Pharmacy First Scotland: Cellulitis treatment from your local pharmacy Adults 18 years and over with symptoms of cellulitis can get advice and treatment directly from a pharmacy in certain instances. This includes cases where cellulitis is linked to an insect bites on the arms or body. If the pharmacist cannot treat you they may recommend you see your GP. Pharmacies When to get professional advice See your pharmacist as soon as possible if an area of your skin suddenly turns red, painful and hot. Early treatment can help reduce the risk of the infection becoming severe. Phone 999 or go to A&E if: your face or the area around your eye is affected your symptoms are getting rapidly worse you experience other symptoms in addition to the changes in your skin, such as a fever or vomiting you have a weak immune system for example, because of HIV or chemotherapy  or severe lymphoedema ,a condition that causes swelling in the bodys tissues a young child or elderly person has possible cellulitis Treatments for cellulitis Cellulitis is usually treated with antibiotics . Many infections can be treated with antibiotic tablets at home. Youll usually be given a five-day course of treatment, and your symptomsshould start to improve after a few days. Make sure you complete the whole course of medicine youve been given, even if youre feeling better. Contact your GP if your symptoms get worse after a few days or dont improve within a week. For serious infections, treatment is usually started in hospital. Youll normally be given antibiotics directly into a vein through an injection or a drip. Many hospitals can then arrange for this treatment to continue at home or in an outpatient clinic. Treatment is usually for five days. If the infection responds to treatment quickly, it may be possible to complete the course with antibiotic tablets instead of having injections or a drip. Read more about how cellulitis is treated . Outlook for cellulitis Cellulitis can usually be treated successfully with antibiotics, and most people make a full recovery. But there is a risk it could cause potentially serious problems, particularly if its not treated quickly, such as: blood poisoning (sepsis) where the bacteria enter the blood kidney damage leg ulcers Septicaemia and kidney problems can be life threatening and require immediate treatment in hospital. Causes of cellulitis Cellulitis is usually caused by a bacterial infection. The bacteria that cause it often live harmlessly on the skin, but they can lead to an infection if they get into a break in your skin, such as: a bruise, cut or graze an animal bite or insect bite a legulcer dry, crackedskin  for example, because of eczema or athletes foot In most cases the trigger for the infection is unknown. The infectionisnt normally spread from person to person. Readabout the causes of cellulitis , including information on whos most at risk of the condition. Preventing cellulitis If youve had cellulitis before, youre more likely to get it again. Its not always possible to prevent it, but the following measures may help reduce your risk: use moisturiser if your skin is dry or prone to cracking lose weight if youre overweightbeing obese can increase your risk of cellulitis try to ensure any conditions that can increase your risk of cellulitis  such as eczema, athletes foot, leg ulcers and lymphoedema  are well managed make sure any cuts, grazes or bites are kept clean  wash them under running tap water and cover them with a plaster or dressing wash your hands regularlyparticularly when treating or touching a wound or skin condition If you get cellulitis often or severely, your GP may refer you to a skin specialist called a dermatologist, or aninfection specialist, to discuss the option of taking antibiotics on a long-term basis to protect against further infections. Symptoms of cellulitis Symptoms of cellulitis develop suddenly and can get worse quickly. It affects the skin and can also cause additional symptoms. Skin symptoms Cellulitis causes the affected skin to become: red hot swollen painful tender There may also be a break in the skin, although this isnt always obvious, and pus or blood-filled blisters . Any part of the body can be affected. Commonly affected areas include the lower legs, feet, arms or hands, and sometimes the face, particularly around the eyes. See your GP or visit your nearest minor injuries unit as soon as possible if an area of your skin suddenly turns red, painful and hot. The symptoms of cellulitis include redness, swelling and tenderness. Source: https://dermnetnz.org/ Additional symptoms Cellulitis can also cause additional symptoms that may develop before or alongside the changes to yourskin. These can include: feeling generally unwell feeling sick shivering chills Occasionally the infection can spread to other parts of the body, such as the deeper layers of tissue, blood, muscle and bone. This canbe very serious and potentially life threatening. Signs the infection has spread include: a high temperature (fever) of 38C (100.4F) or above a fastheartbeatorfast breathing being sick diarrhoea feeling dizzy or faint confusionor disorientation cold, clammy,paleskin unresponsiveness or loss of consciousness Call 999 orgo to your nearest accident and emergency (A&E) department immediately if you have other symptoms in addition to changes to your skin. Causes of cellulitis Cellulitis is usually caused by a bacterial infection. It occurs when bacteria get into the tissues beneath the skin. Howthe infectionoccurs The bacteria that cause cellulitis often live harmlessly on the skin. But if the surface of your skin is damaged, they can get into the layers underneath and cause an infection. The break in the skin may be so small its not noticeable. Itmay be caused by: a cut or graze a burn an animal or human bite an insect bite a puncture wound a legulcer the skin becoming dry and cracked for example, because of eczema or athletes foot Cellulitis isnt normally spread from person to person as the infection occurs deep within the skin and is often caused by bacteria that live on the skins surface without causing problems. Increased risk Anyone can get cellulitis, but youre at an increased risk if: youre obese you have poor circulation in your arms, legs, hands or feet you have a weakened immune system for example, because of HIV or chemotherapy treatment you have lymphoedema a condition that causes fluid to build up under your skin you have poorlycontrolled diabetes youve had cellulitis before you use injected drugs Ensuringthe underlying health conditionsmentioned above are well controlled may help reduce your risk of getting cellulitis. Treating cellulitis Cellulitis can often be treated at home with a course of antibiotics, although severe cases may need to be treated in hospital. Treatment at home Antibiotics If youre treated at home, youll usually be prescribed antibiotic tablets to take two to four times a day for a week. A longer course may be needed if your symptoms dont improve after a week or youhave an underlying condition that makes cellulitis more difficult to treat,such as lymphoedema . Commonly prescribed antibiotics include flucloxacillin and clarithromycin. Possible side effects can includean upset stomach or diarrhoea . Your symptoms may get worse in the first 48 hours after treatment starts, but should start to improve soon afterwards. Make sure you complete the whole course of medicine youre given, even if youre feeling better. Looking after yourself While youre recovering at home, the followingstepscan help ease your symptoms and aid your recovery: take paracetamol or ibuprofen for the pain raise the affected body part to reduce swelling for example, if your leg is affected, rest it on pillows or a chair when youre sitting or lying down try to regularly move the joint near the affected body part, such as your wrist or ankle, to stopit getting stiff drink plenty of fluids to avoid dehydration if you usually wear compression stockings for example, for lymphoedema avoid these until youve recovered When to get medical advice Contact your GP as soon as possible if: your symptoms get worse after 48 hours your symptoms havent improved after a week you develop additional symptoms, such as a high temperature (fever) or vomiting Treatment in hospital If you need to be admitted to hospital for treatment, youll be given antibiotics directly into a vein through an injection or a drip (intravenous antibiotics). Once youve recovered from the initial symptoms, you can usually be treated with antibiotic injections or tablets at home or as an outpatient, rather than staying in hospital. Source: NHS 24 - Opens in new browser window Last updated: 09 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Cerebral palsy,"Cerebral palsy | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Cerebral palsy Cerebral palsy Cerebral palsy is a condition caused by either damage to the brain, or abnormal development of the brain. This damage normally occurs before birth or during a childs early development. Cerebral palsy is not normally progressive in nature. Cerebral palsy usually causes abnormal muscle tone and movement. The main types of abnormal muscle tone are: Spastic cerebral palsy This is the most common type of abnormal muscle tone. Someone with spastic cerebral palsy is likely to experience a tightening of the muscles throughout the body. This tightening can be persistent or intermittent. The amount of stiffness experienced will vary from person to person. Dyskinetic cerebral palsy Individuals with this type of muscle tone may have dystonia or more rarely athetosis. This describes a type of abnormal muscle control where the muscles can shift from tight to floppy without warning, resulting in involuntary movements. Ataxic cerebral palsy This is the least common type of cerebral palsy. It can be identified by shaky movement and poor balance. Someone with ataxic cerebral palsy may struggle with fine motor movements and coordination, like writing or using cutlery. They may have a tremor that increases with activity, and struggle with balance. This can make standing or sitting in an upright position difficult. Mixed cerebral palsy Someone with mixed cerebral palsy may have signs of more than one type of abnormal muscle tone at the same time. Symptoms of cerebral palsy The symptoms of cerebral palsy can vary from person to person and are dependent on the type of brain injury or abnormality. Someone with cerebral palsy may: struggle with movement and balance, and may be unable to walk struggle to speak, and possibly need to use electronic aids have difficulties with eating, drinking and swallowing have problems with their vision experience pain symptoms experience fatigue (tiredness) have problems with their sleep have epilepsy have a learning disability display behavioural problems have bladder control problems have problems with their digestive system ( constipation ) struggle to control their saliva struggle to process information from their senses A person with cerebral palsy may have secondary symptoms. These are caused by the impact of the condition on their body, rather than directly by cerebral palsy. These can include: tightness in joints and muscles dislocations a change in their physical abilities changes in the amount of pain they experience increased fatigue Causes of cerebral palsy Cerebral palsy is caused by damage to the brain during pregnancy, birth or early development. There are some things that can increase the risk of a child developing cerebral palsy. These include: premature birth (being born early) neonatal encephalopathy (caused by lack of oxygen to the brain in pregnancy or around the time of birth) stroke or bleeding in the babys brain during pregnancy or after birth infection during pregnancy or after birth meningitis head injuries Its not always possible to tell why a child has developed cerebral palsy. A child can develop cerebral palsy despite their parents having done everything right during pregnancy and childbirth. The parents of a child with cerebral palsy are not to blame. Diagnosing cerebral palsy There isnt one single test that can diagnose cerebral palsy. Your medical professional will need to see how your child develops over time to make a diagnosis. They may also use tests such as brain scans to confirm the diagnosis. Coping with waiting for a diagnosis Waiting for a diagnosis can be very stressful for parents. Its natural to feel anxious when your child is unwell. NHS inform has advice on dealing with anxiety and stress, and information on where to go to find support for your mental wellbeing. Read more about mental wellbeing services Most children are diagnosed by two years old. Some children are diagnosed earlier if theyve spent time in medical settings, for example children who were born premature. To diagnose cerebral palsy, your medical professional will examine your childs medical history, and how well they can move, balance, and react. They may also use scans like an MRI to see if theres any sign of damage or abnormal development of the brain. Living with cerebral palsy While cerebral palsy is a non-progressive condition (it doesnt normally get worse over time), it may not stay the same throughout life. Symptoms can change with age, even in adulthood. Contact your GP if: you or your child is experiencing a change in condition you or your childs symptoms are getting worse Cerebral palsy doesnt normally shorten life expectancy. People with cerebral palsy often go on to live long, rich and rewarding lives. There are resources and treatments available to help both children and adults with cerebral palsy. Everyone with cerebral palsy will have individual needs and these needs may change over time. Your healthcare professional will help you find treatments and resources that work for you or your child. Physiotherapy Targeted physiotherapy can help you or your child improve and maintain posture, coordination, strength and balance. Physiotherapists may recommend specialist mobility equipment and advise about the use of orthotic splints. Occupational therapy Occupational therapists help people who struggle to complete everyday tasks find new ways of completing them. They can show you or your child how to break down activities into smaller movements, helping build confidence. Occupational therapists also have good knowledge of the medical aids and technologies available to help you or your child. Speech and language therapy If you or your child is struggling to talk, a speech and language therapist can help. They have a range of techniques that can help people improve at talking, like helping you or your child learn to shape a sound. Some speech therapists will recommend the use of specialist communication aids. If you or your child is having issues with swallowing, a speech and language therapist can also help by performing an assessment and making recommendations. Orthotics An orthotic device is a piece of equipment that supports a part of the body. This can help improve you or your childs ability to move and be active. Orthotics can help with a wide range of the physical problems that can be caused by cerebral palsy. Some will only be used for a short period of time, while others may be used throughout you or your childs entire life.The need for them can also changewith time. An orthotist will examine you or your childs ability to move and make recommendations according to you or your childs personal needs. Mental health support for those with cerebral palsy If you have cerebral palsy and need support with your mental health, there are services available through the NHS. Read more about mental health Mental wellbeing support for the parents of children with cerebral palsy Finding out that your child has cerebral palsy can be very overwhelming for parents. You may feel anxious about the future and isolated from other parents. There are resources available from NHS inform that can help you cope with the emotions youre feeling. If youre feeling isolated, an online support group might help you feel less alone. Read more about mental wellbeing services Find out more about online support groups for parents of children with cerebral palsy Medication Although medication cannot cure cerebral palsy, some types may help ease some of the symptoms, like muscle relaxants for those with spastic or dystonic cerebral palsy. Speak to your healthcare provider for further information about medication. Surgery Surgery may be recommended to help with certain symptoms of cerebral palsy. For example, surgery on muscles, bones and nerves can help mobility. Speak to your healthcare provider for further information on surgical options. Last updated: 06 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites Cerebral Palsy Scotland NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Cervical cancer,"""Cervical cancer - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Cervical cancer Cervical cancer About cervical cancer Symptoms of cervical cancer Causes of cervical cancer Diagnosing cervical cancer Treating cervical cancer Complications of cervical cancer Living with cervical cancer Preventing cervical cancer About cervical cancer Cervical cancer is a type of cancer that develops in a womans cervix (the entrance to the womb from the vagina). Cancer of the cervix often has no symptoms in its early stages. If you do have symptoms,the most common is unusual vaginal bleeding, which can occur after sex, in between periods or after the menopause . Abnormal bleeding doesnt mean that you definitely have cervical cancer, but it should be investigated by your GP as soon as possible. If your GP thinks you might have cervical cancer, you should be referred to see a specialist within 2 weeks. Read more about the symptoms of cervical cancer and diagnosing cervical cancer Screening for cervical cancer Cervical screening (also known as a smear test) is routinely offered to anyone with a cervix in Scotland, between the ages of 25 and 64, every 5 years.You may be recalled more often depending on your test results. Those on non-routine screening (where screening results have shown changes that need further investigation or follow up) will be invited up to 70 years of age. If you have unusual discharge, or bleeding after sex, between periods or after the menopause, contact your GP practice. These symptoms are not usually caused by cancer but its important to have them checked. Youwill be sent a letter confirming when your screening appointment is due. Contact your GP if you think you may be overdue for a screening appointment. Read more about cervical screening What causes cervical cancer? Almost all cases of cervical cancer are caused by the human papilloma virus (HPV) . HPV is a very common virus that can be passed on through any type of sexual contact with a man or a woman. There are more than 100 different types of HPV, many of which are harmless. However, some types of HPV can cause abnormal changes to the cells of the cervix, which can eventually lead to cervical cancer. Two strains of the HPV virus (HPV 16 and HPV 18)are known to be responsible for 70% of all cases of cervical cancer.These types of HPV infection dont have any symptoms, so many women wont realise they have the infection. However, its important to be aware that these infections are relatively common and most women whohavethem dont develop cervical cancer. Using condoms during sex offers some protection against HPV, but it cant always prevent infection, because the virus is also spread through skin-to-skin contact of the wider genital area. Since 2008, a HPV vaccine has been routinely offered to girls aged 12 and 13. Read more about the causes of cervical cancer and preventing cervical cancer Treating cervical cancer If cervical cancer is diagnosed at an early stage, its usually possible to treat it using surgery. In some cases, its possible to leave the womb in place, but itmay need to be removed. The surgical procedure used to remove the womb iscalled a hysterectomy . Radiotherapy is an alternative to surgery for some women with early-stage cervical cancer. In some cases, its used alongside surgery. More advanced cases of cervical cancer are usually treated using a combination of chemotherapy and radiotherapy . Some of the treatments used can have significant and long-lasting side effects, including early menopause and infertility . Read more about treating cervical cancer Complications Many women with cervical cancer will have complications. These can arise as a direct result of the cancer or as a side effect of treatments such as radiotherapy, chemotherapy andsurgery. Complications associated with cervical cancer can range from the relatively minor, such as minor bleeding from the vagina orhaving to urinate frequently, to life-threatening, such as severe bleeding or kidney failure. Read more about the complications of cervical cancer Outlook The stage at which cervical cancer is diagnosed is an important factor in determining outlook. The staging, given as a number from 1 to 4, indicates how far the cancer has spread. The chances of living for at least 5 years after being diagnosed with cervical cancer are: stage 1  80-99% stage 2  60-90% stage 3  30-50% stage 4  20% Read more about the staging of cervical cancer Whos affected by cervical cancer? Following the success of the NHS Cervical Screening Programme and the early detection of cell changes, the number of cervical cancer cases in the UK has reduced. Around 3,000 cases of cervical cancer are diagnosed in the UK each year. Its possible for women of all ages to develop cervical cancer, but the condition mainly affects sexually active women aged between 30 and 45. Cervical cancer is very rare in women under 25. Symptoms of cervical cancer The symptoms of cervical cancer arent always obvious, and it may not cause any symptoms at all until its reached an advanced stage. This is why its very important that you attend all of your cervical screening appointments. Unusual bleeding In most cases, vaginal bleeding is the first noticeable symptom of cervical cancer. It usually occurs after having sex. Bleeding at any other time, other than your expected monthly period is also considered unusual. This includes bleeding after the menopause (when a womans monthly periods stop). Visit your GP for advice if you experience any type of unusual vaginal bleeding. Other symptoms Other symptoms of cervical cancer may include pain and discomfort during sex and an unpleasant smelling vaginal discharge. Advanced cervical cancer If the cancer spreads out of your cervix and into surrounding tissue and organs, it can trigger a range of other symptoms, including: constipation blood in your urine (haematuria) loss of bladder control ( urinary incontinence ) bone pain swelling of one of your legs severe pain in your side or back caused by swelling in your kidneys, related to acondition called hydronephrosis changes to your bladder and bowel habits loss of appetite weight loss tiredness and a lack of energy When to seek medical advice You should contact your GP if you experience: bleeding after sex (postcoital bleeding) bleeding outside of your normal periods new bleeding after the menopause Vaginal bleeding is very common and can have a wide range of causes, so it doesnt necessarily mean you have cervical cancer. However, unusual vaginal bleeding is a symptom that needs to be investigated by your GP. Causes of cervical cancer In almost all cases, cervical cancer is the result of a change in cell DNA caused by the human papilloma virus (HPV). Cancer begins with a change in the structure of the DNA thats present in all human cells. DNA provides the cells with a basic set of instructions, including when to grow and reproduce. A change in the DNAs structure is known as a mutation. It can alter the instructions that control cell growth, which means the cells continue growing instead of stopping when they should. If the cells reproduce uncontrollably, they produce a lump of tissue called a tumour. Human papilloma virus (HPV) More than99% of cervical cancercases occur in women who have been previously infected with HPV. HPV is a group of viruses, rather than a single virus. There are more than 100 different types. HPV is spread during sexual intercourse and other types of sexual activity (such as skin-to-skin contact of the genital areas, or using sex toys) and is thought to be very common.Its estimated that 1 in 3 women will develop an HPV infection within 2 years of starting to have regular sex, and about 4 in 5women will develop the infection at some point in their lives. Some types of HPV dont cause any noticeable symptoms and the infection will pass without treatment. Other types of HPV can cause genital warts , although these types arent linked to an increased risk of causing cervical cancer. About 15 types of HPV are considered high-risk for cervical cancer. The 2 types known to have the highest risk are HPV 16 and HPV 18, whichcause about 7 out of every 10 cervical cancers. High-risk types of HPV are thought to contain genetic material that can be passed into the cells of the cervix. This material begins to disrupt the normal workings of the cells, which can eventually cause them to reproduce uncontrollably, leading to the growth of a cancerous tumour. As most types of HPV dont cause any symptoms, you or your partner could have the virus for months or years without knowing it. See preventing cervical cancer for more information about reducing your chances of developing an HPV infection. Cervical intraepithelial neoplasia (CIN) Cancer of the cervix usually takes many years to develop. Before it does, the cells in the cervix often show changes known as cervical intraepithelial neoplasia (CIN) or, less commonly, cervical glandular intraepithelial neoplasia (CGIN). CIN and CGIN are pre-cancerous conditions. Pre-cancerous conditions dont pose an immediate threat to a persons health, but they can potentially develop into cancer in the future. However, even if you develop CIN or CGIN, the chances of it developing into cervical cancer are very small, and if the changes are discovered during cervical screening , treatment ishighly successful. The progression from becoming infected with HPV to developing CIN or CGINand then developing cervical cancer is very slow, oftentaking 10 to 20 years. Read more about cervical screening results Increased risk The fact that HPV infection is very common but cervical cancer is relatively uncommonsuggests that only a very small proportion of women are vulnerable to the effects of an HPV infection. There appear to be additionalrisk factors that affecta womans chance of developing cervical cancer. These include: smoking  women who smoke are twice as likely todevelop cervical cancer than women who dont; this may be caused by the harmful effects of chemicals found in tobacco on the cells of the cervix having a weakened immune system this can occur as a result of taking certain medications, such as immunosuppressants, which are used to stop the body rejecting donated organs, or as a result of a condition such as HIV or AIDS taking the oral contraceptive pill for more than 5 years  women who take the pill are thought to have twice the risk of developing cervical cancer than those who dont, although its not clear why having children (the more children you have, the greater your risk)  women who have 2 children have twice the risk of getting cervical cancer comparedwith women who dont have any children The reason for the link between cervical cancer and childbirth is unclear. One theory is that the hormonal changes that occur during pregnancy may make the cervix more vulnerable to the effects of HPV. The spread of cervical cancer If cervical cancer is undiagnosed and untreated, it will slowly spread out of the cervixand into the surrounding tissue and organs. The cancer can spread down to the vagina and the surrounding muscles that support the bones of the pelvis. Alternatively, it can spread upwards, blocking the tube that runs from your kidneys to your bladder (ureters). The cancercan then spread into your bladder, rectum (back passage) and eventually into your liver, bones and lungs. Cancerous cells can also spread through your lymphatic system. The lymphatic system is a series of nodes (glands) and channels spread throughout your body in a similar way to the blood circulation system. The lymph nodes produce many of the specialised cells needed by your immune system (the bodys natural defence against infection and illness). If you have an infection, the nodes in your neck or under your armpits can become swollen. In some cases of early cervical cancer, the lymph nodes close to the cervix contain cancerous cells. In some cases of advanced cervical cancer, lymph nodes in the chest and abdomen can be affected. Diagnosing cervical cancer If cervical cancer is suspected, youll be referred to a gynaecologist (a specialist in treating conditions of the female reproductive system). Referral will be recommended if the results of your cervical screening test suggest that there are abnormalities in the cells of your cervix. However, in most cases, the abnormalities dont mean you have cervical cancer. You may also be referred to a gynaecologist if you have abnormal vaginalbleeding, or if your GP has noticed a growth inside your cervix during an examination. The sexually transmitted infection (STI) chlamydia is one of the most common reasons why women experience unusual vaginal bleeding. Your GP may recommend that youre tested for it first before being referred. Testing for chlamydia involves taking a small tissue sample from your cervix, or carrying out a urine test. Colposcopy If youve had an abnormal cervical screening test result, or your symptoms suggest that you may have cervical cancer, your gynaecologist will usually carry out a colposcopy . This is an examination to look for abnormalities in your cervix. During a colposcopy, a small microscope with a light source at the end (colposcope) is used. As well as examining your cervix, your gynaecologist may remove a small tissue sample ( biopsy ) so that it can be checked under a microscope for cancerous cells. Cone biopsy In some cases, a minor operation called a cone biopsy may also be carried out. The operation is carried out in hospital, usually under a local anaesthetic . During a cone biopsy, a small, cone-shaped section of your cervix will be removed so that it can be examined under a microscope for cancerous cells. You may experience vaginal bleeding for up to four weeks after the procedure. You may also have period-like pains. Further testing If the results of the biopsy suggest you have cervical cancer and theres a risk that the cancer may have spread, youll probably need to have some further tests to assess how widespread the cancer is. These tests may include: a pelvic examination carried out under general anaesthetic  your womb, vagina, rectum and bladder will be checked for cancer blood tests these can be used to help assess the state of your liver, kidneys and bone marrow computerised tomography (CT) scan  scans are taken of the inside of your body and a computer is used to assemble them into a detailed three-dimensional image; the CT scan can help to identify cancerous tumours and show whether cancerous cells have spread magnetic resonance imaging (MRI) scan  this type of scan uses strong magnetic fields and radio waves to produce detailed pictures of the inside of your body; it can also be used to check whether cancer has spread chest X-ray  this will indicate whether cancer has spread to your lungs positive emission tomography (PET) scan a specialised scan, where a mildly radioactive substance is injected into your veins so the cancerous tissue shows up more clearly; its often combined with a CT scanand is used to see if the cancer has spread, or to check how well a person is responding to treatment Staging After all of the tests have been completed and your test results are known, it should be possible to tell you what stage cancer you have. Staging is a measurement of how far the cancer has spread. The higher the stage, the further the cancer has spread. The staging for cervical cancer is as follows: stage 0 (pre-cancer)  there are no cancerous cells in the cervix, but there are biological changes that could trigger cancer in the future; this is called cervical intraepithelial neoplasia (CIN) or carcinoma in situ (CIS) stage 1  the cancer is still contained inside the cervix stage 2  the cancer has spread outside of the cervix into the surrounding tissue, but hasnt reached the tissues lining the pelvis (pelvic wall) or the lower part of the vagina stage 3  the cancer has spread into the lower section of the vagina and/or into the pelvic wall stage 4  the cancer has spread into the bowel, bladder or other organs, such asthe lungs Treating cervical cancer Treatment for cervical cancer depends on how far the cancer has spread. As cancer treatments are often complex, hospitals use multidisciplinary teams (MDTs) to treat cervical cancer and tailor the treatment programme to the individual. MDTs are made up of a number of different specialists who work together to make decisions about the best way to proceed with your treatment. Your cancer team will recommend what they thinkthe best treatment options are, but the final decision will be yours. In most cases, the recommendations will be: early cervical cancer  surgery to remove some or all of the womb, radiotherapy ,or a combination advanced cervical cancer  radiotherapy and/or chemotherapy , althoughsurgery is also sometimes used The prospect of a complete cure is good for cervical cancer diagnosed at an early stage, although the chances of a complete cure decrease the further the cancer has spread. In cases where cervical cancer isnt curable, its often possible to slow its progression, prolong lifespan and relieve any associated symptoms, such as pain and vaginal bleeding. This is known as palliative care . Removing abnormal cells If your screening results show that you dont have cervical cancer, but there are biological changes that could turn cancerous in the future, a number of treatment options are available. These include: large loop excision of the transformation zone (LLETZ)  the abnormal cells are cut away using a fine wire and an electrical current cone biopsy  the area of abnormal tissue is removed during surgery laser therapy  a laser is used to burn away the abnormal cells Read more about treating abnormal cells in the cervix Surgery There are 3 main types of surgery for cervical cancer. They are: radical trachelectomy  the cervix, surrounding tissue and the upper part of the vagina are removed, but the womb is left in place hysterectomy  the cervix and womb are removed; depending on the stage of the cancer, it may also be necessary to remove the ovaries and fallopian tubes pelvic exenteration  a major operation in which the cervix, vagina, womb, bladder, ovaries, fallopian tubes and rectum are removed Radical trachelectomy A radical trachelectomy is usually only suitable if cervical cancer is diagnosed at avery early stage. Its usually offered to women who want to preserve their child-bearing potential. During the procedure, the surgeon will make a number of small incisions (cuts)in your abdomen. Specially designed instruments will be passed through the incisions and used to remove your cervix and the upper section of your vagina. Lymph nodes from your pelvis may also be removed. Your womb will then be reattached to the lower section of your vagina. Comparedwith a hysterectomy or pelvic exenteration,the advantage of this type of surgeryis that your womb remains intact, which means that you maystill be able to have children. However, its important to be aware that the surgeons carrying out this operation cant guarantee youll still be able to have children. If you do have children after the operation, your child would have to be delivered bycaesarean section. Its also usually recommended that you wait 6 to 12 months after having surgery before trying for a baby, so that your womb and vagina have time to heal. Radical trachelectomy is a highly skilled procedure. Its only available at a number of specialist centres in the UK, so it may not be available in your area and you may have to travel to another city to be treated. Hysterectomy A hysterectomy is usually recommended for early cervical cancer. This may be followed by a course of radiotherapy to help prevent the cancer coming back. There are 2 types of hysterectomies used to treat cervical cancer: simple hysterectomy  where the cervix and womb are removed and, in some cases, the ovaries and fallopian tubes are also removed; this is only appropriate for very early stage cervical cancers radical hysterectomy  where the cervix, womb, surrounding tissue and lymph nodes, ovaries and fallopian tubes are all removed; this is the preferred option in advanced stage 1 and some early stage 2 cervical cancers Short-term complications of a hysterectomy include infection, bleeding, blood clots and accidental injury to your ureter, bladderor rectum. The risk of long-term complications issmall, but they can be troublesome. They include: the risk that your vagina canbecome shortened and drier, which can make sex painful urinary incontinence swelling of your arms and legs, caused by a build-up of fluid ( lymphoedema ) your bowel becomes obstructedbecause ofa build-up of scar tissue this may require further surgery to correct As your womb is removed during a hysterectomy, youll no longer be able to have children. If your ovaries are removed, it will also trigger the menopause if you havent already experienced it. See complications of cervical cancer for more information about the menopause. Pelvic exenteration A pelvic exenteration is a major operation thats usually only recommended when cervical cancer returns after what was thought to be a previously successful course of treatment. Its offered if the cancer returns to the pelvis, but hasnt spread beyond this area. A pelvic exenteration involves two phases of treatment: the cancer is removed, plus your bladder, rectum, vagina and the lower section of your bowel 2 holes called stomas are created in your abdomen the holes are used to pass urine and faeces out of your body into collection pouches called colostomy bags Following a pelvic exenteration, your vagina can be reconstructed using skin and tissue taken from other parts of your body. This means youll be able to have sex after the procedure, although it may be several months until you feel well enough to do so. Radiotherapy Radiotherapy may beused on its own or combined with surgeryfor early-stagecervical cancer. It may be combined with chemotherapy for advanced cervical cancer, where it can be used to control bleeding and pain. There are 2 ways that radiotherapy can be delivered. These are: externally  a machine beams high-energy waves into your pelvis to destroy cancerous cells internally  a radioactive implant is placed inside your vagina and cervix In most cases, a combination of internal and external radiotherapy will be used. A course of radiotherapy usually lasts for around 5 to 8 weeks. As well as destroying cancerous cells, radiotherapy can sometimes also harm healthy tissue.This means it can cause significant side effects many months, and even years, after treatment. However,the benefits of radiotherapy often tend to outweigh the risks. For some people, radiotherapy offers the only hope of getting rid of the cancer. Side effects of radiotherapy are common and can include: diarrhoea pain when urinating bleeding from your vagina or rectum feeling very tired (fatigue) feeling sick (nausea) sore skin in your pelvis regionsimilar to sunburn narrowing of your vagina, which can make having sex painful infertility damage to the ovaries, which will usually trigger an early menopause (if you havent already experienced it) bladder and bowel damage, which could lead to incontinence Most of these side effects will resolve within about eight weeks of finishing treatment, although in some cases they can be permanent. Its also possible to develop side effects several months, or even years after treatment has finished. If infertility is a concern for you, it may be possible to surgically remove eggs from your ovaries before you have radiotherapy, so that they can be implanted in your womb at a later date. However, you may have to pay for this. It may also be possible to prevent early menopause by surgically removing your ovaries and replanting them outsidethe area of your pelvis that will be affected by radiation. This is known as an ovarian transposition. Your MDT can provide more information about the possible options for treating infertility and whether youre suitable for an ovarian transposition. Chemotherapy Chemotherapy can be combined with radiotherapy to tryto cure cervical cancer, or it can be used as a sole treatment for advanced cancer to slowits progression and relieve symptoms (palliative chemotherapy). Chemotherapy involves using either a single chemotherapy medication called cisplatin or a combination of different chemotherapy medications to kill thecancerous cells. Chemotherapy is usually given using an intravenous drip on an outpatient basis, so youll be able to go home once youve received your dose. As with radiotherapy, these medications can also damage healthy tissue. Side effects are thereforecommon and caninclude: nausea and vomiting diarrhoea feeling tired all the time reduced production of blood cells, which can make you feel tired and breathless (anaemia) and vulnerable to infection because of a lack of white blood cells mouth ulcers loss of appetite hair loss  your hair should grow back within three to six months of your course of chemotherapy being completed, although not all chemotherapy medications cause hair loss Some types of chemotherapy medication can damage your kidneys, so you may need to have regular blood tests to assess the health of your kidneys. Follow-up After your treatment has been completed and the cancer has been removed, youll need to attend regular appointments for testing. This will usually involve a physical examination of your vagina and cervix (if it hasnt been removed). As theres a risk of cervical cancer returning, these examinations will be used to look for signs of this. If anything suspicious is found,a further biopsy can be carried out. If cervical cancer does return, it usually returns around 18 months after a course of treatment has been completed. Follow-up appointments are usually recommended every four months after treatment has been completed for the first 2 years, and then every 6 to 12 months for a further 3 years. Complications of cervical cancer Complications of cervical cancer can occur as a side effect of treatment or as the result of advanced cervical cancer. Side effects Early menopause If your ovaries are surgically removed or theyre damaged during treatment with radiotherapy , it will trigger an early menopause (if you havent already had it). Most women experience the menopause in their early fifties. The menopause is caused when your ovaries stop producing the hormones oestrogen and progesterone. This leads to the following symptoms: you no longer have monthly periodsor your periods become much more irregular hot flushes vaginal dryness loss of sex drive mood changes stress incontinence (leaking urine when you cough or sneeze) night sweats thinning of the bones, which can lead to brittle bones ( osteoporosis ) These symptoms can be relieved by taking a number of medications that stimulate the production of oestrogen and progesterone. This treatment is known as hormone replacement therapy (HRT) . Narrowing of the vagina Radiotherapy to treat cervical cancer can often cause your vagina to become narrower, which can make having sex painful or difficult. There are 2 main treatment options if you have a narrowed vagina. The first is to apply hormonal cream to your vagina. This should increase moisture within your vagina and make having sex easier. The second is to use a vaginal dilator, which is a tampon-shaped device made of plastic. You insert it into your vagina and is designed to help make it more supple. Its usually recommended that you insert the dilator for 5 to 10 minutes at a time on a regular basis during the day over the course of 6 to 12 months. Many women find discussing the use of a vaginal dilator embarrassing, but its a standard and well-recognised treatment for narrowing of the vagina. Your specialist cancer nurse or radiographers in the radiotherapy department should be able to give you more information and advice. You may find that the more times you have sex, the less painful it becomes. However, it may be several months before you feel emotionally ready to be intimate with a sexual partner. The Macmillan Cancer Support website has more information about sexuality and cancer Lymphoedema If the lymph nodes in your pelvis areremoved, it can sometimes disrupt the normal workings of your lymphatic system. One of the functions of the lymphatic system is to drain away excess fluid from the bodys tissue. A disruption to this process can lead to a build-up of fluid in the tissue known as lymphoedema . This can cause certain body parts to become swollen  usually the legs, in cases of cervical cancer. There are exercises and massage techniques that can reduce the swelling. Wearing specially designed bandages and compression garments can also help. Read more about treating lymphoedema Emotional impact The emotional impact of living with cervical cancer can be significant. Many people report experiencing a rollercoaster effect. For example, you may feel down when you receive a diagnosis, but feel better when removal of the cancer has been confirmed. You may then feel down again as you try to come to terms with the after-effects of your treatment. This type of emotional disruption can sometimes trigger depression . Typical signs of depression include feeling sad, hopeless and losing interest in things you used to enjoy. Contact your GP if you think you may be depressed. There is a range of effective treatments available, including antidepressant medication and talking therapies, such as cognitive behavioural therapy (CBT). You may also find Jos Cervical Cancer Trust a useful resource. Its the UKs only charity dedicated to women affected by cervical cancer. Local cancer support groups may also be availablein your area for women affected by cancer. Your specialist cancer nurse should be able to provide contact details. Read more aboutfeelings andcancer Advanced cervical cancer Some of the complications that can occur in advanced cervical cancer are discussed below. Pain If the cancer spreads into your nerve endings, bones or muscles, it can often cause severe pain. A number of effective painkilling medications can usually be used to control the pain. Depending on the levels of pain, they can range from paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen , to more powerful opiate-based painkillers, such as codeine and morphine. Tell your care team if the painkillers youre prescribed arent effective in reducing your pain. You may need to be prescribed a stronger medication. A short course of radiotherapy may also be effective in controlling the pain. Macmillan nurses , who work both in hospitals and in the community, can also provide expert advice about pain relief. Kidney failure Your kidneys remove waste material from your blood. The waste is passed out of your body in urinethrough tubes called the ureters. Kidney function can be monitored by a simple blood test called serum creatinine level. In some cases of advanced cervical cancer, the cancerous tumour can press against the ureters, blocking the flow of urine out of the kidneys. The build-up of urine inside the kidneys is known ashydronephrosis and can cause the kidneys to become swollen and stretched. Severe cases of hydronephrosis can cause the kidneys to become scarred, which can lead to the loss of most or all of the kidneys functions. This is known as kidney failure. Kidney failure can cause a wide range of symptoms, including: tiredness swollen ankles, feet or hands, caused bywater retention shortness of breath feeling sick blood in your urine (haematuria) Treatment options for kidney failure associated with cervical cancer include draining urine out of the kidneys using a tube inserted through the skin and into each kidney (percutaneous nephrostomy). Another option is to widen the ureters by placing a small metal tube called a stent inside them. Blood clots As with other types of cancer, cervical cancer can make the blood stickier andmore prone to forming clots. Bed rest after surgery and chemotherapy can also increase the risk of developing a clot. Large tumours can press on the veins in the pelvis, which slows the flow of blood and can lead to a blood clot developing in the legs. Symptoms of a blood clot in your legs include: pain, swelling and tenderness in one of your legs (usually your calf) a heavy ache in the affected area warm skin in the area of the clot redness ofthe skin, particularly at the back of your leg, be",,,,,,,,,,,,,
Cervical cancer," A major concern in these cases is that the blood clot from the leg vein will travel up to the lungs and block the supply of blood. This is known as apulmonary embolism andcan be fatal. Blood clots in the legs are usually treated using a combination of blood-thinning medication	 such as heparin or warfarin 	 and compression garmentsdesigned to help encourage the flow of blood through the limbs. Read more about treating deep vein thrombosis Bleeding If the cancer spreads into your vagina	 bowel or bladder	 it can cause significant damage	 resulting in bleeding. Bleeding can occur in your vagina or rectum (back passage)	 or you may pass blood when you urinate. Minor bleeding can often be treated using a medication called tranexamic acid	 which encourages the blood to clot and stop the bleeding. Radiotherapy can also be highly effective in controlling bleeding caused by cancer. Major bleeding may be treated temporarily by vaginal packing (using gauze to stem the bleeding)and later by surgery	 radiotherapy or by cutting off blood supply to the cervix. Fistula A fistula is an uncommon but distressing complication that occurs in around 1 in 50 cases of advanced cervical cancer. A fistula is an abnormal channel that develops between 2 sections of the body. In most cases involving cervical cancer	 the fistula develops between the bladder and the vagina. This can lead to a persistent discharge of fluid from the vagina. A fistula can sometimes develop between the vagina and rectum. Surgery is usually required to repair a fistula	 although its often not possible inwomen with advanced cervical cancer	 because theyre usually too frail to withstand the effects of surgery. In such cases	 treatment often involves using medication	 creams and lotions to reduce the amount of discharge and protect the vagina and surrounding tissue from damage and irritation. Vaginal discharge Another uncommon	 but distressing	 complication of advanced cervical cancer is an unpleasant-smelling discharge from your vagina. The discharge can occur for a number of reasons	 such as the breakdown of tissue	 the leakage of bladder or bowel contents out of the vagina	 or a bacterial infection of the vagina. Treatment options for vaginal discharge include an antibacterial gel called metronidazole and wearing clothing that contains charcoal. Charcoal is a chemical compound thats very effective in absorbing unpleasant smells. Palliative care If your doctors cant do any more to treat your cancer	 your care will focus on controlling your symptoms and helping you to be as comfortable as possible. This is called palliative care . Palliative care also includes psychological	 social and spiritual support for you and your family or carers. There are different options for terminal care in the late stages of cancer. You may want to think about whether youd like to be cared for in hospital	 in a hospice or at home	 anddiscuss these issues with your doctor. Some organisations who provide care for people with cancer include: Macmillan Cancer Support  whichhas specially trained nurses who help to look after people with cancer at home. To be referred to a Macmillan nurse	 ask your hospital doctor or GP	 or call 0808 808 00 00. Marie Curie Cancer Care  have specially trained nurses who help to look after people with cancer at home. They also run hospices for people with cancer. Hospice UK  provides information about hospice care and how to find a hospice. Living with cervical cancer The impact of cervical cancer on your daily life will depend on the stage of cancer and the treatment youre having. Many women with cervical cancer have a radical hysterectomy . This is a major operationthat takes around 6 to 12 weeks to recover from. During this time	 you need to avoid strenuous tasks and lifting	 such aslifting childrenorheavy shopping bags. You wont be able to drive for 3 to 8 weeks after the operation. Most women will also need 8 to 12 weeks off work to recover after having a radical hysterectomy. Some of the treatments for cervical cancer can make you very tired	 particularly chemotherapy and radiotherapy . Because of this	 you may need to take a break from some of your normal activities for a while. Dont be afraid to ask for practical help from family and friends if you need it. Practical help may also be available from your local authority. Ask your doctor or nurse about who to contact. Work Having cervical cancer doesnt necessarily mean youll have to give up work	 althoughyou may need quite a lot of time off. During treatment	 you may not be able to carry on as you did before. If you have cancer	 youre covered by the Disability Discrimination Act . This means that your employer isnt allowed to discriminate against you because of your illness. They have a duty to make reasonable adjustments to help you cope. Examples of these include: allowing you time off for treatment and medical appointments allowing flexibility with working hours	 the tasks you have to perform	 or your working environment The definition of whats reasonable depends on the situation	 such as how much it would affect your employers business	 for example. You should give your employer as much information as possible about how much time youll need off and when. Speak toa member of your human resources department	 if you have one. Your union or staff association representative can also give you advice. If youre having difficulties with your employer	 your union or local Citizens Advice Bureau may be able to help. Macmillan Cancer Support also has more information and advice about work and cancer . Money and benefits If you have to reduce or stop work because of your cancer	 you may find it difficult to cope financially. If you have cancer or youre caring for someone with cancer	 you may be entitled to financial support. For example: if you have a job but cant work because of your illness	 youre entitled to Statutory Sick Pay from your employer if you dont have a job and cant work because of your illness	 you may be entitled to Employment and Support Allowance if youre caring for someone with cancer	 you may be entitled to Carers Allowance you may be eligible for other benefits if you have children living at home or you have a low household income Its a good idea to find out what help is available as soon as possible. You could ask to speak to the social worker at your hospital	 who can give you the information you need. Your sex life Many women feel nervous about having sex soon after treatment for cervical cancer	 but its perfectly safe.Sex wont make the cancer come back and your partner cant catch cancer from you. Ifyou want to	 you can resume your normal sex life within a few weeks of finishing radiotherapy or having surgery. This will give your body time to heal. If youre having chemotherapy	male partners should wear a condom when you have sex	 because its not clear if having sex after chemotherapy can have an effect on them. Some women find sex difficult after being treated for cervical cancer	 because theside effects of some treatments can include vaginal dryness and narrowing of the vagina. In these cases	 there are treatments that can help	 such as vaginal dilators. See complications of cervical cancer for more information Preventing cervical cancer Theres no single way to completely prevent cervical cancer	 but there are things that can reduce your risk. Safer sex Most cases of cervical cancer are linked to an infection with certain types of human papillomavirus (HPV) . HPV can be spread through unprotected sex	 so using a condom can reduce your risk of developing the infection. However	 the virus isnt just passed on through penetrative sex  it can be transmitted during other types of sexual contact	 such as skin-to-skin contact between genital areas and by using sex toys. Your risk of developing an HPV infection increases the earlier you start having regular sex and with the more sexual partners you have	 although women who have only had 1 sexual partner can also develop it. Read more about sexual health Cervical screening Regular cervical screening is the best way to identify abnormal changes in the cells of the cervix at an early stage. Cervical screening (also known as a smear test) is routinely offered to anyone with a cervix in Scotland between the ages of 25 and 64 every 5 years. You may be recalled more often depending on your test results. Make sure that your GP surgery has your up-to-date contact details	 so that you continue getting screening invitations. Its important that you attend yourcervical screeningtests	 even if youve been vaccinated for HPV	 because the vaccine doesnt guarantee protection against cervical cancer. If youve been treated for abnormal cervical cell changes	 youll be invited for screening more frequently for several years after treatment. How regularly you need to go will depend on how severe the cell change is. Although it can identify most abnormal cell changes in the cervix	 cervical screening isnt always 100% accurate. Therefore	you should report symptoms such as unusual vaginal bleeding to your GP	 even if youve recently been tested. Cervical cancervaccination The NHS cervical cancer vaccination programme uses a vaccine called Gardasil. Gardasil protects against four types of HPV	 including the 2 strains responsible for more than 70% of cervical cancers in the UK (HPV16 and HPV 18). It also prevents genital warts . Girls are offered the childhood immunisation programme . The vaccine isgiven to girls when theyre12to 13 years old	 with 3 doses givenover a 6-month period. Although the HPV vaccine can significantly reduce the risk of cervical cancer	 it doesnt guarantee that you wont develop the condition. You should still attend cervical screening tests	 evenif youve had the vaccine. Avoidsmoking You can reduce your chances of getting cervical cancer by not smoking. People who smoke are less able to get rid of the HPV infection from the body	 which can develop into cancer. If you decide to give up smoking	 youcouldcontactthe Quit Your Way Scotland on0800 84 84 84.Quit Your Way Scotlandis run by NHS 24 and is staffed by trained advisors wholl be able to give you expert advice. If you want to give up smoking	 but you dont want to be referred to a stop smoking service	 your GP should be able to prescribe medical treatment to help with any withdrawal symptoms that you may experience after giving up. For more information and advice on giving up smoking	 see stopping smoking and treatments for stopping smoking . ",,,,,,,,,,,,,
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Chest infection,"Chest infection | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Chest infection Chest infection Chest infections are common, especially after a cold or flu during autumn and winter. Although most are mild and get better on their own, some can be serious or even life-threatening. Signs and symptoms of a chest infection The main symptoms of a chest infection can include: a persistent cough coughing up yellow or green phlegm (thick mucus), or coughing up blood breathlessness or rapid and shallow breathing wheezing a high temperature (fever) a rapid heartbeat chest pain or tightness feeling confused and disorientated You may also experience more general symptoms of an infection, such as a headache , fatigue, sweating, loss of appetite, or joint and muscle pain. What causes chest infections? A chest infection is an infection of the lungs or airways. The main types of chest infection are bronchitis and pneumonia . Most bronchitis cases are caused by viruses, whereas most pneumonia cases are due to bacteria. These infections are usually spread when an infected person coughs or sneezes. This launches tiny droplets of fluid containing the virus or bacteria into the air, where they can be breathed in by others. The infections can also be spread to others if you cough or sneeze onto your hand, an object or a surface, and someone else shakes your hand or touches those surfaces before touching their mouth or nose. Certain groups of people have a higher risk of developing serious chest infections, such as: babies and very young children children with developmental problems people who are very overweight elderly people pregnant women people who smoke people with long-term health conditions, such as asthma , heart disease , diabetes , kidney disease , cystic fibrosis or chronic obstructive pulmonary disease (COPD) people with a weakened immune system  this could be due to a recent illness, a transplant, high-dose steroids, chemotherapy or a health condition, such as an undiagnosed HIV infection Read more about the causes of bronchitis and the causes of pneumonia Caring for your symptoms at home Many chest infections arent serious and get better within a few days or weeks. You wont usually need to see your GP, unless your symptoms suggest you have a more serious infection. While you recover at home, there are things you can do to improve your symptoms. Do get plenty of rest drink lots of fluid to prevent dehydration and to loosen the mucus in your lungs, making it easier to cough up treat headaches, fever and aches and pains with pain relief such as paracetamol or ibuprofen drink a warm drink of honey and lemon to relieve a sore throat caused by persistent coughing raise your head up with extra pillows while youre sleeping to make breathing easier stop smoking if you smoke Avoid cough medicines, as theres little evidence they work. Coughing actually helps you clear the infection more quickly by getting rid of the phlegm from your lungs. Antibiotics arent recommended for many chest infections, because they only work if the infection is caused by bacteria, rather than a virus. Your GP will usually only prescribe antibiotics if they think you have pneumonia, or youre at risk of complications such as fluid building up around the lungs ( pleurisy ). If theres a flu outbreak in your local area and youre at risk of serious infection, your GP may also prescribe antiviral medication. Read more about treating bronchitis and treating pneumonia When to contact your GP practice Contact your GP practice if: you feel very unwell or your symptoms are severe your symptoms are not improving you feel confused, disorientated or drowsy you have chest pain or difficulty breathing you cough up blood or blood-stained phlegm your skin or lips develop a blue tinge (cyanosis) youre pregnant youre 65 or over youre very overweight and have difficulty breathing you think a child under five has a chest infection you have a weakened immune system you have a long-term health condition you have a cough that has lasted more than 3 weeks Your GP should be able to diagnose you based on your symptoms and by listening to your chest using a stethoscope (a medical instrument used to listen to the heart and lungs). In some cases, further tests  such as a chest X-ray , breathing tests and testing phlegm or blood samples  may be needed. Preventing chest infections There are measures you can take to help reduce your risk of developing chest infections and stop them spreading to others. Stop smoking If you smoke, one of the best things you can do to prevent a chest infection is to stop. Smoking damages your lungs and weakens your defences against infection. Read more information and advice about stopping smoking Good hygiene Although chest infections generally arent as contagious as other common infections, like flu, you can pass them on to others through coughing and sneezing. Therefore, its important to cover your mouth when you cough or sneeze, and to wash your hands regularly. Put tissues in the bin immediately. Alcohol and diet Excessive and prolonged alcohol misuse can weaken your lungs natural defences against infections and make you more vulnerable to chest infections. To keep your risk of alcohol-related harm low, the NHS recommends: not regularly drinking more than 14 units of alcohol a week if you drink as much as 14 units a week, its best to spread this evenly over 3 or more days if youre trying to reduce the amount of alcohol you drink, its a good idea to have several alcohol-free days each week Regular or frequent drinking means drinking alcohol most weeks. The risk to your health is increased by drinking any amount of alcohol on a regular basis. Eating a healthy, balanced diet can help strengthen the immune system, making you less vulnerable to developing chest infections. Read more about healthy eating and tips on cutting down on alcohol Vaccinations If youre at an increased risk of chest infections, your GP may recommend being vaccinated against flu and pneumococcal infections (a bacterium that can cause pneumonia). These vaccinations should help to reduce your chances of getting chest infections in the future. Flu and pneumococcal vaccinations are usually recommended for: babies and young children pregnant women (flu jab only) people aged 65 and over people with long-term health conditions or weakened immune systems Source: NHS 24 - Opens in new browser window Last updated: 04 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Chronic obstructive pulmonary disease NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Chest pain,"Chest pain | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Heart and blood vessels Conditions Chest pain Chest pain Phone 999 immediately if: You or someone else has symptoms like: central chest pain or discomfort in the chest that doesnt go away  it may feel like pressure, tightness or squeezing pain that radiates down the left arm, or both arms, or to the neck, jaw, back or stomach unconsciousness seizures or fitting difficulty breathing (snoring or rasping) rapid heart beat low or undetectable heart beat chest pain and breathlessness, nausea, sweating or coughing up blood Causes of chest pain There are a number of different conditions that can cause chest pain. You should always seek medical advice to make sure you get a proper diagnosis. Depending on your symptoms and circumstances, you may need further investigation. Heart attack A heart attack occurs when the blood supply to part of the heart is suddenly blocked. Chest pain is more likely to be caused by a heart attack if it: lasts more than 15 minutes occurs while resting Angina Angina is a condition where the blood supply to the muscles of the heart is restricted. Chest pain caused by angina is usually triggered by physical activity (exertion). It usually gets better with rest after a few minutes. Pulmonary embolism A pulmonary embolism is a blockage in the blood vessel that carries blood from the heart to the lungs. This can cause sharp, stabbing chest pain that may get worse when you breathe in. It can also be accompanied by: breathlessness a cough dizziness coughing up blood Pericarditis Pericarditis is inflammation of the sac surrounding your heart. This can cause a sudden, sharp and stabbing pain in your chest. It may also cause more of a dull ache. This pain usually gets worse when you lie down. Lung conditions Lung conditions that can cause chest pain include: pneumonia  inflammation of the lungs (usually caused by an infection) pleurisy  inflammation of the membrane surrounding the lungs (usually caused by an infection) Conditions affecting the lungs can cause sharp chest pain that: gets worse when you breathe in and out is accompanied by other symptoms like coughing or breathlessness If someone has severe pneumonia or pleurisy, they may also have symptoms like: rapid breathing confusion Seek medical advice immediately if you or someone else has symptoms of: a heart attack angina a pulmonary embolism pericarditis pneumonia pleurisy Other causes of chest pain There are many other potential causes of chest pain, including: gastro-oesophageal reflux disease (GORD) acid from the stomach comes up into the oesophagus (gullet) causingburning chest pain (heartburn) and an unpleasant taste in the mouth acute cholecystitis  inflammation of the gallbladderthat can cause a sudden sharp pain in the upper right side of your tummy that spreads towards your right shoulder strained muscle  can cause chest pain thats painful and tender to touch costochondritis  inflammation in the cartilage that joins the ribs to the breastbone (sternum) that can cause pain, swelling and tenderness around the ribs panic attack or anxiety  can sometimes be accompanied by chest pain Source: Scottish Government - Opens in new browser window Last updated: 08 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Angina What to do in a heart emergency Other health sites NICE: Chest pain NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Chickenpox,"Chickenpox | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Chickenpox Chickenpox Chickenpox is a mild and common illness that mostly affects children but can be caught at any age. Causes of chickenpox Chickenpox (known medically as varicella) is caused by a virus called the varicella-zoster virus. Its spread quickly and easily from someone who is infected. Chickenpox is most common in children under the age of 10. Children usually catch chickenpox in winter and spring, particularly between March and May. Symptoms of chickenpox Chickenpox causes a rash of red, itchy spots that turn into fluid-filled blisters . They then crust over to form scabs, which eventually drop off. Chickenpox spots The spots normally appear in clusters and tend to be: behind the ears on the face over the scalp on the chest and belly on the arms and legs But, the spots can be anywhere on the body, including: inside the ears and mouth on the palms of the hands soles of the feet inside the nappy area. The rash starts as small, itchy red spots. These develop a blister on top and become very itchy after about 12 to 14 hours. After a day or two, the fluid in the blisters gets cloudy and they begin to dry out and crust over. After 1 to 2 weeks, the crusting skin will fall off naturally. New spots can keep appearing in waves for 3 to 5 days after the rash begins. So, different groups of spots may be at different stages of blistering or drying out. Before chickenpox spots appear Before the rash appears, you or your child may have some mild flu -like symptoms, including: feeling sick a high temperature (fever) of 38C (100.4F) or over aching, painful muscles headache generally feeling unwell loss of appetite These symptoms, especially the fever, tend to be more common and worse in adults than in children. Contacting your doctor about chickenpox For most children, chickenpox is a mild illness that gets better on its own. Chickenpox tends to be more severe in adults than children. Adults have a higher risk of developing complications. Contact your GP practice if: You or your child develop any abnormal symptoms, such as: the skin around the blisters becomes hot, red and painful, (redness may be harder to see on brown or black skin) pain in the chest or difficulty breathing signs of dehydration , such as fewer wet nappies, drowsiness and cold hands and feet blisters on their skin become infected any of your or your childs symptoms suddenly get worse or You have been in contact with someone who has chickenpox, or you have chickenpox symptoms and: you are pregnant or have given birth in the last 7 days you have a weakened immune system (the bodys defence system) your baby is less than 4 weeks old you are breastfeeding If your GP is closed, phone 111. Contact your GP practice if: youre not sure if you or your child has chickenpox youre worried about your child Tell the receptionist you think it might be chickenpox before going in to a GP practice. Chickenpox treatment There is no treatment for chickenpox. But, you can get remedies from your pharmacy that can help symptoms. These include: paracetamol to help bring down a fever calamine lotion and cooling gels to ease itching. In most children, the blisters crust up and fall off naturally within 1 to 2 weeks. Adults with chickenpox may be helped by taking antiviral medicine if its diagnosed early enough. Stopping the spread of chickenpox You should keep children off school or nursery until all their spots have crusted over. This will help stop chickenpox being spread. Adults with chickenpox should stay off work until all the spots have crusted over. Chickenpox is infectious from 1 to 2 days before the rash starts. It stops being infectious when all the blisters have crusted over. This happens usually 5 to 6 days after the start of the rash. If you or your child has chickenpox, try to keep them away from public areas. This will help them avoid contact with people who may not have had it. You should especially stay away from people who are at risk of serious problems, such as: newborn babies pregnant women anyone with a weakened immune system, (for example people having cancer treatment or taking steroid tablets) Whos at higher risk from chickenpox? Some children and adults are at special risk of serious problems if they catch chickenpox. They include: pregnant women newborn babies people with a weakened immune system These people should speak to their GP as soon as they are exposed to the chickenpox virus or they develop chickenpox symptoms. They may need a blood test to check if they are protected from (immune to) chickenpox. Chickenpox in pregnancy If youre pregnant, chickenpox can occasionally cause complications. Chickenpox occurs in approximately 3 in every 1,000 pregnancies. Your risk of developing pneumonia is slightly higher if youre pregnant, especially if you smoke. The further you are into your pregnancy, the more serious the risk of pneumonia tends to be. If you get chickenpox while youre pregnant, there is also a small but significant risk to your unborn baby. If you get chickenpox during the first 28 weeks of your pregnancy, there is a risk that your unborn baby could develop a condition known as foetal varicella syndrome (FVS). This syndrome is rare. FVS can cause serious complications, including: scarring eye defects, such as cataracts shortened limbs brain damage There are also other risks from catching chickenpox after week 20 of pregnancy. Its possible that your baby may be born prematurely (before week 37 of the pregnancy). If you are infected with chickenpox 7 days before or 7 days after giving birth, your newborn baby may develop a more serious type of chickenpox. In a few severe cases, this type of chickenpox can be fatal. Chickenpox and shingles Once you have had chickenpox, you usually develop antibodies to the infection and become immune to catching it again. But, the virus that causes chickenpox, the varicella-zoster virus, stays inactive in your bodys nerve tissues. This can come back later in life as an illness called shingles. Its possible to catch chickenpox from someone with shingles, but not the other way around. Read more about shingles . Is there a vaccine against chickenpox? There is a chickenpox vaccine, but it is not part of the routine childhood vaccination schedule. Only children and adults who are more vulnerable to the complications of chickenpox will get offered the vaccine. It may be possible to develop the infection after vaccination. There is also a chance that someone who has had the vaccine could develop chickenpox after coming into close contact with a person who has shingles. Source: NHS 24 - Opens in new browser window Last updated: 24 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Self-help guide: Rash Skin rashes in children NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Chilblains,"Chilblains | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Skin, hair and nails Chilblains Chilblains Chilblains are small, itchy swellings on the skin that occur as a reaction to cold temperatures. They most often affect the bodys extremities, such as the toes, fingers, heels, ears and nose. Chilblainscan beuncomfortable, but rarely cause any permanent damage.They normally heal within a few weeks iffurther exposure to the cold is avoided. Chilblains can turn the skin red and may cause a burning or stinging sensation. Source: https://dermnetnz.org/ In severe cases, chilblains can cause the skin to blister. Source: https://dermnetnz.org/ Signs and symptoms of chilblains Chilblainsusually develop several hours after exposure to the cold. Theytypically cause a burning and itching sensation in the affected areas, whichcan become more intense if you go into a warm room. The affected skin may also swell and turn red or dark blue. In severe cases, the surface of the skin may break and sores or blisters can develop. Its importantnot to scratch the skin as it can break easily and become infected. When to seek medical advice for chilblains Most people dont need to seek medical advice if they have chilblains as they usually heal within a few weeks and dont cause any permanent problems. Speak to your GP or chiropodist if you have: severe or recurring chilblains chilblains that dont improve within a few weeks You should also seek medical advice if you think your skin may have become infected. Signs of infection include: swelling and pus forming in the affected area feeling generally unwell a high temperature (fever)of 38C (100.4F) or above swollen glands What causes chilblains? Chilblains are the result ofan abnormal reaction to the cold.Theyre common in the UKbecause damp, cold weather is usual in the winter. Some people develop chilblains that last for several monthsevery winter. When the skin is cold, blood vessels near its surface get narrower.If the skin is then exposed to heat, the blood vessels become wider. If this happens too quickly, blood vessels near the surface of the skin cant always handle the increased blood flow. This can cause blood toleak into the surrounding tissue, which may cause theswelling and itchiness associated with chilblains. Whos more at risk of chilblains? Some people are more at risk of chilblains than others. This includes people with: poor circulation a family history of chilblains regular exposure to cold, damp or draughty conditions a poor diet or low body weight lupus  a long-term condition that causes swelling in the bodys tissues Raynauds phenomenon a common condition that affects the blood supply to certain parts of the body, usually the fingers and toes People who smoke are more at risk of chilblains as nicotine constricts blood vessels. Chilblains can also occur on areas of the feetexposed to pressure, such as a bunion or a toe thats squeezed by tight shoes. Treating chilblains Chilblains often get better on their own after a week or twowithout treatment. It may help to use a soothing lotion, such as calamine or witch hazel, to relieve itching. Your pharmacist may also be able to recommend a suitable product. If your chilblains are severe and keep returning, speak to your GP. They may recommend taking a daily tablet or capsule of a medication called nifedipine. This works by relaxing the blood vessels, improving your circulation. Nifedipine can be used to help existing chilblains heal, or can be taken during the winter tostopthem developing. Preventing chilblains If youre susceptible to chilblains, you canreduce your risk of developing themby: limiting your exposure to the cold looking after your feet taking stepsto improve your circulation If your skin gets cold, its important to warm it up gradually. Heating the skin too quicklyfor example, by placing your feet in hot water or near a heateris one of the main causes of chilblains. Do stop smoking  nicotine causes the blood vessels to constrict, which can make chilblains worse keep active  this helps improve your circulation wear warm clothes and insulate your hands, feet and legs  wearing long johns, long boots, tights, leg warmers or long socks will help, and its a good idea to wear a clean pair of socks if you get cold feet in bed avoid tight shoes and boots  these can restrict the circulation to your toes and feet moisturise your feet regularly  this stops them drying out and the skin cracking eat at least one hot meal during the day  thisll help warm your whole body, particularly in cold weather warm your shoes on the radiator before you put them on  make sure damp shoes are dry before you wear them; if your feet are already cold, make sure your shoes arent too hot to avoid causing chilblains warm your hands before going outdoors  soak them in warm water for several minutes and dry thoroughly, and wear cotton-lined waterproof gloves if necessary; if your hands are already cold, make sure not to warm them up too quickly to avoid causing chilblains keep your house well heated  try to keep one room in the house warm and avoid drafts if youre diabetic, regularly check your feet (or ask someone else to do this)  people with diabetes may not be able to feel their feet and could have infected chilblains without realising it Complications of chilblains If you havesevereor recurring chilblains, theres a small risk of further problems developing, such as: infection from blistered or scratched skin ulcers forming on the skin permanent discolouration of the skin scarring of the skin Avoiding complications of chilblains Its often possible to avoid complications of chilblains. Dont do not scratch or rub the affected areas of skin do not directly overheat the chilblains (by using hot water, for example) You can also help reduce your risk of infection bycleaning any breaks in your skin with antiseptic and covering the area withan antiseptic dressing. The dressing should be changed every other day until the skin heals. If the skin does become infected, antibiotics may be prescribed to treat the infection. Source: NHS 24 - Opens in new browser window Last updated: 25 November 2022 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Chlamydia,"Chlamydia | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Sexual and reproductive Chlamydia Chlamydia British Sign Language (BSL) | Polski | slovenina |  | Romn Chlamydia is a bacterial infection. Its one of the most common sexually transmitted infections (STIs) in the UK. Symptoms of chlamydia Most people with chlamydia dont notice any symptoms and dont know they have it. So its important to get tested if you think youre infected. If you do get symptoms, its usually 1 to 3 weeks after having unprotected sex. Some people dont get symptoms until months later. If you do develop symptoms, you may experience: pain when peeing unusual discharge from the vagina, penis or anus pain in the lower tummy, bleeding after sex, and bleeding between periods pain in the testicles red, sticky eyes Sometimes symptoms can disappear after a few days. Even if symptoms go away you may still have the infection and could pass it on. Testing for chlamydia If you think you might have chlamydia, get tested for free by: booking an appointment at your local sexual health service (if you have symptoms) contacting your GP practice for an appointment (if you have symptoms) ordering a home test kit (if you do not have symptoms) Services available may vary depending on where you live. What does a chlamydia test involve? The test for chlamydia is simple, painless and very reliable. It involves sending a sample from the area of the body thought to be infected to a lab for analysis. You usually dont have to be examined by a doctor or nurse and can often collect the sample yourself. The 2 main ways the sample can be collected are: using a swab  a small cotton bud is gently wiped over the area that might be infected, such as inside the vagina, throat, or inside the anus urine sample (if you have a penis)  this is more accurate if its at least 1 or 2 hours after you last peed People who have had anal or oral sex may have a swab taken from their anus or throat. Treatment for chlamydia Antibiotics will treat the chlamydia infection. You should avoid having sex until 1 week after you and your partner(s) have been treated. This includes oral sex and sex using a condom. If chlamydia is left untreated you may pass it on to other sexual partners. If chlamydia is left untreated in women, it can spread to the womb and cause a serious condition called pelvic inflammatory disease (PID) . This is a major cause of ectopic pregnancy and infertility in women. If men are not treated, the infection may spread to the testicles and cause discomfort. This could affect your fertility. How chlamydia is passed on You can get chlamydia by having unprotected vaginal, anal or oral sex (sex without a condom). Other ways of getting chlamydia include: sharing sex toys that arent washed or covered with a new condom each time theyre used infected semen or vaginal fluid getting into your eye Chlamydia can be passed from a pregnant woman to her baby during childbirth. Any sexually active person can get chlamydia. Its most common in people under the age of 30. You can have had chlamydia for a while without knowing. How to prevent chlamydia The best way to reduce your risk of STIs is to practice safer sex . This means using a condom for vaginal, anal and oral sex. Other STIs If you have been diagnosed with chlamydia you should get tested for all STIs including: gonorrhoea syphilis HIV Find your local sexual health clinic Source: Scottish Government - Opens in new browser window Last updated: 26 February 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Other languages and formats British Sign Language (BSL) | Polski | slovenina |  | Romn British Sign Language (BSL) | Polski | slovenina |  | Romn Add this page to\n            Info For Me Also on NHS inform Book a sexual health appointment online Chlamydia (BSL) Chlamydia (Chinese) Chlamydia (Polish) Chlamydia (Romanian) Chlamydia (Slovak) NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Chronic fatigue syndrome,"ME or CFS | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Myalgic encephalomyelitis (ME) or chronic fatigue syndrome (CFS) Myalgic encephalomyelitis (ME) or chronic fatigue syndrome (CFS) Myalgic encephalomyelitis (ME) or chronic fatigue syndrome (CFS) is a long term (chronic) neurological condition that affects the nervous and immune systems. People with ME/CFS experience severe pain and fatigue associated with post-exertional malaise (PEM). This is when the body is not able to recover after using even small amounts of energy. This fatigue feels very different from ordinary tiredness. It might take a day or 2 to kick in after physical, mental, or emotional exertion. ME/CFS affects more women than men, can affect children and adults of all ages and from all social and ethnic groups. It doesnt go away with sleep or rest and affects everyday life. It cansometimes be diagnosed as post viral fatigue syndrome (PVFS). Symptoms of ME/CFS The symptoms ofthe condition vary from person to person. There may be times when your symptoms improve and youll be able to do some normal everyday activities. At other times, symptoms may get worse, affecting your daily life. If you experience new symptoms, talk to your GP or specialist as the new symptoms may be unrelated to ME/CFS. Women often find that symptoms worsen at different times in their menstrual cycle. Not everyone will experience all of the symptoms. Post-exertional malaise People with ME/CFS experience severe pain, fatigue and a range of other symptoms associated with PEM. This is the body and brains inability to recover after using even small amounts of energy. Simple physical or mental activities, or combinations of activities, can leave people with ME/CFS feeling completely exhausted. It can also lead to an increase in other symptoms. Other symptoms of ME/CFS include: feeling generally unwell pain broken sleep problems with concentration, thinking and memory (brain fog) speech and language problems, including word-finding difficulties poor temperature control dizziness being very sensitive to light and sound nausea loss of appetite muscle pain (myalgia) Read more about the symptoms of ME/CFS Frustration, anxiety , low mood and depression are sometimes experienced by people with ME/CFS because of the impact of the condition and its symptoms on their lives. This does not mean that ME/CFS is a mental health condition. Causes of ME/CFS Further research is needed to confirm what causes ME/CFS. There might be various factors involved and there may be a number of different types of the illness. These different sub-groups still need more research to be identified, including how they lead to different experiences of the condition and how it develops. ME/CFS may appear suddenly or more slowly over time. It may follow an infection, typically, but not always, viral. Other possible triggers can be: trauma surgery stressful major life events In some cases, there may be no identifiable trigger. How is ME/CFS diagnosed? Theres no single test to detect ME/CFS. A diagnosis is made after other possible known causes for symptoms have been excluded. The earlier the illness is recognised, the sooner you can get help to manage your symptoms. Many people with ME/CFS find it helps to keep a diary of their symptoms so that they can take this to their GP or specialist. Your GP will usually: do a physical and mental examination to rule out other conditions ask about recent travel, tick or insect bites, unusual infections, and drug and alcohol use review current medication arrange tests They may be able to make a diagnosis after 3 or 4 months of seeing a pattern of symptoms. Anyone suspected of having ME/CFS should be considered for routine blood tests to identify other possible illnesses. More investigation may be needed if the diagnosis remains in doubt. Some people with ME/CFS also have another long-term condition and its important that you talk to your GP about how to manage the symptoms of the 2 conditions. Treating ME/CFS Although theres no cure for ME/CFS, there are ways to help manage your symptoms. Because of the complexity of the illness different things work for different people. Your GP may be able to support you through managing your individual symptoms. To decide what treatment is right for you, you should look at the evidence, including published research and patient surveys. Make sure you fully understand what the treatment involves before you make a decision. You have the right to decline any treatment option you do not feel comfortable with. Your GP may suggest some of the following treatment options. Management of medicines Your GP may suggest reviewing and changing the medicines you take. Theyll consider other conditions you may already be receiving treatment for alongside the most important ME/CFS symptoms that need to be treated. Your GP may also need to consider the combined impact of medication for symptoms and possibly for managing other conditions, especially as sensitivity to medicine is a feature of ME/CFS. This could mean there may be issues around polypharmacy (use of many medications) for your healthcare professional to consider. Dietary advice Your illness might make it more difficult for you to eat the right balance of nutrients in your diet due to loss of appetite and food intolerances. Your GP may be able to advise you on how you can alter and adjust your diet. Disability support advice Your GP may work with you or refer you to another therapist to suggest aids, activities or support that can help you to recover or adjust. Pacing advice Balancing periods of activity and rest and noticing what activities demand most from you, can allow you to reduce the number of episodes of PEM. Pacing yourself involves stopping activities before you feel the impact so that you have energy in reserve. Its easy to do too much on a good day and then feel the impact later. It can take time to change your habits and stop doing something even while things are going well. However, doing this is key to managing your condition in the long term. Counselling Counselling can support you to adjust to the impact ME/CFS can have on your life. This does not mean that the condition itself is psychological. Cognitive behavioural therapy (CBT) CBT should only be delivered by a healthcare professional with the right training and experience in CBT for ME/CFS. The 2021 NICE guidelines suggest that CBT might help some people with ME/CFS manage their symptoms. CBT can sometimes be used to help changes in mood that can come with having a long-term condition. Alternative and holistic therapies Alternative or holistic therapies may provide some comfort but be cautious of any method that claims to offer a cure for ME/CFS. You should discuss any alternative or holistic therapy with your GP before you try it. Until further research is done, no one can be certain whether someone with ME/CFS might benefit from alternative therapies. Living with ME/CFS There are some things that you can do for yourself to help you manage the condition. Small changes make a difference to your energy and mobility. This is called self-management. To help with this, you might try: Planning your time Record what you do so that you can build a picture of what uses more energy and what activities you can ask others to do for you. This will show you if there are patterns of symptoms and when they appear during your day. Rest and relaxation This is very important for managing ME/CFS. You may need some support and advice on what that might mean for you in terms of your physical, mental and emotional activities for resting. Getting support Being open with people and asking for help when you need it before youre exhausted is a key approach to managing your condition. Talking about how youre feeling is important for long term health conditions because of the impact your symptoms have on the way you live your life. Talk to your GP about emotional support available to you. How will ME/CFS affect my quality of life? Not everyone will experience the same symptoms so its important not to compare people with ME/CFS. People with ME/CFS can have very different experiences of the condition and how long their symptoms last. The impact of symptoms can be: mild moderate severe very severe As symptoms change over time so does the impact they have on peoples lives. How long will it last? Most people with ME/CFS improve over time, although some people dont make a full recovery. Its also likely there will be periods when symptoms get better or worse. Children and young people with ME/CFS are more likely to recover fully. Where can I get support? ME/CFS can have a significant emotional and financial impact on your life. A lack of understanding and awareness about ME/CFS means patients can experience disbelief, and even discrimination, from friends, family, health and social care professionals and employers. Information on entitlements to welfare benefits, accessing health and social care and others sources of support for patients and carers are available from Action for M.E . They also offer resources and services for children and young people affected by ME/CFS and their families. Peer support In some regions of Scotland there are local support groups providing peer support, information and advice. ALISS and Action for ME can assist with signposting to these groups. Source: Action for ME - Opens in new browser window Last updated: 25 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Depression Fibromyalgia Insomnia Other health sites Action for ME NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Chronic kidney disease,"Chronic kidney disease - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Kidneys, bladder and prostate Chronic kidney disease Chronic kidney disease About chronic kidney disease Symptoms of chronic kidney disease Causes of chronic kidney disease Diagnosis of chronic kidney disease Treating chronic kidney disease Preventing chronic kidney disease Living with chronic kidney disease About chronic kidney disease Chronic kidney disease (CKD) is a long-term condition where the kidneys do not work effectively. CKD does not usually cause symptoms until it reaches an advanced stage. Its usually detected at earlier stages by blood and urine tests. Symptoms of advanced kidney disease The main symptoms of advanced kidney disease include: tiredness swollen ankles, feet or hands (due to water retention) shortness of breath nausea blood in the urine Read more about the symptoms of chronic kidney disease Diagnosing chronic kidney disease Chronic kidney disease is most frequently diagnosed through blood and urine tests. If youre at a high risk of developing CKD, you may be screened annually. Screening may be recommended if you have: high blood pressure (hypertension) diabetes a family history of CKD Read more about diagnosing chronic kidney disease Why does it happen? The kidneys are 2 bean-shaped organs, the size of your fist. Theyre located on either side of the body, just beneath the ribcage. The main role of the kidneys is to filter waste products from the blood before converting them into urine. The kidneys also: help maintain blood pressure maintain the correct levels of chemicals in your body which, in turn, will helpheart and muscles function properly produce the active form of vitamin D that keeps bones healthy produce a substance called erythropoietin, which stimulates production of red blood cells Chronic kidney disease is the reduced ability of the kidney to carry out these functions in the long-term. This is most often caused by damage to the kidneys from other conditions, most commonly diabetes and high blood pressure. Read more about the causes of chronic kidney disease Who is affected? CKD is common andmainly associated with ageing. The older you get, the more likely you are to have some degree of kidney disease. Its estimated that about 1 in 5 men and 1 in 4 women between the ages of 65 and 74 has some degree of CKD. CKD is more common in people of south Asian origin (those from India, Bangladesh, Sri Lanka and Pakistan) and black people than the general population. The reasons for this include higher rates of diabetes in south Asianpeople and higher rates of high blood pressure in African or Caribbean people. Treating chronic kidney disease There is no cure for chronic kidney disease, although treatment can slow or halt the progression of the disease and can prevent other serious conditions developing. People with CKD are known to have an increased risk of a heart attack because of changes that occur to the circulation. Inaminority of people, CKD may cause kidney failure, also known as established renal failure (ERF) or end-stage kidney disease. In this situation, the usual functions of the kidney stop working. To survive, people with ERF may need to have artificial kidney treatment, called dialysis , or a kidney transplant. Read more about treating chronic kidney disease Living kidney donation A kidney transplant from a living donor can be planned to avoid or reduce the time someone is on dialysis. This can offer a better long term outcome for the person receiving the organ. There are 2 types of living kidney donation: directed donation  a person can donate a kidney to someone they know, like a family member or a friend altruistic kidney donation  a person can donate a kidney anonymously to someone they do not know Further information about living donation. Living with chronic kidney disease Being diagnosed with chronic kidney disease can be worrying, but support and advice are available to help you cope. Read more about living with chronic kidney disease Preventing chronic kidney disease The main way to reduce the chances of CKD developing is to ensure any existing conditions, such as diabetes and high blood pressure, are carefully managed. Some lifestyle changes can also reduce the risk of CKD developing, these include: having a healthy diet avoiding drinking excessive amounts of alcohol exercising regularly avoiding medicines that can damage the kidney Read more about preventing chronic kidney disease Symptoms of chronic kidney disease Most people with CKD have no symptoms because the body can tolerate even a large reduction in kidney function. In other words, we are born with a lot more kidney function than is necessary for survival. Kidney function is often sufficient if only 1 kidney is working. That is why people can give a kidney to someone needing a kidney transplant. A change in kidney function is usually discovered through a routine blood or urine test. If you are diagnosed with kidney disease, your kidney function will be monitored with regular blood and urinetests, and treatment aims to keep any symptoms to a minimum. If the kidneys continue to lose function and there is progression towards kidney failure (established renal failure or ERF), this will usually be tracked by blood tests and monitoring. If kidney failure does occur, the symptoms may include: weight loss and poor appetite swollen ankles, feet or hands (due to water retention) shortness of breath blood or protein in your urine (protein in your urine is not something you will notice as it can only be detected during a urine test) an increased need to urinate, particularly at night insomnia itchy skin muscle cramps high blood pressure (hypertension) nausea erectile dysfunction in men(an inability to get or maintain an erection) These are general symptoms and can be caused by many less serious conditions. Many of the symptomsabove can be avoided if treatment begins at an early stage, before any symptoms appear. If you are worried by any of these symptoms, arrange to see your GP. Causes of chronic kidney disease Kidney disease is most often caused by other conditions that put a strain on the kidneys. High blood pressure (hypertension) and diabetes are the most common causes of kidney disease. High blood pressure Blood pressure is a measure of the pressure your heart generates in your arteries with each pulse. Too much pressure can damage your bodys organs, leading to heart disease, stroke and worsening of kidney function. The cause of around 90% of cases of high blood pressure is unknown. There appears to be a link between the condition and a persons general health, diet, and lifestyle. Known risk factors for high blood pressure include: age (the risk of developing high blood pressure increases as you get older) family history of high blood pressure (the condition seems to run in families) being of African-Caribbean or south Asian origin obesity lack of exercise smoking excessive alcohol consumption high amount of salt in your diet high-fat diet stress Hypertension causes damage by putting strain on the small blood vessels in the kidneys. This prevents the filtering process from working properly. Diabetes Diabetes is a condition in which the body produces no  or too little  insulin ( type 1 diabetes ) or has become unable to make effective use of insulin ( type 2 diabetes ). Insulin is needed to regulatelevels of glucose (sugar) in your blood, preventing the levels going too high after a meal and too low between meals. If diabetes is poorly controlled, too much glucose can build up in your blood. The glucose can damage the tiny filters in the kidneys, which affects the ability of your kidneys to filter out waste products and fluids. It is estimated that 20% to 40% of people with type 1 diabetes will develop kidney disease before they reach 50 years of age. Around 30% of people with type 2 diabetes also show signs of developing kidney damage. The first sign of diabetic kidney disease is the appearance of low levels of protein in the urine. Therefore, your GP will ask for an annual urine test so any kidney disease can be detected as early as possible. All people with diabetes should have a kidney check every year. Early detection of kidney dysfunction in diabetes is important because it identifies people at risk or complications, such as eye problems and impotence. Other causes There are many other conditions that less commonly cause CKD, including: glomerulonephritis (inflammation of the kidney) pyelonephritis (infection in the kidney) polycystic kidney disease (an inherited condition where both kidneys are larger than normal due to the gradual growth of masses of cysts) failure of normal kidney development in an unborn baby while developing in the womb systemic lupus erythematosus (a condition of the immune system where the body attacks the kidney as if it were foreign tissue) long-term, regular use of medicines, such as lithium and non-steroidal anti-inflammatory drugs (NSAIDs) , including aspirin and ibuprofen blockages, for example due to kidney stones or prostate disease Diagnosis of chronic kidney disease Chronic kidney disease (CKD) is most frequently diagnosed through blood and urine tests. Screening If you are in a high-risk group for developing CKD, it is importantto be regularly screened for the condition. People who are not in a high-risk group are not normally screened for CKD. Annual screening is recommended for the following groups: people with high blood pressure (hypertension) people with diabetes people withacute kidney injury caused by medications such as lithium or NSAIDs such as ibuprofen, kidney stones or an enlarged prostate people with cardiovascular disease (conditions that affect the heart, arteries and veins, such as coronary heart disease or heart failure ) people with a family history of stage 5 CKD (see below for more information about staging) or an inherited kidney disease people with diseases that affect several parts of the body and may affect the kidneys, such as systemic lupus erythematosus people with blood in the urine (haematuria) or protein in the urine (proteinuria) where there is no known cause Your GP can advise you about whether or not you should be screened for CKD. Most often, the diagnosis of kidney disease is made because a routine blood or urine test indicates the kidneys may not be functioning normally. If this happens, the test is usually repeated toconfirm the diagnosis. Glomerular filtration rate (GFR) An effective way of assessing how well your kidneys are working is to calculate your glomerular filtration rate (GFR). GFR is a measurement of how many millilitres (ml) of waste fluid your kidneys can filter from the blood in a minute (measured in ml/min). A healthy pair of kidneys should be able to filter more than 90ml/min. It is difficult to measure the GFR directly, so it is estimated using a formula. The result is called the estimated GFR or eGFR. Calculating your eGFR involves taking a blood sample and measuring the levels of a waste product called creatinine and taking into account your age, gender and ethnic group. The result is similar to the percentage of normal kidney function. For example, an eGFR of 50ml/min equates to 50% kidney function. The following tests are used to detect proteinuria (protein in the urine) urine tests  used to see whether there is blood or protein in your urine albumin and creatinine testing  this is another urine test which compares the amounts of albumin (a protein) and creatinine in your urine, and the ratio of the 2 (the albumin:creatinine ratio or ACR) can be used with eGFR to give doctors a more accurate idea of how the kidneys are functioning Staging A 6-stage system, based on eGFR levels, is used to describe the progression of CKD. The higher the stage, the more severe the CKD. Stage 1 (sometimes called G1): the eGFR is normal (above 90 or more), but other testing shows evidence of kidney damage. Stage 2 (G2): the eGFR has decreased slightly (60 to 89), but is still considered to be in the normal range for a young adult. If you have stage 1 or 2 CKD, it is recommended you have annual eGFR tests so the progression of the condition can be carefully monitored. Stage 3 is divided into 2: stage 3a (G3a) and 3b (G3b). In stage 3a, the eGFR has decreased mildly (45 to 59) and this is termed a mild to moderate decrease in kidney function and should be checked annually. In stage 3b (G3b) it has decreased moderately (30 to 44) and is termed a moderate to severe reduction in kidney function and should be checked every 6 months. Stage 4 (G4): the eGFR has reduced severely (15 to 29). By this time, it is possible you will be experiencing symptoms of CKD. Further testing should be carried out every 6 months. Stage 5 (G5): the kidneys have lost almost all of their function (an eGFR of below 15), which is known as establishedrenal failure. Further testing should be carried out every 3 months. However, over time, GFR can fluctuate, so one abnormal test result does not automatically mean you have CKD. A diagnosis of CKD is usually only confirmed if repeated eGFR tests show your eGFR is consistently lower than normal over 3 months. Other tests Other tests are also used to assess the levels of damage to your kidneys: kidney scans, such as an ultrasound scan, a magnetic resonance imaging (MRI) scan or a computerised tomography (CT) scan, are used to find out whether there are any unusual blockages in your urine flow  in cases of advanced kidney disease, the kidneys are shrunken and have an uneven shape kidney biopsy  a small sample of kidney tissue is taken so that the cells can be examined under a microscope for damage Treating chronic kidney disease Lifestyle changes The following lifestyle changes are known to help reduce your blood pressure and help control CKD: stopping smoking eating a healthy, low-fat, balanced diet restricting your salt intake to less than 6g (0.2oz) a day notusing over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) , such as ibuprofen, except when advised to by a medical professional moderating your alcohol intakeso it is within recommended limits losing weight if you are overweight or obese doing regular exercisefor at least 30 minutes a day, 5 times a week Readmore about preventing high blood pressure through lifestyle changes. Medications for high blood pressure One of the main ways to reduce the progression of kidney damage is to manage high blood pressure . Good control of blood pressure isvital to protect the kidneys. People with CKD should aim to get their blood pressure down to below 140/90mmHg but if you also have diabetes you should aim to get it down to below 130/80mmHg. There are many types of blood pressure drugs.Medicines called angiotensin converting enzyme (ACE) inhibitors are used to control high blood pressure in people with CKD. As well as reducing blood pressure around the body and reducing the strain on blood vessels,ACE inhibitorsgive additional protection to the kidney. ACE inhibitors include: ramipril enalapril lisinopril perindopril Side effects of ACE inhibitors include: a persistent, dry cough dizziness tiredness or weakness headaches Most of these side effects should pass within a few days, although some people continue to have a dry cough. If the side effects of ACE inhibitors are particularly troublesome, you can be given an alternative medication called an angiotensin-II receptor blocker (ARB).This group of medicines includes: candesartan eprosartan irbesartan azilsartan olmesartan temisartan valsartan losartan The side effects of ARBs are uncommon, but can include dizziness. Both ACE inhibitors and ARBs can cause a reduction in kidney function in some peopleand increased levels of potassium in the blood, so blood tests will need to be performed after you start treatment and whenever the dose changes. If you are on an ACE inhibitor or ARB and you develop a fever/infection or need medicines for other conditions, its important to ask your doctor if the ACE inhibitor or ARB needs to be temporarily stopped. Medication to reduce cholesterol Studies have shown that people with CKD have a higher risk of cardiovascular disease, including heart attacks and strokes. This is because some of the risk factors for CKD are the same as those for heart attacks and strokes, including high blood pressure and high levels of cholesterol in the blood (atherosclerosis). Statins are a type of medication used to lower cholesterol levels. Cholesterol causes narrowing of the arteries that can lead to a blockage of the blood supply to the heart (causing a heart attack) or the brain (causing a stroke). Statins work by blocking the effects of an enzyme in your liver (called HMG-CoA reductase), which is used to make cholesterol. Statins sometimes have mild side effects, including: constipation diarrhoea headaches abdominal pain Occasionally, statins can cause muscle pain, weakness and tenderness. If you experience any of these symptoms, contact your GP. Youmay need to have a blood test or change your treatment. If you have kidney disease, you may be asked to reduce your daily fluid and salt intake. You may develop a build-up of fluid as your kidneys will not be able to get rid of fluid as well as they did before. If you are asked to reduce the amount of fluid you drink, you must also take into account fluid in foods, such as soup and yoghurt. Your GP or dietitian can advise you about this. The excess fluid that occurs as a result of kidney disease often builds up in your ankles or around your lungs. You may also be given diuretics (water tablets), such as furosemide, which will help get rid of the excess fluid from your body. If you do not have any fluid retention and youhave notbeen toldto reduce your fluid intake, there is no need to do so.In fact, it could be harmful in some circumstances. Anaemia Many people with stage three, four and five CKD develop anaemia . Anaemia is a condition in which you do not have enough red blood cells. Symptoms of anaemia include: tiredness lethargy shortness of breath (dyspnoea) palpitations (awareness of heartbeat) Anaemia can occur because of many other conditions and your doctor will investigate to rule outother possible causes. Most people with kidney disease will be given iron supplements because iron is needed for the production of red blood cells. To boost iron levels, iron may be given as tablets, such as daily ferrous sulphate tablets, or as occasional intravenous infusions. If this is not enough to treat anaemia, you may be started on injections of erythropoietin, a hormone which helps your body produce more red blood cells. These injections are often administered into a vein (intravenously)or under the skin (subcutaneously). Examples of these injections include epoetin alfa, beta and zeta, darbepoetin and methoxy polyethylene glycol-epoetin beta. Correction of phosphate balance If you have stage 4 or 5 kidney disease, you can get a build-up of phosphate in your body because your kidneys cannot get rid of it. Phosphate is a mineral that, with calcium, makes up most of your bones. Phosphate is obtained through diet, mainly dairy foods. The kidneys usually filter outexcess phosphate. If phosphate levels rise too much, it can upset the normal calcium balance of the body. This can lead to thinning of the bones and furring of the arteries. You may be asked to limit the amount of phosphate in your diet. Foodshigh in phosphate include red meat, dairy produce, eggs and fish. Your GP or dietitian should be able to advise you about how much phosphate you can eat. However, there is no advantage in reducing your intake of these foods unless you have a raised phosphate level.Always aska healthcare professional before changing your diet. If reducing the amount of phosphate in your diet does not lower your phosphate level enough, you may be given medicines called phosphate binders. These medicines bind to the phosphate in the food inside your stomach and stop it from being absorbed into your body. To work properly, phosphate binders must be taken just before meals. The most commonly used phosphate binderis calcium carbonate, but thereare also alternatives that may be more suitable foryou. The side effects of phosphate binders are uncommon but include: nausea stomach ache constipation diarrhoea flatulence (wind) skin rash itchy skin Vitamin D supplements People with kidney disease can have low levels of vitamin D, necessary for healthy bones. This is because the kidneys need to activate the vitamin D from food andthe sun before it can be used by the body. Treatment for kidney failure  transplant or dialysis Many people with kidney failure can continue with treatment using medicines and will have good-functioning kidneys for the rest of their lives. In a few people, kidney disease will progress to the stage where the kidneysstop working and it becomes life threatening. This is called kidney failure or established renal failure (ERF). This rarelyhappens suddenly, and there will be time to plan the next stage of your condition. The decision whether to have dialysis, a kidney transplant or supportive treatment should be discussed with your healthcare team. Read more about dialysis andkidney transplants. Supportive treatment If you decide not to have dialysis or a transplant for kidney failure, or they are not suitable for you,you will be offered supportive treatment. This is also called palliative care. The aim is to treat and control the symptoms of kidney failure without using dialysis or transplantation. Supportive treatment includes medical, psychological and practical care for both the person with kidney failure and their family, including discussion about how you feel and planning for the end of life . Many people choose supportive treatment because they: are unlikely to benefit or have quality of life with treatment do not want to go through the inconvenience of treatment with dialysis are advised against dialysis because they have other serious illnesses that will shorten their life, and the negative aspects of treatment outweigh any likely benefits have been on dialysis but have decided to stop this treatment are being treated with dialysis, but have another serious physical illness, especially severe heart disease or stroke, that will shorten their life If you choose to have supportive treatment, your kidney unit will still look after you. Doctors and nurses will make sure you receive: medicines to protect your remaining kidney functionfor as long as possible medicines to treat other symptoms of kidney failure, such as feeling out of breath, anaemia, loss of appetite or itchy skin helpto plan your home and money affairs bereavement support for your family after your death Read more information: Kidney Research UK: Information on choosing not to start dialysis Bereavement support from CRUSE What is good kidney disease care? Kidney disease services should: identify people at risk of kidney disease, especially people with high blood pressure or diabetes, and treat them as early as possible to maintain their kidney function give people access to investigative treatment and follow them up to reduce the risk of the disease getting worse give people good-quality information about managing their condition provide information about the development of the disease and treatment options provide access to a specialist renal (kidney) team give people access to transplant or dialysisservices if required provide supportive care Your treatment for kidney disease will need to be reviewed regularly. It may be helpful for you to make a care plan because this can help you manage your day-to-day health. Your kidney disease specialist nurse may be able to help with this. Preventing chronic kidney disease In most cases, chronic kidney disease (CKD) cannot be completely prevented, although you can take steps to reduce the chances of the condition developing. Managing your condition If you have a chronic (long-term) condition, such as diabetes, that could potentially cause chronic kidney disease, it is importantit is carefully managed. Follow the advice of your GP and keep all appointments relating to your condition. People with diabetes are advised to have their kidney function tested every year. Read more about Type 1 diabetes and Type 2 diabetes Smoking Smoking increases your risk of cardiovascular disease, includingheart attacks or strokes, and it can increase the likelihood that any existing kidney problems will get worse. If you stop smoking, you will improve your general health and reduce your risk of developing other serious conditions, such as lung cancer and heart disease. The NHS smoking helpline can offer you advice and encouragement to help you quit smoking.Phone Quit Your Way Scotland on0800 84 84 84. Read moreabout stopping smoking Diet A healthy diet is importantfor preventing chronic kidney disease. It will lower the amount of cholesterol in your blood and keep your blood pressure at a healthy level. Eat a balanced diet that includes plenty of fresh fruit and vegetables ( 5 a day ) and whole grains. Limit the amount of salt in your diet to no more than 6g (0.2oz) a day. Too much salt will increase your blood pressure. One teaspoonful of salt is equal to about 6g. Avoid eating foods high in saturated fat because this will increase your cholesterol level. Foods high in saturated fat include: meat pies sausages and fatty cuts of meat butter ghee (a type of butter often used in Indian cooking) lard cream hard cheese cakes and biscuits foods that contain coconut oil or palm oil Eating some foods that are high in unsaturated fat can help decrease your cholesterol level. Foodshigh in unsaturated fat include: oily fish avocados nuts and seeds sunfloweroil rapeseedoil olive oil Read more abouthealthy food and diet Alcohol Drinking excessive amounts of alcohol will cause your blood pressure to rise, as well as raising cholesterol levels in your blood. Therefore, sticking to the recommended alcohol consumption limits is the best way to reduce your risk of developing high blood pressure (hypertension) and CKD. Exercise Regular exercise should help lower your blood pressure and reduce your risk of developing CKD. At least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity (such as cycling or fast walking) every week, is recommended. Read more about health and fitness Painkillers Kidney disease can be caused by the improper use (such as taking too many)of non-steroidal anti-inflammatories (NSAIDs) , such as aspirin and ibuprofen . If you need to take painkillers,make sure you follow the instructions. This can help to avoid kidney damage. Living with chronic kidney disease Relationships and support Coming to terms with a condition such as kidney disease can put a strain on you, your family and your friends. It can be difficult to talkto people about your condition, even if they are close to you. Learning about kidney disease often helps because you and your family will understand more about what to expect and feel more in control of the illness, instead of feeling that your lives are now dominated by kidney disease and its treatment. Be open about how you feel, and let your family and friends know what they can do to help. However, do not feel shy about telling them that you need some time to yourself, if that is what you need. Get support Your GP or nurse can reassure you if you have questions about your kidney disease, or you may find it helpful to talk to a trained counsellor, psychologist or specialist telephone helpline operator. Your GP practice will have information on these. Some people find it helpful to talk to other people with kidney disease at a local support group or online. Money and finances If you have to stop work or work part time because of your kidney disease, you may find it hard to cope financially. You may be entitled to one or more of the following types of financial support: if you have a job but cannot work because of your illness, you are entitled to Statutory Sick Pay from your employer if you do not have a job and cannot work because of your illness, you may be entitled to Employment and Support Allowance if you are aged 64 or under and need help with personal care or have walking difficulties, you may be eligible for Disability Living Allowance if you are aged 65 or over, you may be able to get Attendance Allowance if you are caring for someone with kidney disease, you may be entitled to Carers Allowance you may be eligible for other benefits if you have children living at home or if you have a low household income Sex and pregnancy The symptoms of kidney disease and the stress it causes in your life can affect your sexual relationships. Some couples become closer after a diagnosis of kidney disease, while others find that their loved ones are affected by worries about how they will cope with the effects of the illness. Both men and women may experience issues about body image and self-esteem, and this can affect the relationship. Try to share your feelings with your partner. If you have problems with sex that do not get better with time, speak to a counsellor or sex therapist. People on dialysis often experience specific sexual difficulties. Loss of sex drive in both men and women and impotence in men are commonly reported problems. Treatment is available, butit may take some time and requires commitment from both partners. The first step is to discuss it with your healthcare team. Pregnancy Both men and women with early stage kidney disease will findtheir fertility is unaffected. This means it is important to use contraception unless you want to have a baby. Later stage kidney disease may affectwomens periods, which can make pregnancy more difficult. For men, later stage kidney disease can cause a reduction in sperm count. However, having kidney disease does not mean you will not get pregnant or be able to father a child, soboth men and womenneed to use an effective method of contraception unless they want to have a baby. Women who want to have a baby should talk to their renal specialist or an obstetrician with an interest in kidney disease.Depending on the stage of kidney disease, there can be risks to both the mother and the baby. It is important to minimise any risk with a planned pregnancy. Your healthcare team can advise you about this. Holidays and insurance If you have mild kidney disease or youve had a transplant, going on holiday shouldnt pose additional health problems, whether youre staying in the UK or going abroad. If youre on dialysis, you can still enjoy holidays provided you book your treatment before you go away. If youre on dialysis and want to travel, discuss your plans with your renal unit as early as you can. It can sometimes be more difficult to arrange dialysis in the UK than it is abroad. The NHS will look after you if you get ill while on holiday in the UK. If youre in Europe, the European Health Insurance Card (EHIC) entitles you to free or reduced-cost hospital treatment. Its a good idea to take out holiday health insurance in addition to carrying the EHIC. Anyone with kidney disease should declare it as a pre-existing medical condition on standard insurance application forms. It may exclude you from some policies. Using over-the-counter medicines Some remedies are potentially harmful for people with kidney disease. Make sure you check with your doctor before taking a new over the counter medicine. Youre at higher risk of being harmed by certain over the counter remedies if: you have advanced kidney disease (stage 4 or 5, or a kidney function below 30% of normal) you have mild-to-moderate kidney disease (stage 3 with a kidney function between 30 and 60% of normal) and are elderly with another serious illness, such as coronary heart disease Whats safe and whats not Summarised below is a list of which over the counter remedies are safe for people with kidney disease to use and which should be avoided. This is just a guide. For more detailed information, consult your pharmacist, renal specialist or GP. Headaches Paracetamol is safe and the best choice of painkiller to treat a headache, but avoid soluble products as they are high in sodium. If your kidney function is less than about 50%, avoid painkillers containing aspirin, ibuprofen or similar drugs such as diclofenac. These products can deteriorate the function of damaged kidneys. Low-dose aspirin of 75mg to 150mg a day can be used if its ",,,,,,,,,,,,,
Chronic kidney disease,"rescribed for the prevention of vascular disease. You should also avoid ibuprofen if youre taking anti-rejection treatment following a kidney transplant. Coughs and colds Many of the products available for coughs and colds contain a mixture of ingredients	 so check the packaging carefully. Some products contain paracetamol	 which is safe	 but others contain high doses of aspirin	 which its best to avoid. Many cold remedies also contain decongestants 	 which you should avoid if you have high blood pressure. The best way to clear congestion is by steam inhalation with menthol or eucalyptus. For coughs	 try a simple linctus or glycerine honey and lemon to soothe your throat. Muscle and joint pains If you have muscle or joint pain	 its ideal to use topical preparations (applied to the skin)	 which are rubbed on to the painful area. Avoid tablets containing ibuprofen or similar drugs such as diclofenac if your kidney function is below 50%. Ibuprofen gel or spray is safer than ibuprofen tablets	 but it isnt completely risk-free as a small amount of the drug penetrates the skin into the bloodstream. Kidney failure About 1% of people with stage three CKD develop kidney failure	 also called established renal failure (ERF). Kidney failure has a major impact on your life and the lives of those close to you. People diagnosed with kidney failure usually go through shock	 grief and denial before they accept their condition. Choices if you have established renal failure If you have established renal failure (ERF)	 you will need to decide whether to have treatment with dialysis or a kidney transplant. You may decide to have neither treatment and to have supportive care. These choices should be made with your healthcare team. For people who want active treatment for their ERF	 a transplant would be the best option. However	 a transplant is only suitable for about half of all people with ERF. This is because they may have had recent cancer orare not physically fit. Many people who have slowly progressive kidney failure and other serious health problems	 and who are usually older	 may choose to avoid dialysis. Supportive care can still allow you to live for some time with a good quality of life. Transplant A kidney transplant	 when suitable	 is the best treatment for ERF. The transplanted kidney can be obtained from a deceased or living donor and survival rates are now extremely good. About 90% of transplants still function after five years and many transplants work usefully after 20 years. The main reason people have to wait for a transplant is the shortage of available donors. Over a third of kidney transplants are now from live donors. A live donor kidney can be transplanted before the need for dialysis	 rather than after a period of time on dialysis. One major risk after transplantation is rejection	 where the immune system attacks the donated kidney because it mistakes it for a foreign object. This is prevented with the use of strong drugs to suppress the immune system. These drugs need to be taken meticulously. They are usually well tolerated but may have side effects	 including an increased susceptibility to infections and some forms of cancer. For this reason	 transplant patients are given regular reviews in a specialist transplant clinic. Dialysis Dialysis can take place at home or in hospital. It involves filtering the blood of waste products and excess water. It is not as efficient as a human kidney	 so people with kidney failure usually need to restrict their intake of fluid and certain foods. They also require additional medicines such as iron supplements	 phosphate binders and antihypertensive medicine (to reduce blood pressure). There are 2 types of dialysis: peritoneal dialysis and haemodialysis. Peritoneal dialysis The abdomen (tummy) has a lining called the peritoneal membrane	 which can be used as a filter to remove excess waste and water. If you have opted for peritoneal dialysis	 a tube (catheter) will be inserted into your abdomen during an operation. This will allow you to drain dialysis fluid in and out of your tummy yourself. You will not need to go into hospital to be treated	 but you will have to spend an hour or two each day draining the fluid. The treatment involves either four exchanges spaced out during the day	 each taking half an hour	 or attaching yourself to a machine overnight that pumps the fluid in and out for you. Haemodialysis Haemodialysis removes waste products and excess fluid that build up in the body when the kidneys stop working. Blood is taken from the body to be cleaned in a filter known as a dialyser. It is effectively an artificial kidney. The whole process takes about four hours and usually has to be repeated three times a week. Most people go into hospital to have haemodialysis. However	 some people choose to have the treatment in their own home. Home haemodialysis will give you more flexibility	 but comes with greater responsibility. Youll need to have the space in your home for a dedicated machine and	 in most cases	 a lot of support from a close family member or friend. Some people choose to have their dialysis at night while they are asleep. Most people who choose home haemodialysis have it every day	 so their fluid intake is not as restricted. Quality vascular access During haemodialysis	 it is important that large volumes of blood are passed through the machine. This requires special measures to get into large enough blood vessels. For this reason	 haemodialysis patients need a minor operation to join one of the deep arteries to a superficial vein (called a fistula). This is carried out in day surgery and should be done at least 6 weeks before dialysis is required because it needs time to mature before it can be used. Occasionally	 there will be insufficient time for a fistula to be created before dialysis is required. In this case	 a temporary solution is found	 usually involving the use of an indwelling plastic dialysis catheter. A catheter is a surgical tube inserted into the body to allow for the transfer of fluid. All the issues will be discussed in detail with you by the dialysis team before any decisions are made. ",,,,,,,,,,,,,
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Chronic lymphocytic leukaemia,"Chronic lymphocytic leukaemia | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Chronic lymphocytic leukaemia Chronic lymphocytic leukaemia About chronic lymphocytic leukaemia Diagnosing chronic lymphocytic leukaemia Treating chronic lymphocytic leukaemia Complications of chronic lymphocytic leukaemia Causes of chronic lymphocytic leukaemia About chronic lymphocytic leukaemia Chronic lymphocytic leukaemia is a type of cancer that affects the white blood cells and tends to progress slowly over many years. It mostly affects people over the age of 60 and is rare in people under 40.Children are almost never affected. In chronic lymphocytic leukaemia (CLL),the spongy material found inside some bones (bone marrow)produces too many white blood cells called lymphocytes thatarent fully developed and dont work properly. Over time this can cause a range of problems, such as an increased risk of picking up infections, persistent tiredness,swollen glandsin the neck, armpits or groin, and unusual bleeding or bruising. CLL is differentfrom other types of leukaemia, including chronic myeloid leukaemia , acute lymphoblastic leukaemia and acute myeloid leukaemia . Symptoms of CLL CLL doesnt usually cause any symptoms early on and may only be picked up during a blood test carried out for another reason. When symptoms develop, they may include: getting infectionsoften anaemia persistent tiredness, shortness of breath and pale skin bleeding and bruising more easily than normal a high temperature (fever) night sweats swollen glands in yourneck, armpits or groin swelling and discomfort in your tummy unintentional weight loss You should speak to your GP if you have any persistent or worrying symptoms. These symptoms can have other causes other than cancer, but its a good idea to get them checked out. Read more about diagnosing CLL and complications of CLL . Treatmentsfor CLL As CLLprogresses slowly and often has no symptoms at first, you may not need to be treated immediately. If its caught early on, youll have regular check-ups over the following months or yearsto see if its getting any worse. If CLLstarts to cause symptoms, or isnt diagnosed until later on, the main treatments are: chemotherapy  where medicationis taken as a tablet or given directly into a vein is used to destroy the cancerous cells a stem cell or bone marrow transplant  where donated cells called stem cells are transplanted into your body so you start to produce healthy white blood cells Treatment cantusually cureCLL completely, but can slow its progression and lead toperiods where there are no symptoms. Treatment may be repeated if the condition comes back. Read more about treating CLL . Outlook for CLL The outlook for CLL depends on how advanced it is when its diagnosed, how old you are when diagnosed, andyour general health. Younger, healthier people who are diagnosed whenCLL isstill in the early stages generally have the best outlook. Although it cant normally be cured, treatment can help control the condition for many years. Causes of CLL Its not clear what causes CLL. Theres no proven linkwith radiation or chemical exposure, diet or infections. You cant catch it from anyone else or pass it on. However, having certain genes can increase your chances of developing CLL. You may be at a slightly higher risk of it if you have a close family member with it, although this risk is still small. Diagnosing chronic lymphocytic leukaemia Most cases of chronic lymphocytic leukaemia (CLL) are detected during blood tests carried out for another reason. However, you should speak to your GP if you have worrying symptoms of CLL , such aspersistent tiredness, unusual bleeding or bruising, unexplained weight loss or night sweats. Your GP may: ask about your symptoms and your medical and family history carry out a physical examination to check for problems such as swollen glands and a swollen spleen send off a bloodsample for testing Ifyour GPthinks you could have CLL, youll be referred to a hospital doctor called a haematologist, a specialist in blood disorders, for further tests. Blood tests The main test used to help diagnose CLL is a type of blood test called a full blood count. This is where the number and appearance of the different blood cells in a sample of your blood are checked in a laboratory. An abnormally high number of unusual white blood cells(lymphocytes) can be a sign ofCLL. A detailed examination of these cells can usually confirm the diagnosis. X-rays and scans You may also have: a chest X-ray an ultrasound of your tummy a computerised tomography (CT) scan These tests can check for problems caused by CLL, such as swollen glandsora swollenspleen,and helprule out other possible causes of your symptoms. Bone marrow biopsy Sometimesthehaematologistmayrecommend removing a sample of your bone marrow(bone marrow biopsy) so they canexamine itunder a microscope to check it for cancerous cells. The sample is removedusinga needle inserted into your hip bone. Local anaesthetic is normally used tonumb the area where the needle is inserted, although you may experience some discomfort during the biopsy. The procedure willlast around 15 minutes and you shouldnt need to stay in hospital overnight. You mayhave some bruising and discomfort for a few days afterwards. Lymph node biopsy In some cases, removing and examining a swollen lymph gland can help confirm a diagnosis of CLL. This is known as a lymph node biopsy. The gland is removed during a minor operation carried out under either local or general anaesthetic , where youre asleep. You wont usually need to stay in hospital overnight. After the operation, youll be left with a small wound that will be closed with stitches. Genetic tests Tests may also be carried out on your blood and bone marrow samples to check for any unusual genes in the cancerous cells. Identifying unusual genes in these cells can help your doctors decide how soon you should start treatment and which treatment is best for you. Some treatments for CLL dont work as well in people with certain abnormal genes in the affected cells. Treating chronic lymphocytic leukaemia Treatment for chronic lymphocytic leukaemia (CLL) largely depends on what stage the condition is at when its diagnosed. You may just need to be monitored at firstif its caught early on. Chemotherapy is the main treatment if its more advanced. Treatment can often help keep CLL under control for manyyears. Itmay go away after treatment initially (known as remission), but will usually come back (relapse) a few months or years later and may need to be treated again. Stages of CLL Doctors use stages to describe how far CLL has developed and help them determine when it needs to be treated. There are 3 main stages of CLL: stage A you have enlarged lymphglands in fewer than 3 areas (such as your neck, armpit or groin) and a high white blood cell count stage B you have enlarged lymph glands in 3 or more areas and a high white blood cell count stage C you have enlarged lymphglands or an enlarged spleen, a high white blood cell count, and a low red blood cell or platelet count Stage B and C CLL are usually treated straight away. Stage A generally only needs to be treated if its getting worse quickly or starting to cause symptoms. Monitoring early-stage CLL Treatment may not be needed if you dont have any symptoms when youre diagnosed with CLL. This is because: CLLoften develops very slowly and may not cause symptoms formany years theres no benefit in starting treatment early treatment can cause significant side effects In these cases, you will normally just need regular visits to your doctor and blood tests to monitor the condition. Treatment with chemotherapy will usually only be recommended if you develop symptoms, or tests show that the condition is getting worse. Chemotherapy for more advanced CLL Many people with CLL will eventually need to have chemotherapy. This involves taking medication to keep the cancer under control. There are a number of different medicines for CLL, but most people will take 3 main medications in treatment cycles lasting 28 days. These medicines are: fludarabine usually taken as a tabletfor 3 to 5 days at the start of each treatment cycle cyclophosphamide  alsousually taken as a tabletfor 3 to 5 days at the start of each treatment cycle rituximab  giveninto a vein over the course ofa few hours (intravenous infusion) at thestart of each treatment cycle Fludarabine and cyclophosphamide can usually be taken at home. Rituximab is given in hospital, and sometimes you may need to stay in hospital overnight. A number of different medicines can also be tried if you cant have these medicines, youve tried them but they didnt work, or your CLL has come back after treatment. These include bendamustine, chlorambucil, ibrutinib, idelalisib, obinutuzumab, ofatumumab and prednisolone (a steroid medication ). Side effects of treatment The medicines used to treat CLL can cause some significant side effects, including: persistent tiredness feeling sick an increased risk of infections easy bruising or bleeding anaemia shortness of breath , weakness and pale skin hair loss or thinning an irregular heartbeat an allergic reaction Most side effects will pass once treatment stops. Let your care team know if you experience any side effects, asthere are some treatments that can help. Read more about the side effects of chemotherapy Stem cell or bone marrow transplants Stem cell or bone marrow transplants are sometimes used to try toget rid of CLL completely, or control it for longer periods. Stem cellsare cells produced by the spongy material found in the centre of some bones (bone marrow) that can turn into different types of blood cells, including white blood cells. A stem cell transplant involves: having high-dose chemotherapy and radiotherapy to destroythe cancerous cells in your body removing stem cells from the blood or bone marrowof a donor this will ideally be someone closely related to you, such as a sibling transplanting the donor stem cells directly into one of your veins Thisis the only potential cure for CLL,but its not done very oftenas its an intensive treatment and many people with CLL are older and not well enough for the benefits to outweigh the risks. The initial treatment with chemotherapy and radiotherapycan place a significant strain on your body and causetroublesome side effects. Theres also a risk of serious problems after the transplant, such as graft versus host disease. This is wherethe transplanted cells attack the other cells in your body. Other treatments for CLL There are also a number of other treatments that are sometimes used to help treat some of the problems caused by CLL, particularly if you cant have chemotherapy or it doesnt work. These include: radiotherapy toshrink enlarged lymph glands or a swollen spleen surgery to remove a swollen spleen antibiotics ,antifungals and antiviral medications to help reduce your risk of picking up an infection during treatment blood transfusions to provide more red blood cells andplatelets (clottingcells)if you experience severe anaemia or problems with bleeding and bruising immunoglobulin replacement therapy a transfusion ofantibodies taken from donated blood thatcan help prevent infections injections of medication calledgranulocyte-colony stimulating factor (G-CSF) to help boost the number of white blood cells You may also need additional treatment for any complications of CLL that develop. Deciding against treatment As many of the treatments for CLL can have unpleasant side effects that may affect your quality of life, you may decide against having a particular type of treatment. This is entirely your decision and your treatment team will respect any decision you make. You wont be rushed into deciding about your treatment, and before making a decision you can talk to your doctor, partner, family and friends. Pain relief and nursing care will still be available as and when you need it. Complications of chronic lymphocytic leukaemia Chronic lymphocytic leukaemia (CLL) can sometimes cause a number of further complications. Infections People with CLL usually have a weakened immune system and are more vulnerable to infectionsbecause they have a lack of healthy, infection-fighting white blood cells. Treatment with chemotherapy can also further weaken the immune system. If you have CLL, its a good idea to: report any possible symptoms of an infection to your GP or care team immediately  things to look out for include a high temperature (fever), aching muscles, diarrhoea or headaches ensure your vaccinations are up-to-date speak to your GP or care team for advice about any additional vaccines you might need, as some arent safe if you have a weak immune system avoid close contact with anyone who has an infection  even if its an infection to which you were previously immune, such as chickenpox You may also be prescribed regular doses of medications such as antibiotics to help reduce the risk of infection. Richters syndrome In up to1 in every 20 people withCLL, the condition will change to become very similar to an aggressive form of non-Hodgkin lymphoma . This is called Richters transformation or Richters syndrome. Symptoms of Richters syndrome include: sudden swelling of your lymph glands a high temperature (fever) night sweats unintentional weight loss tummy (abdominal) pain Richter syndrome is usually treated with a combination of chemotherapy and other powerful medicines. TheCancer Research UK website has more information on Richters syndrome . Autoimmune haemolytic anaemia Around1 in every 10 people with CLL will develop a condition called autoimmune haemolytic anaemia. This is where theimmune systemstarts to attack and destroy red blood cells. It can cause severe anaemia, making you feel breathless and easily tired. Its usually treated with steroid medication Psychological effects Being diagnosed with CLL can be very distressing and difficult to take in at first, particularly as it cant necessarily be cured and you may be advised to wait for it to get worse before starting treatment. Having to wait years to see how the condition develops can also be very stressful and make you feel anxious or depressed . Speak to your GP or care team if youre finding it difficult to cope. You may also find it useful to talk to other people who are living with leukaemia. Your GP or care team willbe able to provide you with the details of support groups in your area. Macmillan Cancer Support provides an excellent level of help and support. Their helpline number is 0808 808 00 00 , Monday to Friday, 9am to 8pm. Causes of chronic lymphocytic leukaemia Its not known what causes most cases of leukaemia. However, there are many risk factors that are known to increase your chances of getting chronic lymphocytic leukaemia. Risk factors for chronic lymphocytic leukaemia include: having a family history of the condition being of European, American or Australian origin having certain medical conditions being male Family history In some cases, chronic lymphocytic leukaemia appears to run in families. Its thought that an inheritedgene mutation (change to a gene) could increase your susceptibility to developing the condition. This means there may be certain genes in your family that make it more likely that youll develop chronic lymphocytic leukaemia. More research is needed, but having a parent or sibling (brother or sister) withchronic lymphocytic leukaemia slightlyincreases your chances of also developing the condition. Ethnicity Chronic lymphocytic leukaemia most commonly affects people of European, American and Australian origin. Its rare in people from China, Japan and South East Asia, and it affects more white people than black people. Its not known why the condition affects people of some ethnic backgrounds and not others. Other medical conditions Research has shown that having certain medical conditions slightly increases your chances of developing chronic lymphocytic leukaemia. These conditions include: pneumonia (chest infection) sinusitis shingles autoimmune haemolytic anaemia long-term (chronic) osteoarthritis prostatitis (an inflamed prostate) However, rather than causingchronic lymphocytic leukaemia, some of these conditions may occur as a result ofhaving lowered immunity during the early stages of the condition. Having a lowered immunity due to having a condition such as HIV or AIDS , or taking immunity lowering medication following an organ transplant can also increase your risk of developing chronic lymphocytic leukaemia. Radiation exposure Exposure toradiation is known to increase the risk of getting other types of leukaemia, butits not been linked specifically to chronic lymphocytic leukaemia. The Cancer Research UK website has more information about the risk factors for chronic lymphocytic leukaemia . Sex and age For reasons that are unclear, men are around twice as likely to develop chronic lymphocytic leukaemia than women. The risk of developing leukaemia also increases as you get older. Source: NHS 24 - Opens in new browser window Last updated: 13 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Chemotherapy Other health sites Cancer Research UK: Chronic lymphocytic leukaemia (CLL) Blood Cancer UK: Chronic lymphocytic leukaemia (CLL) Lymphoma Action: Chronic lymphocytic leukaemia (CLL) and small lymphocytic lymphoma (SLL) Macmillan Cancer Support: Leukaemia Macmillan Cancer Support: Chemotherapy Chronic Lymphocytic Leukaemia Support Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Chronic myeloid leukaemia,"Chronic myeloid leukaemia - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Chronic myeloid leukaemia Chronic myeloid leukaemia About chronic myeloid leukaemia Symptoms of chronic myeloid leukaemia Causes of chronic myeloid leukaemia Diagnosing chronic myeloid leukaemia Treating chronic myeloid leukaemia Complications of chronic myeloid leukaemia About chronic myeloid leukaemia Leukaemia is cancer of the white blood cells. Chronic leukaemia means the condition progresses slowly over many years. Chronic leukaemia is classified according to the type of white blood cells that are affected by cancer. There are 2 main types: lymphocytes  mostly used to fight viral infections myeloid cells  which perform a number of different functions, such as fighting bacterial infections, defending the body against parasites and preventing the spread of tissue damage These pages focus on chronic myeloid leukaemia, which is a cancer of the myeloid cells. The following other types of leukaemia are covered elsewhere: chronic lymphocytic leukaemia acute myeloid leukaemia acute lymphoblastic leukaemia What happens in chronic leukaemia Your bone marrow produces stem cells. These are unique cells because they have the ability to develop into three important types of blood cell: red blood cells  which carry oxygen around the body white blood cells  which help fight infection platelets  which help stop bleeding In leukaemia, a genetic mutation in the stem cells causes a huge over-production of white blood cells and a corresponding drop in red blood cells and platelets. Its this lack of red blood cells which causes symptoms of anaemia, such as tiredness, and the lack of platelets that increases the risk of excessive bleeding. Warning signs of chronic myeloid leukaemia In its early stages, chronic myeloid leukaemia usually causes no noticeable symptoms. As the condition develops, symptoms include: tiredness weight loss night sweats a feeling of bloating bruising bone pain Read more about the symptoms of chronic myeloid leukaemia How common is chronic myeloid leukaemia? Chronic myeloid leukaemia is quite a rare type of cancer. Chronic myeloid leukaemia can affect people of any age, but it is more common in people aged 40 to 60. There is no evidence that it runs in families. Symptoms of chronic myeloid leukaemia In its early stages, chronic myeloid leukaemia usually causes no noticeable symptoms and it is often diagnosed during tests for a different condition. When symptoms do develop, they are similar to those of many other illnesses and can include: tiredness frequent infections unexplained weight loss a feeling of bloating less commonly, swollen lymph nodes  glands found in the neck and under your arms, which are usually painless Chronic myeloid leukaemia can also cause swelling in your spleen (an organ that helps to filter impurities from your blood). This can cause a lump to appear on the left side of your abdomen, which may be painful when touched. A swollen spleen can also put pressure on your stomach, causing a lack of appetite and indigestion. The symptoms of chronic myeloid leukaemia in its advanced stage will be much more noticeable and troublesome. They include: severe fatigue bone pain night sweats fever easily bruised skin Causes of chronic myeloid leukaemia Chronic myeloid leukaemia is caused by a DNA mutation in the stem cells which produce white blood cells. The change in the DNA causes thestem cells toproduce more white blood cells than are needed. They are also released from the bone marrow before they are matureand able to fight infection like healthy adult white blood cells. As the number of immature cells increases,the number ofhealthy red blood cells and platelets fall, and its thisfallwhich causes many of thesymptoms of chronic leukaemia. Philadelphia chromosome Although the cause of chronic myeloid leukaemia is genetic, it is not inherited as it is an acquired genetic abnormality. Most people with the condition have an abnormal chromosome, where a section of DNA from one chromosomehas been swapped with a section from another. This is called thePhiladelphia chromosome and it makes the cell produce a protein that encourages the leukaemic cells to resist normal cell death andgrow and multiply far more quickly than usual. Possible triggers for chronic leukaemia What triggers the development of chronic leukaemia and causes the initial mutation in stem cells is unknown. The one proven risk factor is exposure to radiation. However, radiation is only a significant risk if the levels are extremely high, such as those recorded after an atomic bomb explodes, or those released after a nuclear reactor accident, such as the one at Chernobyl. Benzene There is limited evidence that prolonged exposure to the chemical benzene leads to an increased risk of chronic myeloid leukaemia. Benzene is found in petrol and is also used in the rubber industry, but in the UKthere are strict controls to protect people from prolonged exposure. Benzene is also found in cigarettes. However, it is thought that smoking is more of a risk factor in acute leukaemia than it is in chronic leukaemia. Occupational risks A number of occupations have been linked to an increased risk of chronic leukaemia, possibly due to exposure to certain substances such as pesticides or chemicals. These occupations include: all types of agricultural workers people who are involved with rubber or plastic manufacture tailors and dressmakers cleaners builders labourer Other risk factors There is some evidence to show an increased risk of chronic leukaemia in people who: are obese have a weakened immune system  due to HIV or AIDS or taking immunosuppressants after an organ transplant have inflammatory bowel disease  such as ulcerative colitis or Crohns disease Diagnosing chronic myeloid leukaemia Chronic myeloid leukaemia is often first detected when a routine blood test is carried out to diagnose another, unrelated, condition. A blood test that reveals abnormally high levels of white blood cells could be a sign of chronic leukaemia. If you have a blood test with abnormal results, you will be referred to a haematologist (a specialist in treating blood conditions) for further testing. Bone marrow biopsy To confirm a diagnosis of chronic leukaemia, the haematologist will take a small sample of your bone marrow to examine under a microscope. This procedure is known as a bone marrow biopsy . A bone marrow biopsy is usually carried out under a local anaesthetic . The haematologist will numb an area of skin at the back of your hip bone, before using a needle to remove the bone marrow sample.Youmay experience some painonce the anaesthetic wears off andsome bruising and discomfort for a few days afterwards. The procedure takes around 15 minutes to complete and you should not have to stay in hospital overnight. The bone marrow sample will be checked to see if there are cancerous cells. Ifthere are, the biopsy will also be able to help determine which type of chronic leukaemia is present. Further tests There are a number of additional tests that can be used to help reveal more information about the progress and extent of the leukaemia. These can also provide an insight into how the leukaemia should be treated. Cytogenetic testing Cytogenetic testing involves identifying the genetic make-up of the cancerous cells. There are a number of specific genetic variations that can occur during leukaemia and knowing what these variations are can have an important impact on treatment. For example, 90% of people with chronic myeloid leukaemia have the Philadelphia chromosome. People who have thischromosome are known to respond well to a medicine called imatinib. Polymerase chain reaction (PCR) A polymerase chain reaction (PCR) testcan bedone on a blood sample. This is an important test to diagnose and monitor the response to treatment. The blood test is repeated every 3 months for at least 2 years after starting treatment, then less often once remission is achieved. Imaging tests In some cases, the hospital may want to perform some imaging tests to help rule out other conditions or confirm a diagnosis. This may be either: an X-ray  usually to examine your chest an ultrasound scan  usually to examine your spleen and liver Treating chronic myeloid leukaemia Imatinib tablets are usually given as soon as you have been diagnosed withchronic myeloid leukaemia, to slow its progression. These tablets are taken every day for life, and most patients do really well on them. The aim of treatment is to achieve the following: by 3 months, correct the blood count by 12 months, clear the bone marrow of cells containing the Philadelphia chromosome (see Causes page for information on this) by 18 months, get to a stage wherethe leukaemia can only be detected by a very sensitive molecular test (molecular remission) Chemotherapy is usually offered if the cancer reaches an advanced stage. Treating early-stage chronic myeloid leukaemia Imatinib A medicine called imatinib is the main treatment recommended for chronic myeloid leukaemia. It is usually given as soon as a diagnosis is made because the medicine is designed to slow the progression of the cancer and toprevent the condition reaching the accelerated or advanced phase. Imatinib is a type of tyrosine kinase inhibitor. This means it blocks a protein called tyrosine kinase(tyrosine kinasehelps to stimulate the growth of cancer cells). This reduces the production of abnormal white blood cells. Imatinib is taken as a tablet. The side effects of imatinib are usually mild and should improve with time. They include: nausea vomiting swelling in the face and lower legs muscle cramps rash diarrhoea Nilotinib It is estimated that 10to 40% of people who take imatinib become resistant to its effects, so an alternative treatment is required. The National Institute for Health and Care Excellence (NICE) has recommended nilotinib for the treatment of chronic myeloid leukaemia that is resistant or intolerant to imatinib. In some cases, nilotinib is recommendedas the first treatment. Nilotinibworks in a similar way to imatinib in that it blocks the effects of proteins that help stimulate the growth of cancer cells. Side effects of nilotinib can include: vomiting abdominal pain bone and joint pain dry skin loss of appetite hair loss insomnia night sweats dizziness tingling or numbness If theside effects become particularly troublesome, temporarily stopping the treatment usually helps to bring them under control. Treatment can then be resumed, possibly using a lower dose of medication. Read about the complications of chronic myeloid leukaemia for more information and advice about being vulnerable to infection and bleeding. Treating advanced chronic myeloid leukaemia Chemotherapy Once chronic myeloid leukaemia has progressed toa more advanced stage, chemotherapy is the next treatment. Chemotherapy tablets are usually used first because they have fewer and milder side effects than chemotherapy injections. Side effects include: tiredness skin rash increased vulnerability to infection Chemotherapy can weaken your immune system, which helps protect you against infection. This is known as being immunocompromised. Read chronic leukaemia complications for more information about this. If your symptoms persist or get worse, chemotherapy injections (intravenous chemotherapy) will need to be used. Intravenous chemotherapy causes more side effects than chemotherapy tablets and they tend to be more severe. Side effects include: nausea vomiting tiredness hair loss infertility These side effects should resolve after your treatment has finished, although there is a risk that infertility could be permanent. Bone marrow and stem cell transplants A bone marrow transplant can offer a cure forchronic leukaemia, although it is only suitable and necessaryforsome patients. Before transplantation can take place, the person receiving the transplant has to have aggressive, high-dose chemotherapy and radiotherapy to destroy any cancerous cells in their body. This can put enormous strain on the body and can cause significant side effects and potential complications. Transplantations have better outcomes if the donor has the same tissue type as the person who is receiving the donation. The best candidate to provide a donation is usually a brother or sister with the same tissue type. Due to these issues, transplantations are usually only successful when they are carried out in children and young people, or older people in good health, and there is a suitable brother or sister who can provide a donation. In most cases of chronic leukaemia, the potential risks of transplantation far outweigh any benefit. However, your specific circumstances may mean that the benefits of treatment outweigh the risks. Read more about bone marrow transplants Complications of chronic myeloid leukaemia Being immunocompromised (having a weakened immune system) is a possible complication for some patients with chronic leukaemia. There are 2 reasons for this: the lack of healthy white blood cells means your immune system is less able to fight infection many of the medicines used to treat chronic leukaemiacan weaken the immune system This means you are more vulnerable to developing an infection, and that any infection you have has an increased potential to cause serious complications. You may be advised to take regular doses of antibiotics to prevent infections from occurring. You should immediately report any possible symptoms of an infection to your GP orcare teambecause prompt treatment may be required to prevent serious complications. Symptoms of infection include: high temperature (fever) of 38C (101.4F) or above headache aching muscles diarrhoea tiredness Avoid contact with anyone who is known to have an infection, even if it is a type of infection that you were previously immune to, such as chickenpox or measles. This is because your previous immunity to these conditions will probably be suppressed (lowered). While it is important to go outside on a regular basis, both for exercise and for your psychological wellbeing, avoid visiting crowded places and using public transport during rush hour. Also ensure that all of your vaccinations are up-to-date. Your GP or care team will be able to advise you about this. You will be unable to have any vaccine that contains activated particles of viruses or bacteria, such as: themumps, measles and rubella (MMR) vaccine the polio vaccine the oral typhoid vaccine the BCG vaccine (used to vaccinate against tuberculosis) the yellow fever vaccine Psychological effects of chronic leukaemia Receiving a diagnosis of chronic leukaemia can be very distressing, particularly if it is unlikely that your condition can be cured. At first, the news may be difficult to take in. The situation can be made worse if you are confronted with the knowledge that even though your leukaemia may not currently be causing any symptoms, it could be a serious problem in later life. Having to wait many years to see how the leukaemia develops can be immensely stressful and can trigger feelings of stress, anxiety and depression . If you have been diagnosed with leukaemia, talking to a counsellor or psychiatrist (a doctor who specialises in treating mental health conditions) may help you to combat feelings of depression and anxiety. Antidepressants or medicines that help to reduce feelings of anxiety may also help you cope better with the condition. You may find it useful to talk to other people who are living with leukaemia. Your GP or multidisciplinary team may be able to provide you with details of local support groups. Another excellent resource is Macmillan Cancer Support . Their helpline number is 0808 808 00 00 and is open Monday to Friday, 9am-8pm. Further information You can read more information from Cancer Research UK about coping with chronic myeloid leukaemia . Source: NHS 24 - Opens in new browser window Last updated: 13 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Chronic lymphocytic leukaemia Acute myeloid leukaemia Other health sites Blood cancer UK: Chronic myeloid leukaemia Macmillan Cancer Support: Chronic myeloid leukaemia Cancer Research UK: Chronic myeloid leukaemia Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Chronic obstructive pulmonary disease,"Chronic obstructive pulmonary - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Lungs and airways COPD Chronic obstructive pulmonary disease Chronic obstructive pulmonary disease About COPD Symptoms of COPD Causes of COPD Diagnosing COPD Treating COPD About COPD Chronic obstructive pulmonary disease (COPD) is the name for a collection of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease. People with COPDhave difficulties breathing, primarily due to the narrowing of their airways, this is called airflow obstruction. Typical symptoms of COPD include: increasing breathlessness when active a persistent cough with phlegm frequent chest infections Read more about the symptoms of chronic obstructive pulmonary disease Why does COPD happen? The main cause of COPD is smoking. The likelihood of developing COPD increases the more you smoke and the longer youve been smoking. This is because smoking irritates and inflames the lungs, which results in scarring. Over many years, the inflammation leads to permanent changes in the lung. The walls of the airways thicken and more mucus is produced. Damage to the delicate walls of the air sacs in the lungs causes emphysema and the lungs lose their normal elasticity. The smaller airways also become scarred and narrowed.These changes cause the symptoms of breathlessness, cough and phlegm associated with COPD. Some cases of COPD are caused by fumes, dust, air pollution and genetic disorders, but these are rarer. Read more about the causes of chronic obstructive pulmonary disease Who is affected? COPD is one of the most common respiratory diseases in the UK. It usually only starts to affect people over the age of35, although most people are not diagnosed until they are in their 50s. It is thought there are more than 3 million people living with the disease in the UK, of which only about 900,000 have been diagnosed. This is because many people who develop symptoms of COPD do notget medical help because they often dismiss their symptoms as a smokers cough. COPD affects more men than women, althoughrates in womenare increasing. Diagnosis It is important that COPD is diagnosed as early as possible sotreatment can be used to try to slow down the deterioration of your lungs. You should see your GP if you have any of the symptoms of COPD. COPD is usually diagnosed after a consultation with your doctor, which may be followed by breathing tests. Read more about diagnosing chronic obstructive pulmonary disease TreatingCOPD Although the damage that has already occurred to your lungs cannot be reversed, you can slow down the progression of the disease. Stopping smoking is particularly effective at doing this. Treatments for COPD usually involve relieving the symptoms with medication, for example by using an inhaler to make breathing easier. Pulmonary rehabilitation may also help increase the amount ofexercise you are capable of doing. Surgery is only an option for a small number of people with COPD. Read more about treating chronic obstructive pulmonary disease Living with COPD COPD can affect your life in many ways, but help is available to reduce its impact. Simple steps such as living in a healthy way, being as active as possible,learning breathing techniques, and taking your medication can help you to reduce the symptoms of COPD. Financial support and advice about relationships and end of life careis also available for people with COPD. Read more about living with chronic obstructive pulmonary disease . Can COPD be prevented? Although COPD causes about 25,000 deaths a year in the UK, severe COPD can usuallybe prevented by making changes to your lifestyle. If you smoke, stopping is the single most effective way to reduce your risk of getting the condition. Research has shown you are up to four times more likely to succeed in giving up smoking if you use NHS support along with stop-smoking medicines such as patches or gum. Ask your doctor about this, phone Quit Your Way Scotland on 0800 84 84 84orread more about stopping smoking . Also avoid exposure to tobacco smoke as much as possible. Symptoms of COPD Symptoms of chronic obstructive pulmonary disease (COPD) usually develop over a number of years, so you may not be aware you have the condition. COPD does not usually become noticeable until after the age of 35 and most people diagnosed with the condition are over 50 years old. See your GP if you have the following symptoms: increasingbreathlessness when exercising or moving around a persistent cough with phlegm that never seems to go away frequent chest infections , particularly in winter wheezing Middle-aged smokers and ex-smokers who have a persistent chesty cough (especially in the morning), breathlessness on slight exertion or persistent coughs and colds in the winter should see their GP or practice nurse for a simple breathing test. If you have COPD, the airways of the lungs become inflamed and narrowed. As the air sacs get permanently damaged, it will become increasingly difficult to breathe out. While there is currently no cure for COPD, the sooner the condition is diagnosed and appropriate treatment begins, the less chance there is of severe lung damage. Read more about treating COPD . Flare-ups Symptoms of COPD are often worse inwinter, and it is common to have two or more flare-ups a year. A flare-up (also known as an exacerbation) is when your symptoms are particularly bad.This is one of the most common reasons for people being admitted to hospital in the UK. If youre experiencing a flare-up that is worse than normal day to day, you should visit your GP or call NHS 24 on 111. Other signs of COPD Other signs of COPD can include: weight loss tiredness and fatigue swollen ankles Chest painandcoughing up blood (haemoptysis) are not common symptoms of COPD. They are usually caused by other conditions such as a chest infection or, less commonly, lung cancer . Causes of COPD There are several things that may increase your risk of developing chronic obstructive pulmonary disease (COPD), many of which can be avoided. Things you can change You can reduce your risk of developing COPD bynot smoking and avoidingexposure to certain substances at work. Smoking Smoking is themain cause of COPD and is thought tobe responsible foraround 90% of cases. The lining of the airways becomes inflamed and permanently damaged by smoking and this damage cannot be reversed. Up to 25% of smokers develop COPD. Passive smoking Exposure to other peoples smoke increases the risk of COPD. Fumes and dust Exposure to certain types of dust and chemicals at work, including grains, isocyanates, cadmium and coal, has been linked to the development of COPD, even in people who do not smoke. The risk of COPD is even higher if you breathe in dust or fumes in the workplace and you smoke. Air pollution According to some research, air pollution may be an additional risk factor for COPD. However, at the moment it is notconclusive and research is continuing. Read further information: stopping smoking treatments to help you stop smoking Health and Safety Executive: COPD Things you cannot change There are a few factors for COPDthat you cannot change. Having a brother or sister with severe COPD A research study has shown that smokers who have brothers and sisters with severe COPD are at greater risk of developing the condition than smokers who do not. Having a genetic tendency to COPD There is a rare genetic tendency to develop COPD called alpha-1-antitrypsin deficiency. This causes COPD in a small number of people (about 1%). Alpha-1-antitrypsin is a protein that protects your lungs. Without it, the lungs can be damaged by other enzymes that occur naturally in the body. People who have an alpha-1-antitrypsin deficiency usually develop COPD at a younger age, often under 35. Read further information: British Lung Foundation: Alpha-1-antitrypsin Alpha1 Awareness UK Diagnosing COPD Chronic obstructive pulmonary disease (COPD) is usually diagnosed after a consultation with your GP, as well as breathing tests. If you are concerned about the health of your lungs and have symptoms that could be COPD, see your GP as soon as you can. Being diagnosed early means you will receive appropriate treatment, advice and help to stop or slow the progression of COPD. At a consultation, your doctor will askabout your symptoms, how long you have had them, and whether you smoke, or used to smoke. They will examine you and listen to your chest using a stethoscope. You may also be weighed and measured to calculate your body mass index (BMI). Your doctor will also check how well your lungs are working with a lung function test called spirometery. Spirometry To assess how well your lungs work, a breathing test calledspirometry is carried out. You will be asked to breathe into a machine called a spirometer. The spirometer takes two measurements: the volume of air you can breathe out in one second (called the forced expiratory volume in one second or FEV 1 ) and the total amount of air you breathe out (called the forced vital capacity or FVC). You may be asked to breathe out a few times to get a consistent reading. The readings are compared with normal measurements for your age, which can show if your airways are obstructed. Other tests Youmay have other tests as well as spirometry. Often, these other tests will help the doctor rule out other conditionsthat cause similar symptoms. Chest X-ray A chest X-ray will show whether you have another lung conditionwhich may be causing symptoms, such as a chest infection orlung cancer. Blood test A blood test will show whether your symptoms could be due to anaemia , as this can also cause breathlessness. Further tests Some people may need more tests. The tests may confirm the diagnosis or indicate the severity of your COPD. This will help you and your doctor plan your treatment. Electrocardiogram (ECG) and echocardiogram An electrocardiogram (ECG) or echocardiogram may be used to check the condition of your heart. An ECG involves attaching electrodes (sticky metal patches) to your arms, legs and chest to pick up the electrical signals from your heart. An echocardiogram uses sound waves to build a detailed picture of your heart. This is similar to an ultrasound scan . Peak flow test To confirmyou haveCOPD and not asthma, you may beasked to take regular measurements of your breathing using a peak flow meter, at different times over several days. The peak flow meter measures how fast you can breathe out. Blood oxygen level The level of oxygen in your blood is measured using a pulse oximeter, which looks like a peg and isattached to the finger. If you have low levels of oxygen, you may need an assessment to see whether extra oxygen would help you. Blood test for alpha-1-antitrypsin deficiency If the condition runs in your family or you developed the symptoms of COPD under the age of35 and have never smoked, you will probably have a blood test to see if you are alpha-1-antitrypsin deficient. Computerised tomography (CT) scan Some people may need a CT scan . This provides more information than an X-ray and can be useful in diagnosing other lung diseases or assessing changes to your lungs due to COPD. Other breathing tests If your symptoms seem worse than would be expected from your spirometry results, your doctor may decide you need more detailed lung function tests. You may be referred to a hospital specialist for these tests. Phlegm sample The doctor may take a sample of phlegm (sputum) to check whether it has been infected. Treating COPD Stop smoking Stopping smoking is themost effectiveway for people with COPD to help themselves feel better and is the only proven way to reduce the rate of decline in lung function. Stopping smoking at an early stage of the disease makes a huge difference. Any damage already done to the airways cannot be reversed, but giving up smoking can slow the rate at which the condition worsens. If COPD is in the early stages and symptoms are mild, no other treatments may be needed. However, it is never too late to stop smoking. Even people with fairly advanced COPD are likely to benefit from quitting, which may prevent further damage to the airways. Research has shownyou are up to four times more likely to give up smoking successfully if you use NHS support along with stop-smoking medicines such as tablets, patches or gum. Ask your doctor about this. Read more about stopping smoking . Inhalers If an inhaler is prescribed for you, your GP, practice nurse or pharmacist can explain how to use it. They will check you are using it properly. Most people learn to use an inhaler successfully, but if you are having problems, a spacer or adifferent type of inhaler device may help you take your medicines correctly. A spacer is a device that increases the amount of medication that reaches the lungs. Short-acting bronchodilator inhalers Short-acting bronchodilator inhalers deliver a small dose of medicine directly to your lungs, causing the muscles in your airways to relax and open up. There are two types of short-acting bronchodilator inhaler: beta-2 agonist inhalers, such as salbutamol and terbutaline antimuscarinic inhalers, such as ipratropium The inhaler should be used when you feel breathless and this should relieve the symptoms. Long-acting bronchodilator inhalers If a short-acting bronchodilator inhaler does not help relieve your symptoms, your GP may recommend a long-acting bronchodilator inhaler. This works in a similar way to a short-acting bronchodilator, but each dose lasts for at least 12 hours. There are two types of long-acting bronchodilator inhalers: beta-2 agonist inhalers, such as salmeterol, formoterol and indacaterol antimuscarinic inhalers, such as tiotropium, glycopyronium and aclidinium Steroid inhalers Steroid inhalers, also called corticosteroid inhalers, work by reducing the inflammation in your airways. If you are still getting breathless or having flare-ups even when taking long-acting bronchodilator inhalers, your GP may suggest including a steroid inhaler as part of your treatment. Most people with COPD will be prescribed a steroid inhaler as part of a combination inhaler. Medicines Theophylline tablets If you are getting breathless or having flare-ups when using a combination of inhalers, your GP may prescribe theophylline tablets. Theophylline causes the muscles of your airways to relax and open up. When you have been taking theophylline tablets regularly, youmay need to give a blood sample to measure the amount of theophylline in your blood and help your GP prescribe the appropriate dose of tablet. This will allow you to get the correct dose of theophylline while reducing the likelihood of side effects. Due to the risk of potential side effects, such as increased heart rate and headaches, other medicines, such as a bronchodilator inhaler, are usually tried before theophylline. Mucolytic tablets or capsules Mucolytics, such as carbocisteine, make the mucus and phlegm in your throat thinner and easier to cough up. They are particularly beneficial for people with a persistent cough with lots of thick phlegm or who have frequent or bad flare-ups. Antibiotics and steroid tablets If you have a chest infection, your GP may prescribe a short course of antibiotics . Steroid tablets may also be prescribed as a short course if you have a bad flare-up. They work best if they are taken as the flare-up starts, so your GP may give you a course to keep at home. Occasionally, you may have to take a longer course of steroid tablets. Your GP will give you the lowest effective dose and monitor you for side effects. Side effects are uncommon if steroid tablets are given for less than three weeks. Read more about the medicines used inthe chronic obstructive pulmonary disease medicines guide . Other types of treatment Nebulised medication Nebulised medicationcan be used for severe cases of COPD if other inhaler devices have not worked effectively. A compressor is a machine that administers nebulised medicine through a mouthpiece or a face mask. The medicine is in a liquid form and is converted into a fine mist. This enables a large dose of medicine to be taken in one go. You can usually choose whether to use nebulised medicationwith a mouthpiece or a facemask. Your GP will advise you onhow to use the machine correctly. Long-term oxygen therapy If the oxygen level in your blood is low, you maybe advised to have oxygen at home through nasal tubes, also called a nasal cannula, or through a mask. Oxygen is not a treatment for breathlessness, but it is helpful for some patients with persistently low oxygen levels in the blood. You will probably be referred for more detailed assessment to see whether you might benefit from long-term oxygen therapy. If you are prescribed long term oxygen therapy, it must be taken for at least 15 hours a day to be effective. However, the longer you use it, the more effective it is. The tubes from the machine are long so you will be able to move around your home while you are connected. Portable oxygen tanks are available if you need to use oxygen away from home. The aim of long-term oxygen therapy is to extend your life. Do not smoke when you are using oxygen. The increased level of oxygenproduced is highly flammable, and a lit cigarette could trigger a fire or explosion. Ambulatory oxygen therapy Part of the oxygen assessment is likely to consider if you may benefit from ambulatory oxygen  oxygen used when you walk or are active in other ways. If your oxygen levels are normal while you are resting, but fall when you exercise, you may not need long-term oxygen therapy alongside ambulatory oxygen therapy. Read more about home oxygen treatment . Non-invasive ventilation (NIV) Non-invasive ventilation (NIV) helps a person breathe using a portable machine connected to a mask covering the nose or face. You may receive it if you are taken to hospital because of a flare-up. You may be referred to a specialist centre to see ifhome NIV could help you.NIV is used to improve the functioning of your lungs. Pulmonary rehabilitation programmes Pulmonary rehabilitation is a programme of exercise and education designed to help people with chronic lung problems. It can increase your exercise capacity, mobility and self-confidence. Pulmonary rehabilitation is based on a programme of physical exercise training tailored to your needs. It usuallyinvolves walking or cycling, andarm and strength-building exercises. It also includes education aboutyour disease foryou andyour family, dietary assessment and advice, and psychological, social and behavioural changes designed to helpyou cope better. A rehabilitation programme is provided by a multidisciplinary team, whichincludes physiotherapists, respiratory nurse specialists and dietitians. Pulmonary rehabilitation takes place in a group and the course usually lasts for about six weeks. During the course, you will learn more about your COPD and how to control your symptoms. Pulmonary rehabilitation can greatly improve your quality of life. Source: NHS 24 - Opens in new browser window Last updated: 31 January 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Living well with COPD Bronchodilators Corticosteroids Quit Your Way Scotland Other health sites HSE: COPD British Lung Foundation: COPD NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Chronic pain,"Chronic pain | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Chronic pain Chronic pain Chronic or persistent pain is pain that lasts longer than 12 weeks, or beyond the natural healing time What is chronic pain? Read about chronic pain symptoms and causes Living with chronic pain Read about pain management strategies to live better with chronic pain Coping with a flare up of chronic pain Find out how to cope with a flare up of chronic pain Fibromyalgia Read about fibromyalgia symptoms, causes and treatment. NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Chronic pancreatitis,"Chronic pancreatitis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Chronic pancreatitis Chronic pancreatitis About chronic pancreatitis Symptoms of chronic pancreatitis Causes of chronic pancreatitis Diagnosing chronic pancreatitis Treating chronic pancreatitis Complications of chronic pancreatitis About chronic pancreatitis Chronic pancreatitis is a condition where the pancreas (a small organ located behind the stomach and below the ribcage) becomes permanently damaged from inflammation. Its different to acute pancreatitis , where the inflammation is only short-term. The most common symptom of chronic pancreatitis is repeated episodes of abdominal(tummy) pain, which can be severe. Other symptoms tend to develop as the damage to the pancreas progresses, such as producing greasy, foul-smelling stools. Read more about the symptoms of chronic pancreatitis and diagnosing chronic pancreatitis . When to seek medical advice Always visit your GP if youre experiencing severe pain  its a warning sign that something is wrong. Why it happens Long-term alcohol misuse is responsible for around 7 out of every 10 cases of chronic pancreatitis. This is because heavy drinking over a number of years can repeatedly damage the pancreas. Less common causes include: smoking a problem with the immune system, causing it to attack the pancreas an inheritedgenetic mutation disrupting the functions of the pancreas Inas many as3 out of 10 people with the condition, the cause cannot be identified this is known as idiopathic chronic pancreatitis. Read more about the causes of chronic pancreatitis . Whos affected Chronic pancreatitis can affect people of any age, but is most common in middle-aged men aged between 45 and 54. How its treated In most cases of chronic pancreatitis, theres no specific treatment to reduce the inflammation and repair the damage to the pancreas. Treatment mainly focuses on lifestyle changes and medication to relieve the pain. Surgery is sometimes needed to treat severe chronic pain that doesnt respond to painkillers. However, the pain can be difficult to treat and can seriously affect your quality of life. People who dont smoke cigarettes and avoid drinking alcohol tend to experience less pain and live longer than those who continue to drink and smoke after receiving a diagnosis. Read more about treating chronic pancreatitis . Complications Living with chronic paincan cause mental as well as physical strain. Its important to speak to your GP if youre experiencing stress , anxiety or depression caused by chronic pancreatitis. Diabetes is a common complication of chronic pancreatitis and affects about a third of people with the condition. It occurs when the pancreas is damaged and unable to produce insulin. People with chronic pancreatitis also have an increased risk of developing pancreatic cancer . Read more about the possible complications of chronic pancreatitis . Symptoms of chronic pancreatitis The most common symptom of chronic pancreatitis is repeated episodes of abdominal (tummy) pain. Eventually, there may also be digestion problems. The pain usually develops in the middle or left side ofthe abdomen and can sometimes travel along your back. Its been described as a burning or shooting pain which comes and goes, but can last for several hours or days, in some cases. Some people also experience symptoms of nausea and vomiting during the pain. As chronic pancreatitis progresses, the painful episodes may become more frequent and severe. Although the pain sometimes occurs after eating a meal, theres often no trigger. Eventually, a constant mild to moderate pain can develop in the abdomen in between episodes of severe pain. This is most common in people who continue to drink alcohol after being diagnosed with chronic pancreatitis. Some people who stopdrinking alcohol and stop smoking may experience a reduction in the severity of their pain. Advanced chronic pancreatitis Additional symptoms can occur when the pancreas loses its ability to produce digestive juices, which help to break down food in the digestive system. The pancreas usually only loses these functions many years after the original symptoms started. The absence of digestive juicesmakes it difficult for your digestive system to breakdown fats and certain proteins. This can cause your stools to become particularly smelly and greasy, and make them difficult to flush down the toilet. You may also experience: weight loss loss of appetite jaundice(yellowing of the skin and eyes) symptoms of diabetes  such as feeling very thirsty, urinating frequently and feeling very tired ongoing nausea and vomiting When to seek medical advice Always visit your GP if youre experiencing severe pain, as this is a warning sign that something is wrong. You should also visit your GP if you develop symptoms of jaundice. Jaundice can have a range of causes other than pancreatitis, but its usually a sign that theres something wrong with your digestive system. You should also visit your GP if you develop persistent vomiting. Causes of chronic pancreatitis Most cases of chronic pancreatitis are associated with drinking excessive amounts of alcohol over a long period of time. However,in up to3 out of 10 people with the condition,the causecant beidentified  known as idiopathic chronic pancreatitis. Alcohol consumption Heavy drinking over many years can cause repeated episodes of acute pancreatitis . Acute pancreatitis is usually a short-term condition, but it can recur if you continue to drink alcohol. Over time, repeated inflammation causes permanent damage to the pancreas, resulting in chronic pancreatitis. Anyone who regularly consumes alcohol has an increased risk of chronic pancreatitis, although only a minority develop the condition. Read more about alcohol misuse . Problems with the immune system Rare cases of chronic pancreatitis are the result of a problem with the immune system, which causes it to attack the pancreas. This is known as autoimmune pancreatitis and its not clear exactly why it happens. Many people with autoimmune pancreatitis also have other conditions caused by the immune system attacking healthy tissue. These include ulcerative colitis or Crohns disease , both of which cause inflammation inside the digestive system. Genetics Some cases of chronic pancreatitis are inherited. This is thought to be caused by mutations (alterations) in a number of genes, including genes called PRSS1 and SPINK-1. These mutations disrupt thenormal working of the pancreas. Genetic mutations may also have a role in the effect of alcohol on your pancreas. Evidence suggests that certain genetic mutations makethe pancreas more vulnerable to the harmful effects of alcohol. Certain mutations of the CFTR gene, responsible for cystic fibrosis ,are also thought to cause chronic pancreatitis in a small amount of cases. Other causes Several other rare causes of chronic pancreatitis have also been identified, including: injury to the pancreas blockedor narrowedopenings (ducts)of the pancreas smoking radiotherapy to theabdomen (tummy) Diagnosing chronic pancreatitis Chronic pancreatitis can usually only be diagnosed by carrying out scans of the pancreas. Your GP will ask about your symptoms and may carry out a simple physical examination, but theyll refer you for further tests if they suspect chronic pancreatitis. Thesetests are usually carried outinyour local hospital andmay include: requesting a stool sample an ultrasound scan  where sound waves are used to build up a picture of the inside of your pancreas a computerised tomography (CT) scan  where a series of X-rays are taken to build up a more detailed, three-dimensional image of the pancreas an endoscopic ultrasonography a magnetic resonance cholangiopancreatography or MRCP Endoscopic ultrasonography During an endoscopic ultrasonography, a thin, flexible telescope (endoscope) is passed through your mouth and towards your stomach. An ultrasound probe attached to the tip of theendoscope is able to get close to the pancreas and take very accurate pictures of it. Youll usually be given a sedative to help you relax during the procedure. MRCP An MRCP involves injecting you with a substance known as a contrast agent thatmakes your pancreas and surrounding organs, such as the gallbladder and liver, show up very clearly on a magnetic resonance imaging (MRI) scanner . AnMRI scanner is a type of imaging system that uses magnetic fields and radio waves to build up a detailed image of the inside of your body. An MRCP is a useful way of checking whether gallstones may be contributing to your symptoms. Biopsy Sometimes, the symptoms of chronic pancreatitis can be very similar to pancreatic cancer . Therefore, if you have symptoms such asjaundice (yellowing of the skin and whites of the eyes)and weight loss, a biopsy may be recommended to rule out a diagnosis of pancreatic cancer. A biopsy involves taking a small sample of cells from the pancreas and sending it to a laboratory, so it can be checked under a microscope for the presence of cancerous cells. A biopsy can be taken using a long, thin needle thats passed through your abdomen. The needle can be guided towards the tumour using an ultrasound scan or CT scan. Alternatively, a biopsy can be taken during an endoscopic ultrasonography. Treating chronic pancreatitis Treatment for chronic pancreatitis aims to help control the condition and reduce any symptoms. Lifestyle changes If youre diagnosed with chronic pancreatitis, some lifestyle changes will be recommended. Avoiding alcohol The most important thing you can do is to stop drinking alcohol, even ifit isnt the cause of your condition. This helps toprevent further damage to your pancreas and may help to reduce the pain. If you continue to drink alcohol, its likely that youll experience debilitating pain and youll be more likely to die from a complication of chronic pancreatitis . Some people with chronic pancreatitis caused by alcohol consumption have a dependency on alcohol and require additional help and support to stop drinking. If this applies to you, talk to your GP about getting help to stop drinking. Treatment options for alcohol dependence include: one-to-onecounselling self-help groups  such as Alcoholics Anonymous a medication called acamprosate that can help to reduce cravings for alcohol Read more about treating alcohol misuse . Stopping smoking If you smoke, you should stop. Smoking can speed up the progress of chronic pancreatitis, making it more likely that your pancreas will lose its function. Its recommended that you use an anti-smoking treatment, such as nicotine replacement therapy (NRT) or bupropion (a medication used to reduce cravings for cigarettes). People who use these types of treatments have a much greater success rate in permanently stopping smoking than those who try to quit using willpower alone. If you want to give up smoking, its a good idea to start by visiting your GP. Theyll be able togive youhelp and advice about quitting and can refer you to an NHS Stop Smoking support service. These services offer the best support for people who want to give up smoking. Studies show you are 4times more likely to give up smoking if you do it through the NHS. Read more about stopping smoking . Dietary changes As chronic pancreatitiscan affect your ability to digest certain foods, you may need to change your diet. Your GPmay be able to provide you with appropriate dietary advice, ormay refer you to a dietitian, who will draw up a suitable dietary plan. Alow-fat, high-protein, high-calorie diet with fat-soluble vitamin supplements is usually recommended, but dont make changes to your diet without consulting a health professional. Enzyme supplements You may be givenpancreatic enzyme supplements, which is medication containing an artificial version of the enzymes produced by your pancreas. These supplementsmay help to improve the effectiveness of your digestive system. Side effects ofpancreatic enzyme supplements can include diarrhoea , constipation , nausea, vomiting and stomach pains. Talk to your GP if youre experiencing troublesome side effects, as your dosage may need to be adjusted. Steroid medication If you have chronic pancreatitis caused by problems with your immune system, treatment is relatively straightforward. The inflammation affecting the pancreas can usually be relieved using steroid medication ( corticosteroids ). However, taking corticosteroids for a long time can cause side effects, such as osteoporosis and weight gain. Pain relief Pain relief is an important part of the treatment of chronic pancreatitis. At first,mildpainkillers will be used, but more powerful ones will beneededif these dont work. Mild painkillers In most cases, the first painkiller used is paracetamol or a non-steroidal anti-inflammatory drug (NSAID) , such as ibuprofen . Taking NSAIDs on a long-term basis can increase your risk of developing stomach ulcers , so you may be prescribed an additional medication called a proton pump inhibitor (PPI) to protect against this. Stronger painkillers If NSAIDs or paracetamol prove to be ineffective in controlling your pain, its likely that youll need an opiate-based painkiller, such as codeine or tramadol. Side effects of these types of medication can include constipation, nausea, vomiting and drowsiness. The side effect of constipation can be particularly troublesome if you need to take an opiate-based painkiller on a long-term basis. You may be prescribed a laxative to help relieve your constipation. See the page on treating constipation for more information. If you feel drowsy after taking an opiate-based painkiller, avoid driving and using heavy tools or machines. Severe pain If you experience an attack of very severe pain, you may need a stronger opiate-based painkiller, such as morphine or pethidine. These have similar side effects to opiate-based painkillers. Long-term use of these stronger opiate-based painkillers isnt usually recommended, because theres a high risk of addiction. Therefore, if you have persistent severe pain, surgeryis usually recommended. In some cases, an additional medication called amitriptyline may be recommended. Amitriptyline was originally designed to treat depression, but it can help to relieve pain in some people. If medication isnt effective, severe pain can sometimes be temporarily relieved fora few weeks ormonths using a procedure calleda nerve block. This is an injection that blocks the pain signals from the pancreas. Severe episodes If the inflammation of your pancreas suddenly gets worse, you may need a short stay in hospital for treatment. This may involve having fluids delivered directly into a vein, and oxygen supplied through tubes into your nose. Read more about treating acute pancreatitis . Surgery Surgery can be used to treat severe pain in people with chronic pancreatitis. Depending on the exact cause of your pain, there are a variety of surgical techniques that may be used. Endoscopic surgery Patients with stones in the opening of their pancreas (the pancreatic duct) may benefit from endoscopic surgery and a treatment called lithotripsy. Lithotripsy involves using shock waves to break the stone into smaller pieces. Anendoscope (a long, thinflexible tube with a light source and a video camera at one end) is then used to pass surgical instruments into the pancreatic duct so the pieces can be removed. This treatment may improve pain to some extent, but the benefit may not be permanent. Pancreas resection In cases where specific parts of the pancreas are inflamed and causing severe pain, these parts can be surgically removed. This type of surgery is called a pancreas resection. Pancreas resection can also be used if endoscopic treatment is ineffective. Thetechnique usedfor pancreas resection depends on exactly which parts need to be removed. For example, some techniques involve removing the gallbladder, along with parts of the pancreas. The different surgical techniques tend to have the same levels of effectiveness in terms of reducing pain and preserving the function of the pancreas, althoughsome of the more complex techniques have an increased risk of complications, such as infection and internal bleeding. Simpler procedures have a lower risk of complications and usually have faster recovery times. Discuss the pros and cons of the appropriate pancreas resection techniques with your surgical team before making a decision. Total pancreatectomy In the most serious cases of chronic pancreatitis, where the pancreas has been extensively damaged, it may be necessary to remove the entire pancreas. This is known as a total pancreatectomy. A total pancreatectomy can be very effective in treating pain. However, youll no longer be able to produce the insulin thats needed by your body. To overcome this problem, a relatively new technique called autologous pancreatic islet cell transplantation (APICT) is sometimes used. During APICT,the islet cells responsible for producing insulin are removed from your pancreas, before your pancreas is surgically removed. Theislet cells are mixed with a special solution, which is injected into your liver. If the APICT procedure is successful, the islet cells remain in your liver and begin to produce insulin. In the short term, APICT appears to be effective, but you may need additional insulin treatment in the long term. See guidelines from the National Institute for Health and Care Excellence (NICE) about autologous pancreatic islet cell transplantation for more information. Complications of chronic pancreatitis Complications of chronic pancreatitis are relatively common and usually caused by living with chronic pain or damage to the pancreas. Psychological effects of chronic pancreatitis Any chronic health condition, particularly one causing recurring or constant pain, can have an adverse effect on your emotional and psychological health.The InternationalAssociation for the Study of Painfound that up to 94% of people withchronic pancreatitis experience pain. One study ofpeople living with chronic pancreatitis found that one inseven people had some sort of psychological or emotional problem, such as stress , anxiety or depression . Contact your GP if youre experiencing psychological and emotional difficulties. Effective treatments are availableto help improve the symptoms of stress, anxiety and depression. Joining a support group for people with chronic pancreatitismay also help. Talking to other people with the same condition can often help to reduce feelings of isolation and stress. Diabetes Around a third of people with chronic pancreatitis develop diabetes , usually many years after receiving their diagnosis (its not unusual for 20 years to pass before diabetes occurs). Diabetes develops when your pancreas is no longer able to produce insulin (a chemical the body uses to break glucose down into energy). The main symptoms of diabetes are: feeling very thirsty going to the toilet a lot, particularly at night extreme tiredness weight loss and muscle wasting (loss of muscle bulk) If you develop diabetes because of chronic pancreatitis, youll probably need to have regular insulin injections to compensate for the lack of natural insulin in your body. Pseudocysts Another common complication of chronic pancreatitis is pseudocysts (sacs of fluid which develop on the surface of your pancreas). Theyre thought to affect around1 in10people with chronic pancreatitis. In many cases, pseudocysts dont cause any symptoms and are only detected during a computerised tomography (CT) scan . However, in some people, pseudocysts can cause the following symptoms: bloating indigestion dull abdominal pain If the pseudocysts are small and not causing any symptoms, there may be no need for treatment, because they usually disappear on their own. Treatment is usually recommended if youre experiencing symptoms or the pseudocysts are larger than 6cm (2.3 inches) in diameter. Larger pseudocysts are at risk of bursting open, which could cause internal bleeding or trigger an infection. Pseudocysts can be treated by draining the fluid out of the cyst. This can be done by inserting a needle through your skin and into the cyst. Alternatively, an endoscopymay be used. This is where a thin, flexible tube called an endoscope is passed down your throat, and tiny tools are used to drain away the fluid. Sometimes, pseudocysts are treated by removing part of the pancreas using laparoscopic or keyhole surgery. This is known as a laparoscopic distal pancreatectomy. See guidelines from the National Institute for Health and Care Excellence (NICE) on laparoscopic distal pancreatectomy . Pancreatic cancer Chronic pancreatitis increases your risk of developing pancreatic cancer . However, the increased risk is relatively small. For example, its estimated that for every 100 people with chronic pancreatitis, only 1or 2will develop pancreatic cancer. The most common initial symptoms of pancreatic cancer are much the same as chronic pancreatitis. Theyinclude jaundice, abdominal pain and weight loss. Source: NHS 24 - Opens in new browser window Last updated: 12 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Acute pancreatitis Other health sites NICE: Autologous pancreatic islet cell transplantation for improved glycaemic control after pancreatectomy NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Cirrhosis,"Cirrhosis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Cirrhosis Cirrhosis About cirrhosis Symptoms of cirrhosis Causes of cirrhosis Diagnosing cirrhosis Treating cirrhosis Preventing cirrhosis About cirrhosis Cirrhosis is scarring of the liver caused by continuous, long-term liver damage. Scar tissue replaceshealthy tissue in the liver and prevents the liver from working properly. The damage caused by cirrhosis cant be reversed and can eventually become so extensive that your liver stops functioning. This is called liver failure. Cirrhosis can be fatal if the liver fails. However, it usuallytakesyears forthe conditionto reach this stage and treatment can help slow its progression. Each year inthe UK, around 4,000 people die from cirrhosis and 700 people with the condition need a liver transplant to survive. Signs and symptoms There are usually few symptoms in the early stages of cirrhosis. However, as your liver loses its ability to function properly, youre likely to experience a loss of appetite, nausea anditchy skin. In the later stages, symptoms can include jaundice, vomiting blood, dark, tarry-looking stools, and a build-up of fluid in the legs (oedema) and abdomen (ascites). Read more about the symptoms of cirrhosis. When to see your GP As cirrhosis doesnt have many obvious symptoms during the early stages, its often picked up during tests for an unrelated illness. See your GP if you have any of the following symptoms: fever and shivering shortness of breath vomiting blood very dark or black, tarry stools (faeces) periods of confusion or drowsiness Read more about diagnosing cirrhosis . What causes cirrhosis? Inthe UK, the most common causes of cirrhosis are: drinking too much alcohol ( alcohol misuse ) over many years beinginfected with the hepatitis C virus for a long time acondition called non-alcoholic steatohepatitis (NASH) that causes excess fat to build up in the liver NASH is on the rise in the UK, due to increasing levels of obesity and reduced physical activity. Its likely that it will overtake alcohol and hepatitis C as the most common cause of cirrhosis. Less common causes of cirrhosis include hepatitis B infection and inherited liver diseases, such as haemochromatosis. Read more about the causes of cirrhosis . Treating cirrhosis Theres currently no cure for cirrhosis.However, its possible to managethe symptomsand any complications, and slowits progression. Treating underlying conditions that may be the cause, such as using anti-viral medication to treat a hepatitis C infection, can also stop cirrhosis getting worse. You may be advised to cut down or stop drinking alcohol, or to lose weight if youre overweight.A widerange of alcohol support services are available. In its more advanced stages, the scarring caused by cirrhosis can make your liver stop functioning. In this case, a liver transplant is the only treatment option. Read more about treating cirrhosis . Preventing cirrhosis Notexceedingthe recommended limits for alcohol consumption is the best way of preventing alcohol-related cirrhosis. Hepatitis B and C are infections you can get by having unprotected sex or sharing needles to inject drugs. Using a condom during sex and not injecting drugs will reduce your risk of developing hepatitis B and C. A vaccine forhepatitis B is available, but theres currently no vaccine for hepatitis C. Read more about preventing cirrhosis . Symptoms of cirrhosis There are usually few symptoms during the early stages of cirrhosis. Noticeable problems tend to develop as the liver becomes more damaged. Inearly stage cirrhosis, the liver is able to function properly despite being damaged. As the condition progresses, symptoms tend to develop when functions of the liver are affected. Symptoms of cirrhosiscan include: tiredness and weakness loss of appetite weight loss and muscle wasting feeling sick(nausea) and vomiting tenderness or pain around the liver area tiny red lines (blood capillaries) on the skin above waist level very itchy skin yellowing of the skin and the whites of the eyes (jaundice) a tendency to bleed and bruise more easily, such as frequent nosebleeds or bleeding gums hair loss fever and shivering attacks swelling in the legs, ankles and feet due to a build-up of fluid (oedema) swelling in your abdomen (tummy), due to a build-up of fluid known as ascites (severe casescan make you look heavily pregnant) You mayalso notice changes in your personality, problems sleeping ( insomnia ), memory loss, confusion and difficulty concentrating. This is known as encephalopathy andoccurs when toxins affect your brain because your liver is unable to remove them from your body. Late-stage symptoms In the later stages of cirrhosis, you may vomit blood or have tarry, black stools. This is because blood cant flow through the liver properly, which causes an increase in blood pressure in the vein that carries blood from the gut to the liver (portal vein). The increase in blood pressure forces blood through smaller, fragile vessels that line your stomach and gullet (varices). These can burst under high blood pressure, leading to internal bleeding, which is visible in vomit and/or stools. Over time, the toxins that would normally be removed from the body by a healthy liver can cause multiple organ failure, followed by death. When toseek medical help You should see your GP if you have persistent signs and symptoms of cirrhosis. Seek immediate medical help if you develop the following symptoms, particularly if youve been previously diagnosed with cirrhosis: fever and shivering attacks shortness of breath vomiting blood very dark or black tarry stools periods of mental confusion or drowsiness Causes of cirrhosis There are many different causes of cirrhosis. In the UK, the most common causes are drinking excessive amounts of alcohol and long-term hepatitis C infections. Insome cases, no specific cause is identified. Alcohol consumption The liver breaks down toxins (poisons), such as alcohol, but too much alcohol can scar and damage the livers cells. Men and women who drink more than 14units of alcohol a week are considered to be drinking too much. If youre a heavy drinker, your chances of developing cirrhosis are increased. However, its important to realise that cirrhosis of the liver isnt just a condition that affects people dependent on alcohol. If youre a heavy social drinker, you can also develop cirrhosis. Alcohol-related cirrhosis usually develops after 10 or more years of heavy drinking. For unknown reasons, some people are more susceptible to liver cell damage than others. Women who drink heavily are more susceptible to liver damage than men, partly because of their different body size and build. Stages of alcoholic liver damage People who drink excessively and continue to drink heavily develop cirrhosis in 3separate stages. The first stage of alcohol-related liver disease is known as fatty liver, which almost all excessive drinkers develop. Its a side effect of the liver breaking alcohol down and disappears when you drink less. The second stage of alcohol-related liver disease is alcoholic hepatitis. Around 20% to 30% of people who continue to drink heavily develop alcoholic hepatitis. During this stage, the liver becomes inflamed. If alcoholic hepatitis deteriorates into its most extreme form (liver failure) it can lead to death. About 10% of heavy drinkersdevelop cirrhosis, which is the third stage of alcohol-related liver disease. This risk of developing cirrhosis, along with the risk of alcoholic hepatitis, is one of the main reasons the government recommends that men and women should not regularly drink more than 14 units a week. If you do drink as much as 14 units a week, it is advised that you spread your drinking over 3 or more days. A unit of alcohol is roughly equivalent to half a pint of normal-strength lager or a single measure (25ml) of spirits. A small glass of wine (125ml) is about 1.5 units. Read more about alcohol units . Your GP can give you help and advice if youre finding it difficult to cut down the amount you drink. Hepatitis Hepatitisisinflammationof the liver. Left untreated, it can damage the liver over many years, eventually resulting in cirrhosis. Inthe UK, hepatitis C isthe most common form of hepatitis. The hepatitis Cvirusis usually transmitted through blood-to-blood contact,most commonly by sharing needles used to inject drugs. Two other types of hepatitis infection, hepatitis B and D, can also cause cirrhosis. Non-alcoholic steatohepatitis Non-alcoholic steatohepatitis (NASH) is a severe liver condition that can lead to cirrhosis. As with alcohol-related liver disease, the early stage of NASH is the build-up of excess fat in the liver. This fat is associated with inflammation and scarring, which could lead to cirrhosis. NASH can develop in peoplewho areobese, have diabetes , havehigh levels of fat in the blood ( high cholesterol ) and high blood pressure . Most people with NASH feel well and arent awarethey have a problem until cirrhosis occurs and liver function is affected. NASH is on the rise in the UK due to increasing levels of obesity and reduced physical activity. Its likely that it will overtake alcohol and hepatitis C as the most common cause of cirrhosis. Other causes There are a number of other conditions that can prevent the liver functioning healthily and can lead to cirrhosis. These include: autoimmuneliver disease  the immune system usually makes antibodies to attack bacteria and viruses; however, if you have an autoimmune disease, such as autoimmune hepatitis, primary biliary cirrhosis or primary sclerosing cholangitis (PSC),your immune system will make antibodies that attack healthy organs some rare, genetic conditions  such as haemochromatosis (a build-up of iron in the liver and other parts of the body) and Wilsons disease (a build-up of copper in the liver and other parts of the body) any condition that causes the bile ducts to become blocked  such as cancer of the bile ducts or pancreatic cancer Budd-Chiari syndrome  caused by blood clots blocking the veins that carry blood from the liver Less commonly, the use of certain medications, such as amiodarone and methotrexate, can also cause cirrhosis. Diagnosing cirrhosis If your GP suspects cirrhosis, theyll check your medical history and carry out a physical examination to look for signs of chronic liver disease. If your GP suspects your liver is damaged, youll be referred for tests to confirm the diagnosis. Tests You may have a number of different tests. Blood tests Blood tests can measure your liver function and the amount of liver damage. A blood test may be used to measure the levels of the liver enzymes alanine transaminase (ALT) and aspartate transferase (AST) in your blood, as these will be raised if you have inflammation of the liver (hepatitis). Scans An ultrasound scan ,transient elastography scan, computerised tomography (CT) scan or a magnetic resonance imaging (MRI) scan may be carried out on your liver. Atransient elastography scan is similar to an ultrasound scan carried out during pregnancy (its sometimes known as a Fibroscan). These scans can produce detailed images of your liver or check liver stiffness to identify any scarring. The Lab Tests Online UK website hasmore information about ALT and AST measurements. Liverbiopsy A liver biopsy is where afine needle is inserted into your body (usually between your ribs) to removea small sample of liver cells. The sample is sent to a laboratory so it can be examined under a microscope. The biopsy is usually carried out under local anaesthetic , as a day case or with an overnight stay in hospital. The outcome of the biopsy will confirm a diagnosis of cirrhosis and may provide more information about the cause.However, transient elastography is increasingly being used as an alternative to a biopsy in the diagnosis of cirrhosis. Endoscopy Anendoscopy is where an endoscope (a thin, long, flexible tube with a light and video camera at the end) is passed down your throat and into your stomach. Images of your oesophagus (tube from your throat to your stomach) and stomach are transmitted to an external screen where any varices (swollen vessels),which are a sign of cirrhosis, can be seen. Grading There are several different grading systems for cirrhosis according to how serious it is. One system is theChild-Pugh score which, based on your examination and laboratory tests, grades cirrhosis from A (relatively mild) to C (severe). An alternativesystem calledmodel of end-stage liver disease (MELD) uses the results of a blood test to help identifypeople who need an urgent liver transplant. Treating cirrhosis Cirrhosis cant be cured, so treatment aims to manage the symptoms and any complications and stop the condition getting worse. Its usually not possible to reverseliver damage thats already occurred, although recent research suggests this may eventually be possible in cases where the underlying cause of the liver damage can be successfully treated. Treatment is likely to take place at a hospital with a specialist hepatology unit, which treats disorders of the liver, gall bladder and biliary ducts. Stoppingcirrhosis getting worse Taking medication to treatthe underlying cause of the liver damageand making healthy lifestyle changes can help stop cirrhosis getting worse and reduce your risk of developing further health problems. Medication The medication you need will depend on the specific cause of the damage to your liver. For example, if you have viralhepatitis you may be prescribed anti-viral medications. If you have autoimmune hepatitis you may be given steroid medication ( corticosteroids ) or medication to suppress your immune system (immunosuppressants). Lifestyle changes There are a number of things you can do to help yourself stay healthy and reduce your chances of developing further problems if you have cirrhosis, including: completely avoid alcohol , regardless of the cause of your cirrhosis, asalcohol consumption increases the rate at which the condition progresses lose weight if youre overweight or obese regular exercise toreduce muscle wasting practisegood hygiene to reduce your chances of developing infections speak to your GP about vaccinations you may need, such as the annual flu vaccine ortravel vaccines speak to your GP or pharmacist ifyoure taking over-the-counter or prescription medications, as cirrhosis can affect the way your body processes some medicines Malnutrition is common in people with cirrhosis, so its important to ensure you have a balanced diet to help you get all the nutrients you need. Avoiding salty foods andnot adding salt to foods you eat can helpreduce your risk of developing swelling in yourlegs, feet and abdomen (tummy) caused by a build up of fluid. Seetips for a lower salt diet for more information. The damage to your liver can alsomean itsunable to store glycogen,a carbohydrate that provides short-term energy. When this happens, the body uses its own muscle tissue to provide energy between meals, which leads to muscle wasting and weakness. Therefore, youmay need extra calories and protein in your diet. Healthy snacking between meals can top up your calories and protein.It may also be helpful to eat 3or 4small meals a day, rather than 1or 2large meals. Easing symptoms A number of treatments can ease the symptoms of cirrhosis, including: a low-sodium (salt) diet ortablets called diureticsto reduce the amount of fluid in your body tablets to reduce high blood pressure in your portal vein (the main vein that transports blood from the gut to the liver) and prevent or treat any infection creams to reduce itching Managing complications of advanced cirrhosis In cases of advanced cirrhosis, complications caused by the condition mayneed treatment. Swollen varices If you vomit blood or pass blood in your stools, you probably have swollen veins in your oesophagus (the long tube that carries food from the throat to the stomach). These are known as oesophageal varices. In these cases,urgent medical attention is required. This means seeing your GP or going to theaccident and emergency (A&E) department of your nearest hospital immediately. Certain procedures can help stop the bleeding and reduce the risk of it happening again, such as: banding  anendoscopy is carried out (a thin, flexible tube is passed down your throat) and a small band is placed around the base of the varices to help control the bleeding injection glue therapy  following an endoscopy, a type of medical super glue is injected into the varices to make the blood clot, which helps to stop the bleeding a Sengstaken tube with a balloon on the end  a specialtube is passed down your throat into your stomach and the balloon is inflated; thisputs pressure on the varices and helps stop the bleeding and youll be heavily sedated during the procedure a transjugular intrahepatic portosystemic stent shunt (TIPSS)  a metal tube called a stent is passed across your liver to join 2 large veins (the portal vein and hepatic vein); this creates a new route for your blood to flow through, therefore relieving the pressure that causes the varices You may also be given a type of medication called a beta-blocker , such as propanolol, to reduce the risk of bleeding or reduce the severity of any bleed thatdoes occur. Fluid in thetummy and legs Ascites (a build-up of fluid around your stomach area) and peripheral oedema (fluid around your legs and ankles) are common complications of advanced cirrhosis. Theyll need to be addressed as soon as possible. You may have 20 to 30 litres of free water in your stomach area (abdomen), which can make it difficult for you to eat and breathe properly. The main treatments for ascites and oedema are restricting sodium (salt) in your diet and taking diuretic tablets, such as spironolactone or furosemide. If thefluid around your stomach becomes infected, you may need to be treated with antibiotics . Alternatively, antibiotics may be used on a regular basisto prevent infection in people at high risk. In severe cases of ascites, tubes may be used to drain the fluid from your abdomen. This will usually be repeated every few weeks. Encephalopathy People with cirrhosis can sometimes develop problems with their brain function (encephalopathy). This occurs because the liver isnt clearing toxins properly. The main treatment for encephalopathy is lactulose syrup. This acts as a laxative (it helps clear the bowels) and helps the body remove the toxins that build up in the body when the liver is failing. In some cases, other laxatives or an enema may be used. Bleeding Cirrhosis can affect the livers ability to make the blood clot (thicken), leaving you at risk of severe bleeding if you cut yourself. Vitamin K and a blood product called plasma can be given in emergencies to treat episodes of bleeding. Youll need to apply pressure to any cuts that bleed. Therefore,you should seek specialist advice before having medical procedures, including any dental work. Liver transplant Your liver may stop functioning if its severely damaged by scarring. In this situation, a liver transplant is the only option. This is a major procedure that involves removing your diseased liver and replacing it with a healthy donor liver. However, youll probably have to wait a long time for a liver transplant because there are more people waiting for a transplant than there are donors. The NHSBT Organ Donation website has more information about transplants and joining the Organ Donor Register . Preventing cirrhosis You can reduce your chances of developing cirrhosis by limiting your alcohol consumption and protecting yourself from a hepatitis infection. Limiting your alcohol consumption Heavy alcohol consumption is one of the most common causes of cirrhosis of the liver.One of the best ways to avoid thisis to keep withinrecommended limits. men and women are advised not to regularly drink more than 14 units a week spread your drinking over 3days or more if you drink as much as 14 units a week If you have cirrhosis, you should stop drinking alcohol immediately because it speeds up the rate at which the condition progresses, regardless of the cause. Read more about alcohol misuse . Protect yourself from hepatitis Cirrhosis can be caused by infectious conditions, such as hepatitis B and C. Hepatitis B and C can be caught through having unprotected sex or by sharing needles to inject drugs. Using a condom when having sex will help you avoid the risk of getting hepatitis, as will avoiding injecting drugs. Anyone whos at risk of getting hepatitis B, such as police officers and social care workers, can be protected by being vaccinated against the condition. However, theres currently no vaccine for hepatitis C . People born in areas of the world where hepatitis B and C are widespread, such as parts of South Asia and Africa, need to be screened for hepatitis, as early treatment can help prevent the onset of cirrhosis. Source: NHS 24 - Opens in new browser window Last updated: 12 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites Lab Tests Online UK: bilirubin Adfam: support for families British Liver Trust British Liver Trust: hepatitis C PBC Foundation: primary biliary cholangitis Hepatitis C Trust NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Clostridium difficile,"Clostridium difficile | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Clostridium difficile Clostridium difficile Clostridium difficile, also known as C. difficile or C. diff, is a bacterium that can infect the bowel and cause diarrhoea. The infection most commonly affects people who have recently been treated with antibiotics , but can spread easily to others. C. difficileinfections are unpleasant and can sometimescauseserious bowel problems, butthey can usually be treated with another course of antibiotics. Symptoms of a C. difficile infection Symptoms of a C. difficileinfection usually develop when youre taking antibiotics, or when youve finished taking them within the last few weeks. The most common symptoms are: watery diarrhoea , which can be bloody painful tummy cramps feeling sick signs of dehydration , such asa dry mouth , headaches and peeing less often than normal a high temperature (fever) of above 38C (100.4F) loss of appetite and weight loss Insome cases, serious complications can develop, such as damage to the bowel or severe dehydration, which may causedrowsiness, confusion, a rapid heart rate and fainting. Whos most at risk of C. difficile? C. difficile mostly affects people who: have been treated with broad-spectrum antibiotics (antibiotics that work againstseveral types of bacteria) or several different antibiotics at the same time, or thosetakinglong-term antibiotics have had to stayin a healthcare setting, such as a hospital or care home, for a long time are over 65 years old havecertain underlyingconditions, including inflammatory bowel disease (IBD), cancer or kidney disease have a weakened immune system, which can be because of a condition such as diabetes or a side effect of a treatment such as chemotherapy or steroid medication are takinga medication called a proton pump inhibitor (PPI) to reduce the amount of stomach acid they produce have had surgery on their digestive system Many C. difficile infections used to occur in places where many people take antibiotics and are in close contact with each other, such as hospitals andcare homes. However, strict infection control measures have helped to reduce this risk, and an increasingnumber of C. difficile infections now occur outside these settings. When to get medical advice Visiting your GP surgery with a possible C. difficile infectioncan put others at risk, so its best to phone your GP or NHS 111 if youre concerned or feel you need advice. Phone your GP if: you have persistent diarrhoea after finishinga course ofantibiotics you have bloody diarrhoea you have diarrhoea andexperiencesevere tummy pain,a high fever, a rapid heart rate or fainting you have symptoms of severe dehydration , such as confusion, drowsiness, only passing small amounts of urine or no urine at all If your GP is closed, phone 111. Diarrhoea can be caused by a number of conditions and isa common side effect of antibiotics, so having diarrhoea while taking antibiotics doesnt necessarily mean you have aC. difficile infection. Your GP may suggest sending off a sample of yourpoo to confirm whether you have C. difficile. A blood test may also be carried out to help determine how severe the infection is, and sometimes you may need tests or scans in hospital to check if your bowel is damaged. Treatment for C. difficile Your GP will decide whether you need hospital treatment (if youre not already in hospital). Ifthe infection isrelatively mild, you may be treated at home. If youre in hospital, youmight be moved to a room of your own during treatment to reduce the risk of the infection spreading to others. Treatment for C. difficile can include: stoppingthe antibiotics thought to be causing the infection, if possible  in mild cases, this may be the only treatment thats needed taking a 10 to 14-day course of antibiotics that are known to kill C. difficile bacteria rarely,seriousinfections mayrequiresurgery to remove a damaged section of the bowel C. difficile infectionsusually respond well to treatment, with most people making a full recovery in a week or two. However, the symptoms come back in around 1 in 5 cases and treatment may need to be repeated. Looking after yourself at home If youre well enough to be treated at home, the following measures can helprelieve your symptoms and prevent the infection spreading. Do make sure you finish the entire course of any antibiotics youre prescribed, even if youre feeling better drink plenty of fluids to avoid dehydration and eat plain foods such as soup, rice, pasta and bread if you feel hungry take paracetamol for tummy pain or a fever regularly wash your hands and contaminated surfaces, objects or sheets stay at home until at least 48 hours after your last episode of diarrhoea Dont do not take anti-diarrhoeal medication, as this can stop the infection being cleared from your body Your GP may contact you regularly to make sure youre getting better. Phone them if your symptoms return after treatment finishes, as it may need to be repeated. How you get C. difficile C. difficile bacteria are found in thedigestive systemof about 1 in every 30 healthy adults. The bacteriaoften live harmlessly because the other bacteria normally found in the bowel keep it under control. However, some antibiotics can interfere with the balance of bacteria inthe bowel, whichcan cause the C. difficile bacteria to multiplyand produce toxins that make the person ill. When this happens, C. difficile can spread easily to other people because the bacteria are passed out of the body in the persons diarrhoea. Once out of the body, the bacteria turn into resistant cells called spores. These can survive for long periods on hands, surfaces (such as toilets), objects and clothing unless theyre thoroughly cleaned, and can infect someone else if they get into their mouth. Someone with a C. difficile infection is generally considered to be infectious until at least 48 hours after their symptoms have cleared up. How to stop C. difficile spreading C.difficileinfections canbe passed onvery easily. You can reduce your risk of picking it up or spreading it by practising good hygiene, both at homeand in healthcare settings. The following measures can help: stay at home until at least 48 hours after your symptoms have cleared up wash your hands regularly with soap and water, particularly after going to the toiletand before eating use liquid rather than bar soap and dont use flannels or nail brushes clean contaminated surfacessuch as the toilet, flush handle, light switches and door handleswith a bleach-based cleaner after each use dont share towels and flannels wash contaminated clothes and sheets separately from other washing at the highest possible temperature when visiting someone in hospital,observe anyvisiting guidelines, avoid taking any children under the age of 12, and wash your hands with liquid soap and water when entering and leaving ward areas dont rely on alcohol hand gels, as theyre not effective against C. difficile avoid visiting hospitalif youre feeling unwell or have recently had diarrhoea Source: NHS 24 - Opens in new browser window Last updated: 29 May 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Antibiotics Preparing and cooking food safely Other health sites Lab Tests Online UK: C. difficile test Food Standards Scotland: Food safety and hygeine NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Coeliac disease,"Coeliac disease | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Coeliac disease Coeliac disease Coeliac disease About coeliac disease Symptoms of coeliac disease Causes of coeliac disease Diagnosing coeliac disease Treating coeliac disease Complications of coeliac disease About coeliac disease Coeliac disease is a common autoimmune condition where the immune system in a persons intestine (gut) reacts when they eat gluten. This causes chronic inflammation. What is gluten? Gluten is a protein found in wheat, barley and rye. Gluten is found in food and drink that contains wheat, barley and rye, such as: most types of bread pasta cakes biscuits crackers many breakfast cereals pastry certain types of sauces some types of ready meals most beers and lagers certain fruit squashes How many people have coeliac disease? Coeliac disease affects 1 person in every 100. Only about one third of them are ever diagnosed. Coeliac disease can be diagnosed at any age. Reported cases of coeliac disease are twice as high in women than men. Symptoms Coeliac disease can cause a wide range of symptoms in the digestive system and rest of the body. Symptoms can develop at any age, but coeliac disease is most commonly diagnosed between the ages of 40 and 60 years. More about the symptoms of coeliac disease or what is coeliac disease? Causes Coeliac disease is more common in people with certain conditions and in relatives of people with coeliac disease. Its unknown exactly why people develop the condition. More about the causes of coeliac disease Diagnosis Most people with coeliac disease have antibodies in their blood. The first stage in diagnosis is a simple blood test. The second stage might result in a biopsy, if necessary. More about how coeliac disease is diagnosed Treatment Coeliac disease can be effectively treated with a gluten-free diet. By adopting a gluten-free diet and lifestyle, you can manage your condition and improve your quality of life. More about how coeliac disease is treated Complications If coeliac disease isnt treated, youre at greater risk of conditions like osteoporosis and cancer in later life. More about the complications of coeliac disease Living well with coeliac disease Living with coeliac disease can be challenging but with the right support and information, its completely manageable. Symptoms of coeliac disease Symptoms of coeliac disease vary from person to person and can range from mild to severe. Some people may have no symptoms at all. Sometimes the symptoms of coeliac disease are mistaken for: irritable bowel syndrome (IBS) wheat intolerance stress just getting older Common symptoms Some common symptoms of coeliac disease include: severe diarrhoea, excessive wind and/or constipation persistent or unexplained gastrointestinal symptoms, such as nausea and vomiting recurrent stomach pain, cramping or bloating iron, vitamin B12 or folic acid deficiency anaemia tiredness sudden or unexpected weight loss (but not in all cases) mouth ulcers skin rash ( dermatitis herpetiformis ) depression repeated miscarriages neurological (nerve) problems such as ataxia (loss of coordination, poor balance) and peripheral neuropathy (numbness and tingling in the hands and feet) If youve any of these symptoms, speak to your GP. You must continue eating gluten as part of your diet until youve been diagnosed. You can also take Coeliac UKs online assessment . Symptoms in children Children with coeliac disease might also not grow at the expected rate, or be late to reach puberty. Causes of coeliac disease Its not known exactly why people develop coeliac disease or why some have mild symptoms while others have severe symptoms. It could be that a persons genetics and the environment play a part in why this condition develops. Pre-exisiting conditions Coeliac disease is more common in people with certain conditions  such as type 1 diabetes, Downs syndrome or autoimmune thyroid disease. Also, in close family members (parents or siblings) of people with coeliac disease. Genetics Coeliac disease often runs in families. If youve a close relative with the condition  such as a parent or sibling  your chance of developing it is higher. This risk is approximately 10% for those with a family history, compared with 1% for someone without a close relative with the condition. If you have a close relative with coeliac disease and you have symptoms you should speak to your GP. If youve an identical twin with coeliac disease, theres an 85% chance youll also develop the condition. Diagnosing coeliac disease Coeliac disease can be diagnosed at any age, and both children and adults can show symptoms Delayed diagnosis is common. It can take an average of 13 years to diagnose. Blood tests Most people with coeliac disease have antibodies that show up in their blood. The first stage in diagnosis can be a blood test. Wholl have a blood test A blood test should be offered if youve any of the following: type 1 diabetes autoimmune thyroid disease dermatitis herpetiformis irritable bowel syndrome (IBS) anaemia without an obvious cause certain symptoms related to your digestive system  such as frequent diarrhoea, abdominal pain or vomiting, nausea or sudden weight loss close relatives (parents, siblings or children) with coeliac disease A blood test might also be offered if: you feel tired all the time a child is not growing as fast as expected youve other symptoms or conditions that sometimes occur in people with coeliac disease  such as mouth ulcers, particular types of problems with your bones or liver, Downs syndrome, Turner syndrome or persistent constipation Blood tests for coeliac disease are not recommended for infants whove not started to eat foods containing gluten. Before a blood test Before a blood test is taken, its important that you eat gluten-containing foods in more than one meal every day for at least 6 weeks before the test. Remember to eat a normal gluten diet for 6 weeks before any tests. This means eating more than one meal a day that includes gluten-based foods. Whats involved in a blood test? A blood test for coeliac disease involves taking a blood sample and testing it for antibodies in the blood. You must have been eating gluten-containing food in more than 1 meal for at least 6 weeks before the test, for it to be successful. Blood tests are 95% accurate at diagnosing coeliac disease. Positive result If the coeliac antibodies are found in your blood, further investigation will be needed. Thisll be discussed with you. Your GP will refer you to your local coeliac service for confirmation of the diagnosis. You should remain on a normal diet until all investigations are complete. Negative result Its sometimes possible to have coeliac disease and not have antibodies in your blood. If you continue to have coeliac disease-like symptoms your GP may still refer you for a biopsy of your gut. Biopsy A biopsy can help confirm a diagnosis of coeliac disease. If youre referred for a biopsy, this will be carried out in hospital. Usually, a biopsy will be done by a gastroenterologist. This is a doctor who specialises in treating conditions of the stomach and intestines. Whats involved in a biopsy? If you need to have a biopsy, a thin flexible tube with a light called an endoscope will be inserted into your mouth or nose and passed down to your small intestine. Before the procedure, a local anaesthetic is given to numb the throat and/or a sedative to help you relax. During the procedure, the endoscopist will pass a tiny biopsy tool through the endoscope to take samples of the lining of your small intestine. The sample will then be examined under a microscope for signs of coeliac disease. For those under 16 years the endoscopy would be under an anaesthetic. Diet before and after testing You should continue to eat gluten-containing foods every day until a diagnosis has been confirmed. A biopsy will only show coeliac disease if the person being tested has been eating gluten-containing foods regularly. Only after coeliac disease is confirmed can you start a gluten-free diet. If youre already on a gluten-free diet and find it hard to eat gluten again, your GP should refer you to a specialist. You may not be able to get gluten-free foods on prescription if you do not have coeliac disease confirmed by a biopsy. Read further information: Diet advice when being tested for Coeliac Disease NICE guidelines  coeliac disease recognition, assessment and management BSG guidelines on the diagnosis and management of adult coeliac disease Lynseys diagnosis story Tests after diagnosis If youve been diagnosed with coeliac disease, you may also have other tests to assess how the condition has affected you so far. Additional blood tests You may have further blood tests to check levels of iron and other vitamins and minerals in your blood. Thisll help check for anaemia . Dual energy X-ray (DEXA) scan (adults only) In coeliac disease, a lack of nutrients caused by poor absorption can make bones weak and brittle (osteoporosis). A DEXA scan is a type of very low dose X-ray that measures bone density. This may be required if your risk score (FRAX/Qfracture) is high. This will be calculated as part of your assessment. Over-the-counter tests You can buy over-the-counter tests for coeliac disease at pharmacies. There isnt enough evidence that these tests are reliable. If youve used one, its important that you talk to your GP about the result. Before a diagnosis can be confirmed, youll still need to have a blood test and biopsy. Treating coeliac disease The only treatment for confirmed coeliac disease is a lifelong gluten-free diet. How does a gluten-free diet help? Following a gluten-free diet helps prevent gluten damaging the lining of the intestines (gut). This will improve or remove the symptoms. A gluten-free diet will also help to prevent the complications later in life. What if I continue to eat gluten? If youre diagnosed with coeliac disease and continue to eat foods that contain gluten, your symptoms will return and could cause long-term damage to your health. Gluten-free food on prescription If youve a confirmed diagnosis of coeliac disease or dermatitis herpetiformis, you can access gluten-free foods on prescription through your GP or Scottish Gluten-free Food Service. How to register with the Scottish Gluten-free Food Service\u200b How long does treatment take to work? Symptoms should improve within weeks of starting a gluten-free diet. However, it may take up to 2 years for the digestive system to heal completely. Dietary advice After a confirmed diagnosis of coeliac disease, youll be seen by a dietitianfor help with adjusting to your new gluten-free diet and lifestyle. The dietitian will help by: making sure the diet is balanced and contains all the nutrients you need advising how to adjust your diet and lifestyle to ensure its gluten-free The dietitian should provide you with: guidance on gluten-free food alternatives information on shopping, preparing, cooking and storing gluten-free foods information about gluten-free prescriptions and the Scottish Gluten-free Food Service details of local and national support groups More about a dietitians perspective Dietary supplements As well as adopting a gluten-free diet and lifestyle, your GP or dietitian might also recommend that you take vitamin and mineral supplements for at least the first 6 months after diagnosis. This will ensure that the you get all the nutrients you need while your digestive system repairs itself. Taking supplements can also help correct any deficiencies, such as anaemia (a lack of iron in the blood). Feeding your baby If youve coeliac disease, you shouldnt introduce gluten into your babys diet before its 6 months old. Breast milk is naturally gluten-free and all infant milk formulas are too. Foods with gluten should be introduced slowly when a child is around 6 months old. The situation should be carefully monitored. Vaccinations If you have coeliac disease, you should get vaccinations for: pneumococcus flu (annually) You should discuss this with your GP or specialist before having any vaccinations. Annual health checks After starting treatment, youll need to have an annual coeliac disease health check to monitor your condition. This will be done by your GP, a dietitian or a pharmacist. At this health check, theyll ask you: about your health in relation to coeliac disease how youre managing your gluten-free diet Youll also be given the chance to discuss any concerns. Living with coeliac disease can be challenging but with the right support and information, its completely manageable. More about living well with coeliac disease Complications of coeliac disease Complications of coeliac disease only tend to affect people that continue to eat gluten, or in people that have taken a long time to diagnose. Possible complications of coeliac disease include: lactose intolerance nutritional deficiencies osteoporosis cancer Lactose intolerance If youve coeliac disease, you may also develop lactose intolerance because the body lacks the enzyme to digest milk sugar (lactose) found in dairy products. Lactose intolerance is only temporary. It normally disappears when you follow a gluten-free diet. More about lactose intolerance Nutritional deficiencies Severe symptoms of coeliac disease can lead to malnutrition. However, this is rare. More common is malabsorption where your body fails to absorb nutrients from the foods you eat. This can lead to anaemia if the body doesnt take in enough iron, and osteoporosis if theres not enough calcium and vitamin D being taken in. More about nutritional deficiencies Osteoporosis Osteoporosis causes the bones to become brittle, weak and fracture more easily. Bones need a wide variety of vitamins and minerals to stay dense and strong. If youve coeliac disease, youve an increased risk of developing osteoporosis due to the damaged gut failing to absorb key bone nutrients from food. This decreases blood vitamin and mineral levels and the body compensates for this by taking nutrients like calcium from the bones. This weakens your bones and puts you at increased risk of fracture. If you have coeliac disease, you should make sure youre eating enough calcium and take vitamin D supplements. Read further information: NHS inform: Vitamin D NHS inform: osteoporosis Cancer Having undiagnosed or untreated coeliac disease can increase your risk of developing lymphoma and some types of bowel cancer but these are rare. Risks are reduced by following a gluten-free diet. Less common complications Less common complications of coeliac disease include low birth weight in newborn babies and in rare cases, hyposplenia. Source: Scottish Government - Opens in new browser window Last updated: 12 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Living well with coeliac disease Gluten-free diet Gluten-free Food Service Other health sites Coeliac UK NICE: Coeliac disease NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Cold sore,"Cold sore | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Mouth Cold sore Cold sore About cold sores Symptoms of cold sores Causes of cold sores Treating cold sores About cold sores Cold sores are small blisters that develop on the lips or around the mouth. Theyre caused by the herpes simplex virus and usually clear up without treatment within 7 to 10 days. Youmay nothave any symptoms when you first become infected with the herpes simplex virus. An outbreak of cold sores mayhappen some time later. Cold sores often start with a tingling, itching or burning sensation around your mouth. Small fluid-filled sores then appear, usually on the edges of your lower lip. Read more about the symptoms of cold sores . When toget professional advice Pharmacy First Scotland: Cold sore treatment from your pharmacy If you have cold sores you can get advice and treatment directly from a pharmacy. Find your local pharmacy on Scotlands Service Directory. Search for a pharmacy near you Cold sores arent usually serious and can be treated by a pharmacist. Your pharmacist may recommend that you contact your GP practice if required. If youve had outbreaks of cold sores before, its likely that youll know what they are if they return. You only need to visit your pharmacist if youre unsure whether its a cold sore or if its severe and spreading further than just the lip. See your pharmacistifa cold sore hasnt healed after 7 to 10 days. What causes cold sores? The strain of herpes simplex virus usually responsible for cold sores is known as HSV-1. In rare cases,cold sorescan also be caused by the herpes simplex virus type 2 (HSV-2). This canbe the result of having oral sex with someone who has genital herpes . Read more about the causes of cold sores . Herpes simplex virus The herpes simplex virusor cold sore virusis highly contagious and can be easily passed from person to person by close direct contact. After someone has contracted the virus, it remains inactive (dormant) most of the time. However, every so often the virus can be activated by certain triggers, resulting in an outbreak of cold sores. These triggers vary from person to person, but can include sunlight,fatigue, an injury to the affected area, and, in women, their period. Some people have frequently recurring cold sores around two or three times a year, while others have one cold sore and never have another. Some people never get cold sores at all because the virus never becomes active. Treating cold sores Cold sores usually clear up by themselves without treatment within 7 to 10 days. However, antiviral creams are available over the counter from pharmacies without a prescription. If used correctly, these can help ease your symptoms and speed up the healing time. To be effective, these treatmentsshould be applied as soon as the first signs of a cold sore appear when youfeela tingling, itching or burning sensation around your mouth. Using an antiviral cream after this initial period is unlikely to have much of an effect. Cold sore patches are also available that contain hydrocolloid gel, which is an effective treatment for skin wounds. The patch is placed over the cold sore while it heals. Antiviral tablets may be prescribed for severe cases. Read more about treating cold sores . Complications of cold sores Cold sores are usually mild, but may cause complications in rare cases. People with weak immune systems caused by illness or treatments such as chemotherapy are particularly at risk of complications. Dehydration sometimes occurs if drinking fluids becomes painful. Young children are particularly at risk of becoming dehydrated. The herpes simplex virus can also spread to other parts of your body. Examples of when this can occur include: skin infections these oftenoccur if the virus comes into contact with broken skin, such as a cut or graze , ora skin condition such as eczema herpetic whitlow (whitlow finger) thiscausespainful sores and blisters to appear on and around your fingers herpetic keratoconjunctivitis this causes swelling and irritation (inflammation) of your eye area and sores to develop on your eyelids Left untreated, herpetic keratoconjunctivitis can cause the cornea, the transparent layer at the front of your eye, to become infected, which can eventually lead to blindness. Its therefore important not to touch your eyes if you have an unhealed cold sore. If you must touch your eyes for example, to remove contact lenses wash your hands thoroughly first. In very rare cases,encephalitis, a condition where the brain becomes inflamed and swollen, can be caused by the cold sore virus spreading to the brain. It can be treated with intravenous injections of antiviral medications, such asaciclovir. Preventing infection Its not possible to prevent infection with the herpes simplex virus or prevent outbreaks of cold sores, but you can take steps to minimise the spread of infection. Cold sores are at their most contagious when they burst (rupture), but remain contagious until theyre completely healed. Avoid close contact with others until your cold sore has completely healed and disappeared. However, theres no need to stay away from work or miss schoolif you or your child have a cold sore. You can help minimise the risk of the cold sore virus spreading and cold sores recurring by following the advice below: avoid touching cold sores unless youre applying cold sore cream creams should be dabbed on gently rather than rubbed in,as this can damage your skin further always wash your hands before and after applying cold sore cream and after touching the affected area do not share cold sore creams or medication with other peopleas this can cause the infection to spread do not share items that come into contact with the affected area, such as lipsticks or cutlery avoid kissing and oral sex until your cold sores have completely healed be particularly careful around newborn babies, pregnant women and people with a low immune system, such as those with HIV or those having chemotherapy if you know what usually triggers your cold sores, try to avoid the triggers for example, a sun block lip balm (SPF 15 or higher) may help prevent cold sores triggered by bright sunlight Symptoms of cold sores You wont usually have any symptoms when you first become infected with the herpes simplex virus (the primary infection). An outbreak of cold sores may occur some time later and keep coming back (recurrent infection). However, if the primary infection does cause symptoms, they can be quite severe. Herpes simplex virus primary infection In children Symptoms of the primary infection are most likely to develop in children younger than 5 years old. Symptoms include: swollen and irritated gums with small, painful sores in and around the mouth this is known as herpes simplex gingivostomatitis sore throat and swollen glands producing more saliva than normal high temperature (fever) of 38C (100.4F) or above dehydration feeling sick (nausea) headaches Herpes simplex gingivostomatitis usually affects young children, but adults can alsodevelop it. It can last 7 to 14 days, with the sores taking up to 3 weeks to heal. However, gingivostomatitis doesnt usually recur after the primary infection. In adults Primary herpes simplex viruses are rare in adults, but the symptoms are similar to those experienced by children. Youll usually have a sore throat with or without swollen glands. You may also havebad breath (halitosis) and painful sores in and around your mouth. These can develop into ulcers with grey or yellow centres. If you develop the herpes simplex virus at an early age, it may be triggered periodically in later life and can cause recurring bouts of cold sores. After the primary infection, the symptoms are usually reduced to just the cold sores themselves. Recurrent infections (cold sores) Recurrent infections usually last for less time and areless severe than the primary infection. The only symptom is an outbreak of cold sores, although you may also have swollen glands. An outbreak of cold sores usually starts with a tingling, itching or burning sensation around your mouth. Small fluid-filled sores then develop, usually on the edges of your lower lip. If you have frequent recurrent infections, you may develop cold sores in the same place every time. They may grow in size and cause irritation and pain. Initially, they may ooze before crusting or scabbing over within 48 hours of the initial tingling sensation. If the cold sores are very troublesome, its possible to suppress them by taking an antiviral tablet called acyclovir regularly, every day for a few months. This is usually only recommended if cold sores are causing a lot of problems, and they may come back when treatment is stopped. Most cold sores disappear within 7 to 10 days without treatment and usually heal without scarring. Causes of cold sores Cold sores are usually caused by the herpes simplex virus type 1 (HSV-1). In most cases the virus is passed on in early childhoodfor example, when a child is kissed by a family member or friend with a cold sore. The virus passes through the skin and travels up the nerves, where it lies inactive (dormant) until its triggered at a later date. Cold sore triggers Factors thought to trigger outbreaks of cold sores include: having another infection, such as arespiratory tract infection having a high temperature (fever) emotional upset or psychological stress tiredness and fatigue an injury to the affected area menstruation (periods) strong sunlight However, in many cases theres no obvious trigger for an outbreak. Herpes simplex virus type 2 Occasionally, cold sores can be caused by the herpes simplex virus type 2 (HSV-2). This can happen after having oral sex with a man or woman who has genital herpes , which is usually caused by HSV-2. In genital herpes, painful blisters develop on your genitals and the surrounding area. Treating cold sores Cold sores usually clear up without treatment within 7 to 10 days. Antiviral tablets or cream can be used to ease your symptoms and speed up the healing time. If you develop a cold sore, some general advice to follow includes: drink plenty of fluids to avoid dehydration avoid acidic or salty foods and eat cool, soft foods if brushing your teeth is painful, use an antiseptic mouthwash dab creams on to sores rather than rubbingthem in wash your hands using soap and water before and after applying cold sore creams avoid touching your cold sores, other than to apply cream, and dont share your cold sore cream with others Antiviral creams and tablets Antiviralcreams such asaciclovir or penciclovir (also known as Fenistil  ) may speed up the healing time of a recurrent cold sore infectionif used correctly. Cold sorecreams are widely available over the counter from pharmacies without a prescription. Theyre only effective if you apply them as soon as the first signs of a cold sore appear, when the herpes simplex virus is spreading and replicating. Using an antiviralcream after this initial period is unlikely to have much effect. If you have frequently recurring bouts of cold sores,use antiviral medicationas soon as you feel the tingling sensation thatindicates a cold sore is about to develop. Youll need to apply the cream up to 5 times a day for 4 to 5 days. Antiviral creams can only help toheal a current outbreak of cold sores. They dont get rid of the herpes simplex virus or prevent future outbreaks of cold sores occurring. Antiviral tablets are generally more effective than creams at treating cold sores, but are usually only prescribed for more severe cases. Cold sore patches Cold sore patches that contain a special gel called hydrocolloid are also available. Theyre an effective treatment for skin wounds and are placed over the cold sore to hide the sore area while it heals. Non-antiviral treatments Several non-antiviral creams are also available over the counterfrom pharmacieswithout the need for a prescription. These creams arent specifically designed to treat cold sores and wont help them heal faster, but theymay help ease any pain orirritation. Ask your pharmacist to recommend a suitable treatment for you. Pain can also be treated with painkillers such as ibuprofen or paracetamol  both are available in liquid form for young children. However, dont take ibuprofen if you have asthma or stomach ulcers , or youve had them in the past. Children under the age of 16 shouldnt be given aspirin. Speak to your pharmacist if you have cold sores and youre pregnant. Treating complications If your cold sores are particularly severe or your immune system is damaged for example, if you have HIV or youre having chemotherapy treatment you may be at risk of developing serious complications. For example, your risk of developingencephalitisor the infection spreading to other parts of your body, such as your eyes, is increased. Speak to your GP if youre at risk. Theymay prescribe antiviral tablets and refer you for specialist treatment. The type of treatment recommended will depend on the severity of your cold sore symptoms and the complication thats causing problems. For example, if you develop herpetic keratoconjunctivitis a secondary eye infectionyou may need to see an ophthalmologist, a specialist eye doctor. Gingivostomatitis Visit your pharmacist if you or your child developsswollen, painful gums (gingivostomatitis) as a result ofthe primary herpes simplex infection. Theyll be able to suggest treatments to help ease your symptoms. If the infection is painful, your pharmacist may suggest using a preparation that contains benzydamine, which is available as anoral rinse or oral spray, to help relieve any pain in your mouth or throat. Brushing your teeth may also be painful because of the swelling of your gums. Your pharmacist may suggest using an antiseptic mouthwash. This helps prevent secondary infections and will also control a build-up of plaque if you cant brush your teeth effectively. As with the treatment of cold sores, any pain or fever can be treated using ibuprofen or paracetamol. In rare cases of gingivostomatitis, its possible for your lips to become stuck together in places. Using a lip barrier cream available from your local pharmacist will help prevent this. Dehydration If you or your child has gingivostomatitis, its important to drink plenty of fluids to avoid becoming dehydrated. Young children are particularly at riskas they may refuse to eat or drink because ofthe pain in their mouth. Its important to watch out for signs of dehydration , such as: headaches tiredness irritability lightheadedness low urine output Most cases of gingivostomatitis get better in 7 to 14 days, although it may take up to 3 weeks for the sores to heal completely. Specialist treatment If you or your child still has symptoms of gingivostomatitis after 2 weeks or the infection is severe your pharmacist may advise you to contact your GP, who may refer you for specialist treatment. Specialist referral may also be needed for gingivostomatitis if youre pregnant or have a weakened immune system. Visit your GP if you have a newborn baby who develops gingivostomatitis, as they may also need to be referred for specialist treatment. Source: NHS 24 - Opens in new browser window Last updated: 05 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Search for a pharmacy near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Coma,"Coma - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Coma Coma A coma is a state of unconsciousness where a person is unresponsive and cannot be woken. It can result from injury to the brain, such as a severe head injury or stroke . A coma can also be caused by severe alcohol poisoningor a brain infection (encephalitis). People with diabetes could fall into a coma if their blood glucose levels suddenly became very low (hypoglycaemia) or very high (hyperglycaemia) . What is a coma? Someone who is in a coma is unconscious and has minimal brain activity. Theyre alive, butcant be woken up and show no signs of being aware. The persons eyes will be closed andtheyllappear to be unresponsive to their environment. They wontnormally respond to sound or pain, or be able to communicate or move voluntarily. Someone in a coma will also have very reduced basic reflexes such as coughing and swallowing. They may be able to breathe on their own, although some people require a machine to help them breathe. Over time, the person may start to gradually regain consciousness and become more aware. Some people will wake up after a few weeks, while others may go into a vegetative state or minimally conscious state. Caring for and monitoring a person in a coma Doctors assess a persons level of consciousness using a tool called the Glasgow Coma Scale . This level is monitored constantly for signs of improvement or deterioration. The Glasgow Coma Scale assesses three things: eye opening  a score of one means no eye opening, andfour means opens eyes spontaneously verbal response to a command  a score of onemeans no response, andfive means alert and talking voluntary movements in response to a command  a score of one means no response, and six means obeys commands Most people in a coma will have a total score ofeight or less.A lower score means someone may have experienced more severe brain damage and could be less likely to recover. In the short term, a person in a coma will normally be looked afterin an intensive care unit (ICU). Treatment involves ensuring their condition is stable and their body functions, such as breathing and blood pressure, are supported while the underlying cause is treated. In the longer term, healthcare staff will give supportive treatment on a hospital ward. This can involve providing nutrition, trying to prevent infections, moving the person regularly so they dont develop bedsores, and gently exercising their joints tostop thembecoming tight. What you can do as a visitor The experience of being in a coma differs from person to person. Some people feel they can remember events that happened around them while theywere in a coma, while others dont. Some people have reported feeling enormous reassurance from the presence of a loved one when coming out of a coma. When visiting a friend or loved one in a coma, you may find the advice below helpful: when you arrive, announce who you are talk to them about your day as you normally wouldbe aware that everything you say in front of them might be heard show them your love and support even just sitting and holding their hand or stroking their skin can bea great comfort Research has also suggested thatstimulating the main senses  touch, hearing, vision and smell could potentially helpa personrecover from a coma. As well as talking to the person and holding their hand, you might want to try playing them their favourite music through headphones, putting flowers in their room or spraying a favourite perfume. Recovering from a coma A coma usually only lasts a few weeks, during which time the person may start to gradually wake up and gain consciousness, or progress into a different state of unconsciousness called a vegetative state or minimally conscious state. a vegetative state  where a person is awake but shows no signs of being aware of their surroundings or themselves a minimally conscious state  where a person has limited awareness that comes and goes Some people may recover from these states gradually, while others may not improve for years, if at all. People who do wake up froma coma usually come round gradually. They may be very agitated and confused to begin with. Some people will make a full recovery and be completely unaffected by the coma. Otherswill have disabilities caused by the damage to their brain. They may needphysiotherapy, occupational therapy and psychological assessment and support during a period of rehabilitation, and may need care for the rest of their lives. Thechances of someone recovering from a coma largely depend on the severity andcause of their brain injury, their age and how long theyve been ina coma. But its impossible to accurately predict whether the personwill eventually recover,how long the coma will last and whether theyll have any long-term problems. Further information and support For further information and support from healthcare professionals and the families of people in a coma, you may find the followingwebsites helpful: Brain and Spine Foundation Headway : the brain injury association ICUsteps : the intensive care patient support charity Source: NHS 24 - Opens in new browser window Last updated: 06 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Severe head injury Other health sites Brain and Spine Foundation: Moderate to severe head injuries Headway: coma ICUsteps: patients and relatives NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Common cold,"Common cold | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Common cold Common cold A cold is a very common mild viral infection. You can often treat a cold without seeing a GP. You should begin to feel better in about 1 to 2 weeks. There is a separate page on if your child has cold or flu symptoms . Symptoms of a cold The main symptoms of a cold include: a sore throat a blocked or runny nose sneezing a cough a hoarse voice generally feeling unwell Less common symptoms of a cold include: high temperature (fever)  this is usually about 37C to 39C (98.6F to 102.2F) a headache earache  severe earache may be a sign of a middle ear infection muscle aches loss of taste and smell mild irritation of your eyes a feeling of pressure in your ears and face When to get medical advice Speak to your GP practice if: your symptoms do not improve after 3 weeks your symptoms get suddenly worse your temperature is very high or you feel hot and shivery youre concerned about your childs symptoms youre feeling short of breath or develop chest pain you have a long-term medical condition  for example, diabetes, or a heart, lung or kidney condition you have a weakened immune system  for example, because youre having chemotherapy If your GP is closed, phone 111. Speak to a pharmacist if you have a cold and would like advice and treatment. Find your local pharmacy Treatment for a cold Theres no cure for a cold, but there are things you can do to look after yourself at home. You should begin to feel better in about 1 to 2 weeks. Things you can do to help your symptoms Do rest drink plenty of fluids eat healthily take over-the-counter pain relief, such as paracetamol or ibuprofen , to relieve high temperature and aches use decongestant sprays or tablets to relieve a blocked nose try remedies such as gargling salt water and sucking on menthol sweets Always read the leaflet that comes with your medicine before taking it. Follow the recommended dosage instructions. If youre not sure which treatments are suitable for you or your child, speak to a pharmacist for advice. Be careful not to use cough and cold medicines if youre taking paracetamol and ibuprofen tablets. Cough and cold medicines often also contain paracetamol and ibuprofen so it can be easy to take more than the recommended dose. How do colds spread? A person can start spreading a cold from a few days before their symptoms start until their symptoms have gone. You can catch the virus from an infectious person by: touching an object or surface contaminated by infected droplets and then touching your mouth, nose or eyes touching the skin of someone who has the infected droplets on their skin and then touching your mouth, nose or eyes breathing in tiny droplets of fluid that contain the cold virus  these are launched into the air when an infected person coughs or sneezes Different viruses can cause a cold. Its possible to have different colds one after the other, as each one may be caused by a different virus. How to prevent a cold from spreading Do wash your hands often, especially before touching your nose or mouth and before handling food always sneeze and cough into tissues throw away used tissues straight away and wash your hands clean surfaces regularly use your own cup, plates, cutlery and kitchen utensils do not share towels or toys with someone who has a cold Is it a cold or flu? It can sometimes be difficult to tell if you have a cold or flu, as the symptoms can be similar. The main differences are that flu symptoms: come on quickly usually include a headache, high temperature (fever) and sore muscles make you feel too unwell to continue your usual activities Cold symptoms: come on slowly mainly affect your nose and throat are fairly mild, so you can still get around and are usually well enough to go to work Whats the difference between a cold and flu? Complications of a common cold Colds usually clear up without causing any further problems. But the infection can sometimes spread to your chest , ears or sinuses . Source: NHS 24 - Opens in new browser window Last updated: 01 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform If your child has cold or flu symptoms Search for a pharmacy near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Common heart conditions,"Common heart conditions - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Heart and blood vessels Conditions Common heart conditions Common heart conditions There are many different heart conditions and problems which are collectively called heart disease. Its always best to discuss your heart condition with your health professional or heart specialist who can advise you on the correct diagnosis and name of your condition and treatment plan. Heart disease and different conditions affect the hearts ability to work efficiently. It can be worrying and confusing to be diagnosed with a heart condition, but theres a lot of information and support available to you. Sometimes understanding what is happening can help you worry less. Coronary heart disease The most common heart condition in Scotland is coronary heart disease. This is caused when the hearts blood vessels  the coronary arteries  become narrowed or blocked and cant supply enough blood to the heart. It can lead to angina and/or a heart attack. Read more aboutcoronary heart disease Angina Angina is a pain or discomfort in your chest, arm, neck, stomach or jaw that happens when the blood supply to your heart becomes restricted because of your arteries becoming narrowed. This clogging is called atheroma. Angina is a symptom of coronary heart disease, not an illness in itself. Angina is your hearts way of telling you its not getting enough oxygen when youre doing something strenuous or youre feeling under stress. Many people learn to recognise how much activity will bring on an angina attack  this is called stable angina. If you have unexplained chest pain, seek urgent medical advice  you will need an assessment of your overall health. Unstable angina Unstable angina can be undiagnosed chest pain or a sudden worsening of existing angina. It happens when the blood supply to the heart is severely restricted and angina attacks occur more frequently, with less and less activity. These attacks may even happen at rest or wake you from sleep. They can last up to 10 minutes. You should see your doctor urgently, and you may be admitted to hospital. Until tests confirm the diagnosis, this is sometimes called Acute Coronary Syndrome (ACS). Read m ore about angina Heart attack A heart attack  also known as myocardial infarction or MI  happens when the blood supply to part of your heart muscle becomes completely blocked. This is most commonly caused by a piece of fatty materialbreaking off and ablood clot forms within a coronary artery. This can cause damage to the part of your heart muscle which that particular coronary artery was supplying. Read more about the symptoms of a heart attack Heart failure If the hearts pumping action cant work effectively, your heart muscle cant meet your bodys demand for blood and oxygen, and your body develops various different symptoms, like fatigue and shortness of breath. This is called heart failure because of the failure of your heart to work efficiently. Read more about heart failure Arrhythmia (abnormal heart rhythms) The heart muscle has its own electrical system which helps to stimulate the heartbeat. If the electrical signals within your heart are interrupted or disturbed, your heart can beat too quickly (tachycardia), too slowly (bradycardia) and/or in an irregular way. This is called an arrhythmia. Read about arrhythmia on theChest Heart & Stroke Scotland website Valve disease The valves open and close to regulate the flow of blood through the heart. Problems with the valves can increase the workload of your heart and can put a strain on your heart muscle, leading to a range of symptoms, like: shortness of breath swollen ankles fatigue chest pain (angina or palpitations) dizziness or fainting Read about heart valve problems on theChest Heart & Stroke Scotland website High blood pressure Another condition which can affect the heart is high blood pressure or hypertension. Although its not a disease in itself, hypertension can lead to an increased risk of developing serious conditions such as coronary heart disease, heart attacks and strokes. Read moreabout high blood pressure and reducing the risks to your heart Congenital heart conditions Congenital heart conditions occur when theres an abnormality or defect with the structure of the heart of a developing foetus while inside the mothers womb. A baby may be born with only one defect or with several defects. Some types of congenital heart defects are life-threatening, either immediately to the newborn or over time. Read more about congenital heart disease Inherited heart conditions Inherited conditions can be passed on through families. They are sometimes called familial or genetic heart conditions. They can affect people of any age and can be life-threatening. The first sign theres a problem is often when someone dies suddenly with no obvious cause. These conditions are different from most congenital heart conditions, although some congenital conditions can also be inherited. Read more about inherited heart conditions Source: Chest Heart & Stroke Scotland - Opens in new browser window Last updated: 09 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Adjusting to life with a heart condition Congenital heart disease Angina NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Congenital heart disease,"Congenital heart conditions - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Heart and blood vessels Conditions Congenital heart disease Congenital heart disease About congenital heart disease Symptoms of congenital heart disease Causes of congenital heart disease Diagnosing congenital heart disease Treating congenital heart disease Complications of congenital heart disease About congenital heart disease Congenital heart disease is a general term used to refer to a series of birth defects that affect the heart. Types of congenital heart disease There are over 30 different types of heart defect. The two main types of congenital heart disease are: cyanotic heart disease acyanotic heart disease Cyanotic heart disease Cyanotic heart is where problems with the heart mean there isnt enough oxygen present in the blood. Babies born with cyanotic heart disease generally have a blue-coloured tinge to areas such as their fingers, toes and lips because of a lack of oxygen. They may also experience symptoms of: breathlessness chest pain palpitations fainting fatigue Acyanotic heart disease Acyanotic heart disease is where the blood contains enough oxygen but its pumped abnormally around the body. Babies born with acyanotic heart disease may not have any apparent symptoms but, over time, the condition can cause health problems. In this group of conditions there can be a significant increase in blood pressure, putting the heart under more strain as it works much harder. This can weaken the heart, and increases the risk of developing heart failure, where the muscle is unable to efficiently pump blood around the body. In addition, the blood pressure in the lungs is often too high. This is known as pulmonary hypertension and can damage the lungs and cause symptoms such as: breathlessness fatigue dizziness fainting How common is congenital heart disease? Congenital heart disease is the most common type of birth defect, with 1 in 180 babies being born with the condition. Some babies born with congenital heart disease will require immediate surgery after birth, while many others will probably require surgery or medication at some point during their childhood. Congenital heart disease can sometimes develop alongside certain genetic conditions, such as Downs syndrome . An infection during pregnancy, such asrubella, can also cause congenital heart disease. However, many cases of congenital heart disease have no clear cause. Outlook for congenital heart disease The outlook for congenital heart disease varies depending on the type and severity of the heart defect. Research into the causes and improved treatments have meant that, 80% of children with congenital heart disease will survive into adulthood. This poses new challenges for healthcare services because some of these adults have complex health needs and require life-long specialised care. In response to this, the Department of Health has recommended the creation of specialised centres to care for adults with congenital heart disease. Congenital heart disease in adults is sometimes known as grown-up congenital heart disease (GUCH) or Adult Congenital Heart Disease (ACHD). Congenital and rare condition register Babies with congenital heart disease are included in the secure congenital and rare condition (CARDRISS) register. The register is maintained by Public Health Scotland. The register records how many babies have this condition, and some relevant personal information. Its also used to support the planning and improvement of health, care, and other public services. Further information about CARDRISS Symptoms of congenital heart disease As stated in the introduction, the two main types of congenital heart disease are: cyanotic heart disease acyanotic heart disease Symptoms of cyanotic heart disease The symptoms of cyanotic heart disease include: a blue coloured tinge to the lips, fingers and toes (cyanosis) palpitations fainting fatigue chest pains breathing problems Children with cyanotic heart disease have lower levels of oxygen in their blood, this is known as hypoxia. Sometimes, their oxygen levels can fall further and cause additional symptoms such as anxiety and confusion or disorientation. Symptoms of acyanotic heart disease The symptoms of acyanotic heart disease include: severe tiredness palpitations chest pain shortness of breath (particularly during activities such as climbing the stairs) Common symptoms of congenital heart disease There are some symptoms that are present in both cyanotic and acyanotic heart disease. These include: poor appetite and feeding difficulties sweating, particularly when a baby is feeding delayed growth Children with acyanotic heart disease are usually underweight, and children with cyanotic heart disease are usually underweight and small for their age. Causes of congenital heart disease To understand how congenital heart disease can affect your childs heart and general health, its useful to first understand how a healthy heart works. Find out how your heart works, on the British Heart Foundation website . Congenital heart disease develops when abnormalities in the hearts structure prevent it from working as it should. As outlined in the introduction , the two main types of congenital heart disease are: cyanotic heart disease acyanotic heart disease Find common causes of each below. Common types of acyanotic heart disease Ventricular septal defect (VSD) Ventricular septal defect (VSD) is a very common cause of acyanotic heart disease. In cases of VSD, there is a hole between the left and right ventricle. As blood pressure is higher on the left-hand side of the heart, blood is pushed through the hole and into the right ventricle. The heart then has to work harder to pump the excess blood out of the right ventricle, which can put a strain on the heart. The excess level and pressure of the blood can also increase the blood pressure in the lungs and damage them (pulmonary hypertension). Atrial septal defect (ASD) Atrial septal defect (ASD) is a similar type of defect to VSD, but the hole is between the left and right atria rather than the ventricles. ASD can place extra strain on the heart, and potentially damage the lungs. When referring to a hole in the heart, healthcare professionals are usually referring to either VSD or ASD. Find out more about ASD on the British Heart Foundation website . Pulmonary stenosis In pulmonary stenosis, the pulmonary valve in the right side of the heart is unusually narrow meaning that the heart has to work harder to pump blood into the lungs, which can put a strain on the heart. Find out more about pulmonary stenosis on the British Heart Foundation website . Aortic stenosis In aortic stenosis, the aortic valve in the left side of the heart is unusually narrow, which means that the heart has to work harder to pump blood through the valve. Because the aortic valve is the main route for oxygen-rich blood to supply the body, the narrowing can lower the bodys oxygen supply, which can cause symptoms of breathlessness and dizziness. Find out more about aortic stenosis on the British Heart Foundation website . Patent ductus ateriosus (PDA) Patent ductus ateriosus (PDA) is a duct or passage in the heart that is meant to close shortly after birth. When an unborn baby is in the womb, there is no need for the babys heart to send blood to the lungs because the baby is getting all the oxygen it needs from the mother through the placenta. Therefore, the ductus ateriosus acts as a bypass, meaning that the blood can flow back into the heart without entering the lungs. Shortly after birth, the duct should close as the baby begins to breathe normally. However, in cases of PDA, the duct fails to completely close, which means that some oxygen-rich blood that is meant to be pumped away from the lungs leaks back through the duct and back into the lungs. This can place strain on the heart and the lungs because they have to work harder to compensate for the problems caused by the duct. Common types of cyanotic heart disease Tetralogy of Fallot (TOF) Tetralogy of Fallot (TOF) is the most common cause of cyanotic heart disease. TOF is not one heart defect but a combination of four different heart defects. Tetralogy is a Greek word that means four-fold, and Fallot is the name of the doctor who first identified the condition. In cases of TOF, there are four defects that affect the heart: A hole between the left and right ventricle (Ventricular Septal Defect). A narrowing of the pulmonary valve (pulmonary stenosis). The muscles of the right ventricle are unusually thick (right ventricular hypertrophy). The aorta sits over both the left and right ventricles, instead of just the left ventricle in a normal heart (overriding aorta). As a result of this complex set of heart defects, oxygen-rich blood and oxygen-low blood become mixed. This leads to blood with lower-than-normal oxygen content being pumped around the body. As the bodys cells and tissue are not receiving enough oxygen, the child will develop symptoms of cyanotic heart disease. Find out more about TOF on the British Heart Foundation website . Transposition of the great arteries (TGA) Transposition of the great arteries (TGA) is a major cause of cyanotic heart disease. In cases of TGA, the pulmonary artery is attached to the left side of the heart, and the aorta is attached to the right side of the heart. This leads to oxygen-low blood, which should be pumped into the lungs, being pumped around the body, causing symptoms of cyanotic heart disease. Find out more about TGA on the British Heart Foundation website . Risk factors for congenital heart disease In many cases of congenital heart disease, there is no clear reason why a baby is born with a defective heart. The known risk factors for congenital heart disease are listed below. Maternal diabetes Women with diabetes are five times more likely to give birth to a baby with congenital heart disease compared with women who do not have diabetes. It is estimated that out of every 100 pregnancies in women with diabetes, three to four will result in the birth of a baby with a heart defect. The increased risk is thought to be due to the high levels of insulin in the blood, which may interfere with the development of the foetus. Rubella The viral infection rubella (also known as German measles) is a major risk factor for congenital heart disease if a woman contracts an infection during early pregnancy. If a woman contracts the viral infection rubella (also known as German measles) during the first 12 weeks of pregnancy, there is an 80% chance that her baby will be born with a birth defect, such as congenital heart disease. Maternal alcohol abuse Mothers who exceed the recommended daily alcohol intake during pregnancy have an increased risk of their baby being born with congenital heart disease. Alcohol is best avoided during pregnancy; however no more than 2-3 units should be consumed on a daily basis for any adult. Genetic conditions There are a number of genetic conditions (health conditions that a baby inherits from one or both parents) that can cause congenital heart disease. Downs syndrome is the most widely known genetic condition that can cause congenital heart disease. Downs syndrome is a condition where children are born with a range of disabilities as the result of a genetic abnormality. Approximately half of children with Downs syndrome will have congenital heart disease. Other genetic conditions linked to congenital heart disease include: Turner syndrome Noonan syndrome Diagnosing congenital heart disease An increasing number of cases of congenital heart disease are now diagnosed by carrying out a foetal echocardiograph before a baby is born. A foetal echocardiograph is made possible by using a type of ultrasound scanner that has been specially designed to build a picture of the unborn babys heart. It should be carried out during routine antenatal examinations, usually sometime between the 18th and 20th week of pregnancy. It is not always possible to detect heart defects (particularly mild ones) using a foetal echocardiography. Postnatal diagnosis If a baby is born with cyanotic heart disease, a diagnosis can usually be made quickly and confidently due to the distinctive blue colour of their skin. If your baby is born with acyanotic heart disease, their symptoms may not become immediately apparent for several months, or possibly years, after birth. Possible signs that your child may have a cyanotic heart disease include: problems feeding slow growth shortness of breath after exercising tiredness after exercising swelling of their hands, feet and ankles You should contact your GP if your child has any of the above symptoms. Further testing can confirm or disprove a diagnosis of congenital heart disease. Further testing Echocardiogram An echocardiogram may be used to check your childs heart. Sometimes, underlying problems with the heart, which were missed during a foetal echocardiogram, can be detected as a child grows up. Find out more about an echocardiogram on the British Heart Foundation website . Electrocardiogram (ECG) An electrocardiogram (ECG) is a test that measures the electrical activity of the childs heart. Electrodes are placed on the skin across the chest, arms and legs, and then connected to an ECG machine. The machine analyses the electrical signals produced by the heart in order to assess the heart rhythm. Find out more about an ECG on the British Heart Foundation website . Chest X-ray A chest X-ray of the heart and lungs can check whether there are any abnormalities in the lungs, or whether the heart is larger than normal. Both of these can be signs of congenital heart disease. Find out more about a chest x-ray on the British Heart Foundation website. Pulse oximetry Pulse oximetry is a test that measures how much oxygen is present in the blood. The test involves placing a special sensor on your childs fingertip, ear or toe. The sensor sends out light waves. A computer that is connected to the sensor measures how the light waves are being absorbed, and gives a percentage reading. A healthy person should have a reading of 94% or above. It is common for those with cyanotic heart defects to have readings below this value. Cardiac catheterisation Cardiac catheterisation is a useful way of finding out more information about exactly how the blood is pumping through the childs heart. During a cardiac catheterisation, a small flexible tube, known as a catheter, will be inserted into one of the childs blood vessels, usually in the groin or arm. The tube is moved up into the heart, using X-rays to help guide it. A contrast dye that shows up on X-rays can be injected into the tube. The dye can then be studied as it moves through the heart, enabling medical staff to see how well each chamber of the heart is working. Blood pressure readings in different parts of the heart can also be taken; this will help with diagnosis and treatment planning. Cardiac catheterisation is usually performed under a local anaesthetic and is a relatively painless procedure. Treating congenital heart disease There are a number of different surgical techniques that can be used to treat congenital heart disease. Some of these are explained below. Catheters A catheter, similar to the tube that is used during diagnosis, is inserted into the heart and tools are passed down the catheter to repair the heart defects. The advantage of this type of surgery is that its minimally invasive, which means that your child will not have to have open heart surgery. Open heart surgery For more serious types of heart defects, it may be necessary to operate directly on the heart. During open heart surgery, the heart may be stopped and a machine used to pump blood around your childs body (bypass machine). An incision is made in your childs chest so that the heart defects can be surgically repaired, or damaged parts of the heart, such as the valves, can be replaced. Heart transplant In more serious cases of congenital heart disease, the heart may be too damaged, and the child too ill, for corrective surgery to be safely carried out. In this circumstance, their heart may have to be replaced with a donated heart. If your child requires a heart transplant, their details will be placed on the National Transplant Database (NTD). Depending on the condition of your childs heart, it may be necessary to keep them in hospital in order to support the function of their heart until a donated heart becomes available. Machines, such as the ventricle assist device (VAD), act like an external mechanical heart, and can assist in pumping blood around the body. Priority for heart transplants is based on clinical need, rather than on a first-come-first-served basis. If your child is in a very unstable condition, they will be prioritised whereas more stable children will have to wait for a longer period of time. Once a donated heart of the right size and blood group becomes available, you will be contacted by the transplant team and asked to go to the transplant unit as soon as possible. You may be given a bleeper so that you can be contacted as soon as possible. Find out more about heart transplantation on the British Heart Foundation website. Treatment for common types of congenital heart disease Specific treatments for the most common types of congenital heart disease are described below. Septal defects If your child is diagnosed with a ventricular septal defect (VSD) or an atrial septal defect (ASD), the recommended treatment will depend on the size of the defect. If the defect is small, a policy of watchful waiting may be recommended, where your child receives no immediate treatment but their health is carefully monitored. This is because 90% of small defects will close as the child grows older. In cases of mild to medium-sized defects, it may be possible to seal the defect using a catheter. The catheter is guided to the site of the hole, and a specially designed mesh is passed through the catheter to seal the defect. In cases of medium to large-sized defects, open-heart surgery may be required. This involves a patch being stitched directly over the defect. Stenosis If your child is diagnosed with a stenosis (a narrowing one of their valves) the treatment that is recommended will depend on the extent of the stenosis and if they are symptomatic. In mild cases, a policy of watchful waiting may be recommended. Medication that lowers blood pressure may also be recommended to reduce the strain on your childs heart and lungs. In more serious cases of stenosis, a catheter can be used to widen the valve. A small balloon is passed up through the catheter and then inflated to widen the affected valve. This is known as a balloon angioplasty. Once the valve has been widened, the balloon is removed. Sometimes, a metal coil (stent) is used to keep the valve widened. In more serious cases of stenosis, its sometimes necessary to replace the valve using open heart surgery. Replacement valves can be obtained from human donors, or made from artificial materials, such as titanium, or taken from pigs and modified for human use. Pigs are used because their hearts are the most similar to the human heart. For people who are too ill or weak to withstand the effects of open heart surgery, a catheter approach can be used. The catheter is passed through a blood vessel in the groin and up into the heart. A replacement valve is passed through the catheter and into position. Patent ductus ateriosus (PDA) Many cases of patent ductus ateriosus (PDA) can be treated shortly after birth, using medication. Two types of medication  indomethacin and a special type of ibuprofen  have been shown to effectively stimulate the closure of the duct that is responsible for PDA. If a PDA does not respond to medication, a catheter can be used to seal the duct with a metal coil or plug. Tetralogy of Fallot (TOF) Babies born with Tetralogy of Fallot (TOF) who are experiencing severe symptoms of breathlessness may require emergency surgery such as a Blalock-Taussig shunt (a BT shunt). During a BT shunt, an artery is diverted (or shunted) into the lungs so that a supply of oxygen-rich blood becomes available. Further open-heart surgery is then recommended when the baby is old enough to withstand the after-effects of surgery. During open-heart surgery, the defect between the ventricles is sealed and the pulmonary valve is widened. Transposition of the great arteries (TGA) Transposition of the great arteries (TGA) will require open-heart surgery, which is usually done shortly after your baby is born. A surgical technique, known as an arterial switch, is usually used to treat cases of TGA. During an arterial switch, the affected arteries are cut and reattached to their correct position on the other side of the heart. Congenital heart disease in adulthood About 80% of children with congenital heart disease will survive into adulthood. Living as an adult with congenital heart disease involves a new set of challenges. Some adults will require specialised care. Routine medical procedures, such as giving birth or having a general anaesthetic, will need to be closely supervised by specialist staff with experience in treating adults with congenital heart disease. There is also the risk that previous heart surgery, such as the insertion of a replacement valve, will fail and that further surgery will be required. Due to these factors, its recommended that older teenagers register with a specialised adult congenital heart disease clinic. The clinic will be able to provide regular check-ups and assessments, liaise with other specialised medical services as required, and provide on-going support and advice. Your GP or treatment team can give you more information about services in your area for adults with congenital heart disease. Complications of congenital heart disease Many children with congenital heart disease will experience delays in their development, and may take longer to reach certain stages in their development, such as walking or talking. Some children with congenital heart disease also have associated learning difficulties and require specialised educational and psychological assistance. If your child has congenital heart disease, your local educational authority should draw up an individual education plan (IEP). The IEP makes an assessment of your childs current and future needs, and provides access to any specialised services that your child needs, such as speech and language therapy or an educational psychologist. The IEP will take into account what level of physical activity is safe for your child. Children with congenital heart disease should be encouraged to be as active as possible, but certain activities, such as contact sports, may have to be avoided. Endocarditis Both children and adults with congenital heart disease have an increased risk of developing endocarditis. Endocarditis is an infection of the lining of the heart and, left untreated, it can be life-threatening because it damages the valves of the heart. Symptoms of endocarditis include: fever chills sweating (including night sweats) muscular aches and pains chest pain coughs weakness and fatigue headache shortness of breath Endocarditis will need to be with injections of antibiotics (intravenous antibiotics). This will involve a hospital stay for several weeks. Endocarditis usually develops when an infection in another part of the body, such as on the skin or the gums spreads through the blood into the heart. Due to the risk of gum disease leading to endocarditis, it is very important that you have excellent oral hygiene if you have congenital heart disease. It is also usually recommended that you avoid having any cosmetic procedure that involves the piercing of the skin, such tattoos or body piercings. Source: Chest Heart & Stroke Scotland - Opens in new browser window Last updated: 22 February 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites British Heart Foundation: Congenital heart disease NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Conjunctivitis,"Conjunctivitis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Eyes Conjunctivitis Conjunctivitis Return to Symptoms Enter age Last Updated: Next Review Date: Review my answers Find your local services Search for a service near you by entering your postcode below. Please input your postcode in the following format: A12 1BC GP Practices Dental Services Pharmacies Opticians Postcode Search NHS inform has more information on this condition. Read more Previous Start guide Review my answers  You told us your credentials were: : You said: Based on the information you gave us, we made the following recommendation: Close Keep a copy View PDF Conjunctivitis (or red eye) is a common eye condition. It usually gets better in a few weeks without treatment. Symptoms of conjunctivitis Conjunctivitis usually causes symptoms in both eyes like: inflammation redness itching a burning or gritty feeling watering pus that sticks to the eyelashes Causes of conjunctivitis Conjunctivitis happens when the conjunctiva becomes inflamed. This is a thin layer of cells covering the front of your eyes. The 3 most common causes of this inflammation are: infection (infective conjunctivitis) an allergic reaction (allergic conjunctivitis) something irritating the conjunctiva, like a loose eyelash (irritant conjunctivitis) Treating and preventing conjunctivitis Do boil water and let it cool down before you gently wipe your eyelashes to clean off crusts with a clean cotton wool pad (1 piece for each eye) hold a cold towel over your eyes for a few minutes wash your hands regularly  this is particularly important after touching your eyes use lubricant eye drops  these are available at pharmacies or they may be prescribed for you Dont do not rub your eyes do not wear contact lenses until the symptoms have cleared up dont re-use old lenses after the infection has gone  they could cause re-infection do not not share pillows or towels You dont need to take time off school or work if you have conjunctivitis unless youre feeling very unwell. Get advice from a pharmacist Speak to a pharmacist for advice about conjunctivitis. They can suggest eyedrops or antihistamines to help with your symptoms. Find your nearest pharmacy Phone an optometrist urgently if you have: pain in your eyes sensitivity to light changes in your vision, like wavy lines or flashing very red eyes (1 eye or both eyes) a baby less than 28 days old with red eyes These can be signs of a more serious eye problem. If your optometrist is closed phone 111. Speak to an optometrist if: your baby has red eyes  get an urgent appointment if your baby is less than 28 days old you wear contact lenses and have conjunctivitis symptoms as well as spots on your eyelids  you might be allergic to the lenses you have symptoms that havent cleared up after 2 weeks Treatments for conjunctivitis Treatment for conjunctivitis will depend on whats causing it. You may be prescribed antibiotics to treat a bacterial infection. But these wont work if the symptoms are caused by a virus or an allergy. Allergic conjunctivitis can usually be treated with antihistamines. If possible, you should also try to avoid the substance that triggered the allergy. Irritant conjunctivitis will ease when whatever is causing the symptoms is removed. Some sexually transmitted infections (STIs) can cause conjunctivitis. This type takes longer to get better. Eye problems self-help guide Complete our self-help guide to check your symptoms and find out what to do next. Source: Scottish Government - Opens in new browser window Last updated: 27 February 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Self-help guide: Eye problems Other health sites Look after your eyes: conjunctivitis NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Constipation,"Constipation | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Constipation Constipation About constipation Symptoms of constipation Causes of constipation Diagnosing constipation Treating constipation Complications of constipation Preventing constipation About constipation Constipation is a common condition that affects people of all ages. It can mean that youre not passing stools regularly or youre unable to completely empty your bowel. Constipation can also cause your stools to be hard and lumpy, as well asunusually large or small. The severity of constipation varies from person to person. Many people only experience constipation for a short time, but for others, constipation can be a long-term (chronic) condition that causes significant pain and discomfort and affects quality of life. Read more about the symptoms of constipation . What causes constipation? Its often difficult to identify the exact cause of constipation.However, there are a number of things thatcontribute to the condition, including: not eating enough fibre, such as fruit, vegetables and cereals a change in your routine or lifestyle, such as a change in your eating habits ignoring the urge to pass stools side effects of certain medications not drinking enough fluids anxiety or depression In children, poor diet, fear about using the toilet and problems toilet trainingcan allleadto constipation. Read more about the causes of constipation . Whos affected Constipation can occur in babies, children and adults. Its estimated that around 1in every 7adults and up to 1in every 3children in the UK has constipation at any one time. The condition affects twice as many women as men and is also more common in older adults and during pregnancy. When to get professional advice Pharmacy First Scotland: Constipation treatment from your pharmacy If you have constipation you can get advice and treatment directly from a pharmacy. Find your local pharmacy on Scotlands Service Directory. Search for a pharmacy near you Constipation isnt usually serious and can be treated by a pharmacist. Your pharmacist may recommend that you contact your GP practice if required. Also speak to your pharmacist if you think your child might be constipated. Laxatives are often recommended for children alongside diet and lifestyle changes. You may be able to treat constipation yourself by making simple changes to your diet and lifestyle (see below). If these changes dont help and the problem continues, you should see your pharmacist. However, you should see your GP for advice if: you notice any rectal bleeding you notice any unexplained weight loss you have persistent tiredness yourconstipation lasts longer than 14 days without improvement Treating constipation Diet and lifestyle changes are usually recommended as the first treatment for constipation. This includes gradually increasing your daily intake of fibre, making sure you drink plenty of fluids, and trying to get more exercise. If these arent effective, yourpharmacist may recommend an orallaxative medicationthat canhelp you empty your bowels. Treatment for constipation is effective, although in some cases it can take several months before a regular bowel pattern is re-established. Read more about treating constipation . Preventing constipation Making the diet and lifestyle changes mentioned above can alsohelp to reduce your risk of developing constipation in the first place. Giving yourself enough time and privacy to pass stools comfortably may also help, and you should try not toignore the urge to go to the toilet. Read more about preventing constipation . Complications For most people constipation rarely causes complications, but people withlong-term constipation can develop: haemorrhoids (piles) faecal impaction (where dry, hard stools collect in the rectum) bowel incontinence (the leakage of liquid stools) Read more about the complications of constipation . Symptoms of constipation When youre constipated, passing stools becomes more difficult and less frequent than usual. Normal bowel habits vary from person to person. Some adults go to the toilet more than once a day, whereas others may only go every 3or 4days. Similarly, some infants pass stools several times a day, while others only pass them a few times a week. If you or your child pass stools less than usual, it could be a sign of constipation. It may also be more difficult to pass stools and you may feel unable to empty your bowelcompletely. Your stools may appear dry, hard and lumpy, as well as abnormally large or small. Other symptoms of constipation can include: stomach ache and cramps feeling bloated feelingsick loss of appetite Constipation in children As well as infrequent or irregular bowel movements, a child with constipation may also have any of the following symptoms: loss of appetite a lack of energy being irritable, angry or unhappy foul-smelling wind and stools stomachpain and discomfort soiling their clothes generally feeling unwell Causes of constipation Constipation usually occurs when stools remain in the colon (large intestine) for too long, and the colon absorbs too much water from the stools, causing them to become hard and dry. Most cases of constipation arent caused by a specific condition and it may be difficult to identify the exact cause. However, several factors can increase your chances of having constipation, including: not eating enough fibre, such as fruit, vegetables and cereals a change in your routine or lifestyle, such as a change in your eating habits having limited privacy when using the toilet ignoring the urge to pass stools immobility or lack of exercise not drinking enough fluids having a high temperature (fever) being underweight or overweight anxiety or depression psychiatric problems, such as those brought on by sexual abuse, violence or trauma Medication Constipation may sometimes be a side effect of a medicine youre taking. Common types of medication that can cause constipation include: aluminiumantacids (medicine to treat indigestion ) antidepressants antiepileptics (medicine to treat epilepsy ) antipsychotics (medicine to treat schizophrenia and other mental health conditions) calciumsupplements opiate painkillers, such as codeine and morphine diuretics (water tablets) ironsupplements If constipation is caused by medication, the condition will usually ease once you stop taking the medicine. However, you shouldnt stop taking any prescribed medication unless your GP advises you to. Speak to your pharmacist if you have constipation thats caused bya medicine. They may be able toadvise you on how to treat the problem, or they might recommend you see your GP for an alternative medicine if appropriate. Pregnancy About 2in every 5women experience constipation during their pregnancy, mostly during the early stages. Constipation occurs during pregnancy because your body produces more of the female hormone progesterone, which acts as a muscle relaxant. The bowel normally moves stools and waste products to the anus by a process known as peristalsis. This is when the muscles lining the bowel contract and relax in a rippling, wave-like motion. An increase in progesterone makes it more difficult for the bowel muscles to contract, making it harder to move waste products along. If youre pregnant, there are ways to safely treat constipation without harming you or your baby. Read more about treating constipation . Other conditions In rare cases, constipation can be a sign of an underlying condition, such as: irritable bowel syndrome (IBS) diabetes hypercalcaemia  where theres too much calcium in the bloodstream underactive thyroid gland (hypothyroidism) muscular dystrophy a genetic condition that causes muscle wasting multiple sclerosis  a condition that affects the nervous system Parkinsons disease where part of the brain becomes progressively damaged, affecting the co-ordination of body movements spinal cord injury anal fissure a small tear or ulcerin the skinjust inside the anus inflammatory bowel disease a condition that causes the intestines to become inflamed (irritated and swollen) bowel cancer Babies and children Constipation in babies and children is quite common. Its estimated that up to 1in every 3children in the UK has constipation at any time. Poor diet, fear about using the toilet and poor toilet trainingcan all be responsible. Poor diet Children who are over-fed are more likely to have constipation, as are those who dont get enough fluids. Babies who have too much milk are also more likely to get constipation. As with adults, its very important that your child has enough fibre in their diet. Toilet training Its important that you dont make your child feel stressed or pressured about using the toilet. Its also important to let your children try things by themselves (when appropriate). Constantly intervening when theyre using the toilet may make them feel anxious and may contribute to constipation. Toilet habits Some children can feel stressed or anxious about using the toilet. They may have a phobia about using the toilet, or feel they are unable to use the toilets at school. This fear may be the result of your child experiencing pain when passing stools. This can lead to poor bowel habits, where children ignore the urge to pass stools and instead withhold them for fear of experiencing pain and discomfort. However, if they do this, their condition will only get worse. Other conditions In rare cases, constipation in babies and children can be a sign of an underlying condition, such as: Hirschsprungs disease  which affects the bowel, making it difficult to pass stools anorectal malformation  where the babys anus and rectum dont form properly spinal cord abnormalities  including rare conditions such as spina bifida and cerebral palsy cystic fibrosis  a genetic condition that causes the body to produce thick and sticky mucus, which can lead to constipation Diagnosing constipation Constipation is a very common condition. Your pharmacist wont usually need to carry out any tests or procedures, but will confirm a diagnosis based on your symptoms and medical history. Your pharmacist will ask you some questions about your bowel habits. Dont feel embarrassed about discussing this with your pharmacist. Its important theyre aware of all of your symptoms, so they can make the correct diagnosis. Your pharmacist may also ask questions about your diet, level of exercise and whether there have been any recent changes to your routines. Constipation can be defined in a number of ways: opening the bowels less than 3times a week needing to strain to open your bowels on more than a quarter of occasions passing a hard or pellet-like stool on more than a quarter of occasions Physical examination If your pharmacist thinks you may have faecal impaction (when dry, hard stools collect in your rectum), they may advise you to contact your GP for a physical examination. Read complications of constipation for more information about faecal impaction. A typical examination will begin with you lying on your back, while the GP feels your abdomen (tummy). Youll then lie on your side while your GP carries out a rectal examination using a lubricated, gloved finger. Your GP will be able to feel for any stools that may have collected. An internal physical examination rarely needs to be carried out on a child. Instead, the diagnosis can usually be made by feeling the childs tummy. Further tests If youre experiencing severe symptoms, your doctor may request further tests, such as blood tests or thyroid tests, to diagnose or rule out other conditions. Other tests you may have include: an abdominal X-ray  where X-rayradiation is used to produce images of the inside of your abdomen transit study examination  where you take a short course of special capsules that show up on X-rays; one or more X-rays are taken later on to see how long it takes for the capsules to pass through your digestive system anorectal manometry  where a small device with a balloon at one end is inserted into your rectum andattached to a machine that measures pressure readings from the balloon as you squeeze, relax and push your rectum muscles; this gives an idea of how well the muscles and nerves in and around your rectum are working As theres an increased risk of bowel cancer in older adults, your doctor may also request tests to rule out a diagnosis of cancer, including a computerised tomography (CT) scan or colonoscopy. Treating constipation Treatment for constipation depends on the cause, how long youve had it and how severe your symptoms are. In many cases, its possible to relieve the symptoms by making dietary and lifestyle changes. Lifestyle advice Changes to diet and lifestyle are often recommended as the first treatment for constipation. In many cases,this will improve the conditionwithout the need for medication. Some self-help methods of treating constipation are: increase your daily intake of fibre (you should eat at least 18 to 30g of fibre a day) add some bulking agents, such as wheat bran, to your diet to help make your stools softer and easier to pass avoid dehydration by drinking plenty of water exercise more regularly for example,by going for a daily walk or run if constipation is causing pain or discomfort, you may want to take a painkiller, such as paracetamol  always follow the dosage instructions carefully; children under 16 shouldnt take aspirin keep to a routine (a place and time of day) when youre able to spend time on the toilet and respond to your bowels natural pattern: when you feel the urge, dont delay try resting your feet on a low stool while going to the toilet, so that your knees are above your hips; this can make passing stools easier if medication youre takingcould be causing constipation, your GP may be able to prescribe an alternative Read about preventing constipation for more ways to change your diet and lifestyle. Your pharmacist may recommend an oral laxative if diet and lifestyle changes dont help. Laxatives Laxatives are a type of medicine that help you pass stools. There are several different types of laxative and each one has a different effect on your digestive system. Bulk-forming laxatives Your pharmacist will usually startyou ona bulk-forming laxative. These work by helping your stools to retain fluid. This means theyre less likely to dry out, which can lead to faecal impaction. Bulk-forming laxatives also make your stools softer, which means they should be easier to pass. Commonly prescribed bulk-forming laxatives include ispaghula husk,methylcellulose and sterculia. When taking this type of laxative, you must drink plenty of fluids, and dont take them before going to bed. It will usually be 2to 3days before you feel the effects of a bulk-forming laxative. Osmotic laxatives If your stools remain hard after youve taken a bulk-forming laxative, your pharmacist may prescribe an osmotic laxative instead. Osmotic laxatives increase the amount of fluid in your bowels. Thissoftens your stools and stimulates your body to pass them. Commonly prescribed osmotic laxatives includelactulose and macrogols. As with bulk-forming laxatives, make sure you drink enough fluids. It will usually be 2to 3days before you feel the effect of the laxative. Stimulant laxatives If your stools are soft, but you still have difficulty passing them, your pharmacist may recommend a stimulant laxative. This type of laxative stimulates the muscles that line your digestive tract, helping them to move stools and waste products along your large intestine to your anus. The most commonly prescribed stimulant laxatives are senna, bisacodyl and sodium picosulphate. These laxatives are usually only used on a short-term basis, and they start to work within 6 to 12 hours. According to your individual preference andhow quicklyyou needrelief, your pharmacist may decide to combine different laxatives. How long will I need to take laxatives for? If youve had constipation for a short time, your pharmacist will usually advise you to stop taking the laxative once your stools are soft and easily passed. However, if your constipationis caused byan underlying medical condition or a medicine youre taking,your GP may advise you to take laxatives for much longer, possibly many months oreven years. If youve been taking laxatives for some time, you may have to gradually reduce your dose, rather than coming off them straight away. If you have been prescribed a combination of laxatives, youll normally have to reduce the dosage of each laxative, one at a time, before you can stop taking them. This can take several months. Your GP will advise you about when its best to stop taking long-term laxatives. Treating faecal impaction Faecal impaction occurs when stools become hard and dry and collect in your rectum. This obstructs the rectum, making it more difficult for stools to pass along. Sometimes as a result of impaction, overflow diarrhoea may occur (where loose stools leak around the obstruction). You may have difficulty controlling this. If you have faecal impaction, youll initially be treated with a high dose of the osmotic laxative macrogol. After a few days of using macrogol, you may also have to start taking a stimulant laxative. If you dont respond to these laxatives, and/or if you have overflow diarrhoea, you may need one of the following medications. Suppository  this type of medicine is inserted into your anus. The suppository gradually dissolves at body temperature and is then absorbed into your bloodstream. Bisacodyl is an example of a medication that can be given in suppository form. Mini enema  where a medicine in fluid form is injected through your anus and into your large bowel. Docusate and sodium citrate can be given in this way. Pregnancy or breastfeeding If youre pregnant, there are ways for you to safely treat constipation without harming you or your baby. Your pharmacist will first advise you to change your diet by increasing fibre and fluid intake. Youll also be advised to do gentle exercise. If dietary and lifestyle changes dont work, you may be prescribed a laxative to help you pass stools more regularly. Lots of laxatives are safe for pregnant women to use because most arent absorbed by the digestive system. This means that your baby wont feel the effects of the laxative. Laxatives that are safe to use during pregnancy include the osmotic laxatives lactulose and macrogols. If these dont work, your pharmacist may recommend taking a small dose of bisacodyl or senna (stimulant laxatives). However, senna may not be suitable if youre in your third trimester of pregnancy, because its partially absorbed by your digestive system. Read more about constipation and other common pregnancy problems . Babieswho havent been weaned If your baby is constipated but hasnt started to eat solid foods, the first way to treat them is to give them extra water between their normal feeds. If youre using formula milk, make the formula as directed by the manufacturer and dont dilute the mixture. You may want to try gently moving your babys legs in a bicycling motion or carefully massaging their tummy to help stimulate their bowels. Babies who are eating solids If your baby is eating solid foods, give them plenty of water or diluted fruit juice. Try to encourage them to eat fruit, which can be pured or chopped, depending on their ability to chew. The best fruits for babies to eat to treat constipation are: apples apricots grapes peaches pears plums prunes raspberries strawberries Never force your baby to eat food if they dont want to. If you do, it can turn mealtimes into a battle and your child may start to think of eating as a negative and stressful experience. If your baby is still constipated after a change in diet, they may have to be prescribed a laxative. Bulk-forming laxatives arent suitable for babies, so theyll usually be given an osmotic laxative. However, if this doesnt work, they can be prescribed a stimulant laxative. Children Forchildren, laxatives are often recommended alongside changes to diet. Osmotic laxatives are usually tried first, followed by a stimulant laxative if necessary. As well as eating fruit, older children should have a healthy, balanced diet , which also contains vegetables and wholegrain foods, such as wholemeal bread and pasta. Try to minimise stress or conflict associated with meal times orusing the toilet. Its important to be positive and encouraging when it comes to establishing a toilet routine. Allow your childat least 10 minutes on the toilet, to make sure theyve passed as many stools as possible. To encourage a positive toilet routine, try making a diary of your childs bowel movements linked to a reward system. This can help them focus on using the toilet successfully. Complications of constipation Constipation rarely causes any complications or long-term health problems. Treatment is usually effective, particularly if its started promptly. However, if you have long-term (chronic) constipation, you may be more at risk of experiencing complications. Rectal bleeding Continually straining to pass stools can cause pain, discomfort and rectal bleeding. In some cases, bleeding is the result of a small tear around the anus (anal fissure), but its more often caused by haemorrhoids (piles) . Piles are swollen blood vessels that form in the lower rectum and anus. As well as bleeding, piles can also cause pain, itching around the anus, and swelling of the anus. The symptoms of piles often settle down after a few days without treatment. However, creams and ointments are available to reduce any itching or discomfort. See your pharmacist as soon as possible if you experience any rectal bleeding. Faecal impaction Long-term constipation can increase the risk of faecal impaction, whichis where dried, hard stools collect in your rectum and anus. Once you have faecal impaction, its very unlikely that youll be able to get rid of the stools naturally. Faecal impaction makes constipation worse because its harder for stools and waste products to pass out of your anus, as the path is obstructed. Faecal impaction can sometimes lead to a number of other complications, including: swelling of the rectum a loss of sensation in and around your anus bowelincontinence bleeding from your anus rectal prolapse  where part of your lower intestine falls out of place and protrudes from your anus (this can also occuras a result ofrepeated straining in people withchronic constipation) Faecal impaction is usually treated with laxative medication, although suppositories (medication inserted into the anus) andmini enemas (where medicine in fluid form is injected through your anus) may sometimes be used. Preventing constipation There are a number of things you can do to prevent constipation, including making diet and lifestyle changes. Fibre Includingenough fibre in your diet can significantly reduce your chances of developing constipation. Most adults dont eat enough fibre. You should aim to have about 30g of fibre a day. You can increase your fibre intake by eating more: fruit and vegetables wholegrain rice wholewheat pasta wholemeal bread seeds and oats Eating more fibre will keep your bowel movements regular, because it helps food pass through your digestive system more easily. Foods high in fibre also make you feel fuller for longer. Its important to increase your fibre intake gradually, because a sudden increase may make you feel bloated. Suddenly increasing your intake of fibre may also cause you to produce more wind( flatulence ) and experience stomach cramps. Read more abouthow to increase your intake of fibre and eating a healthy, balanced diet . Fluids Make sure you drink plenty of fluids to avoid dehydration , and steadily increase your intake when exercising or when its hot. Try to cut back on the amount of caffeine, alcohol and fizzy drinks you consume. Toilet habits Never ignore the urge to go to the toilet, because it can significantly increase your chances of having constipation. When going to the toilet, make sure you have enough time and privacy to pass stools comfortably. Exercise Keeping active andmobile will greatly reduce your risk of getting constipation. You should do at least 150 minutes of physical activity every week. As well as regular exercise reducing your risk of becoming constipated, it will also leave you feeling healthier and improve your mood, energy levels and general fitness. Read more about health and fitness and physical activity guidelines for adults . Source: NHS 24 - Opens in new browser window Last updated: 12 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Haemorrhoids (piles) Laxatives Other health sites British Nutrition Foundation The IBS Network Education and Resources for Improving Childhood Continence (ERIC) NICE: laxatives Search for a pharmacy near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Coronavirus (COVID-19),"Coronavirus (COVID-19) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Coronavirus (COVID-19) Coronavirus (COVID-19) Coronavirus (COVID-19) British Sign Language (BSL) Coronavirus, and other respiratory infections such as flu, can spread easily and cause serious illness in some people. Vaccinations are very effective at preventing serious illness from coronavirus. But theres still a chance you might catch coronavirus, or another respiratory infection, and pass it on to other people. Most people no longer need to take a coronavirus test. To prevent the spread of infection, you should try to stay at home if youre unwell. You can still access testing if you have a health condition which means youre eligible for coronavirus treatments . Symptoms To prevent the spread of coronavirus, try to stay at home and avoid contact with other people if you have symptoms of a respiratory infection such as coronavirus and you: have a high temperature or do not feel well enough to go to work or carry out normal activities Try to do this until you no longer have a high temperature (if you had one) or until you feel better. Symptoms of coronavirus include: continuous cough high temperature, fever or chills loss of, or change in, your normal sense of taste or smell shortness of breath unexplained tiredness, lack of energy muscle aches or pains that are not due to exercise not wanting to eat or not feeling hungry headache thats unusual or longer lasting than usual sore throat, stuffy or runny nose diarrhoea feeling sick or being sick How to help your symptoms Do drink fluids like water to keep yourself hydrated get plenty of rest wear loose, comfortable clothing  dont try to make yourself too cold take over-the-counter medications like paracetamol  always follow the manufacturers instructions Antibiotics will not relieve your symptoms or speed up your recovery. You might continue to have a cough or feel tired after your other symptoms have improved. This does not mean that youre still infectious. Phone 999 or to go A&E if: You or your child: seems very unwell, is getting worse or you think theres something seriously wrong  children and babies in particular can get unwell very quickly gets sudden chest pain is so breathless theyre unable to say short sentences when resting, or breathing suddenly gets worse  in babies their stomach may suck under their ribs starts coughing up blood collapses, faints, or has a seizure or fit for the first time has a rash that does not fade when you roll a glass over it, the same as meningitis Speak to your GP if: your symptoms worsen youre concerned about your symptoms you have symptoms that you can no longer manage at home youre worried about your child, especially if theyre under 2 years If your GP is closed, phone 111. In an emergency phone 999. Its particularly important to get help if youre at increased risk of becoming more unwell from coronavirus such as if youre pregnant, aged 60 or over, or have a weakened immune system. Stay at home advice There are things you can do to reduce the spread of infection if you have symptoms, have tested positive, or are a close contact. If you arent eligible for testing and you have symptoms of a respiratory infection such as coronavirus and have a high temperature or do not feel well enough to go to work or carry out normal activities, try to stay at home and avoid contact with other people. Try to do this until you no longer have a high temperature (if you had one) or until you feel better. If you have a positive coronavirus test result, try to stay at home and avoid contact with other people for 5 days after the day you took your test, or from the day your symptoms started (whichever was earlier). You should count the day after you took the test as day 1. If a child or young person aged 18 or under has a positive coronavirus test result, they should try to stay at home and avoid contact with other people for 3 days after the day they took the test or from the day their symptoms started (whichever was earliest), if they can. Children and young people tend to be infectious for less time than adults. If youve had a positive test result, and have completed 5 days of self-isolation Although many people will no longer be infectious to others after 5 days, some people may be infectious to other people for up to 10 days from the start of their infection. If you have a high temperature or still feel unwell after the 5 days, continue to try to stay at home. Try to stay at home until you: feel well enough to go back to normal activities no longer have a high temperature (if you had one) This will help reduce the risk of spreading the virus. You should avoid meeting people at higher risk of becoming seriously unwell from coronavirus, especially those whose immune system means that they are at higher risk of serious illness from coronavirus for 10 days after the day you took your test. If youve received a positive test result and have been following the stay at home advice, you do not need to test after the 5 day period unless youve been advised to do so by a health professional. How to reduce the spread of infection Do work from home if you can  if you cant, talk to your employer about your options if youve been asked to attend a medical or dental appointment in person, tell them about your symptoms or positive test ask friends, family or neighbours to get food and other essentials for you, if you wish tell people you have recently been in contact with that youre feeling unwell or have tested positive so they can be aware of symptoms keep your distance from the people you live with if you can ventilate rooms you have been in by opening windows and leaving them open for at least 10 minutes after you have left the room wear a well-fitting face covering made with multiple layers or a surgical face mask if you do leave home or in shared areas in your home, especially if you live with someone with a weakened immune system regularly clean frequently touched surfaces, such as door handles and remote controls, and shared areas such as kitchens and bathrooms if you do leave home, exercise outdoors in places where you will not have close contact with other people cover your mouth and nose when you cough or sneeze wash your hands regularly with soap and water for 20 seconds or use hand sanitiser after coughing, sneezing, blowing your nose, and before you eat or handle food tell anyone who needs to come into your home that you have symptoms or have tested positive so they can protect themselves Dont do not have close contact with anyone who is at higher risk, especially individuals with a weakened immune system, if you can avoid it do not go to crowded places or anywhere that is enclosed or poorly ventilated if you do leave home do not touch your face with unwashed hands, if you can avoid it Children and young people aged 18 and under Respiratory infections are common in children and young people, particularly during the winter months. Symptoms can be caused by several respiratory infections including the common cold, coronavirus and RSV. For most children and young people, these illnesses will not be serious. Theyll soon recover following rest and plenty of fluids. Very few children and young people with respiratory infections become seriously unwell. When to stay at home Children and young people with mild symptoms who are otherwise well, can continue to attend their education setting. Mild symptoms include a runny nose, sore throat, or slight cough. Children and young people who are unwell and have a high temperature should stay at home and avoid contact with other people, where they can. They can go back to school, college or childcare, and resume normal activities when they no longer have a high temperature and theyre well enough to attend. Its not recommended that children and young people are tested for coronavirus unless advised to by a healthcare professional. Children and young people who usually go to school, college or childcare and who live with someone who has a positive coronavirus test result should continue to attend as normal. Financial Support The Self-Isolation Support Grant closed on 5 January 2023. Visit the Scottish Governments Cost of Living support to find out about other financial help available. Source: Scottish Government - Opens in new browser window Last updated: 01 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Other languages and formats British Sign Language (BSL) British Sign Language (BSL) Add this page to\n            Info For Me Also on NHS inform Long-term effects of COVID-19 (long COVID) NHS Scotland COVID Status Self-help guide: Coronavirus (COVID-19) Coronavirus (COVID-19): Treatments COVID 19 vaccine Other health sites Scottish Government: Respiratory infections including coronavirus (COVID-19) Report your test result NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Cough,"Cough | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Lungs and airways Cough Cough British Sign Language (BSL) |  |  | Polski | Romn |  Return to Symptoms Enter age Last Updated: Next Review Date: Review my answers Find your local services Search for a service near you by entering your postcode below. Please input your postcode in the following format: A12 1BC GP Practices Dental Services Pharmacies Opticians Postcode Search NHS inform has more information on this condition. Read more Previous Start guide Review my answers  You told us your credentials were: : You said: Based on the information you gave us, we made the following recommendation: Close Keep a copy View PDF A cough is a reflex action to clear your airways of mucus and irritants such as dust or smoke. Its rarely a sign of anything serious. Most coughs clear up within 3 weeks and dont require any treatment. A dry cough means itstickly and doesnt produceany phlegm(thick mucus). A chesty cough meansphlegm is produced to help clear your airways. Cough self-help guide Complete our self-help guide to check your symptoms and find out what to do next. Speak to a pharmacist for: advice about coughs cough treatments Find your local pharmacy Speak to a GP if: youve had a cough for more than 3 weeks your cough is particularly severe youcough up blood you experience shortness of breath, breathing difficulties or chest pain you have any other worrying symptoms, such as unexplained weight loss, a persistent change in your voice,orlumps or swellings in your neck If your GP is unsure whats causing your cough, they may refer you to a hospital specialist for an assessment. They may also request some tests, such asa chest X-ray , allergy tests, breathing tests, and an analysis of a sample of your phlegm to check for infection. If youre concerned about coronavirus (COVID-19):visit our coronaviruspage . Short-term coughs Common causes of a short-term cough include: an upperrespiratory tract infection(URTI) that affects the throat, windpipe or sinuses examples area cold , flu , laryngitis , sinusitis or whooping cough a lower respiratory tract infection (LRTI) that affects your lungs or lower airwaysexamples areacute bronchitis or pneumonia an allergy , such as allergic rhinitis or hay fever a flare-up of a long-term condition such as asthma , chronic obstructive pulmonary disease (COPD) or chronic bronchitis inhaled dust or smoke coronavirus (COVID-19) In rare cases, a short-term cough may be the first sign of a health condition that causes apersistent cough. Persistentcoughs A persistent cough may be caused by: along-termrespiratory tract infection, such aschronic bronchitis asthma this also usually causes other symptoms, such as wheezing, chest tightness and shortness of breath an allergy smokinga smokers cough can also be a symptom ofCOPD bronchiectasis where the airways of the lungs become abnormally widened postnasal drip mucus dripping down the throat from the back of the nose, caused by a condition such asrhinitisorsinusitis gastro-oesophageal reflux disease (GORD) where the throat becomesirritated by leaking stomach acid a prescribed medicine, such as an angiotensin-converting enzyme inhibitor (ACE inhibitor), which is used to treathigh blood pressure andcardiovascular disease In most cases, a doctor wont worry whether a cough is dry or chesty, but will need to know if you are producing much more or darker phlegm than usual. Rarely, apersistent cough can bea symptom of a more serious condition, such as lung cancer , heart failure , a pulmonaryembolism(blood clot on the lung) or tuberculosis . Coughsin children Coughsin childrenoften have similar causes to those mentioned above. For example, respiratory tract infections,asthma andGORD can all affect children. Causes of coughs that are more common in children than adults include: bronchiolitis amild respiratory tract infection that usually causes cold-like symptoms croup this causes a distinctive barking cough and a harsh sound known as stridor when the childbreathes in whooping cough  look out for symptoms such as intense, hacking bouts of coughing, vomiting, and a whoop sound with each sharp intake of breath after coughing Occasionally, a persistent cough in a child can be asign of a serious long-term condition, such as cystic fibrosis . Read more about what to do if your child has cold or flu symptoms Cough treatments Treatment isnt always necessary for short-term coughs because its likely to be a viral infection that will getbetter on its own within a few weeks. Do rest drink plenty of fluids take painkillers such as paracetamol or ibuprofen Cough medicines and remedies Although some people find them helpful,medicines that claim to suppress your cough or stop you bringing up phlegm are not usually recommended. This is becausetheres little evidence to suggest theyre any betterthan simple home remedies, and theyre not suitable for everyone. The Medicines and Healthcare products Regulatory Agency (MHRA) recommends that over-the-counter cough and cold medicines shouldnt be given to children under the age of six. Children aged 6 to 12 should only use them on the advice of a pharmacist or doctor. Ahomemade remedy containing honey and lemon is likely to be just as useful and safer to take. Honey shouldnt be given to babies under the age of one because of the risk of infant botulism. Treating the underlying cause If your cough has a specific cause, treating this may help. For example: asthmacan be treatedwithinhaledsteroidsto reduce inflammation inyour airways allergies can be treated by avoiding things youre allergic to and takingantihistaminesto dampen down your allergic reactions bacterial infections can be treated with antibiotics GORD can be treated withantacidsto neutralise your stomach acid and medication to reduce the amount of acid your stomach produces COPD can be treated withbronchodilators to widen your airways If you smoke, quittingis also likely to help improve your cough. Read more about stopping smoking . Contact your GP or, if your GPs closed, phone 111 if your child: is under 3 months old and has a temperature of 38C or above is older than 3 months and has a temperature of 39C or above has fewer wet nappies or nappies that seem drier than usual or has a dry nappy for over 12 hours isnt getting better after a few days is taking less than half their usual amount during their last 2 or 3 feeds If youre very concerned about your child trust your instincts and phone your GP or 111 for advice, or phone 999 in an emergency. Source: NHS 24 - Opens in new browser window Last updated: 10 February 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Other languages and formats British Sign Language (BSL) |  |  | Polski | Romn |  British Sign Language (BSL) |  |  | Polski | Romn |  Add this page to\n            Info For Me Also on NHS inform Whooping cough Search for your nearest pharmacy Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Crohns disease,"""Crohn's disease | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Inflammatory bowel disease (IBD) Crohns disease Crohns disease Crohns disease is a long-term condition that causes inflammation of the lining of the digestive system. Inflammation can affect any part of the digestive system, from the mouth to the back passage. But it mostly occurs in the last section of the small intestine (ileum) or the large intestine (colon). Crohns disease can affect people of all ages, but its usually diagnosed between the age of 15 and 40. Symptoms The symptoms of Crohns disease vary. They depend on which part of the digestive system is inflamed. Common symptoms include: recurring diarrhoea abdominal pain and cramping, which is usually worse after eating extreme tiredness (fatigue) unintended weight loss blood and mucus in your poo You may have long periods without symptoms, or very mild symptoms. This is known as remission. This may be followed by periods where the symptoms are particularly troublesome. These are known as flare-ups or relapses. Less common symptoms include: a high temperature (fever) of 38C (100F) or above feeling sick (nausea) being sick (vomiting) joint pain and swelling ( arthritis ) inflammation and irritation of the eyes (uveitis) areas of painful, red and swollen skin  most often the legs mouth ulcers anal pain and discharge due to perianal Crohns Children with Crohns disease may grow at a slower rate than expected. Speak to your GP practice if you have: diarrhoea for more than 7 days persistent abdominal pain unexplained weight loss blood in your poo concern about your childs development Causes The exact cause of Crohns disease is unknown. A combination of factors may be responsible, including: genetics  genes you inherit from your parents a problem with the immune system (the bodys defence against infection and illness)  where it attacks healthy bacteria in the gut and causes inflammation environmental factors  like air pollution, medication or previous infections smoking  smokers are twice as likely to develop Crohns disease, and usually have more severe symptoms than non-smokers Diagnosis Your GP will usually ask you about: your pattern of symptoms your diet any recent travel  for example, you may have developed travellers diarrhoea whether youre taking any medication, including any over-the-counter medicines whether anyone else in your family has any bowel conditions Your GP may also carry out a tests to check your general health. For example, they may: check your pulse check your blood pressure measure your height and weight measure your temperature examine your abdomen (tummy) Your GP may also: arrange blood tests to check for inflammation, infection and anaemia ask for a stool (poo) sample to use a qFIT test to check for blood and mucus, infection or inflammation via a faecal calprotectin test Referral to a specialist You may be referred to a gastroenterologist. A gastroenterologist is a specialist in conditions of the digestive system. They might recommend more tests, such as: gastroscopy  a thin flexible tube with a camera is put into your mouth to look at your food pipe and stomach colonoscopy  a thin, flexible tube with a camera is put into your bottom to look at the whole of your large bowel sigmoidoscopy  a thin, flexible tube with a camera is put into your bottom to look at the end of your large bowel a colon capsule endoscopy (pill camera) X-ray or barium enema MRI scan or CT scan You will be told what tests you need and what you need to do to prepare for them. Treatment Theres currently no cure for Crohns disease, but treatment can improve the symptoms and keep the inflammation under control. Your treatment will usually be provided by a range of healthcare professionals. Once your symptoms are under control, you are likely to be offered treatment to help keep them under control. If your Crohns stays under control for a long time, you may choose to stop treatment. You may need to start again if your symptoms come back. Steroid medication The first treatment offered is usually steroids, such as prednisolone or budesonide ( corticosteroids ) to reduce inflammation quickly. Steroids are often effective in reducing your symptoms. But they can have significant side effects . So theyre not suitable for long-term use and your dose will slowly be reduced when your symptoms start to improve. Medicines to suppress your immune system Medicines to suppress your immune system (immunosuppressants) may be given alongside steroids if your symptoms flare up twice or more during 12 months, or return when your steroid dose is reduced. Common types include azathioprine, mercaptopurine and methotrexate. Biological therapies If steroids and immunosuppressants dont help or arent right for you, biological therapies may be used. Biological therapies block particular chemicals involved in the immune response, which helps reduce inflammation. Theyre made using living cells in a lab. They can be given as a drip or an injection. Treatment usually lasts at least 12 months. Your inflammatory bowel disease (IBD) team will be able to discuss these with you. Common types are adalimumab, infliximab, ustekinumab or vedolizumab. Theres a risk that these medicines may cause side effects, which can cause symptoms such as: itchy skin a high temperature joint and muscle pain swelling of the hands or lips problems swallowing You should seek immediate medical help if you experience these symptoms. Reactions can occur immediately after treatment or months later, even after treatment stops. Surgery Surgery to treat Crohns disease may be an option if: you choose to have surgery instead of taking medications that may cause side effects medications dont control your symptoms your quality of life is severely affected by your condition you have serious complications of Crohns disease Surgery might involve widening narrow parts of your bowel, or removing parts of it (resection). Resection involves removing the inflamed area of the intestine. If you have a resection, you might have the healthy sections of bowel joined back together. Or you might have the end of your small bowel joined to the skin of your tummy (an ileostomy or stoma). In this case, poo comes out of the opening on your tummy and is collected in special bags that you wear. An ileostomy might be temporary, to give your bowel time to heal, or it might be permanent. Your IBD team will tell you what surgery they recommend and let you know what to expect. Diet and smoking There is no evidence that a particular diet causes or triggers flare-ups of Crohns disease. But alongside medications, some changes to your diet may help control symptoms for some people. Do eat 5 to 6 small meals rather than 3 main meals try to eat a healthy, varied diet that includes a wide variety of fruit, vegetables, nuts, seeds, proteins and wholegrains drink plenty of water Do not make major changes to your diet without talking to your IBD team and make sure you are still getting all the nutrients you need. You can speak to your IBD team about: keeping a food diary to find out if any particular foods affect your symptoms removing trigger foods from your diet taking a food supplement if you are struggling to get enough nutrients from your diet being referred to a dietitian If you smoke, it is advised that you make every effort to stop smoking , especially if you need to have surgery. If you smoke, smoking can make Crohns worse and is it important that you make every effort to stop smoking . Fertility and pregnancy A womans chance of becoming pregnant isnt usually affected by Crohns disease. However, surgery for Crohns disease might affect your fertility. Most women with Crohns disease will have a normal pregnancy and a healthy baby. But if youre pregnant or planning a pregnancy you should discuss it with your IBD team. This is because they may need to change your medication. If youre having a flare-up of Crohns disease you may also be advised to avoid getting pregnant until its under control. Complications Over time, inflammation can damage sections of the digestive system. This can result in complications such as: narrowing of the bowel (stricture) a channel developing between your bowel and your skin, another section of bowel or a body organ (fistula) These problems usually need surgical treatment. Information about you If you have Crohns disease, your clinical team will pass information about you on to the National Congenital Anomaly and Rare Diseases Registration Service (NCARDRS). This helps scientists look for better ways to prevent and treat this condition. You can opt out of the register at any time. Find out more about the register Source: Scottish Government - Opens in new browser window Last updated: 25 January 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Ulcerative colitis Inflammatory bowel disease (IBD) Other health sites Crohn's & Colitis UK: Crohn's Disease Crohn's & Colitis UK: Symptoms Crohn's & Colitis UK: Tests and investigations Crohn's & Colitis UK: Fistulas Crohn's & Colitis UK: Stoma Crohn's & Colitis UK: Smoking Crohn's & Colitis UK: Treatments Crohn's & Colitis UK: Reproductive health Chron's & Colitis UK: Getting a diagnosis Chron's & Colitis UK: Joints Chron's & Colitis UK: Pregnancy and breastfeeding NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Croup,"Croup | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Lungs and airways Croup Croup About croup Symptoms of croup Causes of croup Diagnosing croup Treating croup Complications of croup About croup Croup isa childhood condition that affects the windpipe (trachea), the airways to the lungs (the bronchi) and the voice box (larynx). Childrenwith croup have a distinctive barking cough andwill make a harsh sound, known as stridor, when they breathe in. They may also have ahoarse voice and find it difficult to breathe because their airway is blocked. Take your child to A&E or phone 999 if your child: has severe breathing difficulties has an increased breathing rate (theyre too breathless to feed or talk) or silent chest (youre unable to hear sounds of breathing) has a worsening cough or rasping sound shows distress and agitation has dark, blue-tinged or pale skin the skin around their ribs and chest appears to be pulled in and tight, making the bones of their chest and ribs more visible has abnormal drowsiness and sleepiness has an inability to drink fluids Contact your GP or, if your GPs closed, phone 111 if: is less than 3 months old and has a temperature of 38 C or above is aged 3 months or older and has a temperature of 39 C or above your child has a distinctive barking cough your child makes a harsh sound when they breathe in Croup can usually be diagnosed by a GP and treated at home. Read more about the symptoms of croup and diagnosing croup Why does crouphappen? Commonly, croup is caused by a virus. Several viruses can cause croup but in most cases it is the parainfluenza virus. Read more about the causes of croup Who is affected by croup? Croup usually affects young children aged between six months and three years, with most cases occurring in one-year-olds. However, croup can sometimes develop in babies as young as three months, and older children up to 15 years of age. Adults can also get croup but this is rare. The condition is more common during thelate autumn and early winter months. Ittends to affect more boys than girls. A child may experience croup more than once during childhood. Treating croup Most cases of croup are mild and can be treated at home. Sitting your child upright and comforting them if they are distressed is important, because crying may make symptoms worse. Your child should also drink plenty of fluids to prevent dehydration. Asingle dose of an oral corticosteroid medication called dexamethasone or prednisolone will usually also be prescribed to help reduce the swelling in the throat. If your child has breathing problems they may need hospital treatment, such as adrenaline and oxygen through a mask. Read more about treating croup Complications Mostcasesof croup clear up within 48 hours. However, in some cases symptoms can last for up totwoweeks. It is extremely rare for a child to die from croup. There are a number of conditions thatcan followcroup, such as pneumonia and middle ear infection . Read more about the complications ofcroup . Preventing croup Croup is spread in a similar way to the common cold, so it is difficult to prevent. Good hygiene is the main defence against croup, such as regularly washing hands and cleaning surfaces. A number of your childs routine vaccinations also protect against some of the infections that can cause croup. These include: MMR  protection from measles, mumps and rubella DTaP/IPV/Hib  protection from diphtheria, tetanus, whooping cough, polio and Haemophilus influenzae type b Symptoms of croup A child can get croup at any time of the year, although its more likely to occur duringlate autumn or early winter. This may be because there are more viruses, such as colds and flu,around at this time of year. Typical symptoms of croup include: a bark-like cough a hoarse or croaky voice difficulty breathing a harsh grating sound when breathing in, called stridor Stridor is often most noticeable when the child cries or coughs. But in more severe cases of croup it can also occur when the child is resting or sleeping. Symptoms tend to be worse at night. Some children have cold-like symptoms for a few days before developing croup symptoms. These cold-like symptoms can include: sore throat runny nose cough high temperature (fever) Although croup symptoms usually only last for a few days, they can occasionally last up to two weeks. When to seek medical advice Croup can usually be diagnosed by a GP and mild cases can be treated at home. Take your child to A&E or phone 999 if your child: has severe breathing difficulties has an increased breathing rate (theyre too breathless to feed or talk) or silent chest (youre unable to hear sounds of breathing) has a worsening cough or rasping sound shows distress and agitation has dark, blue-tinged or pale skin the skin around their ribs and chest appears to be pulled in and tight, making the bones of their chest and ribs more visible has abnormal drowsiness and sleepiness has an inability to drink fluids You should take them to your nearest hospitals accident and emergency department or dial 999 for an ambulance. Some of these symptoms may indicate a potentially life-threatening underlying condition called epiglottitis (inflammation and swelling of the epiglottis). The symptoms could also indicate tracheitis (inflammation of the windpipe), which also requires immediate medical attention. Causes of croup Croup usually develops as the result of a viral infection. The infection causes the larynx (voice box) to become swollen and the trachea (windpipe) to become blocked, and may affect the tubes in the lungs (bronchi). It is sometimes called laryngo-tracheo-bronchitis Parainfluenza virus The parainfluenza virus is the most common cause ofcroup.Four strains of the virus are responsible for most croup cases. These are: parainfluenza I parainfluenza II parainfluenza III parainfluenza IV Parainfluenza I isresponsible for most cases of croup. The virus can be transmitted through close contact with infected people, as well as contaminated objects and surfaces. As with many airborne viruses, the parainfluenza virus is often spread by breathing in droplets from infected coughs or sneezes. Other viruses Anumber of other viruses can also cause croup. These include: influenza A and B (flu viruses) the measles virus, in children who have not been immunised against measles the rhinovirus (common cold virus) enteroviruses the respiratory syncytial virus (RSV), which can cause severe breathing problems and pneumonia in babies Othercauses Less common causes of croupinclude: inhaling a small object such as a peanut or a pen cap (inhaled foreign body) epiglottitis  inflammation of the epiglottis, (the flap at the base of the tongue that keeps food from going into the windpipe) an allergic reaction to substances such as pollen or dust mites inhalation ofirritants, such as chemicals acid leaking back out of the stomach and into the throat ( acid reflux ) Diagnosing croup A GP can diagnose croupby studyingyour childs symptoms, particularlythe sound of their cough. Theymay alsocheck your childs temperature for a fever and ask whether they have recently had a cold orviral infection. In some cases, a pulse oximetry test may be carried out. This involves clipping a sensor onto your childs earlobe or finger to find out their oxygen levels. The test does not hurt and should not distress your child, and determines whether your child is absorbing enough oxygen into their blood. Your GP will decide whether your child needs to be admitted to hospital or whethertheir croup is safe to treat at home. You should not try to check your childs throat yourself, because it could trigger a spasm (sudden narrowing) of the airway. This could cause the airway to swell even more, making breathing even more difficult. Ruling out other conditions Croup can usually be diagnosed by studying your childs symptoms, but your GP may want to rule out other conditions that can cause similar symptoms. Other possible causes for your childs symptoms are: an abnormality of the airway, which has been present from birth anabscess in the tissues in the back of the throat inhaled material (something they have breathed in) swelling of the deeper layers of the skin (angio-oedema) epiglottitis congenital lesion an allergic reaction In very rare cases, epiglottitis (inflammation of the epiglottis) or tracheitis (inflammation of the windpipe) can cause similar symptoms to croup. In these cases, however, your child will usually feel very unwell generally, rather than just having the specific symptoms of croup. Differentiating these causes from croup may require further tests. Further investigation If your child is admitted to hospital with severe croup, or if treatmentisunsuccessful, further investigations may be needed to examine their neck and chest area for a possible obstruction. AnX-ray may be recommended if it is thought your child may have inhaled something and it is obstructing their airway. Treating croup Treatment of croup depends on how severe the symptoms are. Most cases are mild and can be managed at home. However, if your child has severe croup, they will need to be admitted to hospital urgently. Treatment croup at home If your GPthinks your child has mildcroup, they will usually recommendmanaging itat home. Thiswill ofteninvolve using childrens paracetamol to ease any pain associated with the condition and may help lower your childs temperature if they have a fever. You should also ensure your child is well hydrated by encouraging them to drink plenty of fluids. Comforting your child is alsoimportant because their symptoms mayget worseif they are agitated or crying. If your child is distressed, sitting them upright on your lap will help to comfort and reassure them. Your GP will usually prescribe a single dose of an oral corticosteroid medication called dexamethasone or prednisolone to help reduce swelling (inflammation) in your childs throat. Side effects of these medications can include restlessness, vomiting, upset stomach and headache. Steam treatment is not advised for the treatment of croup. There is no evidence that allowing your child to breathe in humid air, for example steam from a hot bath or shower in a closed room, will help. You should seek urgent medical advice if you notice your childs symptoms getting worse. Painkillers for children Painkillers, such as paracetamol and ibuprofen , are available in liquid form for children.You can get liquid paracetamol and ibuprofen over the counter from pharmacies and some supermarkets. Children under 16 years of age should not be given aspirin. Speak to your pharmacist or GP if you are unsure about what type of painkiller is suitable for your child. Do not use cough medicines or decongestants as these do not help ease the symptoms of croup.These treatments often have drowsy side effects, which can be dangerous when a childhas breathing difficulties. Hospital treatment In severe cases of croup, treatment in hospital may be required. Breathing problems, such as shortness of breath, are a major symptom of severe croup. You should dial 999 immediately for an ambulance if your child is struggling to breathe. If your child has severe croup, they may be given adrenaline through a nebuliser. This will help improve symptoms within 10 to 30 minutes and the effects should last for up to two hours. A nebuliser allows your child to breathe the medication as a mist. If your child is very distressed and finding itdifficult to breathe, they will be given oxygen through an oxygen mask. As with milder cases of croup, oral dexamethasone or prednisolonewill usuallybe given to help reduce any swelling in your childs airways. In rare cases croup may require hospitalisation, where a child may need intubation. During intubation, a tube is inserted either through a nostril or the mouth and passed down into the windpipe. This will help your child breathe more easily. Intubation is usually performed under general anaesthetic . This means your child will be completely unconscious throughout the procedure so they do not experience pain or distress. Complications of croup Complications that develop as a result of croup are rare. Airway obstruction If an obstructed airway is not treated promptly, it can lead to: severe breathing difficulty (respiratory distress) respiratory arrest(where breathing stops but the heart continues beating) Always phone 999 for an ambulance if your child is struggling to breathe. Your child may find it difficult to drink fluids as a result of an obstruction in their airway. However, it is important they have plenty of fluids to avoid dehydration . If your child refuses fluids, try not to force them. This could distress your child and make the condition worse. Secondary infection A secondary infection can sometimes develop following the initial viral infection that caused croup. A secondary infection can potentially cause: pneumonia , a chest infection which causes swelling of the tissue in one or both lungs bacterial tracheitis, which isa serious and potentially life-threatening infection that can occur after a viral respiratory infection Other complications Although rare, other possible complications of croup can include middle ear infection and lymphadenitis, an infection of the glands of the immune system (lymph nodes). Source: NHS 24 - Opens in new browser window Last updated: 15 June 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Cystic fibrosis,"Cystic fibrosis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Lungs and airways Cystic fibrosis Cystic fibrosis About cystic fibrosis Symptoms of cystic fibrosis Causes of cystic fibrosis Diagnosing cystic fibrosis Treating cystic fibrosis About cystic fibrosis Cystic fibrosis is an inherited condition in which the lungs and digestive system can become clogged with thick, sticky mucus. Itcan cause problems with breathing and digestion from a young age. Over many years, the lungs become increasingly damaged and may eventually stop working properly. Most cases of cystic fibrosis in the UK are now identified through screening tests carried out soon after birth. Its estimated that 1 in every 2,500 babies born in the UKhas cystic fibrosis. A number of treatments are available to help reduce the problems caused by the condition,but unfortunately averagelife expectancy is reduced for people who have it. Symptoms of cystic fibrosis Symptoms of cystic fibrosis tend to start in early childhood, although they can sometimes develop verysoon after birth, or may not be obvious until adulthood. Some of the main symptoms of cystic fibrosis can include: recurring chest infections difficulty putting on weight frequent, wet-sounding coughs diarrhoea occasional wheezing and shortness of breath People with the condition can also develop a number of related conditions, including diabetes ,thin, weakened bones ( osteoporosis ) and liver problems. Read more about the symptoms of cystic fibrosis Causes of cystic fibrosis Cystic fibrosis is caused by a faulty gene that a child inherits from both of their parents. The faulty gene means that some cells struggle to move salt and water across the cell wall. This, along with recurrent infections, can result in a build-up of thick, sticky mucus in the bodys tubes and passageways. To be born with cystic fibrosis, a child has to inherit two copies of this faulty gene  one from each of their parents. Their parents will not usually have the condition themselves, because they will only carry one faulty gene and one that works normally. If both parents carry the faulty gene, theres a 25% chance that each child they have will be born with cystic fibrosis. Read more about the causes of cystic fibrosis Screening and testing for cystic fibrosis Most cases of cystic fibrosis are now detected soon after birth through the newborn blood spot test . This involves collecting a drop of blood from the babys heel and testing it forabnormalities that could indicate cystic fibrosis. More testswill be needed to confirm the diagnosis, such as: a sweat test  to measure the amount of salt in sweat, as the sweat of someone with cystic fibrosis has higher levels of salt than normal a genetic test  where a sample of blood or saliva is checked for the faulty gene that causes cystic fibrosis These tests can also be carried out in older children and adults with symptoms of cystic fibrosis who havent been screened previously. If you have a family history of cystic fibrosis, you can be tested to determine if youre at risk of having a child with the condition by checking if youre acarrier of the faulty gene that causes it. Read more about how cystic fibrosis is diagnosed Treatments for cystic fibrosis Theres currently no cure for cystic fibrosis, but a number of treatments are available to help control the symptoms, preventcomplications, and make the condition easier to live with. Possible treatments include: antibiotics to prevent and treat chest infections medicinestomake the mucus in the lungs thinner and easier to cough up medicines to widen the airways and reduce inflammation special techniques and devices to help clear mucus from the lungs medicines that help the person absorb food better following a special diet and taking supplements to prevent malnutrition A lung transplant may eventually be needed if the lungs become greatly damaged. Read more about treating cystic fibrosis Outlook for cystic fibrosis Cystic fibrosis is a progressive condition, which means it tends to get worse over time. Eventually the condition can be fatal if it leads to a serious infection or the lungs stop working properly. The outlook for cystic fibrosis has improved considerably in recent yearsbecause ofadvancements in treatment, although most people with cystic fibrosis will have a shorter-than-average life expectancy. Currently, about half of the people with cystic fibrosis will live past the age of 40. Children born with the condition nowadays are likely to live longer than this. Information about you If you or your child hascystic fibrosis, your clinical team will pass information about you/your childon to the National Congenital Anomaly and Rare Diseases Registration Service (NCARDRS). This helps scientists look for better ways to prevent and treat this condition. You can opt out of the register at any time. Find out more about the register Symptoms of cystic fibrosis Cystic fibrosis can cause a range of problems. The lungs and digestive system are the main areas that are affected. Symptoms tend to start in early childhood,but sometimes they can develop soon after birthand very occasionallythey may not be obvious until adulthood. Nowadays, cystic fibrosis is usuallydiagnosed before symptoms appear, through screening tests carried out soon after birth. Read more about screening forcystic fibrosis . The main problems associated with cystic fibrosis are outlined below. Lung problems Cystic fibrosis can cause sticky mucus to clog the lungs and airways. This can cause: recurring chest infections  these occur because mucus in the lungs is an ideal breeding ground for bacteria persistent inflammation of the airways, which can cause them to become abnormally widened ( bronchiectasis ) increased coughing occasional wheezing and shortness of breath Over time, the lungs can become increasingly damaged and may eventually stop working properly. Digestive system problems The mucus can also block parts of the digestive system, whichcan affect how food travels through the gut and how itsbroken down or absorbed. This can cause: a serious bowel obstructionin the first few days of life (meconium ileus)this will often need an operation to remove the blockage jaundice diarrhoea or large, smelly stools problems putting on weight and growing this can occur because the bodystruggles todigest and absorb nutrients ( malnutrition ) diabetes from late childhood or early adulthood this can develop if the pancreas becomes severely damaged Other problems People with cystic fibrosis can alsoexperience a number of other problems, including: sinusitis nasal polyps thin,weakened bones ( osteoporosis )this can occur as a result of repeated infections, poor growth, lack of physical activity and malnutrition swelling and pain in the joints ( arthritis or arthralgia) from late childhood difficulty conceiving children  most men with cystic fibrosis are unable to have children naturally (although some fertility treatments may still work) because the tubes that carry sperm dont develop correctly; women can become pregnant, however liver problems caused bythe tiny bile ducts in the liver becoming blocked by mucus leaking of small amounts of urine, particularly during coughing fits ( stress incontinence ) Causes of cystic fibrosis Cystic fibrosis is caused by a faulty gene that a child inherits from both their parents. The faulty gene means that some cells struggle to move salt and water across the cell wall. This, along with recurrent infections, can result in a build-up of thick, sticky mucus in the bodys tubes and passageways  particularly the lungs and digestive system. The condition is present from birth and cannot be caught from someone else who has it. How cystic fibrosis is inherited Genes come in pairs. You inherit one set from your mother and one set from your father. To be born with cystic fibrosis, a child has to inherit a copy of the faulty gene from both of their parents. This can happen ifthe parents are carriers of the faulty gene. This means they dont have cystic fibrosis themselves, but they can have a child with the condition if their partner also carries the faulty gene. Its estimated that around 1 in every 25 people in the UK are carriers of the faulty gene that causes cystic fibrosis. If both parents are carriers, theres a: 25% chance that each child they have will not inherit any faulty genes and wont havecystic fibrosisor be able to pass it on 50% chance that each child they have will just inherit one copy of the faulty gene from one parent and be a carrier 25% chance that each child they have will inherit copies of the faulty gene from both parents and will havecystic fibrosis This is known as an autosomal recessive inheritance pattern. Diagnosing cystic fibrosis Tests can be carried out to diagnose cystic fibrosis at any age. Most cases are now detected soon after birth through newborn screening, but older children and adults with symptoms of cystic fibrosis who werent screened can also have tests to check for the condition. Tests to find out if you are a carrier of the faulty gene responsible forcystic fibrosismay also be recommended for some people. Newborn screening A newborn blood spot test is offered to all babies in Scotland to help detect problems early on, including cystic fibrosis. When your baby is five to eight days old, a health professional will prick their heel and collect drops of blood on a special card. The blood is then sent to a laboratory to be checked for abnormalities that could indicate cystic fibrosis. You should receive the results by the time your baby is six to eight weeks old. You will be contacted sooner if a problem is found, and youll be asked to attend a hospital appointment. The screening result isnt 100% accurate, so more tests will be carried out to confirm the diagnosis. You, your partner and any other children you have may also be tested to see if you carry the faulty gene that causes cystic fibrosis. Confirminga diagnosis Tests to confirm a diagnosis will be carried out if screening suggests that your child may have cystic fibrosis, or your doctor thinks you could have the condition and you havent been screened previously. Two main tests can be used to diagnose cystic fibrosis: sweat test  a test to measure the amount of salt in sweat, as the sweat of someone with cystic fibrosis has higher levels of salt than normal genetic test  where a sample of blood or saliva is checked for the faulty gene that causes cystic fibrosis The sweat test is most commonly used, althoughgenetic testing may be done if the sweat test result is inconclusive or to identify the specific genetic fault thats causing the condition. Carrier testing Testing tofind out if you carry the faulty gene that causes cystic fibrosis may be useful if: youhave a close relative, such as a child, sibling or parent,whos a known carrier youhave a close relativewith cystic fibrosis your partner is known to carry thecystic fibrosis gene This can be done using a blood test, or occasionally a special mouthwash, to collect a sample of cells. The sample is then sent to a laboratory so it can be checked for the faulty gene. Finding out whether youre a carrier of the faulty gene can help determine if youre at risk of having a child with cystic fibrosis.A genetic counsellorwill explain the results of the testto you and discuss the implications and options available forfuture pregnancies. Treating cystic fibrosis Theres currently no cure for cystic fibrosis, but its possible to help control the symptoms, prevent or reduce complications, and make the condition easier to live with. A person with cystic fibrosis will be supported by ateam of healthcare professionals at a specialist cystic fibrosis centre. A care plan will be drawn up thats tailored to their individual needs. A range of treatments may beused and sometimes treatment in hospital will be needed. Regular appointments to monitor the condition will also be recommended. Some of the main treatments for cystic fibrosis include: Medications for lung problems People with cystic fibrosis may need to take a number of different medicines to treat and prevent lung problems. These may be swallowed, inhaled or injected. Some of the main medicines for cystic fibrosis are: antibiotics to prevent and treat chest infections medicines to make the sticky mucus in the lungs thinner, such as dornase alfa, hypertonic saline and mannitol dry powder a medicine called ivacaftor to help reduce the levels of mucus in the body  although this is only suitable for fewer than 1 in every 20 people (4%) with cystic fibrosis bronchodilators to widen the airways and help make breathing easier steroid medication to treatnasal polyps(small growths inside the nose) Its alsoimportant that people with cystic fibrosis are up to date with all routine vaccinations and have the flu jab each year once theyre old enough. Airway clearance techniques In addition to medication, special techniques can be used to help keep the lungs and airways clear. A physiotherapistcan give you advice. Some of the main techniques include: active cycle of breathing techniques (ACBT)  a technique that involves a sequence of relaxed breathing, followed by deep breathing exercises and then huffing autogenic drainage  a series of gentle breathing techniques that clear mucus from the lungs modified postural drainage  a technique that involves changing your position to make it easier to remove mucus from your lungs airway clearance devices  handheld devices that use vibration and air pressure to help remove mucus from your airways; you may have to pay in the region of 45-60 for one of these devices Your care team can provide more information on the techniques mentioned above. Dietary and nutritional advice For people with cystic fibrosis, getting the right nutrition is vital in helping them develop normally and stopping them becoming frequently ill. However, the majority of people with cystic fibrosis cannot digest food and absorb nutrients from when theyre a baby. Occasionally, the condition can cause the pancreas to become damaged over time, causing the same problem. A dietitian will advise on what you can do to help avoid malnutrition . They may recommend: taking digestive enzyme capsules with all meals and snacks to help with digestion  the number of capsules needed depends on the food being eaten and varies from person to person following a special balanced diet thats high in calories (energy), fat and protein takingvitamin and mineral supplements Lung transplants In severe cases of cystic fibrosis, when the lungs stop working properly and all medical treatments have failed to help, a lung transplant may be recommended. A lung transplant is a serious operation that carries risks, but it can greatly improve the length and quality of life for people with severe cystic fibrosis. The outlook for people with cystic fibrosis is often better than for many transplant patients, as theyre often younger and in better general health. Itsestimated that up to 9 out of 10 people will survive for at least a year after a transplant. The Cystic Fibrosis Trust has information on lung transplants in cystic fibrosis . Treatments for associated problems People with cystic fibrosis can have a number of other problems that may benefit from treatment. For example: exercise can help keep bones and joints healthy, and is recommended for everyone withcystic fibrosisany sport or exercise is usually good, but if youre not sure about a particular activity, you should ask your physiotherapist for advice medicines called bisphosphonates can help treat weak and brittle bones that may occur as a result of cystic fibrosis if the person doesnt get enoughvitaminD and calcium(from their diet and/or from supplements) insulin medication and a special diet may help someone with diabetes caused bycystic fibrosis control their blood sugar levels Source: NHS 24 - Opens in new browser window Last updated: 18 October 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites Cystic Fibrosis Trust Genetic Alliance UK NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Cystitis,"Cystitis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Kidneys, bladder and prostate Cystitis Cystitis About cystitis Symptoms of cystitis Causes of cystitis Treating cystitis About cystitis Cystitis is inflammation of the bladder, usually caused by a bladder infection. Its acommon type of urinary tract infection (UTI) , particularly in women, and is usually more of a nuisance than a cause for serious concern. Mild cases will often get better by themselves within a few days. However, some people experience episodes of cystitis frequently and may need regular or long-term treatment. Theres also a chance that cystitiscould lead to a more serious kidney infection in some cases, so its important to seek professional advice ifyour symptoms dont improve. Signs and symptoms of cystitis The main symptoms of cystitis include: pain, burning or stinging when you pee needing to pee more often and urgently than normal urine thats dark, cloudy or strong smelling pain low down in your tummy feeling generally unwell, achy, sick and tired Possible symptoms in young children include a high temperature (fever) of 38C (100.4F) or above, weakness, irritability, reduced appetite and vomiting. Read more about the symptoms of cystitis When togetprofessional advice Speak to your pharmacist if you think you may have cystitis or symptoms of a urine infection. Women who have had cystitis before dont necessarily need to see their GP if the condition returns, asmild cases often get better without treatment. You can try theself-help measures, or ask your pharmacist for advice. Pharmacy First Scotland: Urinary infection treatment from your pharmacy Women over 16 with symptoms of a mild urinary infection can get advice and treatment directly from their pharmacist through the Pharmacy First Scotland service. Your pharmacist may be able to provide you with treatment to clear the infection, although there may be situations where they will recommend you see your GP. Find your local pharmacy on Scotlands Service directory. Search for a pharmacy near you You should see your GP if: your symptomsdont start to improve within a few days you get cystitis frequently you have severe symptoms, such asblood in your urine youre pregnant and have symptoms of cystitis youre a man and have symptoms of cystitis your child has symptoms of cystitis Your GP should be able to diagnose the problem by asking about your symptoms. They may test a sample of your urine for bacteria to help confirm the diagnosis. What causes cystitis? Most cases are thought tooccur when bacteria that live harmlessly in the bowel or on the skin get into the bladder through the urethra (tube that carries urine out of your body). Its not always clear how this happens, but itcan be caused by: having sex wiping your bottom aftergoing to the toilet particularly if you wipe from back to front inserting a tampon or urinary catheter (a thin tube inserted into the urethra to drain the bladder) using a diaphragm for contraception Women may get cystitis more often than men because their anus (back passage) is closer to their urethra, and their urethra is much shorter, which means bacteriamay be able toget into the bladder more easily. Read more about the causes of cystitis Treatments for cystitis If you see your pharmacist with symptoms of cystitis you can be treated under the Pharmacy First Scotland service. If you are female over 16 with signs of a mild urine infection, the pharmacist may offer you a course of antibiotics to treat the infection where appropriate. These should start to have an effect within a day or two. If youve had cystitis before and dont feel you need to see your pharmacist or GP, you may want to treat your symptoms at home. Until youre feeling better, it may help to: take paracetamol or ibuprofen drink plenty of water hold a hot water bottle on your tummy or between your thighs avoid having sex Some people find it helpful to try over-the-counterproducts that reduce the acidity of their urine (such as sodium bicarbonate or potassium citrate), but theres a lack of evidence to suggest theyre effective. If you keep getting cystitis, your GP may give you an antibiotic prescription to take to a pharmacy whenever you develop symptoms, without needing to see yourdoctor first. Your GP can also prescribe a low dose of antibiotics for you to take continuously over several months if necessary. Read more about treating cystitis Preventing cystitis If you get cystitis frequently, there are some things you can try that may stop it coming back. However, its not clear how effective most of these measures are. These measures include: not using perfumed bubble bath, soap or talcum powder around your genitals  use plain, unperfumed varieties having a shower, rather than a bath  thisavoids exposing your genitals to the chemicals in your cleaning products for too long going to the toilet as soon as you need to pee andalways emptying your bladder fully staying well hydrated drinking plenty of fluids may help to stop bacteriamultiplying in your bladder always wiping your bottom from front to back when you go to the toilet emptying your bladder as soon as possible after having sex contraception instead wearing underwear made from cotton, rather than synthetic material such as nylon, andnot wearing tight jeans and trousers Drinking cranberry juice has traditionally been recommended as a way ofreducing your chances of getting cystitis. However,large studies have suggested it doesnt make a significant difference. Symptoms of cystitis Cystitis can cause problems with peeing and make you feel unwell. Symptoms of cystitis in adults Cystitis in adults can cause: pain, burning or stingingwhen you pee needing to pee more often and urgently than normal feeling like you need to pee againsoon after going to the toilet urine thats dark, cloudy or strong-smelling pain low down in your tummy feeling generally unwell, achy, sick and tired blood in your urine In adults, cystitis doesnt usually cause a high temperature (fever). If you have a temperatureof 38C (100.4F) or above and pain in your lower back or sides, it may be a sign of a kidney infection . Symptoms of cystitis in children It can be difficult to tell whether a child has cystitis, because the symptoms can be vague and young children cannot easily communicate how they feel. Possible symptoms of cystitis in young children may include: ahigh temperature (fever) of 38C (100.4F) or above weakness and tiredness irritability reduced appetite vomiting Childrenwith cystitis can sometimes also have symptoms usually found in adults, such aspain whenpeeing, peeing more often than normal and pain in their tummy. When to seeyour GP You should see your GP if you or your child have symptoms of cystitis for the first time. Cystitis isnt usually a cause for serious concern, but thesymptoms canbe similar to several other conditions, soits important to get a proper diagnosis. If youre a woman who has had cystitis before, you dont necessarily need to see your GP again. Cystitis is very common in women and mild cases often get better on their own. Speak to a pharmacist if you need any advice about treating cystitis . However, you should see your GP if your symptoms are severe or dont start to get better in a few days, you get cystitis frequently,or youre pregnant. Children and men should always be seen by a GP if theyhave symptoms of cystitis, as the condition is less common and could be more serious in these groups. Causes of cystitis Cystitis is usually caused by a bacterial infection, although it sometimes happens when the bladder is irritated or damaged for another reason. Bacterial infections Mostinfections are thought tooccur when bacteria that live harmlessly in the bowel or on the skin get into the bladder through the urethra (tube that carries urine out of your body) and start to multiply. Cystitis is much more common in women than men, probably because the anus (back passage) is closer to the urethra in women and the urethra is much shorter. Its not always obvious how the bacteria get into the bladder, but it can be caused by: having sex wiping your bottom aftergoing to the toilet particularly if you wipe from back to front inserting a tampon or urinary catheter (a thin tube inserted into the urethra to drain the bladder) using a diaphragm for contraception What can increase yourrisk? There are a number of things that can increase your chances of developing an infection in your bladder. Not being able to empty your bladder If youre unable to empty your bladder fully, any bacteria that get inside may not be flushed out when yougo to the toiletand can multiply more easily. You may not be able to empty your bladder fully if: you have a blockage in your urinary system, such as a bladder stone youre pregnant, as thebaby may be pressing on your bladder (in men) you have an enlarged prostate gland that presses on the urethra Menopause For women whohave been through the menopause , or are going through it, the lining of the urethra can shrink and become thinner because ofa lack of the hormone oestrogen. The natural balance of bacteria in the vaginamay also change, which can allow potentially harmful bacteria to become more common. Thiscan make the urethra more vulnerable to infection, which could spread into the bladder. Diabetes Youre more likely to get cystitis if you have diabetes  a condition where the level of sugar in your body becomes too high. High levels of sugar in your urine can provide a good environment for bacteria to multiply, so any bacteria that get into the bladder are more likely to cause cystitis. Other causes of cystitis Cystitis can also be caused by damage or irritation to the urethra and bladder. This can be the result of: friction from sex chemical irritants, such as those in perfumed soap or bubble bath damage caused by acatheter or surgery on your bladder radiotherapy to your pelvis or treatment with certain chemotherapy medicines awomans genitalshaving beendeliberately cut or changed for cultural, religious and social reasons (an illegal practice called female genital mutilation or FGM ) Cystitis has also been linked to recreational use of the drug ketamine. Treating cystitis Mild cystitis will usually clear up on its own within a few days, although sometimes you may need to take antibiotics. See your GP for advice and treatment if: you have symptoms of cystitis for the first time your symptomsdont start to improve within a few days you get cystitis frequently you have severe symptoms, such as blood in your urine youre pregnant and have symptoms of cystitis youre a man and have symptoms of cystitis your child has symptoms of cystitis Women who have had cystitis before dont necessarily need to see their GP if the condition returns, asmild cases oftenget better without antibiotics . You can try the self-help measures or ask your pharmacist for advice. Things you can try yourself If youve had cystitis before and dontfeel you need to see your GP, the following advice may help to relieve your symptoms until the condition clears up: take over-the-counter painkillers, such as paracetamol or ibuprofen always read the medicine information leaflet beforehand to check whether you can take it, and check with your pharmacist if youre not sure drink plenty of water  its been suggested this may help flush the infection out of your bladder and some people find it helpful, although its not clear how effective it actually is use a hot water bottle  holding a hot water bottle on your tummy or between your thighs may reduce any discomfort dont have sex until youre feeling better, becauseit may make the condition worse Some people find drinking cranberry juice or using products that reduce the acidity of their urine (such as sodium bicarbonate or potassium citrate) reduce their symptoms, but theres a lack of evidence to suggest theyre effective. These products are also not suitable for everyone. Check with your GP or pharmacist before trying themif youre taking any other medication. Antibiotics In some cases, your GP may prescribe acourse of antibiotics. This will usually involve taking a tabletor capsule 2 to4 times a day for 3 days. Antibiotics should start to have an effect quite quickly. Return to your GP if your symptoms havent started to improve within a few days. Most people wont have any side effects from antibiotic treatment, but possible side effects can include feeling or being sick, itching , a rash and diarrhoea . Ifcystitis keeps coming back If you keep getting cystitis (known as recurrentcystitis) your doctor may prescribe stand-by antibiotics or continuous antibiotics. A stand-by antibiotic is a prescription you can take toa pharmacy the next time you have symptoms ofcystitis, without needing to visit your GP first. Continuous antibiotics are taken for several months to prevent further episodes of cystitis. These may be prescribed: if cystitis usually occurs after having sex  you may be given a prescription for antibiotics to take within 2 hours of having sex if cystitis is not related to having sex  you may be given a low-dose antibiotic to take for a trial period of 6 months Your doctor may also recommend some measures you can take to prevent cystitis, although its not clear how effective these are. Source: NHS 24 - Opens in new browser window Last updated: 01 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Self-help guide: Urinary infection Kidney infection Search for a pharmacy near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Deafblindness,"Deafblindness | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Eyes Deafblindness Deafblindness About deafblindness Signs and symptoms of deafblindness Causes of deafblindness Diagnosing deafblindness Managing deafblindness About deafblindness Deafblindness is a combination of sight and hearing loss that affects a persons ability to communicate, access information and get around. Its also sometimes called dual sensory loss or multi-sensory impairment. A deafblind person wont usually be totally deaf and totally blind, but both senses will be reduced enough to cause significant difficulties in everyday life. These problemscan occur evenifhearing loss andvision loss are mild, as the 2 senses work together and 1 would usually help compensate for loss of the other. Signs of deafblindness Deafblindness most commonly affects older adults, although it can affect people of all ages, including babies and young children. In older people, it may develop gradually and the person themselves may not realise their vision and/or hearing is getting worse at first. Signs of a problemcan include: needing to turn up the volume on the television or radio difficulty following a conversation not hearing noisessuch as a knock at the door asking others to speak loudly, slowly and more clearly needing to hold books or newspapers veryclose, or sitting close to the television difficulty moving around unfamiliar places If someone already has either a hearing or vision problem, its important to look out for signs that suggest the other sense may be getting worse too. Read more about the symptoms of deafblindness Seeing your GP Visit your GP if you think your hearing and/or eyesight may be getting worse. If youre worried about a friend or family member, encourage them to speak to their GP. Its best to seek advice as soon as possible, as treatment for some underlying causes of deafblindness can be more effective if started early.Early diagnosis will also ensure the person is able to access local support services sooner. Read more about diagnosing and assessing deafblindness What causes deafblindness? There are many potential causes of deafblindness. Some babies are born deafblind, but in many cases the hearing and/or vision loss occurs later in life. Causes of deafblindness include: age-related hearing loss genetic conditions, such as Usher syndrome an infection picked up during pregnancy, such asrubella (German measles) cerebral palsy  a problem with the brain and nervous system that mainly affects movement and co-ordination eye problems associated with increasing age, such ascataracts Read more about the causes of deafblindness Living with deafblindness A range ofcare and support services is available to help deafblindpeople. Each deafblind person will have a different level of hearing and sight loss, which means theyll have their own individual care needs. The general aims of care for a deafblind person are to: preserve and maximise any remaining sight or hearing the person has  this could involve treating underlying conditions like cataracts, wearing glasses or using ahearing aid teach alternative methods of communication  such as hand on hand signing or braille helpretain ordevelop as much independence as possible  for example, by training the person to use a long cane, a guide dog or offering acommunicator guide Yourlocal authority should arrange an assessment to determine exactly what care and support is needed. Read more about managing deafblindness Signs and symptoms of deafblindness A person whos deafblind wont usually be totally deaf and totally blind, but both senses will be reduced enough to cause difficulties with everyday activities. The hearing and/or vision problems may be present from birth,but in many cases one or both problems develop gradually as a person gets older andtheymay not notice it themselves at first. If someone you know has a combination of the signs mentioned below, its possible they have some degree of deafblindness and should seek medical advice. Signs of a hearing problem Hearing losscan occur from birth ormay develop gradually or suddenly later on. Signsthat someone may havea problem with theirhearinginclude: not hearing you if you speak to them from behind needing to turn up the volume on the television or radio difficulty following a conversation particularly if several people are speaking or the person theyre speaking to is unfamiliar not hearing noises around them, such as aknock at the door or the doorbell ringing asking others to speak loudly, slowly andmore clearly leaning in very close to hear whats being said If someone already has a hearing problem for example, they wear a hearing aid or use sign language keep an eye out for signs of vision problems that could develop (see below). Signs of a visionproblem Vision losscan also be present from birth or develop later on. Signsthat someone may havea problem with their visioninclude: problemsseeing in low light or bright light difficulty recognising people they know finding it hard to read facial expressions relying on touch to find and identify items more than usual needing to hold books or newspapers close to their face, or sitting near the television difficulty moving around unfamiliar places they may bump into or trip over things regularly not looking directly at you or making proper eye contact If a person alreadyhasa problemwith their vision  for example, they wear glasses, use a caneto get around,or havea condition such as glaucoma orcataracts keep an eye out for signs of hearing problems that could develop (see above). Gettingmedical advice Visit your GP if you noticeany deterioration in your hearing or eyesight. If youre worried about a friend or family members vision and hearing, encourage them to speak to their GP. Its best to seek advice as soon as possible, as treatment for some underlying causes of deafblindness can be more effective if started early. Early diagnosis will also ensure the person is able to access local support services sooner, and enable them to plan for the future (such as learning new communication methods). Read more about diagnosing deafblindness and managing deafblindness Causes of deafblindness There are many possible causes of deafblindness. The condition can either be present at birth or develop later in life. Deafblindnessfrom birth Deafblindness from birth is known as congenital deafblindness. It can be caused by: problems associated withpremature birth (birth before 37 weeks of pregnancy) an infection picked up during pregnancy, such asrubella (German measles),toxoplasmosis orcytomegalovirus (CMV) genetic conditions, such as CHARGE syndrome or Downs syndrome cerebral palsya problem with the brain and nervous system that mainly affects movement and co-ordination foetal alcohol syndrome health problems caused by drinking alcohol in pregnancy Deafblindnesslater in life In most cases, deafblindness develops later in life. This is known as acquired deafblindness. A personwith acquired deafblindnessmay beborn without a hearing or sightproblem and then later loses part or all of both senses. Alternatively, someone may be born with either a hearing or vision problem,and then later loses part or all of the other sense later on. Problems that cancontribute toacquired deafblindness include: age-related hearing loss Usher syndrome  a genetic condition that affects hearing, vision and balance eye problems associated withincreasing age, such asage-related macular degeneration (AMD),cataracts andglaucoma diabetic retinopathy a complication of diabetes where the cellslining the back of the eyeare damaged by high blood sugar levels damage to the brain, such as from meningitis , encephalitis, a stroke or severe head injury Sense has further information about the causes of deafblindness . Diagnosing deafblindness Deafblindness may be detected soon after a baby is born, or after tests carried out later in life. Speak to your GP if you have any concerns about your or your childs hearing and/or vision at any point. If youre worried about a family member or friend, try to encourage them to speak to their GP. Newborn screening Ifyour baby is born deafblind, this will usually be picked up during newborn screening . These are a series of checks carried out tosee if your baby has any serious health problems from birth, including any problems with their eyes or hearing. If no problems are picked up at this stage, they may be detected during routine checks as your child gets older. Hearing and vision tests for adults In most cases, deafblindnessdevelops as a person gets older. It can happen gradually, so you may not notice that your vision and/or hearing are getting worse at first. Its therefore important to have routine eye tests to check for any problems. Adults should normally have their eyes tested every two years. You can request a hearing test at your GP surgery at any point if you think you may be losing your hearing. A personmay be diagnosed with deafblindness iftests show they haveboth hearing and vision problems. Theirhearing and vision should continue to be regularly assessedeven after theyve been diagnosed, as the level of care and supportthey need will depend on how severely each sense is affected. Find your local optometry practice Specialist assessment As soon as deafblindness has been identified, a specialist assessment should be arranged bythe local authority. The assessmentshould only be carried out by a specially trained professional whois able to identify the deafblind persons abilities andneeds.The assessment should include assessing theirneeds in relation to: communication one-to-one human contact social interaction emotional wellbeing support with mobility assistive technology rehabilitation The assessment will also takeinto account the persons current needs and those that develop in the future. A deafblind person should have access to services suitable to their level of hearing and sight and their individual needs. Mainstream services aimed mainly at blind or deaf people may not always be appropriate. Read more about the treatments and services available for deafblind people . Managing deafblindness Its not always possible to treat the underlying causes of deafblindness, but a range of care and support services is available to help people with the condition. Most deafblind people will still have some hearing and/or vision. The level of care and support they need will depend onhow severe their hearing and vision problems are. Individual care plan The individual abilities and needs of a deafblind person should be assessed soon after theyre diagnosed. This will allow a tailored care plan to be drawn up. The care plan will aim to: preserve and maximise any remaining sensory functions the person has teach alternative communication methods such as the deafblind manual alphabet (see below) help the person retain as much independence as possible  for example, by recommending they receive training to use a long cane or guide dog or through the provision of a communicator guide for young children,ensure their educational needs are met Read further information Sense:Benefits and money Sense:Support for disabled children and young people Communication systems As deafblindness can make communicating by speech and writing difficult, alternative forms of communication may be necessary. The main communication systemsused by deafblind people include: clear speech  speaking clearly is one of the most effective and common ways of communicating with deafblind people who have some remaining vision and hearing deafblind manual alphabet a tactile form of communication where words are spelt onto the deafblind persons hand using set positions and movements block alphabet  a simple tactile form of communication where a word is spelt out in capital letters that are drawn onto the deafblind persons palm hands-on signing  an adapted version of British Sign Language (BSL)wherethe deafblind person feels whats being signed by placing their hands on top of the signers hand visual frame signing  an adapted version of BSL wherethe signs are adapted to be signed in a smaller space to match the position and size of a deafblind persons remaining sight braille  a system that usesa series of raised dots to represent letters or groups of letters moon similar to Braille, but uses raised, adapted capital letters that are simpler to feel Read further information: Sense:Ways of communicating Vision aids For somedeafblind people, it may be possible to improve vision using low vision aids, such as glasses, magnifying lenses and task lights. Specially designed items, such as telephones and keyboards, may also help someone who is visually impaired. The Royal National Institute of Blind People (RNIB) has more information about everyday living with vision loss ,including advice about the technology availableto help with everyday tasks. Many libraries stock a selection of large-print books and talking books, where the text is read aloud and recorded onto a CD. The RNIB also offer a talking book subscription service , where books can be ordered and delivered directly to your home for a small annual fee. Read further information: RNIB: Assistive aids and technology Hearing aids and implants Some deafblind people may benefit from wearing ahearing aid. There are various hearing aid styles available to suit different types of hearing loss and personal preference. Hearing aids use microphones to collect the sound from the environment, amplify it and deliver it into the ear canal of the wearer so that it can be processed by the auditory system. An audiologist (hearing specialist) will be able to recommend the most suitable type of aid after testing your hearing. For some people, hearing aids that deliver the sound into the ear canal are not appropriate. In these cases, hearing may be improved using a surgically implanted hearing system, such as a cochlea implant or bone conducting hearing implant. While these still use a microphone to collect the sound initially, they then covert that sound into either an electrical signal or vibration, passing it to the inner or middle ear for processing by the auditory system. Want to know more? Sense:Assistive technology for people with hearing loss RNID: Hearing aids One-to-one support Every deafblind person is entitled to help from aspecially trained one-to-one support worker if they need it. Depending on the persons situation, this may be a: communicator guide someone who works with people who have become deafblind later in life, to offer the support the person needs to live independently interpreter someone who acts as a communication link between the deafblind person and other people, using the deafblind persons preferred method of communication intervenor someone whoworks withchildren and adults who were born deafblind, to help them experience and join in the world around them as much as possible Treating underlyingconditions Some conditions that affect hearing and vision can be treated using medication or surgery. For example: cataractscan often be treated by surgically implanting an artificial lens in the eye glaucomacan often be treated using eye dropsor laser surgery  read more about treating glaucoma diabetic retinopathy can be treated in the early stages using laser surgery Somecauses of temporary hearing loss are also treatable, such as a build-up of earwax or middle ear infections . Source: NHS 24 - Opens in new browser window Last updated: 15 January 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Hearing loss Other health sites Action on Hearing Loss British Deaf Association Hearing Link Royal National Institute of Blind People Sense NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Deep vein thrombosis,"Deep vein thrombosis (DVT) - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Blood and lymph Deep vein thrombosis Deep vein thrombosis About deep vein thrombosis Deep vein thrombosis causes Deep vein thrombosis treatment Complications of deep vein thrombosis Deep vein thrombosis prevention About deep vein thrombosis Deep vein thrombosis (DVT) is a blood clot that develops within a deep vein in the body, usually in the leg. Blood clotsthatdevelop ina vein are also known as venous thrombosis. DVT usually occurs in a deep leg vein,a larger vein that runs through the muscles of the calf and the thigh. It can also occur in the pelvis or abdomen. It can cause pain andswelling in the leg and may lead to complications such as pulmonary embolism. DVT and pulmonary embolism together are known as venous thromboembolism (VTE). DVT symptoms In some cases, there may be nosymptoms of DVT. If symptoms do occur they can include: pain, swelling and tenderness in one ofyour legs (usually your calf or thigh) a heavy ache in the affected area warm skin in the area of the clot red skin, particularly at the back of your leg below the knee DVT usually (although not always)affects oneleg. The pain may be worse when you bend your foot upward towards your knee. If you think you have deep vein thrombosis ask for an urgent GP appointment or call 111 Phone 999 or go to A&E if you have symptoms of DVT like: pain and swelling of the leg, along with either breathlessnessor chest pain Pulmonary embolism This is a serious condition that occurs when a piece of blood clot breaks off into the bloodstream. This then blocks one of the blood vessels in the lungs, preventing blood from reaching them. Ifleft untreated, about 1in 10 people with a DVT will develop a pulmonary embolism. A pulmonary embolism is a very serious condition which causes: breathlessness  which may come on gradually or suddenly chest pain which may become worse when you breathe in sudden collapse Both DVT and pulmonary embolismneed urgent investigation and treatment. Seek immediate medical attention if you have pain, swelling and tenderness in your leg and develop breathlessness and chest pain. Read more about the complications of DVT DVT causes Each year,DVT affects around 1person in every 1,000 in the UK. Anyone can developDVT, butit becomes more common over the age of 40. As well as age, there are alsosome other risk factors, including: having a history of DVT or pulmonary embolism having a family history of blood clots being inactive for long periods such as after an operation or during a long journey blood vessel damage a damaged blood vessel wall can result in the formation of a blood clot having certainconditions or treatmentsthat cause your blood to clot more easily than normalsuch as cancer (including chemotherapy and radiotherapy treatment), heart and lung disease, thrombophilia and Hughes syndrome being pregnant your blood also clots more easily during pregnancy being overweight or obese The combined contraceptive pill andhormone replacement therapy (HRT)both contain the female hormone oestrogen, which causes the blood to clot more easily. If youre taking either of these, your risk of developing DVT isslightly increased. Read more about the causes of DVT Diagnosing DVT See your GP as soon as possible ifyou think you may have DVT for example, if you have pain, swelling and a heavy ache in your leg.Theyll ask you about yoursymptoms and medical history. D-dimer test Itcan bedifficult to diagnose DVT from symptoms alone. Your GP may advise that you have a specialised blood test called a D-dimer test. This test detects pieces of blood clot that have been broken down and are loose in your bloodstream. The larger the number of fragments found, the more likely it is that you have a blood clot in your vein. However, the D-dimer test isnt always reliable because blood clot fragments can increase after an operation, injury or during pregnancy. Additional tests, such asan ultrasound scan, will need to be carried out to confirm DVT. Ultrasound scan An ultrasound scan can be used to detect clots in your veins. A special type of ultrasound called a Doppler ultrasound can also be used to find out how fast the blood is flowing through a blood vessel. This helps doctors identify when blood flow is slowed or blocked, which could be caused by a blood clot. Venogram A venogram may be used if the results of a D-dimer test and ultrasound scan cant confirm a diagnosis of DVT. During a venogram, a liquid called a contrast dye is injected into a vein in your foot. The dye travels upthe leg and can be detected by X-ray , which will highlighta gap inthe blood vessel where a clot is stopping the flow of blood. DVT treatment Treatment for DVT usually involves taking anticoagulant medicines. These reduce the bloods ability to clot and stop existing clots getting bigger. Heparin and warfarin are 2 types of anticoagulant often used to treat DVT. Heparin is usually prescribed first because it works immediately to prevent further clotting. After initial treatment, you may also need to take warfarin to prevent another blood clot forming. A number of anticoagulants, known as directly acting oral anticoagulants (DOACs), may also be used to treat conditions such as DVT. These medications include rivaroxaban and apixaban, and theyve been shown to be as effective as heparin and warfarin with less serious side effects. Youll also be prescribed compression stockings to wear every day, which will improve your symptoms and help prevent complications. Read more about treating DVT DVT prevention If you need to go into hospital for surgery, a member of your care team will assess your risk of developing a blood clot while youre there. If youre at risk of developing DVT, there are a number of things you can do to prevent a blood clot occurring, both before you go into hospital. These include temporarily stopping taking the combined contraceptive pill,and while youre in hospital, such as wearing compression stockings. When you leave hospital, your care team may also make some recommendations to help prevent DVT returning or complications developing. These may include: not smoking eating a healthy, balanced diet taking regular exercise maintaining a healthy weight orlosing weight if youre obese Theres no evidence to suggest that taking aspirin reduces your risk of developing DVT. See your GP before embarking on long-distance travel if youre at risk of getting a DVT, or if youve had a DVT in the past. When taking a long-distance journey(6 hours or more) by plane, train or car, you should take steps to avoid getting DVT. Drink plenty ofwater, perform simple leg exercises and take regular, short walking breaks. Read more about preventing DVT Deep vein thrombosis causes Deep vein thrombosis (DVT) sometimes occurs for no apparent reason. However, the risk of developing DVT is increased in certain circumstances. Inactivity When youre inactive your blood tends to collect in the lower parts of your body, often in your lower legs. This is usually nothing to worry about because when you start to move, your blood flow increases and moves evenly around your body. However, if youre unable to move for a long period of time such as after an operation, because ofan illness or injury, or during a long journeyyour blood flow can slow down considerably. A slow blood flow increases the chances of a blood clot forming. In hospital If you have to go into hospital for an operation or procedure, your risk of getting a blood clot increases. This isbecause DVT is more likely to occur when youre unwell or inactive, or less active than usual. As a patient, your risk of developing DVT depends onthe type of treatment youre having. You may be at increased risk of DVT if any of the following apply: youre having an operation that takes longer than 90 minutes, or 60 minutes if the operation is on your leg, hip or abdomen youre having an operation for an inflammatory or abdominal condition, such as appendicitis youre confined to a bed, unable to walk, or spending a large part of the day in a bed or chair for at least three days You may also be at increased risk of DVT if youre much less active than usual because of an operation or serious injury and have other DVT risk factors, such as a family history of the condition. When youre admitted to hospital youll be assessed for your risk of developing a blood clot and, if necessary, given preventative treatment. Blood vessel damage If the wall of a blood vessel is damaged, it may become narrowed or blocked, which can cause a blood clot to form. Blood vessels can be damaged by injuries such as broken bones or severe muscle damage. Sometimes, blood vessel damage that occurs during surgery can cause a blood clot, particularly in operations on the lower half of your body. Conditions such asvasculitis (inflammation of the blood vessels), varicose veins and some forms of medication, such as chemotherapy ,can also damage blood vessels. Medical and genetic conditions Your risk of getting DVT is increased if you have a condition that causes your blood to clot more easily than normal. These conditions include: cancer  cancer treatments such aschemotherapy and radiotherapy can increase this risk further heart disease and lung disease infectious conditions, such as hepatitis inflammatory conditions, such as rheumatoid arthritis thrombophilia a genetic condition where your blood has an increased tendencyto clot antiphospholipid syndrome an immune system disorder that causes an increased risk of blood clots Pregnancy During pregnancy, blood clots more easily. Its the bodys way of preventing too much blood being lost during childbirth. Venous thromboembolism (VTE) DVT and pulmonary embolism affects about 1in 100,000 women of childbearing age. DVTs are also rare in pregnancy, althoughpregnant women are up to 10 times more likely to develop thrombosis than non-pregnant women of the same age. A clot can form at any stage of pregnancy and up to 6weeks after the birth. Having thrombophilia (a condition where the blood has an increased tendency to clot), or having a parent, or brother or sister, whos had a thrombosis, increase your risk of developing a DVT during pregnancy. Other risk factors during pregnancy include: being over 35 years old being obese (with a BMI of 30 or more) expecting 2 or more babies having recently had acaesarean section being immobile for long periods of time smoking (find out how to stop smoking ) having severe varicose veins dehydration Low molecular weight heparin (LMWH) is usually used to treat pregnant women with DVT. LMWH is an anticoagulant, which means it prevents the blood clot getting bigger. Its given by injection and doesnt affect your developing baby. Contraceptive pill and HRT The combined contraceptive pill and hormone replacement therapy (HRT) both contain the female hormone oestrogen. Oestrogen causes the blood to clot a bit more easily than normal,so your risk of getting DVT is slightly increased. Theres no increased risk from the progestogen-only contraceptive pill . Other causes Your risk of getting DVT is alsoincreased if you or a close relative have previously had DVT and: youre overweight or obese you smoke youre dehydrated youre over 60 particularly if you have a condition that restricts your mobility Deep vein thrombosis treatment If you have deep vein thrombosis (DVT), youll need to take a medicine called an anticoagulant. Anticoagulation Anticoagulant medicinesprevent blood clots getting bigger.They can also help stop part of the blood clot breaking off and becoming lodged in another part of your bloodstream (an embolism). Although theyre often referred to as blood-thinning medicines, anticoagulants dont actually thin the blood. They alter proteins within it, which prevents clots forming so easily. Heparin and warfarin are 2 types of anticoagulants that are used to treat DVT. Heparin is usually prescribed first because it works immediately to prevent further clotting.After this initial treatment, you may also need to take warfarin to prevent another blood clot forming. Heparin Heparin is available in 2different forms: standard (unfractioned) heparin low molecular weight heparin (LMWH) Standard (unfractioned) heparin can be given as: an intravenous injection an injection straight into one of your veins an intravenous infusion where a continuous drip of heparin (via a pump)is fed through a narrow tube into a vein in your arm (this must be done in hospital) a subcutaneous injection an injection under your skin LMWH is usually given as a subcutaneous injection. The dose of standard (unfractionated) heparin to treat a blood clot varies significantly from person to person, so the dosage must be carefully monitored and adjusted if necessary. You may need to stay in hospital for 5 to 10 days and have frequent blood tests to ensure you receive the right dose. LMWHworks differently from standard heparin. It contains small molecules, which means its effects are more reliable and you wont have to stay in hospital and be monitored. Both standard heparin and LMWH can cause side effects, including: a skin rash and other allergic reactions bleeding weakening of the bones if taken for a long time (although rare with LMWH) In rare cases, heparin can also cause an extreme reaction that makes existing blood clots worse and causes new clots to develop.This reaction, and weakening of your bones, is less likely to occur whentaking LMWH. In most cases, youll be given LMWHbecauseits easier to use and causes fewer side effects. Warfarin Warfarin is taken as a tablet. You may need to take it after initial treatment with heparinto prevent further blood clots occurring. Your doctor may recommend that you take warfarin for 3to 6 months. In some cases, it may need to be taken for longer,even forlife. As with standard heparin, the effects of warfarin vary from person to person. Youll need to be closely monitored by having frequent blood tests to ensure youre taking the right dosage. When you first start taking warfarin, you may need to have 2 to 3blood tests a week until your regular dose is decided. After this, you should only need to have a blood test every 4weeks at an anticoagulant outpatient clinic. Warfarin can be affected by your diet, any other medicines youre taking, and by how well your liver is working. If youre taking warfarin you should: keep your diet consistent limit the amount of alcohol you drink (no more than 14 units of alcohol a week) take your dose of warfarin at the same time every day not start to take any other medicine without checking with your GP, pharmacist or anticoagulant specialist not take herbal medicines Warfarin isnt recommended for pregnant women who are given heparin injections for the full length of treatment. Rivaroxaban Rivaroxaban is a medication recommended by the National Institute for Health and Care Excellence (NICE)as a possible treatment for adults with DVT, or to help prevent recurrent DVT and pulmonary embolism. Rivaroxaban comes in tablet form. Its a type of anticoagulant known as adirectly acting oral anticoagulant (DOAC). It prevents blood clots forming by inhibiting a substance called factor Xa and restricting the formation of thrombin (an enzyme that helps blood clot). Treatment usually lasts 3months and involves taking rivaroxaban twice a day for the first 21 days and then once a dayuntilthe end of the course. Read the NICE guidance about rivaroxaban Apixaban NICE also recommendsapixaban as a possible method of treatment and prevention for DVT and pulmonary embolism. Likerivaroxaban, apixaban is a DOAC thats taken orally as a tablet, and prevents blood clots forming by hindering factor Xa and restricting the formation of thrombin. Treatment usually lasts at least 3 months and involves taking apixaban twice a day. Read the NICE guidance about apixaban Compression stockings Wearing compression stockings helps prevent calf pain and swelling, and lowers the risk of ulcers developing after having DVT. They can also help prevent post-thrombotic syndrome. This is damage to leg tissue caused by the increase in venous pressure that occurs when a vein is blocked by a clot and blood is diverted to the outer veins. After having DVT, stockings should be worn every day for at least 2years. This is because symptoms of post-thrombotic syndrome may develop several months or even years after having a DVT. Compression stockings should be fitted professionally and your prescription should be reviewed every 3 to 6months. The stockings need to be worn all day but can be taken off before going to bed or in the evening while you rest with your leg raised. A spare pair of compression stockings should also be provided. Exercise Your healthcare team will usually advise you to walk regularly once compression stockings have been prescribed. This can help prevent symptoms of DVT returning and may help to improve or prevent complications of DVT, such as post-thrombotic syndrome. Raising your leg As well as wearing compression stockings, you might be advised to raise your leg whenever youre resting. This helps to relieve the pressure in the veins of the calf and stops blood and fluid pooling in the calf itself. When raising your leg, make sure your foot is higher than your hip. This will help the returning blood flow from your calf. Putting a cushion underneath your leg while yourelying downshould help raise your leg above the level of your hip. You can also slightly raise the end of your bed to ensure that your foot and calf are slightly higher than your hip. Read more about preventing DVT Inferior vena cava filters Although anticoagulant medicines and compression stockings are usually the only treatments needed for DVT, inferior vena cava (IVC) filters may be used as an alternative. This isusually because anticoagulant treatment needs to be stopped, isnt suitable, or isnt working. IVC filters are small mesh devices that can be placed in a vein. They trap large fragments of a blood clot and stop it travelling to the heart and lungs. They can be usedto help prevent blood clots developing in the legs of people diagnosed with: DVT pulmonary embolism multiple severe injuries IVCscan be placed in the vein permanently, or newer types of filters can be placed temporarily and removed after the risk of a blood clot has decreased. The procedure to insert an IVC filter is carried out usinga local anaesthetic (where youre awake but the area is numb). A small cut is made in the skin and a catheter (thin, flexibletube) is inserted into a vein in the neck or groin area. Thecatheter is guided using an ultrasound scan . The IVC filter is theninserted through the catheter and into the vein. Complications of deep vein thrombosis The 2 main complications of deep vein thrombosis (DVT) are pulmonary embolism and post-thrombotic syndrome. Pulmonary embolism A pulmonary embolismis the most serious complication of DVT. It happens when a piece ofblood clot (DVT)breaks off and travels through your bloodstream to your lungs, where it blocks one of the blood vessels. In severe cases this can be fatal. If theclot is small, it might not cause any symptoms. If its medium-sized, it can causechest painand breathing difficulties . A large clotcan cause the lungs to collapse, resulting in heart failure , which can be fatal. About onein 10people with an untreated DVT develops a severe pulmonary embolism. Post-thrombotic syndrome Ifyouve had a DVT, you may develop long-term symptoms in your calf known as post-thrombotic syndrome. Thisaffects around 20-40% of people with a history of DVT. If you have DVT, the blood clot in the vein of your calf can divert the flow of blood to other veins, causing an increase in pressure. This can affect the tissues of your calf and lead to symptoms, including: calf pain swelling a rash ulcers on the calf (in severe cases) When a DVT develops in your thigh vein, theres an increased risk of post-thrombotic syndrome occurring. Its also more likely to occur if youre overweight or ifyouve had more than one DVT in the same leg. Deep vein thrombosis prevention If youre admitted to hospital or planning to go into hospital for surgery, your risk of developing a blood clot while youre there will be assessed. Surgery and some medical treatments can increase your risk of developing DVT see causes of DVT for more information. If youre thought to be at risk of developing DVT, your healthcare team can take a number of measures to prevent a blood clot forming. Before going into hospital If youre going intohospital to have an operation, and youre taking the combined contraceptive pill or hormone replacement therapy (HRT) , youll be advisedto temporarily stop taking your medication four weeks before your operation. Similarly, if youre taking medication to prevent blood clots, such as aspirin , you may be advised to stop taking it one week before your operation. Theres less risk of getting DVT when having a local anaesthetic compared with a general anaesthetic .Your doctor will discuss whether its possible for you to have a local anaesthetic. While youre in hospital There are a number of things your healthcare team can do to help reduce your risk of getting DVT while youre in hospital. For example, theyll make sure you have enough to drink so you dont become dehydrated , and theyll also encourage you to move around as soon as youre able to. Depending on your risk factors and individual circumstances, a number of different medications can be used to help prevent DVT. For example: anticoagulant medicines suchasdabigatran etexilate or fondaparinux sodium, which are often usedto help prevent blood clots after certain types of surgery, including orthopaedic surgery low molecular weight heparin (LMWH) often used in many cases to help prevent blood clots, including during and shortly after pregnancy unfractionated heparin (UFH) often used in people with severe kidney impairment or established kidney failure Compression stockings or compression devices are also commonly used to help keep the blood in your legs circulating. Compression stockings are worn around your feet, lower legs and thighs, and fit tightly to encourage your blood to flow more quickly around your body. Compression devices are inflatable and work in the same way as compression stockings, inflating at regular intervals to squeeze your legs and encourage blood flow. Your healthcare teamwill usuallyadvise youto walk regularly after youve been prescribed compression stockings. Keeping mobile can help prevent the symptoms of DVT returning and may help prevent or improve complications of DVT , such as post-thrombotic syndrome. Read more about treating DVT When you leave hospital You may need to continue to take anticoagulant medicine and wear compression stockings when you leave hospital. Before you leave, your healthcare team should advise you about how to use your treatment, how long to continue using it for, and who to contact if you experience any problems. Lifestyle changes You can reduce your risk of getting DVT by making changes to your lifestyle, such as: not smoking eatinga healthy, balanced diet getting regular exercise maintaining a healthy weight or losing weightif youre obese Travelling See your GP before long-distancetravel if youre at risk of getting a DVT, or if youve had a DVT in the past. If youre planning a long-distance plane, train or car journey(journeys of six hours or more), make sure you: drink plenty of water avoid drinking excessive amounts of alcohol because it can cause dehydration avoid taking sleeping pills because they can cause immobility perform simple leg exercises, such as regularly flexing your ankles take occasional short walks when possible for example, during refuelling stopovers wear elastic compression stockings Read more about preventing DVT when you travel Travel insurance If youre travelling abroad, its very important to ensure youre prepared should you or a family member fall ill. Make sure you havefull travel insurance to cover the cost of any healthcare you may need while abroad. This is particularly important if you have a pre-existing medical condition, such as cancer or heart disease , which may increase your risk of developing DVT. DVT can be a very serious condition, and its important you receive medical assistance as soon as possible. Treating DVT promptly will help minimise the risk of complications. Source: NHS 24 - Opens in new browser window Last updated: 09 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Warfarin Other health sites Lab Tests Online UK: D-dimer test NICE: Pulmonary embolism NICE: Reducing the risk of VTE NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Dehydration,"Dehydration - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Nutritional Dehydration Dehydration About dehydration Symptoms of dehydration Causes of dehydration Treating dehydration Preventing dehydration About dehydration Dehydration occurs when your body loses more fluid than you take in. When the normal water content of your body is reduced, itupsets the balance of minerals (salts and sugar) in your body, which affects the way it functions. Water makes up over two-thirds of the healthy human body. It lubricates the joints and eyes, aids digestion,flushes out waste and toxins, and keeps the skin healthy. Some of the early warning signs ofdehydration include: feelingthirsty and lightheaded adry mouth tiredness having dark coloured, strong-smelling urine passing urine less often than usual A baby may be dehydrated if they: have a sunken soft spot (fontanelle) on their head have few or no tears when they cry have fewer wet nappies are drowsy The bodyis affectedeven when you lose a small amount of fluid. Read more about the symptoms of dehydration What causes dehydration? Dehydration is usually caused by not drinking enough fluid to replace what we lose. The climate, the amount of physical exercise you are doing (particularly inhot weather)and your diet can contribute to dehydration. You can alsobecome dehydrated as a result of an illness, such aspersistent vomiting and diarrhoea, orsweating from a fever. Read more about the causes of dehydration Who is at risk from dehydration? Anyone can become dehydrated, but certain groups are particularly at risk. These include: babies and infants  they have a low body weight and are sensitive to even small amounts of fluid loss older people  they may be less aware that they are becoming dehydrated and need to keep drinking fluids people with a long-term health condition  such as diabetes or alcoholism athletes  they can lose a large amount of body fluid through sweat when exercising for long periods What to do If youre dehydrated, drink plenty of fluidssuch as water, diluted squash or fruit juice. These are much more effective than large amounts of tea or coffee. Fizzy drinks may contain more sugar than you need and may be harder to take in large amounts. If youre finding it difficult to keep water down because youre vomiting,try drinking small amounts more frequently. Infants and small children who are dehydrated shouldnt be given large amounts of water alone as the main replacement fluid. This isbecause it can dilute the already low level of minerals in their body too much and lead to other problems. Instead, they should be given diluted squash or a rehydration solution (available from pharmacies). You might find a teaspoon or syringe can be helpful for getting fluid into a young child. If left untreated, severe dehydration can be serious and cause fits (seizures), brain damage and death. Read more about treating dehydration When to see your GP See your GP if your symptoms continue, despite drinking plenty of fluids, or if you think your baby or toddler is dehydrated. If your GP suspects dehydration, you may have a blood test or a urine test to check the balance of salts (sodium and potassium) in your body. Contact your GP, out-of-hours service or NHS 24 111 service straight away if you have any of the following symptoms: extreme thirst feeling unusually tired (lethargic) or confused not passing urine for eight hours rapid heartbeat dizziness when you stand up that doesnt go away after a few seconds You should also contact your GP if your baby has hadsix or more episodes of diarrhoea in the past 24 hours, or if they have vomited three times or more in the past 24 hours. Symptoms of dehydration Dehydration can be mild, moderate or severe, depending on how much of your body weight is lost through fluids. Two early signs of dehydration are thirst and dark-coloured urine. This is the bodys way oftrying to increase water intake and decrease water loss. Other symptoms may include: dizziness or light-headedness headache tiredness dry mouth , lips and eyes passing small amounts of urineinfrequently (less than three or fourtimes a day) Dehydration canalsolead toaloss ofstrength and stamina. Itsa maincause of heat exhaustion. You should be able to reverse dehydration at this stageby drinkingmore fluids. If dehydration is ongoing (chronic), it can affect your kidney function and increase the risk of kidney stones . It can also lead to muscle damage and constipation . When to see your GP See your GP if your symptoms continue despite drinking fluids, or if you suspect that your baby or toddler is dehydrated. You should also contact your GP if your baby hashadsix or more episodes of diarrhoeain the past 24 hours, or if they have vomited three times or more in the past 24 hours. If dehydration is suspected, you may be given a blood test or a urine test to check the balance of salts (sodium and potassium) in your body. Severe dehydration If dehydration is left untreated, it can become severe. Severe dehydration is a medical emergency and requires immediate medical attention. Contact your GP,out-of-hours serviceor NHS 24 111 servicestraight away if you have any of the following symptoms: feeling unusually tired (lethargic) or confused, and you think you may be dehydrated dizziness when you stand up that doesnt go away after a few seconds not passing urine for eight hours a weak pulse a rapid pulse fits (seizures) a low level of conciousness Ifseveredehydration is not treated immediately, it can lead to complications. This level of dehydration needs hospital treatment and you will be put on a drip to restore the substantial loss of fluids. Dehydration in babies A baby may be dehydrated if they have: a sunken soft spot (fontanelle) on their head few or no tears when they cry a dry mouth fewer wet nappies dark yellow urine drowsiness fast breathing cold and blotchy-looking hands and feet Read about how to treat dehydration in babies Causes of dehydration Dehydration is caused by not drinking enough fluid or by losing more fluid than you take in. Fluid is lost through sweat, tears, vomiting, urine or diarrhoea. The severity of dehydrationcandepend on a number of factors,such as climate, level of physical activity and diet. There are several causes of dehydration, which are described below. Illness Dehydration is often the result of an illness, such as gastroenteritis , where fluid is lost through persistent bouts of diarrhoea and vomiting. Sweating You can also become dehydrated if you sweat excessively after a fever, exercise, or carrying out heavy, manual work in hot conditions. In these situations, its important to drink regularly to replace lost fluids. It doesnt necessarily need to be hot for you to lose a significant amount of fluid from sweating. Children and teenagers are particularly at risk because they may ignore the symptoms of dehydration , or not know how to recognise and treat them. Alcohol Dehydration can also occur as a result of drinking too much alcohol .Alcohol is a diuretic, which means it makes you wee more. The headache associated with a hangover indicates that your body is dehydrated. You should try to drink plenty of water when you have been drinking alcohol. Diabetes If you have diabetes, youre at risk of becoming dehydrated because you have high levels of glucose in your bloodstream. Your kidneys will try to get rid of the glucose by creating more urine, so your body becomes dehydrated from going to the toilet more frequently. Read more about the different types of diabetes Whos at risk? The groups of people most at risk of dehydration are: babies and infants  their low body weight makes them sensitive to even small amounts of fluid loss older people  they may be less aware theyre becoming dehydrated and need to drink fluids people with a long-term health condition  such as diabetes oralcoholism athletes  they can lose a large amount of body fluid through sweat when exercising for long periods Hyponatremia Its possible to become overhydrated while exercising. This is known as hyponatremia and its caused by low sodium (salt) levels in the blood. It can occur if too much water is drunk over a short period of time. Hyponatremia sometimes affects athletes whose blood sodium level is reduced through sweat and then diluted by drinking large amounts of water. Symptoms of hyponatremia include nausea, vomiting and headache. In serious cases, the brain can swell, causing confusion, seizures, coma and, in rare cases, death. Treating dehydration The best way to treat dehydration is to rehydrate the body by drinking plenty of fluids, such as water, diluted squash or diluted fruit juice. A sweet drink can help to replace lost sugar, and a salty snack can help to replace lost salt. Babies If your baby is dehydrated, takethem to see your GPas soon as possible. Theyll be able to recommend appropriate treatments, such as those outlined below. Giveyour baby plenty of liquids, such as breastmilk or formula. It can often be better to give them smaller amounts of fluid more frequently. Dont dilute your babys formula (if you use it). Babies who are formula-fedand those on solids can begiven extra water. Avoid giving your baby fruit juice, particularlyif they have diarrhoea and vomiting,because it canmake it worse. Giving your baby regular sips(a few times an hour) of oral rehydration solution (ORS)in addition to their usual feed (breastmilk, formula milkand water) will help to replace lost fluids, salts and sugars. Infants and children Infants and children who are dehydrated shouldnt be given solely water, because it can dilute the already low level of minerals in their body and make the problem worse. Instead, they should have diluted squash or a special ORS (see below). If you or your child is finding it difficult to hold down fluids because of vomiting, take smaller amounts more frequently.You may find it easier touse a spoon or a syringe to give your child small amounts of fluid. Read more about vomiting in adults and vomiting in children and babies Oral rehydration solutions Whenyoure dehydrated, you lose sugar and salts, as well as water. Drinking a rehydration solutionwill enable you to re-establish the right balance of body fluids. The solution should contain a mixture of potassium and sodium salts, as well as glucose or starch. There are several different rehydration products available over the counter from pharmacies or on prescription from your GP, including solutions that are suitable for infants and children. Ask your GP or pharmacist for advice about the most suitable rehydration solution for you or your child. Severe dehydration Seekimmediatemedicalhelp if you suspect someone is severely dehydrated (see symptoms of severe dehydration ). They may need to be admitted to hospital for treatment. In particular, babies, infants and elderly people will need urgent treatment if they become dehydrated. Fluid may be given up the nose using a nasogastric tube orusinga saline drip into a vein (intravenously). This will provide essential nutrients faster than using solutions that you drink. If you have had bowel surgery, some rehydration solutions may not contain enough salt. In this instance, you will need a higher-strength solution. Your GP or surgeon can recommend a suitable rehydration solution for you. Preventing dehydration You should drink plenty of fluids to avoid becoming dehydrated. Most of the time, you can prevent dehydration by drinking water regularly throughout the day. Be guided by your thirst, but be aware that in hot weather, when exercising and during illness, you should drink more. Mild dehydration can be relieved by drinking more water and diluted fruit squash. If necessary, you can purchase oral rehydration solutions (ORS) from a pharmacy. As a guide, passing pale or clear-coloured urine (wee) is a good sign that youre well hydrated. Drinkregularly If youre active, or if the weather is particularly hot, theres a greater risk that you will become dehydrated. To prevent becoming dehydrated, you should increase your fluid intake. Asdifferent peoplesweat at different rates, its very difficult to provide specific recommendations about how much fluid you should drink. However, you should drink more than normal while exercising, and its particularly important tokeep well hydrated if youreexercising in warm conditions. This isbecause you will sweat more and fluid will be lost from your body more rapidly. Rarely, drinking more fluid than your body can process can reduce theamount of sodium (salt) in yourblood. This can lead to a serious and potentially fatal conditioncalled hyponatremia. If you start to feel discomfort and bloating from drinking, stop drinkingand allow time to recover. Illness If you, your child or someone you are caring for is ill, particularly witha fever, vomiting or diarrhoea , theres a high riskof becoming dehydrated, so its important to start replacing fluid as soon as possible. Advice for children There are no specific recommendations regarding the amount of water or other fluids that children need. However, its important for children to replace lost fluid, to prevent dehydration. Like adults, children lose more water when they are in hotter climates and when they are physically active. You should give your child healthy drinks as part of an overall healthy, balanced diet . Source: NHS 24 - Opens in new browser window Last updated: 21 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites NICE: Diarrhoea and vomiting in children under five (1) NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Dementia,"Dementia guide | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Dementia Dementia Dementia is a common condition. Your risk of developing dementia increases as you get older, and the condition usually occurs in people over the age of 65. Find out more about the condition. About dementia Information about dementia including causes, possible preventions and treating dementia Living with dementia Living well with dementia Information on living well with dementia, including staying independant and maintaining relationships Dementia care and support Dementia care and support Information about dementia care and support including organising care, care homes and managing legal affairs NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Dementia with Lewy bodies,"Dementia with Lewy bodies - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Dementia with Lewy bodies Dementia with Lewy bodies About dementia with Lewy bodies Symptoms of dementia with Lewy bodies Diagnosing dementia with Lewy bodies Treating dementia with Lewy bodies About dementia with Lewy bodies Dementia with Lewy bodies, also known as Lewy body dementia, is a common form of dementia estimated to affect more than 100,000 people in the UK. The term dementia describes a loss of mental ability (cognitive impairment) associated with gradual death of brain cells. Its rare in anyone younger than 65. Symptomsusually develop gradually and become more severe over the course ofseveralyears. Signs and symptoms People with dementia with Lewy bodies not only experience problems with memory and judgement, like those with Alzheimers disease , but are also likely tohave difficulties with concentration and visual perception (recognising objects and making judgements about where they are in space). They may experience: slowed movement, stiff limbs, and tremors recurrent visualhallucinations (seeing things that arent there) sleep disturbances, including sleepiness during the day fainting, unsteadiness, and falls People with the conditiontend to swing from a state of alertness to drowsiness or staring into space. These extreme changes may be unpredictable and happen from hour to hour or day to day. Read more about the symptoms of dementia with Lewy bodies What causes dementia with Lewy bodies? Dementia with Lewy bodies is caused by deposits of anabnormal protein called Lewy bodies inside brain cells. These deposits, which are also found in people with Parkinsons disease , build up in areas of the brain responsible for things such as memory and muscle movement. Its not clear why the deposits develop and how exactly they damage the brain, but its thoughtthey disrupt the brains normal functions by interfering with chemical signals transmitted from one brain cell to another. Dementia with Lewy bodies usually occurs in people with no family history of the condition, althoughthere have been reports of rare cases that seem to run in families. Diagnosing dementia with Lewy bodies If you think you may have early symptoms of dementia, its a good idea to see your GP. If youre worried about someone else, encourage them to make an appointment, and perhaps suggest that you go along with them. Your GP can do some simple checks to see if there is chance you could have dementia, and they can refer you to a memory clinic or another specialist clinic if necessary. At one of these clinics,you will be asked about your symptoms and have a physical check-up and memory test. You may also have blood tests and brain scans. The results of these checks and tests will give your doctor a good idea as to whether your symptoms are caused bydementia with Lewy bodies, another type of dementia, orsomething elseentirely. Read moreabout how dementia with Lewy bodies is diagnosed How dementia with Lewy bodies is managed There is no cure for dementia with Lewy bodies or anymedication that will slow it down. However, a few different medicines can be effective in controlling some of the symptoms. In particular,acetylcholinesterase inhibitors (used to treat Alzheimers disease ) have been shown to improve symptoms such as hallucinations and confusion in some people. Supportivetreatments such asphysiotherapy, occupational therapy , and speech and languagetherapy can help improve any problems with movement, everyday tasks, and communication. Psychological therapies and specific dementia activities , such as memory cafs, can also helpwith memory loss, confusion, and feelings of disorientation. Read more about treating dementia with Lewy bodies Outlook How quick dementia with Lewy bodies progresses varies from person to person. Home-based help will be needed, and some people will eventually need residential care in a nursing home. The average survival after the time of diagnosis is similar to that of Alzheimers disease around five to eight years. However, as with Alzheimers disease, this can be highly variable. If you or a loved one has been diagnosed with dementia, remember that you are not alone. The NHS, social services, and voluntary organisations will be able to provide advice and support to help you and your family. Symptoms of dementia with Lewy bodies The symptoms of dementia with Lewy bodies usually develop gradually and become more severe over the course of a few years. Like other forms of dementia, thecondition causes problems with: thinking speed language understanding judgement memory (although significant memory loss may not occur until later on) People withdementia with Lewy bodies may also have other symptoms that can help distinguish it from other types of dementia, such as: extreme swingsbetween alertnessand confusion or drowsiness, which may happen unexpectedly and change from hour to hour or day to day slow movement, stiff limbs, andtremors (as seen in Parkinsons disease ), which cause shuffling when walking seeing or hearing things that arentreal (hallucinations), which canrange frompleasant to distressing fainting, unsteadiness, and falls sleep disturbances, whichcan cause talking in your sleep or acting out dreams loss of facial expression difficultyswallowing (dysphagia) depression These symptoms can make daily activities very difficult and can lead to further health problems, such as injuries from falls, and chest infections caused by accidentally inhalingfood instead of swallowing it. Seeking medical advice If you think you may have early symptoms of dementia, its a good idea to see your GP. If youre worried about someone else, encourage them to make an appointment and perhaps suggest that you go along with them. Symptoms of dementia can have a number of different causes. Your GP will be able to carry out some simple checks to try to find out what the cause may be, and they can refer you to a specialist for further tests if necessary. Read more about diagnosing dementia with Lewy bodies Diagnosing dementia with Lewy bodies Confirming a diagnosis of dementia can be difficult, particularly when the condition is in its early stages. This is because many of the symptoms of dementia can also be caused by other conditions. For dementia withLewy bodies to be diagnosed correctly, you will have a number of tests and assessments, including: an assessment of your symptoms  for example, whether you have typical symptoms of dementia with Lewy bodies a full assessment of your mental abilities a physical examination a review of the medication you are taking a range of tests, including blood tests , to rule out other possible causes of your symptoms, such as a vitamin B12 deficiency brain scans, such as a computerised tomography (CT) scan or a magnetic resonance imaging (MRI) scan , whichcan check for signs of a stroke, brain tumour or brain shrinkage asingle photon emissionCT (SPECT) scan, which looks at the dopamine system in the brain, can also sometimeshelp Some of these tests can be carried out by your GP. Some will be carried out by other specialists, such as a neurologist (an expert in treating conditions that affect the brain and nervous system), an elderly care physician, or a psychiatrist with experience of treating dementia. Assessing your mental abilities The Mini Mental State Examination (MMSE) is widely used to help test mental ability. The MMSE can be used to assess a number of different mental abilities, including: short- and long-term memory attention span concentration language and communication skills ability to plan ability to understand instructions The MMSEinvolves a series of tasks, which togethercarry amaximum score of 30 points. Exampletasks include: memorising a short list of objects and then repeating the list back correctly identifying the day of the week, the date, or the year The MMSE is not a test to diagnose dementia, but its useful for assessing the level of mental impairment a person with dementia may have. Treating dementia with Lewy bodies Theres currently no cure for dementia with Lewy bodies, but treatments can help manage the symptoms. First of all, your future health and social care needs will need to be assessed and a care plan drawn up. Thisis a way of ensuring you receive the right treatment for your needs. It involves identifying areas where you may need some assistance, such as: what support you or your carer need for you to remain as independent as possible whether there are any changes that need to be made to your home to make it easier to live in whether you need any financial assistance Read more about care plans Medication Medication cannot stop the progression of dementia with Lewy bodies, butit can sometimes help reduce the symptoms. Acetylcholinesterase inhibitors Acetylcholinesterase inhibitors, such asdonepezil (Aricept), galantamine (Reminyl) or rivastigmine (Exelon), may help improve hallucinations, confusion, and drowsiness in some people. These medicineswork by increasing levels of the chemical acetylcholine in the brain, which improves the ability ofthe brain cells to send signals to each other. Common side effects ofacetylcholinesterase inhibitors include feeling and being sick, diarrhoea , headaches , fatigue (extreme tiredness), and muscle cramps. Othermedications Other medications that may help control some of the symptoms of dementia with Lewy bodies include: levodopa (a medication used to treat Parkinsons disease ) can help reduce movement problems, although it can also worsen hallucinations and other psychotic symptoms, so it needs to be carefully monitored by your doctor antidepressants may help you cope if you have depression clonazepam can sometimes help improve your sleep if you experience sleep disturbances Antipsychotics, such as haloperidol, should be avoided wherever possible, and should only be usedto treatseverely challenging behaviour that is putting you or others at risk of harm. This is because they can cause a range of serious side effects, including rigidity and immobility. If antipsychotics are needed, they will be prescribed at the lowest possible dose, for the shortest possible time, by a specialist experienced in treating dementia with Lewy bodies. Supportive measures andtreatments In addition to medication, there area number of therapies and practical measures that can help make everyday living easier for someone with dementia. These include: occupational therapy to identify problem areas in everyday life, such as getting dressed, and help work out practical solutions speech and language therapy to help improve any communication or swallowing problems physiotherapy to help with movement difficulties psychological treatments, such as cognitive stimulation , to help improve memory, problem-solving skills and language ability relaxation techniques, such as massage, and music or dance therapy home modifications, such as removing loose carpets and potential trip hazards, ensuring the home is well lit, andadding grab bars and handrails checking for problems with vision and hearing that could be contributing to hallucinations Read more about living well with dementia Legal matters If you have been diagnosed with dementia, you will need to make arrangements for your care that take into account thegradual decline in your mental abilities. Thisshould include ensuring that your wishes are upheld ifyoure not able to make decisions for yourself. You may wish todraw up anadvance decision after first receiving a diagnosis of dementia. This makes your treatment preferences known now, in case you are unable to do this in the future. You may alsowanttoconsidergiving a relativelasting power of attorney . This is the power to make decisions about you if you are unable to. Read more about managing legal affairs for someone with dementia Advice for carers If youcare for someone with dementia, you may find it helpful to read more about: respite care this can allow you to take breaks from caring legal issues for carers  such as what to do when someone can no longer make decisions for themselves benefits for carers  such as allowances and tax credits that may be available looking after someone with dementia Telecare Self-Check online tool Visit the Telecare Self-Check online tool to find the right support for you in your area. This easy to use online tool allows you to find helpful information on telecare services that could help you live independently at home for longer. Source: NHS 24 - Opens in new browser window Last updated: 06 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Living well with dementia Dementia care and support Other health sites Lewy Body Society Dementia UK Alzheimer Scotland - dementia with lewy bodies NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Dental abscess,"Dental abscess | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Mouth Dental abscess Dental abscess If you have a dental problem you should, in the first instance always phone the dental practice that you normally attend . If you are not registered with any dental practice thenyou should read our advice on dental emergencies . A dental abscess is a collection of pus that can form inside the teeth, in the gums, or in the bone that holds the teeth in place. Its caused by a bacterial infection. An abscess at the end of a tooth is called a periapical abscess. An abscess in the gum is called a periodontal abscess. Dental abscesses are often painful, but arent always. In either case, they should be looked at by a dentist. Its important to get help as soon as possible, because abscesses dont go away on their own. They can sometimes spread to other parts of the body and make you ill. Symptoms of a dental abscess Symptoms of an abscess in your tooth or gum may include: an intense, throbbing pain in the affected tooth or gum that may come on suddenly andgets gradually worse painthat spreads toyour ear, jaw and neck on the same side asthe affected tooth or gum pain thats worse when lying down, which may disturb your sleep redness and swelling inyour face a tender, discoloured and/or loose tooth shiny, red and swollen gums sensitivity to hot or cold food and drink bad breathand/or an unpleasant taste in your mouth If the infection spreads, you may also developa high temperature (fever) and feel generally unwell. In severe cases, you may find it hard to fully open your mouth andhave difficulty swallowing or breathing. What to do if you have a dental abscess You should see a dentist as soon as possible if you think you have a dental abscess. Avoid visiting your GP, as there is little they can do to help. You can get help from: your registered dentist if its out of hours, they should have an answerphone message with details of how to access out-of-hoursdental treatment NHS 24 111 service who can give you details ofdental services in your area your localclinical commissioning group (CCG)who can tell you the phone number ofyour localdental access helpline your local accident and emergency (A&E) departmentif there are no other options or youre having difficulty breathing You may have to pay for emergency NHS dental treatment, depending on your circumstances. Read about NHS dental charges. Relieving your symptoms While youre waiting to see a dentist, painkillers can help control your pain. Ibuprofen is the preferred painkiller for dental abscesses, but if youre unable to take it for medical reasons, you can take paracetamol instead. Aspirinshouldnt be given tochildren under 16. If one painkiller doesnt relieve the pain, taking both paracetamol and ibuprofen at the doses shown in the medicine leaflet may help. This is safe for adults, but not for children under 16. It may also help to: avoid hot or cold food and drink if it makes the pain worse try eating cool, soft foods if possible, using the opposite side of your mouth use a soft toothbrush and temporarily avoid flossing around the affected tooth These measures can help relieve your symptoms temporarily, but you shouldnt use them to delay getting help from a dentist. Treatments for a dental abscess Dental abscesses are treated by removing the source of the infection and draining away the pus. Depending on the location of the abscess and how severe the infection is, possible treatments include: removing the affected tooth (extraction)  this may be necessary if root canal treatment isnt possible root canal treatment  a procedure to remove the abscess from the root of an affected tooth before filling and sealing it incision and drainage  where a small cut (incision) is made in the gum to drain the abscess (this is usually only a temporary solution and further treatment may be needed) Local anaesthetic will usually be used to numb your mouth for these procedures. More extensive operations may be carried out under general anaesthetic (where youre asleep). Antibiotics arent routinely prescribed for dental abscesses, but may be used if the infection spreads or is particularly severe. What causes dental abscesses? Your mouth is full of bacteria, which form a sticky film on your teeth called plaque. If you dont keep your teeth clean, acids produced by the bacteria in plaque can damage your teeth and gums, leading to tooth decay or gum disease . The following can increase your chances of developing a dental abscess: poor oral hygiene  plaque can build-up on your teeth if you dont floss and brush your teeth regularly consuming lots of sugary or starchy food and drink  these can encourage the growth of bacteria in plaque and may lead to decay that can result in an abscess an injury or previous surgery to your teeth or gums  bacteria can get into any damaged parts of the teeth or gums having a weakened immune system  this includes people with certain underlying health conditions, such as diabetes ,andthose having treatment, including steroid medication or chemotherapy Preventing dental abscesses You can reduce your risk of developing dental abscesses by keeping your teeth and gums as healthy as possible. To do this, you should: use floss or an interdental brush at least once a day to clean between your teeth and under the gum line brush your teeth with afluoride toothpaste twice a day spending at least two minutes each time avoid rinsing your mouth with water or mouthwash after brushing because this washes the protective toothpaste away  just spit out any excess toothpaste cut down on sugary and starchy food and drinks particularly between meals or shortly before going to bed visit your dentist regularly  your dentist can suggest how often you should have a check-up, based on your oral health Read more on how to keep your teeth clean and dental check-ups . Source: NHS 24 - Opens in new browser window Last updated: 05 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Depression,"""Depression | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Mental health Depression Depression What is depression? \u200bSymptoms and causes of depression \u200bDiagnosing and treating depression \u200bLiving with depression \u200bPsychotic depression Depression self-help guide What is depression? Everyone has spells of feeling down, but depression is more than just spending a few days feeling sad or unhappy. Depression can make you feel persistently sad and down for weeks or months at a time. While some people believe that depression is trivial or not a genuine health problem, its actually a real condition that affects around one in 10 people over the course of their lives. It impacts people of all genders and ages  including children. Studies show that around 4% of children in the UK between the ages of five and 16 are depressed or anxious. With the right support and treatment, most people recover fully from depression. Do I have depression? Depression has a range of different symptoms, and it can affect everybody differently. The symptoms include feeling very tearful, feeling hopelessness and sadness, and losing interest in things you enjoyed before. Its also common for people with depression to have symptoms of anxiety . Physical symptoms happen with depression too  these can include feeling tired all the time, getting poor sleep, losing your sex drive, losing your appetite, and feeling aches and pains. If the symptoms are mild, you might simply experience a persistent low mood. Its common to feel stressed, sad or anxious during difficult times in your life, and a low mood can get better after a short time, rather than being a symptom of depression. Learn more about low mood and depression here . Severe symptoms of depression can make people feel suicidal  as if life is no longer worth living. Read more about depression symptoms here . Seeing a doctor about depression Big changes in your life, like bereavement, losing a job, or even having a baby, can cause symptoms of depression. Youre also more likely to experience depression if you have a family history of depression. However, its also possible to become depressed without there being an obvious reason. You can learn more about depression causes here . \u200bSymptoms and causes of depression Symptoms of depression can be very different from person to person. However, as a general rule, if you are depressed you feel hopeless, sad and lacking interest in things that used to make you feel happy. Depression symptoms are bad enough to interfere with work, social life and family life, and can persist for weeks or months. Doctors describe depression in one of three ways, depending on how serious it is: mild depression  it has some impact on daily life moderate depression  it has a significant impact on your daily life severe depression  this makes it nearly impossible to get through your life day to day A few people with severe depression may have symptoms of psychotic depression . Below is a list of depression symptoms  its unlikely that one person would have all of them. Psychological depression symptoms include: continuous sadness or low mood losing interest in things losing motivation not getting any enjoyment in life feeling tearful feeling guilty feeling anxious feeling irritable finding it hard to make decisions feeling intolerant of other people feeling helpless feeling hopeless low self-esteem feeling worried thinking about suicide thinking about harming yourself Physical symptoms include: speaking or moving slower than usual aches and pains that cant be explained losing, or sometimes gaining, appetite or weight constipation loss of interest in sex disturbed sleep (having trouble falling asleep, for example, or waking up very early) loss of energy changes in your menstrual cycle (the time of the month when you get your period) Social symptoms are common too. These include: avoiding talking to or spending time with your friends taking part in fewer social activities neglecting interests and hobbies doing poorly at work difficulties with your family or home life Its not always possible to tell that youre having symptoms of depression right away  it can start and progress gradually. A lot of people dont realise theyre ill and try to carry on and cope with their symptoms. Sometimes it takes a friend or family member to notice that theres a problem. Depression and grief Depression and grief have a lot of the same features, and it can be hard to tell them apart. However, theyre different in many important ways. Depression is an illness  grief is a completely natural response to loss. If youre grieving, you may find your feelings of sadness and loss come and go, but its still possible to enjoy things in life and look forward to the future. People with depression feel sad persistently, find it difficult to be positive about the future, and dont get enjoyment from anything. Learn more about the differences between grief and depression here . Different types of depression There are different types of depression, and there are some conditions where depression is a symptom. These conditions include: Bipolar disorder  people with bipolar disorder, which is also known as manic depression, experience times of depression, where the symptoms are similar to clinical depression. They also go through phases when they have excessively high moods (known as mania). Bouts of mania can include harmful behaviour like unsafe sex, spending sprees and gambling. Seasonal affective disorder (SAD) is also called winter depression. Its depression that is related to weather, usually winter, so it happens seasonally. Postnatal depression happens to some women after theyve had a baby. Its treated similarly to other types of depression, with antidepressant medication and talking therapy. Learn more about how depression is diagnosed here . Causes of depression Depression doesnt have one single cause  it can have a range of triggers, and there are many different reasons a person can develop the condition. Some people are affected after a stressful life event, like a bereavement or divorce. Other people experience depression related to illness, job loss, or money worries. Different reasons can combine and trigger depression. If youre feeling low after a job loss or health issues, and then experience something traumatic, like a bereavement, you can develop depression. Its common to hear about depression being brought on by a downward spiral  one thing causing other problems that combine to cause depression. For example, losing your job could make you feel sad, so you spend less time with family and friends and maybe drink more alcohol. These things all make you feel worse, which triggers depression. There are studies that suggest people are more likely to become depressed when they get older. Theres also evidence that depression is more common for people whose economic and social circumstances are difficult. Depression and illness Long-lasting or life-threatening conditions like cancer or coronary heart disease can put you at higher risk of developing depression. Many people dont know that head injuries can cause depression, and a severe head injury can lead to emotional problems and mood swings. Underactive thyroid (hypothyroidism) can happen as a result of immune system problems. Its also possible, although rare, for a minor head injury to damage the pituitary gland. This is a gland the size of a pea which sits at the base of the brain and produces hormones that stimulate the thyroid. Damage to the pituitary gland can cause symptoms, including severe tiredness and a lack of interest in sex, which can then cause people to develop depression. Depression and drugs and alcohol Drowning your sorrows is actually a bad idea when it comes to depression. Alcohol is categorised as a strong depressant which can make depression worse, and drinking or taking drugs to cope can lead to a downward spiral by having a negative affect on other parts of your life. Theres evidence that cannabis can cause depression, particularly in teenagers, even if it helps you relax. Other causes of depression There are a number of things that can lead to developing depression. Stressful events  big changes in your life, like bereavement, the end of a relationship or the loss of a job, can be difficult to deal with. When these things happen, its important to keep seeing friends and family instead of trying to deal with problems alone  this increases your risk of developing depression. Giving birth  pregnancy and birth can make some people vulnerable to depression. Postnatal depression can happen as the result of physical changes, hormonal changes, and the responsibility of taking care of a new baby. Loneliness  your risk of depression gets higher if you arent in contact or spending time with family and friends. Personality  some personality traits can put you at a higher risk of developing depression. These include low-self esteem or a habit of criticising yourself too much. These personality traits can come from your genes, which you get from your parents, or they can be as a result of experiences in your early life. Family history  its more likely for someone to develop depression if a family member, like a sibling or parent, has experienced it before. \u200bDiagnosing and treating depression Theres no physical test for depression. If you experience depression symptoms most of the day, every day, for more than two weeks, you should visit your GP. This is especially important if: you have symptoms of depression that arent getting any better you have thoughts of self-harm or suicide your work, relationships with friends and family, or interests are affected by your mood It can be hard for people with depression to imagine that anything can help them  but the sooner you seek help, the sooner the symptoms start to get better. Your GP may examine you and perform blood or urine tests to make sure there isnt another condition causing your depression symptoms, like an underactive thyroid . When you see your GP, theyll try to find out if you have depression by asking you questions. These are likely to be about your health, how youre feeling, and how that is affecting you mentally and physically. Telling your doctor your symptoms and the affect they are having on you will help your GP to tell if you have depression, and how severe the condition is. Its important to be as open as possible. Your conversation with your GP will be confidential. This rule can only be broken if your GP thinks there is a significant risk of harm to you or others, and that telling a family member or carer would make that risk lower. Treating depression The first place to go is your GP  they will refer to you local talking treatments for depression that are available on the NHS. You may also have the option to self-refer, depending on where you live, so you can go directly to a professional therapist if youd rather not talk to your GP. Talking treatments for depression There are a number of talking therapies for depression. Cognitive behavioural therapy (CBT) CBT helps you make sense of your thoughts and behaviour and the affect they have on you. Part of its recognising that past events may have played a part in making you who you are, but the main focus is changing how you feel, behave and think now. You can use CBT to learn how to overcome negative thoughts  this can help you to tackle feelings of hopelessness, for example. Most people have a course of six to eight CBT sessions that goes over 10 to 12 weeks. Sessions are one-to-one, between you and a CBT-trained counsellor. You might also be offered group CBT. Computerised CBT (CCBT) This type of CBT is done using a computer instead of face-to-face with the counsellor. It should be supported by a healthcare professional  your GP may prescribe it, and you might have to use the computer in the GP surgery to access it. CCBT involves a series of weekly sessions. Interpersonal Therapy (IPT) IPT is focused on your relationships with people around you, and problems that you might be having with them. These can include problems communicating, or dealing with a bereavement. Theres evidence that suggests IPT can be as effective for depression as CBT or medication, but more research needs to be done. Psychodynamic psychotherapy This is also known as psychoanalytic psychotherapy. Youll work with a therapist who encourages you to say whatever youre thinking. This helps you to find hidden patterns and meanings in your words and behaviour that could be contributing to your depression. Read more about psychotherapy here . Counselling Counselling is a type of therapy that works really well if you have good mental wellbeing overall but need help coping with a crisis thats currently going on in your life. These can include anger, bereavement, infertility, relationship problems, job loss and serious illness. On the NHS, counselling usually takes place over six to 12 sessions, each an hour long. The sessions are confidential. A counsellor helps you to think about whats going on in your life and find new ways of dealing with the problems. Theyll offer practical advice, support you, and help you find solutions, but they dont tell you what to do. Antidepressants Antidepressants are medicines that treat depression symptoms. There are almost 30 different types of antidepressant that can be prescribed to you. Most people who have moderate or severe depression notice improvement when they take antidepressants, but this isnt the case for everyone. One type of antidepressant might not work for you, but another one could. It can take two or more different treatments to find the right one for you. Side effects vary between different people and different antidepressants, but the different types of antidepressant all work around as well as each other. If youre prescribed antidepressants, you should see your GP or specialist nurse regularly while you first start taking the medication  every week or two for at least four weeks. This is so your treatment provider can see how the antidepressants are working. If the medication is working for you, you should continue taking them at the same dose for at least four to six months after the depression symptoms have eased. People who have had depression in the past might have to take antidepressants for up to five years, maybe longer. Antidepressants arent addictive. However, you might have withdrawal symptoms if you stop taking them suddenly or miss a dose. You can read more about withdrawal symptoms below. Selective serotonin reuptake inhibitors (SSRIs) If your GP thinks you would benefit from taking an antidepressant, youll usually be prescribed a modern type called a selective serotonin reuptake inhibitor (SSRI) . Examples of commonly used SSRI antidepressants are Seroxat (paroxetine), Prozac (fluoxetine) and Cipramil (citalopram). They help increase the level of a natural chemical in your brain called serotonin, which is thought to be a good mood chemical. SSRIs work just as well as older antidepressants and have fewer side effects. They can, however, cause nausea and headaches, as well as a dry mouth and problems having sex. However, all these negative effects usually improve over time. Some SSRIs arent suitable for children under the age of 18. Research shows that the risk of self-harm and suicidal behaviour may increase if theyre taken by under-18s. Fluoxetine is the only SSRI that can be prescribed for under-18s, and even then only when a specialist has given the go-ahead. Tricyclic antidepressants (TCAs) This group of antidepressants is used to treat moderate to severe depression. TCAs, which includes Imipramil (imipramine) and amitriptyline, have been around for longer than SSRIs. They work by raising the levels of the chemicals serotonin and noradrenaline in your brain. These both help lift your mood. Theyre generally quite safe, but its a bad idea to smoke cannabis if you are taking TCAs because it can cause your heart to beat rapidly. Side effects of TCAs may include a dry mouth, blurred vision, constipation, problems passing urine, sweating, light-headedness and excessive drowsiness, but vary from person to person. The side effects usually ease after seven to 10 days, as your body gets used to the medication. Other antidepressants New antidepressants, such as Efexor (venlafaxine), Cymbalta or Yentreve (duloxetine) and Zispin Soltab (mirtazapine), work in a slightly different way from SSRIs and TCAs. Venlafaxine and duloxetine are known as SNRIs (serotonin-noradrenaline reuptake inhibitors). Like TCAs, they change the levels of serotonin and noradrenaline in your brain. Studies have shown that an SNRI can be more effective than an SSRI, though theyre not routinely prescribed as they can lead to a rise in blood pressure. Withdrawal symptoms Antidepressants are not addictive in the same way that illegal drugs and cigarettes are, but when you stop taking them you may have some withdrawal symptoms, including: upset stomach flu-like symptoms anxiety dizziness vivid dreams at night sensations in the body that feel like electric shocks In most cases these are quite mild and last no longer than a week or two, but occasionally they can be quite severe. They seem to be most likely to occur with paroxetine (Seroxat) and venlafaxine (Efexor). Withdrawal symptoms occur very soon after stopping the tablets, so can easily be told apart from symptoms of depression relapse, which tend to occur after a few weeks. Other treatments for depression There is a range of other treatments that people are given for depression. St Johns Wort St Johns Wort is a herbal treatment that you can buy from pharmacies and health food shops. Some people take it for depression. Theres some evidence that it can help the symptoms of mild-to-moderate depression, but doctors dont recommend St Johns Wort because the amount of active ingredients change depending on the brand and batch. This means that you can never be sure what kind of effect it will have. If you take St Johns Wort with other medications, like anticonvulsants, anticoagulants, antidepressants and the contraceptive pill, it can cause serious problems. St Johns Wort can interact with the contraceptive pill and reduce its effectiveness at preventing pregnancy. You shouldnt take St Johns Wort while pregnant or breastfeeding, as we cant be certain that its safe. Electroconvulsive therapy (ECT)  electric shock treatment If you have severe depression and other treatments, like medication, havent worked, ECT might be recommended for you. When receiving ECT, you will be given an anaesthetic and medication that relaxes your muscles to begin with. Electrodes will be placed on your head that give an electrical shock to your brain. ECT is given over a series of sessions, normally twice a week for three to six weeks. ECT can cause side effects including nausea, headaches, aches in the muscles and memory problems. Most people find that ECT is good for relieving severe depression, but the beneficial effects tend to wear off when several months have passed. Lithium If youve tried several different antidepressants and had no improvement, your doctor may offer you a type of medication called lithium in addition to your current treatment. There are two types of lithium: lithium carbonate and lithium citrate. Both are usually effective, but if youre taking one that works for you, its best not to change. If the level of lithium in your blood becomes too high, it can become toxic. Youll therefore need blood tests every three months to check your lithium levels while youre on the medication. Youll also need to avoid eating a low-salt diet because this can also cause the lithium to become toxic. Ask your GP for advice about your diet. \u200bLiving with depression Theres a lot of advice available for living with depression and feeling better. Talking about depression You can find support and insight by talking about depression with another person or a group. According to research, talking can help you to recover and deal better with stress. If you dont feel comfortable talking about your symptoms and feelings with other people, you can write about how you feel or use poetry or art to express yourself  doing this can also help you to feel better. Smoking, drugs, alcohol and depression It might feel like cigarettes and alcohol are helpful, but in the long run they can make you feel worse. If you have depression its especially important to be careful when it comes to cannabis. Research has shown theres a strong connection between mental health problems and cannabis use. According to the evidence, if you smoke cannabis while dealing with depression: your symptoms get worse you feel less interested in things youre more likely to have earlier and more frequent relapses of depression youre less likely to recover fully from depression you feel more tired you wont respond as well to antidepressants youre more likely to stop taking antidepressants You can get advice and support from your GP on cutting down or stopping drinking, smoking, and drug use. Learn more about stopping smoking here Learn more about help to cut down or stop drinking alcohol here Work, money, and depression You might need to take time off work if your depression is caused by working too much, or if the symptoms are making it hard for you to do your job. However, research has shown that taking a long time off work can make depression worse, and that going back to work can help you to get better. When youre dealing with depression its important to avoid as much stress, work-related and otherwise, as you can. If youre working you might be able to change to shorter hours, or work more flexibly. This is especially true if pressure at work causes you to experience depression symptoms. The Equality Act means that employers need to make reasonable adjustments to make it possible to employ people with disabilities  this can include people who have been diagnosed with depression and other mental health conditions. You can find more information about dealing with stress at work here . If your depression means you are unable to work, there are benefits you may be eligible to claim. These include: Attendance Allowance Carers Allowance Council Tax Benefit Personal Independence Payment ( PIP ) Housing Benefit Employment and Support Allowance (ESA) Statutory Sick Pay Bereavement and depression Your depression can be triggered by losing someone who is close to you. The emotional blow suffered when a person you care about dies is powerful  it might feel like you will never recover from the loss. Along with time, the right help and support can make it possible to start living your life again. Find out more about coping with a bereavement here . Looking after someone who has depression If youre close to someone with depression, their condition can affect you too. Your relationship, and family life in general, can be strained, and you might not know what to do or how to help. Talking about the situation can help. Finding a support group, or talking to other people in a similar situation, can make it easier to cope. If the condition is causing difficulties in your relationship with your partner, you could contact a relationship counsellor who can talk things through with both of you. When suffering from depression, men are less likely to ask for help than women. Theyre also more likely to turn to drugs and alcohol to cope with the symptoms. Depression and suicide The majority of suicide cases are linked with mental disorders, and most of them are triggered by severe depression. Warning signs that someone with depression may be considering suicide are: making final arrangements, like giving away their things, making a will or saying goodbye to friends talking about death or suicide  this may be with direct statements, like I wish I was dead, but often depressed people talk about the subject indirectly, saying things like: I think dead people must be happier than us or wouldnt it be nice to go to sleep and never wake up self-harm, like cutting their arms or legs, or burning themselves with cigarettes a sudden lifting of mood, which could mean that a person has decided to commit suicide and feels better because of this decision If youre feeling suicidal or are in a crisis of depression, contact your GP as soon as possible. They will be able to help you. If you cant or dont want to contact your GP, call the Samaritans on 116 123, 24 hours a day, seven days a week. Alternatively, visit the Samaritans website or email jo@samaritans.org . Helping a suicidal friend or relative If you see any of the above warning signs: get professional help for the person let them know theyre not alone and that you care about them offer your support in finding other solutions to their problems If you feel there is an immediate danger, stay with the person or have someone else stay with them, and remove all available means of committing suicide, such as medication. Over-the-counter drugs such as painkillers can be just as dangerous as prescription medication. Also, remove sharp objects and poisonous household chemicals such as bleach. \u200bPsychotic depression Some people who have severe depression will also experience symptoms of psychosis  these are hallucinations and delusional thinking. Depression with psychosis is known as psychotic depression. Symptoms of severe depression People who have severe clinical depression feel sad and hopeless for most of the day, and feel no interest in anything. They feel this way practically every day, and getting through the day feels nearly impossible for them. Other symptoms include: fatigue (exhaustion) losing pleasure in things inability to concentrate difficulty making decisions sleep disturbance appetite changes feeling guilty feeling that theyre worthless having thoughts about suicide, or death Read more about the different types of depression symptoms here . Symptoms of psychosis Moments of psychosis are known as psychotic episodes. The person experiencing a psychotic episode will have: Delusions  beliefs or thoughts that are likely to be false. Hallucinations  hearing, seeing or sometimes smelling, feeling or tasting things that arent there. Hearing voices is a common type of hallucination. Hallucinations and delusions almost always reflect the deeply depressed mood of the person experiencing them. They may believe they have committed a crime or that they are to blame for something. People with psychosis also commonly experience something called psychomotor agitation. People experiencing this cannot sit still or relax, and fidget all the time. The opposite symptom can also happen  psychomotor retardation can cause a persons thoughts and the movement of their body to slow down. People who have psychotic depression are at a higher risk of thinking about suicide. Causes and treatments of psychotic depression We dont fully understand what causes psychotic depression yet. However, we know that depression doesnt have one single cause, and that the condition has a lot of different triggers. Causes of psychotic depression Big, stressful events like divorce, serious illness, financial worries, or bereavement can trigger depression for some people. Severe depression can run in families, which suggests genes might play a role in depression, but the reason some people develop psychosis as part of severe depression is not known. Many people who have psychotic depression have experienced a difficult time in childhood, like a traumatic event. Learn more about causes of clinical depression Treating psychotic depression Treatment for psychotic depression has three main parts: medication  taking a combination of antipsychotics and antidepressants can help to relieve psychosis symptoms psychological therapies  cognitive behavioural therapy (CBT) is a talking therapy done one-to-one with a trained counsellor, and it has succeeded in helping some people with psychosis social support  support with social needs like employment, education and accommodation People with psychotic depression may have to spend some time in hospital to receive treatment. Electroconvulsive therapy (ECT, or electric shock treatment) is sometimes recommended if other treatments, including antidepressants, havent worked for severe depression. Although treatment for psychotic depression is usually very effective, people with the condition still need follow-up appointments with their treatment team so they can be continuously monitored. Getting help for someone with psychotic depression Often friends, relatives, or carers have to seek help for a person with psychotic depression. This is because people with psychosis often dont know theyre acting and thinking strangely. If youre worried about someone you know and think they may be experiencing psychosis, and theyve been diagnosed with a mental health condition before, contact their community mental health team or social worker. If theyve never shown signs of a mental health condition and you think they may be experiencing psychotic depression, contact their GP or take them to Accident and Emergency (A&E). If you think the persons symptoms are putting them at risk, you can: take them to the nearest A&E, if they agree phone their GP phone the local out-of-hours GP phone 999 and ask for an ambulance Advice and support Visit the SANE website or the Mind website for more information, support and advice about psychotic depression. Learn more about psychosis here Depression self-help guide Part of treating and living with depression is learning healthy thought patterns and coping skills that can help when youre feeling depressed. Our mental health self-help guides are based on Cognitive Behavioural Therapy (CBT) and have proven highly successful in helping people with depression and other mental health issues. Depression self-help guide Work through a self-help guide for depression that uses Cognitive Behavioural Therapy (CBT). Depression self-help guide Source: NHS 24 - Opens in new browser window Last updated: 08 January 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Low mood and depression What to do if you're worried someone is depressed Exercise for depression Tips for coping with depression Mind to Mind Coping with money worries Other health sites Choice and Medication: Depression SIGN: Treating depression without using prescribed medication NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Dermatitis herpetiformis,"Dermatitis herpetiformis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Skin, hair and nails Dermatitis herpetiformis Dermatitis herpetiformis Dermatitis herpetiformis (DH) is an autoimmune skin condition that can be linked to coeliac disease . How many people have dermatitis herpetiformis? DH affects around 1 in 10,000 people. DH can appear at any age, but is most commonly diagnosed in those between the ages of 15 and 40. Its more common in men than women and is rare in children. Symptoms of dermatitis herpetiformis (DH) People with DH can have: red, raised patches often with blisters that burst with scratching severe itching and often stinging The rash can affect any area of the skin but is most commonly seen on the: elbows knees buttocks The rash usually occurs on both sides of the body, for example on both elbows. Dermatitis herpetiformis often affects the knees. Source: https://dermnetnz.org/ Gut symptoms Most people with DH will have the same kind of gut damage seen with coeliac disease, but may not complain of gut symptoms like: diarrhoea constipation stomach pain bloating Just over half (60%) of people with DH dont have gut symptoms. Causes of d ermatitis herpetiformis (DH) DH is caused by the bodys immune system reacting to a protein called gluten in foods containing wheat, barley and rye. This reaction causes a skin rash to develop. Diagnosing d ermatitis herpetiformis (DH) A diagnosis of DH is confirmed by a skin test called a skin biopsy. A skin biopsy is a procedure where a sample of skin is removed to be tested. As DH is strongly linked to coeliac disease, blood tests may be taken for this condition as well. What happens during a skin biopsy test? During a skin biopsy test, a specialist skin doctor called a dermatologist will take a small sample of skin from an area without the rash. Samples of skin taken from the area with the rash dont always give an accurate result. The skin sample is then tested. If you test positive for DH youll be referred to a specialist gut doctor called a gastroenterologist to be tested for coeliac disease. Diet before and during diagnosis To ensure an accurate skin test is taken first time, its important to keep eating foods with gluten before and during diagnosis. If youve already removed gluten from your diet, you must reintroduce it in more than one meal every day. You should do this for at least 6 weeks before having the tests. Treating d ermatitis herpetiformis (DH) The treatment for DH is a lifelong gluten-free diet. A gluten-free diet is when all gluten-containing foods are removed from your diet Gluten is found in wheat, barley and rye and sometimes people are sensitive to oats too. A gluten free diet should only start once the diagnosis of DH is given and a referral to a dietitian has been made. Find out how to live with a gluten-free diet How long does treatment take to work? The length of time it takes for the skin to heal varies from person to person but it can take up to 2 years or more. Medication during treatment Some patients will be given medication to help them over this period of recovery. Medication will only be given to control the skin itching and blisters and doesnt treat any other symptoms. The drug most likely to be used is called Dapsone. Dapsone Dapsone is taken in tablet form and must be swallowed. It helps ease the itching and controls the development of blisters. It should work within a few days. If you stop taking Dapsone before the gluten-free diet has taken effect, the rash will return. Side effects of Dapsone The most common side effect of Dapsone is anaemia . Less common side effects are headaches and depression , while nerve damage is rare. Youll always be prescribed the lowest effective dose to help prevent these side effects. DH should be monitored once the drug dose has been reduced. Alternatives to Dapsone Some people cant tolerate Dapsone. If youre one of these people, the following drugs can also be taken to clear the rash: Sulphapyridine Sulphamethoxypyridazine Complications ofd ermatitis herpetiformis (DH) DH can cause the same conditions and complications as coeliac disease . Some potential complications of DH include: osteoporosis certain kinds of gut cancer an increased risk of other autoimmune diseases, such as type 1 diabetes and thyroid disease As with coeliac disease, the risk of developing these is reduced by following a gluten-free diet. Source: Scottish Government - Opens in new browser window Last updated: 05 May 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Coeliac disease Gluten-free diet Other health sites Coeliac UK: Dermatitis herpetiformis NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Diabetes,"About Diabetes | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Diabetes Diabetes Diabetes Diabetes is a lifelong condition that causes a persons blood glucose (sugar) level to become too high. There are two main types of diabetes  type 1 diabetes and type 2 diabetes . Type 2 diabetes is far more common than type 1. In the UK, around 90% of all adults with diabetes have type 2. There are 4.7 million people living with diabetes in the UK. Thats more than one in 15 people in the UK who has diabetes (diagnosed or undiagnosed). This figure has nearly trebled since 1996, when there were 1.4 million. By 2025, it is estimated that 5 million people will have diabetes in the UK. Pre-diabetes Many more people have blood glucose levels above the normal range, but not high enough to be diagnosed as having diabetes. This is sometimes known as prediabetes. If your blood glucose level is above the normal range, your risk of developing full-blown diabetes is increased. Its very important for diabetes to be diagnosed as early as possible because it will get progressively worse if left untreated. When to see a doctor You should therefore visit your GP as soon as possible if you have symptoms, such as feeling thirsty, passing urine more often than usual, and feeling tired all the time. Its also advised to see your GP if you have risk factors of diabetes and are worried about developing diabetes in future. Symptoms of diabetes The main symptoms of diabetes are: feeling very thirsty urinating more frequently than usual, particularly at night feeling very tired weight loss and loss of muscle bulk itching around the penis or vagina, or frequent episodes of thrush cuts or wounds that heal slowly blurred vision Type 1 diabetes can develop quickly over a few hours or even days. Many people have type 2 diabetes for years without realising because the early symptoms tend to be general. What causes diabetes? The amount of glucose in the blood is controlled by a hormone called insulin, which is produced by the pancreas (a gland behind the stomach). When food is digested and enters your bloodstream, insulin moves glucose out of the blood and into cells, where its broken down to produce energy. However, if you have diabetes, your body is unable to break down glucose into energy. This is because theres either not enough insulin to move the glucose, or the insulin produced doesnt work properly. Type 1 diabetes In type 1 diabetes, the bodys immune system attacks and destroys the cells that produce insulin. As insulin production decreases until no more is produced, your glucose levels increase, which can seriously damage the bodys organs. Type 1 diabetes usually develops before the age of 40, often during the teenage years. Type 1 diabetes is less common than type 2 diabetes. In the UK, it affects about 10% of all adults with diabetes. If youre diagnosed with type 1 diabetes, youll need insulin injections for the rest of your life. Youll also need to pay close attention to certain aspects of your lifestyle and health to ensure your blood glucose levels stay balanced. For example, youll need to eat healthily , take regular exercise and carry out regular blood tests. Read more about living with type 1 diabetes Type 2 diabetes Type 2 diabetes is where the body doesnt produce enough insulin, or the bodys cells dont react to insulin. This is known as insulin resistance. If youre diagnosed with type 2 diabetes, you may be able to control your symptoms simply by eating a healthy diet, exercising regularly, and monitoring your blood glucose levels. However, as type 2 diabetes is a progressive condition, you may eventually need medication, usually in the form of tablets. Type 2 diabetes is often associated with obesity . Obesity-related diabetes is sometimes referred to as maturity-onset diabetes because its more common in older people. Read more about living with type 2 diabetes Diabetic eye screening Everyone with diabetes aged 12 or over should be invited to have their eyes screened once a year by the national diabetes retinal screening service. If you have diabetes, your eyes are at risk from diabetic retinopathy, a condition that can lead to sight loss if its not treated. Screening, which involves a half-hour check to examine the back of the eyes, is a way of detecting the condition early so it can be treated more effectively. Read more about diabetic eye screening Gestational diabetes (in pregnancy) During pregnancy, all women need to make more insulin. In some women this doesnt happen and blood glucose levels rise  typically in the middle of pregnancy onwards. Diabetes diagnosed in pregnancy is known as gestational diabetes. Risk of gestational diabetes is increased with the same risk factors for type 2 diabetes (increased weight, at risk ethnicity and family history of diabetes), but also if you have given birth to a baby in the past who was bigger than expected. For most women with gestational diabetes, blood glucose levels will return to normal after pregnancy. Although you will have an increased risk of developing diabetes in later life. If youre worried about gestational diabetes then discuss this with your midwife. Blood glucosecontrol is also very important for women with diabetes before pregnancy (type 1, type 2 or other kinds). If youre planning a pregnancy or are in the early stages of pregnancy, its important to discuss this with your GP, midwife or hospital clinic. Other types of diabetes In addition to Type 1, Type 2 and gestational diabetes, there are a range of other types of diabetes. These types of diabetes are much rarer, with about 2% of people having them. The rare types of diabetes include: different types of monogenic diabetes cystic fibrosis-related diabetes diabetes caused by rare syndromes diabetes caused by certain medications such as steroids and antipsychotics diabetes caused by surgery or hormonal imbalances Unfortunately, many people with rarer types of diabetes are misdiagnosed leading to delays in getting the right treatment. For more information on the other types of diabetes visit Diabetes UK and Diabetes Genes . Source: NHS Grampian - Opens in new browser window Last updated: 17 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Type 1 diabetes Type 2 diabetes Other health sites My Diabetes, My Way NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Diarrhoea,"""Diarrhoea | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Diarrhoea Diarrhoea Return to Symptoms Enter age Last Updated: Next Review Date: Review my answers Find your local services Search for a service near you by entering your postcode below. Please input your postcode in the following format: A12 1BC GP Practices Dental Services Pharmacies Opticians Postcode Search NHS inform has more information on this condition. Read more Previous Start guide Review my answers  You told us your credentials were: : You said: Based on the information you gave us, we made the following recommendation: Close Keep a copy View PDF Diarrhoea is passing looser, watery or more frequent poo (stools) than is normal for you. It affects most people from time to time and is usually nothing to worry about. It can be distressing and unpleasant. It normally clears up in a few days to a week. Diarrhoea self-help guide Complete our self-help guide to check your symptoms and find out what to do next. Phone 999 or got to A&E if you or your child: might have swallowed something poisonous have a stiff neck and pain when looking at bright lights have a sudden, severe headache or stomach ache Speak to your GP if: You or your child has diarrhoea and: its particularly frequent or severe it lasts for more than 7 days youre concerned poo with blood on it persistent vomiting and are unable to keep fluid down a severe or continuous stomach ache weight loss have passed a large amount of very watery diarrhoea it occurs at night and is disturbing sleep have recently taken antibiotics or been treated in hospital have signs of dehydration  including drowsiness, peeing less than usual, and feeling lightheaded or dizzy have poo thats dark or black  this may be a sign of bleeding inside your stomach Your child: has had 6 or more episodes of diarrhoea in the past 24 hours has diarrhoea and vomiting at the same time has stopped drinking fluids while theyre ill is a baby and has vomited 3 times or more in the past 24 hours is under 12 months with diarrhoea and youre worried If your GP is closed, phone 111. What causes diarrhoea? There are many different causes of diarrhoea. A bowel infection ( gastroenteritis ) is a common cause in both adults and children. Gastroenteritis can be caused by: a virus  such as norovirus or rotavirus bacteria  such as campylobacter and Escherichia (E. coli), which are often picked up from contaminated food a parasite  such as the parasite that causes giardiasis, which is spread in contaminated water These infections can sometimes be caught during travelling abroad, particularly to areas with poor standards of public hygiene. This is known as travellers diarrhoea. Diarrhoea can also be the result of anxiety, a food allergy , medication, or a long-term condition, such as irritable bowel syndrome (IBS) . What to do if you have diarrhoea Most cases of diarrhoea clear up after a few days without treatment. You should drink plenty of fluids to avoid dehydration . Drink small sips of water often. Its very important that babies and children do not become dehydrated. Your pharmacist may suggest you use an oral rehydration solution (ORS) if you or you child are particularly at risk of dehydration. You should eat solid foods as soon as you feel able to. If youre breastfeeding or bottle feeding your baby and they have diarrhoea, you should try to feed them as normal. Stay at home until at least 48 hours after the last episode of diarrhoea to prevent spreading any infection to others. Medications to reduce diarrhoea, such as loperamide, are available. However, these are not usually necessary. Most types of medication should not be given to children. Read further information about managing diarrhoea , including what to eat and drink Preventing diarrhoea Diarrhoea is often caused by an infection. You can reduce your risk by making sure you maintain high standards of hygiene. Do wash your hands thoroughly with soap and warm water after going to the toilet and before eating or preparing food clean the toilet, including the handle and the seat, with disinfectant after each episode of diarrhoea avoid sharing towels, flannels, cutlery, or utensils with other household members avoid potentially unsafe tap water and undercooked food when travelling abroad Source: NHS 24 - Opens in new browser window Last updated: 29 May 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Self-help guide: Abdominal pain Dehydration Gastroenteritis Other health sites IBS Network: what is IBS? Lab Tests Online UK: stool sample fitfortravel: Travellers' diarrhoea Find your nearest pharmacy Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Discoid eczema,"Discoid eczema | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Skin, hair and nails Discoid eczema Discoid eczema About discoid eczema Symptoms of discoid eczema Causes of discoid eczema Treating discoid eczema About discoid eczema Discoid eczema is a long-term skin condition that causes skin to become itchy, reddened, swollen and cracked in circular or oval patches. Its also known as discoid dermatitis. The patchescan be a few millimetresto a few centimetres in size and can affect any part of the body, although they dont usually affect the face or scalp. The patches are often swollen, blistered (covered with small fluid-filled pockets) and ooze fluid at first, but becomedry, crusty, cracked and flaky over time. The patches may clear up on their own eventually, but this cantake weeks, months or even years if not treated, and they can recur. Read more about the symptoms of discoid eczema . Discoid eczema caused the skin to become dry, red and itchy. The rash is circular or oval   shape. Source: https://dermnetnz.org/ Discoid eczema can appear as swollen and blistered patches. Source: https://dermnetnz.org/ Seeking medical advice You should see your pharmacist or GP if you think you may have discoid eczema. Your GP should be able to make a diagnosis just by examining the affected areas of skin. In some cases they may also ask questions or arrange some tests to rule out other conditions. Your GP may refer you to a dermatologist (a doctor who specialises in managing skin conditions) if they are unsure of the diagnosis or if you need patch testing. Your GP or specialist can recommend suitable treatments. What causes discoid eczema? The cause of discoid eczema is unknown, although it is often accompanied by dry skin and is thoughtto be triggered by irritation of the skin. Discoid eczematends to affect adults and is rare in children. It is more common among men aged from 50 to 70 and womenin their teens or twenties. Some people with discoid eczema may also have other types of eczema, such as atopic eczema . Read more about the causes of discoid eczema . How discoid eczema is treated Discoid eczema is usually a long-term problem, but medications are available to help relieve the symptoms and keep the condition under control. Treatments used include: emollients moisturisers applied to the skin to stop it becoming dry topical corticosteroids  ointments and creams applied to the skin that can help relieve severe symptoms antihistamines medications that can reduce itching and help you sleep better There are also things you can do yourself to help, such as avoiding all the irritating chemicals in soaps, detergents, bubble baths and shower gels. Additional medication can be prescribed if your eczema is infected or particularly severe. Read more about treating discoid eczema . Symptoms of discoid eczema Discoid eczema causes distinctive circular or oval patches of eczema. The patches can appear anywhere on the body, including the: lower legs forearms trunk (torso) hands feet The face and scalp are notnormally affected. Thefirst sign of discoid eczema isusually a group of small red spots or bumps on the skin. These then quickly join up to form largerpink, red or brown patches that can range from a few millimetres to several centimetres in size. Initially, these patches are often swollen, blistered (covered with small fluid-filled pockets) and ooze fluid. They also tend to be very itchy, particularly at night. Over time, the patches may become dry, crusty, cracked and flaky.The centre of the patch also sometimes clears, leaving a ring ofdiscoloured skin that can be mistaken for ringworm . You may just have one patch of discoid eczema, but most people have several patches. The skin between the patchesis often dry. Patches of discoid eczema can last for weeks, months or even years if not treated, and they can keeping recurring  oftenin the same area that was affected previously. Occasionally, areas of skin affected by discoid eczema can be left permanently discoloured after the condition has cleared up. Discoid eczema can occur anywhere on the body, including the ankles. Source: https://dermnetnz.org/ Signs of an infection Patches of discoid eczema can sometimes become infected. Signs of an infection can include: the patches oozing a lot of fluid a yellow crust developing over the patches the skin around the patches becoming red, hot, swollen, and tender or painful feeling sick chills a general sense of feeling unwell When to seek medical advice You should see your GP or pharmacist if you think you may have discoid eczema, as the condition can take a long time to improve without treatment and it may keep recurring. You should also seek medical advice if you think your skin may be infected, as you may need to use antibiotic cream or, in very severe cases, take antibiotics tablets. Read more about diagnosing discoid eczema . Causes of discoid eczema The cause of discoid eczema is unknown, although it may occur as a result of having particularly dry skin. Dry skin means your skin cannot provide an effective barrier against substances that come into contact with it, which could allowa previously harmless substance, such as soap, to irritate (damage) your skin. Its important to look carefully at all the chemicals in cosmetics and toiletries that may have come into contact with your skin. Contact dermatitis, a type of eczema caused by coming into contact with a particular irritant, may therefore have a role in discoid eczema. Some people with discoid eczema also have a history of atopic eczema , which often occurs in people who are prone to asthma and hay fever . However, unlike atopic eczema, discoid eczema does not seem to run in families. Other possible triggers An outbreak of discoid eczema may sometimes be triggered by a minor skin injury, such as an insect bite or a burn . Some medicines may also be associated with discoid eczema, as patches of eczema can appear in people taking: interferon and ribavirin  when they are used together to treat hepatitis C tumour necrosis factor-alpha (TNF-alpha) blockers  which are used to treat some types of arthritis statins (cholesterol-lowering medication), which can cause dry skin and rashes Dry environments and cold climates can make discoid eczema worse and sunny or humid (damp) environments may make your symptoms better. Treating discoid eczema There is no simple cure for discoid eczema, but there are medications that can help ease the symptoms. These include: emollients  to use all the time soap substitutes  to replace irritating soaps and cleaning products topical corticosteroids  for flare-ups oral corticosteroids  for severe flare-ups antibiotics  for infected eczema antihistamines  for severe itching There are many different preparations for each type of medication and it is worth taking time with your pharmacist to find the best one for you. A range of emollient products, soap substitutes and some topical corticosteroids can be bought from pharmacies without a prescription. Some of them are cheaper to buy this way than with a prescription. Ask your pharmacist for advice on the different products and how to use them. See your GP if your eczema does not improve after using an over-the-counter preparation. Self-help There are also some self-help tipsthat may help to control symptoms of discoid eczema, such as: avoiding soaps and detergents, including liquid soaps, bubble bath, shower gels and wet wipes  even if these do not obviously irritate your skin; you should use an emollient soap substitute instead protecting your skin from minor cuts (for example, by wearing gloves) as they may trigger discoid eczema taking daily lukewarm baths or showers  using an emollient when washing may reduce your symptoms, and remember to apply your treatments soon afterwards not scratching the patches  keeping your hands clean and your fingernails short may help reduce the risk of skin damage or infection from unintentional scratching making sure you use and apply your treatments as instructed by your GP or pharmacist If you suspect your skin is infected, for example because there is excessive weeping or tenderness in the patches of eczema, see your GP. Infection can spread quickly, and the use of topical corticosteroid creams can mask or further spread the infection. Emollients Emollients are moisturising treatments applied directly to the skin to reduce water loss and cover it with a protective film. They are often used to help manage dry or scaly skin conditions such as eczema. Choice of emollient Several different emollients are available. You may need to try a few to find one that works for you. You may also be advised to use a mix of emollients, such as: an ointment for very dry skin a cream or lotion for less dry skin an emollient to use instead of soap an emollient to add to bath water or use in the shower one emollient to use on your face and hands, and a different one to use on your body The difference between lotions, creams and ointments is the amount of oil they contain. Ointments contain the most oil so they can be quite greasy, but are the most effective at keeping moisture in the skin. Lotions contain the least amount of oil so are not greasy, but can be less effective. Creams are somewhere in between. Creams and lotions tend to be more suitable for red, inflamed (swollen) areas of skin. Ointments are more suitable for areas of dry skin that are not inflamed. If you have been using a particular emollient for some time, it may eventually become less effective or may start to irritate your skin. If this is the case, your GP will be able to prescribe another product. How to use emollients Use your emollient all the time, even if you are not experiencing symptoms as they can help limit the return of your condition. Many people find it helpful to keep separate supplies of emollients at work or school. To apply the emollient: use a large amount dont rub it in, smooth it into the skin in the same direction that the hair grows instead for very dry skin, apply the emollient every two to three hours after a bath or shower, gently dry the skin and then immediately apply the emollient while the skin is still moist If you are exposed to irritants at work, make sure you apply emollients regularly during and after work. Dont share emollients with other people. Side effects Occasionally, some emollients can irritate the skin. If you have discoid eczema, your skin will be sensitive and can react to certain ingredients in over-the-counter emollients. If your skin reacts to the emollient, stop using it and speak to your GP, who can recommend an alternative product. Emollients added to bath water can make your bath very slippery, so take care getting in and out of the bath. Topical corticosteroids To treat the patches of discoid eczema, your GP may prescribe a topical corticosteroid (corticosteroid medication that is applied directly to your skin) to reduce the inflammation. You may be concerned about using medication that contains steroids. However, corticosteroids are not the same as anabolic steroids, which are sometimes used by bodybuilders and athletes. When used as instructed by your pharmacist or doctor, corticosteroids are a safe and effective treatment for discoid eczema. Choice of topical corticosteroid There are different strengths of topical corticosteroids that can be prescribed depending on the severity of your eczema. Discoid eczema usually needs a stronger type of corticosteroid than other types of eczema. You might be prescribed a cream to be used on visible areas, such as face and hands, and an ointment to be used at night or for more severe flare-ups. How to use topical corticosteroids When using corticosteroids, apply the treatment accurately to the affected areas. Unless instructed otherwise by your doctor, you should follow directions on the patient information leaflet that comes with the corticosteroid. Do not apply the corticosteroid more than twice a day. Most people will only have to apply it once a day. To apply the topical corticosteroid, take the following steps: apply your emollient first and ideally wait around 30 minutes before applying the topical corticosteroid, until the emollient has soaked into your skin apply agood amount of the topical corticosteroid to the affected area use the topical corticosteroid until the inflammation has cleared up, unless otherwise advised by your GP Speak to your prescriber if you have been using a topical corticosteroid and your symptoms have not improved. Side effects Topical corticosteroids may cause a mild and short-lived burning or stinging sensation as you apply them. In rare cases, they may also cause: thinning of the skin changes in skin colour acne (spots) increased hair growth Most of these side effects will improve once treatment stops. Generally, using a stronger topical corticosteroid, or using a large amount of topical corticosteroid, will increase your risk of getting side effects. For this reason, you should use the weakest and smallest amount possible to control your symptoms. Corticosteroid tablets If you have a severe flare-up, your doctor may prescribe corticosteroid tablets to take for up to a week. If corticosteroid tablets are taken often or for a long time, they can cause a number of side effects, such as: reduced growth rate in children high blood pressure (hypertension) osteoporosis (brittle bones) diabetes For this reason, your doctor is unlikely to prescribe repeat courses of corticosteroid tablets without referring you to a specialist. Antibiotics If your eczema becomes infected, you may also be prescribed an antibiotic. Oral antibiotics If you have an extensive area of infected eczema, you may be prescribed an antibiotic to take by mouth. This is most commonly flucloxacillin, which is usually taken for one week. If you are allergic to penicillin, you might be given an alternative such as clarithromycin. Topical antibiotics If you have a small amount of infected eczema, you will normally be prescribed a topical antibiotic, such as fusidic acid. This meansthe medicine is applied directly to the affected area of skin, in the form of an ointment or cream. Some topical antibiotics are available in creams or ointments that also contain topical corticosteroids. Topical antibiotics should normally be used forup to 2weeks as necessary. Antihistamines Antihistamines are a type of medicine that work by stopping the effects of a substance in the blood called histamine. Your body often releases histamine when it comes into contact with an irritant. Histamine can cause a wide range of symptoms, including sneezing, watery eyes and itching. Antihistamines may be prescribed during flare-ups of discoid eczema to cope with the symptom of itching, particularly if it is interfering with your sleep. However, they will not treat the damaged skin. Many older types of antihistamines can make you drowsy, which can be useful if your symptoms affect the quality of your sleep. Otherwise, ask your pharmacist or GP to recommend one of the more modern non-sedating antihistamines. Further treatments If the treatments prescribed by your GP are not successfully controlling your symptoms, they may refer you for assessment and treatment by a dermatologist (specialist in treating skin conditions). Further treatments that may be available from your dermatologist include: phototherapy  where the affected area of skin is exposed to ultraviolet (UV) light to help reduce inflammation bandaging  where medicated dressings are applied to your skin immunosuppressant therapy  medicines that reduce inflammation by suppressing your immune system Source: NHS 24 - Opens in new browser window Last updated: 09 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Varicose eczema Atopic eczema Other health sites National Eczema Society: discoid eczema BAD: discoid eczema BAD: atopic eczema Allergy UK: atopic eczema NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Diverticular disease and diverticulitis,"Diverticular disease | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Diverticular disease and diverticulitis Diverticular disease and diverticulitis About diverticular disease and diverticulitis Symptoms of diverticular disease and diverticulitis Causes of diverticular disease and diverticulitis Diagnosing diverticular disease and diverticulitis Treating diverticular disease and diverticulitis Complications of diverticular disease and diverticulitis Preventing diverticular disease and diverticulitis About diverticular disease and diverticulitis Diverticular disease and diverticulitis are related digestive conditions that affect the large intestine (colon). Indiverticular disease,small bulges or pockets (diverticula) develop in the lining of the intestine. Diverticulitis is when these pocketsbecome inflamed or infected. Symptoms of diverticular disease include: lower abdominal pain feeling bloated The majority of people with diverticula will not have any symptoms; this is known as diverticulosis. Symptoms of diverticulitis tend to be more serious and include: more severe abdominal pain, especially on the left side high temperature (fever) of 38C (100.4F) or above diarrhoea or frequent bowel movements Read more about the symptoms of diverticular disease and diverticulitis . Diverticulosis, diverticular diseaseand diverticulitis Diverticula Diverticula is the medical term used to describe the small bulges that stick out of the side of the large intestine (colon). Diverticula are common and associated with ageing. The large intestine becomes weaker with age, and the pressure of hard stools passing through the large intestineis thought tocause the bulges to form. Read more about the causes of diverticula . Its estimated that5% of people have diverticula by the time they are 40 years old, and at least 50% of people have them by the time they are 80 years old. Diverticular disease 1in 4people who develop diverticula will experience symptoms, such as abdominal pain. Having symptoms associated with diverticula is known as diverticular disease. Diverticulitis Diverticulitis describes infection that occurs when bacteria becomes trapped inside one of the bulges, triggering more severe symptoms. Diverticulitis can lead to complications, such as an abscess next tothe intestine. Read more about the complications of diverticulitis . Treating diverticular disease and diverticulitis A high-fibre diet can often easesymptoms of diverticular disease, and paracetamol can be used to relieve pain other painkillers such as aspirin or ibuprofen are not recommended for regular use, as they can cause stomach upsets. Speak to your GP if paracetamol alone is not working. Mild diverticulitis can usually be treated at home with antibiotics prescribed by your GP. More serious cases may need hospital treatment to prevent and treat complications. Surgery to remove theaffected section of the intestine is sometimes recommended if there have been serious complications, although this is rare. Read more about treating diverticular disease and diverticulitis . Who is affected Diverticular disease is one of the most common digestive conditions. Both sexes are equally affected by diverticular disease and diverticulitis, although the condition is more likely to appear at a younger age (under 50) in men than in women. Overall, symptoms of diverticulitis are most likely to occur in people over 70 years old. Diverticular disease is often described as a Western disease because the rates are high in European and North American countries, and low in African and Asian countries. A combination of genetics and diet is thought to be the reason for this and the fact that people in Western countries tend toeat less fibre. People aged 50 to 70 who eat a high-fibre diet (25g a day) have a 40% lower chance of admission to hospital with complications of diverticular disease  compared to others in their age range with the lowest amount of dietary fibre. Symptoms of diverticular disease and diverticulitis Symptoms of diverticular disease and diverticulitis include abdominal pain, bloating and a change in normal bowel habits. Diverticulosis If diverticula have been discovered during a camera test for another reason (colonoscopy) or during a CT scan, you may be worried about what this means. However, if you have never had abdominal pain or bouts of diarrhoea, there is a 70% to 80% chance that you will never have any symptoms from them. Diverticulaareextremely common over the age of 70 and they do not increase your risk of cancer.Its thought that a high-fibre diet is likely to reduce the risk of any symptoms developing. Diverticular disease The most common symptom of diverticular disease is intermittent (stop-start) pain in your lower abdomen (stomach), usually in the lower left-hand side. The pain is often worse when you are eating, or shortly afterwards. Passing stools and breaking wind (flatulence) may helprelieve the pain. Other long-term symptoms of diverticular disease include: a change in your normal bowel habits, such as constipation or diarrhoea , or episodes of constipation that are followed by diarrhoea  a classic pattern is multiple trips to the toilet in the morning to pass stools like rabbit pellets bloating Another possible symptom of diverticular disease isbleeding dark purple blood from your rectum (back passage). This usually occurs after diarrhoea-like cramping pain, and often leads to hospital admission, but fortunately this isan uncommon complication. Diverticular disease does not cause weight loss, so if you are losing weight, seeing blood in your stools or experiencing frequent bowel changes, see your GP. Diverticulitis Diverticulitis sharesmost of the symptoms of diverticular disease (see above). However, thepain associated with diverticulitis is constant and severe, rather than intermittent. It is most likely to occur if you have previously had symptoms of diverticular disease, and develops over a day or 2. Other symptoms of diverticulitis can include: a high temperature (fever) of 38C (100.4F) or above a general feeling of being tired and unwell feeling sick (nausea) or being sick (vomiting) The pain usually starts below your belly button, before moving to the lower left-hand side of your abdomen. In Asian people, the pain may move to the lower right-hand side of your abdomen. This is because East Asian people tend to develop diverticula in a different part of their colon for genetic reasons. When to seek medical advice Contact your GP as soon as possible if you think you have symptoms of diverticulitis. If you have symptoms of diverticular disease and the condition has previously been diagnosed, you do not usually need to contact your GP asthe symptoms can be treated at home. Read more about the treatment ofdiverticular disease . If you have not been diagnosed with the condition, contact your GP so they can rule out other conditions with similar symptoms, such as: a stomach ulcer pancreatitis cholecystitis bowel cancer Irritable bowel syndrome (IBS) can also cause similar symptoms to diverticular disease. Causes of diverticular disease and diverticulitis Diverticular disease is caused by small bulges in the large intestine (diverticula) developing and becoming inflamed. If any of the diverticula become infected, this leads to symptoms of diverticulitis. The exact reason why diverticula develop is not known, buttheyare associated with not eating enough fibre. Fibre makes your stools softer and larger, so less pressure is needed by your large intestine to push them out of your body. The pressure of moving hard, small pieces of stools through yourlarge intestine creates weak spots in the outside layer of muscle. This allows the inner layer (mucosa)to squeeze through these weak spots, creating the diverticula. There is currently no clinical evidence to fully prove the link between fibre and diverticula. However, diverticular disease and diverticulitis are both much more common in Western countries, where many people do not eat enough fibre. Diverticular disease It is not known why only 1in 4people with diverticula go on to have symptoms of diverticulitis. Diverticular disease may be chronic low-level diverticulitis. The symptoms are very similar to irritable bowel syndrome (IBS) and may overlap. However,factors that appear to increase your risk of developing diverticular disease include: smoking being overweight or obese having a history of constipation use of non-steroidal anti-inflammatory drugs (NSAIDs) painkillers, such as ibuprofen or naproxen having a close relative with diverticular disease, especially if they developed it under the age of 50 Exactly how these lead to developing diverticular disease is unclear. Diverticulitis Diverticulitis is caused by an infection of one or more of the diverticula. It is thought an infection develops when a hard piece of stool or undigested foodgets trapped in one of the pouches. This gives bacteria in the stool the chance to multiply and spread, triggering an infection. Diagnosing diverticular disease and diverticulitis Diverticular disease can be difficult to diagnose from the symptoms, alone because there are other conditions that cause similar symptoms, such as irritable bowel syndrome (IBS) . As a first step, your GP may recommend blood tests to rule out other conditions such as coeliac disease (a condition caused by an abnormal immune response to gluten) or bowel cancer . In some cases, you may be offered treatment for IBS and diverticular disease at the same time. Colonoscopy To make sure there is not a more serious cause of your symptoms, your GP may refer you for a colonoscopy, where athin tube with a camera at the end (a colonoscope) is inserted into your rectum and guided into your colon. Before the procedure begins, you will be given a laxative to clear out your bowels. A colonoscopy is not usually painful,but itcan feel uncomfortable. You may beoffered painkilling medicationand asedative beforehand to make you feel more relaxed and helpreduce any discomfort. CT pneumocolon or colonography Another technique for confirming the presence of diverticula is a computerised tomography (CT scan) . A CT scan uses X-rays and a computer to create detailed images of the inside of the body. As with a colonoscopy, you will be given a laxative to clear out your bowels before you have the CT scan. Unlike a regular CT scan, the colonography scan involves a tube being inserted into your rectum, which is used topump some airup into your rectum. The CT scan is then taken with you lying on your front, and again lying on your back. You may need to have an injection of contrast dye before the scan, but this is not always necessary. Diverticulitis If you have had a previous history of diverticular disease, your GP will usually be able to diagnose diverticulitis from your symptoms and aphysical examination. A blood test may be taken, because a high number of white blood cells indicates infection. If your symptoms are mild, your GP will treat it at home and you should recover within 4days. Further tests will be needed if you have no previous history of diverticular disease. If you are unwell, your GP may refer you to hospital for blood tests and investigations. This is to look for complications of diverticulitis and to rule out other possible conditions, such as gallstones or a hernia. An ultrasound scan may be used, as well as a CT scan. A CT scan may also be used if your symptoms are particularly severe. This is to check whether a complication, such as a perforation or anabscess, has occurred. Treating diverticular disease and diverticulitis Treatment options for diverticular disease and diverticulitis depend on how severe your symptoms are. Diverticular disease Most cases of diverticular disease can be treated at home. The over-the-counter painkiller paracetamol is recommended to help relieve your symptoms. Painkillers known as non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, are not recommended because they may upset your stomach and increase your risk of internal bleeding. Eating a high-fibre diet may initially help to control your symptoms. Some people will notice an improvement after a few days, although it can take around a monthto feel the benefits fully. Read more advice about using diet to improve the symptoms ofdiverticular disease . If youhave constipation , you may be given a bulk-forming laxative. These can cause flatulence (wind) and bloating. Drink plenty of fluids to prevent any obstruction in your digestive system. Heavy or constant rectal bleeding occurs in about 1 in20 cases of diverticular disease. This can happen if the blood vessels in your large intestine (colon) are weakened by the diverticula, making them vulnerable to damage. The bleeding is usually painless, but losing too much blood can be potentially serious and may need a blood transfusion . Signs that you may be experiencing heavy bleeding (aside from the amount of blood) include: feeling very dizzy mental confusion pale clammy skin shortness of breath If you suspect that you (or someone in your care) is experiencing heavy bleeding, seek immediate medical advice. Contact your GP at once. If this is not possible then phone NHS 24 111 service or your local out-of-hours service . Diverticulitis Treatment at home Mild diverticulitis can often be treated at home. Your GP will prescribe antibiotics for the infection and you should take paracetamol for the pain.Its important that you finish the complete course of antibiotics, even if you are feeling better. Some types of antibiotics used to treat diverticulitis can cause side effects in some people, including vomiting and diarrhoea . Your GP may recommend that you stick to a fluid-only diet for a few days until your symptoms improve. This is because trying to digest solid foods may make your symptoms worse. Youcan gradually introduce solid foods over the next 2or 3days. For the 3to 4days of recovery, a low-fibre diet is suggested, until you return to the preventative high-fibre diet. This is to reduce the amount of faeces (poo) your large bowel has todeal withwhile it is inflamed. If you have not been diagnosed with diverticular disease before, your GP may refer you for a test such as acolonoscopy orCT colonographyafter the symptoms have settled. Treatment at hospital If you have more severe diverticulitis, you may need to go to hospital, particularly if: your pain cannot be controlled using paracetamol you are unable to drink enough fluids to keep yourself hydrated you are unable to take antibiotics by mouth your general state of health is poor you have a weakened immune system your GP suspects complications your symptoms fail to improve after 2 days of treatment at home If you are admitted to hospital for treatment, you are likelyto receive injections of antibiotics and be kept hydrated and nourished using an intravenous drip (a tube directly connected to your vein). Most people start to improve within 2to 3days. Surgery In the past, surgery was recommended as a preventative measure for people who had 2episodes of diverticulitis as a precaution to prevent complications. This is no longer the case, as studies have found that in most cases, risks of serious complications from surgery (estimated to be around 1 in 100) usually outweigh the benefits. However, there are exceptions to this, such as: if you have a history of serious complications arising from diverticulitis if you havesymptoms of diverticular disease froma young age (it is thought the longer you live with diverticular disease, the greater your chances of having a serious complication) if you have a weakened immune system or are more vulnerable toinfections If surgery is being considered, discuss bothbenefits and risks carefully with the doctor in charge of your care. In rare cases, a severe episode of diverticulitis can only be treated with emergency surgery. This is when a hole (perforation) has developed in the bowel. This is uncommon, but causes very severe abdominal pain, which needs an emergency trip to hospital. Colectomy Surgery for diverticulitis involves removing the affected section of yourlarge intestine. This is known as a colectomy. There are 2ways this operation can be performed: an open colectomy where the surgeon makes a large incision (cut) in your abdomen (stomach) and removes a section of yourlarge intestine laparoscopic colectomy  a type of keyhole surgery where the surgeon makes a number of small incisions in your abdomen and uses special instrumentsguided by a camera to remove a section oflarge intestine Open colectomies and laparoscopic colectomies are thought equally effective in treating diverticulitis, and have a similar risk of complications. People who have laparoscopic colectomies tend to recover faster and have less pain after the operation. Emergency surgery when the bowel has perforated is more likely to be open and may result in a stoma being formed. Stoma surgery (having a bag) In some cases, the surgeon may decide yourlarge intestine needs to heal before it can be reattached, or that too much of yourlarge intestine has been removed to make reattachment possible. In such cases, stoma surgery provides a way of removing waste materials from your body without using all of yourlarge intestine. It is known as having a bag as a bag is stuck to the skin on your belly and the faeces (poo) are collected in the bag. Stoma surgery involves the surgeon making a small hole in your abdomen  known as a stoma. There are 2ways this procedure can be carried out. An ileostomy where a stoma is made in the right-hand side of your abdomen. Your small intestine is separated from yourlarge intestine and connected to the stoma, and the rest of thelarge intestine is sealed. You will need to wear a pouch connected to the stoma to collect waste material (poo). A colostomy where a stoma is made in your lower abdomen and a section of yourlarge intestine is removed and connected to the stoma. As with an ileostomy, you will need to wear a pouch to collect waste material. In most cases, the stoma will be temporary and can be removed once yourlarge intestine has recovered from the surgery. This will depend on the situation when you had the operation. If it was an emergency operation, you may need a few months to recover before having surgery to reverse the stoma. If a large section of yourlarge intestine is affected by diverticulitis and needs to be removed, or if you have multiple other conditions that make major surgery a risk, you may need a permanent ileostomy or colostomy. Results of surgery In general terms, elective (non-emergency) surgery is usually successful, although it does not achieve a complete cure in all cases. Following surgery, an estimated 1 in 12 people will have a recurrence of symptoms of diverticular disease and diverticulitis. In an emergency setting, the success rate depends on how unwell you are when you require the operation. Complications of diverticular disease and diverticulitis Complications of diverticulitis affect 1in 5people with the condition. Those most at risk are aged under 50. Bleeding Around 15% of people with diverticular disease or diverticulitis experience bleeding,which is usually painless, quick and resolves itself in 70% to 80% of cases. However,if the bleeding does not resolve itself,an emergency blood transfusion may be required due to excessive bleeding. If the bleeding is severe, you may need to be admitted to hospitalfor monitoring. Urinary problems Diverticulitis can lead to the inflamed part of the bowelbeing in contact withthe bladder.This maycause urinary problems, such as: pain when urinating (dysuria) needing to urinate more often than usual in rare cases, air in the urine Abscess The most common complication of diverticulitis is an abscess outside the large intestine (colon). An abscess is a pus-filled cavity or lump in the tissue. Abscesses are usually treated with a technique known as percutaneous abscess drainage (PAD). A radiologist (a specialist in the use of imaging equipment, such as computerised tomography (CT) scans) uses an ultrasound or CT scanner to locate the site of the abscess. A fine needle connected to a small tube is passed through the skin of your abdomen (stomach) and into the abscess. The tube is then used to drain the pus from the abscess. A PAD is performed under a local anaesthetic. Depending on the size of the abscess, the procedure may need repeating several times before allthe pus has been drained. If the abscess is very small  usually less than 4cm (1.5 inches)  it may be possible to treat it using antibiotics . Fistula Afistula is anothercommon complication of diverticulitis. Fistulas are abnormal tunnels that connect 2parts of the body together, such as your intestine and your abdominal wall or bladder. If infected tissues come into contact with each other, they can stick together. After the tissues have healed, a fistula may form. Fistulas can be potentially serious as they can allow bacteria in your large intestine to travel to other parts of your body, triggering infections, such as an infection of the bladder ( cystitis ). Fistulas are usually treated with surgery to remove the section of the colon that contains the fistula. Peritonitis In rare cases, an infected diverticulum (pouch in your colon) can split, spreading the infection into the lining of your abdomen (perforation). An infection of the lining of the abdomen is known as peritonitis. Peritonitis can be life-threatening, and requires immediate treatment with antibiotics. Surgery may also be required todrain any pus that has built up, and it may be necessary to perform a colostomy . Intestinal obstruction If the infection has badly scarred yourlarge intestine, it may become partially or totally blocked. A totally blockedlarge intestine is a medical emergency because the tissue of yourlarge intestine will start to decay and eventually split, leading to peritonitis. A partially blockedlarge intestine is not as urgent, but treatment is still needed. If left untreated, it will affect your ability to digest food and cause you considerable pain. Intestinal blockage from diverticular disease is very rare. Other causes, such as cancer, are more common. This is one of the reasons your GP will investigate your symptoms. In some cases, the blocked partcan be removed duringsurgery. However, if the scarring and blockage is more extensive, a temporary or permanent colostomy may be needed. Preventing diverticular disease and diverticulitis Eating a high-fibre diet may help prevent diverticular disease, and should improve your symptoms. Your diet should be balanced and include at least 5portions of fruit and vegetables a day, plus whole grains. Adults should aim to eat 18g (0.6oz) to 30g (1.05oz) of fibre a day, depending on their height and weight. Your GP can provide a more specific target, based on your individual height and weight. Its recommended that you gradually increase your fibre intake over the course of a few weeks. This will help prevent side effects associated with a high-fibre diet, such as bloating and flatulence (wind). Drinking plenty of fluids will also help prevent side effects. If you have established diverticular disease, it may be suggested that you avoideatingnuts, corn and seedsdue tothe possibility thatthey could block the diverticular openings and cause diverticulitis. People usually find out themselves if these foods cause symptoms. Probiotics have also been recommended, but evidence is lacking. Overall, there is a lack of good quality scientific evidence on how to prevent diverticular disease. Sources of fibre Good sources of fibre include fruit vegetables nuts breakfast cereals  but check fibre content as some are very low starchy foods  such as brown bread, rice and pasta Once you have reached your fibre target, stick to it for the rest of your life, if possible. Fresh fruit Good sources of fibre in fresh fruit (plus the amount of fibre that is found in typical portions) include: avocado pear  a medium-sized avocado pear contains 4.9g of fibre pear (with skin)  a medium-sized pear contains 3.7g of fibre orange  a medium-sized orange contains 2.7g of fibre apple (with skin)  a medium-sized apple contains 2g of fibre raspberries  2handfuls of raspberries (80g) contain 2g of fibre banana  a medium-sized banana contains 1.7g of fibre tomato juice  1small glass of tomato juice (200ml) contains 1.2g of fibre Dried fruit Good sources of fibre in dried fruit (plus the amount of fibre found in typical portions) include: apricots  3whole apricots contain 5g of fibre prunes  3whole prunes contain 4.6g of fibre Vegetables Good sources of fibre in vegetables (plus the amount of fibre found in typical portions) include: baked beans (in tomato sauce)  a half can of baked beans (200g) contains 7.4g of fibre red kidney beans (boiled)  3tablespoons of red kidney beans contain 5.4g of fibre peas (boiled)  3heaped tablespoons of peas contain 3.6g of fibre French beans (boiled)  4heaped tablespoons of French beans contain 3.3g of fibre Brussel sprouts (boiled)  8Brussel sprouts contain 2.5g of fibre potatoes (old, boiled)  1medium-sized potato contains 2.4g of fibre spring greens (boiled)  4heaped tablespoons of Spring greens contain 2.1g of fibre carrots (boiled, sliced)  3heaped tablespoons of carrots contain 2g of fibre Nuts Good sources of fibre in nuts (plus the amount of fibre found in typical portions) include: almonds  20 almonds contain 2.4g of fibre peanuts (plain)  a tablespoon of peanuts contains 1.6g of fibre mixed nuts  a tablespoon of mixed nuts contains 1.5g of fibre Brazil nuts  10 Brazil nuts contain 1.4g of fibre Breakfast cereals Good sources of fibre in breakfast cereals (plus the amount of fibre found in typical portions) include: All-Bran  a medium-sized bowl of All-Bran contains 9.8g of fibre Shredded Wheat  2pieces of Shredded wheat contain 4.3g of fibre Bran Flakes  1medium-sized bowl of Bran flakes contains 3.9g of fibre Weetabix  2Weetabix contain 3.6g of fibre muesli (no added sugar)  1medium-sized bowl of muesli contains 3.4g of fibre porridge (milk or water)  1medium-sized bowl of porridge contains 2.3g of fibre Note  the own-brand equivalents of the cereals mentioned shouldcontain similar levels of fibre. Starchy foods Good sources of fibre in starchy food (plus the amount found in typical portions) include: crispbread  4crispbreads contain 4.2g of fibre pitta bread (wholemeal)  1piece (75g) contains 3.9g of fibre pasta (plain, fresh-cooked)  1medium portion of pasta (200g) contains 3.8g of fibre wholemeal bread  2slices of wholemeal bread contain 3.5g of fibre naan bread  1piece of naan bread contains 3.2g of fibre brown bread  2slices of brown bread contain 2.5g of fibre brown rice (boiled)  1medium portion of brown rice (200g) contains 1.6g of fibre Fibre supplements  usually in the form of sachets of powder you mix with water  are also available from pharmacists and health food shops. Some contain sweetener. A tablespoon of fibre supplement contains around 2.5g of fibre.If you require long-term fibre supplements, your GP can prescribe them. Source: NHS 24 - Opens in new browser window Last updated: 13 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Health benefits of eating well Self-help guide: Abdominal pain NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Dizziness (Lightheadedness),"Dizziness (lightheadedness) - Illnesses & conditions Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Dizziness (lightheadedness) Dizziness (lightheadedness) Dizziness (lightheadedness) is a common symptom thats not usually a sign of anything serious, but should beinvestigated by a doctor. The term dizziness means different things to different people some use it to describe feeling lightheaded or off balance, while others use it to describe a feelingthat their surroundings are spinning. Because thesymptom is quite vague and can be caused bya wide range of things, it may not always be easy to identify the underlying cause. Thispage explains what you should do if you feeldizzy for no apparent reason, and outlines the most common causes. When to seek help with dizziness Speak to your GP if you: are feeling lightheaded or off balance have fainting episodes experienceheadaches Your GP will want to establish exactly what you mean by dizziness, and check that youre not actually describing vertigo  a severe type of dizziness,where you feel your surroundings are spinning or moving. Theyll also want to know: whether the dizziness started for no apparent reason, or if it followed an illness whether you have repeated episodes of dizziness and, if so, when you tend to experience these how long the dizziness lasts Dizziness can sometimes be caused by an ear condition. A simple way of distinguishing between ear-related dizziness and dizziness due to other causes is todetermine whether it occurs only when youre upright or also when youre lying down. If feeling dizzyoccurswhen youre upright its probably not related to the ear. If it happens when youre lying down, its usually caused by a viral ear infection, which cant be treated with antibiotics . Its a good idea to keep a diary recording when and where you feel dizzy and take it with you to your GP appointment. Its helpful to note: what you were doing at the time you felt dizzy how long it lasted and how bad it was whether you had any other symptoms such as fainting,vomiting, nausea, blurred vision, headache, hearing loss or tinnitus If youre taking prescription medicine, your GP will probably review this to check whether dizziness is a possible side effect. If necessary, they can prescribe a different medication for you to try. You may be referred to a specialist for further tests and investigations. Common causes of dizziness The most common causes are: labyrinthitis an inner ear infection that affects your hearing and balance, and can lead to a severe form of dizziness called vertigo migraine  dizziness may come on before or after the headache, or even without the headache stress or anxiety  particularly if you tend to hyperventilate (breathe abnormally quickly when resting) low blood sugar level (hypoglycaemia)  which is usually seen in people with diabetes postural hypotension  a sudden fall in blood pressure when you suddenly sit or stand up, which goes away after lying down. This is more common in older people dehydration orheat exhaustion dehydration could bedue to not drinking enoughduring exercise, or illness that causesvomiting, diarrhoea or fever vertebrobasilar insufficiency decreased blood flow in the back of the brain, which may be caused by the blood vessels that lead to the brain from the heart being blocked (known as atherosclerosis) Less common causes of dizziness Less common causes include: having a severe illness or condition that affects the whole body using recreationaldrugsor consuming excessive amounts of alcohol (either binge drinking or long-term alcohol misuse ) certain types of prescription medicine  such as antidepressants or blood pressure medication having aheart rhythm problem  such as atrial fibrillation (a fast, irregular heartbeat) carbon monoxide poisoning Source: NHS  24 - Opens in new browser window Last updated: 07 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Labyrinthitis Headaches Self-help guide: Headache Other health sites Brain and Spine Foundation: Dizziness and balance problems NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Downs syndrome,"""Down's syndrome - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Downs syndrome Downs syndrome A babywith Downs syndrome is born with more of chromosome 21 in some or all of the cells that make up their DNA. Its also known as Trisomy 21. People with Downs syndrome may lead active, healthy and independent lives into their 60s, 70s and beyond. Most will have mild to moderate learning disabilities and some may have more complex needs. It cannot be known before birth if a person will need any additional help and support. Living with Downs syndrome There are increasing opportunities and support in education, work and housing for people with Downs syndrome. People with Downs syndrome canlive healthy and fulfilling lives as part of their families and communities. Some may: live independently have jobs be in relationships socialise with minimal support. Evidence suggests most families of people with the condition feel satisfied with their lives. Many children with Downs syndrome attend mainstream school and receive additional support if they need it. Congenital and rare condition register Babies with Downs syndrome are included in the secure congenital and rare condition (CARDRISS) register. The register is maintained by Public Health Scotland. The register records how many babies have this condition, and some relevant personal information. Its also used to support the planning and improvement of health, care, and other public services. Read more about CARDRISS Downs syndrome and health Many children with Downs syndrome have similar health conditions to all children. Some health conditions can be more common in people with Downs syndrome, but some are less common. Around half of all children with Downs syndrome will have heart issues, although fewer than 1 in 5 of those may need surgery. Theyre more likely to have muscle tone and digestion issues and may have reduced hearing or vision. However, theyre less likely to develop some cancers and types of heart disease. Regular health checks can make sure any health conditions are picked up early and managed. Downs syndrome is not a life-limiting condition. People with the condition can lead active, healthy and fairly independent lives into their 60s, 70s and beyond. Screening for Downs syndrome During your pregnancy youll be offered a screening test to detect if your baby might have Downs syndrome. All pregnant women, no matter what age, can be tested. A blood test and nuchal translucency (NT) scan can be used to screen for this condition. Further information You can get more information about Downs syndromeand find out about life with a child with the condition at Downs Syndrome Scotland . Source:\r\n                                        Down's Syndrome Scotland - Opens in new browser window Last updated: 21 February 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Dry mouth,"Dry mouth | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Mouth Dry mouth Dry mouth Its normal to occasionally have a dry mouth if youre dehydrated or feeling nervous. A persistently dry mouth can be a sign of an underlying problem though. Contact your dentist or GP if: You have a dry mouth and: your mouth is still dry after trying home or pharmacy treatments for a few weeks you have difficulty chewing, swallowing or talking youre struggling to eat regularly youre having problems with your sense of taste that are not going away your mouth is painful, red, swollen or bleeding you have sore white patches in your mouth you think a prescribed medicine might be causing your dry mouth you have other symptoms, like needing to pee a lot or dry eyes The GP can check what the cause might be and recommend treatment for it. What can cause a dry mouth? A dry mouth can happen when the salivary glands in your mouth do not produce enough saliva. This is often the result of dehydration . This means you do not have enough fluid in your body to produce the saliva you need. Its also common for your mouth to become dry if youre feeling anxious or nervous. A dry mouth can sometimes be caused by an underlying problem or medical condition, such as: medication  many different medications can cause a dry mouth including antidepressants , antihistamines and diuretics a blocked nose  breathing through your mouth while you sleep can cause it to dry out diabetes  a lifelong condition that causes a persons blood sugar level to become too high radiotherapy to the head and neck  this can cause the salivary glands to become inflamed (mucositis) Sjgrens syndrome  a condition where the immune system attacks and damages the salivary glands If you contact your dentist or GP, tell them about any other symptoms youre experiencing. Also tell them about any treatments youre having. This will help them work out why your mouth is dry. What problems can a dry mouth cause? Saliva plays an important role in keeping your mouth healthy. If you have a dry mouth, you may experience some other problems, such as: a burning sensation or soreness in your mouth dry lips bad breath (halitosis) a reduced or altered sense of taste mouth infections that keep coming back, such as oral thrush tooth decay and gum disease difficulty speaking, eating or swallowing Its important to maintain good oral hygiene if you have a dry mouth. This can reduce the risk of dental problems. You should also see a dentist regularly, so they can identify and treat any problems early on. Treating a dry mouth If your doctor or dentist is able to find out whats causing your dry mouth, treating this may help your symptoms. If medication is suspected as a cause, for example, your doctor may lower your dose or suggest trying a different treatment. Some of the conditions mentioned have specific treatments, like: nasal decongestants for a blocked nose insulin for diabetes Things to try yourself There are things you can do to help relieve your symptoms. Do drink plenty of cold water  take regular sips during the day and keep some water by your bed at night suck on ice cubes or ice lollies sip on cold unsweetened drinks chew sugar-free gum or suck on sugar-free sweets use lip balm if your lips are also dry brush your teeth twice a day and use alcohol-free mouthwash  youre more likely to get tooth decay if you have a dry mouth Dont do not drink lots of alcohol, caffeine (such as tea and coffee) or fizzy drinks do not eat foods that are acidic (like lemons), spicy, salty or sugary do not smoke do not sleep with dentures in do not use acidic artificial saliva products if you have your own teeth do not stop taking a prescribed medicine without getting medical advice first  even if you think it might be causing your symptoms Saliva substitutes and stimulants If the measures above dont help, your dentist, GP or specialist may suggest using an artificial saliva substitute. An artificial saliva substitute will help keep your mouth moist. This may come in the form of a spray, gel or lozenge. Use it as often as you need to, including before and during meals. If your dry mouth is caused by radiotherapy or Sjgrens syndrome, a medication called pilocarpine may be prescribed. This is taken as a tablet several times a day. It helps to stimulate your salivary glands to produce more saliva. Source: NHS 24 - Opens in new browser window Last updated: 05 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Dysphagia (swallowing problems),"Dysphagia (swallowing problems) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Dysphagia (swallowing problems) Dysphagia (swallowing problems) About dysphagia Causes of dysphagia Diagnosing dysphagia Treating dysphagia Complications of dysphagia About dysphagia Dysphagia is the medical term for swallowing difficulties. Some people with dysphagia have problems swallowing certain foods or liquids, while others cant swallow at all. Other signs of dysphagia include: coughing or choking when eating or drinking bringing food back up, sometimes through the nose a sensation that food is stuck in your throat or chest persistent drooling of saliva Over time, dysphagia can also cause symptoms such as weight loss and repeated chest infections. You should see your GP if you have swallowing difficulties. What causes dysphagia? Dysphagia is usually caused by another health condition, such as: a condition that affects the nervous system, such as a stroke , head injury ,or dementia cancer  such as mouth cancer or oesophageal cancer gastro-oesophageal reflux disease(GORD)  where stomach acid leaks back up into theoesophagus Dysphagia can also occur in childrenasthe result of a developmental or learning disability. Dysphagia can be caused by problems with the: mouth or throat, known as oropharyngeal or high dysphagia oesophagus (the tube that carries food from your mouth to your stomach), known as oesophageal or low dysphagia Read more about the causes of dysphagia . Treating dysphagia Treatment usually depends on the cause and type of dysphagia. The type of dysphagia you have can usually be diagnosed after testing your swallowing ability and examining your oesophagus. Many cases of dysphagia can be improved with treatment, but a cure isnt always possible. Treatments for dysphagia include: speech and language therapy to learn new swallowing techniques changing the consistency of food and liquids to make them safer to swallow alternative forms of feeding, such as tube feeding through the nose or stomach surgery to widen the narrowing of the oesophagus by stretching it or inserting a plastic or metal tube (known as a stent) Read more about diagnosing dysphagia and treating dysphagia . Complications of dysphagia Dysphagia can sometimes lead to further problems. One of the most common problems is coughing or choking when foodgoes down the wrong way and blocks your airway. If this occurs frequently, you may avoid eating and drinkingbecause you fearchoking, whichcan lead to malnutrition and dehydration . Some people with dysphagia have a tendency to develop chest infections, such as aspiration pneumonia , which require medical treatment. Dysphagia can also affect your quality of lifeas it may preventyou enjoying meals and social occasions. Read more about the complications of dysphagia . Causes of dysphagia As swallowing is a complex process, there are many reasons why dysphagia can develop. Neurological causes The nervous system is made up of the brain, nerves and spinal cord. Damage to the nervous system can interfere with the nerves responsible for starting and controlling swallowing. This can lead to dysphagia. Some neurological causes of dysphagia include: a stroke neurological conditions that cause damage to the brain and nervous system over time,including Parkinsons disease , multiple sclerosis , dementia ,and motor neurone disease brain tumours myasthenia gravis  a rare condition that causes your muscles to become weak Congenital and developmental conditions The term congenital refers to something youre born with. Developmental conditions affect the way you develop. Congenital or developmental conditions that may cause dysphagia include: learning disabilities where learning, understanding, and communicating are difficult cerebral palsy a group of neurological conditions that affect movement and co-ordination a cleft lipandpalate a common birth defect that results in a gap or split in the upper lip or roof of the mouth Obstruction Conditions that cause an obstruction in the throat or a narrowing of the oesophagus(the tube that carries food from your mouth to the stomach)can make swallowing difficult. Some causes of obstruction and narrowing include: mouth cancer or throat cancer, such as laryngeal cancer or oesophageal cancer  once these cancers are treated, the obstruction may no longer be an issue pharyngeal (throat) pouches, also known as Zenker diverticulum  where a large sac develops in the upper part of the oesophagus, which reduces the ability to swallow both liquids and solids;its a rare condition that mainly affects older people eosinophilic oesophagitis where a type of white blood cell known as an eosinophilbuilds up in the lining of the oesophagus as the result of a reaction to foods, allergens, or acid reflux; the build-up damages the lining of the oesophagus and causes swallowing difficulties radiotherapy treatment  thiscan cause scar tissue, which narrows the passageway in your throat and oesophagus gastro-oesophageal reflux disease(GORD)  stomach acid can cause scar tissue to develop, narrowing your oesophagus infections, such as tuberculosis or thrush  thesecan lead to inflammation of the oesophagus (oesophagitis) Muscular conditions Any condition that affects the muscles used to push food down the oesophagus and into the stomach can cause dysphagia,althoughsuch conditions are rare. 2muscular conditions associated with dysphagia are: scleroderma where the immune system (the bodys natural defence system) attacks healthy tissue, leading to a stiffening of the throat and oesophagus muscles achalasia  where muscles in the oesophagus lose their ability to relax and open to allow food or liquid to enter the stomach Other causes As you get older, themusclesused for swallowing can become weaker. This may explain why dysphagia is relatively commonin elderly people. Treatment is available to help people with age-related dysphagia. Chronic obstructive pulmonary disease(COPD) is a collection of lung conditions that make it difficult to breathe in and out properly. Breathing difficulties can sometimes affect your ability to swallow. Dysphagia can also sometimes develop as a complication of head or necksurgery. Diagnosing dysphagia See your GP if youre having any difficulty swallowing. Theyll carry out an initial assessment and may refer you for further tests and treatment. Tests will help determine whether your dysphagia isthe result ofa problem with your mouth or throat (oropharyngeal, or high dysphagia), or your oesophagus, the tube that carries food from the mouth to the stomach (oesophageal, or low dysphagia). Diagnosing the specific type of dysphagia can make treatment more effective and reduce your chances of developing complications of dysphagia , such as choking or pneumonia . Your GP will want to know: how long youve had dysphagia whether your symptoms come and go, or are getting worse whether dysphagia has affected your ability to swallow solids, liquids, or both whether youve lost weight Specialist referral Depending on the suspected cause,you may be referred for further tests with: an ear, nose and throat (ENT) specialist a speech and language therapist (SLT) a neurologist a specialist in conditions that affect the brain, nerves, and spinal cord a gastroenterologist a specialist in treating conditions of the gullet, stomach, and intestines a geriatrician a specialist in the care of elderly people Water swallow test A water swallow testis usually carried out by a speech and language therapist, andcangive a good initial assessment of your swallowing abilities. Youll be given 150ml of water and asked to swallow it as quickly as possible. The timeit takes you to drink all of the water and the number of swallows required will be recorded. You may also be asked to swallow a soft piece of pudding or fruit. Videofluoroscopy A videofluoroscopy, or modified barium swallow, is one of the most effective ways of assessing your swallowing ability and finding exactly where the problem is. An X-ray machine records a continuous moving X-ray on to video, allowing your swallowing problems to be studied in detail. Youll be asked to swallow different types of food and drink of different consistencies, mixed with a non-toxic liquid called barium that shows up on X-rays. A videofluoroscopy usually takes about 30 minutes. You may feel sick after the test, and the barium may cause constipation . Your stools may also be white for a few days as the barium passes through your system. Nasoendoscopy A nasendoscopy, sometimes also known as fibreoptic endoscopic evaluation of swallowing (FEES),is a procedure that allows the nose and upper airways to be closely examined usinga very small flexible tube known as an endoscope. The endoscope is inserted into your nose so the specialist can look down on to your throat and upper airways. It has a light and camera at the end so images of the throat can be viewed on a television screen. This allows any blockages or problem areas to be identified. FEES can also be used to test for oropharyngeal dysphagia after youre asked to swallow a small amount of test liquid (usually coloured water or milk). Before the procedure, you may have local anaesthetic spray into your nose, but because the camera doesnt go as far as your throat, it doesnt cause retching. The procedure is safe and usually only takes a few minutes. Manometry and 24-hour pH study Manometry is a procedure to assess the function of your oesophagus. It involves passing a smalltube (catheter) with pressure sensors through your nose and into your oesophagus to monitor its function. The test measures the pressureswithin youroesophagus when you swallow, which determines how well its working. The 24-hour pH study involves inserting a tube into your oesophagus through your nose to measure the amount of acid that flows back from your stomach. Thiscan help determine the cause of any swallowing difficulties. Diagnostic gastroscopy Diagnostic gastroscopy, also known as diagnostic endoscopy of the stomach,or oesophagogastroduodenoscopy (OGD), is an internal examination using an endoscope. The endoscopeis passed down your throat and into your oesophagus, and images of the inside of your body are transmitted to a television screen. It can often detect cancerous growths or scar tissue. Read more about treating dysphagia . Nutritional assessment If dysphagia has affected your ability to eat, you may need a nutritional assessment to check that youre notlacking nutrients (malnourished) . This could involve: measuring your weight calculating your body mass index (BMI) to check whether youre a healthy weight for your height carrying out blood tests Treating dysphagia Most swallowing problems can be treated, although the treatment you receive will depend on the type of dysphagia you have. Treatment will depend on whether your swallowing problemis in the mouth or throat (oropharyngeal, or high dysphagia), or in the oesophagus (oesophageal, or low dysphagia). The cause of dysphagia is also considered when deciding on treatment. In some cases, treating the underlying cause, such as mouth cancer or oesophageal cancer ,can help relieve swallowing problems. Treatment for dysphagia may be managed by agroup of specialists known as a multidisciplinary team (MDT). Your MDT may includea speech and language therapist (SLT), a surgeon, and a dietitian. High (oropharyngeal) dysphagia High dysphagia is swallowing difficulties caused by problems with the mouth or throat. It can be difficult to treat if its caused by a condition thataffects the nervous system.This is because these problems cant usually be corrected using medication or surgery. There are 3main treatmentsfor high dysphagia: swallowing therapy dietary changes feeding tubes Swallowing therapy You may be referred to a speech and language therapist (SLT) for swallowing therapy if you have high dysphagia. An SLT is a healthcare professional trained to work with people with feeding or swallowing difficulties. SLTs use a range of techniques that can be tailoredfor your specific problem, such asteaching you swallowing exercises. Dietary changes You may be referred to a dietitian (specialist in nutrition)for advice about changes to your diet to make sureyou receive a healthy, balanced diet. An SLTcan give you advice aboutsofter foods and thickened fluids that you may find easier to swallow. They may also try to ensure youre getting the support you need at meal times. Feeding tubes Feeding tubes can be used to provide nutrition while youre recovering your ability to swallow. They may also be required in severe cases of dysphagia that put you at risk of malnutrition and dehydration . A feeding tubecan also make it easier for you to take the medication you may need for other conditions. There are 2types of feeding tubes: a nasogastric tube  a tube that is passed down your nose and into your stomach a percutaneous endoscopic gastrostomy (PEG) tube a tube that is implanted directly into your stomach Nasogastric tubes are designed for short-term use. The tube will need to be replaced and swapped to the other nostril after about a month. PEG tubes are designed for long-term use and last several months before they need to be replaced. Most people with dysphagia prefer to use a PEG tube because it can be hidden under clothing. However, they carry a greater risk of complications comparedwith nasogastric tubes. Minor complications of PEG tubes include tube displacement, skin infection, and a blocked or leaking tube. 2major complications of PEG tubes are infection and internal bleeding. Resuming normal feeding may be more difficult with a PEG tube compared with using a nasogastric tube. The convenience of PEG tubes can make people less willing to carry out swallowing exercises and dietary changes than those whouse nasogastric tubes. You should discuss the pros and cons of both types of feeding tubes with your treatment team. Low (oesophageal) dysphagia Low dysphagia is swallowing difficultiescaused byproblems with the oesophagus. Medication Depending on the cause of low dysphagia, it may be possible to treat it with medication. For example, proton pump inhibitors (PPIs) used to treat indigestion may improve symptoms caused by narrowing or scarring of the oesophagus. Botulinum toxin Botulinum toxincan sometimes be used to treat achalasia. This is a condition where the muscles in the oesophagus become too stiff to allow food and liquid to enter the stomach. It can be used to paralyse the tightened muscles that prevent food from reaching the stomach. However, the effects only last for around 6months. Surgery Other cases of low dysphagia can usually be treated with surgery. Endoscopic dilatation Endoscopic dilation is widely used to treat dysphagia caused by obstruction. Itcan also be used to stretch youroesophagus if its scarred. Endoscopic dilatation will be carried out during aninternal examination of your oesophagus (gastroscopy)using an endoscopy. An endoscope is passed down your throat and into youroesophagus, andimages of the inside of your body are transmitted to a television screen. Using the image as guidance, a small balloon or a bougie (a thin, flexible medical instrument) is passed through the narrowed part of your oesophagus to widen it. If a balloon is used, it will be gradually inflated to widen your oesophagus before being deflated and removed. You may be given a mild sedative before the procedure to relax you. Theres a small risk that the procedurecould cause a tear or perforate youroesophagus. Inserting a stent If you have oesophageal cancer that cant be removed, its usually recommended that you have astent inserted instead of endoscopic dilatation. This is because, if you have cancer,theres a higher risk of perforating your oesophagus if its stretched. A stent (usually a metal mesh tube)is insertedinto youroesophagus during an endoscopy or under X-ray guidance. The stent then gradually expands to create a passage wide enough to allow food to pass through. Youll need to follow a particular diet to keep the stent open without havingblockages. Congenital dysphagia If your baby is born with difficulty swallowing (congenital dysphagia), their treatment will depend on the cause. Cerebral palsy Dysphagia caused by cerebral palsycan be treated with speech and language therapy. Your child will be taught how to swallow, how to adjust the type of food they eat, and how to use feeding tubes. Cleft lip and palate Cleft lip and palateis a facial birth defect that can cause dysphagia. Its usually treated with surgery. Narrowing of the oesophagus Narrowing of the oesophagus may be treated with a type of surgery called dilatation to widen the oesophagus. Gastro-oesophageal reflux disease (GORD) Dysphagia caused by gastro-oesophageal reflux disease (GORD) can be treated using special thickened feeds instead of your usual breast or formula milk. Sometimes medication may also be used. Breastfeeding or bottle feeding If youre having difficulty bottle feeding or breastfeeding your baby, see your midwife, health visitor or GP. Complications of dysphagia The main complication of dysphagia is coughing and choking, which can lead to pneumonia. Coughing and choking If you have dysphagia, theres a risk of food, drink or saliva going down the wrong way. It can block your airway, making it difficult to breathe and causing you to cough or choke. Read more information and advice about what to do if someone is choking . If you have dysphagia, you may alsodevelop a fear of choking. However, its very importantyou dont avoideating and drinking, as it could cause dehydration and malnutrition . If you often choke on your foodbecause ofdysphagia, you may also be at an increased risk of developing acondition called aspiration pneumonia . Aspiration pneumonia Aspiration pneumonia is a chest infection that can develop after accidentally inhaling something, such as a small piece of food. It causes irritation in the lungs, or damages them. Older people are particularly at risk of developing aspiration pneumonia. The symptoms of aspiration pneumonia include: a cough  this may be a drycough, or you may produce phlegm thats yellow, green, brown, or bloodstained a high temperature of 38C (100.4F) or over chest pain difficulty breathing  your breathing may be rapid and shallow and you may feel breathless, even at rest Contact your treatment teamimmediately if youre being treated for dysphagia and you develop these symptoms. If this isnt possible, contact your local out-of-hours service or phone NHS 24 111 service . Symptoms of aspiration pneumonia can range from mild to severe, and it is usually treated with antibiotics . Severe cases will require hospital admission and treatment with intravenous antibiotics (through a drip). Read more about treating pneumonia . In particularly old orfrail people, theres a chance the infection could lead to their lungs becoming filled with fluid, preventing them working properly. This is known asacute respiratory distress syndrome (ARDS). Your chances of developing pneumonia as a result ofdysphagia are higher if you havea weakened immune system, chronic obstructive pulmonary disease (COPD) , or if your oral and dental hygiene is poor. Dysphagia in children If children with long-term dysphagiaarent eating enough, they may not get the essential nutrients they need for physical and mental development. Children who have difficulty eating may also find meal times stressful, which may lead to behavioural problems. Source: NHS 24 - Opens in new browser window Last updated: 13 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Gastro-oesophageal reflux disease (GORD) Other health sites The Stroke Association: Life after stroke NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Dystonia,"""Dystonia | NHS inform | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Dystonia Dystonia Dystonia is a neurological movement disorder. People with dystonia experience involuntary muscle spasms and contractions. Movements are often repetitive and cause unusual, awkward and sometimes painful postures. Tremor (shaking) is often associated with some types of dystonia. Dystonia can be a condition on its own (primary dystonia). Some people experience dystonia as a symptom of another condition (secondary dystonia). Symptoms of dystonia Symptoms of dystonia can include: uncontrolled muscle spasms parts of your body twisting into unusual positions  like your neck being pulled to the side or your feet turning inwards shaking (tremors) excessive blinking The symptoms may be continuous or come and go. They may be triggered by voluntary movements. Types of dystonia There are different types of dystonia. Generalised dystonia Generalised dystonia affects all parts of the body. Focal dystonia If you have focal dystonia, only one muscle group is affected. The most common type of focal dystonia is neck dystonia, also known as cervical dystonia. This usually causes the head to be pulled in one direction. This can then affect movement and cause pain. Other types of focal dystonia can impact: your voice (laryngeal dystonia) the muscles around your eyes (blepharospasm) limbs (like writers cramp) Causes of dystonia Dystonia is thought to be caused by a problem with the part of the brain that controls movement. Primary and secondary dystonia may have different underlying causes. Causes of primary dystonia Primary dystonia often begins in childhood. This type of dystonia is more likely to have a recognised genetic cause. Causes of secondary dystonia You might experience dystonia as a symptom of another condition. Secondary dystonia might be caused by: Parkinsons disease cerebral palsy certain medications (like some antipsychotics and some anti sickness medications) injury to the brain stroke Diagnosing dystonia If your GP thinks you have dystonia, they may refer you to a specialist neurologist. You may need to have tests to confirm whether you have primary or secondary dystonia. Depending on your symptoms, you might have a blood test or scan. Treating dystonia There are treatments that can control the involuntary movements and spasms of dystonia. You might need to try several treatment options to find out which one works best. Botulinum toxin If you have focal dystonia, you might be offered botulinum toxin. Botulinum toxin is injected into the affected muscles. It blocks the neurotransmitters within the nerve, reducing muscle spasms. The effects of the injection can last from around 3 months to 6 months. Medication Oral medications, like tablets, can be effective for some people with generalised dystonia. The following are medications which might be used to treat dystonia: anticholinergics baclofen muscle relaxants Physiotherapy Depending on the type of dystonia you have, physiotherapy might help you improve your range of movement. Surgery You might have surgery if your dystonia symptoms dont improve with other treatments. Deep brain stimulation (DBS) Deep brain stimulation (DBS) is a type of brain surgery. Its offered to some people with dystonia where other treatments havent been successful. The surgeon will place a small device, like a pacemaker, under the skin of your chest or tummy. The device sends electrical signals along wires placed in the part of the brain that controls movement. Itll be several weeks or months before you begin to feel the benefit of DBS. Read more about deep brain stimulation Source:\r\n                                        Scottish Government - Opens in new browser window Last updated: 07 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Parkinson's disease Other health sites Dystonia UK NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Earache,"Earache | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Ears, nose and throat Earache Earache Return to Symptoms Enter age Last Updated: Next Review Date: Review my answers Find your local services Search for a service near you by entering your postcode below. Please input your postcode in the following format: A12 1BC GP Practices Dental Services Pharmacies Opticians Postcode Search NHS inform has more information on this condition. Read more Previous Start guide Review my answers  You told us your credentials were: : You said: Based on the information you gave us, we made the following recommendation: Close Keep a copy View PDF Earache is a common problem, particularly in children. It can be worrying, but its usually only caused by a minor infection and will often get better in a few days without treatment. Earache can be a sharp, dull or burning ear pain that comes and goes or is constant. One or both ears may be affected. Earache self-help guide Complete our self-help guide to check your symptoms and find out what to do next. When to get medical advice You do not always need to see a GP as earache will usually get better on its own within a few days. Speak to your pharmacist for advice and treatment if you have earache. Your pharmacist may recommend that you speak to your GP practice if required. Find your nearest pharmacy Speak to your GP practice if: You or your child have earache and: a high temperature (fever) vomiting a severe sore throat hearing loss swelling around the ear discharge from the ear there is something stuck in your or your childs ear the earache doesnt improve within a few days your child is under 2 and has earache in both ears If your GP practice is closed, phone 111. Speak to your GP practice if: You or your child: have earache for more than 3 days keep getting earache Treatment for earache Do ask your pharmacist about using over-the-counter painkillers such as paracetamol or ibuprofen , or eardrops to treat the pain place a warm flannel against the affected ear Dont do not use eardrops or olive oil drops if the eardrum has burst If you or your child has an ear infection, you should avoid putting objects in the ear, such as cotton buds, or getting the affected ear wet. Common causes of earache Ear infections If the cause of earache is an ear infection, there may be a watery or pus-like fluid coming out of the ear. Outer ear infections (infections of the tube connecting the outer ear and eardrum) and middle ear infections (infections of the parts of the ear behind the eardrum) are very common causes of earache. Many ear infections clear up on their own without treatment in a few days or weeks, but in some cases your GP may prescribe eardrops or antibiotics . Glue ear Glue ear (also known as otitis media with effusion, or OME) is a build-up of fluid deep inside the ear, which commonly causes some temporary hearing loss . The condition tends to be painless, but sometimes the pressure of this fluid can cause earache. Glue ear will often clear up on its own, although this can take a few months. If the problem is persistent, a minor procedure to place small tubes called grommets in the ear may be recommended to help drain the fluid. Read more about glue ear Damage to the ear Earache can sometimes result from injury to the inside of the ear. For example, by scraping earwax from the ear canal using a cotton bud, or poking a cotton bud too far into your ear, which can puncture the eardrum. The ear canal is very sensitive and can easily become damaged. The ear should heal on its own without treatment, but it can take up to 2 months for a perforated eardrum to heal. If you have a perforated eardrum, eardrops shouldnt be used. Earwax or an object in the ear A build-up of earwax or an object stuck inside the ear can sometimes cause earache. If there is something in your or your childs ear that seems be causing pain, dont attempt to remove it yourself. You may push it further inside and you may damage the eardrum. If you have a build-up of earwax in your ear, your pharmacist will be able to recommend eardrops to soften it so it falls out naturally. In some cases, your GP will organise for removal of the wax (once softened with eardrops) by flushing the ear with water. This is known as ear irrigation. If there is an object in the ear, your GP may need to refer you or your child to a specialist to have it removed. Throat infections If you find it painful to swallow and you have a sore throat, your earache could be a symptom of a throat infection such as tonsillitis or quinsy. Quinsy is an abscess on the back of your throat, which can sometimes make it very difficult to swallow. Some types of tonsillitis will clear up after a few days without the need for antibiotics . But if you have quinsy, you will need to see your GP as soon as possible for treatment. You may have quinsy if your sore throat gets worse very quickly. A problem with your jaw Earache is occasionally caused by a problem with the joint of your jaw bone (where the jaw meets the skull). This is known as temporomandibular joint pain and can be caused by problems such as arthritis or teeth grinding. Jaw pain can often be treated with painkillers, warm or cold compresses, and trying not to clench your jaw and grind your teeth. A dental abscess A dental abscess is a collection of pus that can form in your teeth or gums as a result of a bacterial infection. The main symptom is pain in your affected tooth, which can be intense and throbbing, although the pain can sometimes spread to your ear. If you think you may have a dental abscess, make a dentist appointment as soon as possible. They may need to remove the abscess and drain the pus. Read more about treating dental abscesses Source: NHS 24 - Opens in new browser window Last updated: 30 March 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Self-help guide: Earache Tonsillitis Otitis externa Middle ear infection (otitis media) NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Earwax build-up,"Earwax build-up | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Ears, nose and throat Earwax build-up Earwax build-up Earwax is made inside your ears to keep them clean. It usually falls out on its own. Sometimes too much can build up and block the ears. A build-up of earwax is a common problem. It can often be treated using eardrops bought from a pharmacy. Symptoms of an earwax build-up A build-up of earwax in your ear can cause: earache hearing loss tinnitus (hearing sounds from inside your body) itchiness in or around the ear ear infections These problems will usually get better once the build up of earwax has been removed. What to do if you think your ear is blocked Do not try to remove a build-up of earwax yourself with your fingers, a cotton bud or any other object. This can damage your ear and push the wax further down. Try eardrops If the earwax is only causing minor problems, you can try buying some eardrops from a pharmacy. Using drops may make your hearing or symptoms a little worse at first before getting better. These can help soften the earwax so that it falls out naturally. There are several different types of eardrops you can use, including drops containing: sodium bicarbonate olive oil almond oil Eardrops arent suitable for everyone and some can irritate the skin. You shouldnt use eardrops if you have a hole or tear in your eardrum. Speak to your pharmacist about the right product for you and make sure you read the leaflet that comes with it. Find your nearest pharmacy When to get medical advice Speak to your GP practice if: youre worried about your symptoms eardrops havent helped after 1 week Diagnosing earwax build up Your GP or practice nurse will look inside your ears to check if theyre blocked. They might carry out some simple hearing tests. Treatments to remove earwax If pharmacy treatment doesnt work, speak to your GP practice. Treatments may include: ear irrigation  a quick and painless procedure where an electric pump is used to push water into your ear and wash the earwax out microsuction  a quick and painless procedure where a small device is used to suck the earwax out of your ear (you may need to be referred for this) These treatments are not suitable for everyone. Your doctor can discuss this with you. If these treatments dont help, your GP may refer you to an ear, nose and throat (ENT) specialist. What causes a build up of earwax? Some people regularly get blocked ears because they naturally produce a lot of earwax. Other causes include: producing naturally hard or dry earwax having narrow or hairy ear canals (the tube between the opening of the ear and the eardrum) being elderly, as earwax becomes drier with age bony growths in the outer part of the ear canal Earwax can also block your ear if you often insert objects into your ear, such as cotton buds, ear plugs or hearing aids. Source: ENT Scotland - Opens in new browser window Last updated: 28 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Self-help guide: Earache Earache Tinnitus Other health sites British Tinnitus Association: Tinnitus and earwax Action on Hearing Loss: Protect your hearing Hearing Link: Your hearing Find your nearest pharmacy Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Ebola virus disease,"Ebola virus disease | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Ebola virus disease Ebola virus disease Ebola virus disease is a serious illness that originated in Africa, where a large outbreak occurred in 2014to 2015.In June 2016, the outbreak was officially declared over. The 2014to 2015 outbreak of Ebola mainly affected 3 countries in west Africa: Guinea, Liberia and Sierra Leone. Some cases also occurred in parts of central Africa. Around 28,000 cases and more than 11,000 deaths were reported by the World Health Organization . This was the largest known outbreak of Ebola. Is Ebola still a risk? Theres still a small chance occasional cases of Ebola may occur in Africa as the virus is present in several countries there, but the risk for people travelling to Africa is minimal. People who remain most at risk are those who care for infected people or handle their blood or fluid, such as hospital workers, laboratory workers and family members. To find out what the health risks are for an area youre planning to visit, check the NHS Fit for Travel destination guide , Travel Health Pro country information or GOV.UK foreign travel advice . The risk of an Ebola outbreak occurring in the UK remains negligible. Symptomsof Ebola A person infected with Ebola virus will typically develop: a high temperature (fever) a headache joint and muscle pain a sore throat severe muscle weakness These symptoms start suddenly between2 and 21 days after becoming infected. Diarrhoea , vomiting , a rash, stomach pain and reduced kidney and liver function can follow. The person may then bleed internally, and may also bleed from the ears, eyes, nose or mouth. What to do if you become ill Get medical advice as soon as possible if you become ill while travelling abroad. Phone 111 or contact your GP if you become ill after returning to the UK. Its extremely unlikely you have Ebola, but it could be another serious condition such ascholera or malaria , so its a good idea to get help in case you need tests or treatment. Always remember to mention your recent travel history, as this will help identify what the problem could be. Sometimes your doctor may want to take a sample of your blood, urine or stools so it can be checked for any infections. How Ebola virus is spread The Ebola virus is spread in the blood, body fluids or organs of a person or animal with the infection. For example, it can be spread by: directly touching the body of someone with the infection who has symptoms orrecently died  the virus can survive for several days outside the body cleaning up body fluids (blood, stools, urine or vomit) or touching the soiled clothing of an infected person handling unsterilised needles or medical equipment used in the care of the infected person having sex with an infected person without using a condom  studies show traces of Ebola may remain in a mans semen many months after he has recovered handling or eating raw or undercooked bushmeat Ebola cant be caught through routine social contact, such as shaking hands, with people who dont have symptoms. Treatment for Ebola Theres currently no licensed treatment or vaccine for Ebola. Potential new vaccines and drug therapies are being developed and tested. Any area affected by an outbreak should be immediately quarantined, and people confirmed to have the infection should be treated in isolation in intensive care. Dehydration is common, so fluids may be given directly into a vein. Blood oxygen levels and blood pressure also need to be maintained at the right level, and body organs supported while the persons body fights the infection. Healthcare workers need to avoid contact with the bodily fluids of their infected patients by taking strict precautions, such as wearing protective equipment. Ebola virus disease is sometimesfatal. The sooner a person is given care, the better the chance theyll survive. Preventing Ebola Follow these simple precautions to minimise your risk of picking up potentially serious infections. Do wash your hands frequently using soap and water  use alcohol hand rubs when soap isnt available make sure fruit and vegetables are properly washed and peeled before you eat them avoid physical contact with anyone who has possible symptoms of an infection Dont do not handle dead animals or their raw meat do not eat bushmeat You can check the advice for an area youre planning to visit using the NHS Fit for Travel destination guide , Travel Health Pro country information or GOV.UK foreign travel advice . Source: NHS 24 - Opens in new browser window Last updated: 29 May 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites Fit For Travel: Viral Haemorrhagic Fever NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Ectopic pregnancy,"Ectopic pregnancy | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Pregnancy and childbirth Ectopic pregnancy Ectopic pregnancy An ectopic pregnancy is when a fertilised egg develops outside the womb. This usually happens in one of the fallopian tubes which lead from your ovaries to your womb. If an egg implants there, it cant develop into a baby. Ectopic pregnancy puts your health at risk too, and can be very serious if it isnt treated. About 1 in 100 pregnancies are an ectopic pregnancy. Symptoms of an ectopic pregnancy Symptoms usually start when youre about 6 weeks pregnant and can include: pain low down and on one side of your abdomen bleeding from your vagina pain in the tip of your shoulder discomfort when going to the toilet a brown watery discharge from your vagina You might also have: other more general symptoms such as pale skin and sweating missed a period some of the early signs of being pregnant, such as feeling tired or having sore breasts Its important to get medical help quickly if you have any of these symptoms. If you have an ectopic pregnancy Unfortunately, its not possible to save an ectopic pregnancy. It will need to be removed: during an operation by taking a medicine prescribed by your doctor Further information in other languages and formats Public Health Scotland have created leaflets on pregnancy. If you need this leaflet in a different format or language, please contact phs.otherformats@phs.scot. Ready Steady Baby guide in Arabic, Polish, Simplified Chinese (Mandarin) and Ukrainian Source: Public Health Scotland - Opens in new browser window Last updated: 14 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Edwards syndrome,"""Edwards' syndrome | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Chromosomal conditions Edwards syndrome Edwards syndrome Edwards syndrome (also known as trisomy 18) is a genetic condition that begins to affect babies when theyre in the womb, and continues to impact their health throughout their life. Its a rare but serious condition. In the UK, around 3 in every 10,000 births are affected by Edwards syndrome. What is Edwards syndrome? When a baby is conceived (made), they inherit genetic material from both their parents. This genetic material is called a chromosome. Humans normally have 23 pairs of chromosomes. In each pair, 1 of the chromosomes is inherited from the mother and 1 is inherited from the father. If a baby has Edwards syndrome, they have inherited an extra copy of chromosome 18. This extra copy can be present in some or all of the babys cells and can lead to health problems for the baby. There are 3 different forms of Edwards syndrome: Full form In full form Edwards syndrome, the baby has inherited a complete extra copy of chromosome 18. This extra copy is present in all of the babys cells. Around 94% of babies born with Edwards syndrome have the full form of the syndrome. Mosaic form In mosaic form Edwards syndrome, the baby has inherited a complete extra copy of chromosome 18, but the copy is only present in some of the babys cells. Partial form In partial form Edwards syndrome, the baby has only inherited part of an extra copy of chromosome 18. This is a very rare form of Edwards syndrome. Why does Edwards syndrome happen? Most cases result from a random change in the egg or sperm in healthy parents. This change is not caused by anything the parents did before or during pregnancy. Effects of Edwards syndrome on pregnancy Screening for Edwards syndrome Youll be offered screening for Edwards syndrome when youre between 11 and 14 weeks pregnant. The screening test will show if your baby has a high or low chance of having Edwards syndrome. If screening shows that theres a high chance your baby has Edwards syndrome,you can choose to have a further diagnostic test if you wish. No test can tell if your baby has full, mosaic or partial Edwards syndrome or how theyll be affected. Risk of miscarriage and stillbirth Around 7 in 10 (70%) of pregnancies diagnosed with Edwards syndrome from screening tests will end in miscarriage or stillbirth . The risk of miscarriage decreases as the pregnancy progresses, but theres still a risk of stillbirth. Effects of Edwards syndrome on babies If your baby is affected by Edwards syndrome, it is likely they will have associated health conditions (other conditions often found in babies with Edwards syndrome). Some of these may be serious. Exactly how your baby is affected will depend on the form of Edwards syndrome they have. Babies with full form Edwards syndrome Full form Edwards syndrome is considered to be a life-limiting condition. This means it can affect how long a baby can live. Around 5 in 10 (52.5%) will live longer than 1 week. Around 1 in 10 (12.3%) will live longer than 5 years. Babies born with full form Edwards syndrome will have a learning disability which may be severe. Theyre also likely to have a wide range of health conditions, some of which can be serious. Statistically: around 9 in 10 (90%) will have heart issues around 5 in 10 (50%) will have seizures around 5 in 10 (50%) will have hearing loss around 5 in 10 (50%) will have joint contractures (shortening of muscle tissue that can cause a deformity) around 1 in 10 (10%) will have a cleft lip and/or palate Babies with mosaic form and partial form Edwards syndrome Currently we cant predict how babies with mosaic or partial forms of Edwards syndrome will be affected. This is because it depends on: how many cells contain the extra chromosome (mosaic) how much of the extra chromosome they have (partial) Some babies may have severe health problems like those seen in full form Edwards syndrome. Other babies may have much less serious health issues. There are even cases where the baby seems to have no health issues at all. Many babies with the mosaic form of Edwards syndrome will have some form of learning disability and developmental delay (when a child takes longer to start doing certain activities, like walking and talking, than other children their age). The life expectancy for babies with mosaic or partial forms of Edwards syndrome is also very variable. Some will live long lives, while others will have a much shorter life expectancy. Living with Edwards syndrome Each child is unique, and Edwards syndrome will affect each child differently. Like all children theyll have their own personalities, likes and dislikes, and things that make them who they are. Babies with full form Edwards syndrome usually have a low birthweight and are considered medically fragile. This means they are at high risk of infections and complications that require treatment in hospital. They may also: have difficulty feeding and may need fed by a tube have difficulty breathing and have apnoea (pauses in their breathing) Despite their complex needs, children with Edwards syndrome can make progress with their development, although slowly. Many children are reported to be able to communicate their needs, show awareness of surroundings, and some can sit and stand supported. There are also cases of older children attending school. Feedback from many parents suggests that children with Edwards syndrome have a good quality of life and are valued members of the family. Congenital and rare condition register Babies with Edwards syndrome are included in the secure congenital and rare condition (CARDRISS) register. The register is maintained by Public Health Scotland. The register records how many babies have this condition, and some relevant personal information. Its also used to support the planning and improvement of health, care, and other public services. Read more about CARDRISS Further information and support You can find out more information about Edwards syndrome, including stories from parents of a child with the syndrome, at SOFT UK (Support Organisation for Trisomy 13/ 18) Source:\r\n                                        SOFT UK - Opens in new browser window Last updated: 21 February 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Screening for Downs syndrome, Edwards syndrome and Pataus syndrome Other health sites SOFT UK NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Endometriosis,"""Endometriosis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Healthy living Women's health Girls and young women (puberty to around 25) Periods and menstrual health Endometriosis Endometriosis  |  | Polski |  |  | British Sign Language (BSL) | Easy Read Endometriosis is a long-term (chronic) condition where tissue similar to the lining of the womb is found elsewhere in the body. Its very common, affecting around 1 in 10 of those who menstruate. For some people, it can have a significant impact on their physical health, emotional wellbeing , and daily routine. What are the symptoms? Symptoms can be different from person to person and month to month. Some people have no symptoms at all. Speak to your doctor if: Youre experiencing: pain in the lower abdomen (tummy), pelvis, lower back or legs painful periods which affect your day to day life  for example, you cant go to school or work or take part in day to day activities that you enjoy pain during ovulation heavy or prolonged (long lasting) periods spotting or bleeding between periods pain during and after sex pain or bleeding when going to the toilet (pain before or after peeing or pooing) bleeding from your back passage (rectum) blood in your poo (usually at the same time as your period) persistent exhaustion and tiredness (fatigue) difficulty getting pregnant These symptoms may be endometriosis, but could also be a number of other health conditions. Endometriosis: a hidden condition Causes The exact cause of endometriosis is not known but it is sometimes believed to be genetic. That means, if someone in your family has the condition, its more likely you may have it too. Diagnosis It can be difficult to diagnose endometriosis because symptoms can vary a lot and many other conditions can cause similar symptoms. If you think you have symptoms of endometriosis, its important that you speak to your doctor. Share as much information as possible during your first appointment. Thisll hopefully help speed up your diagnosis. It can be helpful to keep a note of your period dates and symptoms using a calendar, a diary or an app. You can then discuss this with your doctor to give then a better understanding of what you are experiencing. If youre seeing your doctor, there are some useful pieces of information to think about beforehand: the first day of your last period (when it started) how many days your period usually lasts what was the shortest time between your periods (from the first day of one period to the first day of the next) what was the longest time between your periods (from the first day of one period to the first day of the next) how often you need to change your period products on a heavy day if you are over 25, when you had your last smear test When you see your doctor about your symptoms, theyll carry out what is called a pelvic examination. They will look at your vulva, vagina and cervix (the opening between the vagina and the womb). Sometimes other tests might be needed. Your doctor will discuss this with you and you can ask any questions that you might have. As this is an intimate examination, the doctor who performs it will have another person (chaperone) present. You can ask for a female doctor to carry it out. If there isnt a female doctor available, you can ask if theres a female health professional who could carry out the examination. If symptoms continue, your doctor may refer you to a gynaecologist. Laparoscopy The only way to confirm endometriosis is by a laparoscopy. This is an operation in which a camera (a laparoscope) is inserted into the pelvis via a small cut near the belly button. Sometimes its possible to remove some endometrial tissue at the same time. After the laparoscopy, the doctor will be able to tell you if you have endometriosis. This is known as a confirmed diagnosis. Its also possible that no endometriosis is seen at laparoscopy. Your doctor will discuss the findings and any further treatment after laparoscopy. Not everyone with endometriosis will need a laparoscopy if the symptoms can be managed. Your doctor will discuss your treatment options with you so you can decide whats best for you. If you have a type of endometriosis that needs additional treatment, you might be referred to a specialist centre. These are located in Edinburgh, Glasgow and Aberdeen. Your doctor will discuss the best option for you. Whether youre having, or have had a laparoscopy, you can access the Recovering well patient information leaflet for more information. Managing endometriosis There is no cure for endometriosis but there are treatments that can help to control or improve your symptoms. Heat and comfort A hot water bottle or hot bath may help to provide comfort and help you to feel a bit better. Pain relief Paracetamol and non-steroidal anti-inflammatories (NSAIDs), such as ibuprofen and naproxen, can help reduce your pain. Hormone treatment Hormone treatment can be used to help thin the womb lining, causing periods to become shorter and lighter easing the symptoms of endometriosis such as heavy menstrual bleeding Hormone treatments include: contraceptive pill (the pill) contraceptive patch contraceptive injection intrauterine system (IUS) Surgery Some people will have surgery to help treat or remove areas of endometriosis. Not everyone who has endometriosis will need surgery. It depends on where in the body the endometriosis is and how much. Even after surgery, the endometriosis may grow back so some people may need further surgery. Your doctor will discuss this with you and you can ask any questions that you might have. Laparoscopy The only definitive way to confirm or exclude endometriosis is by a laparoscopy. This is called a confirmed diagnosis. A laparoscopy is a procedure where a camera (a laparoscope) is inserted into the pelvis via a small cut near the belly button. The doctor will discuss with you any findings and any course of treatment. Sometimes it is also possible to remove some endometrial tissue during the laparoscopy. If you have a more complex type of endometriosis that needs additional treatment, you might be referred to a specialist centre. These are located in Edinburgh, Glasgow and Aberdeen and your doctor will discuss the best option for you. However, not everyone with endometriosis will need a laparoscopy. Your doctor will discuss your treatment options so you can decide whats best for you. Laparotomy During a laparotomy, the surgeon makes a cut in the tummy so that endometriosis can be removed. Further information about endometriosis treatment Adhesions and ovarian cysts Endometriosis can also cause: adhesions  scar tissue that can fuse organs together ovarian cysts  fluid-filled cysts in the ovaries that can sometimes become very large and painful Both of these complications can be treated with surgery but may come back if the endometriosis returns. Read information about treating ovarian cysts Endometriosis and fertility Many people with endometriosis are able to get pregnant naturally. However, more severe cases of endometriosis can cause scar tissue (adhesions) making it more difficult to get pregnant. If youre having difficulty getting pregnant, your doctor or specialist may suggest extra support or treatments that can help. Your doctor will discuss these with you and you can ask any questions that you might have. Additional help and support Sometimes it can feel hard to talk about endometriosis and the symptoms youre experiencing. Hearing from other women in Scotland, discussing their experiences with endometriosis within online support networks or in real life can really help. There might be peer support groups near you or other local groups where you can hear other womens stories, and share your own. Living with endometriosis Source: Scottish Government - Opens in new browser window Last updated: 07 March 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Other languages and formats  |  | Polski |  |  | British Sign Language (BSL) | Easy Read  |  | Polski |  |  | British Sign Language (BSL) | Easy Read Add this page to\n            Info For Me Also on NHS inform Self-help tool: Periods and mental wellbeing Other health sites Royal College of Obstetricians and Gynaecologists: Laparoscopy - recovering leaflet Endometriosis UK: Endometriosis treatment Endometriosis UK: Endometriosis pain and symptom diary Endometriosis UK: Get support Samaritans British Society for Gynaecological Endoscopy Royal College of Obstetricians and Gynaecologists: Endometriosis patient information leaflet The University of Edinburgh: Endometriosis NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Epilepsy,"Epilepsy | NHS inform | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Epilepsy Epilepsy Epilepsy is a condition that affects the brain and is defined by repeated seizures. Epilepsy affects more than 600,000 people in the UK. Almost one in every 100 people has the condition. Symptoms of epilepsy The main symptoms of epilepsy are repeated seizures. There are different types of seizure, depending on which part of the brain it affects. The cells in the brain, known as neurons, conduct electrical signals. They communicate with each other in the brain using chemical messengers. During a seizure, there are abnormal bursts of neurons firing off electrical impulses. This can cause the brain and body to behave strangely. The severity of seizures can differ from person to person. Some people experience an odd feeling with no loss of awareness, or may have a trance-like state for a few seconds or minutes. Others lose consciousness and have convulsions (uncontrollable shaking of the body). Some people might only have a single seizure. If they do not have a high risk of having further seizures, they would not be regarded as having epilepsy. Types of seizures People with epilepsy can experience any type of seizure, although most people have a consistent pattern of symptoms. Seizures can occur when youre awake or asleep. The type of seizure depends on how much of the brain it affects. There are: focal (or partial) seizures  where only a small part of the brain is affected generalised seizures  where most or all of the brain is affected Some seizures do not fit into these categories and are known as unclassified seizures. Focal seizures There are two main types of focal seizure. Focal aware seizures Focal aware seizures are where you remain fully conscious throughout. Symptoms of a focal aware seizure can include: a general strange feeling that is hard to describe a rising feeling in your tummy  sometimes likened to the sensation in your stomach when on a fairground ride an intense feeling that events have happened before (dj vu) experiencing an unusual smell or taste a tingling sensation, or pins and needles, in your arms and legs a sudden intense feeling of fear or joy stiffness or twitching in part of the body, such as an arm or hand These seizures are sometimes known as warnings or auras, because they can be a sign that another type of seizure is on its way. This can give you time to warn people around you and make sure youre in a safe place. Focal impaired awareness seizures Focal impaired awareness seizures are when you lose your sense of awareness. You wont remember what happened after this type of seizure. The symptoms of a focal impaired awareness seizure can involve random bodily behaviour, like: smacking your lips rubbing your hands making random noises moving your arms around picking at clothes fiddling with objects adopting an unusual posture chewing or swallowing During a focal impaired awareness seizure, youll not be able to respond to anyone else. Youll usually have no memory of it. Generalised seizures There are 6 main types of generalised seizure. Absences Absence seizuresmainlyaffect children, but they also occur in adults. They cause the person to lose awareness of their surroundings, usually for up to 15 seconds. The person will seem to starevacantlyinto space. Some people will flutter their eyes or smack their lips. The person will have no memory of the seizure. Absences can occur several times a day. They may affect a childs performance at school. They can be dangerous if they occur at a critical time, like crossing a busy road. Myoclonic seizures These types of seizures cause your arms, legs or upper body to jerk or twitch, as if you have received an electric shock. They often only last for a fraction of a second, and youll normally remain conscious during this time. Myoclonic jerks often happen in the first few hours after waking up. They can occur in combination with other types of generalised seizures. Clonic seizures These cause the same sort of twitching as myoclonic jerks, except the symptoms will last longer, normally up to 2 minutes. You might lose consciousness during a clonic seizure. Atonic seizures Atonic seizures cause all your muscles to relax suddenly. Theres a chance you may fall to the ground and you could injure yourself. Tonic seizures Tonic seizures cause all your muscles to suddenly become stiff. You might lose balance and fall over. Like atonic seizures, theres a risk of injury. Tonic-clonic seizures Tonic-clonic seizures or convulsions have 2 stages. Your body will initially become stiff and then your arms and legs will begin twitching. Youll lose consciousness and some people will wet themselves. The seizure normally lasts a minute, but can last longer. This type of seizure is what most people think of as an epileptic fit. Myoclonic-tonic-clonic seizures and Myoclonic-atonic are seizures involving a combination of the generalised seizures above. What to do if someone has a seizure If you see someone having a seizure, there are some things you can do to help. It will not usually be necessary to call an ambulance after a seizure. Phone 999 if: the seizure has not stopped after 5 minutes the person has more than one seizure without recovering in between you know its the persons first seizure the person is injured, has breathing problems, or needs emergency medical attention for any other reason the persons behaviour after a seizure is unsafe If youre with someone who has a seizure: protect them from injury by removing any dangerous or potentially harmful objects nearby cushion their head with your hands or soft material do not restrain them or attempt to move them (unless they are in immediate danger) dont put anything in their mouth stay calm, and stay with them until they regain consciousness When the convulsions have stopped, put them into the recovery position until theyve recovered. Status epilepticus Status epilepticus is the name for any seizure that lasts longer than 5 minutes, or a series of seizures where the person does not regain consciousness in between. This is a medical emergency and requires treatment as soon as possible. You can be trained to treat status epilepticus if you care for someone with epilepsy. Its important to phone 999 for an ambulance immediately if you suspect status epilepticus. If youve been trained to treat the condition, youll usually have been advised to use either: a medication called buccal midazolam that comes in liquid form and is given by trickling the liquid onto the inside of the persons cheek or up their nose (this is the most common immediate treatment) a medication called diazepam thats placed in the persons rectum (less commonly used) If youve tried one of these treatments and the seizures are continuing, phone 999 for an ambulance. Causes of epilepsy In some cases of epilepsy a cause cannot be found. If theres an identifiable cause, it usually involves the brain being affected by a condition. The brain is a delicate mix of nerve cells, electrical impulses and chemicals, known as neurotransmitters. Any damage has the potential to disrupt the workings of the brain and cause seizures. The categories of epilepsy can be separated by their causes which might be: Structural Causes of structural epilepsy can include: cerebrovascular disease (problems with the blood vessels that supply the brain)  such as a stroke or subarachnoid haemorrhage brain tumours severe head injuries Genetic A genetic abnormality can cause epilepsy. Research has found more genetic causes of epilepsy. Sometimes epilepsy is hereditary (passed on from one or both parents) or it can be a new gene abnormality. Infectious Infections like meningitis can cause damage to the brain which can result in epilepsy. Viral infections like HIV can also cause epilepsy. Metabolic Sometimes epilepsy is caused by an imbalance of the bodies chemicals. This is very rare. Immune Autoimmune conditions that cause encephalitis (inflammation of the brain) can cause someone to develop epilepsy. Unknown In many cases, no cause of epilepsy is found. This may be because medical investigations are not advanced enough to identify the cause. Seizure triggers For many people with epilepsy, seizures can occur without any obvious trigger. However, certain circumstances or the use of certain substances can sometimes come before a seizure. These include: stress lack of sleep withdrawal from alcohol following heavy drinking some medications illegal drugs your menstrual cycle or period flashing lights (this is an uncommon trigger that affects less than 5% of people with epilepsy, and is known as photosensitive epilepsy) Keeping a seizure diary is a good way to help find out what might trigger your seizures. Every time you have a seizure, record it and make a note of what you were doing. Over time, you might notice some avoidable things that seem to trigger your symptoms. Diagnosing epilepsy Epilepsy is usually difficult to diagnose quickly. In most cases, it cannot be confirmed until you have had more than one seizure. It can be difficult to diagnose because many other conditions, like fainting, migraines and panic attacks , can cause similar symptoms. If youve had a seizure, youll be referred to a specialist in epilepsy. This will normally be a neurologist (a doctor who specialises in conditions affecting the brain and nervous system). Describing your seizures Some of the most important pieces of information needed to diagnose epilepsy are the details about your seizures. The doctor will ask you what you can remember and any symptoms you may have had before it happened things like feeling strange before the seizure or experiencing any warning signs. It is extremely useful to talk to anyone who seen your seizure and ask them exactly what they saw, especially if you cannot remember. The doctor will also ask about your medical and personal history. Theyll ask whether you use any medicines, drugs or alcohol. The doctor may be able to make a diagnosis of epilepsy from the information you give. They might run further tests like an electroencephalogram (EEG) or magnetic resonance imaging (MRI) scan . Even if these tests dont show anything, its still possible that you have epilepsy based on your symptoms and description of your seizures. Magnetic resonance imaging (MRI) scan An MRI scan is a type of scan which uses strong magnetic fields to produce detailed images of the inside of your body. It can be useful in cases of suspected epilepsy. It can often detect possible causes of the condition, such as defects in the structure of your brain. Electroencephalogram (EEG) An EEG test can detect unusual brain activity associated with epilepsy. It measures the electrical activity of your brain through electrodes placed on your scalp. During the test, you may be asked to breathe deeply or close your eyes and you may be asked to look at a flashing light. The test will be stopped immediately if it looks like the flashing light could trigger a seizure. In some cases, an EEG may be carried out while youre asleep (sleep EEG). Or you may be given a small, portable EEG recording device to monitor your brain activity over 24 hours (ambulatory EEG). You might be asked to come into the hospital for a few days to have a video telemetry and EEG. During this, an EEG and video will be used to monitor you. Treating epilepsy Most people with epilepsy can be successfully treated with anti-seizure medication (ASMs). ASMs do not cure epilepsy, but can prevent seizures from occurring. There are many different ASMs. They work by changing the levels of the chemicals in your brain that conduct electrical impulses. This reduces the chance of a seizure. The type of ASM recommended for you will depend on a number of factors like: the type of seizures you have your age whether there are any concerns about a certain ASM interacting with other medicines (like the contraceptive pill ) whether youre thinking of having a baby Examples of commonly used ASMs include sodium valproate, carbamazepine, lamotrigine and levetiracetam. Taking ASMs ASMs are available in different forms, including tablets, capsules, liquids and syrups. Its important you follow any advice about when to take ASMs and how much to take. Never suddenly stop taking an ASM because it could cause a seizure. You shouldnt take any other medicines whilst taking ASMs without speaking to your GP or epilepsy specialist. This includes over-the-counter medicines or complementary medicines such as St Johns Wort. Other medicines could have a dangerous interaction with your ASM and cause a seizure. Sodium valproate is not usually prescribed for women of childbearing age. This is because it could causea baby to have physical defects or developmental problems. It can be used if there is no alternative, or if your specialist has assessed you and its unlikely youll respond to or tolerate other treatments. Your specialist or GP will also need to check youre using a reliable form of contraception. Learn more about the risks of valproate medicines during pregnancy . Side effects are common when starting treatment with ASMs. Theyre usually short-lived and pass in a few days. Speak to your healthcare team for more information on the side effects. Brain surgery If your epilepsy is still poorly controlled after trying treatment with ASMs, you may be referred to a specialist epilepsy centre. Theyll assess if youre suitable for surgery. This involves having various types of brain scans to find out where the epilepsy is focused. Memory and psychological tests will assess how the surgery might affect you. Surgery is only recommended when: a single area of the brain is causing seizures (focal seizures) removing that part of the brain would not cause any significant loss of brain function Most people recover from the effects of surgery after a few days. But it could be several months before youre feeling fit and able to return to work. Alternative procedures Your doctor might suggest an alternative procedure if: your epilepsy is still poorly controlled after trying treatment with ASMs brain surgery is not suitable for you This might be vagus nerve stimulation (VNS). Vagus nerve stimulation (VNS) VNS involves surgically implanting a small electrical device under your skin, near your collarbone. The device is like a pacemaker . The device has a wire thats wrapped around one of the nerves in the left side of your neck, known as the vagus nerve. The device passes a regular dose of electricity to the nerve to stimulate it. This can help reduce the frequency and severity of seizures. If you feel the warning sign of a seizure coming on, you can activate an extra burst of stimulation. This might prevent the seizure from occurring. The stimulation normally occurs every five minutes and lasts for 30 seconds. How and why VNS works is not fully understood. Its thought that stimulating the vagus nerve alters the chemical transmissions in the brain. Most people who undergo VNS still need to take ASMs. The battery for the VNS device typically lasts up to 10 years. After 10 years youll need another procedure to replace it. Ketogenic diet A ketogenic diet is a diet high in fats and low in carbohydrates and protein. Its thought that it may make seizures less likely by altering the chemical composition of the brain. A ketogenic diet is sometimes advised for children with seizures that are difficult to control and have not responded to ASMs. This is because its reduces the number of seizures in some children. It should only be used under the supervision of an epilepsy specialist with the help of a dietitian. It can also be effective in adults with certain types of epilepsy. Living with epilepsy Regular exercise and a healthy diet are recommended for everyone. They can help prevent many conditions, including heart disease and many forms of cancer . Try to eat a balanced diet, containing all the food groups, to give your body the nutrition it needs. Exercising regularly can increase the strength of your bones, relieve stress and reduce fatigue. Drinking Alcohol can also interact with anti-seizure medication (ASMs). ASMs can heighten the effects of alcohol. Alcohol also can make the side effects of ASMs worse and make the medication less effective. Heavy drinking can disrupt your sleep patterns. This increases your chances of having a seizure. Drinking no more than the recommended daily limits may help reduce this risk. Read more about drinking and alcohol Contraception Some anti-seizure medication (ASMs) can reduce the effectiveness of some types of contraception. This includes: contraceptive injections contraceptive patches the combined oral contraceptive pill  often known as the pill the progesterone-only pill (POP) or mini pill contraceptive implants If youre sexually active and do not want to become pregnant, ask your GP or epilepsy specialist if your ASMs could affect your contraception. You may need to ensure you or your partner use another form of contraception like a condom or intrauterine device (IUD) . The effectiveness of the ASM lamotrigine may be reduced if youre taking the combined oral contraceptive pill. Some ASMs can make the emergency contraceptive pill less effective. If you need emergency contraception, you may need an IUD. Your GP, family planning clinic or pharmacist should be able to help you. Pregnancy Theres no reason why women with epilepsy cannot have a healthy pregnancy. Its better if the pregnancy is planned because theres a slightly higher risk of complications. With forward planning, you can minimise these risks. The main risk is that some ASMs increase the chances of a serious birth defect, like spina bifida, cleft lip or congenital heart disease . The risks depend on the type of ASM and the dose youre taking. The UK Epilepsy and Pregnancy Register can provide more information and advice about the use of ASMs during pregnancy. If youre planning a pregnancy, talk to your epilepsy specialist. It may be possible to change the ASM youre taking to minimise risks. Taking 400micrograms (mcg)of a folic acid supplement each day can also help reduce risks of birth defects. You might be recommended to take more than this by your healthcare team. If you discover youre pregnant, do not stop taking your medicine. The risks to your baby from uncontrolled seizures are far higher than any risks associated with your medicines. If youre breastfeeding or planned to breastfeed, discuss the medication youre taking with your healthcare team or midwife. Children and epilepsy Many children with well-controlled epilepsy can learn and take part in their schools activities unaffected by their condition. Others may need extra support to get the most out of their time at school. Make sure your childs teachers know about their condition and the medication they need to control it. Epilepsy is more common among children with learning disabilities and special educational needs. These children are entitled to extra help to overcome their difficulties. Driving You must tell the Driving and Vehicle Licence Authority (DVLA) if youve had any epileptic seizures or blackouts. You must stop driving right away. If you ignore these regulations, you might be prosecuted. The DVLA may wish to contact your GP or epilepsy specialist. The DVLA may issue a licence if your seizures have never caused you to lose awareness or affected your ability to safely control a vehicle. Your GP has a legal responsibility to inform the DVLA if they feel that your driving is putting both you and others at risk. Read about epilepsy and driving on the DVLA website Sudden unexpected death in epilepsy (SUDEP) When somebody with epilepsy dies and theres no clear cause, its known as sudden unexpected death in epilepsy (SUDEP). The risk of SUDEP for someone with epilepsy is low. The exact causes of SUDEP are unknown. Its not possible to predict who it will affect. One theory is that seizures could affect the persons breathing and heartbeat. Things that may lead to SUDEP include: having seizures which cause loss of consciousness and the body to go stiff and jerk (tonic-clonic seizures) poorly controlled epilepsy, such as not using ASMs prescribed to control seizures having sudden and frequent changes to ASMs being a young adult (in particular male) having sleep seizures having seizures when alone drinking large amounts of alcohol If youre worried that your epilepsy is poorly controlled, contact your epilepsy specialist. It may be possible to refer you to a specialist epilepsy centre for further treatment. A charity called SUDEP Action can offer advice and support on SUDEP. They have a helpline for people who have lost a loved one as a result of epilepsy. Last updated: 07 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Febrile seizures Other health sites Epilepsy Society Epilepsy Research UK Epilepsy Action SUDEP Action UK Epilepsy and Pregnancy Register Brain and Spine Foundation: Epilepsy Epilepsy Scotland Choice and Medication: Epilepsy NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Erectile dysfunction (impotence),"Erectile dysfunction - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Sexual and reproductive Erectile dysfunction (impotence) Erectile dysfunction (impotence) About erectile dysfunction Symptoms of erectile dysfunction Causes of erectile dysfunction Diagnosing erectile dysfunction Treating erectile dysfunction About erectile dysfunction Erectile dysfunction (ED), also known as impotence, is the inability to get and maintain an erection. Erectile dysfunctionis a very common condition, particularly in older men. It is estimated that half of all men between the ages of 40and 70 will have it to some degree. When to see your GP See your GP if you have erectile dysfunction for more than a few weeks. They will assess your general state of health because the condition can be the first sign of more serious health conditions, such as heart disease (when the hearts blood supply is blocked or interrupted). Find your local GP practice Why does erectile dysfunction happen? Erectile dysfunctioncan have a range of causes, both physical and psychological. Physical causes include: narrowing of the blood vessels going to the penis commonly associated with high blood pressure (hypertension), high cholesterol or diabetes hormonal problems surgery or injury Psychological causes of ED include: anxiety depression relationship problems Sometimes erectile dysfunction only occurs in certain situations. For example, you may be able to get an erection during masturbation, or you may find that you sometimes wake up with an erection but you are unable to get an erection with your sexual partner. If this is the case, it is likely the underlying cause of erectile dysfunction is psychological (stress related). If you are unable to get an erection under any circumstances, it is likely that the underlying cause is physical. Erectile dysfunction can also be a side-effect of using certain medicines. Read more about the causes of erectile dysfunction Diagnosis Although you may be embarrassed, its important to get a diagnosisso that the cause can be identified. Your GP can usually diagnose erectile dysfunction. This will involve answering questions about your symptoms, as well as a physical examination and some simple tests. Read more about diagnosing erectile dysfunction How is erectile dysfunction treated? Erectile dysfunction is primarily treated by tackling the cause of the problem, whether this is physical or psychological. The narrowing of the arteries (called atherosclerosis) is one of the most common causes of ED. In these casesyour GP may suggest lifestyle changes, such as losing weight, to try to reduce your risk of cardiovascular disease . This mayhelp to relieve your symptoms as well as improving your general health. You may also be given medication to treat atherosclerosis, such as cholesterol-lowering statins and drugs to reduce your blood pressure. A number of treatmentshavebeen successful in the treatment of erectile dysfunction. Medication, suchas sildenafil (sold as Viagra),can be used to manage it in at least two-thirds of cases. Vacuum pumps that encourage blood to flow to the penis and cause an erection are also successful in 90% of cases. Psychological treatmentsincludecognitive behavioural therapy (CBT) and sex therapy. Overall, treatments forerectile dysfunctionhave improved significantly in recent years. Most men are eventually able to have sex again. Read more about treating erectile dysfunction Symptoms of erectile dysfunction The main symptom of erectile dysfunction (ED) is the inability to get and maintain an erection for satisfactory intercourse. ED should not be confused withejaculation problems such as premature ejaculation, which is a condition where the process of arousal, orgasm and ejaculation occurs very rapidly. Inability to get an erection Sometimes ED only occurs in certain situations. For example, you may be able to get an erection during masturbation, or you may find that you sometimes wake up with an erection but you are unable to get an erection with your sexual partner. In these circumstances, it is likely that the underlying cause of ED is primarily psychological (stress related). However, if you are unable to get an erection under any circumstances, it is likely that the underlying cause is primarily physical. Seek medical advice See your GP if ED persists for more than a few weeks. They will assess your general state of health because the condition can be the first sign of more serious health conditions, such as heart disease (when the hearts blood supply is blocked or interrupted). Many websites offer treatments for ED but their use is not recommended. The medications that are offered by these sites could be fake and may be dangerous. Even if the medications are genuine, they may not be suitable for you. It is important that you only take medication for ED that your GP has prescribed for you. Read more about treating erectile dysfunction Causes of erectile dysfunction Erectile dysfunction (ED) can have many causes, such as certain medical conditions, medications and stress. Its important to identifythe cause of erectile dysfunction and treat any underlying conditions. Erections Whena manbecomes sexually excited (aroused), his brain sends signals to the nerves in his penis. The nerves increase the blood flow to the penis, causing the tissue to expand and harden. Anything that interferes with the nervous system or the blood circulation could lead toerectile dysfunction. Anything that affects the level of sexual desire (libido)can also causeerectile dysfunction because a reduced libido makes it more difficult for the brain to trigger an erection. Psychological conditions, such as depression , can reduce libido, as can changes in hormone levels (chemicals produced by the body). Physical causes There are four main types of health conditions that can cause physical problems resulting inerectile dysfunction. These are: conditions affecting the flow of blood to your penis vasculogenic conditions affecting your nervous system, which is made up of your brain, nerves and spinal cord  neurogenic conditions affecting your hormone levels  hormonal conditions affecting the physical structure of your penis anatomical Injuries and surgery Penis injuries or surgical treatment of the penis, pelvis or surrounding areas can sometimes lead to erectile dysfunction. Erectile dysfunction is also thought to occur in up to 15-25% of people whoexperience a severe head injury . Vasculogenic conditions Examples of vasculogenic conditions that cause erectile dysfunction include: cardiovascular disease  a disease of the heart or blood vessels, such as atherosclerosis (hardening of the arteries) high blood pressure (hypertension) diabetes a condition caused by high blood sugar levels. This can affect both the blood supply and the nerve endings in your penis, so it is also a neurogenic condition Erectile dysfunctionis strongly associated with cardiovascular disease. For this reason, it may be one of the first causes your GP considers whenmaking a diagnosisand planning your treatment. Neurogenic conditions Examples of neurogenic conditions that causeerectile dysfunction include: multiple sclerosis  a condition that affects the bodys actions, such as movement and balance Parkinsons disease  a condition that affects the way that the brain coordinates body movements, including walking, talking and writing a spinal injury or disorder a stroke  a serious condition that occurs when the blood supply to the brain is interrupted Hormonal conditions Examples of hormonal conditions that causeerectile dysfunction include: hypogonadism a condition that affects the production of the male sex hormone, testosterone, causing abnormally low levels an overactive thyroid gland (hyperthyroidism) where too much thyroid hormone is produced an underactive thyroid gland (hypothyroidism)  where not enough thyroid hormone is produced Cushings syndrome  a condition that affects the production of a hormone called cortisol Anatomical conditions Peyronies disease, which affects the tissue of the penis, is an example of an anatomical condition that can causeerectile dysfunction. Medicine In some men,certain medicines can causeerectile dysfunction, including: diuretics  these increase the production of urine and are often used to treat high blood pressure (hypertension), heart failure and kidney disease antihypertensives such as beta-blockers , that are used to treat high blood pressure fibrates medicines used to lower cholesterol levels antipsychotics used to treat some mental health conditions, such as schizophrenia antidepressants  used to treat depression and some types of pain corticosteroids  medication that contains steroids, which are a type of hormone H2-antagonists medicines used to treat stomach ulcers anticonvulsants used to treat epilepsy antihistamines used to treat allergic health conditions, such as hay fever anti-androgens medication that suppresses androgens (male sex hormones) cytotoxics medication used in chemotherapy to prevent cancer cells from dividing and growing Speak to your GP if you are concerned that a prescribed medicine is causing erectile dysfunction. Alternative medication may be available. However,it is important never tostop taking a prescribed medicine unless you are advised to do so by a qualified healthcare professional who is responsible for your care. Psychological causes Possible psychological causes oferectile dysfunction include: depression  feelings of extreme sadness that last for a long time anxiety a feeling of unease, such as worry or fear Erectile dysfunction can often have both physical and psychological causes. For example, if you have diabetes, it may be difficult for you to get an erection, which may cause you to become anxious about the situation. The combination of diabetes and anxiety may lead to an episode of erectile dysfunction. There aremany emotional issues that may also affect your physical ability to get or maintain an erection. These include: relationship problems lack of sexual knowledge past sexual problems past sexual abuse being in a new relationship Other causes Other possible causes oferectile dysfunctioninclude: excessive alcohol intake tiredness using illegal drugs, such as cannabis, heroin or cocaine Cycling Men who cycle for more than three hours per week may be recommended to try a period without cycling to see if this helps improve erectile dysfunction. Riding in the correct position with a properly fitted seat may also help to prevent regular cycling from leading to erectile dysfunction. Diagnosing erectile dysfunction Erectile dysfunction (ED) can often be diagnosed by your GP. They will talk to you about your situation and may carry out a physical examination. Your GP may ask you about: your symptoms your overall physical and mental health your alcohol consumption whether you take drugs whether you are currently taking any medication If you do not want to talk to your GP about erectile dysfunction, you can visit a genitourinary medicine (GUM) clinic. You can find your nearest GUM clinic on the British Association for Sexual Health and HIV(BASHH) website. Sexual history Youll also be askedabout your sexual history. Try not to be embarrassed becauseerectile dysfunction is a common problem.You can request a male GP at your surgery if you prefer. You may be asked about: your previous and current sexual relationships what your sexual orientation is how long you have been experiencing erectile dysfunction whether you can get any degree of erection with your partner, on your own or when you wake up in the morning whether you have been able to ejaculate or orgasm your libido (your level of sexual desire) Erectile dysfunctionthathappens all the time may suggest an underlying physical cause. Erectile dysfunction thatonly occurs when you are attempting to have sex may suggest an underlying psychological (mental) cause. Assessing your cardiovascular health Your GP may assess your cardiovascular health. Narrowed blood vessels are a common cause of erectile dysfunction and linked with cardiovascular disease (conditions that affect the heart and blood flow). Your GP may: measure your blood pressure to see if you have high blood pressure (hypertension) listen to your heart rate to check for any abnormalities measure your height, weight and waist circumference to see if you are a healthy weight for your height ask you about your diet and lifestyle, for example, how much exercise you do test a sample of your blood for glucose (sugar) and lipids (fatty substances), as high levels can indicate conditions affecting your heart or blood vessels Physical examinations and tests Aphysical examination of your penis may be carried outto rule out anatomical causes (conditions that affect the physical structure of your penis). If you have symptoms of an enlarged prostate , such as weak or irregular urination, a digital rectal examination (DRE) may be suggested. Blood tests can alsocheck for underlying health conditions. For example, measuring the levels of hormones such as testosterone can rule out hormonal conditions, such as hypogonadism (an abnormally low level of testosterone). Further testing In some cases you may be referred to a specialist for further testing. This might be the case if youare unusually young to be experiencingerectile dysfunction as its rare in men under 40 years of age. Intracavernous injection test An intracavernous injection test involves injecting a man-made (synthetic) hormone into your penis to increase the blood flow. This helpsassess anyabnormalities in your penis and plan surgery. If the injection doesnt result in anerection it may indicate a problem with the blood supply to your penis. In some cases, you may also need an ultrasound scan . Arteriography and dynamic infusion cavernosometry or cavernosography These specialised tests involve injecting dye into the blood vessels of your penis and studying the dye on a scanner. These are likely to be used if you are being considered for surgery or if a problem has been detected with your blood vessels. Psychological assessment If the cause of your erectile dysfunction is thought to be psychological, you may be refferedfor a psychological assessment. Treating erectile dysfunction If you have erectile dysfunction (ED), treatment will depend on whats causing it. The various treatments for erectile dysfunction are outlined below. Treating underlying conditions If yourerectile dysfunction is caused by an underlying health condition, such as heart disease or diabetes , that condition may need to be treated first. In some cases, treating the underlying cause may also resolve the problem. If you are taking medication that can cause erectile dysfunction, there may be an alternative. It is important never to stop taking a prescribed medication unless you are advised to do so by your GP or another qualified healthcare professional responsible for your care. Lifestyle changes Erectile dysfunction can often be improved by making changes to your lifestyle, such as: losing weight if you are overweight giving up smoking cutting backyour alcohol consumption not taking illegal drugs exercising regularly reducing stress As well as helping to improve yourerectile dysfunction, these changes can also improve your general health and may help to reduce your risk of cardiovascular disease (conditions that affect your heart and blood vessels). Read more about preventing cardiovascular disease Phosphodiesterase-5 (PDE-5) inhibitors Phosphodiesterase-5 (PDE-5) inhibitors are one of the most widely used and effective types of medication for treating erectile dysfunction. They work by temporarily increasing the blood flow to your penis. In England,four PDE-5 inhibitors are available for treating erectile dysfunction. They are: sildenafil sold under the brand name Viagra tadalafil sold under the brand name Cialis vardenafil sold under the brand name Levitra avanafil sold under the brand name Spedra Sildenafil, vardenafil and avanafil work for about eight hours and they are designed to work on demand. Tadalafil lasts for up to 36 hours and is more suitable if you require treatment for a longer period of time, for example, over a weekend. Depending on the type of PDE-5 inhibitor you are taking and the dose, it should take about 30-60 minutes before it starts to work. With sildenafil, vardenafil and avanafil, you should be able to have sex from one to 10 hours after taking the medicine. After taking tadalafil, the effects will last for up to 36 hours. It may take longer to notice the effects if the tablet is taken with food, so its best to take it on an empty stomach. You can then eat after an hour without affecting the medicine. Only take one tablet within a 24-hour period. Your GP should explain the benefits of each medication and how it works. The choice may depend on: how often you are sexually active whether you have tried any of the medications before There have been many studies to test the effectiveness of these medications. In general,at leasttwo-thirds of men report having improved erections after taking one of these medicines. If you do not find that PDE-5 inhibitors are effective it may be because: you have not waited long enough after taking the dose you have waited too long after taking the dose the dose is not high enough you have not had enough sexual stimulation These medications are triggered by sexual stimulation, so you also need to be aroused for it to work. Warnings PDE-5 inhibitors should be usedwith caution in men who have cardiovascular disease , such as coronary heart disease. However, sexual activity is also likely to be beneficial for your cardiovascular health. You should discuss the risks and benefits with your GP. PDE-5 inhibitors should also be used with caution in men who have anatomical problems with their penis, such as Peyronies disease (a condition that affects the tissue of the penis). PDE-5 inhibitors should also be used with caution in men who: are at risk of priapism a painful erection that lasts for several hours are also taking long lasting alpha-blockers  a medication used to treat a number of conditions, such as high blood pressure (hypertension) Do not take PDE-5 inhibitors if you are also taking medicines or recreational drugs that contain nitrates. The combination of the two substances can have a dangerous effect on your heart. Organic nitrates are often used to treat angina, and butyl nitrate is a recreational drug that is more commonly known as poppers. Youarealsowarnednot to take PDE-5 inhibitors if you: have been advised not to take part in sexual activity or in activities that widen your blood vessels have low blood pressure (hypotension) have recently had a stroke  a medical emergency that occurs when the blood supply to the brain is interrupted have unstable angina  an underlying heart condition that causes symptoms such as chest pain have had a heart attack  a medical emergency where the blood supply to the heart is suddenly blocked have a history of non-arteritic anterior ischaemic optic neuropathy an eye condition that causes a sudden loss of vision Side effects PDE-5 inhibitors can cause some side effects, including: headaches and migraines flushing (redness) indigestion nausea (feeling sick) vomiting (being sick) a blocked or runny nose back pain vision disturbances muscle pain Vacuum pumps A vacuum pump consists of a clear plastic tube that is connected to a pump, which is either hand or battery operated. You place your penis in the tube and pump out all of the air. This creates a vacuum that causes the blood to fill your penis, making it erect. You then place a rubber ring around the base of your penis to keep the blood in place, allowing you to maintain an erection for around 30 minutes. It may take several attempts to learn how to use the pump correctly, but they are usually effective. After using a vacuum pump,nine out of 10 men are able to have sex, regardless of the cause of their ED. Considerations You should not use a vacuum pump if you have a bleeding disorder or if you are taking anticoagulant medicines , which reduce the ability of your blood to clot. Side effects of vacuum pumps include pain or bruising, although these occur in less than a third of men. Men who qualify for NHS prescriptions for erectile dysfunction treatments may be able to get a vacuum pump on the NHS (see above for more details). However,some men will need to buy one. The Sexual Advice Association produces a number of factsheets, including one on vacuum pumpsthat provides details of companies that supply them. Alprostadil If yourerectile dysfunction doesntrespond to treatment, or you are unable or unwilling to use PDE-5 inhibitors or a vacuum pump, you may be given a medicine called alprostadil. This is a synthetic (man-made) hormone that helps to stimulate blood flow to the penis. Alprostadil is available as: an injection directly into your penis this is called an intracavernosal injection a small pellet placed inside your urethra (the tube that carries urine from your bladder to the tip of your penis) this is called urethral application You may be trained to correctly inject or insert alprostadil. If your partner is pregnant,use a condom during sex if you are inserting alprostadil into your urethra. Alprostadil will usually produce an erection after five to 15 minutes. How long the erection lasts will depend on the dose. In men who did not respond to PDE-5 inhibitors, alprostadil injections were successful in 85 out of 100 men. Alprostadil inserted into the urethra is successful for up to two-thirds of men. Warnings Alprostadil should not be used: inmen at risk of priapism (a painful erection that lasts for several hours) for example, those with sickle cell anaemia alongside othererectile dysfunction medications if you have a penile implant or if you have been advised to avoid sexual activity Urethral application may also not be used in: somemen who have anatomical problems with their penis (conditions that affect the physical structure of the penis) men who have infections of their penis, such asbalantis(inflammation of the head of the penis) Side effects Alprostadil can cause some side effects including: changes in your blood pressure dizziness headache pain in your penis urethral burning or bleeding reactions at the site of the injection, such as swelling NHS prescriptions As with PDE-5 inhibitors, NHS prescriptions for alprostadil may only be available formen with particular health conditions or those receiving some types of medical treatments. If you need to pay the full prescription cost, a single injection of alprostadil costs around 8 to 22, depending on the dose. A single dose of alprostadil for urethral application is around 10. Hormone therapy If a hormonal condition is causingerectile dysfunction, you may be referred to an endocrinologist (who specialises in the treatment of hormonal conditions). Hormones are chemicals produced by the body. Many hormonal conditions can be treated using injections of synthetic (man-made) hormones to restore normal hormone levels. Surgery Surgery forerectile dysfunction is usually only recommended if all other treatment methods have failed. It may also be considered in: younger men who have experienced serious injury to their pelvic area for example, in a car accident men with a significant anatomical problem with their penis In the past, surgery was used if there was clear evidence of a blockage to the blood supply of the penis. The surgeon could unblock the blood vessels to restore a normal supply of blood. However, research now suggests that the long-term results of this type of surgery are poor, so its unlikely to be used. Penile implants Penile implants are a type of surgery that may be considered. These can be: semi-rigid implants  which may be suitable for older men who do not have sex regularly inflatable implants  which consist of two or three parts that can be inflated to give a more natural erection Penile implants are not usually available on the NHS and inflatable implants may be very expensive. However, around three-quarters of men report being satisfied with the results of this type of surgery. Complications As with all types of surgery, having penile implants insertedcarries a risk of infection. If you take preventative antibiotics, the rate of infection is aroundtwoor threein 100. Mechanical problems with the implants may occur within five years infiveper cent ofcases. Psychological treatments If yourerectile dysfunction has an underlying psychological cause then you may benefit from a type of treatment called sensate focus. If conditions such as anxiety or depression are causing yourerectile dysfunction, you may benefit fromcounselling(a talking therapy). Sensate focus Sensate focus is a type of sex therapy that you and your partner complete together. It starts with youboth agreeing not to have sex for a number of weeks or months. During this time, you can still touch each other, but not in the genital area (or a womans breasts). The idea is to explore your bodies knowing that you will not have sex. After the agreed period of time has passed, you can gradually begin touching each others genital areas. You can also begin to use your mouth to touch your partner, for example, licking or kissing, them. This can build up to include penetrative sex. You can find out more about sensate focus from the CollegeofSexual and Relationship Therapists (COSRT) . Psychosexual counselling Psychosexual counselling is a form of relationship therapy where you and your partner can discuss any sexual or emotional issues that may be contributing to yourerectile dysfunction. By talking about the issues, you may be able to reduce any anxiety that you have and overcome yourerectile dysfunction. The counsellor can also provide you with some practical advice about sex, such as how to make effective use of other treatments forerectile dysfunction to improve your sex life. Psychosexual counselling may take time to work and the results achieved have been mixed. Cognitive behavioural therapy (CBT) Cognitive behavioural therapy (CBT) is another form of counselling that may be useful if you haveerectile dysfunction. CBT is based on the principle that the way you feel is partly dependent on the way you think about things. CBT helps you realise that your problems are often created by your mindset. It is not the situation itself that is making you unhappy, but how you think about it and react to it. Your CBT therapist can help you to identify any unhelpful or unrealistic thoughts that may be contributing to your erectile dysfunction  for example, to do with: your self-esteem (the way you feel about yourself) your sexuality your personal relationships Your CBT therapist will be able to help you to adopt more realistic and helpful thoughts about these issues. Pelvic floor muscle exercises Some studies have suggested that, in a few cases, it may be beneficial to exercise your pelvic floor muscles. These are a group of muscles around the underside of the bladder and rectum, as well as at the base of the penis. Pelvic floor muscle exercise involves strengthening and training the muscles used to control the anus (back passage) and urinate. If your GP feels this type of exercise could be beneficial, then you may want to discuss it with a physiotherapist to learn it correctly. By strengthening and trainingthese muscles, you may be able to reduce the symptoms oferectile dysfunction. Complementary therapies Some complementary therapies, such as acupuncture, have claimed to treat erectile dysfunction. However, there is little evidence they are useful. In some cases, they may even include ingredients that could interact with other medications and cause side effects. Always speak to your GP before using any complementary therapies. Source: NHS 24 - Opens in new browser window Last updated: 12 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites Prostate Cancer UK Institute of Psychosexual Medicine COSRT: therapy Fertility Network UK Lab Tests Online UK: testosterone British Cardiovascular Society Sexual Advice Association NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Escherichia coli (E. coli) O157,"Escherichia coli (E. coli) O157 | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Escherichia coli (E. coli) O157 Escherichia coli (E. coli) O157 Escherichia coli O157, sometimes called VTEC, is a bacterial infection. It can cause severe stomach pain, bloody diarrhoea and kidney failure. E. coli O157 is found in the gut and faeces of many animals, particularly cattle. Its an uncommon cause of gastroenteritis but can be caught by: eating contaminated food, such as raw leafy vegetables or undercooked meat  a lways wash all vegetables, including salad leaves, that will be eaten raw,unless they have been pre-prepared and are labelled ready to eat(washing may reduce the risk of infection, but will not eliminate any risk of infection completely) touching infected animals or accidentally coming into contact with their faeces contact with people who have the illness, particularly if you do not wash your hands thoroughly after using the toilet or before handling food drinking water from inadequately treated water supplies swimming or playing in contaminated water, such as ponds or streams Symptoms of E. coli O157 infection Symptoms include diarrhoea, stomach cramps and occasionally fever. About half of people with the infection will have bloody diarrhoea. People usually notice symptoms3 to 4 days after they have been infected. But symptoms can start any time between 1 and 14 days afterwards. These symptoms can last up to 2 weeks. A small number of people with E. coli O157 infection go on to develop a serious condition called haemolytic uraemic syndrome (HUS). This can sometimes lead to kidney failure and death, although this is rare. The risk of HUS is highest in children aged under5 years. Some people become infected but dont develop symptoms. Further information about gastroenteritis Treatment and care at home There is no specific treatment for E. coli O157 infection. People who are infected can usually be cared for at home and most will get better without medical treatment. Its important to drink plenty of fluids, as diarrhoea can lead to dehydration. Contact your GP practice if: you or your child has bloody diarrhoea Antibiotics are not recommended, and may increase the risk of complications. Anti-diarrhoea drugs such as loperamide (Imodium) are also not recommended as they may prolong your exposure to the toxin. Find out more about caring for a child with gastroenteritis and caring for an adult with gastroenteritis . How to prevent E. coli O157 from spreading at home Strict hygiene measures are essential to stop others getting infected. Do wash your hands thoroughly with soap in running water and dry them completely  use liquid soap and warm water if you can everyone must wash their hands after contact with an infected person, particularly after handling their clothes or bedding always wash your hands after going to the toilet or changing babies nappies, and before preparing or serving food or eating meals if youve been infected, avoid cooking or preparing food until 48 hours after your symptoms have cleared up wash soiled clothing and bed linen separately from other clothes in a washing machine at the highest temperature possible (for example 60C) wipe down the outside of the washing machine with hot water and detergent after any heavily soiled load clean toilet seats, toilet flush handles, basin taps, surfaces and toilet door handles at least daily, preferably more often, using hot water and detergent disinfection sprays and wipes or alcohol-based wipes may be used on toilet seats and other surfaces, but only after any visible soiling has been removed thick household bleach is highly effective  dilute one part bleach to every 10 parts water for soiled surfaces and one part bleach to every 100 parts water for other hard surfaces ideally, use heavy-duty domestic rubber gloves and disposable cloths for cleaning dispose of cloths by placing them in a plastic bag, sealing the neck and placing in household waste thoroughly wash rubber gloves in hot water and detergent after use, then rinse and allow to dry deal with any spillage of faeces immediately  clean the soiled area with hot water and detergent using heavy-duty domestic rubber gloves then clean gloves and wash hands thoroughly Dont do not share towels or nappy changing mats do not clean soiled items in the kitchen Returning to work or school Anyone who has had an E. coli O157 infection should stay away from work or school until they have been completely free of symptoms for 48 hours. Most people are no longer infectious after about a week, although some people, particularly children, may carry E. coli O157 for several months after they have got better. Some people need to take special care before returning to work or school. If you work in health or social care, or your work involves handling food, you should ask your local authority environmental health officers about when it is safe to return to work. This advice applies to both people who have been infected and those who live in the same household as someone who has. If you have a child under 5 years of age who has had E. coli, or lives with someone who has, you should talk to your GP about when it is safe for your child to return to school or nursery. Children under 5 years of age who have had an E. coli O157 infection should not swim in public swimming pools, or share paddling pools with others, until they have had test results showing that they are no longer an infection risk to others. Source: NHS 24 - Opens in new browser window Last updated: 29 May 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Ewing sarcoma,"Ewing sarcoma - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Ewing sarcoma Ewing sarcoma Ewing sarcoma is a rare type of bone cancer. The 3 main types of primary bone cancer are chondrosarcoma, osteosarcoma and Ewing sarcoma. Ewing sarcoma most commonly affects people who are 10 to 20 years old. Sarcomas A sarcoma is a type ofcancerthat develops in the bodys supporting tissues. Bone sarcomas and soft tissue sarcomas are the 2 main types. Ewing sarcoma usually occurs in bone. It most commonly develops in the: pelvis bone(hips) thigh bone(femur) shin bone (tibia) However,the conditioncan also develop in the soft tissues surrounding the bone or joint. This type of Ewing sarcoma is known as extraosseous, which means outside the bone. Symptoms of Ewing sarcoma The symptoms of Ewing sarcoma will depend on the size of the cancer and where it is in the body. The main symptoms are pain in the affected area that gets progressively worse, and swelling and tenderness. Other possible, but less common, symptoms may include a high temperature (fever), severe tiredness and weight loss. In some cases of Ewing sarcoma, there may not be any symptoms at all. However, as the tumour grows it could weaken the affected bone, increasing the risk of fracture. What causes Ewing sarcoma? Likeother types of bone cancer, the exact cause of Ewing sarcoma isunknown. As thecondition tends to predominantly affect older children and teenagers, one theory isthat it may be related to fast-growing bones. The rapid growth spurt thathappens during pubertymay in some way make bone tissue more vulnerable to cancer. Research has also found babies born with anumbilical hernia are 3 times more likely to develop Ewing sarcoma. However, the increased risk is still small as only 1 in 110,000 children with an umbilical hernia will go on to develop the condition. The Cancer Research UK website has more information about the risks and causes of bone cancer . Diagnosing Ewing sarcoma Whenyou visit your GP because of bone pain, theyll ask you about your symptoms and examine the affected area. Your GP may refer you foran X-ray to check for anything abnormal. Ifabnormalities are found, youll be referred to an orthopaedic surgeon (a bone specialist). They may recommend that youhave a magnetic resonance imaging (MRI) scan to examine the area in closer detail. A bone biopsy may be carried out to confirm whether cancer is present. A fine needleis used to remove a sample of bone marrow from the affected area so it can be examined under a microscope. It can either be carried out using a general anaesthetic or a local anaesthetic . The Cancer Research UK website has more information about tests for bone cancer and the stages of bone cancer . Treating Ewing sarcoma Like all types of cancer, the earlier Ewing sarcoma is diagnosed, the easier it is to treat. Ewing sarcoma is usually treated with a combination of chemotherapy ,surgery and radiotherapy. Chemotherapy may be used before surgery to shrink the tumour and make it easier to remove. Ewing sarcoma also responds well to radiotherapy . It can be used to shrink the tumour after chemotherapy, and before or after surgery to lower the risk of the cancer returning. In some cases, surgically removing Ewings sarcoma can be difficult for example, if it develops in the pelvis. In this case, radiotherapy may be used as the main treatment. Surgery If surgery is recommended, the type youll have will depend on: the size of the tumour where it is in your body whether it hasgrown into the tissues surrounding the bone You may have surgery to remove part or all of the bone affected by cancer. This type of surgery is known as resection. Limb-sparing surgeryinvolves removing the area of bone on an arm or legwhere the cancer is growing. A piece of metal (prosthesis) or a bone graft will be used to replace the piece of bone that is removed. In some cases, your whole arm or leg may need to be removed ( amputation ).This may be the only optionto prevent the cancer returning if its spread into the tissues surrounding the bone. For more information about the types of treatment for bone cancer , visit the Cancer Research UK website. Living with bone cancer If youre diagnosed with bone cancer, it can be upsetting andfrightening.Knowing as much about the type of cancer you have and the best treatment options will help youmake decisions. The majority of people who have surgery for bone cancer have a limb-sparing procedure. However, for some people, having their limb amputated may be the best option. This can be a very difficult situation to cope with and you may experience emotions such as grief and bereavement . Its important to seek help and talk about how youre feeling. You could talk toyour partner, family, friends or the healthcare professionals in charge of your care. Talking to others will help you come to terms with your condition and treatment. There arealso a number of practical issues youll need to deal with, such as financial mattersand coping with day-to-day activitiessuch as school, college or work. The Cancer Research UK website has more informationon coping with bone cancer . Information about you If you or your child hasEwing sarcoma, your clinical team will pass information about you/your child on to the National Congenital Anomaly and Rare Diseases Registration Service (NCARDRS). This helps scientists look for better ways to prevent and treat this condition. You can opt out of the register at any time. Find out more about the register Source: NHS 24 - Opens in new browser window Last updated: 13 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Ewing sarcoma: Children Other health sites Cancer Research UK: Bone cancer types Macmillan Cancer Support: Ewing sarcoma Bone Cancer Research Trust: Ewing sarcoma Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Ewing sarcoma: Children,"""Ewing sarcoma: Children | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in children Ewing sarcoma: Children Ewing sarcoma: Children Ewing sarcoma is a type of bone cancer in children and young people. This information describes Ewing sarcoma, its symptoms, diagnosis and possible treatments. More children than ever are surviving childhood cancer. There are now new and better drugs and treatments, and we can now also work to reduce the after-effects of having had cancer in the past. Its devastating to hear that your child has cancer. At times it can feel overwhelming but there are many healthcare professionals and support organisations to help you through this difficult time. Understanding more about the cancer your child has, and the treatments that may be used, can often help parents to cope. Your childs specialist will give you more detailed information and if you have any questions its important to ask the specialist doctor or nurse who knows your childs individual situation. Sarcomas Sarcomas are rare types of cancer that develop in the supporting tissues of the body. There are 2 main types: bone sarcomas and soft tissue sarcomas. Bone sarcomas can develop in any of the bones of the skeleton, but may also develop in the soft tissue near bones. Soft tissue sarcomas can develop in muscle, fat, blood vessels or any of the other tissues that support, surround and protect the organs of the body. Ewing sarcoma Ewing sarcoma is the second most common primary sarcoma in children and young people. This type of cancer is a bone cancer and most commonly occurs in the long bones, ribs, pelvis and spine (vertebral column). It usually occurs in the teenage years, and is more common in boys. Although Ewing sarcoma is a type of bone cancer, it can also occur very rarely in the soft tissues. This is called extraosseous Ewing sarcoma. Another type of Ewing sarcoma is a primitive neuroectodermal tumour (PNET). These can be found in either the bone or soft tissue. Causes The exact causes of primary bone cancer are unknown. The development of Ewing sarcoma may be related in some way to times of rapid bone growth, which may explain why more cases are seen in teenagers. Like other cancers, its not infectious and cannot be passed on to other people. Signs and symptoms Pain is the most common symptom of bone cancer. It is frequently worse at night. However, symptoms may vary depending on the position and size of the cancer. There may be some swelling in the affected area if the tumour is close to the surface of the body and it may become tender to touch. This may cause a limp if in the leg or pelvis. Bone cancer is sometimes discovered when a bone that has been weakened by cancer breaks after the child has a minor fall or accident. Occasionally, there may be fever or weight loss. How Ewing sarcoma is diagnosed Usually you begin by seeing your GP, who will examine your child and may arrange tests or X-rays. If a sarcoma is suspected, your GP should refer your child directly to a specialist hospital or bone tumour centre. A variety of tests and investigations are needed to diagnose Ewing sarcoma, including an X-ray of the painful part of the bone, a chest X-ray and a blood test. A specialist doctor will remove a small piece of the tumour to look at under a microscope ( biopsy ). Other tests may be done, such as a bone scan, PET scan, a bone marrow biopsy. An MRI or CT scan may also be done. Any tests and investigations that your child needs will be explained to you. Treatment A combination of various treatments is used to treat Ewing sarcoma. These include chemotherapy, surgery and radiotherapy. Treatment will depend on a number of factors, including the size and position of the tumour. Chemotherapy Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. This is a very important component of treatment for the majority of children with Ewing sarcoma and can help make surgery more straightforward. A combination of different chemotherapy drugs are given before surgery and continued afterwards in order to destroy any remaining cancer cells and prevent the sarcoma from spreading. Chemotherapy given in this way is called adjuvant chemotherapy. Surgery If surgery is needed, it should be carried out at a specialist orthopaedic bone tumour centre. The aim of surgery is to remove the tumour without causing too much damage. If the tumour is in one of the main bones of the arm or leg, it may be necessary to remove the whole limb (amputation) or part of the affected bone. If only part of the affected bone is removed, this is known as limb-sparing surgery. Amputation Sometimes amputation of the limb is unavoidable if the cancer has affected the surrounding blood vessels and nerves. After amputation, a false limb will be fitted, and this will be regularly adjusted as your child grows. False limbs work very well. It should be possible for your child to join in with normal activities and even sport. Limb-sparing surgery There are several ways in which limb-sparing surgery may be done. It may involve: replacing the bone with a prosthesis (a specially designed artificial part) replacing the bone with bone taken from another part of the body (a bone graft) After limb-sparing surgery, the child is often able to use the limb almost normally. However, it is best not to take part in any contact sports, because any damage to the bone graft or prosthesis may require another major operation to repair or replace it. If the child is growing, the limb prosthesis will need to be lengthened from time to time as the bone grows. This may mean further short stays in hospital, although some prostheses can be lengthened during an outpatient procedure. Radiotherapy Radiotherapy treats cancer by using high energy rays that destroy cancer cells while doing as little harm as possible to normal cells. Ewing sarcoma responds very well to radiotherapy. Its often used after chemotherapy and before or after surgery. If the tumour is impossible to remove surgically, its a good option. Side effects of treatment for Ewing sarcoma Treatment often causes side effects . Your childs doctor will discuss this with you before the treatment starts. Any possible side effects will depend on the actual treatment being used and the part of the body thats being treated. Side effects can include: feeling sick (nausea) and being sick (vomiting) hair loss increased risk of infection bruising and bleeding tiredness diarrhoea Radiotherapy can cause irritation or soreness of the skin in the area being treated and general tiredness. If your child is having surgery, the surgeon will explain the possible complications of the surgery that your child is having. Late side effects A small number of children may develop other side effects, sometimes many years later. These include a reduction in normal bone growth, reduced fertility, a change in heart function, and a small increase in the risk of developing a second cancer later in life. Your childs doctor or nurse will explain all of this to you and will monitor your child carefully for any potential late side effects. Clinical trials Many children have their treatment as part of a clinical research trial. Trials aim to improve our understanding of the best way to treat an illness, usually by comparing the standard treatment with a new or modified version. Specialist doctors carry out trials for childrens cancers. If appropriate, your childs medical team will talk to you about taking part in a clinical trial, and will answer any questions you have. Written information will be provided to help explain things. Treatment guidelines Sometimes, clinical trials are not available for your childs tumour. This may be because a recent trial has just finished, or because the tumour is very rare. In these cases, you can expect your doctors and nurses to offer treatment which is agreed to be the most appropriate, using guidelines which have been prepared by experts across the country. The Childrens Cancer and Leukaemia Group (CCLG) is an important organisation which helps to produce these guidelines. Follow-up care Your child will have regular follow-up appointments, with x-rays or scans as necessary. Many children with Ewing sarcoma can be cured. Even if the tumour comes back, further treatment may be given successfully. Your child will be checked up on every few months for the first 3 years after treatment and then every 6 months for another 2 years. If you have specific concerns about your childs condition and treatment, its best to discuss them with your childs doctor who knows the situation in detail. Your feelings As a parent, the fact that your child has cancer is one of the worst situations you can be faced with. You may have many emotions, such as fear, guilt, sadness, anger and uncertainty. These are all normal reactions and are part of the process that many parents go through at such a difficult time. Its not possible to address here all of the feelings you may have. However, the CCLG booklet Children & Young Peoples Cancer; A Parents Guide talks about the emotional impact of caring for a child with cancer and suggests sources of help and support. Your child may have a variety of powerful emotions throughout their experience with cancer. The Parents Guide discusses these further and talks about how you can support your child. Source: Children's Cancer and Leukemia Group - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Eye cancer,"Eye cancer | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Eye cancer Eye cancer There are a number of different types of cancer that affect the eyes, including: eye melanoma squamous cell carcinoma lymphoma retinoblastoma  a childhood cancer Cancer can also sometimes develop in the tissues surrounding your eyeball or spread to the eye from otherparts of the body, such as the lungs or breasts. This topic focuses on melanoma of the eye, one of the most common types of eye cancer. Symptoms of eye cancer Eye cancer doesnt always cause obvious symptoms and may only be picked up during a routine eye test. Symptoms of eye cancer can include: shadows, flashes of light, or wiggly lines in your vision blurred vision a dark patch in youreye thats getting bigger partial or total loss of vision bulging of one eye a lump on your eyelid or inyour eye thats increasing in size pain in or around your eye, although this is rare These symptoms can also be caused by more minor eye conditions, so theyre not necessarily a sign of cancer. However, its important to get the symptomschecked by a doctor as soon as possible. Melanoma of the eye Melanoma is cancer that develops from pigment-producing cells called melanocytes. Mostmelanomas develop in the skin, but its also possible for them to occur in other parts of the body, including the eye. Eye melanoma most commonly affects the eyeball. Doctors sometimes call ituveal or choroidal melanoma, depending on exactly which part of your eye is affected. Itcan also affect the conjunctiva, the thinlayer that covers the front of the eye, or the eyelid. What causes eye melanoma? Eye melanoma occurs whenthe pigment-producing cells in the eyes divide and multiply too rapidly. This produces a lump of tissue known as a tumour. Its not clear exactly why this occurs, but the following factors may increase the risk of it happening: lighter eye colour  if you have blue, grey or green eyes, you have a higher risk of developing eye melanoma comparedwith people who have brown eyes white or pale skin  eye melanoma mostly affects white people and is more common inthose with fair skin unusual moles  if you haveirregularly shaped or unusually coloured moles, youre more at risk of developing skin cancer and eye melanoma use of sunbeds theres some evidence to suggest that exposing yourself to ultraviolet (UV) radiation from sunbeds, for example, can increase your risk of eye melanoma overexposure to sunlight  this increases your risk of skin cancer, and may also be a risk factor for eye melanoma The risk of developing eye melanoma also increases with age, with most cases being diagnosed in people in their fifties. Diagnosing melanoma of the eye If your GP or optician (optometrist) suspectsyou have a serious problem with your eyes, they will refer you to a specialist eye doctor called an ophthalmologistfor an assessment. If they suspect you have melanoma of the eye, theyll refer you to a specialist centre for eye cancer. There are 4 centres in the UK, located in London, Sheffield, Liverpool, and Glasgow. Its likely youll have a number of different tests at the centre, including: an eye examination to look at the structures of your eyes in more detail and check for abnormalities an ultrasound scan of your eye a small probe placed over your closed eye uses high-frequency sound waves to create an image of the inside of your eye; this allowsyour doctor tofindout more about the position of the tumour and its size afluorescein angiogram  where photographs of the suspected cancer are taken using a special camera after dye has been injected into your bloodstream to highlight the tumour Occasionally,a thin needlemay beused to remove a small sampleof cells fromthetumour (biopsy) .The genetic information in these cells is analysed togive an indication of the chances of the cancer spreading or coming back. Treatments foreye melanoma Treatment for melanoma of the eye depends on the size and location of the tumour. Your care team will explain each treatment option in detail, including the benefits and any potential complications. Treatment will aim to conserve the affected eye whenever possible. The main treatments for eye melanoma are: brachytherapy tiny plates lined with radioactive material called plaques are inserted nearthe tumour and left in place for up to a week to kill the cancerous cells external radiotherapy  a machine is used to carefully aim beams of radiation at the tumour to kill the cancerous cells surgery to remove the tumour or part of the eye  this may be possible ifthe tumour is small and you still have some vision in your eye removal of the eye (enucleation)  this may be necessary if the tumour is large or youve lost your vision;the eye will eventually be replaced with an artificial eye that matchesyour other eye Chemotherapy is rarely used for eye melanoma, but may be suitable for other types of eye cancer. TheCancer Research UK website has more information about the treatment options for eye cancer and thetypes of eye cancer surgery. Source: NHS 24 - Opens in new browser window Last updated: 13 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Radiotherapy Other health sites Cancer Research UK: Eye cancer Macmillan Cancer Support: Eye cancer Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Febrile seizures,"Febrile seizures | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Febrile seizures Febrile seizures About febrile seizures Symptoms of febrile seizures Causes of febrile seizures Diagnosing febrile seizures Treating febrile seizures About febrile seizures A febrile seizure is a fit that can happen when a child has a fever. Febrile seizures are also sometimes called febrile convulsions. They are relatively common and, in most cases, arent serious. Around one in 20 children will have at least one febrile seizure at some point. They most often occurbetween the ages of six months and three years. During a febrile seizure, the childs body usually becomes stiff, they lose consciousness and their arms and legs twitch. Some children may wet themselves. This is known as a tonic clonic seizure. Read more about the symptoms of febrile seizures What to do during a seizure If your child is having a febrile seizure, place them in the recovery position . Lay them on their side, on a soft surface, with their face turned to one side. This will stop them swallowing any vomit, keep their airway open and help prevent injury. Stay withyour childand try to make a note of how long the seizure lasts. If its your childs first seizure, or it lasts longer than five minutes,take them to the nearest hospital as soon as possible, or dial 999 for an ambulance. While its unlikely that theres anything seriously wrong,its best to be sure. Ifyour child has hadfebrile seizuresbefore and the seizure lasts for less than five minutes, phone your GP or the NHS 24 111 service for advice. Dont put anything, including medication,in your childs mouth during a seizure because theres a slight chance thatthey might bite their tongue. Almost all children make a complete recovery after having a febrile seizure. Read more about diagnosing febrile seizures and treating febrile seizures Types of febrile seizure There are two main types of febrile seizure. Simple febrile seizure A simple febrile seizure is the most common type of febrile seizure, accounting for about eight out of 10 cases. Its a fit that: is a tonic clonic seizure (see above) lasts less than 15 minutes doesnt reoccur within 24 hours or the period in which your child has an illness Complex febrile seizure Complex febrile seizures are less common, accounting for two out of 10 cases. A complex febrile seizure is any seizure that has one or more of the following features: the seizure lasts longer than 15 minutes your child only has symptoms in one part of their body (this is known as a partial or focal seizure) your child has another seizure within 24 hours of the first seizure, or during the same periodof illness your child doesnt fully recover from the seizure within one hour Why febrile seizures occur The cause of febrile seizures is unknown, although theyre linked to the start of a fever (a high temperature of 38C (100.4F) or above). In most cases, a high temperature is caused by an infection such as: chickenpox flu (influenza) middle ear infections (otitis media) tonsillitis There may also be a genetic link to febrile seizures because the chances of having a seizure are increased if a close family member has a history of them. Around one in four children affected by febrile seizures has a family history of the condition. Read more about the causes of febrile seizures Complications Febrile seizures have been linked to an increased risk of epilepsy , as well as other problems. Recent research findings may indicate a link between febrile seizures and sudden unexplained death in childhood (SUDC), possibly due to the connection between febrile seizures and epilepsy. However, this link hasnt been proven and SUDC is incredibly rare, affecting around one in 100,000 children which is equivalent to a 0.001% chance. In addition, one of the biggest studies of its kind looked at more than 1.5 million children with a history of febrile seizures and found no evidence of an increased risk of death in later childhood or adulthood. Febrile seizures and epilepsy Many parents worry that if their child has one or more febrile seizures, theyll develop epilepsy when they get older. Epilepsy is a condition where a person has repeated seizures without fever. While its true that children who have a history of febrile seizures have an increased risk of developing epilepsy, it should be stressed that the risk is still small. Its estimated that children with a history of simple febrile seizures have a one in 50 chance of developing epilepsy in later life. Children with a history of complex febrile seizures have a one in 20 chance of developing epilepsy in later life. This is compared to around a one in 100 chance for people who havent had febrile seizures. Symptoms of febrile seizures The main symptom of a febrile seizure is a fit that occurs while a child has a fever. Febrile seizures often occur during the first day of a fever, which is defined as a high temperature of 38C (100.4F) or above. However, there appears to be no connection between the extent of your childs fever and the start of a seizure. Seizures can occur even if your child has a mild fever. Simple febrile seizures canhappen when theres a rapid rise in temperatureand you may only realise your child is ill when they have a fit.Alternatively,they can occur as your childs temperature drops from a high level. During simple febrile seizures: your childs body will become stiff and their arms and legs will begin to twitch theyll lose consciousness and they may wet or soil themselves theymay also vomit and foam at the mouth and their eyes may roll back the seizure usually lasts for less than five minutes following the seizure, your child may be sleepy for up to an hour afterwards Complex febrile seizures tend to last longer than 15 minutes, and the symptoms may only affect one area of your childs body. The seizure sometimes recurs within 24 hours or during the period in which your child is ill. Seeking medical advice You should take your child to hospital or dial 999 for an ambulance if: your child is having a fit for the first time the seizure lasts longer than five minutes andshows no signs of stopping you suspect the seizure is being caused by another serious illness, for example meningitis your child is having breathing difficulties If your child has previously had febrile seizures, its recommended that you telephone your GP or call the NHS 24 111 service for advice. You should also contact your GP or the NHS 24 111 service if your child shows signs and symptoms ofdehydration (a lack of fluid in the body). This includes: a dry mouth sunken eyes a lack of tears when crying a sunken fontanelle  the soft spot usually found at the top of a young childs head Causes of febrile seizures Febrile seizures are linked to fevers, but the exact cause is unknown. Some researchers think that the biological processes associated with a high temperature may be responsible. A high temperature is thought to be caused by a bacterial or viral infection that stimulates the release of cytokines. Cytokines are proteins that affect the parts of the brain and nervous system responsible for regulating the bodys temperature. Their release causes a rise in the bodys temperature. One theory is that in certain people, high levels of cytokines may temporarily scramble the workings of the brain and nervous system, triggering a seizure. Family history Althoughfebrile seizures are poorly understood, a family history of the conditions is thought to increase the risk. If a child has a first-degree relative (mother, father, sister or brother) with a history of febrile seizures, their risk of having seizures increases. The more relatives affected, the higher the risk. This is probably the result of one or more genetic mutations that a child inherits from their parents, which makes them more susceptible to seizures. A genetic mutation means the instructions carried in certain genesbecome scrambled, resulting in some of the bodys processes not working in the normal way. Associated infections Most febrile seizures occur whena child has a high temperature caused by an infection. The three most common infections associated with febrile convulsions are: viral infections, such as chickenpox and flu middle ear infections (otitis media) tonsillitis Other infections associated with febrile seizures are: urinary tract infections(UTIs) upperrespiratory tract infection an infection of the mouth, nose and throat, and associated tissues and structures gastroenteritis  an infection of the digestive system lower respiratory tract infections, such as pneumonia (a lung infection) and bronchitis (an infection of the airways that supply the lungs) Vaccinations In rare cases, febrile seizures can occur after a child has a vaccination. Research has shown that your child has a one in 3,000 to 4,000 chance of having a febrile seizure after having the MMR vaccine . The risks are even lower with the DTaP/IPV/Hib vaccine  a one in 11,000 to 16,000. Diagnosing febrile seizures Febrile seizures can often be diagnosed from a description of what happened. Further tests may be needed if the cause of the associated infection isnt clear. Its unlikely that your doctorwill see the seizure, so an account of what happenedis useful. Its useful to know: how long the seizure lasted what happened  body stiffening, twitching of the face, arms and legs, staring and loss of consciousness whether your child recovered within one hour whether theyve had a seizure before Tests to identify the source of the infection will only usually be necessary to rule out rarer conditions which can cause similar symptoms, such as meningitis . A blood or urine sample may be needed to test for signs of infection. It can sometimes be difficult to obtain a urine sample from young children, so it may have to be done in hospital. Read more about blood tests Further tests Further tests may be carried out in hospital if your childs symptoms are unusual  for example, if they dont have a high temperature or their seizures dont follow the normal pattern. Further testing and observation in hospital is also usually recommended if your child is having complex febrile seizures . Your child may have other tests including an electroencephalogram and lumbar puncture, particularly if theyre less than 12 months old. These two testsare explained below. Electroencephalogram Anelectroencephalogram (EEG) measures your childs electrical brain activity through electrodes that are placed on their scalp. Unusual patterns of brain activity can sometimes indicate epilepsy . However, some studies have suggested that an EEG may not be useful in many cases of febrile seizures. Lumbar puncture During a lumbar puncture , a small sample of cerebrospinal fluid (CSF) is removed for testing. CSF is a clear fluid that surrounds and protects the brain and spinal cord. A hollow needle is inserted into the base of the spine to obtain the CSF sample. During the procedure, local anaesthetic will be used to numb your childs back so that they dont feel any pain. A lumbar puncture can be used to determine whether your child has an infection of the brain or nervous system. Treating febrile seizures In many cases, febrile seizures do not need to be treated, although care should be taken to deal with a seizure as it happens. What to do during a seizure If your child is having a febrile seizure, place them in the recovery position . Lay them on their side, on a soft surface, with their face turned to one side. This will stop them swallowing any vomit, and will keep their airway open and help prevent injury. Stay with your child while theyre having a seizure, and make a note of when the seizure started to keep track of how long it lasts. If the seizure lasts for less than five minutes, phone your GP or call the NHS 24 111 service. If its your childs first seizure, or if it lasts longer than five minutes,take your child to the nearest hospital as soon as possible. While theres probably nothing seriously wrong with your child, its best to be sure. Dont put anything, including medication,in your childs mouth while theyre having a seizure. Theres a slight chance that they might bite their tongue, although any damage isnt usually serious and will heal within a few days. Trying to stop someone biting their tongue by placing your hand or an object in their mouth could be dangerous both for you and forthem. High temperature (fever) Reducing a high temperature can help make your child feel more comfortable. Paracetamol and ibuprofen have been shown to be effective in reducing a high temperature. However, they wont reduce thechances of your child actually having a seizure. Removing any unnecessary clothes and bedding will also help to lower your childs temperature. Aspirin should never be given to childrenunder 16 years of age because theres a small risk that the medication could trigger a condition called Reyes syndrome, which can cause brain and liver damage. The use of cold sponges or fans isnt recommended for treating a high temperature. Theres little evidence that theyre effective, and they may cause your child discomfort. Your GP will be able to give you additional advice about treating the underlying cause of your childs high temperature. Its also important to prevent dehydration during a fever by making sure your child drinks plenty of fluids. Recurring febrile seizures About one third of children will have a febrile seizure again during a subsequent infection. This often occurs within a year of the first febrile seizure. Recurrence is more likely if: the first febrile seizure occurred before your child was 18 months old theres a history of seizures or epilepsy in your family before having the first seizure your child had a fever that lasted less than onehour or their temperature was less than 40C (104F) your child has multiple seizures during the same febrile episode ( complex febrile seizure ) your child attends a day care nursery (this increases their chances of developing common childhood infections, such as the flu or chickenpox ) Itsnot recommended that your child is given a prescription of regular medicines to prevent further febrile seizures. This is because the adverse side effects associated with many medicines outweigh any risksof the seizures themselves. Research has shown that the use of medication to control feverisnt likely to prevent recurrence of further febrile seizures. However, there may be exceptional circumstances where medication to prevent recurrent febrile seizures is recommended. For example, children may need medication if they have a low threshold for having seizures during illness, particularly if the seizures are prolonged. In this case, your child may be prescribed medications such as diazepam or lorazepam to take at the start of a fever. Children whove had a febrile seizure following a routine vaccination (which is very rare), are no more at risk of having another seizure compared to children whove had a seizure due to another cause for fever. Source: NHS 24 - Opens in new browser window Last updated: 07 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Feeling of something in your throat (Globus),"Feeling of something in your throat (Globus) Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Ears, nose and throat Feeling of something in your throat (Globus) Feeling of something in your throat (Globus) Globus is a symptom that can make you feel like you have a lump in your throat. Its also called globus sensation. Globus is usually not a sign of anything serious. It can be caused by many things, such as an increased tension of muscles or irritation in the throat. Your throat can be irritated by, for example, reflux. There are things you can do to help your globus symptoms at home, without the need to attend your GP. Symptoms of globus Different people describe globus differently. It may be felt as: tightness or a pressure in your throat mucus that you cannot clear ( catarrh ) an area of discomfort in your throat a feeling of something stuck or a lump in your throat If you feel something sticking in your throat, but can eat and drink normally and without pain, you do not need to worry. Your symptoms may: be most noticeable youre swallowing your saliva get worse with stress and worry vary from day to day When to get medical advice Speak to your GP practice if: you develop any difficulty or pain when swallowing you feel a lump in the neck you experience unintentional weight loss your symptoms do not improve If your symptoms do not improve, your GP will provide further support and advice on whether you need to see an ear nose and throat (ENT) specialist. Treatment for globus at home There are a number of things you can do to try to relieve globus symptoms. In most people, symptoms will get better following these self-help tips. However, for some people symptoms can recur off and on for several months. Eating and drinking Do drink at least 1.5 litres (3 pints) of water every day  drink in small sips as swallowing helps to relax the throat avoid too much alcohol, tea, coffee and fizzy drinks reduce the amount of fatty and spicy food in your diet leave at least 3 hours between your last meal and going to bed try anti-reflux medication (ask a pharmacist for advice) Stop smoking Smoking causes irritation to your throat. By stopping smoking, you can help to improve your globus symptoms. Further information on stopping smoking Avoid clearing your throat Try not to clear your throat as this can make your globus sensation worse. Try sipping water instead. Maintain a healthy weight Losing any excess weight may reduce your symptoms. Reduce stress Stress can increase your globus sensation. If you think you might be stressed, try to relax in a way that is doable for you and your situation. Breathing and relaxation exercises can sometimes help. If you feel you need further help with managing stress, your GP can discuss this with you. Further information about relieving stress Source: ENT Scotland - Opens in new browser window Last updated: 28 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Fever in adults,"Fever in adults | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Fever in adults Fever in adults Return to Symptoms Enter age Last Updated: Next Review Date: Review my answers Find your local services Search for a service near you by entering your postcode below. Please input your postcode in the following format: A12 1BC GP Practices Dental Services Pharmacies Opticians Postcode Search NHS inform has more information on this condition. Read more Previous Start guide Review my answers  You told us your credentials were: : You said: Based on the information you gave us, we made the following recommendation: Close Keep a copy View PDF Your normal body temperature is approximately 37C.A fever is usually when your body temperature is 37.8C or higher. You may feel warm, cold or shivery. You can find out if you have a fever by using a thermometer to take your temperature. Fever in adults self-help guide Complete our self-help guide to check your symptoms and find out what to do next. What causes a fever? A fever is your bodys natural response to many common illnesses such as: flu tonsillitis kidney or urinary tract infections (UTIs) Fever helps your body fight infections by stimulating your immune system (your bodys natural defence). By increasing your bodys temperature, a fever makes it harder for the bacteria and viruses that cause infections to survive. When to get help Contact your GP practice immediately if: You have a fever and you: are on treatment for immune deficiency are on immune-suppressant drugs, such as regular steroids, methotrexate, azathioprine or cyclophosphamide are taking medication where you have been warned about a risk of a reduced immune system are on, or recently completed, treatment for cancer, leukaemia or lymphoma are a transplant recipient are HIV positive have chronic lung disease have asthma which has been treated with medication in the last 3 years have heart disease (excluding blood pressure which is currently well controlled) have diabetes or another metabolic disease have chronic gastrointestinal or liver disease have chronic renal (kidney) disease have cystic fibrosis have neurological conditions such as cerebral palsy, stroke, multiple sclerosis or muscular dystrophy have sickle cell disease Contact your GP practice if: you have severe thirst or are peeing less you are passing urine that is darker than normal you are light-headed or weak you have new, severe muscle cramps your symptoms have worsened or you notice new symptoms youve had a fever after recent foreign travel If your GP practiceis closed, phone 111. Treating a fever Most fevers will improveon their own in a few days. However, there are a number of things you can do to help the uncomfortable feelings associated with a fever. Do wear loose comfortable clothing make sure the room you are in isnt too warm drink more fluids (for example water) so you dont get dehydrated  you should be peeing approximately every 6 hours (a pale yellow urine means youre unlikely to be dehydrated) avoid alcohol as this can make dehydration worse take a medicine that reduces fever such as paracetamol (unless youre allergic or have been told by a healthcare professional that you cant take it) Dont do not over dress do not attempt to make yourself feel cold Fever in children Fever affects people of all ages, however it often affects babies and younger children in response to minor illnesses such as: coughs colds Find out more about fever in children . Source: NHS 24 - Opens in new browser window Last updated: 05 December 2022 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Self-help guide: Fever in babies Coronavirus (COVID-19) NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Fever in children,"Fever in children | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Fever in children Fever in children Return to Symptoms Enter age Last Updated: Next Review Date: Review my answers Find your local services Search for a service near you by entering your postcode below. Please input your postcode in the following format: A12 1BC GP Practices Dental Services Pharmacies Opticians Postcode Search NHS inform has more information on this condition. Read more Previous Start guide Review my answers  You told us your credentials were: : You said: Based on the information you gave us, we made the following recommendation: Close Keep a copy View PDF It can be extremely worrying if your child has a high temperature. But its very common and often clears up by itself without treatment. A quick and easy way to find out whether your child has a fever is to take their temperature using a thermometer. What causes a high temperature? Most fevers are caused by infections or other illnesses.The high body temperaturemakes it more difficult for thebacteria and viruses that cause infections to survive. Common conditions that can cause fevers include: upper respiratory tract infections (RTIs) flu ear infections roseola a virus that causes a temperature and arash tonsillitis kidney or urinary tract infections (UTIs) common childhood illnesses, such as chickenpox and whooping cough Your childs temperature can also be raised after vaccinations, or if they overheat because of too much bedding or clothing. When to seek medical help Phone 999 if your child: has a stiff neck has a rash that does not fade when you press a glass against it ( use the glass test from Meningitis Now ) is bothered by light has a fit ( febrile seizure ) for the first time (they cannot stop shaking) has unusually cold hands and feet has blue, pale or blotchy skin, lips or tongue has a weak, high-pitched cry thats not like their normal cry is drowsy and hard to wake is extremely agitated (does not stop crying) or is confused finds it hard to breathe and sucks their stomach in under their ribs is not responding like they normally do, or is not interested in feeding or normal activities Contact your GP if: Your child: is under 3 months and has a temperature of 38C (101F) or above is over 3 months and has a temperature of 39C (102F) or above has other signs of illness, such as a rash , as well as a high temperature has a high temperature thats lasted for 5 days or more has persistent vomiting does not want to eat, or is not their usual self and youre worried has a high temperature that does not come down with paracetamol is dehydrated  such as nappies that are not very wet, sunken eyes, and no tears when theyre crying If your GP is closed, phone 111. If your child seems to be otherwise well  for example, if theyre playing and attentive  its less likely theyre seriously ill. Fever in babies and children under 2 years of age self-help guide Complete our self-help guide to check your childs symptoms and find out what to do next. Treating a fever If your child has a fever, itsimportant to keep them hydrated by giving them plenty of cool water to drink. Babies should be given plenty of liquids, such as breast milk or formula.Even if your child isnt thirsty, try to get them to drink little and often to keep their fluid levels up. If its warm, you could help your child to stay at a comfortable temperature by covering them with a lightweight sheet or opening a window. However, they should still be appropriately dressed for their surroundings and sponging your child with coolwaterisnt recommendedto reduce a fever. Medicine to reduce fever (antipyretics) Childrens paracetamol or ibuprofen work as antipyretics, which help to reduce fever, as well as being painkillers. You cant give them both at the same time, but if one doesnt work, you may want to try the other later. Antipyretics arent always needed. If your child isnt distressed by the fever or underlying illness, theres no need to use antipyretics to reduce a fever. Always read the patient information leaflet that comes with the medication. This will tell you the correct dose and frequency for your childs age. More serious illnesses Sometimes a hightemperature in children is associated with more serious signs and symptoms, such as: breathlessness vomiting rash fits or seizures Possible serious bacterial illnesses include: meningitis  infection of the meninges, the protective membranes that surround the brain and spinal cord septicaemia  infection of the blood pneumonia  inflammation of the lung tissue, usually caused by an infection Potentially serious causes of fever are relatively rare. Source: NHS 24 - Opens in new browser window Last updated: 29 May 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Coronavirus (COVID-19) If your child has cold or flu symptoms NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Fibroids,"""Fibroids | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Healthy living Women's health Girls and young women (puberty to around 25) Periods and menstrual health Fibroids Fibroids  |  | Polski |  |  | British Sign Language (BSL) | Easy Read Fibroids are non-cancerous growths that develop in the muscular wall of the womb (uterus). These growths are made up of muscle and tissue and can be different sizes. Some can be the size of a pea, others can be the size of a melon. Theyre sometimes known as uterine myomas or leiomyomas. Fibroids are common. Around 1 in 3 people who menstruate develop them at some point in their life. Theyre more common as you get older. Symptoms Many people dont know that they have fibroids because they dont have any symptoms. This is nothing to worry about. Speak to your doctor if: Youre worried about your symptoms or you regularly have: heavy periods painful periods tummy (abdominal) pain lower back pain a frequent need to urinate constipation pain or discomfort during sex symptoms which are affecting your day to day life If your doctor thinks you might have fibroids, theyll usually refer you for an ultrasound scan to confirm the diagnosis. Why fibroids develop The exact cause of fibroids is unknown. Theyre linked to the hormones produced by the ovaries, oestrogen and progesterone. Fibroids usually develop and grow as long as the ovaries are producing these hormones. Fibroids may continue to grow during pregnancy. They tend to shrink when these hormone levels fall, such as after the menopause . Types of fibroids There are different types of fibroid. The main types of fibroids are: intramural  the most common type of fibroid, these develop in the muscular wall of the womb subserosal  fibroids that develop on the outside part of the wall of the womb and can become very large submucosal  fibroids that develop in the muscular layer of the womb beneath the wombs inner lining (endometrium) and grow into the inside of the womb pedunculated  subserosal or submucosal fibroids that are attached to the womb with a narrow stalk of tissue Treatment Fibroids will often shrink after the menopause,as hormone levels in your body change. If you have fibroids, but youre not affected by any symptoms then you dont need treatment. However, if you do have symptoms, your doctor can recommend the right treatment for you. Treatment options include: over-the-counter pain relief like ibuprofen the contraceptive pill which can reduce heavy menstrual bleeding medication taken only during your period that can reduce heavy menstrual bleeding medicines that can shrink fibroids by lowering your oestrogen and progesterone levels in rare cases, surgery Your doctor will discuss these treatments with you and you can ask any questions that you might have. Fibroids andgetting pregnant If youre having difficulty getting pregnant, your doctor or specialist may suggest extra support or treatments that can help. Your doctor will discuss these with you and you can ask any questions that you might have. Source: Scottish Government - Opens in new browser window Last updated: 28 February 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Other languages and formats  |  | Polski |  |  | British Sign Language (BSL) | Easy Read  |  | Polski |  |  | British Sign Language (BSL) | Easy Read Add this page to\n            Info For Me Also on NHS inform Periods (menstruation) Self-help tool: Periods and mental wellbeing Other health sites NICE: heavy menstrual bleeding NICE: hysteroscopic morcellation of fibroids NICE: MRI-guided percutaneous laser ablation of fibroids NICE: MRI-guided transcutaneous ultrasound for fibroids NICE: uterine artery embolisation for fibroids Pelvic Pain Support Network British Fibroid Trust Fertility Network UK NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Fibromyalgia,"""Fibromyalgia | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Chronic pain Fibromyalgia Fibromyalgia Fibromyalgia is a long-term condition that causes pain all over the body. Symptoms of fibromyalgia The main symptom of fibromyalgia is widespread pain that might feel like: an ache a burning sensation a sharp stabbing pain a mixture of these 3 feelings The pain is likely to be continuous, but it might be better or more severe at different times. As well as widespread pain, people with fibromyalgia might also have: increased sensitivity to sensations like touch, light, temperature, noise fatigue (extreme tiredness) muscle stiffness difficulty sleeping problems with mental processes (known as fibro-fog)  like problems with memory and concentration headaches irritable bowel syndrome (IBS)  a digestive condition that causes stomach pain and bloating dizziness and clumsiness feeling too hot or too cold restless legs syndrome tingling, numbness, prickling or burning sensations in your hands and feet (pins and needles, also known as paraesthesia) unusually painful periods (if you get periods) anxiety depression Speak to your GP or healthcare professional if: you think you might have fibromyalgia Causes of fibromyalgia Its not clear why some people develop fibromyalgia. The exact cause is unknown, but its likely that many factors are involved. Altered pain messages Your brain, nerves and spinal cord make up your central nervous system. Changes in the way your central nervous system sends and receives information to your body might cause fibromyalgia. Fibromyalgia is a type of chronic pain. Read more about chronic pain Genetics Some people are more likely than others to develop fibromyalgia because of the genes inherited (passed on) from their parents. Triggers Fibromyalgia is often triggered by a stressful event. This might be a physically stressful event or an emotionally (psychologically) stressful event. Possible triggers of fibromyalgia might be: an injury a viral infection giving birth an operation the breakdown of a relationship being in an abusive relationship the death of a loved one Sometimes there isnt an obvious trigger. Diagnosing fibromyalgia Diagnosing fibromyalgia can be difficult. Theres no specific test to diagnose the condition. The symptoms of fibromyalgia can vary. The symptoms can be similar to those of several other conditions. Your GP will have to rule out other conditions with similar symptoms. Youll be asked about how your symptoms are affecting your daily life. Youll be examined to check for signs of other conditions. Theyll check for swollen joints which might suggest arthritis, rather than fibromyalgia. Tests to check for some of these conditions include urine and blood tests . You may also have X-rays and other scans. If youre found to have another condition, you could still have fibromyalgia as well. Criteria for diagnosing fibromyalgia For fibromyalgia to be diagnosed, certain criteria usually have to be met. The most widely used criteria for diagnosis are: you have pain in multiple areas of your body your symptoms have stayed at a similar level for at least 3months your symptoms cant be explained by any other reason you feel unrefreshed after sleep you have problems thinking or remembering (cognitive difficulties) you experience fatigue Diagnosing other conditions Its also possible to have other conditions alongside fibromyalgia, like: depression anxiety irritable bowel syndrome (IBS) osteoarthritis hypermobility spectrum disorder Identifying all possible conditions will help to guide your treatment. Treating fibromyalgia Fibromyalgia is a long term (chronic) condition. Theres no cure for fibromyalgia. But there are treatments to help relieve some of the symptoms. This can make the condition easier to live with. Traditional treatments like pain medication arent always helpful for people with fibromyalgia. Learning about your condition and finding the best self management approaches for you is the best way to manage it. A healthcare professional can help you explore your options. Exercise, movement and activity Exercise, movement and activity can be helpful way to manage pain. A physiotherapist can help you to develop self-management skills to reduce the impact of pain on your life. They might help you create a tailored exercise programme suited to your needs, abilities and goals. Physiotherapy can also help prevent further loss of strength and increase your fitness. Pain management movement videos Visit the living with chronic pain page for more information about exercise and relaxation techniques. Occupational therapy can help you manage your everyday activities around fibromyalgia. The aim is to do this without increasing your pain or overwhelming yourself. Your occupational therapist may suggest new ways to do things. They may be able to support you to continue to work, if you want to. Access to Work has information on how to get or stay in work if you have a health condition or disability. Group support Some pain clinics offer pain management programmes run by a team of specialists. These specialists can include physiotherapists and psychologists. They can provide support to develop coping skills and manage your activity levels. Speak to your GP if you think youd benefit from a pain management programme. Talking therapies Talking therapies can help you manage the stress of living with fibromyalgia. Examples of talking therapies are: cognitive behavioural therapy (CBT)  a treatment approach to help you understand the link between how we think and what we do acceptance and commitment therapy (ACT)  often used for pain management Medication Medication cant treat fibromyalgia but it can help reduce some symptoms. Speak to your GP or pain specialist to find out the potential benefits and risks. Your GP will likely suggest you try exercise, CBT and physiotherapy first. This is because these treatments are more likely to help. Antidepressants can help some people with fibromyalgia. They help: relieve pain treat sleep problems This can be useful even if you havent been diagnosed with depression. Other medications can be used for the treatment of fibromyalgia symptoms, but theyre likely to be less effective. Speak to your GP, pharmacist or healthcare professional if youre taking medication and you dont feel its helping. Alternative therapies Some people with fibromyalgia try complementary or alternative treatments, like acupuncture or massage. Theres little scientific evidence that these treatments help in the long term. Some people find that certain treatments help them to relax and feel less stressed. This allows them to cope with their condition better. If you decide to use complementary or herbal remedies, check with your GP or healthcare professional first. Some remedies can react unpredictably with other medication, or make it less effective. Read more about herbal medicines Source:\r\n                                        NHS Scotland - Opens in new browser window Last updated: 20 October 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform What is chronic pain? Living with chronic pain Coping with a flare up of chronic pain Other health sites UK Fibromyalgia's support group section Flippin Pain Pain Concern Pain Association Scotland Flippin Pain NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Farting,"Farting | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Farting Farting Farting (flatulence) is passing gas from the digestive system out of the back passage. Its a normal process and something everyone experiences regularly. There are things you can do if you fart a lot or your farts are smelly. Causes of farting When you swallow food, water or saliva, you also swallow small amounts of air. This collects in the digestive system. The body needs to get rid of the build-up by farting or burping. Gases can also build up when you digest food. Causes of excessive farting Excessive farting can be caused by: swallowing more air than usual eating foods that are difficult to digest conditions affecting the digestive system like indigestion or irritable bowel syndrome (IBS) some medicines like non-steroidal anti-inflammatory drugs (NSAIDs) , statins and some laxatives Do not stop or change your medication without speaking to your GP first. Its important that you dont self-diagnose. Speak to a GP if: farting is affecting your life and self help and pharmacy treatments havent worked you have a stomach ache or bloating thatll not go away or comes back you keep getting constipation or diarrhoea you have lost weight without trying youve had blood in your poo for 3 weeks you have signs of an infection like a high temperature, vomiting, chills, joint pain and muscle pain youre unable to control your bowel movements (involuntary pooing) Get advice from a pharmacist A pharmacist can give you advice about excessive or smelly farts. They may be able to recommend something to help like: charcoal tablets special underwear or pads that absorb smells A pharmacist may also be able to tell you if you need to speak to your GP. Find your nearest pharmacy How reduce excessive or smelly farting Do chew food slowly with your mouth closed eat smaller meals, more often drink slowly exercise regularly to improve digestion eat foods that are easy to digest like rice, bananas, citrus fruits and potatoes drink peppermint tea Dont do not chew gum, smoke or suck on pen tops or hard sweets to avoid swallowing excess air do not wear loose-fitting dentures do not drink lots of fizzy drinks and hot drinks do not drink too much beer, wine or fruit juice do not eat lots of foods that are difficult to digest and cause farting like beans, cabbage and lentils do not eat lots of foods containing sorbitol (a sweetener) and fructose (a sugar) as these can cause farting Source: NHS 24 - Opens in new browser window Last updated: 29 May 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Flu,"Flu | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Flu Flu Return to Symptoms Enter age Last Updated: Next Review Date: Review my answers Find your local services Search for a service near you by entering your postcode below. Please input your postcode in the following format: A12 1BC GP Practices Dental Services Pharmacies Opticians Postcode Search NHS inform has more information on this condition. Read more Previous Start guide Review my answers  You told us your credentials were: : You said: Based on the information you gave us, we made the following recommendation: Close Keep a copy View PDF Flu (influenza) is a common infectious viral illness. You can catch flu all year round, but its especially common in winter. This is why its also known as seasonal flu. You can catch flu many times because flu viruses change regularly. Your body wont have a natural resistance to the new versions. Flu symptoms Some of the main symptoms of flu include: a sudden high temperature tiredness and weakness a headache general aches and pains a dry, chesty cough sore throat difficulty sleeping loss of appetite diarrhoea or tummy pain feeling sick and being sick chills a runny or blocked nose sneezing The symptoms are similar for children. They may also get pain in their ear and be less active. How long do symptoms last The symptoms of flu usually develop 1 to 3 days after becoming infected. Most people will feel better within a week. But, you may have a lingering cough and still feel very tired for a few more weeks. Flu-like illness self-help guide Complete our self-help guide to check your symptoms and find out what to do next. Phone 999 or go to A&E if you: get sudden chest pain have difficulty breathing start coughing up a lot of blood Phone 111 or ask for an urgent GP appointment if: You or your child have symptoms of flu and: youre worried about your babys or childs symptoms youre 65 or over youre pregnant you have a long-term medical condition  for example, diabetes or a condition that affects your heart, lungs, kidneys, brain or nerves you have a weakened immune system  for example, because of chemotherapy or HIV your symptoms dont improve after 7 days Get advice from a pharmacist A pharmacist can give you advice about how to treat flu. Find your nearest pharmacy Treating flu at home If you have flu, there are things you can do to help you recover more quickly. Do rest get plenty of sleep keep warm drink lots of water to avoid dehydration take paracetamol or ibuprofen to lower your temperature and treat aches and pains stay off work or school until you feel better Dont do not take paracetamol and flu remedies that contain paracetamol at the same time GPs dont recommend antibiotics for flu. They wont relieve your symptoms or speed up your recovery. Preventing the spread of flu Flu is spread by germs from coughs and sneezes. These can live on hands and surfaces for 24 hours. You can help stop yourself catching flu or spreading it to others with good hygiene measures. Do wash your hands regularly with soap and warm water clean surfaces like your computer keyboard, telephone and door handles regularly use tissues to cover your mouth and nose when you cough or sneeze bin used tissues as soon as possible avoid unnecessary contact with other people while youre infectious stay off work or school until youre feeling better How to wash your hands properly Help to keep germs at bay by washing your hands properly. The difference between flu and a cold It can sometimes be difficult to tell if you have flu or a cold. Flu symptoms: come on quickly usually include fever and aching muscles are more severe Cold symptoms: come on gradually mainly affect your nose and throat are fairly mild, so you can still get around and are usually well enough to go to work Flu vaccine The annual flu vaccine can help reduce your risk of getting flu each year. Its offered every year for free by the NHS to help protect people at risk of flu and its complications. Further information about the flu vaccine for adults Further information about the flu vaccine for children Source: NHS 24 - Opens in new browser window Last updated: 04 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Foetal alcohol syndrome,"Alcohol and pregnancy | Ready Steady Baby! 0 Ready Steady Baby Pregnancy Health problems in pregnancy Looking after yourself and your baby Preparing for parenthood Relationships and wellbeing in pregnancy Your antenatal care Your babys development Labour and birth After the birth Assisted birth Getting ready for the birth Giving birth Labour Meeting your new baby Early parenthood Caring for your new baby Getting to know your baby Going home If your babys ill Your growing family Your wellbeing after the birth Other languages and formats Back Ready Steady Baby! Home Ready Steady Baby Pregnancy Looking after yourself and your baby Alcohol and pregnancy Theres no known safe limit of drinking during pregnancy. Some people will tell you that having the odd drink when youre pregnant is okay. The safest option is to stop drinking when youre trying to get pregnant or as soon as you know youre pregnant. How alcohol can harm your baby Your babys developing all the way through your pregnancy. Alcohol can be harmful at any stage. Drinking alcohol: damages your babys developing cells which can affect how their brain and organs develop and how they look makes it more likely youll have a miscarriage, or your baby will be born early or underweight can cause fetal alcohol spectrum disorder Even small amounts of alcohol can cross over from your body into your baby. The exact level of alcohol exposure that can lead to harm is not known with certainty, but the more you drink, the greater the possible harm. Drinking a lot in a single occasion (sometimes called binge drinking) is especially harmful Fetal alcohol spectrum disorder (FASD) If you drink while pregnant your baby could develop fetal alcohol spectrum disorder (FASD). This is a term used to describe a range of alcohol-related birth defects. About 3 in every 100 children and young people in the UK have FASD, but its preventable by avoiding alcohol when pregnant or planning a pregnancy. FASD may not always be detected at birth but can cause problems later in life, including: problems with hyperactivity, impulsivity, and attention learning and behavioural difficulties experiencing difficulty in social interaction, personal care, making sense of the world, and staying safe sensory difficulties such as being sensitive to, and distressed by, certain patterns of light, sound, or touch vulnerability to victimisation and bullying Nows the time to stop drinking Lots of pregnancies arent planned, so you might not have known you were pregnant for a while and may have drunk alcohol in that time. The first and most important thing you can do now is to stop drinking alcohol completely. When you go to your first antenatal appointment, your midwife will ask you whether you drink alcohol and if so how much. Be honest with your midwife or GP if you have been drinking during pregnancy  you can speak safely and openly to them. There are lots of organisations available to provide information, help and support . Sometimes drinking alcohol can be a response to other problems in your life, including money worries or mental health problems. Getting help with other issues may make it easier to cut down or stop drinking. Read more about the support to available to help with the cost of living Read advice about dealing with low mood, anxiety, phobias and stress Stopping drinking when pregnant For lots of women, stopping drinking when pregnant can be difficult  sometimes harder than they thought. The social pressure to have a drink can be huge and can make it harder to say no. With the right support and a bit of planning, you can do it. Talking to your midwife is the first step towards getting the right support for you and your baby. Support your partner Dads and partners can support a healthy, alcohol-free pregnancy by: not drinking alcohol around their partner trying activities that dont involve alcohol  you could go swimming or go for a walk trying non-alcoholic alternatives such as mocktails, smoothies, and flavoured and fizzy water If you need help and support, visit Scotlands Service Directory or our where to get help page. Further information, other languages and alternative formats Translations and alternative formats of this information are available from Public Health Scotland . If you need a different language or format, please contact phs.otherformats@phs.scot. Ready Steady Baby leaflet in Arabic, Polish, Simplified Chinese (Mandarin) and Ukrainian Source: Public Health Scotland - Opens in new browser window Last updated: 14 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Alcohol Other health sites NOFAS: Alcohol and pregnancy Find local alcohol services Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Food poisoning,"Food poisoning | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Food poisoning Food poisoning Food poisoning is an illness caused by eating contaminated food. Its not usually serious and most people get better within a few days without treatment. In most cases, food is contaminated by bacteria or a virus like: campylobacter  the most common cause of food poisoning salmonella Escherichia coli (E. coli) norovirus listeria Food Standards Scotland has further information about bacteria and viruses that can cause food poisoning. Symptoms of food poisoning Symptoms of food poisoning include: feeling sick (nausea) being sick (vomiting) diarrhoea, which may contain blood or mucus stomach cramps and abdominal pain a lack of energy and weakness loss of appetite a high temperature of 38C or above (fever) aching muscles chills The symptoms of food poisoning usually begin within 1 to 2 days of eating contaminated food. They can also start a few hours later or several weeks later. What to do if you have food poisoning Do stay off school or work until you have not been sick or had diarrhoea for at least 2 days rest drink lots of water to prevent dehydration  you can sip it if this is easier consider speaking to your pharmacist about an oral rehydration solution (ORS) eat when you feel up to it  try small, light meals eat bland foods like toast, crackers, banana and rice until you feel better avoid alcohol, caffeine, fizzy drinks, spice and fatty foods  they may make you feel worse Speak to a GP if you: have a weak immune system  for example, because of medication, cancer treatment or HIV have severe symptoms are pregnant dont start to see improvements to your symptoms after a few days are unable to keep down any fluids because youre vomiting repeatedly have symptoms of severe dehydration, like confusion, a rapid heartbeat, sunken eyes and passing little or no urine are over 60 think your baby or young child has food poisoning have a long-term underlying condition, like inflammatory bowel disease (IBD), diabetes or kidney disease How you get food poisoning Food poisoning is caused by eating something thats been contaminated with germs. Any type of food can cause food poisoning. Food can be contaminated if its not cooked or reheated thoroughly not stored correctly  for example, its not been frozen or chilled left out for too long handled by someone whos ill or hasnt washed their hands eaten after its use by date not reheating cooked food well enough Further information on preparing and cooking food safely Preventing infection when youre ill Do try to keep contact with vulnerable people to a minimum, for example the very young or elderly wash your hands with soap and warm water often clean surfaces, toilet seats, flush handles, basins and taps often make sure everyone in the household has their own towels and flannels wash the laundry of the infected person on the hottest washing machine setting Source: NHS 24 - Opens in new browser window Last updated: 29 January 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Preparing and cooking food safely Other health sites FSA: Find your local environmental health officer FSA: food hygiene ratings Food Standards Scotland: Food safety and hygeine NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Functional neurological disorder (FND),"Functional neurological disorder (FND) | NHS inform | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Functional neurological disorder Functional neurological disorder Functional neurological disorder (FND) describes a problem with how the brain receives and sends information to the rest of the body. Its often helpful to think of your brain as a computer. In someone who has FND, theres no damage to the hardware, or structure, of the brain. Its the software, or program running on the computer, that isnt working properly. The problems that cause FND are going on in a level of the brain that you cannot control. It includes symptoms like arm and leg weakness and seizures. Other symptoms like fatigue or pain are not directly caused by FND, but are often found alongside it. Symptoms of FND FND can have many symptoms that can vary from person to person. Some people may have few symptoms, and some people may have many. A diagnosis of FND should be made because you have one or more clinical features that a specialist can recognise as typical of FND. It shouldnt be made just because scans or tests for other neurological conditions that have similar symptoms are normal. What is a clinical feature? A clinical feature is a distinctive way that your symptom presents that is unique to FND. For example, it could be that your eyes close during seizures, or that limb weakness briefly disappears during certain physical tests. Clinical features are what specialists use to identify FND from other neurological conditions with similar symptoms. Functional limb weakness Functional limb weakness is when a leg or an arm doesnt work properly. In FND, this happens because of a problem with how the nervous system is functioning. It can cause a range of symptoms, including: problems walking heaviness down one side dropping things feeling like a limb isnt part of you Functional limb weakness can often look a symptoms of a stroke or multiple sclerosis. If you have FND, any scans you have will show no damage to the brain to explain the weakness. A specialist will diagnose functional limb weakness based on specific clinical features (symptoms) they find when they examine you. Read more about functional limb weakness Functional seizures A functional seizure (also called a dissociative seizure) is an episode where someone loses either their awareness of, or their ability to interact with, their surroundings. It may look like an epileptic seizure or a faint. A functional seizure can appear as: uncontrolled shaking suddenly going motionless and unresponsive staring without responding to surroundings Some people are aware that seizures are about to happen, while others experience them without warning. A specialist will ask you and your friends or family about what happens during a seizure, and will look at any video footage you can provide. Theyll use this evidence to decide if its epilepsy , a faint or a functional seizure. Read more about functional seizures Functional tremor Tremor is uncontrollable shaking of part of the body. Its most often found in the arms and legs. Functional tremor can come and go throughout the day, and change in speed and strength. A specialist will diagnose functional tremor based on specific features of your symptoms that they find when they examine you. Read more about functional tremor Functional dystonia Functional dystonia is a type of muscle spasm. It causes a part of the body to become stuck in an unusual position. This can be for a short or a long period of time. Someone with functional dystonia will often present with curled fingers, a clenched hand, or an ankle that turns in. Read more about functional dystonia Functional gait disorder Functional gait disorder describes the problems walking that you may experience as part of FND. You may find you have a dragging leg, that you feel unsteady when walking, or that you make excessive movements when walking. A specialist will diagnose functional gait disorder based on clinical features, like the way your walking changes when doing different activities. Read more about functional gait disorder Functional facial spasm Functional facial spasm is when there are muscle spasms in the face. These can lead to problems like a narrowing of the eye or the pulling of the mouth or jaw upwards, downwards or to the side. Read more about functional facial spasm Functional tics A tic is a fast repetitive movement or sound that happens suddenly. Functional tics can be a symptom of FND. Functional tics can look similar to the tics in Tourettes syndrome. A specialist will look at the clinical features of your tics to make a diagnosis. Its quite common to have both functional tics and Tourettes syndrome. Functional jerks and twitches A symptom of FND can be jerks or twitches, which is when someone makes sudden movements. Everyone experiences random jerks occasionally, like when you jolt awake as youre falling asleep. In FND, however, these uncontrolled jerks and twitches can become much more frequent. Read more about functional jerks and twitches Functional drop attacks Functional drop attacks are when someone falls to the ground suddenly, without losing consciousness. Read more about functional drop attacks Functional sensory symptoms A symptom of FND can be numbness, pins and needles, or a feeling that a limb isnt part of your body. Read more about functional sensory symptoms Functional cognitive symptoms Problems with your memory or concentration can be a symptom of FND. You might find that you: lose track while doing things, for example being unable to remember why you went into a room go blank, for example when trying to recall your pin number lose track during conversations misplace important things, like your keys or phone forget words Its normal to experience these things occasionally. For someone with functional cognitive symptoms, these things happen so often that they interfere with work and home life. The cognitive symptoms of FND can sometimes be mistaken for dementia. Specialists will look for features that are typical of functional cognitive symptoms when diagnosing FND. Read more about functional cognitive symptoms Functional speech and swallowing difficulties Functional speech and swallowing difficulties can be a symptom of FND. You might experience: slurred speech a new stutter difficulties finding the right word unintentionally mixing words up whispering or hoarse speech (dysphonia) difficulty swallowing, including feeling like theres something stuck in your throat A specialist will diagnose functional speech and swallowing difficulties based on specific features. Read more about functional speech and swallowing difficulties Persistent postural perceptual dizziness (PPPD) PPPD (sometimes called functional dizziness, triple PD or 3PD) can be a symptom of FND. The dizziness in PPPD is typically experienced constantly, and gets worse while walking or in crowded environments. There are many causes of dizziness. Most people with PPPD have another cause of dizziness at the same time. A specialist will diagnose PPPD based on specific features when they assess you. Read more about PPPD Functional visual symptoms Visual symptoms can be a part of FND. You may experience changes to your vision, like: blurred vision double vision photophobia (sensitivity to light) reduced vision A specialist will diagnose functional visual symptoms based on specific features that they find when they examine you. Read more about functional visual symptoms Dissociative symptoms Dissociative symptoms are common in FND, although there are many other causes. These symptoms can be hard to describe, but are often described as feeling: that your body is disconnected from you that your body doesnt belong to you disconnected from the world around you spaced out that you are floating that you are having an out-of-body experience there but not there You may also be able to hear whats going on around you, but not be able to respond. These experiences are called dissociation, and can link into other FND symptoms. Read more about dissociative symptoms There are other symptoms or conditions that are commonly associated with FND. These include: chronic pain , including fibromyalgia , back and neck pain, and complex regional pain syndrome persistent fatigue sleep problems including insomnia (not sleeping enough) and hypersomnia (sleeping too much) migraines and other types of headache and facial pain irritable bowel syndrome and other problems with the function of your stomach and bowel anxiety and panic attacks depression post-traumatic stress disorder chronic urinary retention despite all tests being normal (which may be diagnosed as Fowlers syndrome) dysfunctional breathing What causes FND? We know that the symptoms of FND happen because theres a problem with how the brain is sending and receiving messages to itself and other parts of the body. Using research tools, scientists can see that certain circuits in the brain are not working properly in people with FND. However, theres still a lot of research to be done to understand how and why FND happens. Why does FND happen? FND can happen for a wide range of reasons. Theres often more than one reason, and the reasons can vary hugely from person to person. Some of the reasons why the brain stops working properly in FND include: the brain trying to get rid of a painful sensation a migraine or other neurological symptom the brain shutting down a part or all of the body in response to a situation it thinks is threatening In some people, stressful events in the past or present can be relevant to FND. In others, stress is not relevant. The risk of developing FND increases if you have another neurological condition. Read more about how and why FND happens. Diagnosing FND When diagnosing FND, your healthcare provider will carry out an assessment to see if there are typical clinical features of FND. Your healthcare provider may still choose to test for other diseases and conditions before diagnosing FND. This is because many conditions share the same symptoms and, in around a quarter of cases, FND is present alongside another neurological condition. Someone can have both FND and conditions like sciatica, carpal tunnel syndrome, epilepsy, or multiple sclerosis (MS). The diagnosis of FND, however, should be given because you have the clinical features of FND. It shouldnt be given just because theres no evidence of other conditions or illnesses. Because the symptoms of FND are not always there, your healthcare provider may ask you to video your symptoms. This will allow them to see what your symptoms look like. Treatments FND is a really variable condition. Some people have quite short-lived symptoms. Others can have them for many years. There are treatments available that can manage and improve FND. These treatments are all forms of rehabilitation therapy, which aims to improve your ability to carry out every day activities. Many of these treatments are designed to retrain the brain. Some people with FND benefit a lot from treatment and may go into remission. Other people continue to have FND symptoms despite treatment. Physiotherapy Specialised physiotherapy can be useful in treating FND. It helps to remind the body how it should move. It can also help you build up strength and stamina you may have lost. Read more about physiotherapy for FND Occupational therapy Occupational therapy can be helpful in treating FND. An occupational therapist will work with you to plan your treatment goals, and gradually build your confidence and ability to reach them. Read more about occupational therapy for FND Psychological therapy Psychological therapy can be helpful to many people with FND, even those without stress in their lives. It can help you gain a better understanding of FND and its relationship to your personal circumstances. There are specific psychological techniques which can help you gain better control over movement or seizure symptoms. Psychological therapy can also help you learn to manage low mood, anxiety and past traumatic events, as well as other psychological problems (if present). Not everyone with FND will need psychological therapy. Read more about psychological therapy for FND Speech, language and swallowing therapy Speech and language therapists are available to help if youre struggling with speaking or swallowing. They have a range of techniques to try, designed to help with specific problems. These might include helping you to shape certain sounds, or to practice breathing patterns as you try to talk. Read more about speech and language therapy for FND Medication Medication can play a role in treating the some of the problems associated with FND, like pain, depression and anxiety. Your healthcare provider can help decide if medication is right for you. There are many types of medication that can make FND worse, including opiates like morphine, dihydrocodeine or codeine. It may be worth discussing your current medications with your healthcare provider. Do not stop taking any medicine thats been prescribed without checking with your GP or healthcare provider first. You could make yourself very ill. Read more about treating FND FND in children and young people FND is broadly the same condition in children and young people. Its unusual for it to occur under the age of 10. It becomes more common through the teenage years. The treatment for FND in children and young people is similar to adults. Its especially important for families and schools to learn about the condition, so they can respond in the most helpful way. Where to find support If youve been diagnosed with FND there are sources of information, charities and support groups that can help you. The Neurosymptoms FND Guide has more detailed information. Theres also an app available with further details about the condition. My FND is an app that allows you to learn about your symptoms. It helps you track them, and offers advice for managing them. FND Hope UK is a charity that raises awareness of FND. It provides further information, resources, and support services for those with FND. FND Action is a charity that provides information on FND and support for those with a diagnosis. Source:\r\n                                        Scottish Government - Opens in new browser window Last updated: 07 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites Neurosymptoms FND Guide My FND FND Hope UK FND Action NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Fungal nail infection,"Fungal nail infection | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Skin, hair and nails Fungal nail infection Fungal nail infection Many people develop a fungal nail infection at some point in their life. Its not usually serious, but can be unpleasant and difficult to treat. The infection develops slowly and causes the nail to become discoloured, thickened and distorted. Toenails are more frequently affected than the fingernails. The medical name for a fungal nail infection is onychomycosis. A fungal nail infection can cause the nail to become thick, yellow and brittle. https://dermnetnz.org/ Signs and symptoms of a fungal nail infection A fungal nail infection may not cause any obvious symptoms at first. As it progresses, the infection can cause: discolouration of the nail  it may turn white, black, yellow or green thickening and distortion of the nail  it may become an unusual shape or texture and be difficult to trim pain or discomfort  particularly when using or placing pressure on the affected toe or finger brittle or crumbly nails  pieces may break off and come away completely Sometimes the skin nearby may also become: infected itchy cracked red swollen What causes a fungal nail infection Most fungal nail infections occur as a result of the fungi that cause athletes foot infecting the nails. These fungi often live harmlessly on your skin, but they can sometimes multiply and lead to infections. The fungi prefer warm, dark and moist places like the feet. Youre more likely to get a fungal nail infection if you: dont keep your feet clean and dry wear shoes that cause your feet to get hot and sweaty walk around barefoot in places where fungal infections can spread easily, like communal showers, locker rooms and gyms have damaged your nails have a weakened immune system have certain other health conditions, like diabetes , psoriasis or peripheral arterial disease Fungal nail infections can be spread to other people, so you should take steps to avoid this if you have an infection. Speak to your GP or pharmacist if: youre bothered by the appearance of a nail with a fungal nail infection the fungal nail infection is causing problems like pain or discomfort Treating a fungal nail infection A fungal nail infection is unlikely to get better without treatment. However, if youre not bothered by it you might decide its not worth treating because treatment: can take a long time can cause side effects isnt always effective Treatment may also be unnecessary in mild cases of fungal nail infection. Its also unlikely to cause any further problems so you may feel its not worth treating. For more severe or troublesome fungal nail infections, antifungal medication may be recommended. Antifungal medication Antifungal medication comes in tablets or a special paint you apply directly to the nail. A small sample of the infected nail may need to be taken and sent off for testing before treatment starts, to confirm that you do have a fungal infection. If the treatment is working, you should see a new healthy nail start to grow from the base of nail over the course of a few months. The old infected nail should begin to grow out and can be gradually clipped away. Antifungal treatments are thought to be effective in treating about 60 to 80% of fungal nail infections. It can take between 6 and 18 months for the appearance of the affected nail to return to normal, and in some cases the nail may not look the same as before the infection. Antifungal tablets Terbinafine and itraconazole are the 2 medicines most commonly prescribed for fungal nail infections. These usually need to be taken once or twice a day for several months to ensure the infection has completely cleared up. If you stop taking the medication too early, the infection may return. Possible side effects of antifungal tablets can include: headache itching diarrhoea loss of sense of taste a rash Antifungal tablets are currently not licensed to be sold over the counter. This is because these tablets have many listed side effects, contraindications and need to be taken for several months. Antifungal nail paint If you prefer not to take antifungal tablets, your GP or pharmacist may suggest you try antifungal nail paint instead. Nail paint isnt generally considered to be as effective as tablets because it can be difficult for it to reach the deeper layers of the nail. However, it doesnt usually cause any side effects. Like antifungal tablets, antifungal nail paint also normally needs to be used for several months to ensure that the infection has cleared up. Speak to your GP if new, healthy nail doesnt start to grow after a few weeks of treatment. Keep using the treatment until your GP says you can stop. Stopping too early could result in the infection returning. Softening and scraping away the nail As it can take a long time for antifungal medication to work, some people may prefer to use a treatment that involves softening and removing infected parts of nail over a few weeks. Treatment kits are available from pharmacies that contain a 40% urea paste, plasters and a scraping device. The paste softens the infected parts of the nail, allowing them to be scraped away so they can be gradually replaced with healthy nail. To use the treatment: wash the affected area and dry it thoroughly carefully apply the paste to the infected nails cover the nails with plasters and leave them for 24 hours wash the paste off the next day and scrape away the softened parts of the nail repeat this process each day for 2 to 3 weeks Once no more infected parts of the nail can be removed, ask your pharmacist for antifungal nail paint to prevent re-infection as the nail regrows over the next few months. Removing the nail A procedure to remove affected nails completely isnt usually necessary, but may be recommended if the infection is severe or painful and other treatments havent helped. If your nail is surgically removed, a new nail should eventually grow back in its place. However, it could take a year or more for the nail to grow back completely. Laser treatment Laser treatment is a possible option if you have a fungal nail infection thats particularly stubborn. The laser emits high doses of light energy, which are used to destroy the fungus. Early research suggests the treatment may be helpful in treating fungal nail infections, but theres currently not enough evidence to recommend it as a routine treatment. If you want to try laser treatment, youll have to pay for it privately because its not available on the NHS. Be aware that the treatment may need to be repeated several times for up to a year, so it could get very expensive. How to prevent fungal nail infections Whether or not you decide to have treatment, you should still follow self-help advice to help stop the condition getting worse or spreading to others. Do keep your hands and feet clean and dry wear well-fitting shoes made of natural materials and clean cotton socks  these will allow your feet to breathe clip your nails to keep them short  dont share clippers or scissors with other people replace old footwear that could be contaminated with fungi treat athletes foot as soon as possible to avoid the infection spreading to your nails ensure your towels are washed regularly make sure any equipment is properly sterilised between uses if you visit a nail salon Dont do not share towels and socks with other people do not walk around barefoot in public pools, showers, and locker rooms  special shower shoes are available to protect your feet Source: NHS 24 - Opens in new browser window Last updated: 07 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites BAD: fungal infections of the nails NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Gallbladder cancer,"Gallbladder cancer - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Gallbladder cancer Gallbladder cancer Gallbladder cancer is very rare. There are a number of different types of gallbladder cancer,depending on the cells affected. Over 85% of gallbladder cancers are adenocarcinoma, which means thecancerstarted in the gland cells lining the gallbladder. Cancer that starts in the skin-like cells that line the gallbladder is known as squamous cell cancer. The Cancer Research UK website has more information about thedifferent types of gallbladder cancer . Cancer of the gallbladder is more common in women than men, with around 7 out of 10 cases diagnosed in women. Its also more common in older people, particularly those over 70 years of age. The gallbladder The gallbladder is a small, pear-shaped organ thats located underneath the liver. Its main purpose is to store and concentrate bile. Bile is a liquid produced by the liver that helps to digest fats. It passes from the liver through a series of channels (bile ducts) into the gallbladder, where its stored. Over time, bile becomes more concentrated, which makes it better at digesting fats. The gallbladder releases bile into the digestive system when its needed. The gallbladder is a useful but not essential organ, which can be safely removed without interfering with your ability to digest food. Symptoms of gallbladder cancer In the early stages, gallbladder cancer doesnt cause symptoms, whichmeans it could be at an advanced stage by the time its diagnosed. Symptoms that occur at a later stage can include: abdominal (stomach) pain feeling sick jaundice (yellowing of the skin and whites of the eyes) These symptoms could be linked toa number of conditions and may not be related to gallbladder cancer. However,if you have these symptoms, you should speak to your GP so they can investigate whats causing them. Other possible symptoms of gallbladder cancer can include loss of appetite, unexplained weight lossand a swollen stomach. What causes gallbladder cancer? In gallbladder cancer, abnormal cells grow within the gallbladder. Its not known why this happens, but certain things are thought to increase your chances of developing the condition. Gallbladder cancer is more common in older people, and your chances of developing it increase with age. Lifestyle factors  such as obesity , smoking and an unhealthy diet  are believed to increase the risk of gallbladder cancer. However, theres not enough evidence to show a firm link between diet and gallbladder cancer. There are also a number of conditions that can increase your chances of developing gallbladder cancer. For example, gallstones ,cholecystitis(inflammation of the gallbladder) and diabetes have been closely linked to the condition. If you have a family history of gallstones, cholecystitis, or gallbladder cancer, youre more likely to develop these conditions yourself. The Cancer Research UK website has more information about the risks and causes of gallbladder cancer . Diagnosing gallbladder cancer Your GP will examine you and ask about your symptoms. If they suspect gallbladder cancer, they may refer you to a specialist, usually a gastroenterologist (a doctor who specialises in conditions of the digestive system). Thespecialist will ask about your medical history and check to see whether the lymph glands in your neck and groin are swollen. You may also have some initial tests, including: blood tests an ultrasound scan a computerised tomography (CT) scan If these tests reveal anything abnormal in or around your gallbladder, further tests may be arrangedto helpconfirm whether you have gallbladder cancer. These mayinclude: an endoscopic retrograde cholangiopancreatography (ERCP) a magnetic resonance cholangiopancreatography (MRCP) biopsy and fine needle aspiration (FNA) The Cancer Research UK website has more information about tests for gallbladder cancer . Treating gallbladder cancer The main treatment for gallbladder cancer is surgery to remove the gallbladder and possibly some of the surrounding tissue. Chemotherapy and radiotherapy are also sometimes used, either on their own or in combination with surgery. The treatment programme thats most suitable for you will depend on: the type of gallbladder cancer you have the stage of your cancer your overall level of health As with all cancers, the chances of survival depend on how far the condition has advanced when it is diagnosed. The Cancer Research UK website has more information about treatinggallbladder cancer and the stages and outlook for gallbladder cancer . Source: NHS 24 - Opens in new browser window Last updated: 13 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites Cancer Research UK: Gallbladder cancer Macmillan Cancer Support: Gallbladder cancer Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Gallstones,"Gallstones | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Gallstones Gallstones About gallstones Symptoms of gallstones Causes of gallstones Diagnosing gallstones Treating gallstones Complications of gallstones Preventing gallstones About gallstones Gallstones are small stones, usually made of cholesterol, that form in the gallbladder. In most cases they dont cause any symptoms and dont need to be treated. However, if a gallstone becomes trapped in a duct (opening) inside the gallbladder it can trigger a sudden intense abdominal pain that usually lasts between 1and 5hours. This type of abdominal pain is known as biliary colic. Some people with gallstonescan alsodevelop complications, such as inflammation of the gallbladder ( cholecystitis ), which can cause: persistent pain jaundice a fever When gallstones cause symptoms or complications, its known as gallstone disease or cholelithiasis. Read more about: symptoms of gallstones complications of gallstones The gallbladder The gallbladder is a small, pouch-like organ found underneath the liver. Its main purpose is to store and concentrate bile. Bile is a liquid produced by the liver to help digest fats. Its passed from the liver through a series of channels, known as bile ducts, into the gallbladder. The bile is stored in the gallbladder and over time it becomes more concentrated, which makes it better at digesting fats. The gallbladder releases bile into the digestive system when its needed. What causesgallstones? Gallstones are thought to develop because of an imbalance in the chemical make-up of bile inside the gallbladder. In most cases the levels of cholesterol in bile become too high and the excess cholesterol forms into stones. Gallstones are very common. Its estimated that more than 1in every 10 adults in the UKhas gallstones, although onlya minorityofpeople develop symptoms. Youre more at risk of developing gallstones if youre: overweightor obese female, particularly if youve had children 40 or over (the risk increases as you get older) Read more about: causes of gallstones preventing gallstones Treating gallstones Treatment is usually only necessary if gallstones are causing: symptoms such as abdominal pain complications  such as jaundice or acute pancreatitis In these cases, keyhole surgery to remove the gallbladder may be recommended.This procedure,known as a laparoscopic cholecystectomy , is relatively simpleto perform and has a low risk of complications. You can lead a perfectly normal life without a gallbladder. Your liver will still produce bile to digest food, butthe bile will just drip continuously into the small intestine, rather thanbuild up in the gallbladder. Read more about: treating gallstones diagnosing gallstones Outlook Most cases of gallstone disease are easily treated with surgery.Very severe cases can be life-threatening, especially in people who are already in poor health. However, deaths from gallstone diseaseare rare in the UK. Symptoms of gallstones Most cases of gallstones dont cause any symptoms. But if a gallstone blocks one of the bile ducts, it can cause sudden, severe abdominal pain, known as biliary colic. Other symptoms may developif the blockage is more severe ordevelops in another part of the digestive system. Abdominal pain (biliary colic) Gallstonescan causesudden, severe abdominal pain that usually lasts 1to 5hours(although it can sometimes last just a few minutes). The pain can be felt: in the centre of your abdomen (tummy) just under the ribs on your right-hand side it may spread from hereto your side or shoulder blade The pain is constant and isnt relieved when you go to the toilet, pass wind or are sick.Its sometimes triggered by eating fatty foods, butmay occur at any time of dayand it may wake you up during the night. Biliary colic doesnt happen often. After an episode of pain, it may be several weeks or months before you experience another episode. Some people also have periods where they sweat excessively and feel sick or vomit. Whengallstones cause episodes of biliary colic, it is known as uncomplicated gallstone disease. Other symptoms In a small number of people, gallstones can cause more serious problems if they obstruct the flow of bile for longer periods or move into other organs (such as the pancreas or small bowel). If this happens,youmay develop: a high temperature of 38C (100.4F) or above more persistent pain a rapid heartbeat yellowing of the skin and whites of the eyes (jaundice) itchy skin diarrhoea chills or shivering attacks confusion a loss of appetite Doctors refer to this more severe condition as complicated gallstone disease. Read more about the complications of gallstones . When to seek medical advice If you think you may be experiencing biliary colic, you should make an appointment with your GP. Contact your GP immediately for advice if you develop: jaundice abdominal pain lasting longer than eight hours a high temperature and chills abdominal pain so intense that you cant find a position to relieve it Ifits not possible to contact your GP immediately, phone your local out-of-hours or NHS 24s 111 service. Causes of gallstones Gallstones are thought to be caused by an imbalance in the chemical make-up of bile inside the gallbladder. Bile is a liquid produced by the liver to aid digestion. Its still unclear exactly what leads to this imbalance, but gallstones can form if: there are unusually high levels of cholesterol inside the gallbladder (about 4in every 5gallstones are made up of cholesterol) there are unusually high levels of a waste product called bilirubin inside the gallbladder (about 1in every 5gallstones is made up of bilirubin) These chemical imbalances cause tiny crystals to develop in the bile. These can gradually grow (often over many years) into solid stones that can be as small as a grain of sand or as large as a pebble. Sometimes only 1stone will form, but there are often several at the same time. Whos at risk? Gallstones are more common if you: are female, particularly if youve had children,are taking the combined Pill, or are undergoing high-doseoestrogen therapy are overweight or obese are aged 40 years or older (the older you are, the more likely you are to develop gallstones) have a condition that affects the flow of bile  such as cirrhosis (scarring of the liver), primary sclerosing cholangitis, or obstetric cholestasis have Crohns disease or irritable bowel syndrome (IBS) have a close family member whos also had gallstones have recently lost weight (from eitherdieting or weight-loss surgery) are taking an antibiotic called ceftriaxone Diagnosing gallstones Gallstones may be discovered during tests for a different condition, as they often dont cause any symptoms. If you do have symptoms of gallstones ,make an appointment with your GP so they can try to identify the problem. Seeing your GP Your GP will ask about your symptoms in detail and maycarry out the Murphys sign test to help determine if your gallbladder is inflamed. During this test, yourGP places their hand or fingers on the upper-right area of your tummy and asks you to breathe in. If you find this painful, it usuallymeans your gallbladder is inflamed and you may need urgent treatment. Your GP may also recommend having blood tests to look for signs of infection, or to check if your liver is working normally.If gallstones have moved into your bile duct, the liver may not be able tofunction properly. Further tests If your symptoms and test results suggest you may have gallstones, youll usually be referred for further tests. You may be admitted to hospital for tests the same day if your symptoms suggest you have a more severe form of gallbladder disease. Ultrasound scan Gallstones can usually be confirmed using an ultrasound scan, which uses high frequency sound waves to create an image of the inside of the body. The type of ultrasound scan used for gallstonesis similar to the scan used during pregnancy, where a small handheld device called a transducer is placed onto your skin and moved over your upper abdomen. Sound waves are sent from thetransducer, through your skin and into your body. They bounce back off the body tissues, forming an imageon a monitor. This is a painless procedure that usually takes about 10 to 15 minutes to complete. When gallstones are diagnosed, there may be some uncertainty about whether any stones have passed into the bile duct. Gallstones in the bile duct are sometimes seen during an ultrasound scan.If theyre not visible but yourtestssuggest the bile duct may be affected, you may need an MRI scan or a cholangiography. MRI scan A magnetic resonance imaging (MRI) scan may be carried out to look for gallstones in the bile ducts. This type of scan uses strong magnetic fields and radio waves to produce detailed images of the inside of the body. Cholangiography A procedure called a cholangiography can give further information about the condition of your gallbladder. A cholangiography uses a dye that shows up on X-rays . The dyemay be injected into your bloodstream or injected directly into your bile ducts during surgery or using anendoscopepassed through your mouth. After the dye has been introduced, X-ray images are taken. Theyll reveal any abnormality in your bile or pancreatic systems. If your gallbladder and bile systems are working normally, the dye will be absorbed in the places its meant to go (your liver, bile ducts, intestines and gallbladder). If a blockage is detected during this test, your doctor may try to removeit at this point using an endoscope. This is known asan endoscopic retrograde cholangio-pancreatography (ERCP). See treating gallstones for more information about ERCP. CT scan A computerised tomography (CT) scan may be carried out to look for any complications of gallstones, such as acute pancreatitis . This type of scan involves taking a series of X-rays from many different angles. CT scans areoften donein an emergency to diagnose severe abdominal pain. Treating gallstones Your treatment plan for gallstones depends on how the symptoms are affecting your daily life. If you dont have any symptoms, a policy of active monitoring is often recommended. This means you wont receive immediate treatment, but you should let your GP know if you notice any symptoms. As a general rule, the longer you go without symptoms, the less likely it is that your condition will get worse. You may need treatment if you have a condition that increases your risk ofdeveloping complications, such as: scarring of the liver ( cirrhosis ) high blood pressure inside the liver  this is known as portal hypertension and is often a complication of alcohol-related liver disease diabetes Treatment may also be recommended if a scan shows high levels of calcium inside your gallbladder, as this can lead to gallbladder cancer in later life. If you have episodes of abdominal pain (biliary colic), treatment depends on how the pain affects your daily activities. Ifthe episodes aremild and infrequent, you may be prescribed painkillers to control further episodes and given advice abouteating a healthy diet to help control the pain. If your symptoms are more severe and occur frequently,surgery to remove the gallbladderis usually recommended. The gallbladder isnt an essential organ andyou can lead a perfectly normal life without one.Some people may experience symptoms of bloating and diarrhoea after eating fatty or spicy food. If certain foods do trigger symptoms, you may wish to avoid them in the future. Keyhole surgery to remove the gallbladder If surgery is recommended, youll usually have keyhole surgery to remove your gallbladder. This is known as a laparoscopic cholecystectomy. Duringa laparoscopic cholecystectomy, 3or 4small cuts are made in your abdomen. One larger cut (about 2cm to 3cm) will be by the belly button and the others (each 1cm or less) will be on the right side of your abdomen. Your abdomen is temporarily inflated using carbon dioxide gas. This is harmless and makes it easier for the surgeon to see your organs. Alaparoscope (long thin telescope with a tiny light and video camera at the end) is inserted through one of the cuts in your abdomen. This allows your surgeon to view the operation on a video monitor.Your surgeon will then remove your gallbladder using special surgical instruments. If its thought there may be gallstones in the bile duct, an X-ray or ultrasound scan of the bile duct is also taken during the operation. If gallstones are found, they may be removed during keyhole surgery. If the operation cant be done this way or an unexpected complication occurs, it may have to be converted to open surgery. After the gallbladder has been removed, the gas in your abdomen escapes through the laparoscope and the cuts are closed with dissolvable stitches and covered with dressings. Laparoscopic cholecystectomies areusually performed under a general anaesthetic , which means youll be asleep during the procedure and wont feel any pain while its carried out. The operation takes 60 to 90 minutes and you can usually go home the sameday.Full recovery typically takes around 10 days. Single-incision keyhole surgery Single-incision laparoscopic cholecystectomy is a newer type of keyhole surgery used to remove the gallbladder. During this type of surgery, only one small cut is made, which means youll only have onebarely visible scar. However, single-incision laparoscopic cholecystectomies havent been carried out as often as conventional laparoscopic cholecystectomies, so there are still some uncertainties about it. Access to this type of surgery is also limited because it needs an experienced surgeon with specialist training. The National Institute for Health and Care Excellence (NICE) has more information on single-incision laparoscopic cholecystectomy . Open surgery Alaparoscopic cholecystectomy may not always be recommended, for example if you: are in the third trimester (the last three months) of pregnancy are extremely overweight have an unusual gallbladder or bile duct structure that makes akeyhole procedure difficult and potentially dangerous In these circumstances, an open cholecystectomy may be recommended. During this procedure, a 10cm to 15cm (4in to 6in) incision is made in your abdomen underneath the ribs so the gallbladder can be removed.Thisis done under general anaesthetic, so youll be asleep and wont feel any pain. Open surgery is just as effective as laparoscopic surgery, but it does have a longer recovery time and causes more visible scarring. Most people have to stay in hospital for up to 5days and it typically takes 6weeks to fully recover. Endoscopic retrograde cholangio-pancreatography (ERCP) An endoscopic retrograde cholangio-pancreatography (ERCP) is a procedure that can be used to remove gallstones from the bile duct. The gallbladder isnt removed during this procedure, so any stones in the gallbladder will remain unless removed using the surgical techniques mentioned above. ERCP is similar to a diagnostic cholangiography (see diagnosing gallstones for more information), where an endoscope (long, thin flexible tube with a camera at the end) is passed through your mouth down to where the bile duct opens into the small intestine. However, during ERCP theopening of the bile ductis widened with a small incision or an electrically heated wire. The bile duct stones are then removed or left to pass into your intestine and out of your body. Sometimes a small tube called a stent is permanently placed in the bile duct to help the bile and stones pass. An ERCP is usually carried out under sedation, which means youll be awake throughout the procedure but wont experience any pain. The ERCP procedurelasts about 30 minutes on average, but can take from 15 minutes to over an hour.You may need to stay overnight in hospital after the procedure so you can be monitored. Medication to dissolve gallstones If yourgallstones are small and dont contain calcium, it may be possible to take ursodeoxycholic acidtablets to dissolve them. However, these arentprescribed very often because: theyrerarely very effective they need to be taken for a long time (up to 2years) gallstones can recur once treatment is stopped Side effects of ursodeoxycholic acid are uncommon and are usually mild. The most commonly reported side effects are feeling sick, being sick and itchy skin. The use of ursodeoxycholic acid isnt usually recommended for pregnant or breastfeeding women. Sexually active women should use either a barrier method of contraception , such as a condom , or a low-dose oestrogen contraceptive pill while taking ursodeoxycholic acid, as it may affect other types of oral contraceptive pills. Ursodeoxycholic acid tablets are occasionally also prescribed as a precaution against gallstones if its thought youre at risk of developing them. For example, you may be prescribed ursodeoxycholic acid if youve recently had weight loss surgery, as rapid weight loss can cause gallstones to grow. Complications of gallstones A small number of people with gallstones may develop serious problems if the gallstones cause a severe blockage or move into another part of the digestive system. Inflammation of the gallbladder (acute cholecystitis) In some cases of gallstone disease a bile duct can become permanently blocked, which can lead to a build-up of bile inside the gallbladder. This can cause the gallbladder to become infected and inflamed. The medical term for inflammation of the gallbladder is acute cholecystitis. Symptoms include: pain in your upper abdomen that travels towards your shoulder blade (unlike biliary colic, the pain usually lasts longer than five hours) a high temperature (fever) of 38C (100.4F) or above a rapid heartbeat An estimated 1in 7people with acute cholecystitis also experience jaundice (see below). Acute cholecystitis is usually treated first with antibiotics to settle the infection and then keyhole surgery to remove the gallbladder . This operation can be more difficult when performed as an emergency and theres a higher risk of it being converted to an open procedure. Sometimes asevere infection can lead to a gallbladder abscess (empyema of the gallbladder). Antibiotics alone dont always treat these and they may need to be drained. Occasionally a severely inflamed gallbladdercan tear, leading toperitonitis(inflammation of the inside lining of the abdomen).If this happens, you may need to have antibiotics given directly into a vein (intravenous antibiotics) and surgery may be required to remove a section of the lining if part of it becomes severely damaged. Read more about acute cholecystitis . Jaundice If a gallstone passes out of the gallbladder into the bile duct and blocks the flow of bile, jaundice occurs. Symptoms of jaundice include: yellowing of the skin and eyes dark brown urine pale stools itching Sometimes the stone passes from the bile duct on its own. If it doesnt, the stone needs to be removed. See treating gallstones . Infection of the bile ducts (acute cholangitis) If the bile ducts become blocked, theyre vulnerable to infection by bacteria. The medical term for a bile duct infection is acute cholangitis. Symptoms of acute cholangitis include: pain in your upper abdomen that travels towards your shoulder blade a high temperature jaundice chills confusion itchy skin generally feeling unwell Antibiotics will help treat the infection, but its also important to help the bile from the liver to drain with anendoscopic retrograde cholangio-pancreatography (ERCP). Read treating gallstones for more information. Acute pancreatitis Acute pancreatitis may develop when a gallstone moves out of the gallbladder and blocks the opening (duct) of the pancreas, causing it to become inflamed. The most common symptom of acute pancreatitis is a sudden severe dull pain in the centre of your upper abdomen, around the top of your stomach. The pain of acute pancreatitis often gets steadily worse until it reaches a constant ache. The ache may travel from your abdomen and along your back and may feel worse after you have eaten. Leaning forward or curling into a ball may help to relieve the pain. Other symptoms of acute pancreatitis can include: feeling sick being sick diarrhoea loss of appetite a high temperature (fever) of 38C (100.4F) or above tenderness of the abdomen less commonly, jaundice Theres currently no cure for acute pancreatitis, so treatment focuses on supporting the functions of the body until the inflammation has passed. This usually involves admission to hospital so you can be given: fluids into a vein (intravenous fluids) pain relief nutritional support oxygen through tubes into your nose With treatment,most people with acute pancreatitis improve within a week and are well enough to leave hospital after 5 to 10 days. Read more about acute pancreatitis . Cancer of the gallbladder Gallbladder cancer is a rare but serious complication of gallstones. An estimated 660 cases of gallbladder cancer are diagnosed in the UK each year. Having a history of gallstones increases your risk of developing gallbladder cancer.Approximately 4out of every 5people who have cancer of the gallbladder also have a history of gallstones. However, people with a history of gallstones have a less than one in 10,000 chance of developing gallbladder cancer. If you have additional risk factors, such as a family history of gallbladder cancer or high levels of calcium inside your gallbladder, it may be recommended that your gallbladder be removed as a precaution, even if your gallstones arent causing any symptoms. The symptoms of gallbladder cancer are similar to those of complicated gallstone disease, including: abdominal pain high temperature (fever) of 38C (100.4F) or above jaundice Gallbladder cancer can be treated with a combination of surgery, chemotherapy and radiotherapy . Gallstone ileus Another rare but serious complication of gallstones is known as gallstone ileus. This is where the bowel becomes obstructed by a gallstone. Gallstone ileus can occur when an abnormal channel, known as a fistula, opens up near the gallbladder. Gallstones are then able to travel through the fistula and can block the bowel. Symptoms of gallstone ileus include: abdominal pain being sick swelling of the abdomen constipation A bowel obstruction requires immediate medical treatment. If its not treated, theres a risk that the bowel could split open (rupture). This could cause internal bleeding and widespread infection. If you suspect you have an obstructed bowel, contact your GP as soon as possible. If this isnt possible, phone the NHS 24 111 service . Surgery is usually required to remove the gallstone and unblock the bowel. The type of surgery you receive depends on where in the bowel the obstruction has occurred. Preventing gallstones From the limited evidence available, changes to your diet and losing weight (if youre overweight) may help prevent gallstones. Diet Because of the role cholesterol appears to play in the formation of gallstones, it is advisable to avoid eating too many foods with a high saturated fatcontent. Foods high in saturated fat include: meat pies sausages and fatty cuts of meat butter, ghee and lard cream hard cheeses cakes and biscuits food containing coconut or palm oil A healthy, balanced diet is recommended. This includes plenty of fresh fruit and vegetables (at least 5portions a day) and wholegrains. Theres also evidence that regularly eating nuts, such as peanuts or cashews, can help reduceyour risk of developing gallstones. Drinking small amounts of alcohol may alsohelp reduce your risk of gallstones. However, you shouldnt regularly drink more than 14 units of alcohol a week as this can lead to liver problems and other health conditions. Regularly drinking any amount of alcohol can increase the risk to your health. Read more about: high cholesterol how to lower your cholesterol healthy eating Losing weight Being overweight, particularly being obese, increases the amount of cholesterol in your bile, which increases your risk of developing gallstones. You should control your weight by eating a healthy diet and taking plenty of regular exercise. However, avoid low-calorie, rapid-weight-loss diets. Theres evidence they can disrupt your bile chemistry and increase your risk of developing gallstones. A more gradual weight loss plan is recommended. Read more about losing weight and getting started with exercise . Source: NHS 24 - Opens in new browser window Last updated: 13 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. 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Ganglion cyst,"Ganglion cyst | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Muscle, bone and joints Conditions Ganglion cyst Ganglion cyst About ganglion cysts About ganglion cysts Ganglion cysts are soft, gel-like masses that often change size. They tend to be smooth and round, and are: the most common type of swelling in the hand, wrist and foot harmless and can safely be left alone If you have a ganglion, try to stay positive. Theres a lot you can do to help yourself. What causes ganglion cysts? A ganglion cyst starts when the fluid leaks out of a joint or tendon tunnel and forms a swelling beneath the skin. The cause of the leak is generally unknown, but may be due to trauma or underlying arthritis. How common are they? Ganglion cysts are 3 times more common in women than men between 20 and 40 years of age. Types of ganglion cysts Ganglions can form: at the back of the wrist  these typically occur in young adults and often disappears without treatment at the front of the wrist  these may occur in young adults, but also seen in older people with arthritis at the base of the finger (flexor tendon sheath)  these usually occur in young adults on the finger (mucoid cyst)  these usually occur in middle-aged or older people Approximately 80% of ganglions are found in the wrist. Ganglion cyst symptoms If you have a ganglion cyst the swelling can become noticeable, but often there are no symptoms at all. Sometimes a ganglion can cause pain and limit movement in your joint. Some people are also concerned about the cysts appearance. Most symptoms settle with time. How theyre diagnosed To diagnose a ganglion cyst, a healthcare professional will ask you about it and examine your wrist and hand. Giving a diagnosis is usually straightforward. However, scans may be helpful if the diagnosis is uncertain. Treating a ganglion cyst About 50% of ganglions disappear on their own without treatment. In the early stages you should wait to see if this happens. You wont need treatment unless the cyst is painful. Medication Many people take medication to cope with their pain and symptoms, and help them remain active. You may be prescribed pain medication to ease the pain. Make sure you take any medication as prescribed, and get advice from a GP, pharmacist or suitably trained healthcare professional. Surgery If the ganglion hasnt reduced in size after 6 months or is causing significant functional difficulty and/or pain, you may be referred for further help and possible surgery. Surgery is considered if it causes significant pain or restricts movement in your joint. However, theres a chance it will come back even after surgery. Ganglion cyst at the back of the wrist Draining this ganglion can reduce the swelling but it often returns. Problems after surgery include: persistent pain loss of wrist movement painful trapping of nerve branches in the scar Theres a 10% chance of it coming back again after surgery. Ganglion cyst at the front of the wrist Draining this ganglion may be useful, but it can be dangerous as the cyst is often close to the artery at the wrist (where you can feel the pulse). Problems after surgery include: persistent pain loss of wrist movement trapping of nerve branches in the scar For these reasons, many surgeons advise against operating on these cysts. Theres a 30 to 40% chance of it coming back again after surgery. Ganglion cyst at the base of the finger These ganglions feel like a dried pea at the base of the finger, and can cause pain when gripping. Problems after surgery include: persistent pain loss of finger movement painful trapping of nerve branches in the scar Theres a small chance of it coming back again after surgery. Finger ganglion cyst These ganglions are associated with wearing out of the end joint of a finger. Pressure from the cyst may cause a furrow in the fingernail. Occasionally the cyst fluid leaks through the thin overlying skin. Problems after surgery include: infection stiffness and pain from the worn out joint Theres a 10% chance of it coming back again after surgery. Work If you have a ganglion cyst try to stay at or get back to work as soon as possible. You dont need to be fully pain and symptom free to return to work. Research shows the longer youre off work the less likely you are to return. Source: MSK Expert Panel - Opens in new browser window Last updated: 24 February 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. 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Gastroenteritis,"Gastroenteritis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Gastroenteritis Gastroenteritis Gastroenteritis is a very common condition that causes diarrhoea and vomiting. Its usually caused by a bacterial or viral tummy bug. It affects people of all ages, but is particularly common in young children. Most cases in children are caused by a virus called rotavirus. Cases in adults are usually caused by norovirus (the winter vomiting bug) or bacterial food poisoning . Gastroenteritis can be very unpleasant, but it usually clears up by itself within a week. You can normally look after yourself or your child at home until youre feeling better. Try to avoid going to your GP, as gastroenteritis can spread to others very easily. Phone 111 or your GP if youre concerned or need any advice. Symptoms of gastroenteritis The main symptoms of gastroenteritis are: sudden, watery diarrhoea feeling sick vomiting, which can be projectile a mild fever Some people also have other symptoms, such as a loss of appetite, an upset stomach , aching limbs and headaches. The symptoms usually appear up to a day after becoming infected. They typically last less than a week, but can sometimes last longer. What to do if you have gastroenteritis If you experience sudden diarrhoea and vomiting, the best thing to do is stay at home until youre feeling better.Theres not always a specific treatment, so you have to let the illness run its course. You dont usually need to get medical advice, unless your symptoms dont improve or theres a risk of a more serious problem. There are things you can do to help ease your symptoms. Do drink plenty of fluids to avoid dehydration; you need to drink more than usual to replace the fluids lost from vomiting and diarrhoea  water is best, but you could also try fruit juice and soup take paracetamol for any fever or aches and pains get plenty of rest if you feel like eating, try small amounts of plain foods, such as soup, rice, pasta and bread use special rehydration drinks made from sachets bought from pharmacies if you have signs of dehydration, such as a dry mouth or dark urine take anti-vomiting medication (such as metoclopramide) and/or antidiarrhoeal medication (such as loperamide) if you need to  some types are available from pharmacies, but check the leaflet that comes with the medicine; you can also ask your pharmacist or GP for advice about whether theyre suitable Read further information about treating dehydration Gastroenteritis can spread very easily. You should wash your hands regularly while youre ill and stay off work or school until at least 48 hours after your symptoms have cleared, to reduce the risk of passing it on. When to get medical advice You dont normally need to see your GP if you think you have gastroenteritis, as it should get better on its own. Visiting your GP practice can put others at risk, so its best to phone 111 or your GP if youre concerned or feel you need advice. Phone 111 or your GP practice if: you have symptoms of severe dehydration , such as persistent dizziness , only passing small amounts of urine or no urine at all, or if youre losing consciousness you have bloody diarrhoea youre vomiting constantly and are unable to keep down any fluids you have a fever over 38C (100.4F) your symptoms havent started to improve after a few days in the last few weeks youve returned from a part of the world with poor sanitation you have a serious underlying condition, such as kidney disease , inflammatory bowel disease or a weak immune system, and have diarrhoea and vomiting Your GP may suggest sending off a sample of yourpoo to a laboratory to check whats causing your symptoms. Antibiotics may be prescribed if this shows you have a bacterial infection. Looking after a child with gastroenteritis You can look after your child at home if they have diarrhoea and vomiting. Theres not usually any specific treatment and your child should start feeling better in a few days. You dont normally need to get medical advice unless their symptoms dont improve or theres a risk of a more serious problem. There are things you can do to help ease your childssymptoms. Do encourage them to drink plenty of fluids as they need to replace the fluids lost from vomiting and diarrhoea  water is generally best; avoid giving them fizzy drinks or fruit juice, as they can make their diarrhoea worse babies should continue to feed as usual, either with breast milk or other milk feeds make sure they get plenty of rest let your child eat if theyre eating solids and feel hungry  try small amounts of plain foods, such as soup, rice, pasta and bread give them paracetamol if they have an uncomfortable fever or aches and pains  young children may find liquid paracetamol easier to swallow than tablets use special rehydration drinks made from sachets bought from pharmacies if theyre dehydrated  your GP or pharmacist can advise on how much to give your child Dont give your child antidiarrhoeal and anti-vomiting medication, unless advised to by your GP or pharmacist. Make sure you and your child wash your hands regularly while your child is ill. Keep themaway from school or nursery until at least 48 hours after their symptoms have cleared. Getting medical advice for your child You dontusually need to see your GP if you think your child has gastroenteritis, as it should get better on its own, and taking them to a GP practice can put others at risk. Phone 111 or your GP practice if: Youre concerned about your child, or they: have symptoms of dehydration , such as passing less urine than normal, being unusually irritable or unresponsive, pale or mottled skin, or cold hands and feet have blood in their poo or green vomit are vomiting constantly and areunable to keep down any fluids or feeds have had diarrhoea for more than a week have been vomiting for 3 days or more have signs of a more serious illness, such as a high fever (over 38C or 100.4F), shortness of breath, rapid breathing, a stiff neck, a rash that doesnt fade when you roll a glass over it or a bulging fontanelle (the soft spot on a babys head) have a serious underlying condition, such as inflammatory bowel disease or a weak immune system, and have diarrhoea and vomiting Your GP may suggest sending off a sample of your childs poo to a laboratory to confirm whats causing their symptoms. Antibiotics may be prescribed if this shows they have a bacterial infection. How gastroenteritis is spread The bugs that cause gastroenteritis can spread very easily from person to person. You can catchthe infectionif small particles of vomit or poo from an infected person get into your mouth, such as through: close contact with someone withgastroenteritis  they may breathe out small particles of vomit touching contaminated surfaces or objects eating contaminated food this can happen if an infected person doesnt wash their hands before handling food, or you eat food that has been in contact with contaminated surfaces or objects, or hasnt been stored and cooked at the correct temperatures A person withgastroenteritis is most infectious from when their symptoms start until48 hours after all their symptoms have passed, although they may also be infectious for a short time before and after this. Preventing gastroenteritis Its not always possible to avoid gettinggastroenteritis, but following this advice can help stop it spreading. Do stay off work, school or nursery until at least 48 hours after the symptoms have passed  you or your child should also avoid visiting anyone in hospital during this time ensure you and your child wash your hands frequently and thoroughly with soap and water, particularly after using the toilet and before preparing food  dont rely on alcohol hand gels, as theyre not always effective disinfect any surfaces or objects that could be contaminated  its best to use a bleach-based household cleaner wash contaminated items of clothing or bedding separately on a hot wash flush away any poo or vomit in the toilet or potty and clean the surrounding area practice good food hygiene: make sure food is properly refrigerated, always cook your food thoroughly, and never eat food that is past its use-by date Dont do not rely on alcohol hand gels, as theyre not always effective dont share towels, flannels, cutlery or utensils while you or your child is ill Take extra care when travelling to parts of the world with poor sanitation, as you could pick up a stomach bug. For example, you may need to boil tap water before drinking it. Young children can have the rotavirus vaccination when theyre 2to 3months old, which can reduce their risk of developing gastroenteritis. Source: NHS 24 - Opens in new browser window Last updated: 13 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Self-help guide: Diarrhoea Self-help guide: Abdominal pain Dehydration Preparing and cooking food safely Other health sites fitfortravel: Norovirus NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Gastro-oesophageal reflux disease (GORD),"""Gastroesophageal reflux disease | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Gastro-oesophageal reflux disease (GORD) Gastro-oesophageal reflux disease (GORD) About gastro-oesophageal reflux disease (GORD) Symptoms of GORD Causes of GORD Diagnosing GORD Treating GORD Complications of GORD About gastro-oesophageal reflux disease (GORD) Gastro-oesophageal reflux disease (GORD) is a common condition, where acid from the stomach leaks up into the oesophagus (gullet). It usually occurs as a result of the ring of muscle at the bottom of the oesophagus becoming weakened. Read more about the causes of GORD . GORD causes symptoms such as heartburn and an unpleasant taste in the back of the mouth. It may just be an occasionalnuisance for some people, but forothers it can bea severe, lifelongproblem. GORDcan often becontrolled with self-help measures and medication. Occasionally, surgery to correct the problem may be needed. Thistopic focuses on GORD in adults. Symptoms of GORD Symptoms of GORD can include: heartburn (an uncomfortable burning sensation in the chest that often occurs after eating) acid reflux (where stomach acid comes back up into your mouth and causes an unpleasant, sourtaste) oesophagitis(a sore, inflamed oesophagus) bad breath bloating and belching feeling or being sick pain when swallowing and/or difficulty swallowing Read more about the symptoms of GORD . What to do if you have GORD You canoften controlthe symptoms of GORD by making somelifestyle changes andtaking over-the-counter medication. Read treatments for GORD for more information. You dont necessarily need to see your GP if you only have symptoms occasionally. Ask your pharmacist for advice on treatments. When to see your GP Visit your GP if youre worried about your symptoms, or if: you have symptoms several times a week over-the-counter medications arent helping your symptoms are severe you have difficulty swallowing you have possible signs of a more serious problem, such as persistent vomiting,vomiting blood orunexplained weight loss Your GP will usually be able to diagnose GORD based on your symptoms, although theymay refer youfor some tests. Read more about diagnosing GORD . Treatments for GORD The main treatments for GORD are: self-help measures  this includes eating smaller but more frequent meals, avoiding any foods or drinks that trigger your symptoms, raising the head of your bed, and keeping to a healthy weight over-the-counter medicines  ask your pharmacist to recommend anantacidor analginate stronger prescription medicines  includingproton-pump inhibitors (PPIs)and H2-receptor antagonists (H2RAs) You may only need to take medication whenyou experience symptoms, although long-term treatment may be needed if the problem continues. Surgery to stop stomach acid leakinginto your oesophagus may be recommended if medication isnt helping, or you dont want to take medication on a long-term basis. Read more about the treatments for GORD . Complications of GORD If you have GORD for a long time, stomach acid can damage your oesophagus and cause further problems. These include: ulcers(sores)on the oesophagus  thesemay bleed and make swallowing painful the oesophagus becoming scarred and narrowed this can make swallowing difficult and may require an operation to correct it changes in the cells lining the oesophagus (Barretts oesophagus)  very occasionally, oesophageal cancer can develop from these cells, so you may need to be closely monitored Read more about the complications of GORD . Symptoms of GORD The main symptoms of gastro-oesophageal reflux disease (GORD) are heartburn and acid reflux. Heartburn Heartburn is an uncomfortableburning sensation in the chest. Its usually felt just below your breastbone, but can spread up to the throat in some people. Thediscomfort is usually worse after eating, or when bending over or lying down. Acid reflux Acid reflux is where acidand otherstomach contents arebrought back up (regurgitated)into your throat and mouth. It usually causes an unpleasant, sour taste at the back of your mouth. Othersymptoms If you have GORD, you may also experience: a sore, inflamed oesophagus (oesophagitis) bad breath bloating and belching feeling or being sick difficulty swallowing , whichmay feellike a piece of food is stuck low down in your throat pain when swallowing a sore throat and hoarseness a persistent cough or wheezing, which may be worse at night tooth decay and gum disease If you also have asthma , the symptoms may get worse as a result of stomach acid irritating your airways. Causes of GORD Gastro-oesophageal reflux disease (GORD) is usually caused by the ring of muscle at the bottom of the oesophagus (gullet) becoming weakened. Normally, this ring of muscleopens to let food into your stomach and closes tostopstomach acid leaking back up into your oesophagus. But for people with GORD, stomach acid is able to pass back up into the oesophagus. This causes symptoms of GORD , which can include heartburn and acid reflux. Its not always clear what causes thisring of muscleto become weakened, but certain things can increase the risk ofit happening. Whos most at risk of GORD? The following factors mayincrease your risk of developing GORD: being overweight or obese this can place increased pressure on your stomach and weaken themuscles at the bottom of the oesophagus eating large amounts of fatty foods the stomach takes longer toget ridof stomach acid after digesting a fatty meal and the resulting excess acid may leak up into the oesophagus smoking, alcohol, coffee or chocolate  these may relax the muscles at the bottom of the oesophagus pregnancy temporary changes in hormone levelsand increased pressure on your stomach during pregnancy can cause GORD hiatus hernia when part of your stomach pushes up through your diaphragm (thin sheet of muscle between the chest and tummy) gastroparesis when the stomach takes longer toget ridof stomach acid, which meansexcess acid can leak up into the oesophagus certain medicines  some medicines can cause GORD or make the symptoms worse, includingcalcium-channel blockers (used to treat high blood pressure ),nitrates (used to treat angina ) and non-steroidal anti-inflammatory drugs (NSAIDs) stress GORD can sometimes affect several members of the same family and its been suggested that the genes you inherit from your parents may also affect your chances ofdeveloping the condition. Diagnosing GORD Your GP will often be able to diagnosegastro-oesophageal reflux disease (GORD) based on your symptoms. They may prescribe medication to treat it without needing to carry out any tests. Read more about treating GORD . When tests may be needed Youll usually only need to bereferred for tests in hospital if: your GP is unsure whether you have GORD your symptoms are persistent, severe or unusual prescription medications arent controlling your symptoms your GP thinks you might benefit from surgery you have signs of a potentially more severe condition, such as difficulty swallowing orunexplained weight loss Tests can help to confirm the diagnosis of GORD, check for other possible causes of your symptoms and determine whether you may be suitable for surgery. Tests for GORD Tests you may have include: anendoscopy abarium swallow or barium meal test manometry 24-hour pH monitoring blood tests Endoscopy Anendoscopy is a procedure where the inside of your body is examined using an endoscope, which is a long, thin, flexible tube witha light and camera at one end. The endoscope will be gently inserted into your mouth and down your throat. The procedure is usually carried out while youre awake, but you may be given a sedative to help you relax. The camera can showif the surface of your oesophagus (gullet) has been damaged by stomach acid, although this doesnt happen to everyone with GORD. Barium swallow or barium meal A barium swallow, or barium meal, is a test to assess your swallowing ability and look for any blockages or abnormalities in your oesophagus. You are first given some barium solution, then some X-rays are taken.Barium is a harmless substance that shows up clearly on X-rays as it passes through your digestive system. Youll be asked not toeat anything for a few hours before the procedure. Afterwards, youll be able to eat and drink normally, although you may need to drink more water to help flush the barium out of your body. Manometry Manometry is used to assess how well the ring of muscle at the end of your oesophagus is working, by measuring the pressure in your oesophagus. This can rule out other possible causes of your symptoms andcan help determine whether surgery would be suitable. During the procedure,a small tube will be passed up your nose and then down into your oesophagus. The tube contains pressure sensors that can detect the pressure in the oesophagus. 24-hour pH monitoring It may be necessary to measure the acidity level (pH) in your oesophagus to confirm a diagnosis of GORD if nothing is found during an endoscopy. The acidity level is measured over 24 hours, using a thin tube containing a sensor thats passed up your nose and down your oesophagus. This is usually connected to a recording device worn on your waist. Youll be asked to press a button on the recorder every time you become aware of your symptoms and to record your symptoms in a diary. You should eat as you normally would during the test to ensure an accurate result. Blood tests Sometimes a blood test may be carried out to check for anaemia , which can be a sign of internal bleeding. Treating GORD Heartburn and gastro-oesophageal reflux disease (GORD) can often be treated with self-help measures and over-the-counter medicines. If these dont help, your GP can prescribe stronger medication or refer you to a specialist to discuss whether surgery may be an option. Self-help You may find the following measures can help reduce heartburn and other symptoms of GORD: eat smaller and more frequent meals, rather than 3large meals a day dont eat or drink alcohol within 3or 4hours before going to bed, and avoid having your largest meal of the day in the evening avoid anything you think triggers your symptoms  common triggers includecoffee, chocolate, tomatoes, alcohol,and fatty or spicy food dont wear tight clothing  clothes that are tight around your tummy may make your symptoms worse raise the head of your bedbyup to 20cm (8 inches)  placing a piece of wood or blocks underneath one end of your bedmay reduce symptoms at night; dont just use extra pillows, as this can put a strain on your tummy tryto relax  stress can make heartburn and GORD worse, so learning relaxation techniques may help if youre often feeling stressed maintain a healthy weight  if youre overweight, losing weight mayhelpreduce your symptoms stop smoking  smoke can irritate your digestive system andmay makeyour symptoms worse If youre taking medication for other health conditions, check with your GP to find out whether they could be contributing to your symptoms. Differentmedicines may be available, but dont stop taking any prescribed medication without consulting your GP first. Medication A number of different medications can be used to treat symptoms of GORD. Over-the-counter medicines Over-the-counter heartburn and GORD medicines are available from pharmacies without a prescription. The main types are: antacids theseneutralise the effects of stomach acid alginates theseproduce a coating that protects the stomach and oesophagus (gullet) from stomach acid low-dose proton-pump inhibitors andH2-receptor antagonists see below for more information about these These medicines arent suitable for everyone, so you should check the leaflet first. Ask a pharmacist for advice if youre not sure. Proton-pump inhibitors (PPIs) If your symptoms dont get better despite trying self-help measures and over-the-counter medicines, your GP may prescribe a PPI. These work by reducing the amount of acidproduced by your stomach. Youll usually be given enough medication to last a month. Go back to your GP if they donthelp or your symptoms return after treatment finishes.Some people need to takePPIs on a long-term basis. The possible side effects of PPIs are usually mild. They include headaches, diarrhoea or constipation , feeling sick, abdominal pain , dizzinessand a rash. Your GP will prescribe the lowest dose that they think will control your symptoms to reduce the risk of side effects. H2-receptor antagonists (H2RAs) If PPIs dont control your symptoms, a medicine known as a H2RA may be recommended for you to take alongside them on a short-term basis, or as an alternative. Like PPIs, H2RAs reduce the amount of acid produced byyour stomach. Side effects of H2RAs are uncommon, but caninclude diarrhoea, headaches, dizziness, arash and tiredness. Surgery and procedures Surgery may be an option if: the above treatments dont help,arent suitable for you, orcause troublesome side effects you dont want to take medication on a long-term basis The main procedure used is calleda laparoscopic Nissen fundoplication (LNF).Alternativetechniques have been developed more recently,although these arent yet widely available. Laparoscopic Nissen fundoplication (LNF) LNF is a type of laparoscopic or keyhole surgery. This means its carried out using special surgical instruments inserted through small cuts (incisions) in the skin. The procedure is used to tighten the ring of muscle at the bottom of the oesophagus,which helps to stop acid leaking up from the stomach. Its carried out in hospital under general anaesthetic . Most people need to stay in hospital for 2or 3days after the procedure. Depending on your job, you may be able to return to work within 3to 6weeks. For the first 6weeks after surgery, you should only eat soft food, such as mince, mashed potatoes or soup. Some people experience problems with swallowing, belching and bloating after LNF,but these should get better with time. Newer operations and procedures In the last few years, several new techniques for treating GORD have been developed. The National Institute for Health and Care Excellence (NICE) says these procedures appear to be safe, butnot muchis known about their long-term effects. These techniques include: Endoscopic injection of bulking agents where special filler is injected into the area between the stomach and oesophagus to makeit narrower. Endoluminal gastroplication where folds are sown into the ring of muscles at the bottom of the oesophagus to restrict how far it can open. Endoscopic augmentation with hydrogel implants where implants containingspecialgelare placedinto the area between the stomach and oesophagus to make it narrower. Endoscopic radiofrequency ablation where a tiny balloon is passed down to the bottom ofthe oesophagus and electrodes attached to it are used to heat it and make it narrower. Laparoscopic insertion of a magnetic bead band (LINX) where a ring of magnetic beads are implanted around the lower part of the oesophagus to strengthen it and help keep it closed when not swallowing. Speak to your surgeon about these techniques for more information. Complications of GORD A number of possible complications can occur as a result of having gastro-oesophageal reflux disease (GORD) for a long time. Oesophageal ulcers Thestomach acid that leaks into the oesophagus in people with GORD can damage the lining ofthe oesophagus (oesophagitis), which can cause ulcers to form. These ulcers can bleed, causing pain and making it difficult to swallow. Medications used to treat GORD, such as proton pump inhibitors (PPIs), can help ulcers heal by reducing the amount of acid that leaks into the oesophagus. Read more about treatments for GORD . Scarred and narrow oesophagus Repeated damage to the oesophagus by stomach acid can also cause it to become scarred and narrowed. This is known as oesophageal stricture and itcan make swallowing difficult and painful. If this happens,a procedure to widen the oesophagus using a small balloon or other widening device may be recommended. Barretts oesophagus Repeated episodes of GORD can sometimes lead to changes in the cells in thelining of your lower oesophagus. This is known as Barretts oesophagus. Its estimated that about 1 in every 10 people with GORD will develop Barretts oesophagus, usuallyafter many years. Barretts oesophagus doesnt usually cause noticeable symptoms other than those caused by GORD. However, theres a small risk that the changed cells could become cancerous in the future (see below). Your doctor may suggest having an endoscopyevery few years to check for this. Oesophageal cancer Its estimated that 1 in every 10 to 20 people withBarretts oesophagus will develop oesophageal cancer within 10 to 20 years. Symptoms of oesophageal cancer include: difficulty swallowing unexplained weight loss persistent indigestion hoarseness a persistent cough and/orcoughing blood vomiting Speak to your doctorif you experience any swallowing difficulties, or any other unusual or persistent symptoms. Surgery to remove the cancer can be carried out if itsdiagnosed at an early stage. Read more about treatments for oesophageal cancer . Source: NHS 24 - Opens in new browser window Last updated: 13 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Hiatus hernia Indigestion Other health sites Macmillan Cancer Support: Barrett's oesophagus NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Genital herpes,"Genital herpes | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Sexual and reproductive Genital herpes Genital herpes Genital herpes is a sexually transmitted infection (STI) caused by a virus called herpes simplex virus (HSV). There are 2 different types of the virus. Both of which affect the genitals. Genital herpes causes painful blisters and sores on and around the genitals. It can also sometimes cause problems if you have it for the first time during pregnancy. Symptoms of genital herpes Most people with the herpes virus dont notice any symptoms and dont know they have it. So its important to get tested if you think youre infected. If you do get symptoms, it takes usually 2 to 12 days after contact for them to appear. Some people dont get symptoms until months or sometimes years later. Once you have the herpes infection, the virus stays in your body. It can lie dormant for long periods but can reactivate in the area that was originally infected. If this happens, the sores and blisters can reappear. This is known as a recurrent episode of genital herpes. This first episode of genital herpes may last from 2 to 4 weeks. Repeated episodes are not usually as severe, or long, as the first and you may never have a repeat episode. Symptoms of the first infection include: spots or red bumps around the genital area pain inside the vagina, head of penis or anus vaginal discharge pain peeing or being unable to pee fever flu-like symptoms, backache, headache and a temperature mild swelling of the lymph glands in the groin, armpits and neck If you have a recurrent infection, your symptoms may include: a tingling or burning sensation before blisters appear painful red blisters, which soon burst to leave ulcers pain inside the vagina, head of penis or anus When to get medical advice Speak to your GP practice or midwife if: youre pregnant and think you have genital herpes Testing for genital herpes If you think you might have genital herpes, get tested for free by: contacting your GP practice for an appointment booking an appointment at your local sexual health service Your doctor or nurse may be able to diagnose by looking at symptoms such as blisters, sores and ulcers. If you have visible blisters, your doctor or nurse may take a swab for testing. This is to check if its herpes and what type. The swab can also test for another STI which causes blisters called syphilis . The genital herpes swab tests are very reliable, though if the ulcer is too dry then it may be less likely to find a positive result. Treatment for genital herpes Genital herpes can be treated with antiviral medication. The symptoms of genital herpes can be treated, although it could keep coming back. Symptoms of recurrent genital herpes will usually clear up without any treatment. Some people experience recurrences of genital herpes. In these cases, a longer course of tablets should stop any recurrent episodes. You can talk to your GP or nurse about which treatment options are right for you. As theres no screening test for herpes, partners should only have a test if they also have symptoms. How genital herpes are passed on You can get genital herpes: from skin to skin contact with the infected area (including vaginal, anal and oral sex) when there are no visible sores or blisters if a cold sore touches your genitals or face kissing (if the person has a cold sore on their face) by sharing sex toys with someone who has herpes Sometimes herpes can be passed on when your sexual partner has no visible sores or symptoms. This is because the virus can become active on the skin without causing any visible blisters or sores. This is sometimes called asymptomatic shedding. This risk goes down during the first months after you catch herpes and is not likely after two years. However, it is more common when people are still having frequent recurrences. Very rarely, herpes is passed to a newborn baby during childbirth. This is only likely to happen if a mother has her first episode of herpes after week 26 of the pregnancy. When women have had herpes longer than three months, normal delivery is expected even if there are symptoms at the time of delivery. How to prevent genital herpes The best way to reduce your risk of STIs is to practice safer sex . This means using a condom for vaginal, anal and oral sex. If your partner has herpes, avoiding sex when they have visible sores reduces your risk of getting herpes. Other STIs If youve been diagnosed with herpes its recommended that you are tested for all STIs including: chlamydia gonorrhoea syphilis HIV This is even more important if you have recurrent episodes. Find your local sexual health clinic Source: Scottish Government - Opens in new browser window Last updated: 26 February 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Genital symptoms,"Managing genital symptoms | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Sexual and reproductive Managing genital symptoms Managing genital symptoms Not all symptoms that you may experience around your genitals are caused by a sexually transmitted infection (STI). Symptoms can be caused by a variety of natural changes in your body as well as infections that are not sexually transmitted. Phone 111 if you: Become very ill and have: severe pain a high temperature nausea and/or vomiting Symptoms to discuss with sexual health services Ulcers on the genitals Single ulcers (sores) could be a sign of a recent infection of syphilis , especially if there is no pain. Painful ulcers may be due to herpes, other infections or recent trauma. It can help to take a photo of your ulcer so you can show the sexual health clinician at your appointment. If you think you have mpox (monkeypox) or youve come into contact in the last 21 days with someone who has mpox, you should phone your local service before you attend in person. Pelvic pain There are many causes of pain in the lower tummy. For example issues of the bowel or urinary tract and many gynaecological conditions. Some STIs such as gonorrhoea , or chlamydia , can very occasionally spread up into the womb and cause pelvic pain and/or deep pain during sex. If you have pain like this and think you have been at risk of an STI then you should contact your local service . If there is any possibility that you could be pregnant, take a pregnancy test. Discharge from the end of the penis Whether you have discomfort peeing or not, discharge from the end of the penis could mean that you have an STI such as chlamydia or gonorrhoea . Book a consultation online or contact your local sexual health service for advice. Pain, swelling or inflammation around the testicles Gonorrhoea and chlamydia usually affect just the urinary tract. But sometimes infection can spread to the testicle and/or the epididymis (the small tube part next to the testicle). This will cause painful swelling for which you should get treatment urgently. Book a consultation online or phone for advice\u200b\u200b. Multiple painful genital ulcers Having multiple genital ulcers could indicate genital herpes which is the same virus that causes cold sores. Herpes is an extremely common virus. It sometimes causes symptoms which are mostly self-limiting. This means your immune system will deal with this itself, but it can take a few days for symptoms to settle. Sometimes the ulcers are itchy before they become sore. There may be pain when peeing because this stings the ulcers. Milder cases can be diagnosed and treated by your GP. If youre worried about your symptoms, you could also contact your local sexual health service for advice. Further information about herpes simplex viruses Symptoms that arent usually a sign of anything serious Spots or lumps on the genitals Sometimes hair follicles (the tiny pockets from where each hair grows) around the genitals or groin area can become inflamed. This is called folliculitis. It may be more common if you shave the area. At first it may look like a small pimple. It may be itchy, and sore but in most cases it will resolve on its own. If you have any concerns contact your local sexual health service . Another common cause of new spots or lumps on your genitals is warts. Another possible cause is molluscum. Sometimes, teenagers notice lumps that are completely normal. If you think that the lumps you have noticed are likely to be genital warts they might clear up ontheir own. One third of warts disappear within 6 months. Your GP practice may be able to prescribe treatment for you or refer you to a sexual health clinic if treatment doesnt work. Sexual health services available may vary across Scotland. Itching Genital skin can be sensitive. Itching is often a sign that youre doing something, or using a product, thats irritating the skin. If itching is your only symptom, it isnt often related to an STI. Itching around or inside the vagina is often due to thrush . You can get treatment over the counter at your local pharmacy . Change in vaginal bleeding pattern If youve changed your method of contraception , then you might notice a change in your bleeding pattern. This should settle but if you have any concerns, talk to your contraception provider. Chlamydia can sometimes cause bleeding after sex or between periods. If you have had unprotected sex with a new sexual partner and notice this type of bleeding, then get tested for STIs . Change in vaginal discharge Read about what to do if you have a change in your vaginal discharge Genital washing advice Do use a soap substitute (emollient) to add moisture instead of soap  these are available from pharmacies use non-soap bath additives such as unfragranced bath oil instead of bubble bath treat athletes foot straight away to prevent it spreading to your genital area when you pull your underwear on if you have a penis with a foreskin, always remember to pull back the foreskin gently but fully when washing and dry gently with a towel before replacing the foreskin Dont do not use soap on or near your genital area, it can be drying do not let products like shampoo or conditioner run onto your genital skin do not use bubble baths, essential oils or soap or shower gels in the bath as theyll get onto the genital skin and may cause irritation do not use wet wipes on the genital skin do not use feminine washing products  even if they say they are pH balanced as they disrupt healthy bacteria in the vagina do not douche (wash out the vagina with water or other products) as it damages the healthy vaginal organisms and changes their natural balance do not use fabric softeners Source: Scottish Government - Opens in new browser window Last updated: 27 February 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Book a sexual health appointment online Find your nearest sexual health service Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Genital warts,"Genital warts | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Sexual and reproductive Genital warts Genital warts Genital warts are a common sexually transmitted infection (STI). They are caused by a virus called Human Papilloma Virus (HPV). Symptoms of genital warts It can take a few weeks or months for genital warts to appear after becoming infected. Genital warts are usually small, rough lumps on the skin. They can appear: around the vagina and on the penis around the anus on the skin between the genitals and the anus Genital warts may: appear on their own or in a group (groups of warts can look like a cauliflower) feel soft or firm be white, red, skin-coloured, or darker than the surrounding skin They dont usually cause symptoms but can sometimes be painful, itchy or bleed. When to get medical advice Speak to your GP practice or local sexual health clinic if you have: 1 or more painless lumps or growths around your vagina, penis or anus itching or bleeding from your genitals or anus a sexual partner (s) who has genital warts Testing for genital warts The test for genital warts involves an examination of the genital area. If you think you might have genital warts, get checked for free by: contacting your GP practice for an appointment booking an appointment at your local sexual health service Warts must be diagnosed by a doctor or nurse. Treatment for genital warts Treatment for genital warts is not always needed. They sometimes disappear on their own within 6 months. If treatment is recommended, itll be prescribed by your doctor. Your doctor or nurse may advise you to avoid sex while youre having treatment for genital warts. The type of treatment youll be offered depends on what your warts are like. Your doctor or nurse will discuss this with you. Treatment options include: cream or liquid freezing surgery Cream or liquid You can usually apply this to the warts yourself a few times a week for several weeks. Freezing A doctor or nurse freezes the warts with liquid nitrogen, usually every week for 4 weeks. Surgery A doctor or nurse can cut or burn the warts off. This is usually only recommended if the warts are not responding or are too large for cream or freezing. Side effects of these treatments include: bleeding wound infection scarring Genital warts and pregnancy Genital warts are not usually harmful during pregnancy. During pregnancy, genital warts may: multiply and get bigger (they may be removed if theyre very big) become more easily irritated be passed on to the baby during childbirth, but this is very rare (the HPV virus can cause infection in the babys throat or genitals) Most creams, liquids and ointments used to treat genital warts are not recommended during pregnancy. Freezing can be used but its often not very successful. Genital warts usually disappear on their own within 6 weeks after childbirth. How genital warts are passed on You can get genital warts from skin to skin contact. Other ways of getting genital warts include: unprotected vaginal, anal, or oral sex (sex without a condom) sharing sex toys with an infected person How to prevent genital warts The best way to reduce your risk of STIs is to practice safer sex . This means using a condom for vaginal, anal, and oral sex, and when sharing sex toys. You can get warts even if you use condoms, as a condom does not cover the whole genital area. The HPV vaccination will reduce your risk of getting HPV virus which causes warts. However, it doesnt treat warts once you have them. HPV and cancer Genital warts are not cancer and dont cause cancer. Theyre caused by a different strain of HPV. HPV vaccination is offered to every person aged 11 to 13. The vaccine can protect against cervical cancer also protects against genital warts. The HPV vaccine is also offered to men who have sex with men (MSM) and trans people aged up to 45 years . If you didnt have the vaccine at school and dont fulfill the above criteria, you can pay for the vaccine privately. Other STIs If youve been diagnosed with genital warts its recommended that youre tested for all STIs including: chlamydia gonorrhoea syphilis HIV Source: Scottish Government - Opens in new browser window Last updated: 06 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Find your local sexual health clinic Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Germ cell tumours,"""Germ cell tumours | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in children Germ cell tumours Germ cell tumours Most children who develop germ cell tumours will be cured. More children than ever are surviving childhood cancer. There are new and better drugs and treatments, and we can now also work to reduce the after-effects of having had cancer in the past. Its devastating to hear that your child has cancer. At times it can feel overwhelming but there are many healthcare professionals and support organisations to help you through this difficult time. Understanding more about the cancer your child has and the treatments that may be used can often help parents to cope. Your childs specialist will give you more detailed information, and if you have any questions, its important to ask the specialist doctor or nurse who knows your childs individual situation. Germ cell tumours can appear at any age. They develop from cells that produce eggs or sperm so germ cell tumours can affect the ovaries or testes. However, its possible for a germ cell tumour to develop in other parts of the body. As a baby develops during pregnancy, the cells producing eggs or sperm normally move to the ovaries or testes. However, occasionally they can settle in other parts of the body where they can develop into tumours. The most common places for this to happen are the bottom of the spine (sacrococcygeal), the brain, chest, and abdomen. Germ cell tumours are sometimes given different names based on their characteristics. These include yolk-sac tumours, germinomas, embryonal carcinomas, mature teratomas and immature teratomas. They may be non-cancerous (benign) or cancerous (malignant). Malignant tumours have the ability to grow and spread to other parts of the body. Benign tumours do not spread but may cause problems by pressing on nearby tissue and organs. Immature teratomas fall between benign and malignant. They can spread within the abdomen but not beyond, and can be removed with an operation. Causes The cause of germ cell tumours is unknown but research into the causes of different cancers is ongoing. Signs and symptoms The symptoms depend on where the tumour develops. Usually it starts with a lump that can either be felt or causes other symptoms. How germ cell tumours are diagnosed Different tests may be needed to diagnose a germ cell tumour. Usually, the doctor will remove a sample of tissue from the lump (a biopsy ) for examination under a microscope to find out if it is a cancer or not. CT or MRI scans may be used to see the exact position of a tumour within the body. Chest X-rays may be taken to see if theres a tumour in the lungs. Germ cell tumours often produce proteins called tumour markers that can be measured in the blood. The ones that are produced by germ cell tumours are alpha-fetoprotein (AFP) and human chorionic gonadotrophin (HCG). Your child will have blood tests to check these tumour markers when they are being diagnosed. The doctors will continue to check these during treatment and after treatment is over. Sometimes a germ cell tumour can be diagnosed with a tumour marker and scan results so that a biopsy isnt necessary. This is particularly so if surgery is not needed for treatment, for example if the tumour is in the brain. Staging The stage of a cancer describes its size and whether it has spread from where it started. Knowing the stage helps doctors to decide on the most appropriate treatment. Generally cancer is divided into 4 stages: stage 1 the cancer is small, has not spread and has been completely removed stages 2 and 3 the cancer is larger and may not have been completely removed, or may have spread to nearby organs stage 4  the cancer has spread to other parts of the body Cancer that has spread to distant parts of the body and formed new tumours is known as secondary or metastatic cancer. Treatment The treatment your child will have usually depends on a number of factors, including the size, position and stage of the tumour. It usually includes either surgery or chemotherapy, or a combination. A benign tumour can be cured if it is removed by surgery. It may mean removing a testicle or an ovary if this is where the tumour started. If the tumour is malignant and can be completely removed with surgery, chemotherapy is not always needed, especially if it began in the testis or ovary. If the tumour cannot be removed easily or has spread, your child will be given chemotherapy. Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. Germ cell tumours are very sensitive to chemotherapy. Its usually given as injections and drips (infusions) into a vein. A combination of drugs is usually given every 3 weeks for 3 or 5 months. The length of time chemotherapy is given for depends on the position of the tumour, the level of AFP, and whether or not the tumour has spread. Treatment of malignant germ cell tumours in the brain is a little different. Although they are very sensitive to chemotherapy, treatment with radiotherapy is also needed. Radiotherapy is the use of high-energy rays to destroy cancer cells. Unlike germ cell tumours elsewhere in the body, its not always necessary to remove germ cell tumours in the brain with surgery. Side effects of treatment Treatment often causes side effects, and your childs doctor will discuss these with you before treatment starts. The operation your child has will be individually planned to try to reduce any possible problems. The surgeon and specialist nurse will discuss this with you. The side effects of chemotherapy usually gradually improve when treatment is over and many of them can be well controlled. The side effects of treatment depend on the drugs used but can include: feeling sick (nausea) and being sick (vomiting) hair loss increased risk of infection bruising and bleeding tiredness diarrhoea Late side effects A small number of children may develop long-term side effects of treatment, sometimes many years later. These are not common but may include problems with how the kidneys or lungs work and some hearing loss. Your childs specialist doctor or nurse will tell you more about any possible late side effects. If your child has only one ovary or testis removed, theyll usually still be able to have children in the future. Clinical trials Many children have their treatment as part of a clinical research trial. Trials aim to improve our understanding of the best way to treat an illness, usually by comparing the standard treatment with a new or modified version. Specialist doctors carry out trials for childrens cancers. If appropriate, your childs medical team will talk to you about taking part in a clinical trial and will answer any questions you have. Written information is often provided to help explain things. Taking part in a research trial is completely voluntary, and youll be given plenty of time to decide if its right for your child. Treatment guidelines Sometimes, clinical trials are not available for your childs tumour. This may be because a recent trial has just finished, or because the tumour is very rare. In these cases, you can expect your doctors and nurses to offer treatment which is agreed to be the most appropriate, using guidelines which have been prepared by experts across the country. The Childrens Cancer and Leukaemia Group (CCLG) is an important organisation which helps to produce these guidelines. Follow-up care Your child will continue to have regular blood tests during and after treatment, to check their levels of AFP and HCG. If the levels rise, this indicates that the tumour might have come back and further treatment is needed. If you have specific concerns about your childs condition and treatment, its best to discuss them with your childs doctor, who knows the situation in detail. Your feelings As a parent, the fact that your child has cancer is one of the worst situations you can be faced with. You may have many emotions, such as fear, guilt, sadness, anger and uncertainty. These are all normal reactions and are part of the process that many parents go through at such a difficult time. Its not possible to address here all of the feelings you may have. However, the CCLG booklet Children & Young Peoples Cancer; A Parents Guide talks about the emotional impact of caring for a child with cancer and suggests sources of help and support. Your child may have a variety of powerful emotions throughout their experience with cancer. The Parents Guide discusses these further and talks about how you can support support your child. Source: Children's Cancer and Leukaemia Group - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Glandular fever,"Glandular fever | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Glandular fever Glandular fever About glandular fever Symptoms of glandular fever Causes of glandular fever Treating glandular fever Complications of glandular fever About glandular fever Glandular fever is a type of viral infection that mostly affects young adults. Its also known asinfectious mononucleosis, or mono. Common symptoms include: a high temperature (fever) a severely sore throat swollen glands in the neck fatigue (extreme tiredness) While the symptoms of glandular fever can be very unpleasant, most of them should pass within 2 to 3 weeks. Fatigue, however, can occasionally last several months. Read moreabout the symptoms of glandular fever . When to seek medical advice You should contact your GP if you suspect that you or your child has glandular fever. While there is little your GP can do in terms of treatment, they can provide advice and support to help you control your symptoms and reduce the risk of passing the infection on to others. You should go to your local accident and emergency (A&E) department or phone 999 for an ambulance if you have glandular fever and you: develop a rasping breath (stridor) or have any breathing difficulties find swallowing fluids difficult develop intense abdominal pain These symptoms can be a sign of a complication of glandular fever that may need to be treated in hospital. Fever in adults self-help guide Complete this guide to assess your symptoms and find out if you should visit A&E, your GP, pharmacist or treat your condition at home. Self-help guide: Fever in adults What causes glandular fever? Glandular fever is caused by the Epstein-Barr virus (EBV). This virus is found in the saliva of infected people and can be spread through: kissing glandular fever is often referred to as the kissing disease exposure to coughs and sneezes sharing eating and drinking utensils, such as cups, glasses and unwashed cutlery EBV may be found in the saliva of someone who has had glandular fever for several months after their symptoms pass, and some people maycontinue to have the virus in their saliva on and off for years. If you have EBV, its a good idea to take steps to avoid infecting otherswhile you are ill,such as not kissing other people, but theres no needno need toavoid all contact with othersas the chances of passing on the infection are generally low. Read more about the causes of glandular fever . Who is affected? Glandular fever can affect people of all ages, but most cases affect teenagers and young adults. Most EBV infections are thought to occur during childhood and cause onlymild symptoms, or no symptoms at all. However, if a person develops an EBV infection during early adulthood, they can develop glandular fever. Once you have had glandular fever, its unlikely you will develop it again. This is because people develop lifelong immunity after the initial infection. How glandular fever is diagnosed Todiagnose glandular fever, your GP will first askabout your symptoms before carrying out a physical examination. Theyll look for signs of glandular fever, such as swollen glands, tonsils, liver and spleen. Your GP may also recommend a blood test to help confirm the diagnosis and rule out infections that can cause similar symptoms, such as cytomegalovirus (CMV), rubella, mumpsand toxoplasmosis. How glandular fever is treated There is no cure for glandular fever. But there are simple treatments and measures that can help reduce the symptoms while you wait for your body tocontrol the infection. These include: drinking plenty of fluids taking over-the-counter painkillers, such as paracetamol or ibuprofen getting plenty of rest andgradually increasing your activity as your energy levels improve Occasionally, antibiotics or corticosteroids may be used if you develop complications of glandular fever. Some people with particularly severe symptoms may need to be looked after in hospital for a few days. Read more about treating glandular fever . Possible complications Complications associated with glandular fever are uncommon, but when they do occur they can be serious. They can include: further infections of other areas of the body, including the brain, liverand lungs severe anaemia (a lack of oxygen-carrying red blood cells) breathing difficulties as a result of the tonsils becomingsignificantly swollen a ruptured (burst) spleen, which may need to be treated with surgery Read more about the complications of glandular fever . Symptoms of glandular fever Symptoms of glandular fever are thought to take around 1 to 2 months to develop after infection with the Epstein-Barr virus (EBV). Main symptoms Themost commonsymptoms of the condition are: a high temperature (fever) a sore throat this is usually more painful than any you may have had before swollen glands in your neck and possibly in other parts of your body, such as under your armpits fatigue (extreme tiredness) Other symptoms Glandular fever can also cause: a general sense of feeling unwell aching muscles chills sweats loss of appetite pain around or behind your eyes swollen tonsils and adenoids (small lumps of tissue at the back of the nose), which may affect your breathing the inside of your throat to become very red and ooze fluid small red or purple spots on the roof of your mouth a rash swelling or puffiness around your eyes a tender or swollen tummy jaundice(yellowing of the skin and whites of the eyes) Some of these symptoms may develop a few days before the main symptomsmentioned above. How the condition progresses Most symptoms of glandular fever willusually resolve within 2 or 3 weeks.Your throat will normally feel mostsorefor 3 to 5 days after symptoms start before gradually improving, and your fever will usually last 10 to 14 days. Fatigue is the most persistent symptom andoften lasts a few weeks, although some people may feel persistently fatigued for several months after the other symptoms have passed. When to seek medical advice You should contact your GP if you suspect that you or your child has glandular fever. While there is little your GP can do in terms of treatment other than provide advice and support, blood tests may be needed to rule out less common but more serious causes of your symptoms, such as hepatitis(a viral infection that affects the liver). You should go to your local accident and emergency (A&E) departmentor phone 999 for an ambulanceif you have glandular fever and you: develop a rasping breath (stridor) or have any breathing difficulties find swallowing fluids difficult developintense abdominal pain If you have these symptoms, you may need to be looked after in hospital for a few days. Read more about treating glandular fever . Causes of glandular fever Glandular fever is caused by the Epstein-Barr virus (EBV). EBV is most often spread through the saliva of someone who carries the infection. For example, it can be spread through: kissing glandular fever is sometimes referred to as the kissing disease sharing food and drinks sharing toothbrushes exposure to coughs and sneezes Small children may be infected by chewing toys that have been contaminated with the virus. When you come into contact with infected saliva, the virus can infect the cells on the lining of your throat. The infection is then passed into your white blood cells before spreading through the lymphatic system. This is a series of glands (nodes) found throughout your body that allows many of the cells that your immune system needs to travel around the body. After the infection has passed, people develop lifelong immunity to the virus and most wont develop symptoms again. Many people are first exposed to EBV during childhood, when the infection causes few symptoms and often goes unrecognised before it eventually passes. Young adults may be most at risk of glandular fever because they might not have been exposed to the virus when they were younger, and the infection tends to produce more severe symptoms when youre older. EBV carriers Not everyone who can pass on EBV will have symptoms themselves. These are known as asymptomatic carriers. Some people can have the virus in their saliva for a few months after recovering from glandular fever, and may continue to have the virus in their saliva on and off for years. This is because the virus remains inactive in the body for the rest of your life after you have been exposed to it. For most people, the inactive virus wont cause any symptoms. However, there is a chance of the virus periodically becoming reactivated, which may mean it re-enters the saliva. This reactivation may be without any symptoms, or itmay cause symptoms to recur for a short time. Treating glandular fever There is currently no cure for glandular fever, but the symptoms should pass within a few weeks. There are things you can do to help control your symptoms. Fluids Drink plenty of fluids(preferably water or unsweetened fruit juice) to avoid dehydration . Avoid alcohol, as this couldharm your liver, which may already be weakened from the infection. Painkillers Painkillers available over the counter, such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen , can help reduce pain and fever. Children under 16 years old should not take aspirin because there is a small riskit could trigger a rare but serious health condition calledReyes syndrome. Regularly gargling with a solution of warm, salty water may also help relieve your sore throat . Rest Take plenty of rest while you recover from glandular fever. Complete bed rest is no longer recommended because itmay make the fatigue last longer. You should gradually increase your activities as your energy levels return, but avoid activities you cannot manage comfortably. For the first month after your symptoms begin, avoid contact sports or activities that put you at risk of falling. This is because you may have a swollen spleen thatits more vulnerable to damage, and a sudden knock could cause it to burst (rupture). Preventing the spread of infection There is no need to be isolated from others if you have glandular feveras most people will already be immune to the Epstein-Barr virus (EBV). You can return to work, college or school as soon as you feel well enough. Theres little risk of spreading the infection to others as long as you follow commonsense precautions while you are ill, such as not kissing other people or sharing utensils. Its also important tothoroughly clean anything that may have been contaminated by saliva until you have recovered. Antibiotics and steroids Antibiotics are not effective in treating glandular fever because they have no effect on viruses,but theymay be prescribed if you also develop a bacterial infection ofyour throat or lungs (pneumonia) . A short course of corticosteroids may also be helpful if: your tonsils are particularly swollenandare causing breathing difficulties you have severe anaemia (a lack of oxygen-carrying red blood cells) you haveproblems affecting your heart, such as pericarditis (inflammation of the sac that surrounds the heart) you haveproblems affecting your brain or nerves, such as encephalitis Read more aboutthe complications of glandular fever . Hospital treatment Most people are able to recover from glandular feverat home, but hospital treatment may be necessary for a few days if you or your child: develop a rasping breath (stridor) or have any breathing difficulties find swallowing fluids difficult develop intense abdominal pain Treatment in hospital may involve receiving fluids or antibiotics directly into a vein (intravenously), corticosteroid injections and pain relief. Ina small number ofcases, emergency surgery to removethe spleen (splenectomy) may be needed if it ruptures. Complications of glandular fever Most people with glandular fever will recover in 2 or 3 weeks and wont experience any further problems. However, complications can develop in a few cases. Prolonged fatigue More than1 in every 10 people with glandular fever will experience prolonged fatigue, which lasts for 6 months or more after the initial infection. Its not known why fatigue lasts longer in some people. Some experts think it may be a form of chronic fatigue syndrome (CFS) . This is a poorly understood condition that causes persistent fatigue and a range of other symptoms, such as headaches and joint pain. Adopting a gradual exercise plan to rebuild your strength and energy levels may helpprevent and reduce prolonged fatigue. Reduction inblood cells In a few cases, glandular fever can lead to a reduction in some blood cells. It can reduce levels of: red blood cells (anaemia)this can make you feel tired and out of breath white blood cells (neutropenia)this can make you more prone to developing a secondary infection platelets  this can make you bruise and bleed more easily In most cases, the reduction in thenumber of blood cells is small and only causes mild symptoms. These problems should get better by themselves within a few weeks or months. Ruptured spleen Around half of people who develop glandular fever will have a swollen spleen. This does not present any immediate health problems, butthere is a small risk of it rupturing (bursting). The main sign of a ruptured spleen issharp pain in the left of the tummy (abdomen). Go toyour local accident and emergency (A&E) department or phone 999 for an ambulance if you have glandular fever and you develop intense abdominal pain. The risk of the spleen rupturing is small, occurring in just1 in every 500 to 1,000 cases of glandular fever, but it can be life threatening because it may cause severe internal bleeding. In some cases,emergency surgery may be required to remove an enlarged orruptured spleen(splenectomy). A ruptured spleen usually occurs as a result of damage caused by vigorous physical activities, such as contact sports. Its therefore very important to avoid these activities for at least a month after the symptoms of glandular fever begin. Be particularly careful during the second and third week of your illness, as this is when the spleen is most vulnerable. Neurological complications In less than1 in every 100 cases, the Epstein-Barr virus (EBV) can affect the nervous system and trigger a range of neurological complications, including: Guillain-Barr syndrome where the nerves become inflamed, causing symptoms such as numbness, weaknessand temporary paralysis Bells palsy wherethe muscles on one side of the face becometemporarily weak or paralysed viral meningitis  an infection of the protective membranes that surround the brain and spinal cord; although unpleasant,viral meningitisis much less serious than bacterial meningitis, which is life threatening encephalitis an infection of the brain These complications will often need specific treatment, but more than four out of every five people with them will make a full recovery. Secondary infection In a small number of cases, the initial infection weakens your immune system and allows bacteria to infect parts of the body. This is called a secondary bacterial infection. Possible secondary infections that can develop during glandular fever include serious conditions such as pneumonia (infection of the lung) andpericarditis (infection of the sac that surrounds the heart). Secondary infections usually occur in people who have a very weak immune system, such as people with HIV or AIDS , or those having chemotherapy . If you have a weakened immune system and you develop glandular fever, as a precaution you may be referred to hospital for specialist treatment. This willallow foryour health to be carefully monitored and any secondary infections to be treated. Source: NHS 24 - Opens in new browser window Last updated: 04 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Self-help guide: Fever in adults Other health sites Lab Tests Online UK NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Gonorrhoea,"Gonorrhoea | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Sexual and reproductive Gonorrhoea Gonorrhoea British Sign Language |  | Polski | Romn | slovenina Gonorrhoea is a sexually transmitted infection caused by bacteria. Infection usually occurs in the genitals but can affect the throat, eyes and anus. Symptoms of gonorrhoea Many people with gonorrhoea wont notice any symptoms. If you do get symptoms, its usually between 1 to 14 days after getting the infection. Symptoms of gonorrhoea may include: green or yellow fluid coming out of the penis pain or a burning sensation when peeing discomfort and swelling of the testicles increased discharge from the vagina pain in the lower tummy, particularly during sex bleeding in between periods or after sex Gonorrhoea can also infect the throat, eyes or anus. You may experience pain or discharge in these areas. Gonorrhoea in the throat usually has no symptoms. Having the infection during pregnancy can result in giving birth to the baby early (premature birth). Gonorrhoea can be passed on to the baby during birth and can result in eye infections in the infant. When to get medical advice Speak to your GP practice or midwife if: youre pregnant and think you have gonorrhoea Testing for gonorrhoea If you think you might have gonorrhoea, get tested for free by: booking an appointment at your local sexual health service (if you have symptoms) contacting your GP practice for an appointment (if you have symptoms) ordering a home test kit (if you do not have symptoms) Services available may vary depending on where you live. What does a gonorrhoea test involve? The test for gonorrhoea is simple, painless and very reliable. It involves sending a sample from the area of the body thought to be infected to a lab for analysis. You usually dont have to be examined by a doctor or nurse and can often collect the sample yourself. The 2 main ways the sample can be collected are: using a swab  a small cotton bud is gently wiped over the area that might be infected, such as inside the vagina, throat, or inside the anus urine sample (if you have a penis)  this is more accurate if its at least 1 or 2 hours after you last peed People who have had anal or oral sex may have a swab taken from their anus or throat. Some sexual health clinics may be able to carry out rapid tests and give you your test results straight away. Otherwise, youll have to wait up to 2 weeks to get the results. If you have gonorrhoea, your partner will be offered testing and treatment. Treatment for gonorrhoea Antibiotics will treat the gonorrhoea infection. These can be given in pill form or as an injection. Some strains of gonorrhoea are becoming resistant to antibiotics. This can make it more difficult to treat. You may be tested again 3 weeks later to check the antibiotics have worked. If theres a high chance you have gonorrhoea, you may be given treatment before you get your results back. You may also be offered treatment if your partner (s) is found to have gonorrhoea. Tell the doctor or nurse if you: are pregnant think you might be pregnant are breastfeeding This may make a difference to the antibiotic youre prescribed. If your infection is untreated you may pass it on to other sexual partners. If gonorrhoea is left untreated in women, it can spread to the womb and cause a serious condition called pelvic inflammatory disease (PID) . This is a major cause of ectopic pregnancy and infertility in women. If men are not treated, the infection may spread to the testicles and cause discomfort. This could affect your fertility. Do not have sex until you and your partner have both finished the treatment. You should also wait until youve had the results of the 2 week test to prevent being infected again. How gonorrhoea is passed on Gonorrhoea is passed through unprotected vaginal, anal or oral sex (without a condom). It can also be passed on by: sharing sex toys that arent washed or covered with a new condom each time theyre used infected semen or vaginal fluid getting into your eye it can also be passed to a newborn during childbirth Reducing the risk of gonorrhoea The best way to prevent all sexually transmitted infections is to practice safer sex . This means using a condom for vaginal, anal or oral sex. Other STIs If you have been diagnosed with gonorrhoea you should get tested for all STIs including: syphilis HIV chlamydia Find your local sexual health clinic Source: Scottish Government - Opens in new browser window Last updated: 26 February 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Other languages and formats British Sign Language |  | Polski | Romn | slovenina British Sign Language |  | Polski | Romn | slovenina Add this page to\n            Info For Me Also on NHS inform Book a sexual health appointment online Gonorrhoea (BSL) Gonorrhoea (Chinese) Gonorrhoea (Polish) Gonorrhoea (Romanian) Gonorrhoea (Slovak) NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Gout,"Gout | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Muscle, bone and joints Conditions Gout Gout About gout Causes of gout Symptoms of gout Diagnosing gout Treating gout Complications of gout About gout Gout is a type of arthritis in which small crystals form inside and around the joints. It causes sudden attacks of severe pain and swelling. Its estimated that between one and two in every 100 people in the UKare affected by gout. The condition mainly affects men over 30 and women after the menopause . Overall, gout is more common in men than women. Gout can be extremely painful and debilitating, but treatments are available to help relieve the symptoms and prevent further attacks. Signs and symptoms of gout Any joint can be affected by gout, but it usually affects jointstowards the ends of the limbs, such as the toes, ankles, knees and fingers. Signs and symptoms of gout include: severe pain inone or morejoints the joint feeling hot and very tender swelling in and around the affected joint red, shiny skin over the affected joint Symptoms develop rapidlyover a few hours and typically lastthree to 10 days. After this time the pain should pass and the jointshould return to normal. Almost everyone with gout will experience further attacks at some point, usually within a year. Read more about the symptoms of gout . When to see your GP See your GP if you suspect you have gout and it hasnt been previously diagnosed, particularly if the pain keeps getting worse and you also have a high temperature (fever). Its important that a diagnosis is confirmed because other conditions that require urgent treatment, such as an infected joint, can sometimes cause similar symptoms. If youve already been diagnosed with gout and you have an attack, see your GP if any medication youve been prescribed (see below) doesnt start working within a couple of days. Read more about diagnosing gout . What causes gout? Gout is caused by a build-up of a substance called uric acid in the blood. If you produce too much uric acid or your kidneys dont filter enough out, it can build up and cause tiny sharp crystals to form in and around joints. These crystals can cause the joint to become inflamed (red and swollen) and painful. Things that may increase your chances of getting gout include: obesity , high blood pressure and/or diabetes having a close relative with gout kidney problems eating foods that causea build-up of uric acid, such as red meat, offal and seafood drinking too much beeror spirits Read more about the causes of gout . Treatments for gout If you have gout, treatment is available from your GP to: relieve symptomsduring an attack this can be done using ice packs and by taking medications such as non-steroidal anti-inflammatory drugs (NSAIDs), colchicine or corticosteroids preventfurther attacks  through a combination oflifestyle changes, such as losing weight or changing your diet, and taking medicationthat lowers uric acidlevels, such asallopurinol With treatment, many people are able to reduce their uric acid levels sufficiently to dissolve the crystals that cause gout  and as a result have no further attacks. However, lifelong treatment is usually required. Read more about treating gout . Can gout cause further problems? Sometimes gout can lead to further problems, particularly if its left untreated. These can include: kidney stones small firm lumps of uric acid crystals under the skin called tophi permanent joint damage Read more about the complications of gout . Whats pseudogout? Pseudogout isa similar condition to gout,but usuallyaffects the knee joint first. Its a form of arthritis that causes pain, stiffness, tenderness, redness, warmth and swelling in one or more of your joints  commonly the knee or wrist. Causes of gout Gout is caused by small crystals forming in the joints, resulting in severe pain, tenderness and swelling. These crystals can grow when a waste product called uric acid starts to build up to high levels inthe body. Uric acid Uric acid is created when the body breaks down chemicals known as purines. If your kidneys dont filter out enough uric acid, or your body is producing unusually high levels of it, it can build up in the body and turn into microscopic crystals. These crystals usually form in and around the joints, possibly because the temperature in these areas is slightly lower than the rest of the body. If they get into the space between joints, the crystals can cause painful inflammation (redness and swelling). What can increase your risk? A high level of uric acid in the blood is the main factor that increases your risk of developing gout. However, its still uncertain why some people with a high level of uric acid in the blood develop gout, while others with an equally high level dont. Other factors that may increase your risk of developing gout are outlined below. Medical conditions Some underlying medical conditions can increase your risk of developing gout, including: high blood pressure diabetes kidney disease high levels of fat and cholesterol in your blood obesity metabolic syndrome(acombination of diabetes, high blood pressure and obesity) psoriasis (a skin condition that causes red, flaky, crusty patches of skin covered with silvery scales) osteoarthritis Medication Certain medications can increase your uric acid levels and your risk of developing gout. These include: diuretics (water tablets) used to treat high blood pressure or an abnormal build-up of fluid in your body certainmedicines used to treat high blood pressureincluding beta-blockers and ACE inhibitors low-dose aspirin  used to reduce the risk of blood clots niacinused to treat high cholesterol ciclosporin used to treat conditions such aspsoriasis some chemotherapy medicines Diet Uric acid is created when the body breaks down purines. Eating foods that contain a high level of purines can increase your risk of gout. Foods naturally high in purines include: red meat such as beef, lamb and pork seafood especially shellfish and oily fish offal such as liver, kidneys and heart Alcohol Alcoholic drinks can raise the level of uric acid in the blood. Beer, fortified wines like port, and spirits do this more than wine. Moderate consumption of wine  one or two glasses a day  shouldnt significantly increase your risk of gout. Sugary drinks Certain sugary drinks may also increase your risk of gout. Some research hasfound that drinking sugar-sweetened soft drinks and drinks with high levels of fructose (a naturally occurring sugar found in manyfruits)had anincreased risk of gout. Family history Studies have shown that gout often runs in families. Aroundone in five people with gout have a close family member with the condition. Symptoms of gout The main symptom of gout is a sudden attack of severe pain in one or more joints, typically your big toe. Other symptoms can include: the joint feeling hot and very tender, to the point ofbeing unable to bear anything touching it swelling in and around the affected joint red, shiny skin over the affected joint peeling, itchy and flaky skin as the swelling goes down The intense pain can make getting around difficult. Even the light pressure of a bed cover or blanket can be unbearable. Which jointscan beaffected? Gout can affect almost any joint and can occur in more than one joint at the same time. The joints towards the ends of the limbs tend to be affected more often, including the: toes particularly the big toe joint midfoot (where your shoelaces sit) ankles knees fingers wrists elbows If gout is left untreated, itslikely to affect more joints over time. Pattern of symptoms Attacksof gout tend to: occur at night, although they canhappen at any time developquickly over a few hours last between three and 10 days  after this time, the affected joint should start to return to normal, but the problem can persist if treatment isnt started early come backyou mayexperience attacks every few months or years become more frequent over time if not treated Its difficult to predict how often attacks will occur and when exactly they will happen. When to seek medical advice See your GP if you suspect you have gout and it hasnt been previously diagnosed. Contact your GP immediately or call the 111 serviceif you have both: severe, worsening joint pain and swelling a high temperature (fever) of 38C (100.4F) or above This could mean you have an infection inside the joint (septic arthritis). If youve alreadybeen diagnosed with gout and you have an attack, see your GP ifany medication youve been prescribed doesnt start working within a couple ofdays. Read more about diagnosing gout and treating gout . Diagnosing gout Your GP may suspect gout based on your symptoms. Sometimes further tests will be needed to confirm the diagnosis and rule out other possible causes. Seeing your GP See your GP if you experience symptoms of gout for the first time. Your GP willask aboutyour symptoms andmedical history, and examine the affected area, to help make a diagnosis. Theymay also ask you about your diet, particularly your intake of beer, spirits and foods high in purines, such as red meat and seafood. Further tests Many conditions can cause gout-like symptoms. Your GP may be unable to make a firm diagnosis straight away and you may be referred for further tests. These will either confirm the diagnosis of gout or rule out other conditions. Joint fluid test A sample of fluid may be taken from the affected joint.The fluid can be checked for the small crystals that cause gout,and it can be tested for infection to rule out septic arthritis. Blood test A blood test known as aserum uric acid testmay be used to measure the amount of uric acid in your blood. A high level or uric acid is often associated with gout. Its sometimes best to wait until two to four weeks after an attack of gout before this test is carried out, as the level of uric acid in your blood is often not raised at the time of an attack. This is because the level of uric acid in your blood can drop when uric acid crystals form in the joints. X-ray An X-ray is rarely used to diagnose gout because the condition isnt usually detectable using this method. However, an X-ray is sometimes used to help rule out similar conditions that affect the joints, such as chondrocalcinosis (a build-up of calcium crystals in the joints) or to assess whether there has been any joint damage due to repeated or persistent attacks of gout. Ultrasound scan An ultrasound scan of an affected joint is a simple and safe investigation thats increasingly used to detect crystals in the joints. It can also detect crystalsdeepin the skin that arent obvious during a physical examination. Treating gout Treatment for gout includes pain relief to help you cope with a gout attack, as well as medication and lifestyle changes to prevent further attacks. Pain relief for a gout attack What to do during an attack You should: take any medication youve been prescribed as early as possible after you notice an attack (see below)  this should start to have an effect within two or three days rest and raise the limb avoid knocking or damaging the affected joint keep the joint cool  remove surrounding clothing and apply an ice pack, such as a bag of frozen peas wrapped in a towel ensure youre well hydrated Apply the ice pack to your joint for around 20 minutes. Dont apply ice directly to your skin and dont apply it for more than 20 minutes at a time because this could damage the skin. If necessary, you can keep reapplying an ice pack to your skin during an attack, but you should wait until your skin has returned to a normal temperature first. NSAIDs Non-steroidal anti-inflammatory drugs (NSAIDs) are usually recommended as the firsttreatment for gout. They work by reducing pain and inflammation during an attack. NSAIDs used to treat gout include naproxen, diclofenac and etoricoxib. If youve been prescribed NSAIDs, its a good ideato have them with you at all times so you can use them at the first sign of a gout attack. Continue to take your medication throughout the attack and for 48 hours afterwards. Your GP may also prescribe a medication called a proton pump inhibitor (PPI), to take alongside your NSAID. Thisreduces the risk of the NSAID causing indigestion , stomach ulcers and bleeding from the stomach. Colchicine If youre unable to take NSAIDs or if NSAIDs are ineffective, a medicine calledcolchicine can be used instead. Colchicine reduces some of the swelling and pain associated with a gout attack. Its best to have it with you at all times so you can use it at the first sign of a gout attack. Your GP will tell you how long to take it for and how often. When taken in high doses, side effects of colchicine include feeling sick, abdominal (tummy) pain and diarrhoea . Corticosteroids Corticosteroids are sometimes used to treat severe cases of gout if other treatments dont work or youre unable to take an NSAID or colchicine. A short course of steroid tablets often provides relief, but they cant be used long-term in high doses as they cause side effects, including: weight gain thinning of the bones ( osteoporosis ) easy bruising muscle weakness Corticosteroids can also be given by injection to provide rapid pain relief. This can be either into a muscle, a vein or directly into the affected joint. Medication and lifestyle changes to prevent further attacks You can reduce your chances of having further gout attacks by taking medication and making lifestyle changes toreduce the level ofuric acid in your body. Medication Medication to reduce uric acid levels known as urate-lowering therapy (ULT) is usually recommended if you have recurrent attacks of gout or you have complications of gout . Most people with gout will eventually need to have ULT, so you may want to discuss the advantages and disadvantages of this treatment with your doctor as soon as youve been diagnosed with gout. They should explain that while ULT can significantly reduce your risk of having further attacks, the medication needs to be taken on a daily basis for the rest of your life and theres a small risk of side effects. If you decide to start ULT, a medicine called allopurinol is usually tried first. If this isnt suitable or doesnt work, other medications may be used instead. These medications are described below. Allopurinol Allopurinolhelps reduce the production of uric acid. It can help prevent gout attacks, although it wont help relieve symptoms during an attack. Allopurinol is a tablettaken once a day.When you first start taking it, your dose will be adjusted to make sure the level of uric acid in your blood is low enough. Regular blood tests will be needed to monitor this until themost effective dose is found. Allopurinol can sometimes cause a gout attack soon after you start taking it and itcan take up to a year or two before no further attacks occur. Its important to persevere with treatment even if you do have attacks during this time. To helprelieve attacks, your doctor will prescribe one of the pain relieving medications described above to take alongside your allopurinol at first. Most people taking allopurinol wont experience any significant side effects. However, side effects can include: a rash  this is usually mild and goes away on its own, but it can be a sign of anallergy; if you develop a rash, stop taking the medication immediately and contact your GP for advice indigestion headaches diarrhoea Febuxostat Like allopurinol, febuxostatis a medication taken once a day thatreduces the bodys production of uric acid. Its often used if allopurinol isnt suitable or causes troublesome side effects. As with allopurinol, febuxostat can make your symptoms worse when you first start taking it. Your doctor will initially prescribe one of the pain relieving medications described in case you experience attacks. Side effects of febuxostat can include: diarrhoea feeling sick headaches arash Othermedications Less commonly used ULT medications include benzbromarone and sulfinpyrazone. These types of medication tend to only be used if people are unable to take allopurinol or febuxostat. They need to be prescribed under the supervision of a specialist. Lifestyle changes Certain lifestyle changes can also help reduce your risk of experiencing further attacks of gout, including: avoiding foods containing high levels of purine (the chemical involved in the production of uric acid), such as red meat, offal, oily fish, seafood and foods containing yeast extract. avoiding sugary drinks and snacks  these are associated with an increased risk of gout maintaining a healthy weight follow a balanced diet ; dont crash diet or tryhigh-protein, low-carbohydrate diets taking regular exercise  try activities that dont put too much strain on your joints, such as swimming drinking plenty of water keeping yourself well hydrated will reduce the risk of crystals forming in your joints cutting down on alcohol  avoid beer and spirits in particular and dont binge drink Theres some evidence to suggest that taking regular vitamin C supplements can reduce gout attacks, although the effectmay only be small. Talk to your GP first if youre thinking about taking vitamin C supplements, as they arent suitable or safe for everyone. Complications of gout Complications of gout can include small lumps forming under the skin (tophi), joint damage and kidney stones. These are more likely to occur if gout is left untreated. Tophi Gout is caused by a chemical called uric acid forming small crystals in and around the joints. These crystals also oftenbuild upunder the skin and form small white or yellow lumps known as tophi. Tophi are usually painless, but they can form in awkward places, such as at the ends of your fingers and around your toes.Sometimes they can makeeveryday tasks such as preparing food or getting dressed difficult. They can alsocan become inflamed and produce a toothpaste-like discharge. Tophi can develop anywhere in the body, but usually form on the: toes heels knees fingers ears forearms elbows It normally takes several years after the first attack of gout for tophi to develop, but some people develop them even before experiencing an attack. Theyre usually a sign of severe gout and a good reason to start treatment to reduce the level or uric acid in your body . Successful treatment will prevent the tophi from getting any bigger, and long term treatment often gradually shrinks them. If you have very large or painful tophi, they may have to be surgically removed. Joint damage Without treatment, gout attacks may become more frequent and prolonged, and your likelihood of developing permanent joint damage will increase. In the most serious cases, surgery may be required to repair or replace a damaged joint. Kidney stones Occasionally, high levels of uric acid canlead to the formation of kidney stones . Some kidney stones interfere with the flow of urine, resulting in pain when you pass urine, and can make you feel that you need to pass urine more often. You may be prescribed medication to make your urine less acidic, which should help dissolve any kidney stones that have developed. Read more about treating kidney stones . Psychological and emotionaleffects Gout can also affect your mood, work and home life. The severe pain that gout causes can make it difficult to do everyday tasks and to get around, which in turn can lead to feelings of depression or anxiety . If gout is affecting your mood or making everyday life difficult, talk to your GP. They will be able to offer treatment and support. There are also a number of organisations that offer information and advice for people who have gout, including Versus Arthritis . Source: MSK Expert Panel - Opens in new browser window Last updated: 19 October 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Corticosteroids Arthritis Other health sites The Pain Toolkit Versus Arthritis: gout Versus Arthritis: NSAIDS NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Gum disease,"Gum disease | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Mouth Gum disease Gum disease About gum disease Symptoms of gum disease Causes of gum disease Treating gum disease Complications of gum disease About gum disease If you have a dental problem you should, in the first instance always phone the dental practice that you normally attend . If you are not registered with any dental practice thenyou should read our advice on dental emergencies . Gum disease is a very common condition where the gums become swollen, sore or infected. Most adults in theUK have gum disease to some degree andmost people experience it at least once. Its much less common in children. If you have gum disease, yourgums may bleed whenyou brush your teeth and you may have bad breath. This early stage of gum disease is known as gingivitis. If gingivitis isnt treated, a condition called periodontitis can develop. This affects more tissues that support teeth andhold them in place. Ifperiodontitisisnt treated, the bone in your jawmay be damaged and small spaces can open upbetween the gum and teeth.Your teeth can become loose and may eventually fall out. Read more about the symptoms of gum disease . What causes gum disease? Gum disease is caused by a build-up of plaque on the teeth. Plaque is a sticky substance that contains bacteria. Some bacteria in plaqueare harmless, but some are harmful for the health of your gums. If you dont remove plaque from your teeth by brushing them, itbuilds up and irritates your gums. This can lead to redness with bleeding, swelling and soreness. Read more about the causes of gum disease. Seeing your dentist You should make an appointment to see your dentist if your gums are painful,swollenor if they bleed when you brush your teeth. Find a dentist near you . Your dentistcan carry out a thorough dental examination to check the health of your gums, which may involve inserting a thinmetal stick with a bend in one end(periodontal probe) beside your teeth. In some cases, a number of X-rays may be needed to check the condition of your teeth and jaw bone. Preventing and treating gum disease Mild cases of gum disease can usually be treated by maintaining a good level of oral hygiene. This includes brushing your teeth at least twice a day and flossing regularly. You should also make sure you attend regular dental check-ups. In most cases, your dentist or dental hygienist will be able to give your teeth a thorough clean and remove any hardened plaque (tartar). Theyll also be able to show you how to clean your teeth effectively to help prevent plaque building up in the future. If you have severe gum disease, youllusually need to have further medical and dental treatment and, in some cases, surgery may need to be carried out.This will usually be performed by a specialist in gumproblems (periodontics). Read more about treating gum disease and keeping your teeth clean . Dental check-ups Its importantto have regular dentalcheck-ups so any problems with your teeth and gums can be detected and treated early. If youve never had gum disease and have good oral health, you may only need to visit your dentist every 1 to 2 years for a check-up. You may need to visit your dentist more frequently if youve had problems with gum disease in the past. At each appointment your dentist will advise when you need your next appointment. If you have an increased risk of developing gum problems for example, if you smoke or have diabetes  you may be advised to visit your dentist more often so your teeth and gums can be closely monitored. Complications of gum disease If you have untreated gum disease that develops into periodontitis, it can lead to further complications, such as: gum abscesses (painful collections of pus) receding gums loose teeth loss of teeth Read more about the complications of gum disease . Symptoms of gum disease Healthy gums should be pink, firm and keep your teeth securely in place. Your gums shouldnt bleed when you touch or brush them. Gum disease isnt alwayspainful and you may be unaware you have it. Its important to have regular dental check-ups . Early symptoms The initial symptoms of gum disease can include: red and swollengums bleeding gums after brushing or flossing your teeth This stage of gum disease is called gingivitis. Advanced symptoms Ifgingivitis is untreated, the tissues and bone that support the teeth can also become affected. This is known asperiodontitis, or periodontal disease. Symptoms of periodontitis can include: bad breath (halitosis) anunpleasanttaste in your mouth loose teeth that can make eating difficult gum abscesses (collections of pus thatdevelop under your gums orteeth) Acute necrotising ulcerative gingivitis In rare cases, a condition calledacute necrotising ulcerative gingivitis (ANUG) can develop suddenly. The symptoms of ANUG are usually more severe than those of gum disease and can include: bleeding, painful gums painful ulcers receding gums inbetween your teeth bad breath a metallic taste in your mouth excess saliva in your mouth difficulty swallowing or talking a high temperature (fever) When to see a dentist You should make an appointment to see your dentist if you think you may have gum disease or ANUG. If you dont currently have a dentist, search for a dentist near you . Read more about treating gum disease . Causes of gum disease Gum disease can be caused by a number of factors, but poor oral hygiene is the most common cause. Poor oral hygiene, such as not brushing your teeth properly or regularly, can cause plaqueto build up on your teeth. Plaque Your mouth is full of bacteria thatcombine with saliva to form a sticky film known as plaque, whichbuilds up on your teeth. When you consume food and drink high in carbohydrates (sugary or starchy foods), bacteria in plaque turn carbohydrates into the energy they need, producing acid at the same time. Over time, acid in plaque begins to break down your tooths surface and causes tooth decay. Other bacteria in plaquecan alsoirritate your gums, making them inflamed and sore. Plaque is usually easy to remove by brushingand flossingyour teeth, but it can harden and form a substance calledtartarif its not removed.Tartar sticks much more firmly to teeth than plaque and can usually only be removed by a dentist or dental hygienist. Who is most at risk? As well as poor oral hygiene,a number of things can increase your risk of developing problems with your gums. These include: smoking your age gum diseasebecomes more common as you get older a family history of gum disease diabetes a lifelong condition that causes a persons blood sugar levels to become too high a weakened immune system for example,because ofconditions such as HIV and AIDS orcertain treatments, such as chemotherapy malnutrition a condition that occurs when a persons diet does not contain the right amount of nutrients stress Treating gum disease The best way to treat gum disease is to practise good oral hygiene, although additional dental and medical treatments are sometimes necessary. Oral hygiene Good oral hygiene involves: brushing your teeth for about 2 minutes last thing at night before you go to bed and on one other occasion everydayit doesnt matter if you use an electric or manual toothbrush but some people find it easier to clean their teeth thoroughly with an electric toothbrush using toothpaste that containsthe right amount of fluoride (a natural mineral that helps protect against tooth decay ) flossing your teeth regularlypreferably daily, before brushing your teeth not smoking regularly visiting your dentist  at least once every 1 to 2 years, but more frequently if necessary See the teeth cleaning guide for more information and advice about how to keep your teeth clean. Mouthwash Antiseptic mouthwashes containing chlorhexidine or hexetidine are available over the counter from pharmacies. However,theres some debate about whether usingmouthwash isnecessary for people with healthy gums. Your dentist may recommend using mouthwash if it helps control the build-up of plaque (the sticky substance that forms when bacteria collects on the surface of your teeth). Your dentist will be able to adviseyou about which type of mouthwash is most suitable and how to use it. Chlorhexidine mouthwash can stain your teeth brown if you use itregularly. Rinse your mouth thoroughly between brushing your teeth and using a chlorhexidine mouthwash because some ingredients in toothpaste can prevent the mouthwash working. Dental treatments Some of the dental treatments described below may also be recommended if you have gum disease. Scale and polish To remove plaque and tartar (hardened plaque) that can build up on your teeth, your dentist may suggest that you have your teeth scaled and polished. This is a professional clean usually carried out at your dental surgery by a dental hygienist. The dental hygienist will scrape away plaque and tartar from your teeth using special instruments, then polish your teeth to remove marks or stains. If a lot of plaque or tartar has built up, you may need to have more than one scale and polish. The price of a scale and polish can vary depending on what needs to be carried out, so ask your dental hygienist how much it will cost beforehand. Root planing In some cases of gum disease, root planing (debridement) may be required. This is a deep clean under the gums that gets rid of bacteria from the roots of your teeth. Before having the treatment, you may need to have a local anaesthetic (painkilling medication) to numb the area. You may experience some pain and discomfort for up to 48 hours after having root planing. Further treatment If you have severe gum disease, you may need further treatment, such as periodontal surgery. In some cases, its necessary to remove the affected tooth. Your dentist will be able to tell you about the procedure needed and how its carried out. If necessary, they can refer you to a specialist. If youre having surgery or root planing, you may be given antibiotics (medication to treat infections). Your dentist will tell you whether this is necessary. Acute necrotising ulcerative gingivitis Acute necrotising ulcerative gingivitis (ANUG) should always be treated by a dentist. However, if you see your GP before visiting a dentist, they may provide you with some treatment while you wait to see your dentist. As well as oral hygiene advice and dental treatments, treatments for ANUG may also include antibiotics, painkillers anddifferent types of mouthwash. Antibiotics Treatment with antibiotics , such as metronidazole or amoxicillin, may be recommended if you have ANUG.Youll usually have to take these for 3 days. Amoxicillin isnt suitable for people allergic to penicillin. Metronidazole can react with alcohol, causing you to feel very unwell. You shouldnt drink alcohol while youre taking metronidazole and for 48 hours after you finish the course of treatment. Other side effects of metronidazole and amoxicillin can include nausea (feeling sick), vomiting and diarrhoea . Painkillers Paracetamol and ibuprofen are the most commonly prescribed painkillers.Theyre also available over the counter from pharmacies. They may help reduce pain and discomfort. However, paracetamol and ibuprofen arent suitable for everyone, so read the manufacturers instructions before taking them. Mouthwash Mouthwash containing chlorhexidine or hydrogen peroxide may be prescribed to treat ANUG. Some chlorhexidine mouthwashes are also available over the counter, though they may not be as effective as a hydrogen peroxide mouthwash. You should always read the instructions before using mouthwash. Some types may need to be diluted in water before theyre taken. Complications of gum disease If you develop gingivitis and dont have the plaque or tartar (hardened plaque) removed from your teeth, the condition may get worse and lead to periodontitis. You may develop further complicationsif you dont treat periodontitis (where the tissue that supports teeth is affected),including: recurrent gum abscesses (painful collections of pus) increasing damage to the periodontal ligament(the tissue that connects the tooth to the socket) increasing damage to and loss of the alveolar bone (the bone in the jaw that contains the sockets of the teeth) receding gums loose teeth loss of teeth Acute necrotising ulcerative gingivitis If you have acute necrotising ulcerative gingivitis (ANUG) and itsnot treated, it can cause more severe complications. The infection can spread to all areas of your gums and the alveolar bone surrounding your teeth. This can lead to: the gums between your teeth being completely destroyed large ulcers (open sores) leaving permanent holes in your gums loose and unstable teeth If ANUG isnt properly treated the first time you have it, youre more likely to have recurring cases inthe future. This can cause persistent bad breath (halitosis) and bleeding gums, as well as gradually receding gums. In rare cases, ANUG can lead to gangrene affecting the lips and cheeks. This occurs when tissue starts to die and waste away. If you developgangrene, you may needto have the dead tissue removed. Other complications Gum disease has also been associated with an increased riskfora number of other health conditions, including: cardiovascular disease lung infections if affected during pregnancy, premature labour and having a baby with a low birth weight However, while people with gum disease may have an increased risk of these problems, there isnt currently any clear evidence that gum disease directly causes them. Source: NHS 24 - Opens in new browser window Last updated: 05 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Dental abscess NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Haemorrhoids (piles),"Haemorrhoids (piles) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Haemorrhoids (piles) Haemorrhoids (piles) About haemorrhoids Diagnosing haemorrhoids Treating haemorrhoids Surgery for haemorrhoids About haemorrhoids Haemorrhoids, also known as piles, are swellings containing enlarged blood vessels that are found inside or around the bottom (the rectum and anus). In many cases,haemorrhoids dont cause symptoms, and some peopledont even realise they have them. However, when symptoms do occur, they may include: bleeding after passing a stool (the blood is usually bright red) itchy bottom a lump hanging down outside of the anus, which may need to be pushed back in after passing a stool a mucus discharge after passing a stool soreness, redness and swelling around your anus Haemorrhoids arent usually painful, unless their blood supply slows down or is interrupted. When to seek medical advice See your GP ifyou have persistent or severe symptoms of haemorrhoids. You should always get any rectal bleeding checked out, so your doctor can rule out more potentially serious causes. The symptoms of haemorrhoids often clear up on their own or with simple treatments that can be bought from a pharmacy without a prescription. However, speak to your GP if your symptoms dont get better or if you experience pain or bleeding. Your GP can often diagnose haemorrhoids using a simple internal examination of your back passage, although they may need to refer you to a colorectal specialist for diagnosis and treatment. Some people with haemorrhoids are reluctant to see their GP. However, theres no need to be embarrassed, because GPs are very used to diagnosing and treating haemorrhoids. Read more about diagnosing haemorrhoids . What causeshaemorrhoids? The exact cause of haemorrhoids is unclear, buttheyre associated with increased pressure in theblood vessels in and around your anus. This pressure can cause the blood vessels in your back passage to become swollen and inflamed. Many cases are thought to be caused by too much straining on the toilet, due to prolonged constipation  this is often due to a lack offibre in a persons diet. Chronic (long-term) diarrhoea can also make you more vulnerable to getting haemorrhoids. Other factors that might increase your risk of developing haemorrhoids include: being overweight or obese age as you get older, your bodys supporting tissues get weaker, increasing your risk of haemorrhoids beingpregnant which can place increased pressure on your pelvic blood vessels, causing them to enlarge (read more about common pregnancy problems ) having a family history of haemorrhoids regularly lifting heavy objects apersistent cough or repeated vomiting sitting down for long periods of time Preventing and treating haemorrhoids Haemorrhoid symptoms oftensettle down aftera few days, without needing treatment. Haemorrhoids that occur during pregnancy often get better after giving birth. However, making lifestyle changes to reduce the strain onthe blood vessels in and around your anus is often recommended. These can include: graduallyincreasing the amount of fibre in your diet  good sources of fibre include fruit, vegetables, wholegrain rice, wholewheat pasta and bread, pulses and beans, seeds, nuts and oats drinking plenty of fluid particularly water,but avoiding orcutting down on caffeine and alcohol not delaying going to the toilet  ignoring the urge to empty your bowels can make your stools harder and drier, which can lead to straining when you do go to the toilet avoiding medication that causes constipation  such as painkillers that contain codeine losing weight (if youre overweight) exercising regularly  can help prevent constipation, reduce your blood pressure and help you lose weight These measures can also reducethe risk of haemorrhoids returning, or even developingin the first place. Medication that you apply directly to your back passage (known as topical treatments) or tablets bought from a pharmacy or prescribed by your GP may ease your symptoms and make it easier for you to pass stools. There are various treatment options for more severe haemorrhoids. One of these options is banding, which is a non-surgical procedure where a very tight elastic band is put around the base of the haemorrhoid to cut offits blood supply. The haemorrhoid should fall offafter about a week. Surgery carried out under general anaesthetic (where youre unconscious) is sometimesused toremove or shrinklarge or external haemorrhoids. Read more about treating haemorrhoids and surgery for haemorrhoids . Diagnosing haemorrhoids Your GP can diagnose haemorrhoids (piles) by examining your back passage to check for swollen blood vessels. Some people with haemorrhoids are reluctant to see their GP. However, theres no need to be embarrassed  all GPs are used to diagnosing and treating piles. Its important to tell your GP about all of your symptoms  for example, tell them if youve recently lost a lot of weight, if your bowel movements have changed, or if yourstools have become dark or sticky. Rectal examination Your GP may examine the outside of your anus to see if you have visible haemorrhoids, and they may also carry out an internal examination called adigital rectal examination (DRE). During a DRE, your GP will wear gloves and use lubricant. Using their finger, theyllfeel for any abnormalities in your back passage. A DRE shouldnt be painful, but you may feel some slight discomfort. Proctoscopy In some cases, further internal examination using a proctoscope may be needed. A proctoscope is a thin hollow tube with a light on the end thats inserted into your anus. This allowsyour doctor to see your entire anal canal (the last section of the large intestine). GPs are sometimes able to carry out a proctoscopy. However, not all GPs have the correct training or access to the right equipment, so you may need togo to ahospital clinicto have the procedure. Types of haemorrhoids After youve had a rectal examination or proctoscopy, your doctor will be able todetermine what type of haemorrhoids you have. Haemorrhoids can develop internally or externally. Internal haemorrhoids develop in the upper two-thirds of your anal canal and external haemorrhoids in the lower third (closest to your anus). The nerves in thelower part can transmit pain messages, while the nervesin the upper partcant. Haemorrhoids can be further classified, depending on their size and severity. They can be: first degree  small swellings that develop on the inside lining of the anus and arent visible from outside the anus second degree  larger swellings that may come out of your anus when you go to the toilet, before disappearing inside again third degree  one or more small soft lumps that hang down from the anus and can be pushed back inside(prolapsing and reducible) fourth degree  larger lumps that hang down from the anus and cant be pushed back inside(irreducible) Its useful for doctors to know what typeand size of haemorrhoid you have, as they can then decide on the best treatment. Read more about treating haemorrhoids . Treating haemorrhoids Haemorrhoids (piles) often clear up by themselves after a few days. However, there are many treatments that can reduce itching and discomfort. Making simple dietary changes and not straining on the toilet are often recommended first. Creams, ointments and suppositories(which youinsert into your bottom) are available from pharmacies without a prescription. They can be used to relieve any swelling anddiscomfort. If more intensive treatment is needed, the type will depend on where your haemorrhoids are in your anal canal  the lower third (closest to your anus)or the upper two-thirds. The lower third contain nerves which can transmit pain, while the upper two-thirds do not. Non-surgical treatments for haemorrhoidsin the lower part of the canalare likely to be very painful, because the nerves in this area can detect pain. In these cases, haemorrhoid surgery will usually be recommended. The various treatments forhaemorrhoids are outlined below. Dietary changes and self care If constipation is thought to be the cause ofyour haemorrhoids, you need tokeep your stools soft and regular, so that you dont strain when passing stools. You can do this by increasing the amount of fibre in your diet. Good sources of fibre include wholegrain bread, cereal, fruit and vegetables. You should alsodrink plenty of water and avoid caffeine (found in tea, coffee and cola). When going to the toilet, you should: avoid straining to pass stools, because it may make your haemorrhoids worse usemoist toilet paper,rather than dry toilet paper, or baby wipesto clean your bottomafter passing a stool pat the areaaround your bottom, rather than rubbing it Read more about preventing constipation . Medication Over-the-counter topical treatments Various creams, ointments and suppositories(which are inserted into your bottom) are available from pharmacies without a prescription. They can be used to relieve any swelling anddiscomfort. These medicinesshould only be used for five to seven days at a time. If you use themfor longer, they may irritate the sensitive skin around your anus.Any medication should be combined with the diet and self-care advice discussed above. Theres no evidence to suggest that one method is more effective than another. Ask your pharmacist for advice about which product is most suitable for you, and always read the patient information leaflet that comes with your medicine before using it. Dont use more than one product at once. Corticosteroid cream If you have severe inflammation in and around your back passage, your GPmay prescribe corticosteroid cream , whichcontains steroids. You shouldnt use corticosteroid cream for more than a week at a time, because it can make the skin around your anus thinner and the irritation worse. Painkillers Common painkilling medication, such as paracetamol , can help relieve the pain of haemorrhoids. However, if you have excessive bleeding, avoid using non-steroid anti-inflammatory drugs (NSAIDs), such as ibuprofen , because it can make rectal bleeding worse. You should also avoid using codeine painkillers, because they can cause constipation. Your GP may prescribe products that contain local anaesthetic to treat painful haemorrhoids. Like over-the-counter topical treatments, these should only be used for a few days, because they can make the skin aroundyour back passage more sensitive. Laxatives If youre constipated, your GP may prescribe a laxative . Laxatives are a type of medicine that can help you empty your bowels. Non-surgical treatments If dietary changes and medication dont improve your symptoms,your GP may refer you to a specialist. They can confirm whether you have haemorrhoids and recommend appropriate treatment. If you have haemorrhoids in the upper part of your anal canal, non-surgical procedures such as banding and sclerotherapy may be recommended. Banding Bandinginvolves placinga very tight elastic band around the base of your haemorrhoids to cut off theirblood supply. The haemorrhoids should then fall offwithin about a week of having the treatment. Banding is usually a day procedure that doesnt need ananaesthetic, and most people can get back to their normal activities the next day. You may feel some pain or discomfort for a day or so afterwards. Normal painkillers are usually adequate, but your GP can prescribe something stronger, if needed. You may not realise that your haemorrhoids have fallen off, as they should pass out of your body when you go to the toilet. Ifyou notice some mucus discharge within a week of the procedure, itusually means that the haemorrhoids have fallen off. Directly after the procedure, you may notice blood on the toilet paper after going to the toilet.This is normal, but there shouldnt be a lot of bleeding. If you pass a lot of bright red blood orblood clots (solid lumps of blood), go toyour nearest accident and emergency (A&E) department immediately. Ulcers (open sores) can occur at the site of the banding, although these usually heal without needing further treatment. Injections (sclerotherapy) A treatment called sclerotherapy may be used as an alternative to banding. During sclerotherapy,achemical solution is injected into the blood vessels in your back passage. This relieves pain by numbing the nerve endings at the site of the injection. It also hardens the tissue of the haemorrhoid so that a scar is formed. After about 4to 6weeks, the haemorrhoid should decrease in size or shrivel up. After the injection, you should avoid strenuous exercise for the rest of the day.You may experience minor pain for a while and may bleed a little. You should be able to resume normal activities, including work, the day after the procedure. Electrotherapy Electrotherapy, also known as electrocoagulation, is anotheralternative to bandingfor people withsmallerhaemorrhoids. During the procedure, adevice called a proctoscope is inserted into the anus to locatethe haemorrhoid.An electric current is then passed through a small metal probe thats placed at the base of the haemorrhoid, above the dentate line. The specialistcan control the electric current using controls attached to the probe. The aim of electrotherapyis to cause the blood supplying the haemorrhoid to coagulate (thicken), which causes the haemorrhoid to shrink. If necessary, more than one haemorrhoid can be treated during each session. Electrotherapycan either be carried out on outpatient basis using a low electric current, or a higher dose can be given while the person is under a general anaesthetic or spinal anaesthetic. You may experience some mild pain during or after electrotherapy, but in most cases this doesnt last long.Rectal bleeding is another possibleside effect of the procedure, but this is usuallyshort-lived. Electrotherapyis recommended by the National Institute for Health and Care Excellence (NICE), and has been shown to be an effective method of treating smaller haemorrhoids. It can also be usedas an alternative to surgery fortreating larger haemorrhoids, but theres less evidence of its effectiveness. Surgery Although most haemorrhoids can be treated using the methods described above, around 1 in every 10 people will eventually need surgery. Surgery is particularly useful for haemorrhoids that have developed below the dentate line because, unlike non-surgical treatments, anaesthetic is used to ensure you dont feel any pain. There are many different types of surgery that can be used to treat haemorrhoids, but they all usually involve either removing the haemorrhoids or reducing their blood supply, causing them to shrink. Read more about surgery for haemorrhoids . Surgery for haemorrhoids Surgery may be recommended if other treatments for haemorrhoids (piles) havent worked, or if you have haemorrhoids that arent suitable for non-surgical treatment. There are many different surgical procedures for piles. Haemorrhoidectomy A haemorrhoidectomy is an operation to remove haemorrhoids. Its usually carried out under general anaesthetic , which means youll be unconscious during the procedure and wont feel any pain while its carried out. A conventional haemorrhoidectomy involves gently opening the anus so the haemorrhoids can be cut out. Youll need to take a week or so off work to recover. Youll probably experience significant pain after the operation, but you will be given painkillers. You may still have pain a few weeks after the procedure, which can also be controlled with painkillers. Seek medical advice if you have pain that continues for longer. After having a haemorrhoidectomy, theres around a 1 in 20 chance of the haemorrhoids returning, which is lower than with non-surgical treatments. Adopting or continuing a high-fibre diet after surgery is recommended to reduce this risk. Haemorrhoidal artery ligation Haemorrhoidal artery ligation is an operation to reduce the blood flow to your haemorrhoids. Its usually carried out under general anaesthetic and involves inserting a small ultrasound probe into your anus. The probe produces high-frequency sound waves that allow the surgeon to locate the vessels supplying blood to the haemorrhoid. Each blood vessel is stitched closed to block the blood supply to the haemorrhoid, which causes the haemorrhoid to shrink over the following days and weeks. The stitches can also be used to reduce prolapsing haemorrhoids (haemorrhoids that hang down from the anus). The National Institute for Health and Care Excellence (NICE) recommends haemorrhoidal artery ligation as a safe andeffective alternative to a haemorrhoidectomy or stapled haemorrhoidopexy (see below). It causes less pain and, in terms of results, a high level of satisfaction has been reported. The recovery time after having haemorrhoidal artery ligation is also quickercompared with other surgical procedures. Theres a low risk of bleeding, pain when passing stools, or the haemorrhoid becoming prolapsed after this procedure, but these usually improve within a few weeks. Stapling Stapling, also known as stapled haemorrhoidopexy, is an alternative to a conventional haemorrhoidectomy. Its sometimes used to treat prolapsed haemorrhoids and is carried out under general anaesthetic. The procedure isnt carried out as often as it used to be, because it has a slightly higher risk of serious complications than the alternative treatments available. During the operation, part of the anorectum (the last section of the large intestine), is stapled. This means the haemorrhoids are less likely to prolapse and it reduces the supply of blood to the haemorrhoids, which causes them to gradually shrink. Stapling has a shorter recovery time than a traditional haemorrhoidectomy, and you can probably return to work about a week afterwards. It also tends to be a less painful procedure. However, after stapling, more people experience another prolapsed haemorrhoid compared with having a haemorrhoidectomy. There have also been a very small number of serious complications following the stapling procedure, such as fistula to vagina in women (where a small channel develops between the anal canal and the vagina) or rectal perforation (where a hole develops in the rectum). Other treatments Other treatment options are available, including freezing and laser treatment. However, the number of NHS or private surgeons who perform these treatments is limited. General risks of haemorrhoid surgery Although the risk of serious problems is small, complications can occasionally occur after haemorrhoid surgery. These can include: bleeding or passingblood clots,whichmay happen a week or so after the operation infection, whichmay lead to a build-up of pus (known as an abscess) you may be given a short course of antibiotics after surgery to reduce this risk urinary retention (difficulty emptying your bladder) faecal incontinence (the involuntarily passing ofstools) anal fistula(a small channel that develops between the anal canal and surface of the skin, near the anus) stenosis (narrowing of the anal canal)  this risk is highest if you have treatment on haemorrhoids that have developed in a ring around the lining of the anal canal These problems canoften be treated with medication or more surgery. Ask your surgeon to explain the risks in more detail before deciding to have surgery. When to seek medical advice Seek medical advice from the hospital unit where the surgery was carried out, or from your GP, if you experience: excessive bleeding a high temperature (fever) problems urinating worsening pain or swelling around your anus If youre unable to contact the hospital or your GP, phone NHS 24s 111 service for advice or visit your nearest accident and emergency (A&E) department. Source: NHS 24 - Opens in new browser window Last updated: 13 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Constipation Other health sites NICE: Circular stapled haemorrhoidectomy NICE: electrotherapy for treating haemorrhoids NICE: haemorrhoidal artery ligation NICE: stapled haemorrhoidopexy NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
"Hand, foot and mouth disease","Hand, foot and mouth disease | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Hand, foot and mouth disease Hand, foot and mouth disease Hand, foot and mouth disease is a common infection that causes mouth ulcers and spots on the hands and feet. Its most common in young children particularly those under10  but can affect older children and adults as well. Hand, foot and mouth disease can be unpleasant, but it will usually clear up by itself within 7 to 10 days. You can normally look after yourself or your child at home. The infection is not related to foot and mouth disease, which affects cattle, sheep and pigs. Symptoms of hand, foot and mouth disease The symptoms of hand, foot and mouth disease usually develop between 3 and 5 days after being exposed to the infection. The first symptoms may include: a high temperature (fever),usuallyaround 38Cto 39C (100.4-102.2F) a general sense of feeling unwell loss of appetite coughing abdominal (tummy)pain a sore throat and mouth Mouth ulcers After1 or 2 days, red spots appear on the tongue and inside the mouth. These quickly develop into larger yellow-grey mouth ulcers with red edges. The ulcers can be painful and make eating, drinking and swallowing difficult. They should pass within a week. Spotty rash and blisters Soon after the mouth ulcers appear, youll probably notice a rash made up of small, raised red spots on the skin. These typically develop on the fingers, the backs or palms of the hand, the soles of the feet, and occasionally on the buttocks and groin. The spotsmay then turn into small blisters with a grey centre. Thespots and blisters can sometimes beitchy or uncomfortable and typicallylast up to 10days. What to do if you or your child has hand, foot and mouth disease If you have hand, foot and mouth disease, the best thing to do is to stay at home until youre feeling better. Theres no cure for it, so you have to let it run its course. There are things you can do to help ease your or your childs symptoms. Do drink plenty of fluids to avoid dehydration  water or milk are ideal; it may help to give a baby smaller but more frequent bottle or breast milk feeds eat soft foods such as mashed potatoes, yoghurt and soups if eating and swallowing is uncomfortable  avoid hot, acidic or spicy foods and drinks take over-the-counter painkillers, such as paracetamol or ibuprofen, to ease a sore throat and fever  aspirin shouldnt be given to children under the age of 16; paracetamol is best if youre pregnant try gargling with warm, salty water to relieve discomfort from mouth ulcers  its important not to swallow the mixture, so this isnt recommended for young children alternatively, use mouth gels, rinses or sprays for mouth ulcers  these are available from pharmacies, but arent routinely recommended, and some arent suitable for young children; ask your pharmacist for advice and make sure you read the instructions first You should keep your child away from nursery or school until theyre feeling better.Adults with the condition should stay away from work until theyre feeling better. When to get medical advice You dont usually need medical attention if you think you or your child has hand, foot and mouth disease. The infection will usually pass in 7 to 10 days, and there isnt much your doctor can do. Antibiotics wont helpas hand, foot and mouthdisease is caused by a virus. If youre unsure whether you or your child has hand, foot and mouth disease, you can phone 111 or your GP for advice. Get medical advice if: your child is unable or unwilling to drink any fluids your child has signs of dehydration ,such asunresponsiveness, passing small amounts of urine or no urine at all, or cold hands and feet your child develops fits (seizures), confusion, weakness or a loss of consciousness your child is underthree months old and has a temperature of 38C (101F) or above, or is between 3 and 6 months old and has a temperature of 39C (102F) or above the skin becomes very painful, red, swollen and hot, or theres a discharge of pus the symptoms are getting worse or havent improved after 7 to 10 days Get advice from your GP if youre pregnant and youbecome infected within a few weeks of your due date. Infection in pregnancy is usually nothing to worry about, but theres a small chance it could make your baby ill if youre infectedshortly before you give birth. Read more about the risks of hand, foot and mouth disease in pregnancy How hand, foot and mouth disease spreads Someonewith hand, foot and mouth disease is most infectious from just before their symptoms start until theyre feeling better. The infection can be spread by close person to person contact and contact with contaminated surfaces. The virus is found in: the droplets in the coughs and sneezes of an infected person  you can become infected if you get these on your hands and then touch your mouth, or if you breathe in the droplets an infected persons poo  if an infected person doesnt wash their hands properly after going to the toilet, they can contaminate food or surfaces an infected persons saliva or fluid from their blisters  you can become infected if this gets in your mouth The infection is caused by anumber of different viruses, so its possible to get it more than once. Mostpeople develop immunity to these viruses as they get older. Preventing hand, foot and mouth disease Its not always possible to avoid getting hand, foot and mouth disease, but following this advice can help stop the infection spreading. Do stay off work, school or nursery until you or your child are feeling better  theres usually no need to wait until the last blister has healed, provided youre otherwise well use tissues to cover your mouth and nose when you cough or sneeze and put used tissues in a bin as soon as possible wash your hands with soap and water often  particularly after going to the toilet, coughing, sneezing or handling nappies, and before preparing food disinfect any surfaces or objects that could be contaminated  its best to use a bleach-based household cleaner wash any bedding or clothing that could have become contaminated separately on a hot wash Dont do not share cups, utensils, towels and clothes with people who are infected Source: NHS 24 - Opens in new browser window Last updated: 29 May 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Blisters Mouth ulcer NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Hay fever,"Hay fever | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Immune system Hay fever Hay fever Return to Symptoms Enter age Last Updated: Next Review Date: Review my answers Find your local services Search for a service near you by entering your postcode below. Please input your postcode in the following format: A12 1BC GP Practices Dental Services Pharmacies Opticians Postcode Search NHS inform has more information on this condition. Read more Previous Start guide Review my answers  You told us your credentials were: : You said: Based on the information you gave us, we made the following recommendation: Close Keep a copy View PDF Hay fever is a common allergic condition. It affects up to 1 in 5 people at some point in their life. Youll experience hay fever symptoms if you have an allergic reaction to pollen. Pollen is a fine powder released by plants as part of their reproductive cycle. It contains proteins that can cause the nose, eyes, throat and sinuses to become swollen, irritated and inflamed. You can have an allergy to: tree pollen, released during spring grass pollen, released during the end of spring and beginning of summer weed pollen, released late autumn Many people find their symptoms improve as they get older. Hay fever self-help guide Complete our self-help guide to check your symptoms and find out what to do next. Symptoms The symptoms of hay fever include: frequent sneezing runny or blocked nose itchy, red or watery eyes (allergic conjunctivitis ) an itchy throat, mouth, nose and ears cough , caused by postnasal drip (mucus dripping down the throat from the back of the nose) Less commonly, you may also experience: the loss of your sense of smell (anosmia) facial pain (caused by blocked sinuses) headaches earache tiredness and fatigue If you have asthma , your asthma symptoms may get worse when you have hay fever. Treatment Theres currently no cure for hay fever. But most peoplecan relieve symptoms with treatment, at least to a certain extent. The most effective way to control hay fever would be to avoid exposure to pollen. However, its very difficult to avoid pollen, particularly during the summer months. Treatment options for hay fever include: antihistamines  which help to prevent an allergic reaction corticosteroids (steroids)  which help to reduce inflammation and swelling When to get professional advice If you have hay fever, you can get advice and treatment from a pharmacist. Find your nearest pharmacy Hay fever can often be controlled using over-the-counter medication from your pharmacist. Speak to your GP if: your symptoms are getting worse your symptoms do not improve after taking medicines from the pharmacy youre experiencing persistent complications of hay fever, such as worsening asthma or repeated episodes of sinusitis For severe and persistent hay fever, theres also a type of treatment called immunotherapy. It involves being exposed to small amounts of pollen over time. This builds resistance to pollens allergic effects. But it can take many months or even years to work. Whos affected You can get hay fever at any age. But it usually begins in childhood or during the teenage years. Its more common in boys than girls. In adults, men and women are equally affected Youre more likely to develop hay fever if you have a family history of allergies , particularly asthma or eczema . Self-help tips Its sometimes possible to prevent the symptoms of hay fever by taking some basic precautions. Do wear wraparound sunglasses to stop pollen getting in your eyes when youre outdoors take a shower and change your clothes after being outdoors to remove the pollen on your body stay indoors when the pollen count is high (over 50 grains per cubic metre of air) apply a small amount of Vaseline (petroleum gel) to the nostrils to trap pollen Complications Hay fever doesnt pose a serious threat to health. But it can have a negative impact on your quality of life. Very severe hay fever may disrupt your productivity at school or work. Inflammation of the sinuses ( sinusitis ) is another common complication of hay fever. Children may also develop a middle ear infection (otitis media) as a result of hay fever. Source: NHS 24 - Opens in new browser window Last updated: 05 May 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Allergic rhinitis Corticosteroids Allergies Other health sites Pollen calendar Manage your hayfever Asthma and lung UK: Pollen Yellow Card Scheme Met Office: pollen forecast Allergy UK: hay fever Find your nearest pharmacy Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Head and neck cancer,"Head & neck cancer - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Head and neck cancer Head and neck cancer Definition Head and neck cancer is a relatively uncommon type of cancer. There are more than 30 areas within the head and neck where cancer can develop, including the: mouth (including the lips) voice box (larynx) throat (pharynx) salivary glands nose and sinuses area at the back of the nose and mouth (nasopharynx) Oesophageal (gullet) cancer , thyroid cancer , brain tumours and eye cancer dont tend to be classified as a head and neck cancer. Mouth cancer Mouth cancer is the most common type of head and neck cancer. It can affect a number of areas in and around the mouth, including the: lips tongue inside of the cheeks floor or roof of the mouth gums Symptoms of mouth cancer can include persistent mouth ulcers and/or a lump in your mouth, both of which may be painful. Read more about mouth cancer . Laryngeal cancer Laryngeal cancer develops in the tissue of the larynx (voice box). Symptoms of laryngeal cancer can include: a change in the voice, such as persistent hoarseness difficulty or pain when swallowing noisy breathing shortness of breath a persistent cough a lump or swelling in your neck Read more about laryngeal cancer . Throat cancers Doctors dont tend to use the term throat cancer, as the throat (pharynx) includes many different parts that can be affected by cancer. The main areas that can be affected are the: oropharynx  the part of the throat at the back of the mouth hypopharynx  the part of the throat connecting the oropharynx to the gullet and windpipe nasopharynx  the part of the throat that connects the back of the nose to the back of the mouth (see below) The most common symptoms of cancer in the oropharynx or hypopharynx include a lump in the neck, a persistent sore throat and difficulty swallowing. Macmillan Cancer Support has more information about oropharyngeal cancer . Salivary gland cancer Salivary glands produce saliva, which keeps your mouth moist and helps withswallowing and digestion. There are 3 main pairs of salivary glands. They are the: parotid glands located between your cheeks and your ears sublingual glands  located under your tongue submandibular glands  located under each side of your jawbone Salivary gland cancer most commonly affects the parotid glands. The main symptom of salivary gland cancer is a lump or swelling on or near your jaw, or in your mouth or neck, although the vast majority of these lumps are non-cancerous. Other symptoms can include numbness in part of your face and drooping on one side of your face. To read more about salivary gland cancer, visit Cancer Research UK and Macmillan Cancer Support . Nose and sinus cancer Nose and sinus cancer affects the nasal cavity (above the roof of your mouth) and the sinuses (the small, air-filled cavities inside the bones of the nose and within the cheekbones and forehead). The symptoms of nose and sinus cancer are similar to viral or bacterial infections, such as the common cold or sinusitis , and include: a persistent blocked nose, which usually only affects one side nosebleeds a decreased sense of smell mucus running from the nose or down the throat Read more about nose and sinus cancer . Nasopharyngeal cancer Nasopharyngeal canceraffects the part of the throat that connects the back of the nose to the back of the mouth. Its one of the rarest types of head and neck cancer in the UK. Symptoms can include: a lump in the neck, due to the cancer spreading to the lymph nodes (pea-sized lumps of tissue that make up part of the immune system)in the neck a blocked or stuffy nose nosebleeds hearing loss (usually only in one ear) Read more about nasopharyngeal cancer . Source: NHS 24 - Opens in new browser window Last updated: 13 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Mouth cancer Thyroid cancer Laryngeal (larynx) cancer Nasopharyngeal cancer Nasal and sinus cancer Other health sites Cancer Research UK: Head and neck cancer Macmillan Cancer Support: Head and neck cancers National Association of Laryngectomee Clubs Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Head lice and nits,"Head lice and nits | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Skin, hair and nails Head lice and nits Head lice and nits Head lice are tiny insects that live in hair. Nits are the empty egg cases attached to hair that head lice hatch from. Head lice are a common problem, particularly in school children aged 4 to 11. Theyre largely harmless, but can live in the hair for a long time if not treated and can be irritating and frustrating to deal with. Head lice nits and bites. https://dermnetnz.org/ Signs of head lice Head lice can be difficult to spot, even when the head is closely inspected. Theyre very small whitish or grey-brown insects that range from the size of a pinhead to the size of a sesame seed. Less reliable signs of head lice include: small white eggs or nits (egg cases) in the hair behind the ears or at the back of the neck an itchy scalp a rash on the back of the neck feeling as though something is moving in the hair How to spot head lice The only way to be sure someone has head lice is to find a live louse by combing their hair with a special fine-toothed comb. This is called detection combing. You can buy detection combs from your local pharmacy , supermarket or online. Combs with flat-faced teeth spaced 0.2 to 0.3mm apart are best for removing head lice, although combs with smaller gaps can be used to remove eggs and nits (egg cases) after treatment. Detection combing can be carried out on dry or wet hair. Dry combing takes less time, but wet combing is more accurate because washing with conditioner stops head lice from moving. Wet detection combing To use the wet detection method: wash the hair with ordinary shampoo apply plenty of conditioner use an ordinary, wide-toothed comb to straighten and untangle the hair once the comb moves freely through the hair without dragging, switch to the louse detection comb make sure the teeth of the comb slot into the hair at the roots, with the edge of the teeth lightly touching the scalp draw the comb down from the roots to the ends of the hair with every stroke, and check the comb for lice each time  remove lice by wiping the comb with tissue paper or rinsing it work through the hair, section by section, so that the whole head of hair is combed through do this at least twice to help ensure you havent missed any areas continue until you find no more lice If you find head lice, you should check the rest of your family. Treat everyone found to have head lice on the same day. Dry detection combing To use the dry detection method: use an ordinary, wide-toothed comb to straighten and untangle the hair once the comb moves freely through the hair without dragging, switch to the louse detection comb make sure the teeth of the comb slot into the hair at the roots, with the edge of the teeth lightly touching the scalp draw the comb down from the crown to the ends of the hair with every stroke look for lice as the comb is drawn through the hair. If you see a louse, trap it against the face of the comb with your thumb to stop if being repelled by static electricity comb each section of hair 3 or 4 times before moving on to the next section continue until the whole head has been combed through How to get rid of head lice and nits Treatments to get rid of head lice are available to buy from pharmacies, supermarkets and online. The main treatments are: lotions and sprays wet combing Everyone with head lice in your household should be treated on the same day. If a treatment doesnt work the first time, you can: try it again try a different treatment get advice from your school nurse, health visitor, pharmacist or GP Lotions and sprays for head lice and nits There are several different products that can be applied to the scalp and hair to kill head lice, including: dimeticone 4% lotion or lotion spray  applied and left for 8 hours (usually overnight) dimeticone 4% spray gel  applied and left for 15 minutes mineral oil and dimeticone spray  applied and left for 15 minutes isopropyl myristate and cyclomethicone solution  applied and left for 5-10 minutes Some treatments need to be done twice  7 days apart. This makes sure that any newly-hatched lice are killed. Detection combing should usually be done 2 or 3 days after finishing treatment, and again another 7 days after that, to check for any live head lice. Always check the pack or leaflet to see if a product is suitable for you, particularly if: youre pregnant youre breastfeeding your child has head lice and is less than 2 years of age Your pharmacist can recommend a suitable treatment and advise you on how to use it correctly if necessary. When to get professional advice Your pharmacist can advise you about treatments for head lice and nits if youre not sure which is best for you or your child. Make sure you carefully follow the instructions that come with the treatment you choose. Find your nearest pharmacy You can get advice and treatment on head lice and nits directly from a pharmacy. Pharmacies How head lice are spread Head lice are spread by direct head to head contact. They climb from one persons hair to anothers. Head lice: cant fly, jump or swim are very unlikely to be spread by objects like hats, combs and pillows dont have a preference for dirty, clean, short or long hair only affect people cant be caught from animals Once detached from the hair, head lice will usually die within 12 to 24 hours. Preventing head lice Its very difficult to prevent head lice. You may want to consider regular detection combing if youre concerned about your children or yourself. For example, on a weekly basis. Lotions and sprays dont prevent head lice and should only be used if a live louse has been found in your or your childs hair. Staying off work or school and washing clothing and bedding on a hot wash is unnecessary, as its unlikely to help prevent the spread of head lice. Source: NHS 24 - Opens in new browser window Last updated: 18 January 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Headaches,"Headaches | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Headaches Headaches Return to Symptoms Enter age Last Updated: Next Review Date: Review my answers Find your local services Search for a service near you by entering your postcode below. Please input your postcode in the following format: A12 1BC GP Practices Dental Services Pharmacies Opticians Postcode Search NHS inform has more information on this condition. Read more Previous Start guide Review my answers  You told us your credentials were: : You said: Based on the information you gave us, we made the following recommendation: Close Keep a copy View PDF Most headaches are not serious. In many cases, you can treat your headache at home. Headache self-help guide Complete our self-help guide to check your symptoms and find out what to do next. How you can help yourheadache yourself Do rest take painkillers such as paracetamol or ibuprofen drink plenty of fluids relax (if stress is the cause) take regular exercise When to get professional advice Your local pharmacy can provide: advice about headaches treatments to help relieve headaches Find your local pharmacy Speak to a GP if: treatments recommended by your pharmacist do not relieve your headache your headache is getting worse despite taking painkillers painful or frequent headachesaffect your daily activities or cause you to miss work Phone 111 if: your headache does not go away and gets worse over time your headache is triggeredsuddenly by coughing, laughing, sneezing,changing posture, orphysical effort You have a headache and: a sore scalp jaw pain while chewing you feel weak Phone 999 if: your headache occurs suddenly and is very severe it may feel like a blinding pain your headache occurs after a severe head injury You have an extremely painful headache and: slurred speech or memory loss a very high temperature, feel hot and shivery, and have a stiff neck or a rash drowsiness or confusion vision problems severe pain and redness in one of your eyes Tension headaches Tension headachesare the most common type of headache. Theyre what we think of as normal, everyday headaches.They feel like a constant ache that affects both sides of the head, as though a tight band is stretched around it. Normally, tension headaches are not severe enough to prevent you doing everyday activities. They usually last for 30 minutes to several hours,but can last for several days. What causes a tension headache? The exact cause is unclear, but tension headaches have been linked to things such as: stress poor posture skipping meals dehydration How to treat a tension headache You can usually treat tension headaches with painkillers suchas paracetamol and ibuprofen . Lifestyle changes may also help, for example: getting regular sleep reducing stress staying well hydrated Migraines Migraines are less common than tension headaches.Theyre usually felt as asevere, throbbing pain at the front or side of the head. Some people also have other symptoms, such as: nausea vomiting increased sensitivity to light or sound Migraines can stop you carrying out your normal daily activities.They usually last at least a couple of hours. Some people find they need to stay in bed for days at a time. How to treat migraines Most people cantreat their migraines with over-the-counter medication from the pharmacist. If your migraines are severe, you may need to be prescribed stronger medication by your GP. This may be able to relieve and preventyour migraines. Read further information about migraines Cluster headaches Cluster headaches are a rare type of headache. They occur in clusters for a month or two at a time around the same time of year. Cluster headaches are excruciatingly painful. They cause intense pain around one eye, and often occur with other symptoms, such as a: watering or red eye blocked or runny nose Pharmacy medications dont usually ease the symptoms of a cluster headache.Your GP can prescribe specific treatments to ease the pain and help prevent further attacks. Medication and painkiller headaches Some headaches are a side effect of taking a particular medication. Frequent headaches can also be caused by taking too many painkillers. This is known as a painkiller or medication-overuse headache. A medication-overuse headache will usually get better within a few weeks once you stop taking the painkillers that are causing it. But, pain may get worse for a few days before it starts to improve. Hormone headaches Headaches in women are often caused by hormones, and many women notice a link with their periods. The combined contraceptive pill ,the menopause and pregnancy are also potential triggers. You may be able to help reduce headaches associated with your menstrual cycle by: reducing your stress levels having a regular sleeping pattern making sure you do not miss meals Other causes of headaches Headaches can also have a number of other causes, including: drinking too much alcohol a head injury or concussion a cold or flu temporomandibular disorders problemsaffecting the chewing muscles and the joints between the lower jaw and the base of the skull sinusitis  inflammation of the lining of the sinuses carbon monoxide poisoning sleep apnoea  a condition where the walls of the throat relax and narrow during sleep, interrupting normal breathing Source: NHS 24 - Opens in new browser window Last updated: 07 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites Brain and Spine Foundation: Headache The Migraine Trust National Migraine Centre Find your local pharmacy Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Hearing loss,"Hearing loss | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Ears, nose and throat Hearing loss Hearing loss Hearing loss is a common problem that often develops with age or is caused by repeated exposure to loud noises. Royal National Institute for Deaf People (RNID) estimates that there are more than 10 million (about 1 in 6) people in the UK with some degree of hearing impairment or deafness. Hearing loss can occur suddenly, but usually develops gradually. When to get medical advice Speak to your GP practice if: You or your child are: having problems with your hearing lose your hearing suddenly, in one or both ears Your GP can check for any problems and may refer you to an audiologist (hearing specialist) or an ENT specialist for further tests. Hearing tests are also available on the high street, but you may have to pay for these. Signs of hearing loss Early signs of hearing loss can include: difficulty hearing other people clearly and misunderstanding what they say, especially in group situations asking people to repeat themselves listening to music or watching television with the volume higher than other people need difficulty hearing the telephone or doorbell finding it difficult to tell which direction noise is coming from regularly feeling tired or stressed from having to concentrate while listening If you also hear a ringing, buzzing or hissing sound in your ears, this could be a sign of tinnitus , which is often associated with hearing loss. Signs in babies You should consider seeing your GP if you notice that your baby or toddler: isnt startled by loud noises doesnt turn towards the source of a sound when under 4 months old doesnt say single words by the time theyre 1 year old notices you when they see you, but not when you call their name hears some sounds but not others Signs in children You should consider seeing your GP if you notice that your child: is slow to learn to talk, or theyre not clear when they speak often asks you to repeat yourself or responds inappropriately to a question doesnt reply when you call them often talks very loudly often turns up the volume of the television so its very loud watches other people to copy instructions, because they havent heard What causes hearing loss? Hearing loss is the result of sound signals not reaching the brain. There are 2 main types of hearing loss, depending on where the problem lies: sensorineural hearing loss  caused by damage to the sensitive hair cells inside the inner ear or damage to the auditory nerve, which can happen naturally with age or as a result of injury conductive hearing loss  when sounds are unable to pass from your outer ear to your inner ear, often because of a blockage such as earwax , glue ear or a build-up of fluid from an ear infection , perforated ear drum or disorder of the hearing bones Its also possible to have both these types of hearing loss. This is known as mixed hearing loss. Some people are born with hearing loss, but most cases develop as you get older. Treatment for hearing loss The way hearing loss is treated depends on the cause and how severe it is. In cases of sensorineural (nerve) hearing loss, there are several options that may help to improve a persons ability to hear and communicate. These include: digital hearing aids  which are available through the NHS bone anchored implants  suitable for people who are unable to use hearing aids and for some levels of sensorineural hearing loss middle ear implants  suitable for some people who are unable to use hearing aids cochlear implants  for people who find hearing aids arent powerful enough lip reading and/or sign language  such as British Sign Language (BSL) Conductive hearing loss is sometimes temporary and can be treated with medication or minor surgery, if necessary. However, more major surgery may be required to fix the ear drum or hearing bones. How to prevent hearing loss It isnt always possible to prevent hearing loss if you have an underlying condition that causes you to lose your hearing. However, there are several things you can do to reduce the risk of hearing loss from long-term exposure to loud noise. Its possible to reduce your risk of noise-induced hearing loss (hearing loss from loud noise). Do use headphones that block out more outside noise, rather than turning up the volume use ear protection equipment such as ear muffs or ear plugs if you work in a noisy environment, such as a pub, nightclub, a garage workshop or on a building site  your employer should provide these use ear-protection equipment at loud concerts and at other events where there are high noise levels, such as motor races be aware of the symptoms of common causes of hearing loss, such as ear infections (otitis media) and Mnires disease speak to your GP practice if you or your child are experiencing hearing problems Dont do not have your television, radio or music on too loud do not insert objects into your ears or your childrens ears  this includes fingers, cotton buds, cotton wool and tissue You should also speak to your GP practice if you have signs of an ear infection, such as flu -like symptoms, severe earache , discharge or hearing loss. Source: ENT Scotland - Opens in new browser window Last updated: 28 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites GOV.UK: Disabled people British Deaf Association Which? Hearing aid types Hearing Link Hearing Dogs for the Deaf Action on Hearing Loss NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Heart attack,"Heart attack | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Heart and blood vessels Conditions Heart attack Heart attack Phone 999 immediately if: You or someone else has symptoms like: central chest pain or discomfort in the chest that doesnt go away  it may feel like pressure, tightness or squeezing pain that radiates down the left arm, or both arms, or to the neck, jaw, back or stomach unconsciousness seizures or fitting difficulty breathing (snoring or rasping) rapid heart beat low or undetectable heart beat chest pain and breathlessness, nausea, sweating or coughing up blood What is a heart attack? A heart attack happens when theres a reduction in blood supply to part of the heart muscle. This lack of blood flow can cause damage to the heart. Sometimes, when chest pain occurs suddenly, its unclear if its due to unstable angina or a heart attack. Until tests confirm the diagnosis, doctors sometimes call this Acute Coronary Syndrome (ACS). Further information on causes and risk factors for a heart attack. Diagnosing a heart attack In order to find out if youre having a heart attack, youll need to have some tests. These tests can include: an electrocardiogram (ECG)  to check your hearts rhythm and electrical activity blood tests  to check troponin levels, a protein thats released into the blood stream when the heart muscle is damaged an assessment of blood pressure an assessment of blood oxygen levels a chest X-ray an echocardiogram  to assess the structure and function of your heart a coronary angiogram  to identify any blood vessels that are narrowed or blocked Based on your test results, your clinical team will decide your treatment plan. Treating a heart attack When someone has a heart attack, its important to restore blood flow quickly. Thisll minimise damage to the heart muscle and start to alleviate symptoms. Your treatment plan will depend on: the type of heart attack youve had your individual situation Types of treatment Treatment for a heart attack may consist of: anti-emetics  to stop sickness and nausea antiplatelet therapy  medication that thins the blood and gets rid of blood clots coronary angioplasty  a procedure to widen coronary arteries that are blocked or narrow oxygen therapy  to help with your breathing and oxygen levels pain-relieving drugs  like morphine reperfusion treatment  to help restore blood flow and maintain the hearts pumping action thrombolysis  a clot-busting drug to help restore blood flow to your heart People whove had a heart attack will need to take several different types of medication. Your doctor will try to find the best drugs for you with the fewest side effects. Complications of a heart attack Sometimes there are complications following a heart attack. The most common complications after a heart attack are: arrhythmias  problems with your hearts natural electrical rhythm heart failure  when the heart isnt pumping blood around the body as well as it should Many problems resolve themselves quite quickly. However, sometimes problems linger and can often be helped by medication. Recovering from a heart attack How long you stay in hospital will depend upon your circumstances and treatment. Dont be afraid to ask your medical team about whats happening. On discharge, you should be referred onto a cardiac rehabilitation programme. Cardiac rehabilitation You should receive an assessment to determine your individual goals and needs after a heart attack. Rehabilitation is usually a mix of exercise and education sessions. This helps to provide you with the information, advice and support to: understand your condition and medication recover from your heart attack, procedure or surgery make lifestyle changes to improve your heart health Your cardiac rehabilitation team can also give you advice on practical issues after a heart attack, including: driving mental wellbeing relationships sexual relationships returning to work long term recovery The British Heart Foundation has further information on cardiac rehabilitation. Source: Scottish Government - Opens in new browser window Last updated: 07 February 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform What to do in a heart emergency Chest pain Other health sites British Heart Foundation: Heart attack Chest Heart & Stroke Scotland: Heart attack St John Ambulance: Heart attack NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Heart failure,"Heart failure Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Heart and blood vessels Conditions Heart failure Heart failure Heart failure is a condition where your heart cannot pump blood around your body as well as it should. It does not mean that your heart has stopped working completely, but you may need support to help it to work better and to manage your symptoms. Symptoms of heart failure When the heart is not pumping blood as well as it should, you can experience a range of symptoms. Speak to a GP if you have: breathlessness a persistent cough tiredness or fatigue that occurs even at rest and gets worse with movement swelling in the legs or ankles Causes of heart failure There are many reasons why someone might develop heart failure. These can include: a heart attack coronary heart disease inherited heart disease (for example, cardiomyopathy) high blood pressure (hypertension) heart rhythm or valve abnormalities viral infection damage from the immune system (myocarditis) congenital heart disease amyloidosis Diagnosing heart failure Your doctor will ask you some questions about your symptoms and do an examination. If they think that you might have heart failure, youll be sent for some further tests. Tests to confirm a diagnosis of heart failure may include: blood tests to check for signs of a problem with your heart  this may include testing your BNP levels, which increase when the heart is not working well a chest X-ray  to check if theres fluid in your lungs or if a lung condition is causing the symptoms an electrocardiogram (ECG)  records the electrical activity and rhythms of your heart an echocardiogram  checks the pumping action of your heart and the function of the valves in your heart Treating heart failure If you have heart failure, treatments are available to help you manage your symptoms. This can help to improve your quality of life. Your doctor will discuss treatment optionswith you.The best option for you willdepend on your individual circumstances. The standard medicines for treating heart failure are: angiotensin converting enzyme (ACE) inhibitors angiotensin-receptor neprilysin inhibitor (ARNI) angiotensin receptor blockers (ARBs) beta blockers diuretics (water tablets) mineralocorticoid receptor antagonists (MRAs) For some people with severe heart failure, a heart transplant may be recommended. Your doctor will discuss whether this is an appropriate option for you. Managing heart failure Do keep as active as possible keep a healthy weight eat a healthy diet limit alcohol intake stop smoking Support Living with heart failure can bring a lot of uncertainty. Some people might find this difficult. You can get support in dealing with heart failure from: a local support group  ask your GP for advice or search Scotlands Service Directory The British Heart Foundation Chest, Heart & Stroke Scotland Further information on heart failure Source: Scottish Government - Opens in new browser window Last updated: 18 October 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites Chest Heart & Stroke Scotland: Heart failure NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Hepatitis A,"Hepatitis A | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Hepatitis A Hepatitis A Hepatitis A is a liver infection thats spread in the poo of an infected person. The chance of getting it in the UK is low. Hepatitis A is not usually serious. Most people get better within a couple of months. A hepatitis A vaccine is available on the NHS if youre at increased risk. Symptoms of hepatitis A Some people with hepatitis A, particularly young children, wont have any symptoms. If you do develop symptoms, they tend to occur around 4 weeks after exposure to the hepatitis A virus. Symptoms of hepatitis A include: feeling tired and generally unwell joint and muscle pain a high temperature (fever) loss of appetite feeling or being sick pain in the upper-right part of your tummy a headache , sore throat and cough constipation or diarrhoea a raised, itchy rash (hives) yellowing of the skin and eyes (jaundice) dark pee pale poo itchy skin the upper-right part of your tummy becoming swollen and tender When to get medical advice Speak to your GP practice if: you think you may have been exposed to the hepatitis A virus  emergency treatment can help prevent infection if given within a few days of exposure you have symptoms of hepatitis A youre at increased risk of hepatitis A Diagnosing hepatitis A A blood test can check whether you have hepatitis A. It can also rule out other conditions that cause similar symptoms, but which may require treatment to prevent more serious problems. Your friends, family and sexual partners may need to be tested too. Treatments for hepatitis A Theres currently no cure for hepatitis A. It will usually get better its own within a couple of months. Once hepatitis A passes, youll normally be immune to it for life. Things you can do yourself There are things you can do to help your symptoms and prevent the infection spreading to others. Do get plenty of rest take painkillers such as paracetamol or ibuprofen for any aches and pains  ask your GP for advice as you may need to take lower doses than normal or avoid certain medications until youve recovered have a cool, airy environment wear loose clothing eat smaller, lighter meals to help reduce feeling sick and vomiting wash your hands with soap and water regularly wash soiled laundry separately on a hot cycle clean the toilet, flush handles and taps more often than usual Dont do not drink alcohol do not have very hot baths or showers do not prepare food for other people, if you can avoid it do not share towels do not go to work or school until at least a week after your jaundice or other symptoms started do not have sex until at least a week after your jaundice or other symptoms started Treatments from your doctor Speak to your GP practice if your symptoms get worse or havent started to improve within a couple of months. They can prescribe medications to help with itchiness, nausea or vomiting, if needed. Long-term hepatitis A Hepatitis A can occasionally last for many months. In rare cases, it can be life-threatening if it causes liver failure. People most at risk include those with other liver problems and elderly people. If liver failure does occur, a liver transplant is usually needed to treat it. How is hepatitis A spread? Hepatitis A is most widespread in parts of the world where standards of cleanliness and food hygiene are poor. You can get the infection from: drinking unclean water eating food thats been washed or grown in unclean water eating food thats been handled by an infected person close contact with someone who has hepatitis A having sex with someone who has the infection  particularly if you touch their anus with your fingers, mouth or tongue injecting drugs using unclean equipment Someone with hepatitis A is most infectious from around 2 weeks before their symptoms appear until about 1 week after the symptoms first develop. The hepatitis A vaccine Vaccination is the best way to prevent hepatitis A. The hepatitis A vaccine isnt routinely offered in the UK because the risk of infection is low for most people. Its only recommended for people at increased risk, including: close contacts of someone with hepatitis A people planning to travel to or live in parts of the world where hepatitis A is widespread , particularly if levels of cleanliness and food hygiene are expected to be poor people with any type of long-term (chronic) liver disease men who have sex with other men people who inject illegal drugs people who may be exposed to hepatitis A through their job  for example sewage workers, staff at homeless shelters, and people working with monkeys, apes and gorillas Last updated: 19 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Hepatitis C Hepatitis B Other health sites British Liver Trust: hepatitis A Lab Tests Online UK: hepatitis A test fitfortravel: Hepatitis A NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Hepatitis B,"Hepatitis B | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Hepatitis B Hepatitis B Hepatitis B is a liver infection thats spread through blood and body fluids. The chance of getting it in the UK is low. It often doesnt cause any symptoms in adults and usually passes in a few months without treatment. In children it often persists for years and may eventually cause serious liver damage. A hepatitis B vaccine is available on the NHS as part of routine child vaccination , or if youre at high risk. Symptoms of hepatitis B Many people with hepatitis B wont have any symptoms. If you do develop symptoms, they tend to occur 2 or 3 months after exposure to the hepatitis B virus. Symptoms of hepatitis B include: tiredness a high temperature (fever) of 38C (100.4F) or above general aches and pains loss of appetite feeling and being sick diarrhoea abdominal pain yellowing of the skin and eyes (jaundice) When to get medical advice Speak to your GP practice if: you think you may have been exposed to the hepatitis B virus  emergency treatment can help prevent infection if given within a few days of exposure you have symptoms of hepatitis B youre at high risk of hepatitis B Diagnosing hepatitis B A blood test can check if you have hepatitis B or have had it in the past. The hepatitis B vaccine may also be recommended to reduce your risk of infection. Treatments for hepatitis B Treatment for hepatitis B depends on how long youve been infected for. Emergency treatment If youve been exposed to the virus in the last few days, emergency treatment can help stop you becoming infected. Treatment for acute hepatitis B Acute hepatitis B means youve only had the infection for a few weeks or months. You may only need treatment to relieve your symptoms while your body fights off the infection itself. Treatment for chronic hepatitis B Chronic hepatitis B means youve had the infection for more than 6 months. You may be offered medicines that can keep the virus under control and reduce the risk of liver damage. Chronic hepatitis B often requires: long-term or lifelong treatment regular checks for any further liver problems How is hepatitis B spread? The hepatitis B virus is found in the blood, semen and vaginal fluids and bodily fluids of an infected person. It can be spread by: a mother to her newborn baby, particularly in countries where the infection is common within families (child to child) in countries where the infection is common injecting drugs and sharing needles and other drug equipment, such as spoons and filters having sex with an infected person without using a condom having a tattoo, body piercing, or medical or dental treatment with unsterilised equipment sharing toothbrushes, razors or scissors contaminated with infected blood Hepatitis B is not spread by kissing, holding hands, hugging, coughing, sneezing, or sharing crockery and utensils. How to prevent hepatitis B A vaccine that offers protection against hepatitis B is available for all babies born in the UK on or after 1 August 2017. Its also available for people at high risk of the infection or complications from it. People at high risk of hepatitis B People at high risk of hepatitis B include: babies born to mothers with hepatitis B close family and sexual partners of someone with hepatitis B people travelling to a part of the world where hepatitis B is widespread families adopting or fostering children from high-risk countries people who inject drugs or have a sexual partner who injects drugs people who change their sexual partner often men who have sex with men male and female sex workers people whose job puts them at risk of contact with blood or body fluids, such as nurses, prison staff, doctors, dentists and laboratory staff people with chronic liver disease people with chronic kidney disease people in prison people receiving regular blood or blood products, and their carers Hepatitis B core antibody (anti-HBc) testing NHS Scotland is making the blood supply safer by introducing enhanced hepatitis B screening. This is an additional measure to improve testing for blood donors and further increase the safety of the blood supply chain. NHS Scotland has been conducting this enhanced screening on all donations since April 2022. Only a small number of donors are impacted, however, these donors will no longer be able to donate. Living with hepatitis B As well as medical treatments, there are some things you can do when you have hepatitis B to help ease the symptoms and stop the infection spreading to others. Do eat a healthy and balanced diet rest and stay hydrated take painkillers like paracetamol and ibuprofen  ask your doctor for advice about how much paracetamol you should take as you may not be able to take a normal dose keep your room well ventilated, wear loose clothing and avoid hot showers and baths if you feel itchy speak to your doctor if youre thinking of having a baby Dont do not have unprotected sex  including anal and oral sex do not drink alcohol  this can increase your risk of developing serious liver problems do not share toothbrushes, razors or needles with other people Your close contacts, such as family members, may need to be vaccinated. Complications of hepatitis B Most people do not have any lasting problems after having a hepatitis B infection. In some patients chronic hepatitis B can cause liver damage ( cirrhosis ) and increase your risk of getting liver cancer . It is important that all patients with chronic hepatitis B are followed up in specialist clinics. If required, treatment can control hepatitis B infection, preventing serious complications. Last updated: 28 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Hepatitis C Hepatitis A Other health sites Hepatitis B Foundation NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Hepatitis C,"Hepatitis C | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Hepatitis C Hepatitis C Hepatitis C is a liver infection thats spread through blood. It can be cured with treatment. But if left untreated, it can sometimes cause serious and potentially life-threatening damage to the liver over many years. Symptoms of hepatitis C Many people with hepatitis C wont have any symptoms until the liver has been significantly damaged. This means many people have the infection without knowing. Early symptoms (acute hepatitis C) Most people will not have symptoms during the first 6 months of a hepatitis C infection. This stage is known as acute hepatitis C. If symptoms do develop, they usually occur a few weeks after infection. Early symptoms may include: a high temperature (fever) of 38C (100.4F) or above tiredness loss of appetite abdominal pain feeling and being sick yellowing of the skin and eyes (jaundice) Later symptoms (chronic hepatitis C) Symptoms can vary from person to person. They can also go away for long periods of time and then return. Later symptoms may include: feeling tired all the time joint and muscle aches and pain feeling sick brain fog  including problems with memory, concentration and mental tasks such as arithmetic mood swings depression or anxiety indigestion or bloating itchy skin abdominal pain When to get medical advice Speak to your GP practice if: you have symptoms of hepatitis C theres a risk youre infected with hepatitis C, even if you dont have symptoms The only way to know for certain if these symptoms are caused by hepatitis C is to get tested. Getting tested for hepatitis C You can get tested for hepatitis C at: your GP practice a sexual health clinic a drug treatment service most substance use recovery services Treatments for hepatitis C Treatment takes 8 to 12 weeks, and usually cures the infection. But you wont be immune to hepatitis C. So you should take steps to reduce your risk of becoming infected again. If the infection is diagnosed early (acute hepatitis), you may not need treatment straight away. Instead, you may have another blood test after a few months to see if your body fights off the virus itself. If the infection continues for several months (chronic hepatitis), treatment will usually be recommended. Things you can do yourself There are things you can do to stop liver damage and prevent the infection spreading to others before you start treatment. Do eat a healthy and balanced diet exercise regularly speak to your doctor if youre thinking of having a baby Dont do not drink alcohol do not smoke do not share toothbrushes, razors, needles or other injecting equipment with other people How is hepatitis C spread? You can become infected with hepatitis C if you come into contact with the blood of an infected person. Some ways the infection can be spread include: injecting drugs and sharing needles and other drug equipment, such as spoons and filters sharing toothbrushes, razors or scissors contaminated with infected blood from a pregnant woman to her unborn baby having sex with an infected person without using a condom  if your partner has hepatitis C, you should be tested if you had a blood transfusion in Scotland before September 1991, for example after a traffic accident or during childbirth, you may have been exposed to hepatitis C  all donor blood in Scotland has been screened for hepatitis C since September 1991 having a tattoo, body piercing, or medical or dental treatment with unsterilised equipment How to prevent hepatitis C Theres no vaccine for hepatitis C. There are things you can do to reduce your risk of becoming infected. Do use condoms when having anal sex, or sex with a new partner get vaccinated against hepatitis A and hepatitis B if you inject drugs, use a fresh safe injecting kit (available from needle exchanges) every time you inject Dont do not share any drug-injecting equipment  including needles, syringes, spoons and filters do not share razors or toothbrushes The risk of getting hepatitis C through vaginal sex is very low. It may be higher if blood is present, such as period (menstrual) blood or from bleeding during anal sex. Complications of hepatitis C If left untreated for many years, hepatitis C can cause liver damage ( cirrhosis ). In severe cases, life-threatening problems such as liver failure or liver cancer can eventually develop. Early treatment of hepatitis C prevents these serious complications, while later treatment reduces the risk. Last updated: 19 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Cirrhosis Hepatitis A Hepatitis B Other health sites British Liver Trust: hepatitis C Hepatitis C Trust NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Hiatus hernia,"Hiatus hernia | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Hiatus hernia Hiatus hernia About hiatus hernia Diagnosing hiatus hernia Treating hiatus hernia Complications of hiatus hernia About hiatus hernia A hiatus hernia, or hiatal hernia, is when part of the stomach squeezes up into the chest through an opening (hiatus) in the diaphragm. The diaphragm is a large, thin sheet of musclebetween the chestand the abdomen (tummy). Hiatus hernia and heartburn A hiatus hernia itself rarelyhas any noticeable symptoms. However, it can cause a problem called gastro-oesophageal reflux disease (GORD) . GORD is where stomach acid leaks into the oesophagus (the tube that carries food to the stomach). It can occur if a hiatus hernia prevents the valve at the bottom of the oesophagus from working properly. Your oesophagus can becomeseverely irritated, because its not protected against stomach acid. This can cause symptoms such as heartburn, chest pain, an unpleasant sourtaste in your mouth, and swallowing problems ( dysphagia ). You should see your GP if you have frequent and severe symptoms of GORD . What causes a hiatus hernia? Its not exactly clear what causes hiatus hernia, but it may be the result of the diaphragm becoming weak with age, or pressure on the abdomen. Hiatus hernia can sometimes occur in newborn babies if the stomach or diaphragm doesnt develop properly. Whos affected Hiatus hernia can affect anyone, but its more common in people who are: over 50 years of age overweight pregnant Its estimated that a third of people over 50 have a hiatus hernia. Theres also arare type of hiatus hernia that affects newborn babies, whichis caused by a congenital defect of the stomach or diaphragm. Congenital means that it is present from birth. Types of hiatus hernia There are 2main types of hiatus hernia. They are: sliding hiatus hernias  hernias thatmove up and down, in and out of the chest area (more than 80% of hiatus hernias are of this type) para-oesophageal hiatus hernias  also called rolling hiatus hernias, where part of the stomach pushes up through the hole in the diaphragm next to the oesophagus (about 5 to 15% of hiatus hernias are of this type) These pagesmainly focus on sliding hiatus hernias. They can usually be diagnosed using an X-ray or an endoscopy, where a long, thin flexible tube with a light and video camera at one end is used to examine the inside of the body. Read more about diagnosing a hiatus hernia . Treating a hiatus hernia Treatment for a sliding hiatus herniausually focuses on relieving the symptoms of GORD, such as heartburn. Lifestyle changes and medication are the preferred treatments. Surgery is usually only recommended as an alternative to long-term medication or if other treatments havent worked. Lifestyle advicemay include: eating smaller, more frequent meals, rather than 3large meals a day avoiding lying down (including going to bed) for 3hours after eating or drinking removing any foods or drinksfrom your dietthat make your symptoms worse If a hiatus hernia isnt causing any noticeable problems, it doesnt usually need to be treated. Surgery is used to repair a para-oesophageal hiatus hernia if theres arisk of serious complications. Read more about treating a hiatus hernia . Further problems Its rare for a hiatus hernia to cause complications,but long-term damageto the oesophaguscaused byleaking stomach acid can lead toulcers, scarring and changes to the cells of the oesophagus,which can increase your risk of oesophageal cancer . Read more about the complications of a hiatus hernia . Diagnosing hiatus hernia A hiatus hernia can usually be diagnosed after a gastroscopy or X-ray. Gastroscopy Agastroscopyis a procedure where theinside of your body is examined using a gastroscope(a long, thin flexible tube with a light and video camera at one end), which sends images to an external monitor. The gastroscope will be inserted into your mouth and down your throat, and will be used to help identify any problems. The procedure may be carried out using a local anaesthetic or a sedative to help you relax. Barium meal X-ray The barium meal X-ray , also called the barium swallow test, is an effective way ofidentifying a hiatus hernia. As part of the test, youll be asked to drink some barium solution. Barium is a non-toxic chemicalthat shows up clearly on anX-ray. Once the barium moves down into your digestive system, a series of X-rays will be taken to identify any problems. If you need to have a barium meal X-ray, you wont be able to eat or drink anything for at least 6hours before the procedure, so that your stomach and duodenum (the top of the small intestine) are empty. You may be given an injection to relax the muscles in your digestive system. Youll be given a white, chalky liquid containing barium to drink while lying down. This will allow the specialist to see your stomach on an X-ray monitor more easily, as well as any ulcers or abnormal growths. Yourbed may be tipped slightly during the test, so that the barium fills all the areas of your stomach. A barium swallow usually takes about 15 minutes to perform. Afterwards, youll be able to eat and drink as normal, although you may need to drink more water to help flush the barium out of your system. You may feel slightly sick after a barium meal X-ray and the barium may cause constipation . Your stools may also be white for a few days afterwards, as the barium passes through your system. Treating hiatus hernia Treatment for a hiatus hernia is usually only necessary if its causing problems. In most cases, people with a hiatus hernia only experience problems if the hernia causes gastro-oesophageal reflux disease (GORD) . GORD can cause symptoms such as heartburn and an unpleasant taste in your mouth. Lifestyle changes and medication are the preferred treatments, although surgery may be used as an alternative to long-term medication, or if other treatments are ineffective. Lifestyle changes There are several things you can do yourself to help relieve symptoms of GORD caused by a hiatus hernia. These include: eating smaller, more frequent meals, rather than three large meals a day avoiding lying down (including going to bed) for at least 3hours aftereating or drinking avoiding drinking during the night removing certainfoodsfrom your diet if you think they make your symptoms worse avoiding alcohol , caffeine, chocolate, tomatoes, fatty foods, spicy foods and acidic foodor drinks, such as citrus fruit juice, if they make your symptoms worse avoiding bending over or stooping, particularly after eating or drinking raising the head of your bed by around 20cm (8 inches) by placing a piece of wood or blocks under it; dont use extra pillows, because this may increase pressure on your abdomen If youre overweight, losing weight may help to reduce the severity and frequency of your symptoms. If you smoke, you should try to give up. Tobacco smoke can irritate your digestive system and may make your symptoms worse. Read about stopping smoking . Medication A number of different medications can be used to treat symptoms of hiatus hernia. These are described below. Antacids Antacid medicinescan relieve some of the symptoms of hiatus hernia.They come in liquid or tablet form andcan be swallowed or chewed. They help to neutralisestomach acid when they reach the oesophagus and stomach by making it less acidic. However, antacid medicines dont work for everyone. Theyre not a long-term solution if symptoms persist or youre in extreme discomfort. Antacids shouldnt be taken at the same time as other medicines, because they can stop other medicines from being properly absorbedby your body. They may also damage the special coating on some types of tablets. Ask your GP or pharmacist for advice. Alginates Alginates are an alternative medicine to antacids. They work by producing a protective coating that shields the lining of your stomach and oesophagus from the effects of stomach acid. H2-receptor antagonists In some cases,a medicine known as an H2-receptor antagonist (H2RA) may be recommended if a hiatus hernia is causing GORD. Examples of H2RAs include cimetidine,famotidine (PepcidTwo) and ranitidine. H2RAs block the effects of the chemical histamine, whichyour bodyuses to produce stomach acid. H2RAs therefore help to reduce the amount of acid in your stomach. Side effects of H2RAs are uncommon. However, possible side effects may include diarrhoea , headaches , tirednessand arash. Some H2RAs are available over the counter at pharmacies. These types of HR2As are taken in a lower dosage than the ones available on prescription. Ask your GP or pharmacist if youre not surewhether these medicines are suitable for you. Proton-pump inhibitors (PPIs) Your GP may prescribe a medication called a proton-pump inhibitor (PPI). PPIs work by reducing the amount of acid produced by your stomach. Examples of thePPIs you may be prescribed include omeprazole, lansoprazole, rabeprazole and esomeprazole. Most people tolerate PPIs well and side effects are uncommon. When they do occur, theyre usually mild and can include headaches, diarrhoea, feeling sick or constipation . To minimise any side effects, your GP will prescribe the lowest possible dose of PPIs they think will be effective. You should let your GP know if the prescribed dose of PPIs doesnt work. A stronger dose may be needed. Surgery Surgery is usually only recommended for a sliding hiatus hernia (hernias that move up and down, in and out of the chest area)if the problem fails to respond to lifestyle changes and medication. You may also want to consider surgery if you have persistent and troublesome symptoms, but dont want to take medication on a long-term basis. Prior to surgery, you may need further investigations to check how well the oesophagus moves (manometry) andhow much acid is being refluxed (24-hour oesopageal pH studies). Laparoscopic nissen fundoplication (LNF) A procedure called a laparoscopic nissen fundoplication (LNF) is one of the most common surgical techniques used to treat GORD and sliding hiatus hernias. LNF is a type of keyhole surgery that involves making a series of small cuts in your abdomen. Carbon dioxide gas is used to inflate your abdomen to give the surgeon room to work in. During LNF,the stomach is put back into the correct position and the diaphragm around the lower part of the oesophagus is tightened. This should prevent any acid moving back out of your stomach. LNF is carried out under general anaesthetic ,so you wont feel any pain or discomfort. The surgery takes 60 to 90 minutes to complete. After having LNF, you should be able to leave hospital after youve recovered from the effects of the general anaesthetic. This is usually within 2to 3days. Depending on the type of job you do, you should be able to return to work within 3to 6weeks. For the first 6weeks after surgery, its recommended that you only eat soft food, such as mince, mashed potatoes or soup. Avoid eating hard food that could get stuck at the site of the surgery, such as toast, chicken or steak. Common side effects of LNF include difficulties swallowing ( dysphagia ), belching, bloating and flatulence . These side effects should resolve over the course of a few months. However, in about 1 in 100 cases they can be persistent. In such circumstances, further corrective surgery may be required. Para-oesophageal hiatus hernia If you have apara-oesophageal hiatus hernia, where the stomach pushes up through the hole in the diaphragm next to the oesophagus, surgery may be recommended to reduce the risk of the hernia becoming strangulated (see complications of a hiatus hernia for more information). Complications of hiatus hernia Complicationsfrom a hiatus hernia are rare, but they can be serious. Hiatus hernias that slide in and out of the chest area (sliding hiatus hernias) can cause gastro-oesophageal reflux disease (GORD) . This is where stomach acid leaks into the oesophagus (gullet). This can damage the oesophagus, increasing the risk of problems. Oesophageal ulcers Damage to the lining of theoesophagus (oesophagitis) caused by stomach acid can lead to the formation of ulcers. The ulcers can bleed, causing pain and making swallowing difficult. Ulcers can usually be successfully treated by controlling the underlying symptoms of GORD . In most cases, over-the-counter medicines called antacidsor alginates are used to treat the condition. Read more about treating GORD . Oesophageal stricture Repeated damage to the lining of your oesophagus can lead to the formation of scar tissue. If the scar tissue is allowed to build up, it can cause your oesophagus to become narrowed. This is known as oesophageal stricture. An oesophageal stricture can make swallowing food difficult and painful. Oesophageal strictures can be treated using a tiny balloon to dilate (widen) the oesophagus. This procedure is usually carried out under a local anaesthetic . Barretts oesophagus and cancer Repeated damage to the oesophagus can also lead to changes in the cells lining your lower oesophagus. This is a condition known as Barretts oesophagus. Barretts oesophagus doesnt usually cause noticeable symptoms, other than those associated with GORD. However, Barretts oesophagus can increaseyour risk of developing oesophageal cancer . If you have persistent reflux symptoms for more than 3weeks, you should talk to your GP because you may need some investigations. Strangulated hernia In some cases, a hiatus hernia causes part of the stomach to push up next to the oesophagus. This is known as a para-oesophageal hiatus hernia. GORD doesnt usually occur in these cases, but theres a risk of the hernia becoming strangulated. Strangulation occurs when the hernia becomes knotted and the blood supply to the area is cut off. Emergency surgery is usually required to correct the problem. Source: NHS 24 - Opens in new browser window Last updated: 13 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Dysphagia (swallowing problems) Stomach ulcer Gastro-oesophageal reflux disease (GORD) Other health sites British Hernia Centre: the anatomy of hernia NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
High cholesterol,"High cholesterol - Illnesses and conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Blood and lymph High cholesterol High cholesterol About high cholesterol Causes of high cholesterol Diagnosing high cholesterol Treating high cholesterol Preventing high cholesterol About high cholesterol Cholesterol is a fatty substance known as a lipid. Its vital for the normal functioning of the body. Cell membranes, hormones and vitamin D are created by your body using cholesterol. There are 2 main sources of the cholesterol in your blood: cholesterol in the food you eat cholesterol produced by your liver Having an excessively high level of lipids in your blood (hyperlipidemia) can have an effect on your health. High cholesterol, on its own, doesnt usually cause any symptoms but increases your risk of serious health conditions. About cholesterol Cholesterol is carried in your blood by proteins. When the two combine, theyre called lipoproteins. There are two main types of lipoprotein. High-density lipoprotein (HDL) carries cholesterol away from the cells and back to the liver. From there its either broken down or passed out of the body as a waste product. For this reason, HDL is referred to as good cholesterol and higher levels are better. Low-density lipoprotein (LDL) carries cholesterol to the cells that need it. If theres too much cholesterol for the cells to use it can build up in the artery walls, leading to disease of the arteries. For this reason, LDL is known as bad cholesterol. The amount of cholesterol in the blood, both HDL and LDL , is measured with a blood test . The recommended cholesterol levels in the blood vary between those with a higher or lower risk of developing arterial disease. Why should I lower my cholesterol? Evidence strongly indicates that high cholesterol can increase the risk of: narrowing of the arteries (atherosclerosis) heart attack stroke transient ischaemic attack (TIA)  often known as a mini stroke peripheral arterial disease (PAD) This is because cholesterol can build up in the artery wall, restricting the blood flow to your heart, brain and the rest of your body. It also increases the risk of a blood clot developing somewhere in your body. Your risk of developing coronary heart disease also rises as your bloods cholesterol level increases. This can cause pain in your chest or arm during stress or physical activity ( angina ). What causes high cholesterol? Many factors can increase your chances of having heart problems or a stroke if you have high cholesterol. These include: an unhealthy diet  in particular, eating high levels of saturated fat smoking  a chemical called acrolin, found in cigarettes, stops HDL transporting cholesterol from fatty deposits to the liver, leading to narrowing of the arteries (atherosclerosis) having diabetes or high blood pressure (hypertension) having a family history of stroke or heart disease Theres also an inherited condition called familial hypercholesterolaemia. This can cause high cholesterol even in someone who eats healthily. Read more about the causes of high cholesterol When should my cholesterol levels be tested? Your GP may recommend that you have your blood cholesterol levels tested if you: have been diagnosed with coronary heart disease, stroke or mini stroke (TIA), or peripheral arterial disease (PAD) have a family history of early cardiovascular disease have a close family member who has a cholesterol-related condition are overweight have high blood pressure, diabetes or a health condition that can increase cholesterol levels Read more about how cholesterol is tested What should my cholesterol levels be? Blood cholesterol is measured in units called millimoles per litre of blood, often shortened to mmol/L. As a general guide, total cholesterol levels should be: 5mmol/L or less for healthy adults 4mmol/L or less for those at high risk As a general guide, LDL levels should be: 3mmol/L or less for healthy adults 2mmol/L or less for those at high risk An ideal level of HDL is above 1mmol/L. A lower level of HDL can increase your risk of heart disease. Your ratio of total cholesterol to HDL may also be calculated. This is your total cholesterol level divided by your HDL level. Generally, this ratio should be below four, as a higher ratio increases your risk of heart disease. Cholesterol is only one risk factor. The level at which specific treatment is required will depend on whether other risk factors, such as smoking and high blood pressure, are also present. How can I lower my cholesterol level? The first step in reducing your cholesterol is to maintain a healthy, balanced diet . Its important to keep your diet low in fatty food. You can swap food containing saturated fat for fruit, vegetables and wholegrain cereals. This will also help prevent high cholesterol from returning . Other lifestyle changes, such as taking regular exercise and giving up smoking , can also make a big difference in helping to lower your cholesterol. If these measures dont reduce your cholesterol and you continue to have a high risk of developing heart disease, your GP may prescribe a cholesterol-lowering medication, such as statins . Your GP will take into account the risk of any side effects from statins. The benefit of lowering your cholesterol must outweigh any risks. Read more about how high cholesterol is treated Causes of high cholesterol Many different factors can contribute to high blood cholesterol, including lifestyle factors like smoking, an unhealthy diet and lack of exercise, as well as having an underlying condition, such as high blood pressure or diabetes. Lifestyle Your lifestyle can increase your risk of developing high blood cholesterol. This includes: an unhealthy diet  some foods, such as liver, kidneys and eggs, contain cholesterol (dietary cholesterol), butthis has little effect on blood cholesterol: its the total amount of saturated fat in your diet thats more important to watch; read more about preventing high cholesterol lack of exercise or physical activity  this can increase your level of bad cholesterol (low-density lipoprotein, or LDL) obesity if youre overweight, its likely that youll have higher levels of LDL cholesterol and triglycerides, and a lower level of high-density lipoprotein (HDL) drinkingexcessive amounts of alcohol  regularly drinking large amountsof alcohol can increase your cholesterol and triglyceride levels smoking  a chemical in cigarettes called acrolein stops good cholesterol (HDL) transporting cholesterol from fatty deposits to the liver, leading to narrowing of the arteries (atherosclerosis) Underlying conditions People with high blood pressure (hypertension) and diabetes often have high cholesterol. Some other health conditions that can also cause raised levels of cholesterol include: kidney disease liver disease an underactive thyroid gland (hypothyroidism) Treating the underlying condition can help to reduce cholesterol. Other factors There are a number of factors associated with high cholesterol that cant be changed that increase your risk of having a heart attack or stroke . Doctors refer to these as fixed factors. They include: family history of early coronary heart disease (CHD) or stroke  youre more likely to have high cholesterol if you have a close male relative (father or brother) aged under 55, or a female relative (mother or sister) aged under 65, whos had CHD or stroke a family history of a cholesterol-related condition  for example, having a parent, brother or sister with familial hypercholesterolaemia age  the older you are, the greater the likelihood of your arteries narrowing (atherosclerosis) ethnic group  people of Indian, Pakistani, Bangladeshi and Sri Lankan descent are at increased risk of having a heart attack sex  males are more likely to have heart attacks than females If you have a fixed risk factor, or several fixed risk factors, its even more important to look at your lifestyle and any underlying conditions you may have. Familial hypercholesterolaemia Familial hypercholesterolaemia is the medical term for high cholesterol that runs in families. Its caused by a gene alteration inherited from a parent, rather than an unhealthy lifestyle. People with familial hypercholesterolaemia have raised cholesterol from birth, which can lead to the early development of heart problems, such as atherosclerosis and CHD. In the UK, familial hypercholesterolaemia is thought to affect about 1 in 500 people, which means approximately 120,000 people are thought to be affected. Theres aone in two (50%) chance that a child orbrother or sister of someone with familial hypercholesterolaemia will also have the condition. Read more about the importance of early identification and diagnosis of familial hypercholesterolaemia Diagnosing high cholesterol Blood cholesterol levels are measured with a simple blood test. Getting a cholesterol test A blood sample is taken that will be used to determine the amount of bad cholesterol (low-density lipoprotein, or LDL), good cholesterol (high-density lipoprotein, or HDL) andother fatty substances (triglycerides) in your blood. You may be asked not to eat for 10-12 hours before the cholesterol test, usually including when youre asleep at night. This ensures that all food is completely digested and wont affect the outcome of the test. Your GP or practice nurse can carry out thecholesterol test and will take a blood sample, either using a needle and a syringe or by pricking your finger. A newer type of test that measures non-high-density lipoprotein (non-HDL) is now sometimes used because its thought to be a more accurate way of estimating cardiovascular disease (CVD) risk than LDL. Non-HDL cholesterol is total cholesterol minus HDL cholesterol. Its also not necessary to fast before the test, so itis more convenient. Who should be tested? Your GP may recommend that you have your blood cholesterol levels tested if you: have been diagnosed with coronary heart disease, stroke or mini-stroke (TIA) , or peripheral arterial disease (PAD) are over the age of 40people over 40 should have their estimate of CVD risk reviewed regularly have a family history of early cardiovascular disease for example, if your father or brother developed heart disease or had a heart attack or stroke before the age of 55, or if your mother or sister had these conditions before the age of 65 have a close family member who has a cholesterol-related condition, such as familial hypercholesterolaemia are overweight or obese have high blood pressure or diabetes have another medical condition, such as kidney disease , an underactive thyroid , or an inflamed pancreas (pancreatitis)  these conditions can cause increased levels of cholesterol or triglycerides Results After your cholesterol test, your GP or nurse will explain your results and calculate whether you have a high, moderate or low risk of developing heart disease or stroke (cardiovascular disease)within the next 10 years. However, this risk isnt just based on your cholesterol reading. It also takes into account: yourBMI (body mass index) which measures your weight in relation to your height treatable risk factorssuch as high blood pressure (hypertension) , diabetes and other medical conditions your age, sex, family history and ethnicity Based on your results, your GP or nurse will recommend steps you can take to reduce your risk of developing CVD. This may include advice about making lifestyle changes, such as eating more healthilyby increasing your intake of omega-3 fatty acids, for example and doing more exercise. Cholesterol-lowering medication, such as statins , may also be recommended. Read more about treating high cholesterol Familial hypercholesterolaemia People with familial hypercholesterolaemia, or inherited high cholesterol, are at increased risk of developing CVD. In the UK, most of the 120,000 people thought to have the condition are undiagnosed and untreated. As a result of the increased risk of developing CVD, its very important that those with familial hypercholesterolaemia are diagnosed as early as possible and offered appropriate treatment. The National Institute for Health and Care Excellence (NICE) recommends that adults with a total cholesterol level of above 7.5mmol/l before treatment should be assessed forfamilial hypercholesterolaemia. If youve been diagnosed withfamilial hypercholesterolaemia, youll be referred for a specialist assessment, which may include DNA testing to confirm the diagnosis. Appropriate treatment will be recommended and other members of your family who may be affected will also be tested. Youll be closely monitored, and should have a full review at least once a year to check how well your treatment is working and assess any symptoms you may have. Children Children at risk offamilial hypercholesterolaemia will be tested by the time they reach10 years of age. This is because any signs of CVD, such as thickening of the carotid artery wall, will be identifiable by this age. The assessment will be carried out by a specialist with expertise in familial hypercholesterolaemia in children and young people. Early diagnosis offamilial hypercholesterolaemia means its possible to recommend lifestyle changes and other appropriate treatments to reduce the long-term problems associated with high cholesterol and improve long-term health. For further information, see the NICE guidance about familial hypercholesterolaemia Treating high cholesterol If youve been diagnosed with high cholesterol, youll be advised to make changes to your diet and increase your level of exercise. After a few months, if your cholesterol level hasnt dropped, you may be advised to take cholesterol-lowering medication. Changing your diet, stopping smoking and exercising morewill also help to prevent high cholesterol developing. The various treatments for high cholesterol are outlined below. Diet Eating a healthy, balanced diet thats low insaturated fats can reduce your level of bad cholesterol (LDL). Try to avoid or cut down on the following foods, which are high in saturated fat: fatty cuts of meat and meat products, such as sausages and pies butter, ghee and lard cream, soured cream,crme frache and ice cream cheese, particularly hard cheese cakes and biscuits milk chocolate coconut oil, coconut cream and palm oil The government recommends that a maximum of 11% of a persons food energy should come from saturated fat. This equates to no more than: 30g of saturated fat a day for the average man 20gof saturated fat a dayfor the averagewoman Children should have less. Check the labels on the foods youre eating to find out how much saturated fat youre consuming. Omega-3 fatty acids Many experts believe that the fats found in avocados andoily fish, such as mackerel, salmon and tuna, are good for you. These are known as omega-3 fatty acids and high doses can improve (lower) triglyceride levels in some people. However, too much omega-3 fatty acids can contribute to obesity . For people with a high triglyceride level, at least two portions of oily fish a week is thought to be beneficial. However, theres no evidence that taking omega-3 fatty acid supplements has the same benefit. Cholesterol-lowering medication There are several different types of cholesterol-lowering medication that work in different ways. Your GP can advise you about the most suitable type of treatment, and may also prescribe medication to lower high blood pressure (hypertension) if it affects you. The most commonly prescribed medications are outlined below. Statins Statins block the enzyme (a type of chemical) in your liver that helps to make cholesterol. This leads to a reduction in your blood cholesterol level. Youll usually be started on a medication called atorvastatin. Other statins include simvastatin and rosuvastatin. When someone has side effects from using a statin, its described as having an intolerance to it. Side effects of statins include headaches , muscle pain and stomach problems, such as indigestion ,diarrhoea or constipation . Statins will only be prescribed to people who continue to be at high risk of heart disease, because they need to be taken for life.Cholesterol levels start to rise again once you stop taking them. Aspirin In some cases, a low daily dose of aspirin may be prescribed, depending on your age (usually over 40 years old) and other risk factors. Low-dose aspirin can help to prevent blood clots forming, particularly for someone whos had a heart attack , has established vascular disease, or a high risk of developing cardiovascular disease (CVD) . You may also be advised to have periodic blood tests to ensure your liver is functioning well. Ezetimibe Ezetimibe is a medication that blocks the absorption of cholesterol from food and bile juices in your intestines into your blood. Its generally not as effective as statins, but is less likely to cause side effects. You can take ezetimibe at the same time as your usual statin if your cholesterol levels arent low enough with the statin alone. The side effects of this combination are generally the same as those of the statin on its own (muscle pain and stomach problems). You can take ezetimibe by itself if youre unable to take a statin. This may be because you have another medical condition, you take medication that interferes with how the statin works, or because you experience side effects from statins. Ezetimibe taken on its own rarely causes side effects. For more information, you can read the National Institute for Health & Care Excellence (NICE) guidelines about the use of ezetimibe for treating high cholesterol . Preventing high cholesterol You can lower your cholesterol by eating a healthy, balanced diet thats low in saturated fat, exercising regularly, not smoking and cutting down on alcohol. Diet If you have an unhealthy diet thats high in fat, fatty plaques are much more likely to build up in your arteries. This is because fatty foods contain cholesterol. There are two types of fat: saturated and unsaturated. You should avoid foods containing saturated fats, as they will increase the levels of bad cholesterol(low-density lipoprotein, or LDL) in your blood. Foods high in saturated fat include: meat pies sausages and fatty cuts of meat butter ghee a type of butter often used in Indian cooking lard cream hard cheese cakes and biscuits food that contains coconut or palm oil However, its not healthy to completely cut out all types of fat from your diet. Its important to replace saturated fats with unsaturated fats theyve been shown to increase levels of good cholesterol (high-density lipoprotein, or HDL) and reduce any blockage in your arteries. Foods that are high in unsaturated fat include: oily fishsuch as mackerel, salmon and tuna avocados nuts and seeds sunflower, rapeseed and olive oil A low-fat diet including lots of fibre, such as wholegrain rice, bread and pasta, and plenty of fruit and vegetables has also been shown to help lower cholesterol. Fruit and vegetablesare full of vitamins, minerals and fibre, and help keep your body in good condition. Aim to eat five 80g portions of fruit and vegetables every day . Smoking A chemical found in cigarettes called acrolein stops HDL transporting fatty deposits to the liver, leading to high cholesterol and narrowing of the arteries (atherosclerosis). This meanssmoking is a major risk factor for bothheart attacks and strokes . If you decide to stop smoking,your GP can refer you to an NHS Stop Smoking Service, which will provide you with dedicated help and advice about the best ways to give up smoking. You can also call Quit Your Way Scotland on 0800 84 84 84. The specially trained helpline staff can offer you free expert advice and encouragement. If youre committed to giving up smoking but dont want to be referred to a stop smoking service, your GP should be able to prescribe medical treatment to help with any withdrawal symptoms you may experience after giving up. Read more about treatment for quitting smoking Exercise Being active and exercising regularly will increase the levels of HDL in your body by stimulating the body to move fatty deposits to the liver, so they can be broken down. Exercise will also help you maintain a healthy weight, andlose weight if youre overweight.Being overweight can increase the amount of bad cholesterol in your blood. Another benefit of regular physical activity is it will help lower your blood pressure by keeping your heart and blood vessels in good condition. Doing 150 minutes of moderate-intensity exercise every week is recommended to help lower your cholesterol. Walking , swimming and cycling are good examples of this type of exercise. Read more about the recommended physical activity guidelinesfor adults (aged 19-64) and the physical activityguidelinesfor older adults (aged 65 and over) Source: NHS 24 - Opens in new browser window Last updated: 18 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Statins Other health sites British Dietetic Association: Food fact sheets Lab Tests Online: cholesterol test British Heart Foundation British Cardiovascular Society Heart UK NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
HIV,"HIV symptoms & treatments - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Immune system HIV HIV HIV is a long-term health condition that is now very easy to manage. HIV stands for human immunodeficiency virus. The virus targets the immune system and if untreated, weakens your ability to fight infections and disease. Speak to a sexual health service as soon as possible if you think you might have been exposed to HIV. Symptoms of HIV Most people experience a short flu-like illness 2 to 6 weeks after infection, which lasts for 2 weeks. This is known as primary HIV infection. Symptoms of primary HIV infection include: fever (high temperature) sore throat body rash Other symptoms can include: tiredness joint pain muscle pain swollen glands After these symptoms disappear, HIV may not cause symptoms for many years. During this time, HIV continues to be active and causes damage to your immune system. This means many people who have HIV do not know theyre infected. Once the immune system becomes severely damaged symptoms can include: weight loss chronic diarrhoea night sweats skin problems recurrent infections serious life-threatening illnesses Testing for HIV If you think you might have HIV, get tested for free by: booking an appointment at your local sexual health service contacting your GP practice for an appointment ordering a home test kit contacting clinics run by charities such as the Terrence Higgins Trust or Waverley Care Scotland for an appointment contacting local drug dependency services for an appointment Services available may vary depending on where you live. Some private clinics may offer HIV testing, but they may charge. Who should get tested for HIV? Anyone who thinks they may have HIV should get tested. Certain groups of people are at a higher risk and are advised to have regular tests. For example: gay and bisexual men or men who have sex with men should have an HIV test at least once a year, or every 3 months if having sex without HIV PrEP or condoms with new or casual partners women and men from countries with high HIV prevalence, especially from sub-Saharan Africa, should have an HIV test if having sex without using HIV PrEP or condoms with new or casual partners people who inject drugs or have unprotected sex (sex without condoms or HIV PrEP ) with people who inject drugs What does a HIV test involve? The test for HIV is straightforward, highly accurate and is the only way to know if youre infected. It involves taking a sample from the body for analysis. There are 4 main types of HIV test. Blood test Where a sample of blood is taken and sent to a lab for analysis. Results are usually available within a few days. Point of care test A sample of saliva from your mouth or a small spot of blood from your finger is taken. This sample doesnt need to be sent to a lab and the result is available within a few minutes. Anyone who has a reactive point of care test still needs a confirmed laboratory test. Home sampling kit Where you collect a saliva sample or small spot of blood at home and send it off in the post for analysis. Youll be contacted by phone or text with your result in a few days. You can buy them online or from some pharmacies. Anyone who has a reactive home testing kit result is still required to have a laboratory confirmed test. Home testing kit Where you collect a saliva sample or small spot of blood yourself and test it at home. The result is available within minutes. Check that any test you buy has a CE quality assurance mark and is licensed for sale in the UK. Treatment for HIV Antiretroviral medicines are used to treat HIV. They work by stopping the virus multiplying in the body, allowing the immune system to repair itself and prevent further damage. These come in tablet form and must be taken every day. Most people with HIV take a combination of medicines. The goal of HIV treatment is to have an undetectable viral load. This means the level of HIV virus in your body is low enough to not be detected by a test. People who take HIV treatment and whose virus level is undetectable cant pass HIV on to others. Although there is no cure for HIV yet, people living with HIV who take their treatment should have a normal lifespan and good health. Without treatment, people with HIV will eventually become unwell. HIV can be fatal if its not detected and treated in time to allow the immune system to repair. Its extremely important to test for HIV if you think youve been exposed. How HIV is passed on You can get HIV by having unprotected vaginal or anal sex (sex without a condom or not taking HIV PrEP ). It may be possible for HIV to be passed on through unprotected oral sex, but the risk is very low. Other ways of getting HIV include: sharing sex toys that arent washed or covered with a new condom each time theyre used sharing needles, syringes and other injecting equipment from mother to baby before or during birth when the mother isnt taking HIV medication from mother to baby by breastfeeding when the mother isnt taking HIV medication blood transfusion (outside of the UK) Who is most at risk? People who are at higher risk of becoming infected with HIV include people who are not taking HIV PrEP medication and who are: men who have had unprotected anal sex with men women who have had unprotected sex with men who have sex with men people who have had unprotected sex with a person who has lived or travelled in a high HIV prevalence country people who inject drugs people who have had unprotected sex with somebody who has injected drugs people who have caught another sexually transmitted infection (STI) How to prevent HIV Safer sex The best way to reduce your risk of STIs is to practice safer sex . This means using a condom for vaginal, anal and oral sex. If youre having anal sex its important to also use water-based or silicon-based lubricant. HIV Pre-Exposure Prophylaxis (PrEP) Taking HIV PrEP before youre exposed to HIV means theres a drug inside of you to block HIV if it gets into your body, so it cant infect you. HIV Post Exposure Prophylaxis (PEP) If you think you may have recently been exposed to HIV and you havent taken HIV PrEP medication or used a condom, you should take PEP medication. PEP is a form of emergency HIV medication taken by someone who does not have HIV but who has or may have been very recently exposed to HIV. PEP should be taken as soon as possible, but it can be taken up to 72 hours after exposure. The earlier it is taken the more effective it is. PEP is available from sexual health services or out of hours from A&E . If you inject drugs If you inject drugs, you should never share needles or other injecting equipment (including syringes, spoons and swabs). You can get free clean needles and other injecting equipment from your local injecting equipment providers, which are sometimes also called needle exchanges . Other STIs If youve been diagnosed with HIV you should get tested for all STIs and blood borne viruses including: chlamydia gonorrhoea syphilis hepatitis B hepatitis C Find your local sexual health clinic Source: Scottish Government - Opens in new browser window Last updated: 28 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform HIV PrEP (Pre-Exposure Prophylaxis) Other health sites Terrence Higgins Trust: My HIV Waverley Care - HIV & Hep C charity NAM: HIV and AIDS HIV i-Base Brook: advice for under 25s Scottish Government: End HIV stigma AVERT: HIV and AIDS NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Hodgkin lymphoma,"Hodgkin lymphoma - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Hodgkin lymphoma Hodgkin lymphoma About Hodgkin lymphoma Symptoms of Hodgkin lymphoma Causes of Hodgkin lymphoma Diagnosing Hodgkin lymphoma Treating Hodgkin lymphoma Complications of Hodgkin lymphoma About Hodgkin lymphoma Hodgkin lymphoma is an uncommon cancer that develops in the lymphatic system, which is a network of vessels and glands spread throughout your body. The lymphatic system is part of your immune system. Clear fluid called lymph flows through the lymphatic vessels and contains infection-fighting white blood cells, known as lymphocytes. In Hodgkin lymphoma, B-lymphocytes (a particular type of lymphocyte) start to multiply in an abnormal way and begin to collect in certain parts of the lymphatic system, such as the lymph nodes (glands). The affected lymphocytes lose their infection-fighting properties, making you more vulnerable to infection. The most common symptom of Hodgkin lymphoma is a painless swelling in a lymph node, usually in the neck, armpit or groin. Read more about the symptoms of Hodgkin lymphoma . Whos affected? Hodgkin lymphomacan develop at any age, but it mostly affects young adults in their early 20s and older adults over the age of 70. Slightly more men than women are affected. What causes Hodgkin lymphoma? The exact cause of Hodgkin lymphoma is unknown. However, your risk of developing the condition is increased if: youhave a medical condition that weakens your immune system you take immunosuppressant medication youve previously been exposed toa common virus called the Epstein-Barr virus  which causes glandular fever You also have an increased risk of developing Hodgkin lymphoma if a first-degree relative (parent, sibling or child) has had the condition. Read more about the causes of Hodgkin lymphoma . How Hodgkin lymphoma is diagnosed The only way to confirm a diagnosis of Hodgkin lymphoma is by carrying out a biopsy . This is a minor surgical procedure wherea sample of affected lymph node tissue is removed and studied in a laboratory. Read more about diagnosing Hodgkin lymphoma . Treatment Hodgkin lymphoma is a relatively aggressive cancer and can quickly spread through the body. Despite this, its also one of the most easily treated types of cancer. Your recommended treatment plan will depend on your general health and age, because many of the treatments can put a tremendous strain on the body.How far the cancer has spread is also an important factor in determining the best treatment. The main treatments used are chemotherapy , followed by radiotherapy or chemotherapy alone. Surgery isnt generally used as a treatment for the condition. Read more about: treatment for Hodgkin lymphoma complications of Hodgkin lymphoma Symptoms of Hodgkin lymphoma The most common symptom of Hodgkin lymphoma is a swelling in the neck, armpit or groin. The swelling is usually painless, although some people find that it aches. The swelling is caused by an excess of affected lymphocytes (white blood cells) collecting in a lymph node (also called lymph glands). Lymph nodes are pea-sized lumps of tissue found throughout the body. They contain white blood cells that help to fight infection. However, its highly unlikely that you have Hodgkin lymphoma if you have swollen lymph nodes , as these glands often swellas a response to infection. Other symptoms Some people with Hodgkin lymphoma also have other more general symptoms. These can include: night sweats unintentional weight loss a high temperature (fever) a persistent cough or feeling of breathlessness persistent itching of the skin all over the body Other symptoms will depend on where in the body the enlarged lymph glands are. For example, if the abdomen (tummy) is affected, you may have abdominal pain or indigestion A few people with lymphoma have abnormal cells in their bone marrow when theyre diagnosed. Thismay lead to: persistent tiredness or fatigue an increased risk of infections excessive bleeding  such as nosebleeds ,heavy periods and spots of blood under the skin Insome cases, people with Hodgkin lymphoma experience pain in theirlymph glands when they drink alcohol. When to seek medical advice Speak to your GP if youhave any of these symptoms, particularly if you have persistently swollen glands with no other signs of infection. While the symptoms are unlikely to be caused by Hodgkin lymphoma, it is best to get them checked out. Causes of Hodgkin lymphoma Hodgkin lymphoma is caused by a change (mutation) in the DNA of a type of white blood cell called B lymphocytes, although the exact reason why this happens isnt known. The DNA gives the cells a basic set of instructions, such as when to grow and reproduce. The mutation in the DNA changes these instructions so the cells keep growing, causing them to multiply uncontrollably. The abnormal lymphocytes usually begin to multiply in one or more lymph nodes in a particular area of the body, such as your neck or groin. Over time, its possible for the abnormal lymphocytes to spread into other parts of your body, such as your: bone marrow spleen liver skin lungs Whos most at risk? While thecause of the initial mutation that triggers Hodgkin lymphoma is unknown, a number of factors can increase your risk of developing the condition. These include: having a medical condition that weakens your immune system, such as HIV having medical treatment that weakens your immune system  for example, taking medication to suppress your immune system afteran organ transplant being previously exposed to the Epstein-Barr virus (EBV) a common virus that causes glandular fever having previously had non-Hodgkin lymphoma , possibly because of treatment with chemotherapy or radiotherapy being very overweight ( obese )this may be more of a risk factor in women than men Hodgkin lymphoma isnt infectious andisnt thought torun in families. Although yourrisk isincreased if a first-degree relative (parent, sibling or child) has had lymphoma, its not clear if this is because of an inherited genetic faultorlifestyle factors. Hodgkin lymphoma can occur at any age, although most cases are diagnosed in people in their early 20s or 70s. The condition is slightly more common in men than women. Diagnosing Hodgkin lymphoma If you speak to your GP because youre concerned about symptoms of Hodgkin lymphoma, theyll ask about your health and carry out a simple physical examination. If necessary, your GPwill refer you to hospital for further tests. In 2015, the National Institute for Health and Care Excellence (NICE) published guidelines to help GPs recognise the signs and symptoms of Hodgkin lymphoma and refer people for the right tests faster. To find out if you should be referred for further tests for suspected Hodgkin lymphoma, read the NICE 2015 guidelines on Suspected cancer: recognition and referral . If youre referred to hospital, a biopsy will usually be carried out, as this is the only way to confirm a diagnosis of Hodgkin lymphoma. Biopsy A biopsy involves removing some or all of an affected lymph node, which is then studied in a laboratory. Biopsies are small operations that can often be carried out under a local anaesthetic (where the area is numbed). In some cases, the affected lymph node isnt easily accessible and a general anaesthetic may be required (where youre asleep). A pathologist (an expert in the study of diseased tissue) will then check the tissue sample for the presence of cancerous cells. If they find cancerous cells, they can also identify exactly which type of Hodgkin lymphoma you have, which is an important factor in planning your treatment. Further testing If a biopsy confirms a diagnosis ofHodgkin lymphoma, further testing will be needed to check how far the lymphoma has spread. This allows a doctor to diagnose the stage of your lymphoma. Further tests may include: blood tests  samples of blood will be taken throughout your diagnosis and treatment to check your general health, the levels of red and white cells and platelets in your blood, and how well organs such as your liver and kidneys are working bone marrow sample  another biopsy may be carried out to see if thecancer has spread to your bone marrow; this involves using a long needle to remove a sample of bone marrow from your pelvis and can be done using a local anaesthetic chest X-ray  this can check whether the cancer has spread to your chest or lungs computerised tomography (CT) scan  this scan takes a series of X-rays that build up a 3D picture of the inside of the body to check the spread of the cancer magnetic resonance imaging (MRI) scan  this scanuses strong magnetic fields to build up a detailed picture of areas of your body, to check the spread of the cancer positron emission tomography (PET) scan this scan measures the activity of cells in different parts of the body andcan check the spread of the cancer and the impact of treatment;its usually taken at the same time as a CT scan to show precisely how the tissues of different sites of the body are working Stages of Hodgkin lymphoma When testing is complete, it should be possible to determine the stage of your lymphoma. Staging means scoring the cancer by how far its spread. The main stages of Hodgkin lymphoma are: stage 1 thecancer is limited to one group of lymph nodes, such as your neck or groin nodes either above or below your diaphragm (the sheet of muscle underneath the lungs) stage 2 2 or more lymph node groups are affected, either above or below the diaphragm stage 3 thecancer has spread to lymph node groups above and below the diaphragm stage 4 thecancer has spread through the lymphatic system and is now present in organs or bone marrow Health professionals alsoadd the letters A or B to your stage, toindicate whether or not you have certain symptoms. A is put after your stage if youhave no additional symptoms other than swollen lymph nodes. B is put after your stage if you haveadditional symptoms of weight loss, fever or night sweats. Treating Hodgkin lymphoma Hodgkin lymphoma can usually be treated successfully with chemotherapy alone, or chemotherapy followed by radiotherapy. Your treatment plan Your specific treatment plan will depend on your general health and your age, asmany of the treatments can put a tremendous strain on the body. How far the cancer has spread is also an important factor in determining the best treatment. Discussions about your treatment plan will usually take place with several doctors and other health professionals who specialise in different aspects of treating lymphoma. This is known as a multidisciplinary team (MDT). Your MDT will recommend the best treatment optionsfor you. However, you shouldnt be rushed into making a decision about your treatment plan. Before deciding, you may wish to talk to friends, family and your partner. Treatment options The main treatments for Hodgkin lymphoma are chemotherapy alone, or chemotherapy followed by radiotherapy. In a few cases, chemotherapy may be combined with steroid medication. Surgery isnt generally usedto treat the condition, except for the biopsy used to diagnose it. Overall, treatment for Hodgkin lymphoma is highly effective and most people with the condition are eventually cured. Chemotherapy Chemotherapy is a type of cancer treatment where medicine is used to kill cancer cells. This medication can be given in a number of different ways, depending onthe stage of your cancer. If doctors think your cancer is curable, youll normally receive chemotherapy through a drip directly into a vein (intravenous chemotherapy).If a cure is unlikely, you may only need to take chemotherapy tablets to help relieve your symptoms. Chemotherapy is usually given over a period of a few months on an outpatient basis, which means you shouldnt have to stay in hospital overnight. However, there may be times when your symptoms or the side effects of treatment become particularly troublesome and a longer hospital stay may be needed. Chemotherapy can have several side effects, the most significant of which is potential damage to your bone marrow. This can interfere with the production of healthy blood cells and cause the following problems: fatigue breathlessness increased vulnerability to infection bleeding and bruising more easily If you experience these problems, treatment may need to be delayed so you can produce more healthy blood cells. Growth factor medicines can also stimulate the production of blood cells. Other possible side effects of chemotherapy include: nausea and vomiting diarrhoea loss of appetite mouth ulcers tiredness skin rashes hair loss infertility , which may be temporary or permanent Mostside effects should pass once your treatment has finished.Tell your care team if the side effects become particularly troublesome, as there are treatmentsthat can help. Read more about the side effects of chemotherapy . High-dose chemotherapy If regular chemotherapy is unsuccessful or Hodgkin lymphoma returns after treatment, you may have a course of chemotherapy at a higher dose. However, this intensive chemotherapy destroys your bone marrow, leading to the problems mentioned above. Youllneed a stem cell orbone marrow transplantto replace the damaged bone marrow. Radiotherapy Radiotherapy is most often used to treat early-stage Hodgkin lymphoma, where the cancer is only in one part of the body. Treatment is normally given in shortdaily sessions, Monday to Friday, over several weeks. You shouldnt have to stay in hospital between appointments. Radiotherapy itself is painless, but it can have some significant side effects. These can vary and will be directly related to thepart of your body being treated. For example, treatment to your throat can lead to a sore throat, while treatment to the head can lead to hair loss. Other common side effectsinclude: tiredness nausea and vomiting dry mouth loss of appetite Most side effects are temporary,but theres a risk of long-term problems, including infertility and permanently darkened skin in the treatment area. Read more about: side effects of radiotherapy complications of Hodgkin lymphoma Steroid medication Steroid medication is sometimes used in combination with chemotherapy as a more intensive treatment for advanced cases of Hodgkin lymphoma, orif initial treatment hasnt worked. The steroid medication is given intravenously, usually at the same time as your chemotherapy. Common side effects of steroid medication include: increased appetite, which can lead to weight gain indigestion problems sleeping feeling agitated The side effects of steroid medication usually start to improve once treatment finishes. Rituximab If youre diagnosed with a rare type of Hodgkin lymphoma called lymphocyte-predominant Hodgkin lymphoma, you may have chemotherapy in combination with a medication called rituximab. Rituximab is a type ofbiological therapycalled a monoclonal antibody. Itattaches itself to the surface of cancerous cells and stimulates the immune system to attack and kill the cell. Its given through a drip directly into a vein over the course of a few hours. Side effects of the drug can include: flu -like symptoms, such as headaches , feverand muscle pain tiredness nausea diarrhoea You may be given additional medication to prevent or reduce side effects. Any side effects should improve over time as your body gets used to the medication. Follow-up After your course of treatment ends, youll need to have regular follow-up appointments to monitor your recovery and check for any signs of the cancer returning. These appointments start off being every few weeks or months, but will become gradually less frequent over time. Read further information: Cancer Research UK:treating Hodgkin lymphoma Cancer Research UK:living with Hodgkin lymphoma Macmillan: treating Hodgkin lymphoma Macmillan: living with Hodgkin lymphoma Complications of Hodgkin lymphoma Some people treated for Hodgkin lymphoma experience long-term problems, even if theyve been cured. Weakened immune system Having a weakened immune system is a common complication of Hodgkin lymphoma and it can become more severe while youre being treated. If you have a weak immune system, youre more vulnerable to infections and theres an increased risk of developing serious complications from infections. In some cases, you may be advised to take regular doses of antibiotics to prevent infections. Its also important to report any symptoms of an infection to your GP or care team immediately, as prompt treatment may be needed to prevent serious complications. Symptoms of infection include: a high temperature (fever) headache aching muscles diarrhoea tiredness Vaccination You should make sure that all of your vaccinations are up-to-date. However, its important to speak toyour GP or care team about this, as it may not be safe for you to have live vaccines (vaccines containing a weakened form of the virus or organism being vaccinated against) until several months after your treatment finishes. Examples of live vaccines include the: shingles vaccine BCG vaccine (against tuberculosis) MMR vaccine (against measles, mumps and rubella) Infertility Chemotherapy and radiotherapy for Hodgkin lymphoma can cause infertility. This is sometimes temporary, but it can be permanent. Your care team will estimate the risk of infertility in your specific circumstances and let you know your options. In some cases, it may be possible for men to store samples of their sperm and for women to store their eggs before treatment, so these can be used to try for a baby afterwards. Second cancers People who have had Hodgkin lymphoma are more likely to get lymphoma, leukaemia or other cancers in the future. Chemotherapy and radiotherapy further increase this risk. Second cancers, such as breast cancer or lung cancer , usually develop more than 10 years after youre treated for Hodgkin lymphoma. In rare cases, other types of cancer, such as leukaemia or other lymphomas, develop after only a few years. You can help to reduce your risk of a second cancer by adopting a healthy lifestyle by not smoking, maintaining a healthy weight with a balanced diet, and getting regular exercise. You should report any symptoms that might suggest another cancer to your GP at an early stage and attend any cancer screening appointments youre invited to. Other health problems The risk of developing other health conditions in the future, such as cardiovascular disease and lung disease, is also higher in people who have had Hodgkin lymphoma. You should report unexpected symptoms, such as increased shortness of breath, to your GP for further advice. Source: NHS 24 - Opens in new browser window Last updated: 09 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Radiotherapy Other health sites Cancer Research UK: Hodgkin lymphoma Bloodwise: Hodgkin lymphoma Lymphoma Action Macmillan Cancer Support: Hodgkin lymphoma Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Hodgkin lymphoma: Children,"""Hodgkin lymphoma | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in children Hodgkin lymphoma: Children Hodgkin lymphoma: Children Hodgkin lymphoma is a type of blood cancer. It can affect children at any age but is more common in older teenagers and young adults. More children than ever are surviving childhood cancer. There are new and better drugs and treatments, and we can now also work to reduce the after-effects of having had cancer in the past. Its devastating to hear that your child has cancer. At times it can feel overwhelming, but there are many healthcare professionals and support organisations to help you through this difficult time. Understanding more about the cancer your child has, and the treatments that may be used, can often help parents to cope. Your childs specialist will give you more detailed information and, if you have any questions, its important to ask the specialist doctor or nurse who knows your childs individual situation. What is Hodgkin lymphoma? Hodgkin lymphoma is a type of cancer that occurs in the lymphatic system. There are 2 main types of Hodgkin lymphoma: classical Hodgkin lymphoma, which affects 95% of patients, and Lymphocyte Predominant Hodgkin Lymphoma (LPHL), which only affects 5% of patients. This information is about classical Hodgkin lymphoma, but it includes a short section about LPHL. The lymphatic system The lymphatic system is part of the immune system, the bodys natural defence against infection and disease. The lymphatic system is made up of the bone marrow, thymus, spleen, and lymph nodes (or lymph glands). Lymph nodes are connected by a network of tiny lymphatic vessels that contain lymph fluid. Lymphomas can start anywhere in the lymphatic system, but Hodgkin Lymphoma is most likely to start in the lymph nodes in the neck. The other areas where lymph nodes are likely to swell are above the collar bone, the armpit, the groin and inside the chest. Glands can swell in these areas as part of the bodys response to infection, not just cancer, which is why a biopsy is needed to diagnose lymphoma. The number of lymph nodes varies from one part of the body to another. In some parts of the body, there are very few lymph nodes, whereas under your arm there may be 20to 50. There are 2 main types of lymphoma: non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL). Although these are both types of lymphoma, there are differences between them, which means they need different treatment. Causes The exact cause of Hodgkin lymphoma is not known. In most people that develop Hodgkin lymphoma, no cause is found. However, there is increasing evidence that infections, such as the virus that causes glandular fever, may play a part in the development of Hodgkin lymphoma, especially in childhood. Poor immunity may also be a risk factor for developing the disease. Very rarely, more than one member of a family may develop Hodgkin lymphoma but it is not inherited from parents and you cannot catch it from another person. Signs and symptoms The first sign of Hodgkin lymphoma is usually a painless swelling of 1 gland, or a group of lymph glands, which continues for some weeks or even months. The first glands that are likely to be affected are in the neck or above the collarbone, most often only on 1 side. However, its important to remember that childrens glands can also become swollen when they have a common infection that causes a sore throat or a cold. If glands in the chest are affected, this can cause a cough or breathlessness. This is caused by the pressure the glands exert on the airways. Sometimes, a child with Hodgkin lymphoma may have a high temperature (fever), night sweats, weight loss or itchy skin. How Hodgkin lymphoma is diagnosed As lymph glands can swell for lots of reasons, a biopsy is carried out to diagnose Hodgkin lymphoma. A biopsy is when a swollen lymph gland is removed and the cells are looked at under a microscope. Its a small operation which is usually done under a general anaesthetic. Sometimes only a small part of the lymph gland has to be removed, which can be done under a local anaesthetic. If Hodgkin lymphoma is diagnosed after the biopsy, further tests are carried out to find out the exact size and position of the lymphoma, and to see whether it has spread beyond the original area. These tests include X-rays, blood tests, CT, MRI and PET scans. Very often, a bone marrow sample will be taken. This is because the lymphoma cells can spread to the bone marrow as well as to other lymph glands. The tests that are carried out are called staging tests. Any tests and investigations that your child needs will be explained to you. The Childrens Cancer and Leukaemia Group (CCLG) has more information about what the tests and scans involve. Staging The stage of Hodgkin lymphoma describes the size and position of the cancer and whether it has spread. Staging is very important because the type of treatment your child receives will depend on the stage of the disease. The staging system for Hodgkin lymphoma is as follows: stage 1  only 1 group of lymph nodes is affected and the lymphoma is only on 1 side of the diaphragm (the sheet of muscle under the lungs that controls breathing) stage 2  2or more groups of lymph nodes are affected, but they are only on 1 side of the diaphragm. stage 3 the lymphoma is in lymph nodes both above and below the diaphragm stage 4 the lymphoma has spread outside the lymph nodes to other organs such as the liver, lungs or bone marrow As well as giving each stage a number, doctors also use a letter code  either A, B, or E: A means your child has no symptoms B means your child has 1 or more of the following symptoms: a fever, night sweats or significant weight loss E means that the lymphoma has grown from the lymph gland to extranodal tissue (tissue in places outside the lymph nodes) A number and letter is used in the staging of every child with Hodgkin lymphoma. This helps the doctor decide on a treatment plan for your child. Treatment Children with Hodgkin lymphoma are usually treated with chemotherapy, but sometimes radiotherapy is also needed. The type and amount of treatment given depend on the stage of the disease when it is diagnosed. Your childs doctor will discuss the treatment options with you. Chemotherapy This is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It is usual for a combination of drugs to be used, which will often be given every few weeks over a number of months. A combination of drugs is used because each chemotherapy drug works in a different way. Using several drugs together increases the effectiveness of the treatment. It also means lower doses of individual drugs can be used, which may reduce the possibility of long-term side effects. Radiotherapy This is used in less than half of people with Hodgkin lymphoma. It treats cancer by using high energy rays that destroy the cancer cells while doing as little harm as possible to normal cells. Side effects of treatment Treatment for Hodgkin lymphoma can cause side effects, and your childs doctor will discuss these with you before the treatment starts. Any possible side effects will depend on the particular treatment being used and the part of the body that is being treated. Some general side effects of chemotherapy that can occur during treatment include: feeling sick (nausea) and being sick (vomiting) hair loss low blood count which can lead to an increased risk of infection, bruising and bleeding tiredness Changes to your childs sense of taste and changes in their bowel may also happen. If your child has side effects from the treatment it is important to discuss them with your doctor or nurse. They may be able to help reduce them. Late side effects of treatment The cure rate for Hodgkin lymphoma is very high, which means some children may develop side effects many years after treatment. The chance of developing late side effects depends on where the original tumour was, how far it spread, and the type of treatment your child had. These late side effects can affect the normal organs such as the heart, kidneys and lungs. Following treatment for Hodgkin lymphoma, there is a small increase in the risk of developing another cancer in later life. There is also a chance that fertility may be affected. Teenage boys who are diagnosed after puberty should have the option of sperm banking before treatment starts. In this situation, sperm can be stored for possible use in later years. Your childs doctor or nurse will explain more about any possible late side effects. Clinical trials Many children have their treatment as part of a clinical research trial. Trials aim to improve our understanding of the best way to treat an illness, usually by comparing the standard treatment with a new or modified version. The aim of treatment for Hodgkin lymphoma is to cure the cancer with the fewest possible short and long-term side effects. This is particularly important in childhood Hodgkin lymphoma where cure rates are high. Its important to get the balance right between curing the cancer and having the lowest risk of long-term side effects. If appropriate, your childs medical team will talk to you about taking part in a clinical trial and will answer any questions you may have. Written information is often provided to help explain things. Taking part in a research trial is completely voluntary, and youll be given plenty of time to decide whether its right for your child. Treatment guidelines Sometimes, clinical trials are not available for your childs tumour. This may be because a recent trial has just finished, or because the tumour is very rare. In these cases, you can expect your doctors and nurses to offer treatment which is agreed to be the most appropriate, using guidelines which have been prepared by experts across the country. The Childrens Cancer and Leukaemia Group (CCLG) is an important organisation which helps to produce these guidelines. Follow-up care About 90% of children who develop Hodgkin lymphoma are cured. When your child completes treatment, they will then go into a follow-up phase, seeing doctors and nurses in out-patient clinics usually for around five years. Clinic visits will be every 3to 4 months to start with and there will be occasional scans, X-rays, and blood tests done for several years after completing treatment. If the cancer comes back, a different course of treatment can be given. If you have specific concerns about your childs condition and treatment, its best to discuss them with your childs doctor, who knows the situation. Lymphocyte predominant Hodgkin lymphoma (LPHL) This is a rare type of Hodgkin lymphoma that affects around 5% of patients. LPHL usually grows at a slower rate than classical Hodgkin lymphoma and normally requires less intensive treatment. Young people with LPHL may have a single swollen gland or group of swollen glands in one area only, such as the neck or groin. The swollen gland often grows very slowly and may be present for many months before a biopsy and diagnosis happens. The biopsy and staging tests will be carried out as with classical Hodgkin lymphoma. The treatment given will depend on the stage of the disease, but most patients are diagnosed with an early stage of the disease. LPHL is usually treated with surgery or low-dose chemotherapy. It may return many years after treatment, and further treatment may be required, but it is rarely a life-threatening condition. In rare cases, patients have advanced LPHL and receive more intensive chemotherapy. There is also a link between LPHL and developing a more aggressive non-Hodgkin lymphoma . Your feelings As a parent, the fact that your child has cancer is one of the worst situations you can be faced with. You may have many emotions, such as fear, guilt, sadness, anger and uncertainty. These are all normal reactions and are part of the process that many parents go through at such a difficult time. Its not possible to address here all of the feelings you may have. However, the CCLG booklet Children & Young Peoples Cancer; A Parents Guide talks about the emotional impact of caring for a child with cancer and suggests sources of help and support. Your child may have a variety of powerful emotions throughout their experience with cancer. The Parents Guide discusses these further and talks about how you can support your child. Source: Children's Cancer and Leukaemia Group - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Hodgkin lymphoma: Teenagers and young adults,"Hodgkin lymphoma: Teenagers and young adults | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in teenagers and young adults Hodgkin lymphoma: Teenagers and young adults Hodgkin lymphoma: Teenagers and young adults This section is for teenagers and young adults and is about a type of cancer called Hodgkin lymphoma. Treatment for Hodgkin lymphoma has a very good success rate and most people are cured. Hodgkin lymphoma is a cancer of the lymphatic system, which is one of the bodys natural defences against infection. Lymphomas, like all cancers, are a disease of the bodys cells. Normally cells in our body divide and grow in a controlled way. But sometimes cells keep dividing and grow out of control. This is how cancer develops. In lymphomas, white blood cells called lymphocytes become abnormal and grow out of control. These lymphocytes can build up in one part of the body and form a lump (tumour). There are2 main types of lymphoma: Hodgkin lymphoma non-Hodgkin lymphoma (NHL) Although these cancers are both lymphomas, they are different and need different treatments. Your doctors will do tests to find out which type you have. Symptoms One of the most common symptoms is having a painless lump. The lump is caused by swollen lymph nodes. There may be one or more lumps and these may be in your neck, armpit or groin. Lumps can also be inside the body. A commonplace would be inside the chest and this can cause a cough or breathlessness. Some people feel tired and lethargic with lymphoma. Itching of the skin is also quite common. Some people with Hodgkin lymphoma have other symptoms such as high temperatures, very heavy sweats (especially at night) and unexplained weight loss. Doctors call these symptoms B symptoms. Most of the symptoms that people get with lymphoma may also be caused by other illnesses. For example swollen lymph nodes, high temperatures and sweats may be caused by an infection. But if you have any of these symptoms or are worried that you may have Hodgkin lymphoma, go to your GP. Theyll examine you and refer you to a hospital if they think you need to see a specialist doctor. Causes Its not known what causes Hodgkin lymphoma. Research is going on to try to find out. Remember, though, it isnt anything that youve done. Hodgkin lymphoma is one of the most common cancers in young people over the age of 10. About 1 in 6 of all cancers affecting young people between 15 and 24 is a Hodgkin lymphoma. Hodgkin lymphoma isnt infectious and cant be passed on to other people or family members. If youre looking for information about Hodgkin lymphoma in people of all ages, read our general Hodgkin lymphoma section. Source: Macmillan - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites Macmillan Cancer Support: Information and support Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Huntingtons disease,"""Huntington's disease | NHS inform | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Huntingtons disease Huntingtons disease Huntingtons disease is a condition that damages nerve cells in the brain causing them to stop working properly. Its passed on (inherited) from a persons parents. The damage to the brain gets worse over time. It can affect movement, cognition (perception, awareness, thinking, judgement) and mental health. Symptoms of Huntingtons disease People can start to show the symptoms of Huntingtons disease at almost any age. Most will develop problems between the ages of 30 and 50. The condition gradually gets worse for around 10-25 years, until the person dies. Early symptoms Behavioural changes are often the first symptoms of Huntingtons disease. These changes often include: a lack of emotions and not recognising the needs of others periods of aggression, excitement, depression , antisocial behaviour and anger apathy  causing a person to appear lazy or have a lack of interest in hygiene and self care difficulty concentrating on more than one task and handling complex situations irritability and impulsiveness Speak to your GP if: youre worried you might have early symptoms of Huntingtons disease, especially if theres a history of the condition in your family Later symptoms Further symptoms of Huntingtons might include: psychiatric problems  some people develop obsessive behaviours , delusional thoughts or behaviours, stubborness, lack of self awareness, or suicidal thoughts uncontrollable movements of the face, jerking, clicking or fidgety movements of the limbs and body difficulty eating because the mouth and throat muscles dont work properly which can lead to choking and chest infections communication problems  difficulty putting thoughts into words and slurring of speech sexual problems  a loss of interest in sex or making inappropriate sexual demands balance problems In the later stages of Huntingtons disease, the person will need full nursing care. Death is usually from a secondary cause, like pneumonia or another infection. You might find the palliative care section useful if youre caring for someone whos dying, or if you want to plan your end of life care. Juvenile Huntingtons disease Juvenile Huntingtons disease is a rare form of the condition that can occur in people under the age of 20. Common signs include: a rapid decline in school performance changes in handwriting problems with movement, such as slowness, stiffness, tremor or muscle twitching (similar to the features of Parkinsons disease ) seizures (fits) Causes of Huntingtons disease Huntingtons disease is caused by a faulty gene. Cells in parts of the brain are very sensitive to the effects of the faulty gene. This makes them function poorly and eventually die. A parent with the Huntingtons disease gene has one good copy of the gene and one faulty copy. This means theres a: 50:50 chance that each of their children will develop Huntingtons disease  affected children can pass the gene to children they may have 50:50 chance that each of their children wont develop Huntingtons disease  unaffected children cant pass the gene to children they may have Its difficult to predict how old a child will be when they develop the condition if they inherit the abnormal gene. In around 3% of cases of Huntingtons disease, theres no obvious family history of the condition. This could be because relatives with the condition died before they were diagnosed with it. In rare cases, its due to a new fault in the gene that causes Huntingtons disease. Diagnosing Huntingtons disease If you have symptoms of Huntingtons disease, your GP will refer you to a specialist clinician. The specialist will ask about your symptoms to: see if its likely you have Huntingtons disease rule out similar conditions Theyll examine you and test your thinking, eye movements, balance and walking. Theyll find out if you have any involuntary movements, such as chorea (fidgety or jerky movements). Tests to diagnose Huntingtons disease You might have genetic testing to confirm if you have Huntingtons disease if: youre showing symptoms of the condition and it runs in your family your doctor strongly suspects you have the condition Diagnosis is based on the doctor recognising a number of factors like neurological examination, family history and genetic testing. Genetic test The children of someone with Huntingtons disease can take a genetic test after the age of 18 to see whether theyve inherited the faulty gene. Its possible to have the gene change and still be healthy when youre tested. This is known as premanifest Huntingtons disease. If theyve inherited the faulty gene, theyll develop Huntingtons disease, but its not possible to work out when. You can ask your GP or neurologist for an appointment at a genetic clinic. Youll receive some counselling and blood samples will be taken. Your DNA from the blood samples will be analysed to see whether you have inherited the faulty gene. Scottish Huntingtons Association has a national youth service to help and support children and young people who are living within a Huntingtons family. Brain scan In the early stages of Huntingtons disease, there may not be any specific changes on the brain scan. A doctor might use a brain scan if theyre concerned there may be other problems in addition to Huntingtons disease. A brain scan may involve having a computerised tomography (CT scan) or a magnetic resonance imaging (MRI) scan . Getting tested in pregnancy If youre pregnant and know you have the Huntingtons disease gene, its possible for your unborn baby to be tested during pregnancy at 11 weeks. You can discuss this with a genetic counselling team. Preimplantation genetic diagnosis Preimplantation genetic diagnosis can be used when one partner is known to have or is at risk of having the faulty gene. It involves having in vitro fertilisation (IVF) treatment. The embryo is genetically tested to make sure it doesnt have the faulty gene before being implanted into the womb. Should I get tested? Not everyone wants to know if theyve inherited the faulty gene. Its a personal choice. Some people say they would rather not know because they want to enjoy their life and they may die of other causes before the condition develops. If youre considering genetic testing, your GP will refer you to a genetic counsellor first. Treating Huntingtons disease Theres no cure for Huntingtons disease. Medication and therapies can help treat some of the symptoms. Speech and language therapy and occupational therapy, can help with communication and day-to-day living. Regular exercise is also very important. People who are active tend to feel much better physically and mentally than those who dont. Medication for Huntingtons disease Most of these medications have side effects, like tiredness. It can sometimes be difficult to tell if the side effects are symptoms of the condition or a result of the medication. Antidepressants to treat depression Antidepressants can help improve mood swings and treat depression . Mood stabilisers to treat irritability or mood swings Mood stabilisers may be considered as a treatment for irritability. Some mood stabilizers cant be used during pregnancy. Medication to suppress involuntary movements Medication can suppress involuntary movements. In the UK, antipsychotic medicines are usually preferred. Antipsychotic medication might help control delusions and violent outbursts, but they can have severe side effects, such as: stiffness and rigidity sedation moving slowly Living with Huntingtons disease Help is available to assist people with Huntingtons disease in their day-to-day life. This might include physiotherapy, occupational therapy and speech therapy. Daily routines such as getting dressed and eating meals can be frustrating and exhausting. The types of help outlined below aim to ease the strain of the condition by improving skills that may deteriorate. Help with communication Speech and language therapy can improve communication skills, and memory. It can help with swallowing problems . Communication aids can sometimes be helpful, as they allow communication without the need for talking. For example, you can point to symbols on a chart to show your mood or whether youre hungry. The family of someone with Huntingtons disease can try alternative ways of communicating if speech is a problem. Help with mealtimes People with Huntingtons disease might need to have a high-calorie diet. A dietitian can help you work out an appropriate diet plan. Food should be easy to chew, swallow and digest. It can be cut into small pieces or pured to prevent choking. Feeding equipment like special straws and non-slip mats can help. At some point, you might be offered a feeding tube that goes into the stomach. If a person doesnt want to be artificially fed, they should tell their family and doctor. They may want to consider making an advance decision (a living will) or a statement of wishes and preferences. Occupational therapy An occupational therapist (OT) can help with day-to-day activities. Your home can be adapted by social services to make life easier for a person with Huntingtons disease. You might also need to think about wheelchair access. Read more about occupational therapy and how it can help. Physiotherapy A physiotherapist can help with mobility and balance. It uses a range of treatments, including manipulation, massage, exercise, electrotherapy and hydrotherapy. You may be referred to a physiotherapist through your GP or social services. Current research Research is underway to find disease-modifying medication and new treatments for Huntingtons disease. Progress has been made in identifying potential ways of slowing down or halting the condition by switching off the faulty gene that causes Huntingtons disease. Speak to your healthcare professional if youre interested in taking part in research for Huntingtons disease. Financial information and support Its worth finding out what benefits you may be entitled to if you have Huntingtons disease, or if youre looking after someone with the condition. The Scottish Huntingtons Association Financial Wellbeing Service provides information, confidential advice and support to people living with Huntingtons disease. You can also contact the Citizens Advice Bureau (CAB) Read more about benefits if you need care, and carers benefits Driving A person diagnosed with Huntingtons disease whos started to experience symptoms should inform the Driver and Vehicle Licensing Agency (DVLA). The condition will affect their ability to drive. The DVLA will write to your doctor, with your permission, to ask for their opinion about your condition. Based on that information, theyll decide whether you can still drive and for how long before another assessment is needed. Theres no need to tell the DVLA if youre carrying the faulty gene but havent yet developed symptoms. You can view the National Care Framework for Huntingtons Disease on the Scottish Huntingtons Association (SHA) website. The SHA employs Huntingtons Disease (HD) Specialists in many areas of Scotland who work as part of multi-disciplinary teams along with HD Clinical Leads , physiotherapy, occupational therapy and speech therapy. Source: Scottish Government - Opens in new browser window Last updated: 14 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites Scottish Huntington's Association NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Hyperglycaemia (high blood sugar),"Hyperglycaemia (high blood sugar) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Blood and lymph Hyperglycaemia (high blood sugar) Hyperglycaemia (high blood sugar) Hyperglycaemia (high blood sugar)can affect people with type 1 diabetes and type 2 diabetes , as well as pregnant women with gestational diabetes. It can occasionally affect people who dont have diabetes, but usually only people who are seriously ill, such as those who have recently had a stroke or heart attack , or have a severe infection. Hyperglycaemia shouldnt be confused with hypoglycaemia , which is when a persons blood sugar level drops too low. This information focuses on hyperglycaemia in people with diabetes. Ishyperglycaemia serious? The aim of diabetes treatment is to keep blood sugar levels as near to normal as possible. But if you have diabetes, no matter how careful you are, youre likely to experience hyperglycaemia at some point. Its important to be able to recognise and treat hyperglycaemia, as it can lead to serious health problems if left untreated. Occasional mild episodes arent usually a cause for concern and can be treated quite easily or may return to normal on their own. However, hyperglycaemia can be potentially dangerous if blood sugar levels become very high or stay high for long periods. Very high blood sugar levels can cause life-threatening complications, such as: diabetic ketoacidosis (DKA) a condition caused by the body needing to break down fat as a source of energy, which can lead to a diabetic coma; this tends to affect people with type 1 diabetes hyperosmolar hyperglycaemic state (HHS) severe dehydration caused by the bodytrying to get rid of excess sugar; this tends to affect people with type 2 diabetes Regularly having high blood sugar levels for long periods of time (over months or years) can result in permanent damage to parts of the body such as the eyes, nerves, kidneys and blood vessels. If you experience hyperglycaemia regularly, speak to your doctor or diabetes care team. You may need to change your treatment or lifestyle to keep your blood sugar levels within a healthy range. Symptoms of hyperglycaemia Symptoms of hyperglycaemia in people with diabetestend to develop slowly over a few days or weeks. In some cases, there may be no symptoms until the blood sugar level is very high. Symptoms of hyperglycaemia include: increased thirst and a dry mouth needing topee frequently tiredness blurred vision unintentionalweight loss recurrent infections, such as thrush, bladder infections (cystitis) and skin infections Symptoms of hyperglycaemia can also be due to undiagnosed diabetes, so see your GP if this applies to you. You can have a test to check for the condition. Whatshouldmy bloodsugar level be? When youre first diagnosed with diabetes, your diabetes care teamwill usually tell you what your bloodsugar level is and what you should aim to get it down to. You may be advised to use a testing device to monitor your blood sugar level regularly at home, or you may have an appointment with a nurse or doctor every few months to see what your level is. Target bloodsugar levels differ for everyone, but generally speaking: if you monitor yourself at home  a normal target is 4-7mmol/l before eating and under 8.5-9mmol/l two hours after a meal if youre tested every few months  a normal target is below 48mmol/mol (or 6.5% on the older measurement scale) What causes high blood sugar? A variety of things can trigger an increase in blood sugar level in people with diabetes, including: stress an illness, such as a cold eating too much, such as snacking between meals a lack of exercise dehydration missing a dose of your diabetes medication, or takingan incorrect dose over-treating an episode of hypoglycaemia (low blood sugar) taking certain medicines, such as steroid medication Occasional episodes of hyperglycaemia can also occur in children and young adultsduring growth spurts. Treating hyperglycaemia If youve been diagnosed with diabetes and you have symptoms of hyperglycaemia, follow the advice your care teamhas givenyou to reduce your blood sugar level. If youre not sure what to do, contact your GP or care team. You may be advised to: change your diet  for example, you may be advised to avoid foods that cause yourblood sugar levels to rise, such as cakes or sugary drinks drink plenty of sugar-free fluids  this can help if youre dehydrated exercise more often gentle, regular exercise such as walking can often lower your blood sugar level, particularly if it helps you lose weight if you use insulin, adjust your dose  your care team can give you specific advice about how to do this You may also be advised to monitor your blood sugar level more closely, or test your blood or urine for substances called ketones (associated with diabetic ketoacidosis). Until your blood sugar level is back under control,watch out for additional symptoms that could be a sign of a more serious condition (see below). When to geturgent medical attention Contactyour diabetes care team immediatelyif you have a high blood sugar level and experience the following symptoms: feeling or being sick abdominal (tummy) pain rapid, deepbreathing signs ofdehydration , such as a headache , dry skin and a weak, rapid heartbeat difficulty staying awake These symptomscould be a sign of diabetic ketoacidosis or a hyperosmolar hyperglycaemic state (see above) and you may need to be looked after in hospital. How to prevent hyperglycaemia There are simple ways to reduce your risk ofsevere or prolonged hyperglycaemia: Be carefulwhat you eat  be particularly aware of how snacking and eatingsugary foodsor carbohydrates can affect your blood sugar level. Stick to yourtreatment plan  remember to take your insulinor otherdiabetes medications as recommended by your care team. Be as active as possible getting regular exercise can help stop your blood sugar level rising, but you should check with your doctor first if youre taking diabetes medication, as some medicines can lead to hypoglycaemia if you exercise too much Take extra care when youre ill your care team can provide you with some sick day rules thatoutline what you can do to keep your blood sugar level under control during an illness. Monitor your blood sugar level  your care team may suggest using a device to check your level at home, so you can spot an increase early and take steps tostop it. Source: NHS 24 - Opens in new browser window Last updated: 17 January 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Hypoglycaemia (low blood sugar)r Type 2 diabetes Other health sites Diabetes.co.uk: hyperglycaemia Diabetes UK: hypos and hypers NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Hyperhidrosis,"Hyperhidrosis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Skin, hair and nails Hyperhidrosis Hyperhidrosis About hyperhidrosis Causes of hyperhidrosis Treating hyperhidrosis Complications of hyperhidrosis About hyperhidrosis Hyperhidrosis is a common condition in which a person sweats excessively. The sweating may affect the whole of your body, or it may only affect certain areas.Commonly affected areas includethe: armpits palms of your hands soles of your feet face and chest groin Both sides of the body are usually affected equally  for example, both feet or both hands. The sweating doesnt usually pose a serious threat toyour health, but it can be embarrassing and distressing. It can also have a negative impact on your quality of life and may lead tofeelings of depression and anxiety . Read more about the complications of hyperhidrosis . What is excessive sweating? There are no guidelines to determine what normal sweating is, but if you feel you sweattoo muchandyour sweatinghas started to interfere with your everyday daily life, you may have hyperhidrosis. For example, you may have hyperhidrosis if: youavoid physical contact, such as shaking hands,because youfeel self-conscious about your sweating you dont take part in activities, such as dancing or exercise, for fear they will make your sweating worse excessive sweating is interfering with your job  for example, you have difficulty holding tools or using a computer keyboard youre having problems with normal daily activities, such as driving youre spending a significant amount of timecoping withsweating  for example, frequently showering and changing your clothes you become socially withdrawn and self-conscious When to see your GP Visit your GP if you feel that your sweating is interfering with your daily activities, or you suddenly start sweating excessively. Many people with hyperhidrosis are too embarrassed to seek medical help or believe that nothing can be done to improve it.Buttreatment isavailable. Also visit your GP if you arehavingnight sweats, because it can sometimes be a sign of something more serious. Your GP will usually be able to diagnose hyperhidrosis based on your symptoms, although occasionally you may need blood and urine tests tocheck for an underlying cause (see below). What causes hyperhidrosis? In many cases, hyperhidrosis has no obvious cause and is thought to be the result of a problem with the part of the nervous system that controls sweating. This is known as primary hyperhidrosis. Hyperhidrosis that does have an identifiable cause is known as secondary hyperhidrosis. This can have many different triggers, including: pregnancy or the menopause anxiety certain medications low blood sugar ( hypoglycaemia ) an overactive thyroid gland ( hyperthyroidism ) infections Read more about the causes of hyperhidrosis . How hyperhidrosis is treated Excessive sweating can be challenging to treat and it may take a while to find a treatment right for you. Doctors usually recommend starting with the least invasive treatment first, such as powerful antiperspirants.Lifestyle changesmay also help, including: wearing loose and light clothes avoiding triggers, such as alcohol and spicy foods, that could make your sweating worse wearing black or white clothestohelp minimise the signs of sweating If this doesnt help, you may be advised to try treatments such as iontophoresis (the affected area is treated with a weak electric current passed through water or a wet pad), botulinum toxin injections, and even surgery in a few cases. Hyperhidrosis is usually a long-term condition, but some people experience an improvement with time and the treatments available can often keep the problem under control. Read more about treating hyperhidrosis . Who is affected Hyperhidrosis is common. Its been estimated to affect between 1and 3in every 100 people which means there are likely to be hundreds of thousands of people living with it in the UK. Hyperhidrosis can develop at any age, although primary hyperhidrosis typically starts during childhood or soon after puberty. Causes of hyperhidrosis Hyperhidrosis can be divided into 2types, depending on whether an obvious cause can be identified. These are known as primary and secondary hyperhidrosis. Primary hyperhidrosis Hyperhidrosis that has no obvious cause is known as primary hyperhidrosis. Although its not clearwhy itdevelops, its thought to be the result of a problem with part of the nervous system called the sympathetic nervous system, and its possible your genes may also play a role. The sympathetic nervous system The sympathetic nervous system controls most of your bodys functions that do not require conscious thought, such as movement of food through your body and the movement of urine out of your kidneys and into your bladder. The sympathetic nervous system also acts like a thermostat. If it senses you are getting too hot, it will send a signal from your brain to the millions of sweat glands in your body to produce sweat. The sweat cools on your skin and reduces the temperature of your body. A specific type of sweat gland, known as the eccrine glands, appears to be involved in hyperhidrosis. There are more eccrine glands on your armpits, hands, feet and face, which may explain why these areas are often affected by hyperhidrosis. Its thought that in cases of primary hyperhidrosis, the brain sends signals to the eccrine glands, even though there is no need to cool the body. Genes Some cases of primary hyperhidrosis appear torun in families, which suggests a genetic mutation may be the cause. A genetic mutation is where the instructions in your cells become scrambled, which can disrupt the normal workings of the body. Some genetic mutations can be passed down from parents to their children. Secondary hyperhidrosis If a cause of hyperhidrosis can be identified, its known as secondary hyperhidrosis. Secondary hyperhidrosis can have a number of different triggers, including: pregnancy the menopause  when a womans monthly periods stop anxiety low blood sugar ( hypoglycaemia ) an overactive thyroid gland ( hyperthyroidism ) obesity certain medications  including some antidepressants ,propranolol, pilocarpine, andbethanechol being drunk or high on drugs, or withdrawing from alcohol or drugs if youhave become addicted to them some infections, such as tuberculosis and HIV Parkinsons disease disorders of the blood cells or bone marrow, such as Hodgkin lymphoma (a cancer of the white blood cells) Secondary hyperhidrosis often starts more suddenly than primary hyperhidrosis and tends to affect the whole body. Treating hyperhidrosis Hyperhidrosis can be challenging to treat and it may take a while to find the best treatment for you. Less invasive treatments will usually be recommended first. Lifestyle changes Changing your lifestyle cannot cure primary hyperhidrosis (hyperhidrosis with no obvious cause), but it can improve your symptoms and help your confidence. The advice below may help. Avoidtriggers that you know make your sweating worse, such as spicy foods and alcohol Use antiperspirant frequently, rather than deodorant Avoid wearing tight, restrictive clothing and man-made fibres, such as nylon Wearing black or white clothing canminimise signs of sweating Armpit shields can absorb excessive sweat and protect your clothes Wear socks that absorb moisture, such as thick socks made of natural fibres, or special soles or sports socks designed to absorb moisture Avoid wearing socks made out of man-made materials and change your socks at least twice a day if possible Ideally wearshoes made of leather, andtry to alternate between different pairs of shoes every day Stronger antiperspirants Ifa regular antiperspirant doesntcontrol your sweating, your GP may prescribeor suggesta stronger one for you. Antiperspirant containing aluminium chloride is often used to treat hyperhidrosis. This works by plugging the sweat glands. You will need to apply it at night just before you go to sleep and wash it off in the morning. The most common side effect of aluminium chloride is mild irritation or itching and tingling where it is applied. Using the antiperspirant less frequently can help reduce irritation. Using emollients (moisturisers) regularly and soap substitutes instead of soap may also help. Anticholinergics You may be prescribed a type of medicine called an anticholinergic or antimuscarinic. These work by blocking the effects of a chemical called acetylcholine, which the nervous system uses to activate the sweat glands. Anticholinergics are available as tablets or solutions that are applied to affected areas. Theyre not widely used to treat hyperhidrosis and most types are not licensed to treat it, but some people find them helpful. Propantheline bromide is an anticholinergic medicine licensed for treating hyperhidrosis. However, anticholinergic medicines unlicensed for hyperhidrosis  such as oxybutynin and glycopyrronium bromide  can also be prescribed if your doctor feels they might help. Possible side effects of anticholinergics include a dry mouth , blurred vision, stomach cramps, constipation and difficulty passing urine. Referral to a dermatologist If lifestyle changes and treatment dont work, your GP may refer you to a dermatologist (a specialist in treating skin conditions) for further treatment, such as iontophoresis, botulinum toxin or surgery. Iontophoresis Iontophoresismay help if you have excessive sweating that affects your hands or feet. It can also be used to treat armpits, although this is usually less effective. Iontophoresis involves treating affected areas of skin with a weak electric current passed through water or a wet pad. This is thought to help block the sweat glands. If your hands and feet need treating, you place them in a bowl of water and a weak electric current is passed through the water. If your armpits need treating, a wet contact pad is placed against each armpit and a current is passed through the pad. The treatment is not painful but the electric current can cause mild, short-lived discomfort and skin irritation. Each session of iontophoresis lasts between 20 and 30 minutes, and you will usually need to have 2to 4sessions a week. Your symptoms should begin to improve after a week or 2, after which further treatment will be required at 1to 4week intervals, depending on how severe your symptoms are. Iontophoresis is often very effective, although you may need to make regular visits to your local hospitals dermatology clinic to receive treatment. Alternatively, iontophoresis kits that you can use at home may be recommended, with prices in the range of 250-500. Botulinum toxin injections Botulinum toxin can be injected into the skin in areas of the body affected by hyperhidrosis. This helps reduce sweating in these areas by blocking the signals from the brain to the sweat glands. Around 15-20 injections are given in the affected areas of the body, such as the armpits, hands, feet or face. The procedure usually takes about 30-45 minutes in total. The effect of the injections usually lasts for several months, after which time the treatment can be repeated if necessary. Potential side effects ofbotulinum toxin injections include: pain, redness or itching where the injections are given nausea, headaches and hot flushes after the injections are given another part of your body sweating more to make up for treated area  known as compensatory sweating muscle weakness around the treatment area Most of these side effects are short-lived or will resolve as the effect of the injections wears off. Availability of botulinum toxin on the NHS can vary widely depending on your clinical commissioning group (CCG), and you may only be able to get it privately. Costs for private treatment depend on the part of the body being treated. For example, injecting the forehead can cost around 150, while treating both armpits could cost up to 450 or more. Surgery and other procedures In a few cases where hyperhidrosis is particularly severe and treatmenthasnt been successful, surgery may be recommended. Endoscopic thoracic sympathectomy (ETS) Endoscopic thoracic sympathectomy (ETS) is the most widely used type of surgery to treat hyperhidrosis. Its usually used in cases affecting the palms or armpits. Small incisions are made in the side of the chest and the nerves that control sweating in the affected area are cut or clipped. This means signals can no longer pass along them to the sweat glands. The operation is carried out under general anaesthetic and done on both sides of the body. The National Institute for Health and Care Excellence (NICE) recommends that ETS can be used to treat excessive sweating of the palms or underarms. However, before the procedure is performed, your clinician should explain: ETScarries a risk of serious complications (see below) its very common for excessive compensatory sweating to occur after the procedure, which causes some people to regret the procedure the procedure is not always successful at reducing sweating For this reason, only people with severe hyperhidrosis which hasnt responded to treatment should be considered. Read the full NICE guidelines on endoscopic thoracic sympathectomy for primary hyperhidrosis of the upper limb . Side effects and complications of ETS can also include: sweating of the face and neck after eating food  this is known as gustatory sweating and may affect up to half of people who have the procedure bleeding into the chest during surgery air becoming trapped inside the chest (pneumothorax), which can cause chest pain and breathing difficulties damage to the nervous system that causesthe upper eyelid on one side of the body to droop (Horners syndrome)  this may be permanent Removing or destroying sweat glands Excessive sweating under the arms may occasionally be treated with a procedure to remove or destroy the sweat glands in the armpits. This can be carried out in a number of ways: making an incision in the armpit and carefully scraping away (curettage) or cutting out (Shelleys procedure) the sweat glands using a probe held above the skin (no incisions are needed), which emits electromagnetic radiation that destroys the sweat glands inserting a laser device under the skin through a small incision and using it to destroy the sweat glands These procedures are generally carried out under local anaesthetic , which means you will be awake but your armpit will be numbed. These procedures can sometimes be a permanent solution to excessive underarm sweating, although they are only carried out by a small number of practitioners. Availability on the NHS is likely to be very limited and you will probably need to pay for private treatment. These procedures dont work for everyone and some of them are relatively new, which means there isnt always evidence about their long-term safety and effectiveness. Treating anxiety Feelings of anxiety are not directly responsible for causing primary hyperhidrosis, but they can make the situation worse and create a vicious cycle. You may feel self-conscious, which can trigger anxiety in certain situations, such as when meeting new people or being in a crowded room. The anxiety can make the sweating worse. If your anxiety is making your sweating worse, a type of talking therapy called cognitive behavioural therapy (CBT)might help. Medication for anxiety is not usually recommended because it can make sweating worse. Complications of hyperhidrosis Hyperhidrosis doesnt usually pose a serious threat to your health, but it can sometimes lead to physical and emotional problems. Fungal infections Hyperhidrosis increases the risk of developing fungal infections, particularlyon the feet mostcommonly fungal nail infections and athletes foot. This is because excessive sweat combinedwith wearing socks and shoes creates an ideal surrounding for fungi to grow. Fungal infections can be treated with antifungal creams. More severe cases may require antifungal tablets or capsules. Skin conditions Excessive sweat can make you more vulnerable tocertain skin conditions, such as: warts  small, rough lumps on the skin that are caused by the HPV virus boils swollen red-yellow bumps in the skin that can develop when a hair follicle becomes infected Eczema canalso be made worse by excessive sweating. Body odour Although people with hyperhidrosis sweat a lot, most dont have problems with body odour. This is because hyperhidrosis doesnt usually affect the sweat glands responsible for producing unpleasant-smelling sweat  called the aprocrine sweat glands. However, if bacteria are allowed to break down the sweat, it can start to smell unpleasant. Eating spicy food and drinking alcohol can also make sweat secreted from the eccrine smell. This can be prevented or eased by following lifestyle advice, such as frequently using antiperspirant spray and using armpit shields to absorb sweat. See treating hyperhidrosis for more information. Emotional impact The emotional impact of living with hyperhidrosis can be severe. Many people with the condition feel unhappy and, in some cases, depressed. Signs that you may be depressed include: feeling down, depressed, or hopeless during the past month having little interest or pleasure in things during the past month It is important not to neglect your mental health. Make an appointment to see your GP if you think that you may be depressed. Readmore about depression or find out more abouttackling stress, anxiety and depression. Source: NHS 24 - Opens in new browser window Last updated: 19 January 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Hypoglycaemia (low blood sugar),"Hypoglycaemia (low blood sugar) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Blood and lymph Hypoglycaemia (low blood sugar) Hypoglycaemia (low blood sugar) Introduction Symptoms of hypoglycaemia Causes of hypoglycaemia Treating hypoglycaemia Preventing hypoglycaemia Introduction Hypoglycaemia, or a hypo, is an abnormally low level of glucose in your blood (less than four millimoles per litre). When your glucose (sugar)level is toolow, your body doesnt have enough energy to carry out its activities. Hypoglycaemia is most commonly associated with diabetes , and mainly occurs if someone with diabetes takes too much insulin, misses a meal or exercises too hard. In rare cases, its possible for a person who doesnt have diabetesto experience hypoglycaemia. It can be triggered by malnutrition ,binge drinking or certain conditions, such as Addisons disease . Read more about the causes of hypoglycaemia Symptoms of hypoglycaemia Most people will have some warning that their bloodglucose levels are too low, which gives them time to correct them. Symptoms usually occur when blood sugar levels fall below four millimoles (mmol) per litre. Typical early warning signs are feeling hungry, trembling or shakiness, and sweating. In more severe cases, you may also feel confused and have difficulty concentrating. In very severe cases, a person experiencing hypoglycaemia can lose consciousness. Its also possible for hypoglycaemia to occur during sleep, which can cause excess sweating, disturbed sleep, and feeling tired and confused upon waking. Read more about the symptoms of hypoglycaemia Correcting hypoglycaemia The immediate treatment for hypoglycaemia is to have some food or drink that contains sugar, such as dextrose tablets or fruit juice, to correct your blood glucose levels. After having something sugary, you may need to have a longer-acting starchy carbohydrate food, such asa sandwich or afew biscuits. If hypoglycaemia causes a loss of consciousness, an injection of the hormone glucagon can be given to raise blood glucose levels and restore consciousness. This is onlyif an injection is available and the person giving the injection knows how to use it. You should dial 999 to request an ambulance if: a glucagon injection kit isnt available theres nobody trained to give the injection the injection is ineffective after 10 minutes Never try to put food or drink into the mouth of someone whos drowsy or unconsciousas they could choke.This includes some of the high-sugar preparations specifically designed for smearing inside the cheek. Read more about treating hypoglycaemia Preventing hypoglycaemia If you have diabetes that requires treatment with insulin, the safest wayto avoid hypoglycaemia is to regularly check your blood sugar and learn to recognise the early symptoms. Missing meals or snacks or eating less carbohydrate than planned can increase your risk of hypoglycaemia. You should be careful when drinking alcohol as it can alsocause hypoglycaemia, sometimes many hours after drinking. Exercise or activity is another potential cause, and you should have aplan for dealing with this, such as eating carbohydrate before, during or after exercise, or adjusting your insulin dose. You should also make sure you regularly change where you inject insulinas the amount of insulin your body absorbs can differ depending on where its injected. Always carry rapid-acting carbohydratewith you, such as glucose tablets, a carton of fruit juice (one that contains sugar), or some sweets in case you feel symptoms coming on or your blood glucose level is low. Make sure your friends and family know about your diabetes and the risk of hypoglycaemia. It may also help to carry some form of identification that lets people know about your condition in an emergency. When hypoglycaemia occurs as the result ofan underlying condition other than diabetes, the condition will need to be treated to prevent a further hypo. Read more about preventing hypoglycaemia Symptoms of hypoglycaemia The symptoms of hypoglycaemia usually begin when your blood glucose level drops below four millimoles (mmol) per litre. If you have diabetes ,particularly if its treated with insulin, you may be advised to use a small device called a blood glucose meter toregularly check your blood glucose levels. Symptoms can vary from person to person, and its important to be aware of the early warning signs so you can treat them. Signs and symptoms of hypoglycaemia can include: feeling hungry sweating dizziness tiredness (fatigue) blurred vision trembling or shakiness going pale fast pulse or palpitations tingling lips irritability difficulty concentrating confusion disorderly or irrational behaviour, which may be mistaken for drunkenness If hypoglycaemia isnt treated promptly and your blood glucose levels drop low enough, you may become drowsy or even lose consciousness. Most people with insulin-treated diabetes notice that the symptoms of hypoglycaemia change and become less obvious the longer they live with the condition. For some people, the warning symptoms become greatly reduced, putting them at significant risk of having severe episodes where theyre dependent on others for help. Let your diabetes care team know if you develop this problemas your treatment may need to be changed to reduce the risk. Read more about how hypoglycaemia is treated Hypoglycaemia while sleeping Having ahypo while youre asleep is known as nocturnal hypoglycaemia. Its more common in people who treat diabetes with insulin. Although some people find their sleep is disturbed when they experience nocturnal hypoglycaemia,you may only notice the symptoms when you wake up in the morning. The symptoms ofnocturnal hypoglycaemia can include: headache often likened to having a hangover feeling unusually tired in the morning damp sheets or clothing from sweating Causes of hypoglycaemia In most cases, hypoglycaemia affects people with diabetes , although more rarely it can also occur as a result of other underlying conditions. Hypoglycaemia in people with diabetes Overdose of diabetes medication A common cause of hypoglycaemia is taking too much insulin for your current needs. Insulin is a medication that helps control your blood glucose levels. Its commonly used to treat type 1 diabetes and is also recommended for somepeople with type 2 diabetes . A fall in bloodglucose levels can also occur after taking too much oral hypoglycaemia medication, such as sulphonylurea, which causes a release of insulin. This medication is often usedto lower blood glucose levels in people with type 2 diabetes. Exercise, food and alcohol For people with type 1 diabetes, maintaining the correct blood glucose level involves balancinghow muchinsulin you inject, the amount of food you eat, and how much energy you burn during exercise. Hypoglycaemia may occur if youve taken your dose of insulin as usual, but your carbohydrate intake is lower than normal or has been used up more quickly. This may happen if you delay or miss a meal or snack, dont eat enough carbohydrate, or exercise more than usual. People with diabetes whovedrunk too much alcohol, or drank alcohol on an empty stomach, can also get hypoglycaemia. However, its not always possible to identify why a particular episode of hypoglycaemia has occurred, and sometimes it happens for no obvious reason. Hypoglycaemia in people without diabetes Hypoglycaemia even mild casesis very rare in people who dont have diabetes. The possible causes are outlined below. Reactive hypoglycaemia People without diabetes can sometimes experience hypoglycaemia if their pancreas produces too much insulin after a large carbohydrate-based meal. This is known as reactive hypoglycaemia. Its not clear why this happens, although its thought to be more common in people who are overweight or have had gastric bypass surgery. In rare cases, a benign (non-cancerous) tumour in the pancreas may cause an overproduction of insulin, or the tumour itself may use up too much glucose. Other possible causes Other possible causes of hypoglycaemia in people without diabetes are: fasting or malnutrition  where not enough nutrients are consumed for your body to function properly binge drinking or heavy drinking of alcohol Addisons disease  a disorder of the adrenal glands (two small glands that sit on top of the kidneys) certain medication  hypoglycaemia has been known to occur in people taking quinine (for malaria ), salicylates (for rheumatic disease) and propranolol (for high blood pressure ) severe illnesses affecting the liver, kidneys or thyroid gland Treating hypoglycaemia In most cases, you can treat hypoglycaemia yourself when you recognise the symptoms. Treating an episode of hypoglycaemia The immediate treatment for hypoglycaemia is to have some sugary food or drink (about 15 to 20g of rapidly acting carbohydrate) to end the attack. For example, this could be: a glass of fruit juice or non-diet soft drink between three and five dextrose tablets a handful of sweets At first you should avoid fatty foods and drinks, such as chocolate and milk, because they dont usually contain as much sugar and the sugar they do contain may be absorbed more slowly. After having something sugary, you should have a longer-acting carbohydrate food, such as a few biscuits, a cereal bar, a piece of fruit or a sandwich. It will usually take around 15 minutes to recover from a mild episode of hypoglycaemia. If you have a blood glucose meter, measure your blood sugar again after 15 to 20 minutes. If its still too low (below 4mmol), you should have some more sugary food or a drink before testingyour levelsagain in another 15 to 20minutes. When treating someone else with hypoglycaemia, if the above treatment isnt effective, you may be able to help them by applying glucose gel (or honey, treacle or jam if glucose gel isntavailable) to the inside of their cheeks, and gently massaging the outside of their cheeks. It may take 10 to 15 minutes before they feel better. This shouldnt be done if the person is drowsy or unconscious because of the risk of choking. If you have several episodes of hypoglycaemia a week, you should contact your diabetes care team to find out the underlying cause. Your medication may need to be adjusted, or there may be another condition causing hypoglycaemia that needs to be treated. If a person is unconscious If a person loses consciousnessbecause ofsevere hypoglycaemia, they need to be put into the recovery position and given an injection of the hormone glucagon(if they have an injection kit). The injection will raise their blood glucose level. The injection should be carried out by a friend or family member who knows what theyre doing, or by a trained healthcare professional. You should dial 999 to request an ambulance if: a glucagon injection kit isnt available theres nobody available whos trained to give the injection the injection is ineffective after 10 minutes Never try to put food or drink into the mouth of someone whos unconscious asthey could choke. If youre able to give a glucagon injection and the person regains consciousness, they shouldeat some longer-acting carbohydrate food, such as a few biscuits, a cereal bar or a sandwich. You should continue to monitor the person for signs of recurring symptomsin case they need to be treated again. Preventing hypoglycaemia If you have diabetes, sticking to your medication plan and eating regular meals can help prevent hypoglycaemia. Its also important to monitor your blood glucose levels. Monitoring blood glucose Regularlymonitoring your blood glucose levelscan help you keep your blood glucose as normal and stable as possible, and will help you spot the signs and symptoms of hypoglycaemia quickly. Your blood glucose level can vary throughout the day, so you may need to check it several times a day, depending on the treatment youre taking. You canmonitor your blood glucose levels using a blood glucose meter, a small device that measures the concentration of glucose in your blood. Read more about living with type 1 diabetes and living with type 2 diabetes Food and alcohol If you have diabetes, strenuous physical activity can lead to hypoglycaemia. Eating extra carbohydrate-based foods before and during exercise can help reducethe chances of this happening. If youre taking insulin, your doctor may advise you to lower your dose beforeyou dostrenuous physical activity. Alcohol can also affect your bodys ability to release glucose. If you have type 1 diabetes , its recommended that you drink no more than 2 to 3 units of alcohol a day and eat a snack after drinking alcohol. Spotting the signs As hypoglycaemia can develop suddenly, its important to be aware of the symptoms of hypoglycaemia so you can treat it quickly. Tell your family and friends about the signs to look outfor andlet them know how to treat it. People with diabetes are advised to carry a form of identification with them that states their condition so they can be helped quickly and efficiently. Keep treatment with you If youre at risk of hypoglycaemia, you should carry sugary food and drink with you at all times to treat mild cases as soon as possible. If you have diabetes, particularly type 1 diabetes, your doctor may recommend medications such as glucose gelto carry with you. This can be used to treat hypoglycaemia that doesnt respond to normal treatment. If youre being treated with insulin, youll usually be given a kit that contains aninjection of a medication called glucagon. Family members or your carer can be trainedto carry out the injection, which should be used if you lose consciousness because ofsevere hypoglycaemia. Preventing hypoglycaemia at night Its important to avoid recurrent hypoglycaemia during the night (nocturnal hypoglycaemia)as it can reduce the early symptoms of daytime episodes. If you experience nocturnal hypoglycaemia, you can try: keeping something sugary by your bedside having a snack before bedtime, such as biscuits and milk checking your blood glucose levels between 3am and 4am, whenhypoglycaemia is most likely to occur Hypoglycaemia and driving As hypoglycaemia can cause confusion, drowsiness, or even unconsciousness, this can present a significant risk to you or other road users. If you have diabetes that requires treatment with insulin, you must: inform the DVLA and your insurance company test your blood sugar before driving and at regular intervals (at least everytwo hours) while driving avoid driving if your blood glucose is low avoid driving for 45 minutes after treating hypoglycaemia carry rapid-acting carbohydrates with you in the vehicle at all times If you experience hypoglycaemia while driving, pull over and stop as soon as its safe to do so. Remove the keys from the ignition and get out of the drivers seat before treating hypoglycaemia in the normal way. If you have two or more episodes of hypoglycaemia that require assistance in a 12-month period, its a legal requirement to stop driving and inform the DVLA. If youre a group two driver (you hold a licence to drive buses, coaches or lorries), youre legally required to stop driving group two vehicles immediately and inform the DVLA if you have a single episode of hypoglycaemia that requires assistance. Inform your diabetes care team if you start having problems recognising hypoglycaemia or you start to have more regular episodes, evenif there werewarning symptoms and you were able to treat them without assistance. See theGOV.UK website for more information about hypoglycaemia and driving Source: NHS 24 - Opens in new browser window Last updated: 09 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Type 2 diabetes Other health sites Diabetes.co.uk: diabetes and hypoglycaemia Diabetes UK: hypos and hypers NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Idiopathic pulmonary fibrosis,"Idiopathic pulmonary fibrosis (IPF) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Lungs and airways Idiopathic pulmonary fibrosis Idiopathic pulmonary fibrosis About idiopathic pulmonary fibrosis Symptoms of idiopathic pulmonary fibrosis Causes of idiopathic pulmonary fibrosis Diagnosing idiopathic pulmonary fibrosis Treating idiopathic pulmonary fibrosis About idiopathic pulmonary fibrosis Idiopathic pulmonary fibrosis (IPF) is a condition in which the lungs become scarred and breathing becomes increasingly difficult. Its not clear what causes it, but it usually affects people around 70-75 years of age and is rare in people under 50. Several treatments can help reduce the rate at which IPF gets worse, but theres currently no treatment that can stop or reverse the scarring of the lungs. Symptoms of idiopathic pulmonary fibrosis The symptoms of IPF tend to develop gradually and get slowly worse over time. Symptoms can include: shortness of breath a persistent dry cough tiredness loss of appetite andweight loss rounded and swollenfingertips (clubbed fingers) Many people ignore their breathlessness at first and blame it on getting old or being out of shape. But eventually even light activity such as getting dressed can cause shortness of breath. When to get medical advice See your GP if youve struggled with your breathing for a while or have had a cough for more than three weeks. These symptoms arent normal and shouldnt be ignored. If your GP thinks you could have a lung condition such as IPF, they can refer you to a hospital specialist for tests such as: breathing (lung function) tests blood tests a chest X-ray and computerised tomography (CT) scan a lung biopsy (where a small piece of lung tissue is removed during keyhole surgery so it can be analysed) Read more about the tests for idiopathic pulmonary fibrosis . Causes of idiopathic pulmonary fibrosis In people with IPF,thetiny air sacs in the lungs(alveoli) become damaged and increasingly scarred. This causes the lungsto become stiff and means its difficult for oxygen to get intothe blood. The reason this happens isnt clear. Idiopathic means the cause is unknown. IPF has been linked to: exposure to certain types of dust, such as metal or wood dust viral infections a family history of IPF  around 1 in 20 people with IPF has another family member with the condition gastro-oesophageal reflux disease (GORD) smoking But its not known whether some of these factors directly cause IPF. Treatments for idiopathic pulmonary fibrosis Theres currently no cure for IPF, but there are several treatments that can help relieve the symptoms and slowdown its progression. Treatments include: self-care measures such as stopping smoking, eating healthily and exercising regularly medication to reduce the rate at which scarring worsens  such as pirfenidone and nintedanib breathing oxygen through a mask you can do this while youre at home and/or while youre out and about pulmonary rehabilitationexercises and advice to help you breathe more easily a lung transplant  this is suitable in a few cases,although donor lungs are rare Read more about how idiopathic pulmonary fibrosis is treated . Outlook for idiopathic pulmonary fibrosis IPFgets worse over time, although the speed at which this happens is highly variable. Some people respond well to treatment and remain relatively free of symptoms for many years, while others may get rapidly worse or find the breathlessness debilitating. Other problems can also sometimes develop, including chest infections , pulmonary hypertension and heart failure . Itsvery difficultto predicthow long someone with IPF will survive at the time of diagnosis. Regular monitoring over time can indicate whether its getting worse quickly or slowly. Before the availability of specific treatments like pirfenidone and nintedanib about half of people with IPF lived at least three years from their diagnosis. Around 1 in 5 survived for more than five years. Its hoped these figures will be improved by the availability of new treatments to slow the diseases progression. Symptoms of idiopathic pulmonary fibrosis The most common symptom of idiopathic pulmonary fibrosis (IPF) is shortness of breath, often when physically active, which can get worse over time. At first, many people ignore theirbreathlessness (especially older patients) and blame it on getting old or being out of shape.But as the disease progresses and lung damagebecomes more severe, even light activitylike getting dressed or having a shower can cause breathlessness. Other symptoms of pulmonary fibrosis include: a persistent dry cough tiredness loss of appetite andweight loss In up to half of all cases, there is also a change in the shape of the finger and toenails. This thickening of tissue at the base of the finger and toenails is known as digital clubbing. The exact cause of clubbing is unknown, but it can occur in people with various chest and heart diseases. Secondary conditions The strain IPF can place on your lungs and your heart can trigger a number of secondary conditions, outlined below. Chest infection You will have an increased risk of developing chest and airway infections such as: bronchitis  an infection of the airway of the lungs pneumonia  an infection of the air sacs of your lungs influenza (flu) Symptoms of a chest infection include: worsening breathlessness chest pain a high temperature (fever) of 38C (100.4F) or above sweating and shivering Pulmonary hypertension Around a third of people with IPF will also go on to develop pulmonary hypertension . Pulmonary hypertension is when blood pressure inside the arteries connecting the lungs to the heart is dangerously high. Symptoms of pulmonary hypertension include: dizziness feeling faint chest pain (angina) a racing heartbeat (tachycardia) Read more about symptoms of pulmonary hypertension . Heart failure Heart failure , where the heart is unable to pump enough blood around the body, can develop when IPF becomes severe. This is due to a combination of factors, including a build-up of blood in the right side of the heart (the side that pumps blood to the lungs), which develops because it is difficult to pump blood through the scarred lung tissue. The poor supply of oxygen from the diseased lungs to the heart muscle also contributes to heart failure. Heart failure can cause various symptoms, including: worsening breathlessness extreme tiredness and weakness swelling in the legs, ankles and feet (oedema) caused by a build-up of fluid Read more about the symptoms of heart failure . Causes of idiopathic pulmonary fibrosis The exact cause of idiopathic pulmonary fibrosis (IPF) is not known. Idiopathic means having no known cause. The current theory is that IPF is triggered when cells that line the lung alveoli (air sacs) become damaged by exposure toone of severalsubstances or viruses. The damaged cells try to repair themselves but the process becomes uncontrolled, resulting in thickening and scarring (fibrosis) of the alveoli and surrounding lung tissue. The amount of oxygen that can pass from the lungs into the blood is then significantly reduced. Triggers A number of factors have been suggested as possible triggers for the initial damage to the cells lining the alveoli. Most experts agree that the two most significant risk factors are: being a smoker or having smoked in the past occupational exposure to certain types of dust  jobs that involve working with wood, metal, textile, stone, cattle or farming mayincrease the risk of IPF Other possible risk factors include: viral infections  such as the Epstein-Barr virus or hepatitis C gastro-oesophageal reflux disease (GORD) (where the acid from your stomach rises back up into your throat)  this may be accidentally inhaled into the lungs, causing damage to the alveoli chronic aspiration  where food, drink or saliva enter the lungs and is not coughed back up, often due to a related condition environmental pollutants or dust genetic tendency the condition appears to run in some families but this only seems to be the case in around 5% of people with IPF As IPF is such a rare condition it is hard to estimate how much of an impact these risk factors can have on your chance of developing it. Diagnosing idiopathic pulmonary fibrosis Idiopathic pulmonary fibrosis (IPF) can be hard to diagnose because its symptoms are similar to other lung conditions, such as chronic obstructive pulmonary disease (COPD) . Your GPcan refer you to hospital specialists for a number of tests to help rule out other conditions and confirm the diagnosis. The checks and tests you may have include: Medical history and examination Breathing and blood tests Chest X-ray and CT scan Bronchoscopy Lung biopsy Medical history and examination Your doctor will ask about your medical history and whether there are other factors that could be causing a problem with your lungs, such as whether you: smoke or have smoked in the past have been exposed to harmful substances at work, such as asbestos haveother medical conditions They may also: check the sound of your breathing through a stethoscope a crackling sound can suggest lung scarring (fibrosis) look at your fingers to see if the ends are swollen (finger clubbing) ask you to walk around for a few minutes to see if you become breathless Breathing and blood tests Lung function tests (also called pulmonary function tests) assess how well your lungs work and can help indicate what the problem may be. These tests measure: how quickly you can move air in and out of your lungs how much airyour lungscan hold how wellyour lungstransfer oxygen into your blood andremove carbon dioxide from it (this can be checked using a blood test ) A commonly used lung function test is spirometry. During the test, you breathe into a mouthpiece thats attached to a monitor. Chest X-ray and CT scan A chest X-ray doesnt show the lungs in much detail, but it can help doctors spot some more obvious problems that could be causing your symptoms,such as cancer or a build-up of fluid. If IPF is suspected, the chest x-ray will be followed by a computerised tomography (CT) scan . A CT scan is similar to an X-ray,but lots more images are taken and these are put together by a computer to create a more detailed image of your lungs. This can help your doctor spot signs of scarring in your lungs. Bronchoscopy If doctors still arent sure what the problem is after the tests described above, they may suggest having abronchoscopy. This is a test where a narrow, flexible tube with a camera (bronchoscope) is passed down into your airways. Your doctor can then look for anything abnormal and can take small tissue samples for testing. Youll usually be awake for a bronchoscopy and it may cause coughing. Local anaesthetic will be used to numb your throat so it doesnt hurt and you may also be given a sedative injection which will make you feel sleepy during the procedure. Lung biopsy If other tests arent conclusive, a lung biopsy may need to be carried out. This involves keyhole surgery to remove a small sample of lung tissue so it can be analysed for signs of scarring. The procedure is performed under a general anaesthetic (where youre asleep).Your surgeon makes several small incisions (cuts) in your side and an endoscope (a thin tube with a camera and a light at the end) is inserted into the area between the lungs and the chest wall. The surgeon can see the lung tissue through the endoscope and is able obtain a small sample. Treating idiopathic pulmonary fibrosis Theres currently no cure for idiopathic pulmonary fibrosis (IPF). The main aim of treatment is to relieve the symptoms as much as possible and slow down its progression. The main treatments are: Self-care Medication Oxygen support Pulmonary rehabilitation Lung transplant As the condition becomes more advanced, end of life (palliative) care will be offered. Self-care There are several things you can do to stay as healthy as possible if you have IPF. These include: stopping smoking if you smoke exercise regularly and stay as fit as you can eat a healthy, balanced diet make sure yougettheannual flu jaband one-offpneumococcal vaccination these infections can be more serious if you have a lung condition try to keep away from people with chest infections and colds whenever possible Medication There are two medications that can help slow down the progression of IPF in some people:pirfenidone and nintedanib. Some people also take a medication calledN-acetylcysteine, although its benefits are uncertain. Pirfenidone Pirfenidone helps to slow the development of scarring in the lungs by reducing the activity ofthe immune system. Its normally taken as capsules three times a day. Its recommended if breathing tests have shownyour lung capacity is 50-80% of what would normally be expected. If your condition gets worse despite takingpirfenidone and your lung capacity falls by 10% or more within a year,the medication will usuallybe stopped. Side effects of pirfenidone can include: feeling sick tiredness diarrhoea indigestion a rash caused byexposure to sunlight For further information see, theNational Institute for Health and Care Excellence (NICE) guidelines on pirfenidone for idiopathic pulmonary fibrosis . Nintedanib Nintedanib is a newer medication that can also help slow down scarring of the lungs in some people with IPF.Its normally taken as capsules twice a day. Likepirfenidone, it may beused if you havea lung capacity 50-80% of what would normally be expected and should be stopped if your lung capacity falls by 10% or more in a year while taking it. Side effects ofnintedanib can include: diarrhoea feeling and being sick abdominal (tummy) pain loss of appetite and weight loss For further information, see the NICE guidelines on nintedanib for idiopathic pulmonary fibrosis . N-acetylcysteine N-acetylcysteine is whats known as an antioxidant. Itsavailable from many health shopsand is usually taken as tablets. There is some limited evidence to suggest itmay reduce the amount of scar tissue in the lungs, althoughother studies have not shown any benefit. If youre considering taking N-acetylcysteine, you should check with your specialist firstas it may not be safe or suitable for everyone with IPF. Oxygen support IPF can causelevels of oxygen inyour blood fall, which can make you feel more breathless. If this happens, oxygen treatmentcan help with your breathing and allow you to be more active. Oxygen is taken through nasal tubes or a maskattached to a small machine. This device provides a much higher level of oxygenthan the air. The tubes from the machine are long, so youll be able to move around your home while connected. Read further about home oxygen treatment . Portable oxygendevices that you can usewhile youre out and about are also available. Pulmonary rehabilitation Pulmonary rehabilitation is used for many long-term lung conditions and aims to help patients come to terms with their condition, learn the best ways to deal with it and improve their ability to function on a daily basis withoutsevere breathlessness. Courses in pulmonary rehabilitation are usually held locally and may involve: education about pulmonary fibrosis physical activity breathing exercises advice on nutrition psychological support a social support network Lung transplant If your condition continues to get worse despite treatment, your specialist may recommend a lung transplant . The decision to have a transplant will be based on: how bad your condition is how quickly your condition is getting worse your age and general health how much your condition is likely to improve after a transplant whether a donor lung is available A lung transplant can significantly improve life expectancy in people with IPF, although its a major procedure that puts a great strain on the body. Few people with idiopathic pulmonary fibrosis are suitable candidates for a transplant and donor lungs are scarce. Palliative care If youre told there is nothing more that can be done to treat your IPF or you decide to decline treatment, your GP or care team will provide you with support and treatment to relieve your symptoms. This is called palliative care. You can choose to receive palliative care: at home in a care home in hospital in a hospice Your doctor or care team should work with you to establish a clear plan based on your wishes. For further information see End of life care . Source: NHS 24 - Opens in new browser window Last updated: 13 February 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Asbestos-related compensation claims NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Impetigo,"Impetigo | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Impetigo Impetigo About impetigo Symptoms of impetigo Causes of impetigo Treating impetigo Complications of impetigo Preventing impetigo About impetigo Impetigo is a common and highly contagious skin infection that causes sores and blisters. Its not usually serious and often improves within a week of treatment or within a few weeks without treatment. Impetigois the most common skin infection in young children in the UK, but it can affect people of all ages. Symptoms of impetigo There are 2 types of impetigo: non-bullous impetigo  the most common type bullous impetigo Non-bullous impetigo The symptoms of non-bullous impetigo begin with the appearance of red sores  usually around the nose and mouth but other areas of the face and the limbs can also be affected. The sores quickly burst leaving behind thick, golden crusts typically around 2cm across. The appearance of these crusts is sometimes likened to cornflakes stuck to the skin. After the crusts dry, they leave a red mark that usually fades without scarring. The time it takes for the redness to disappear can vary between a few days and a few weeks. The sores arent painful, but they may be itchy. Its important not to touch or scratch the sores because this can spread the infection to other parts of the body, and to other people. Other symptoms, such as a high temperature (fever) and swollen glands , are rare but can occur in more severe cases. Bullous impetigo The symptoms of bullous impetigo begin with the appearance of fluid-filled blisters (bullae) which usually occur on the central part of the body between the waist and neck, or on the arms and legs. The blisters are usually about 1cm to 2cm across. The blisters may quickly spread, before bursting after several days to leave a yellow crust that usually heals without leaving any scarring. The blisters may be painful and the area of skin surrounding them may be itchy. As with non-bullous impetigo, its important not totouch or scratch the affected areas of the skin. Symptoms of fever and swollen glands are more common in cases of bullous impetigo. When to get professionaladvice Pharmacy First Scotland: Impetigo treatment from your local pharmacy Adults and children over 2 years with impetigo can get advice and treatment directly from a pharmacy. Find your local pharmacy on Scotlands Service directory. Search for a pharmacy near you Impetigo isnt usually serious and can be treated by a pharmacist. Your pharmacist may recommend that you contact your GP practice if required. Causes of impetigo Impetigo occurs when the skin becomes infected with bacteria, usually eitherStaphylococcus aureus orStreptococcus pyogenes. The bacteria can infect the skin in 2 main ways: through a break in otherwise healthy skin such as a cut , insect bite or other injury this is known as primary impetigo through skin damaged by another underlying skin condition, such as head lice , scabies or eczema  this is known as secondary impetigo The bacteria can be spread easily through close contact with someone who has the infection, such as through direct physical contact, or by sharing towels or flannels. As the condition doesnt cause any symptoms until 4 to 10 days after initial exposure to the bacteria, its often easily spread to others unintentionally. Children and peoplewith diabetes or a weakened immune system either due to a condition such as HIV or a treatment such as chemotherapy  are most at risk of developing impetigo. Treating impetigo Impetigousually gets better without treatment in around 2 to 3 weeks. However, treatment is often recommended because it can reduce the length of the illness to around seven to 10 days and canlower therisk of the infection being spread to others. The main treatments prescribed are antibiotic creams or antibiotic tablets. These usually have to be used for around a week. Read about treating impetigo . Preventing the spread of impetigo During treatment, its important to take precautions to minimise the risk of impetigo spreading to other people or to other areas of the body. Most people are no longer contagious after 48 hours of treatment or once their sores have dried and healed. Its important tostay away from work, school, nursery or playgroup until thispoint. The advice below can alsohelp to prevent the spread of the infection: do not share flannels, sheets or towels with anyone who has impetigo  wash them at a high temperature after use wash the sores with soap and water and cover them loosely with a gauze bandage or clothing avoidtouching or scratching the sores, or letting others touch them it may help to ensure your nails are kept clean and short avoid contact with newborn babies, preparing food, playing contact sports, or going to the gym until the risk of infection has passed wash your hands frequently particularly after touching infected skin washable toys should also be washed wipe non-washable soft toys thoroughly with a cloth that has been wrung out in detergent and warm water and allowed to dry completely If you think that the infection has spread to someone else, make sure theyre seen by a pharmacist as soon as possible. Preventing recurrentimpetigo Toreduce the risk of impetigo returning, make sure any cuts, scratches or bites are kept clean. Ensure any condition that causes broken skin, such as eczema, is treated promptly. If you develop impetigo frequently, your doctor may suggest taking a swab from around your nose to see if you carry staphylococcal bacteria. These bacteria can live in the noses of some people without causing problems, although they can lead to impetigo if they infect broken skin nearby. If youre found to carry these bacteria,you may be prescribed an antisepticnasal cream to apply several times a day for 5 to 10 days in an attempt to clear the bacteria and reduce the chances of impetigo recurring. Complications of impetigo Complications of impetigo are rare, but they can sometimes occur and can be serious. Tell your pharmacist if you have impetigo and your symptoms change or get worse. Some complications associated with impetigo include: cellulitis  an infection of the deeper layers of the skin and underlying tissue scarlet fever a rare bacterial infection that causes a fine, pink rash across the body guttate psoriasis a non-infectious skin condition that can develop in children and teenagers after a bacterial infection septicaemia (a type of sepsis ) a bacterial infection of the blood Staphylococcal scalded skin syndrome (SSSS)a serious skin condition that looks like the skin has been scalded with boiling water post-streptococcalglomerulonephritis an infection of the small blood vessels in the kidneys In very rare cases,impetigo may lead to some scarring, particularly if you scratch at the blisters, crusts or sores Symptoms of impetigo Impetigo does not cause any symptoms until 4 to 10 days after you first become infected. This means that people can easily pass the infection on to others without realising it. There are 2 main types of impetigo, known as non-bullous and bullous impetigo, which have different symptoms. Most people with impetigo have the non-bullous type. Non-bullous impetigo The symptoms of non-bullous impetigo begin with the appearance of red sores  usually around the nose and mouth but other areas of the face and the limbs can also be affected. The sores quickly burst leaving behind thick, golden crusts typically around 2cm across. The appearance of these crusts is sometimes likened to cornflakes stuck to the skin. After the crusts dry, they leave a red mark that usually heals without scarring. The time it takes for the redness to disappear can vary between a few days and a few weeks. The sores are not painful, but they may be itchy. It is important not to touch, or scratch, the sores because this can spread the infection to other parts of your body, and to other people. Other symptoms, such as a high temperature (fever) and swollen glands , are rare but can occur in more severe cases. Bullous impetigo The symptoms of bullous impetigo begin with the appearance of fluid-filled blisters (bullae) which usually occur on the trunk (the central part of the body between the waist and neck) or on the arms and legs. The blisters are usually about 1cm to 2cm across. The blisters may quickly spread, before bursting after several days to leave a yellow crust that usually heals without leaving any scarring. The blisters may be painful and the area of skin surrounding them may be itchy. As with non-bullous impetigo, it is important that you do not touch or scratch the affected areas of the skin. Symptoms of fever and swollen glands are more common in cases of bullous impetigo. Causes of impetigo Impetigo occurs when the skin becomes infected with bacteria, usually either Staphylococcus aureus or Streptococcus pyogenes. These bacteria can infect the skin in 2 ways: through a break in otherwise healthy skin, such asa cut, insect bite or other injury  this is known as primary impetigo through skin damaged by another underlying skin condition, such as head lice , scabies or eczema  this is known as secondary impetigo The bacteria can be spread easily through close contact with someone who has the infection, such as through direct physical contact, or by sharing towels or flannels. As the condition does not cause any symptoms until 4 to 10 days after initial exposure to the bacteria, it is often easily spread to others unintentionally. Impetigo stops being infectious after 48 hours of treatment starting or after the sores have stopped blistering or crusting. Increased risk In addition to the situations mentioned above, there are a number of other factors that can increase your chances of developing impetigo. These include: being a child  impetigo is thought to be more common in children because their immune system has not yet fully developed and because they tend to spend time in places where the infection can easily be spread, such as schools and nurseries having diabetes being a carrier of Staphylococcus aureus bacteria  these bacteria can live in the noses of some people without causing problems, but they can sometimes cause impetigo if they get into damaged skin nearby warm and humid weather  impetigo tends to be more common during the summer months in the UK, possibly because the warm and moist weather is a better environment for the bacteria to grow and/or because the skin is more likely to be exposed to insect bites and cuts at this time of year having a weakened immune system, either due to a condition such as HIV or a treatment such as chemotherapy Treating impetigo Impetigo isnt usually serious and often clears up without treatment after 2 to 3 weeks. Treatment is often recommended as it can help clear up the infection in around 7 to 10 days and reduce the risk of the infection being passed on to others. If impetigo is confirmed, it can usually be effectively treated with antibiotics . If the infection is being caused by an underlying skin condition, such as eczema , this may also need to be treated. Antibiotic cream For mild cases of impetigo that cover a small area, antibiotic cream is often recommended. This usually needs to be applied 3 or 4 times a day for 7 days. Before applyingthe cream, wash anyaffected areas of skin with warm, soapy water and try to clean off any crusts that have developed. To reduce the risk of spreading the infection, its also important that youwash your hands immediately after applying the cream or, if available, wear latex gloves while applying the cream. Side effects of antibiotic cream can include: irritation redness itchiness in the area where the cream is applied If symptoms havent improvedafter seven days of starting treatment,ask your pharmacist about other possible treatment options. Antibiotic tablets Antibiotic tablets may be prescribedif the infection is more severe and widespread, orif the symptoms dont improve after using antibiotic cream. These usually need to be taken 2 to 4 times a day for 7 days. If a course of oral antibiotics is prescribed for you or your child, its very important that the course is finished even if the symptoms clear up before youve takenallthe tablets. Common side effects of oral antibiotics include: feeling sick vomiting diarrhoea Speak to your pharmacist if your symptoms havent improved after 7 days of treatment with antibiotic tablets. Further testing and treatment Further tests are usually only required in cases where the infection is severe or widespread, doesnt respond to treatment, or keeps recurring. In these circumstances, your GP may refer you to a dermatologist (skin specialist) for further tests or they may take a swabof the affected skinthemselves for testing. This can help to rule out or confirm other skin conditions that may be responsible for your symptoms and can detect whether you carry one of the types of bacteria responsible for theinfection inside your nose. If your doctor thinks you may keep gettingimpetigo because you naturally have these bacteria inside your nose, they may prescribe you an antiseptic nasal cream to try to clear the bacteria. Complications of impetigo Complications of impetigo are rare, but they can sometimes occur and can be serious. Tell your pharmacist if you have impetigo and your symptoms change or get worse. Cellulitis Cellulitis occurs when the infection spreads to a deeper layer of skin. It can cause symptoms of red, inflamed skin with fever and pain. It can usually be treated with antibiotics, andpainkillers can be used to relieve pain. Guttate psoriasis Guttate psoriasis is a non-infectious skin condition that can develop in children and teenagers after a bacterial infection. It is usually more common after a throat infection, but some cases have been linked to impetigo. Guttate psoriasis causes small, red, droplet-shaped, scaly patches on the chest, arms, legs and scalp. Creams can be used to control the symptoms and in some casesthe condition will disappear completely after a few weeks. Scarlet fever Scarlet fever is a rare bacterial infection that causes a fine, pink rash across the body. Associated symptoms of infection, such as nausea, pain and vomiting, are also common.The condition is usually treated with antibiotics. Scarlet fever is not usually serious but it is contagious. Therefore, its important to isolate an infected child and avoid close physical contact. Keep your child away from school and other people untilthey havebeen takingantibiotics for at least 24 hours. Septicaemia Septicaemia (a type of sepsis ) is a bacterial infection of the blood. It can cause: diarrhoea cold, clammy skin a high temperature (fever) rapid breathing vomiting low blood pressure (hypotension) confusion feeling faint and dizzy losing consciousness Septicaemia is a life-threatening condition and requires immediate treatment with antibiotics in hospital. Scarring In rare cases, impetigo may lead to some scarring. However, this is more often the result of someone scratching at blisters, crusts or sores. The blisters and crusts themselves should not leave a scar if left to heal. The red mark left after the crusts and blisters clear up should also disappear by itself. The time it takes for the redness to disappear can vary between a few days and a few weeks. Staphylococcal scalded skin syndrome Staphylococcal scalded skin syndrome (SSSS) is a serious skin condition in which one of the causes of impetigo  Staphylococcus bacteria  releases a toxin (poison) that damages the skin. This leads to extensive blistering that looks like the skin has been scalded with boiling water. Other symptoms of SSSS include: painful skin a high temperature (fever) large areas of skin peeling off or falling away redness of the skin which usually spreads across the entire body SSSS usually requires immediate treatment in hospital with antibiotics given directly into a vein (intravenously). Post-streptococcal glomerulonephritis Post-streptococcal glomerulonephritis is an infection of the small blood vessels in the kidneys. Its a very rare complication of impetigo. The symptoms of post-streptococcal glomerulonephritis include: a change in the colour of your urine to a reddish-brown or cola colour swelling of the abdomen (tummy),face, eyes, feet and ankles a rise in blood pressure visibleblood in your urine a reduction in the amount of urine you would normally produce People with post-streptococcal glomerulonephritis will usually require immediate hospital treatment so their blood pressure can be carefully monitored and controlled. Post-streptococcal glomerulonephritis can be fatal in adults, although deaths in children are rare. Preventing impetigo As impetigo is a highly contagious condition, it is important to take precautions to reduce the risk of the infection spreading. Stoppingthe infection spreading To help to prevent the spread of the infection to other people or to other areas of the body you should: stay away from work, school, nursery or playgroup until the sores have dried up, blistered or crusted over, or until 48 hours after starting treatment not share flannels, sheets or towels with anyone who has impetigo, and wash them at a high temperature after use wash the sores with soap and water, and cover them loosely with a gauze bandage or clothing if possible avoidtouching the sores, or letting others touch them, whenever possible not scratch the affected areas  it may help to ensure your or your childs nails are kept clean and short to reduce the risk of further damage caused by scratching avoid contact with newborn babies, preparing food, playing contact sports, or going to the gym until the risk of infection has passed (when the rash has crusted over, or after at least 48 hours of treatment with antibiotics) wash your hands frequently, particularly after touching infected skin washable toys should also be washed, and wipe non-washable soft toys thoroughly with a cloth that has been wrung out in detergent and warm water and allowed to dry completely If you think that the infection has spread to someone else, make sure theycontact their pharmacist as soon as possible. Preventing re-infection Toreduce the risk of impetigo returning, make sure any cuts, scratches or bites are kept clean, and ensure any condition that causes broken skin, such as eczema, is treated promptly. If you develop impetigo frequently, your doctor may suggest taking a swab from around your nose to see if you carry staphylococcal bacteriainside your nose. These bacteria can live in the noses of some people without causing problems, although they can lead to impetigo if they infected broken skin nearby. If you are found to carry these bacteria,you may be prescribed an antiseptic nasal cream to apply several times a day for 5 to 10 days in an attempt to clear the bacteria and reduce the chances of impetigo recurring. Source: NHS 24 - Opens in new browser window Last updated: 04 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Antibiotics Other health sites BAD: impetigo Search for a pharmacy near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Indigestion,"Indigestion | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Indigestion Indigestion About indigestion Symptoms of indigestion Causes of indigestion Diagnosing indigestion Treating indigestion Complications of indigestion About indigestion Indigestion can be pain or discomfort in your upper abdomen (dyspepsia) or burning pain behind the breastbone (heartburn). Dyspepsia and heartburn may occur together or on their own. Symptoms usually appear soon after eating or drinking. Common associated symptoms include: feeling full or bloated feeling sick (nausea) belching bringing up (regurgitating) fluid or food into the gullet (oesophagus) Indigestion is a common problem that affects many people, but in most cases its mild and only occurs occasionally. Read more about the symptoms of indigestion . Why it happens Indigestionmay becaused by stomach acid coming into contact with the sensitive, protective lining of the digestive system (mucosa). The stomach acid breaks down the lining, leading to irritation and inflammation, which can be painful. The majority of people with indigestion dont have inflammation in their digestive system. Therefore, their symptoms are thought to be caused by increased sensitivity of the mucosa (to acidity or stretching). In most cases indigestion is related to eating, although it can betriggered by other factors such as smoking, drinking, alcohol, pregnancy, stressor taking certain medications. Read more about the causes of indigestion . Treating indigestion at home Most people are able totreat indigestion with simple changes to theirdiet and lifestyle, or with a number of different medications, such as antacids. Read more about the treatment of indigestion . Very rarely,a seriousunderlying health condition is the cause of indigestion. If this is suspected, thenfurther investigation such as an endoscopywill be required. When to get professional advice Pharmacy First Scotland: Indigestion treatment from your pharmacy If you have symptoms of indigestion you can get treatment directly from a pharmacy. Find your local pharmacy on Scotlands Service Directory. Search for a pharmacy near you Most people will not need to seek medical advice for their indigestion. However, your pharmacist may advise you see your GP if youhave recurring indigestion and any of the following apply: you are 55 years old or over you have lost a lot of weight without meaning to you have increasing difficulty swallowing (dysphagia) you have persistent vomiting you have iron deficiency anaemia you have a lump in your stomach you have blood in your vomit orblood in your stools This is because these symptomsmay be a sign of an underlying health condition, such as a stomach ulcer or stomach cancer . You may need to be referred for an endoscopyto rule out any serious cause. An endoscopy is a procedure where the inside of the body is examined using an endoscope (a thin, flexible tube that has a light and camera on one end). Severe indigestion can cause long-term problems with parts of your digestive tract, such as scarring of the oesophagus or the passage from your stomach. Read more about the possible complications of severe indigestion . Symptoms of indigestion The main symptom of indigestion is pain or a feeling of discomfort in your upper abdomen (dyspepsia). People often experience the associated feeling of burning behind the breastbone (heartburn), but this may occur on its own. These symptomsusually come on soon after eating or drinking, although there can sometimes be a delay between eating a meal and experiencing indigestion. Heartburn is caused by acid that passes from your stomach into your gullet (oesophagus). If you have indigestion, you may also have symptoms such as: feeling uncomfortably full or heavy belching or flatulence (passing wind) bringingfood or fluidback up from your stomach (reflux) bloating feeling sick (nausea) vomiting Causes of indigestion Indigestion has a number of different causes, but its rarely due to a serious, underlying condition. Its normal for your stomach to produce acid, but sometimes this acid can irritate the lining of your stomach, the top part of your bowel (duodenum) or your gullet (oesophagus). This irritation can be painful and often causes a burning sensation. Indigestion may also be due to the lining of your digestive system being overly sensitive to acid, or the stretching caused by eating. Indigestion can also be triggered or made worseby other factors. Medications You may have indigestion if you take certain types of medication. Some medicines, such as nitrates (taken to widen your blood vessels) relax the oesophageal sphincter (ring of muscle between your oesophagus and your stomach), which allows acid to leak back up. Other medicines, such as non-steroidal anti-inflammatory drugs ( NSAIDs ), can affect your digestive tract and causeindigestion. Donot take NSAIDs, such as aspirin and ibuprofen, if you have stomach problems, such as a stomach ulcer , or have had this in the past. Children under 16 years of age should not take aspirin. Never stop taking a prescribed medication unless you aretold to do so by your GP or another qualified healthcare professional who is responsible for your care. Obesity If you are very overweight, you are more likely to experience indigestion because of increased pressure inside your stomach (abdomen). The increased pressure, particularly after a large meal, may lead to acid reflux into the oesophagus. Stress or anxiety If you regularly experience feelings of stress or anxiety, this can contribute to symptoms of indigestion. Readsome relaxation tips to relieve stress. Hiatus hernia A hernia occurs when an internal part of the body, such as an organ, pushes through a weakness in the surrounding muscle or tissue wall. A hiatus hernia occurs when part of your stomach pushes up into your diaphragm (the sheet of muscle under your lungs).It may partially block refluxed stomachacid clearing from your oesophagus, leading to heartburn. Helicobacter pylori infection Helicobacter infection is very common. It may lead to stomach ulcers or, rarely, stomach cancer. In most cases, however, itdoes not cause any symptoms at all. Some people may get bouts of indigestion from helicobacter infection and, in these cases, getting rid of the bug with antibiotics (eradication) will help. However, many cases of indigestion are not caused by helicobacter, and in these cases eradication will not get rid of symptoms. Gastro-oesophageal reflux disease (GORD) Gastro-oesophageal reflux disease (GORD) is a common condition and one of the main causes of recurring indigestion. Its caused by acid reflux, whichoccurs when the oesophageal sphincter fails to prevent stomach acid from moving back up into your oesophagus. A little bit of acid reflux is normal and rarely cause any symptoms. It becomes GORD when large amounts of reflux occur, and the sensitive lining of your oesophagus may get inflamed by repeated irritation from stomach acid. This can lead to heartburn, the sensation of regurgitation or painful swallowing. Stomachulcers A stomach ulcer is an open sore that develops on the inside lining of your stomach (a gastric ulcer) or small intestine (a duodenal ulcer). If you have astomach ulcer, you may have indigestion as a symptom. Stomachulcers formwhen stomach acid damages the lining in your stomach or duodenum wall. In most cases, the lining is damaged as a result of an H pylori infection. Stomach cancer In rare cases, recurring bouts of indigestion can be a symptom of stomach cancer . Cancer cells in your stomach break down the protective lining, allowing acid to come into contact with your stomach wall. Diagnosing indigestion For most people, indigestion (dyspepsia) is mild and infrequent, and does not require treatment from a healthcare professional. However, if you have indigestion regularly, or if it causes you severe pain or discomfort, see your pharmacist. They will ask about your indigestion symptoms, as well as: any other symptoms you have  whichmay indicate an underlying health condition any medication you are taking  as some medications can cause indigestion your lifestyle  as some lifestyle factors, such as smoking, drinking alcohol or being overweight, can cause indigestion Depending on the type of indigestion symptoms you have, your pharmacist may recommend you see your GP to investigate your condition further. This is because indigestion can sometimes be a symptom of an underlying condition or health problem, such as a Helicobacter pylori (H pylori) bacterial infection. Further investigations Endoscopy You may be referred to hospital to have an endoscopy. An endoscopy is a procedure used to examine the inside of your body using an endoscope  a thin, flexible tube, about the width of your little finger, with a light and a camera on one end. The camera is used to relay images of the inside of your body to aTV monitor. An endoscopy is not often needed to diagnose indigestion, but your GP may suggest that you have one if: they need to examine the inside of your abdomen in more detail you have had treatment for indigestion that has not worked you have any serious symptoms of indigestion Taking certain medicines for indigestion can hide some of the problems that could otherwise be spotted during an endoscopy. Therefore, for at least two weeks before your endoscopy, you will need to stop taking proton pump inhibitors (PPIs) and H2-receptor antagonists. Read more about treatments for indigestion . Your GP may also recommend changing other medications that may be causing your indigestion. However, only stop taking medication if you are advised to do so by your GP or another healthcare professional responsible for your care. Diagnosing H pylori infection If your GP thinks that your symptoms may be due to an infection with H pylori bacteria, you may need to have a test for it, such as: a stool antigen test  a pea-sized stool (faeces) sample will be tested for H pylori bacteria a breath test a blood test  a blood sample will be tested for antibodies to H pylori bacteria (antibodies are proteins produced by the body to fight infection) Antibiotics and PPIs can affect the results of a urea breath test or a stool antigen test. Therefore, these tests may need to be delayed until two weeks after you last used a PPI, and 4 weeks after you last used an antibiotic. Diagnosing other conditions If your GP thinks that your indigestion symptoms may be caused by another underlying medical condition, you may need to have some further tests to rule this out. For example, abdominal pain and discomfort can also be caused by conditions affecting the bile ducts in your liver. Your bile ducts are a series of tubes that carry bile (fluid used by the digestive system to break down fats) from the liver to the gallbladder (a pouch that holds bile) and the bowel. If your GP thinks that you may have such a condition, they may suggest you have a liver function test, which is a type of blood test used to assess how well your liver is working. You may also need to have an abdominal ultrasound. An ultrasound scan uses high-frequency sound waves to create an image of the inside of your body. Treating indigestion Treatment for indigestion (dyspepsia) will vary, depending on what is causing it and how severe your symptoms are. If you have been diagnosed with an underlying health condition, you may want to read our information on: treating gastro-oesophageal reflux disease (GORD) treating astomach ulcer Diet and lifestyle changes If you only have indigestion occasionally, you may not need to see your pharmacist or GP for treatment. It may be possible to ease your symptoms by making a few simple changes to your diet and lifestyle, summarised below. Healthy weight Being overweight puts more pressure on your stomach, making it easier for stomach acid to be pushed back up into your gullet (oesophagus). This is known as acid reflux, and is one of the most common causes of indigestion. If you are overweight or obese, it is important to lose weight safely and steadily through regular exercise and by eating a healthy, balanced diet. Read advice on losing weight . Stop smoking If you smoke, the chemicals you inhale in cigarette smoke may contribute to your indigestion. These chemicals can cause the ring of muscle that separates your oesophagus from your stomach to relax, causing acid reflux. Read more about quitting smoking , or speak to your GP or pharmacist. You can also phone the Quit Your Way Scotland service on 0800 84 84 84. Diet and alcohol Make a note of any particular food or drink that seems to make your indigestion worse, and avoid these if possible. This may mean: eating less rich, spicy and fatty foods cutting down on drinks that contain caffeine  such as tea, coffee and cola avoiding or cutting down on alcohol At bedtime If you tend to experience indigestion symptoms at night, avoid eating for three to four hours before you go to bed. Going to bed with a full stomach means there is an increased risk that acid in your stomach will be forced up into your oesophagus while you are lying down. When you go to bed, use a couple of pillows to prop your head and shoulders up or, ideally,raise the head of your bed by a few inches by putting something underneath the mattress. The slight slope that is created should help to prevent stomach acid moving up into your oesophagus while you are asleep. Stress or anxiety If you regularly experience feelings of stress or anxiety, this can contribute to symptoms of indigestion. Read some relaxation tips to relieve stress . Changing current medication Your pharmacist may recommend making changes to your current medication if they think it could be contributing to your indigestion. As long as it is safe to do so, you may need to stop taking certain medications, such as aspirin or ibuprofen. Where required, your pharmacist may advise you see your GP to prescribe an alternative medication that will not cause indigestion. However, never stop taking any medication without consulting your pharmacist or GP first. Immediate indigestion relief If you have indigestion that requires immediate relief, your pharmacist can advise you about the best way to treat this. As well as lifestyle changes and reviewing your current medication, your GP may prescribe or recommend: antacid medicines alginates Antacids Antacids are a type of medicine that can provide immediate relief for mild to moderate symptoms of indigestion. They work by neutralising the acid in your stomach (making it less acidic), so that it no longer irritates the lining of your digestive system. Antacids are available in tablet and liquid form. You can buy them over the counter from most pharmacies without a prescription. The effect of an antacid only lasts for a few hours at a time, so you may need to take more than one dose. Always follow the instructions on the packet to ensure you do not take too much. It is best to take antacids when you are expecting symptoms of indigestion, or when they start to occur, such as: after meals at bedtime This is because antacids stay in your stomach for longer at these times and have more time to work. For example, if you take an antacid at the same time as eating a meal, it can work for up to three hours. In comparison, if you take an antacid on an empty stomach, it may only work for 20 to 60 minutes. Read moreaboutantacids, including possible interactions with other medicines and side effects. Alginates Some antacids also contain a medicinecalled an alginate. This helps relieve indigestion caused by acid reflux. Acid reflux occurs when stomach acid leaks back up into your oesophagus and irritates its lining. Alginatesform a foam barrier that floats on the surface of your stomach contents, keeping stomach acid in your stomach and away from your oesophagus. Your pharmacist may suggest that you take an antacid that contains an alginate if you experience symptoms of acid reflux or if you have GORD. Take antacids containing alginates after eating, because this helps the medicine stay in your stomach for longer. If you take alginates on an empty stomach, they will leave your stomach too quickly to be effective. Treating persistent indigestion If you have indigestion that is persistent or recurring, treatment with antacids and alginates may not be effective enough to control your symptoms. Your pharmacist may recommend a different type of medication, which willbe prescribed at the lowest possible dose to control your symptoms. Possible medications include: proton pump inhibitors (PPIs) H2-receptor antagonists Your pharmacist may advise you to see your GP who may also test you for the Helicobacter pylori (H pylori) bacteria (see Indigestion  diagnosis ) and prescribe treatment for this if necessary. Proton pump inhibitors (PPIs) PPIs restrict the acid produced in your stomach. The medication istaken as tablets and if you are over 18, you can buy some types of PPIs over the counter in pharmacies, but these should only be used for short-term treatment. PPIs may enhance the effect of certain medicines. If you are prescribed a PPI, your progress will be monitored if you are also taking other medicines, such as: warfarin  a medicine that stops the blood clotting phenytoin  a medicine to treat epilepsy If your ingestion is persistent, your pharmacist might advise you to see your GP. If your GP refers you for an endoscopy (a procedure that allows a surgeon to see inside your abdomen), you will need to stop taking a PPI at least 14 days before the procedure. This is because PPIs can hide some of the problems that would otherwise be spotted during the endoscopy. PPIs can sometimes cause side effects. However, they are usually mild and reversible. These side effects may include: headaches diarrhoea constipation feeling sick (nausea) vomiting flatulence stomach pain dizziness skin rashes H2-receptor antagonists H2-receptor antagonists are another type of medication that your pharmacist or GP may suggest if antacids, alginates and PPIs have not been effective in controlling your indigestion. There are four H2-receptor antagonists: cimetidine famotidine nizatidine ranitidine These medicines work by lowering the acidity level in your stomach. Your GP may prescribe any one of these four H2-receptor antagonists, although ranitidine is available from pharmacies under the Pharmacy First Scotland service. H2-receptor antagonists are usually taken in tablet form. As with PPIs, you will need to stop taking H2-receptor antagonists at least 14 days before having an endoscopy if this has been arranged through your GP. This isbecause they can hide some of the problems that could otherwise be spotted during the endoscopy. Helicobacter pylori (H pylori) infection If your indigestion symptoms are caused by an infection with H pylori bacteria, you will need to have treatment to clear the infection from your stomach. This should help relieve your indigestion, because the H pylori bacteria will no longer be increasing the amount of acid in your stomach. H pylori infection is usually treated using triple therapy (treatment with three different medications). Your GP will prescribe a course of treatment containing: two different antibiotics (medicines to treat infections that are caused by bacteria) a PPI You will need to take these medicines twice a day for seven days. You must follow the dosage instructions closely to ensure that the triple therapy is effective. In up to 85% of cases, one course of triple therapy is effective in clearing an H pylori infection. However, you may need to have more than one course of treatment if it does not clear the infection the first time. Complications of indigestion In most cases, indigestion (dyspepsia) is mild and only occurs occasionally. However, severe indigestion can cause complications, some of which are outlined below. Oesophageal stricture Indigestion is often caused by acid reflux, which occurs when stomach acid leaks back up into your gullet (oesophagus) and irritates its lining. If this irritation builds up over time, it can cause your oesophagus to become scarred. The scarring can eventually lead to your oesophagus becoming narrow and constricted (known as oesophageal stricture). If you have oesophageal stricture, you may have symptoms such as: difficulty swallowing (dysphagia) food that becomes lodged in your throat chest pain Oesophageal stricture is often treated using surgery to widen your oesophagus. Pyloric stenosis Like oesophageal stricture, pyloric stenosis is caused by long-term irritation of the lining of your digestive system from stomach acid. Pyloric stenosis occurs when the passage between your stomach and your small intestine (known as the pylorus) becomes scarred and narrowed. This causes vomiting and prevents any food you eat from being properly digested. In most cases, pyloric stenosis is treated using surgery to return the pylorus to its proper width. Barretts oesophagus Repeated episodes of gastro-oesophageal reflux disease (GORD) can lead to changes in the cells lining your lower oesophagus. This is a condition known as Barretts oesophagus. It is estimated that 1 in 10 people with GORD will develop Barretts oesophagus. Most cases of Barretts oesophagus first develop in people aged 50 to 70 years old. The average age at diagnosis is 62. Barretts oesophagus does not usually cause noticeable symptoms other than those associated with GORD. The concern is that Barretts oesophagus is a pre-cancerous condition. This means that while changes in the cells are not cancerous, there is a small risk they could develop into cancer in the future. This would then trigger the onset of oesophageal cancer . Source: NHS 24 - Opens in new browser window Last updated: 13 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Stomach ulcer NSAIDs Gastro-oesophageal reflux disease (GORD) Search for a pharmacy near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Ingrown toenail,"Ingrown toenail | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Skin, hair and nails Ingrown toenail Ingrown toenail An ingrown toenail develops when the sides of the toenail grow into the surrounding skin. Symptoms of ingrown toenail An ingrown toenail often affects the big toe, either on one or both sides. The nail curls and pierces the skin which becomes red, swollen and tender. Other possible symptoms include: pain if pressure is placed on the toe inflammation of the skin at the end of the toe a build-up of fluid (oedema) in the area surrounding the toe an overgrowth of skin around the affected toe (hypertrophy) bleeding white or yellow pus coming from the affected area Get help from a pharmacist If you have an ingrown toenail, you can ask a pharmacist about: treatments to help ease the pain and prevent an infection whether you need to see a GP Find your nearest pharmacy Speak to your GP practice if: treating your ingrown toenail at home is not helping your toe is painful and swollen with pus coming out of it you have a very high temperature or you feel hot or shivery you have diabetes and an ingrown toenail  foot problems can be more serious if you have diabetes Causes of an ingrown toenail A number of things can cause an ingrown toenail to develop, including: badly cut toenails  cutting your toenails too short, or cutting the edges, will encourage the skin to fold over your nail and the nail to grow into the skin wearing tight-fitting shoes, socks or tights  this places pressure on the skin around your toenail and the skin may be pierced if its pressed on to your toenail sweaty feet  if the skin around your toenails is soft, its easier for your nail to pierce it and embed itself within it injury  for example, stubbing your toe can sometimes cause an ingrown toenail to develop natural shape of the nail  the sides of curved or fan-shaped toenails are more likely to press into the skin surrounding the nail A fungal nail infection can cause your toenail to thicken or widen. Treatment for ingrown toenails Left untreated, an ingrown toenail can become infected. Its important that you: Do keep your feet clean by washing them regularly with soap and water change your socks regularly cut your toenails straight across to stop them digging into the surrounding skin gently push the skin away from the nail using a cotton bud (this may be easier after using a small amount of olive oil to soften the skin) wear comfortable shoes that fit properly Surgery for ingrown toenail Surgery may be recommended if your toenail doesnt improve. Depending on the severity of your symptoms, this may involve removing part or all of your toenail. Partial nail avulsion Partial nail avulsion removes part of your toenail and is the most common operation for treating ingrown toenails. Its about 98% effective. A local anaesthetic is used to numb your toe and the edges of your toenail are cut away. A chemical called phenol is applied to the affected area to prevent the nail growing back and becoming ingrown in the future. A course of antibiotics may be prescribed if your nail is infected, and any pus will be drained away. Total nail avulsion Total nail avulsion completely removes your toenail. This may be necessary if your nail is thick and pressing into the skin surrounding your toe. After your toenail has been removed, youll have an indentation where your nail used to be. However, its perfectly safe for you not to have a toenail. After surgery After toenail surgery, your toe will be wrapped in a sterile bandage. This will help stem any bleeding and prevent infection. Rest your foot and keep it raised for 1to 2days after the operation. To help reduce the pain, you may need to take a painkiller like paracetamol . You may also need to wear soft or open-toed shoes for the first few days after surgery. Preventing ingrown toenails Taking care of your feet will help prevent foot problems like ingrown toenails. Its important to cut your toenails properly (straight across, not at an angle or down the edges). Wash your feet every day, dry them thoroughly and use foot moisturiser. You can also use a foot file or pumice stone to remove hard or dead skin. Wearing shoes that fit properly will help to ensure your feet remain healthy. You should also change your socks (or tights) every day. Visit your GP practice or a podiatrist as soon as possible if you develop problems with your feet. Source: NHS 24 - Opens in new browser window Last updated: 05 April 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Inherited heart conditions,"Inherited heart conditions - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Heart and blood vessels Conditions Inherited heart conditions Inherited heart conditions An inherited heart disease is one which has been passed on through your parents genes. Inherited cardiac conditions (ICC) is an umbrella term covering a wide variety of relatively rare diseases of the heart. They are also referred to as genetic cardiac conditions. ICCs are caused by a fault  also known as a mutation  in one or more of our genes. If someone has a faulty gene, theres a 50/50 chance it can be passed on to your children. The effects of these conditions on you and your family can be enormous. These conditions can  in some cases  become life-threatening. Around 500 young people die every year in the UK as a result of a genetic heart disorder. These conditions do not always have symptoms, so you can be unaware you have the conditions. Sadly, this can sometimes mean that the first time a family is aware of being affected is after a sudden cardiac death (SCD). However, great improvements are being made in the detection of ICCs and also how you can live with your condition. There are effective treatments which allow you to lead a normal life. Family history Its very important to draw a medical family tree with an appropriate health professional. This can help to paint a picture to see if you have  or have had  any other family members with the same condition. The family tree is sometimes known as a pedigree. Signs and symptoms Sometimes people dont experience many signs and symptoms, but the main symptoms of familial arrhythmia are: palpitations fainting or blackouts (also known as syncope or near faint) The majority of children and young adults with syncope have a normal heart disease and no major heart rhythm problem. However, its really important to speak to your GP or health professional if you  or a member of your family  have suffered unexplained fainting, especially if its happened more than once. Different inherited heart conditions Familial cardiomyopathies These include: Hypertrophic Cardiomyopathy (HCM) idiopathic or familial Dilated Cardiomyopathy (DCM) Arrhythmogenic right ventricular cardiomyopathy (ARVC) restrictive cardiomyopathy Familialarrhythmias These include: Long QT syndrome (LQTS) Brugada syndrome Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT) Short QT Syndrome (SQTS) Marfan syndrome Marfan syndrome is an inherited  or genetic  condition that affects the bodys connective tissues. Connective tissues provide support and structure to other tissue and organs. There is a 50/50chance that someone with Marfan syndrome will have a child with the condition, but Marfan syndrome is relatively rare  around 1 in 5,000 people have the syndrome. You can get more information from Marfan Foundation Sudden Arrhythmic Death Syndrome (SADS) This is a condition which means there was an unexplained underlying familial heart rhythm that was not detected until there was an investigation following a death. British Heart Foundation has information on Sudden Arrythmic Death Syndrome and on genetic cardiac conditions and procedure following a sudden death . Cardiac Risk in the Young (CRY) has information on sudden cardiac death . Read about what to do in an emergency , in case you have a heart emergency. Treatments Different conditions require different treatments or interventions, which include: changes to your lifestyle medication implantable cardioverter defibrillators (ICDs)  see heartsurgery heart transplantation (in rare cases)  see heartsurgery See our section on Treatments Sport Sport and physical activity have many benefits. However, vigorous levels of exercise can be dangerous for people with inherited cardiac conditions. Research is, at present,still exploringwhat level of activity is right for the individual affected by an inherited cardiac condition, especially if theyre ayoung person. If you want to find out more, speak to your cardiologist. Cardiomyopathy UK has some general advice. See our Living with a heart condition sectionfor general advice on various aspects of living with a heart condition, likebenefits, driving and going on holiday. Support Living with an inherited cardiac condition can be distressing for both those with the condition and their families. There is support available through psychological help and genetic counselling. Genetic services in Scotland are managed by specialist hospital doctors in four regional centres: Aberdeen  phone 01224 552120 Dundee  phone 01382 632330 Edinburgh  phone 0131 537 1116 Glasgow  phone 0141 354 9235 These regional services have access to: specialist cardiologists geneticists specialist nursing genetic counselling These cardiac-genetic services link with the smaller hospitals in their regions. Genetic testing is done for arrhythmias in Aberdeen and for cardiomyopathies in Edinburgh. You may need to visit your family doctor to obtain a referral to a specialist service. Network for Inherited Cardiac Conditions Scotland (NICCS) NICCS is a National Managed Clinical Network (NMCN). It was set up to help coordinate services for people with  or suspected of having  inherited cardiac conditions. Its part of the NHS and aims to improve services for inherited cardiac conditions (ICCs). The NICCS brings together experts from across Scotland. Those in the network include: heart specialists geneticists genetic counsellors pathologists specialist nurses public representatives other experts The NICCS website has resources for people affected by inherited cardiac conditions. This includes a patient forum made up of patients, family members and organisations with an interest in ICCs. If youd like to get involved in NICCS, visit their website or email nss.niccs@nhs.scot Source: Chest Heart & Stroke Scotland - Opens in new browser window Last updated: 06 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites British Heart Foundation: Inherited heart conditions Marfan Foundation Cardiac Risk in the Young NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Insomnia,"Insomnia | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Mental health Insomnia Insomnia British Sign Language (BSL) Introduction Causes Self-help tips Treatments Introduction Insomnia is difficulty getting to sleep or staying asleep for long enough to feel refreshed the next morning. Its a common problem thought to regularly affect around one in every three people in the UK, and is particularly common in elderly people. If you have insomnia, you may: find it difficult to fall asleep lie awake for long periods at night wake up several times during the night wake up early in the morning and not be able to get back to sleep not feel refreshed when you get up find it hard to nap during the day, despite feeling tired feel tired and irritable during the day and have difficulty concentrating Occasional episodes of insomnia may come and go without causing any serious problems, but for some people it can last for months or even years at a time. Persistent insomnia can have a significant impact on your quality of life. It can limit what youre able to do during the day, affect your mood, and lead to relationship problems with friends, family and colleagues. How much sleep do I need? There are no official guidelines about how much sleep you should get each night because everyone is different. On average, a normal amount of sleep for an adult is considered to be around seven to nine hours a night. Children and babies may sleep for much longer than this, whereas older adults may sleep less. Whats important is whether you feel you get enough sleep, and whether your sleep is good quality. Youre probably not getting enough good-quality sleep if you constantly feel tired throughout the day and its affecting your everyday life. What causes insomnia? Its not always clear what triggers insomnia, but its often associated with: stress and anxiety a poor sleeping environment  such as an uncomfortable bed, or a bedroom thats too light, noisy, hot or cold lifestyle factors  such as jet lag, shift work, or drinking alcohol or caffeine before going to bed mental health conditions  such as depression and schizophrenia physical health conditions  such as heart problems,other sleep disorders and long-term pain certain medicines  such as some antidepressants , epilepsy medicines and steroid medication Read more about the causes of insomnia What you cando about it There are a number of things you can try to help yourself get a good nights sleep if you have insomnia. These include: setting regular times for going to bed and waking up relaxing before bed time try taking a warm bath or listening to calming music using thick curtains or blinds, an eye mask and earplugs to stop you being woken up by light and noise avoiding caffeine, nicotine, alcohol, heavy mealsand exercise for a few hours before going to bed not watching TV or using phones, tablets or computers shortly beforegoing to bed not napping during the day writing a list of your worries, and any ideasabouthow tosolve them, before going to bed to help you forget aboutthem until the morning Some people find over-the-counter sleeping tablets helpful, but they dont address the underlying problem and can have troublesome side effects. Read more self-help tips for insomnia When to see your GP Make an appointment to see your GP if youre finding it difficult to get to sleep or stay asleep and its affecting your daily life  particularly if it has been a problem for a month or more and the above measures have not helped. Your GP may ask you about your sleeping routines, your daily alcohol and caffeine consumption, and your general lifestyle habits, such as diet and exercise. They will also check your medical history for any illness or medication that may be contributing to your insomnia. Your GP may suggest keeping a sleep diary for a couple of weeks to help them gain a better understanding of your sleep patterns. Each day, make a note of things such as the time you went to bed and woke up, how long it took you to fall asleep, and the number of times you woke up during the night. Treatments forinsomnia Your GP will first try to identify and treat any underlying health condition, such as anxiety, that may be causing your sleep problems. Theyll probably also discuss things you can do at home that may help to improve your sleep. In some cases, a special type of cognitive behavioural therapy (CBT)designed for people with insomnia (CBT-I) may be recommended. This is a type of talking therapy that aims to help you avoid the thoughts and behaviours affecting your sleep. Its usually the first treatment recommended and can help lead to long-term improvement of your sleep. Prescription sleeping tablets are usually only considered as a last resort and should be used for only a few days or weeks at a time. This is because they dont treat the cause of your insomnia and are associated with a number of side effects. They can also become less effective over time. Read more about treating insomnia Causes Insomnia can be triggered by a number of possible factors, including worry and stress, underlying health conditions, and alcohol or drug use. Sometimes its not possible to identify a clear cause. Stress and anxiety Some people develop insomnia after a stressful event, such as a bereavement, problems at work, or financial difficulties. The problem can continue long after the event has passed because they start to associate going to bed with being awake. This develops into an anxiety about sleep itself. Having more general worriesfor example, about work, family or healthare also likely to keep you awake at night. These can cause your mind to start racing while you lie in bed, which can be made worse by also worrying about not being able to sleep. Poor sleep routine andsleeping environment You may struggle to get a good nights sleep if you go to bed at inconsistent times, nap during the day, or dont wind down before going to bed. A poor sleeping environment can also contribute to insomniafor instance, an uncomfortable bed or a bedroom thats too bright, noisy, hot or cold. Lifestyle factors Drinking alcohol before going to bed and taking certain recreational drugs can affect your sleep, as can stimulants such as nicotine (found in cigarettes) and caffeine (found in tea, coffee and energy drinks). These should be avoided in the evenings. Changes to your sleeping patterns can also contribute to insomniafor example, because of shift work or changing time zones after a long-haul flight (jet lag). Mental health conditions Underlying mental health problems can often affect a persons sleeping patterns, including: mood disorders  such as depression or bipolar disorder anxiety disorders such as generalised anxiety, panic disorder or post-traumatic stress disorder psychotic disorders  such as schizophrenia Physical healthconditions Insomnia can also be caused by underlying physical conditions, including: heart conditions  such as angina or heart failure respiratory conditions  such as chronic obstructive pulmonary disease (COPD) or asthma neurologicalconditions  such as Alzheimers disease or Parkinsons disease hormonal problems  such as an overactive thyroid joint or muscle problems  such as arthritis problems with the genital or urinary organs  such as urinary incontinence or an enlarged prostate sleep disorders  such as snoring and sleep apnoea , restless legs syndrome ,narcolepsy, night terrors and sleepwalking long-term pain In women, childbirth can sometimes lead to insomnia. Medication Some prescriptions or over-the-counter medications can cause insomnia as a side effect. These include: certain antidepressants epilepsy medicines medicines for high blood pressure , such as beta-blockers steroid medication non-steroidal anti-inflammatory drugs (NSAIDs) stimulant medicines used to treat attention deficit hyperactivity disorder (ADHD) or narcolepsy some medicines used to treat asthma, such as salbutamol, salmeterol and theophylline Check the leaflet that comes with any medication youre taking to see if insomnia or sleeping difficulties are listed as a possible side effect. Self-help tips Insomnia can often be improved by changing your daytime and bedtime habits or by improving your bedroom environment. Making small changes may help you to get a good nights sleep. Try some of the methods below for a few weeks to see if they help. See your GP if youre still having difficulty getting to sleep after trying these techniques. Daytime habits Set a specific time for getting up each day. Try to stick to this time, seven days a week, even if you feel you havent had enough sleep. This should help you sleep better at night. Dont take a nap during the day. Take daily exercise, such as 30 minutes walking or cycling . But dont exercise for at least four hours before going to bed, because this may make it more difficult to fall asleep. Bedtime habits Stop drinking tea and coffee for a few hours before bedtime. Avoid drinking alcohol and smoking, particularly shortly before going to bed. Dont eat a big meal just before bedtime. Only go to bed when youre feeling tired. If necessary, go to bed later than usual if it means you might be able to fall asleep more quickly. Dont use back-lit devices shortly before going to bed, including televisions, phones, tablets and computers. Try to create a relaxing bedtime routine, such as taking a bath, listening to soft music, and drinking a warm, milky drink every night. These activities will be associated with sleep and will cause drowsiness. Avoid regularly using over-the-counter sleeping tablets. It is not clear how effective these are, they dont tackle the underlying problem, and have potential side effects. Read more about treatments for insomnia . Dont lie in bed feeling anxious about lack of sleep. Instead, get up, go to another room for about 20 minutes and do something else, such as reading or listening to soft music, before trying again. Avoid watching the clock because it will only make you anxious about how long its taking you to fall asleep. Write a list of your worries and any ideas to solve them before going to bed. This may help you forget about them until the morning. Bedroom environment Use thick blinds or curtains or wear an eye mask if the early morning sunlight or bright street lamps affect your sleep. Make sure your bedroom is at a comfortable temperature for sleeping. Wear ear plugs if noise is a problem. Dont use your bedroom for anything other than sleeping or sex. Avoid watching television, making phone calls, eating or working while youre in bed. Make sure your mattress is comfortable and that you have a pillow you like, as well as adequate bedding for the time of year. Treatments Insomnia will often improve by making changes to your bedtime habits. If these dont help, your GP may be able to recommend other treatments. If youve had insomnia for more than four weeks, your GP may recommend cognitive and behavioural treatments or suggest a short course of prescription sleeping tablets as a temporary measure. If its possible to identify an underlying cause of your sleeping difficulties, treating this may be enough to return your sleep to normal. The various treatments forinsomnia are outlined below. Good sleeping habits Your GP will be able to advise you about what you can do at home to help you sleep. This is known as sleep hygiene and includes: establishing fixed times for going to bed and waking up creating a relaxing bedtime routine only going to bed when you feel tired maintaining a comfortable sleeping environment thats not too hot, cold, noisy or bright not napping during the day avoiding caffeine, nicotine and alcohol late at night avoiding eating a heavy meal late at night Read more about self-help tips forinsomnia Cognitive and behavioural treatments If changing your sleeping habits doesnt help, your GP may be able to refer you for a type of cognitive behavioural therapy (CBT)thats specifically designed for people with insomnia (CBT-I). The aim ofCBT-I is to change unhelpful thoughts and behaviours that may be contributing to your insomnia. Itsan effective treatment for many people and can have long-lasting results. CBT-Imayinclude: stimulus-control therapy  which aims to help you associate the bedroom with sleep and establish a consistent sleep/wake pattern sleep restriction therapy  limiting the amount of time spent in bed to the actual amount of time spent asleep, creating mild sleep deprivation; sleep time is then increased as your sleeping improves relaxation training  aims to reduce tension or minimise intrusive thoughts that may be interfering with sleep paradoxical intention  you try to stay awake and avoid any intention of falling asleep; its used if you have trouble getting to sleep, but not maintaining sleep biofeedback  sensors connected to a machine are placed on your body to measure your bodys functions, such as muscle tension and heart rate; the machine produces pictures or sounds to help you recognise when youre not relaxed CBT-I issometimes carried out by a specially trained GP. Alternatively, you may be referred to a clinical psychologist. The therapy may be carried out in a small group with other people who have similar sleep problems, or one-to-one with a therapist. Self-help books and online courses may also be used. Sleeping tablets Sleeping tablets (hypnotics) are medications that encourage sleep. In the past, they were frequently used to help with insomnia, but theyre used much less often nowadays. They will generally only be considered: if your insomnia is severe as a temporary measure to help ease short-term insomnia if the good sleep habits and cognitive and behavioural treatments mentioned above dont help Doctors are usually reluctant to recommend sleeping tablets in the long-term because they just mask the symptoms without treating the underlying cause. They can also cause potentially dangerous side effects, such as drowsiness the following morning, and some people become dependent on them. If they are recommended, you should have the smallest effective dose possible for the shortest time (usually no more than two to four weeks). Over-the-counter sleeping pills A number of sleeping tablets are available to buy over the counter (OTC) from pharmacies. These are usually a type ofantihistamine medicine that causes you to feel drowsy. Taking OTC sleeping tablets regularly isnt usually recommended if you have insomnia, because its not clear how effective they are, they dont tackle the underlying cause of your sleeping difficulties and they can cause side effects. In particular, they can cause you to feel drowsy the next morning, which can make activities such as driving and operating machinery dangerous. Speak to your GP for advice if you find yourself needing to take OTC sleeping tablets regularly. Benzodiazepines Benzodiazepines are prescription medicines that can reduce anxiety and promote calmness, relaxation and sleep. Your GP may prescribe them for a short time if you have severe insomnia or its causing extreme distress. Examples of benzodiazepines include temazepam, loprazolam, lormetazepam, diazepam and nitrazepam. Long-term treatment with benzodiazepines isnt usually recommended because they can become less effective over time and some people become dependent upon them. They can also cause a number of side effects, including: drowsiness anddizziness, which can persist into the next day finding it difficult to concentrate or make decisions depression feeling emotionally numb irritability You should avoid driving if you feel drowsy, dizzy, or unable to concentrate or make decisions, as you may not be able to do so safely. Z-drugs Zdrugs are a newer type of medicine that work in a similar way to benzodiazepines and are similarly effective. They include zaleplon, zolpidem and zopiclone. As with benzodiazepines, long-term treatment with Zdrugs isnt normally recommended because they can become less effective over time and some people become dependent on them. Theyre usually only prescribed for a maximum of two to four weeks. Side effects of Z-drugs can include: drowsiness and dizziness, which can persist into the next day feeling and being sick diarrhoea increasedsnoring and breathing problems during sleep dry mouth confusion Zdrugs can also sometimes cause psychiatric reactions, such as delusions,nightmares and hallucinations. Contact your GP if you experience any of these effects. Read the National Institute for Health and Care Excellence (NICE) guidance on zaleplon, zolpidem and zopiclone for the short-term management of insomnia for more information. Melatonin (Circadin) For adults aged 55 or over, a medication called Circadin is sometimes used to help relieve insomnia for a few weeks. It contains a naturally occurring hormone called melatonin, which helps to regulate the sleep cycle. Circadin is usually only recommended for three weeks at first, but it can be continued for a total of 13 weeks if it helps. Common side effects of Circadin include: headaches cold-like symptoms back pain joint pain Treatments that arent recommended The following treatments arent normally recommended for insomnia, because its not clear how effective they are and they can sometimes cause side effects: antidepressants (unless you also have depression) chloral hydrate clomethiazole barbiturates herbal remedies, such as valerian extract complementary and alternative therapies, such asacupuncture, hypnotherapy and reflexology Source: NHS 24 - Opens in new browser window Last updated: 03 May 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Other languages and formats British Sign Language (BSL) British Sign Language (BSL) Add this page to\n            Info For Me Also on NHS inform Sleep problems and insomnia self-help guide Get help with your mental health Insomnia (BSL) Mind to Mind Coping with money worries NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Iron deficiency anaemia,"Iron deficiency anaemia - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Nutritional Iron deficiency anaemia Iron deficiency anaemia About iron deficiency anaemia Causes of iron deficiency anaemia Diagnosing iron deficiency anaemia Treating iron deficiency anaemia Complications of iron deficiency anaemia About iron deficiency anaemia Iron deficiency anaemia is a condition where a lack of iron in the body leads to a reduction in the number of red blood cells. Iron is used to produce red blood cells, whichhelp store and carry oxygen in the blood. If you have fewer red blood cells than is normal, your organs and tissues wont get as much oxygen as they usually would. There are several different types of anaemia, and each one has a different cause. Iron deficiency anaemia is the most common type. Other types of anaemia can be caused by a lack of vitamin B12 or folate in the body read more about vitamin B12 and folate deficiency anaemia . Symptoms of iron deficiency anaemia Many people with iron deficiency anaemia only have a few symptoms. The severity of the symptoms largely depends on how quickly anaemia develops. You may notice symptoms immediately, or they may develop gradually if your anaemia is caused by a long-term problem, such as a stomach ulcer . The most common symptomsinclude: tiredness and lack of energy (lethargy) shortness of breath noticeable heartbeats(heart palpitations) a pale complexion Less common symptomsinclude: headache hearing sounds that come from inside the body, rather than from an outside source (tinnitus) an altered sense of taste feeling itchy a sore orabnormally smooth tongue hair loss a desire to eat non-food items, such as ice, paper or clay (pica) difficulty swallowing (dysphagia) painful open sores (ulcers) on the corners of your mouth spoon-shaped nails When to see your GP See your GP if you experience symptoms of iron deficiency anaemia. They should be able to diagnose the condition using a simple blood test . Read more about diagnosing iron deficiency anaemia What causes iron deficiency anaemia? There are many things that can lead to a lack of iron in the body. In men and post-menopausal women, the most common cause is bleeding in the stomach and intestines. This can be caused by a stomach ulcer, stomach cancer , bowel cancer , or by takingnon-steroidal anti-inflammatory drugs (NSAIDs). In womenof reproductive age,heavy periods and pregnancy are the most common causes of iron deficiency anaemia as your body needs extra iron for your babyduring pregnancy. Unless youre pregnant, its rare for iron deficiency anaemia to be caused just by a lack of iron in your diet. However, if you do lack dietary iron, it may mean youre more likely to develop anaemia than if you have one of the problems mentioned above. Read more about the causes of iron deficiency anaemia How iron deficiency anaemia is treated Treatment for iron deficiency anaemia involves taking iron supplements toboost thelow levels ofiron in your body. This is usually effective, and the condition rarely causeslong-term problems. Youll need to be monitored every few months to check the treatment is working and your iron levels have returned to normal. The underlying cause will need to be treated so you dont get anaemia again. Increasing the amount of iron in your diet may also be recommended. Good sources of iron include: dark-green leafy vegetables, such as watercress and curly kale iron-fortified cereals or bread brown rice pulses and beans nuts and seeds meat, fish andtofu eggs dried fruit, such as dried apricots, prunes and raisins Read more about treating iron deficiency anaemia Further problems If iron deficiency anaemia is left untreated, it can make you more susceptible to illness and infection, as a lack of iron affectsthe bodys natural defence system(the immune system). Severe iron deficiency anaemia may increase your risk of developing complications that affect the heart or lungs, such as an abnormally fast heartbeat (tachycardia) or heart failure , where your heart is unable to pump enough blood around your body at the right pressure. Pregnant women with severe or untreated anaemia also have a higher risk of complications before and after birth. Read more about the complications of iron deficiency anaemia Causes of iron deficiency anaemia Iron deficiency anaemia occurs when the body doesnt have enough iron, leading to the decreased production of red blood cells. Red blood cells carry oxygen around the body. A lack of iron can be caused by several factors. Some of the most common causes of iron deficiency anaemia areoutlined below. Monthly periods In women of reproductive age,periods are themost common cause of iron deficiency anaemia. Usually, only women with heavy periods develop iron deficiency anaemia. If you have heavy bleeding over several consecutive menstrual cycles, its known as menorrhagia. Pregnancy Its also very common for women to develop iron deficiency during pregnancy. This is because your body needs extra ironto ensure your baby has a sufficient blood supply and receives necessary oxygen and nutrients. Some pregnant women require an iron supplement, whileothers may need to increase the amount of iron in their diet. Read more about vitamins and minerals in pregnancy Gastrointestinal blood loss The gastrointestinal tract is the part of the body responsible for digesting food. It contains the stomach and intestines. Bleeding in the gastrointestinal tract is the most common cause of iron deficiency anaemia in men, as well as women whove experienced the menopause (when monthly periods stop). Most people with gastrointestinal bleeding dont notice any obvious blood in their stools and dont experience any changes in their bowel habits. Somecauses of gastrointestinal bleeding are described below. Non-steroidal anti-inflammatory drugs Non-steroidal anti-inflammatory drugs (NSAIDs) can cause bleeding in the stomach. Ibuprofen and aspirin are two commonly prescribed NSAIDs. If your GP thinks your medication is causing gastrointestinal bleeding, they can prescribe a less harmful medicine. However, dont stop taking a medicine youve been prescribed unless your GP advises you to. Stomach ulcers The acid in your stomach, which helps your body digest food, can sometimes eat into your stomach lining. When this happens, the acid forms an open sore (an ulcer). This is also known as a stomach ulcer or a peptic ulcer. Stomach ulcers can cause the stomach lining to bleed, which can lead to anaemia. In some cases, the bleedingcan cause you tovomit blood or pass blood in your stools. However, if the ulcer bleeds slowly, you may nothave any symptoms. Gastrointestinal cancer Ina fewcases, gastrointestinal bleeding can be caused by cancer, usually stomach cancer or bowel cancer . When trying to establish the cause of anaemia, your GP will check for possible signs of cancer. If your GP suspects cancer, youll be referred to a gastroenterologist (a specialist in treating digestive conditions) for a more thorough examination. This means that if cancer is found, it can be treated as quickly as possible. If youre 60 years old or over and have iron deficiency anaemia, your GPshould refer youto a specialist to rule out bowel cancer. Your appointment with the specialist should be within two weeks of your GP referring you. Angiodysplasia Gastrointestinal bleeding can also be caused by a condition called angiodysplasia. This isthe resultofabnormal, fragile superficialblood vessels in the gastrointestinal tract, which can cause bleeding. Chronic kidney disease People with chronic kidney disease (CKD) often develop iron deficiency anaemia. Most people with CKD who have iron deficiency anaemia will be given iron supplement injections, although daily tabletsmay betried first. You can read more about treating anaemia in people with CKD on the National Institutefor Health and Care Excellence (NICE) website. Other causes Other conditions or actions that cause blood loss and may lead to iron deficiency anaemia include: inflammatory bowel diseasea condition that causes redness and swelling (inflammation) in the digestive system, such as Crohns disease and ulcerative colitis oesophagitis inflammation of the gullet (oesophagus)caused by stomach acid leaking through it schistosomiasis an infection caused by parasites, mainly found in sub-Saharan Africa blood donationdonating a large amount of blood may lead to anaemia trauma a serious accident, such as a car crash, may cause you to lose a large amount of blood nosebleeds having regular nosebleeds may lead to anaemia, althoughthis is rare haematuria (blood in your urine)  but this rarely causes anaemiaand may be a symptom of another condition Malabsorption Malabsorption is when your body cant absorb iron from food, and is another possible cause of iron deficiency anaemia. This may happen if you have coeliac disease , a common digestive condition where a person has an adverse reaction to gluten, or surgery to remove all or part of your stomach (gastrectomy). Lack of iron in your diet Unless youre pregnant, its rare for iron deficiency anaemia to be caused solely by a lack of iron in your diet. However, a lack of dietary iron can increase your risk of developing anaemia if you also have any of the conditions mentioned above. Some studies suggest vegetarians or vegans are more at risk of iron deficiency anaemia because of the lack of meat in their diet. If you are vegetarian or vegan,it is possible to gain enough iron by eating other types of food, such as: beans nuts dried fruit, such as dried apricots wholegrains, such as brown rice fortified breakfast cereals soybean flour most dark-green leafy vegetables, such as watercress and curly kale If youre pregnant, you may need to increase the amount of iron-rich food you consume during pregnancy to help prevent iron deficiency anaemia. Read more about vegetarian and vegan diets Diagnosing iron deficiency anaemia See your GP if you experience symptoms of iron deficiency anaemia , such as tiredness, shortness of breath and heart palpitations. A simple blood test can usually confirm the diagnosis. Your GP may also carry out a physical examination and ask you a number of questions to help determine the cause of your anaemia. Blood test To diagnose iron deficiency anaemia, a blood sampleis taken from a vein in your arm and a full blood countis made. This meansall the different types of blood cells in the sample will be measured. If you have anaemia: your levels of haemoglobin a substance that transports oxygen will be lower than normal youll have fewer red blood cells, which contain haemoglobin, than normal your red blood cells may be smaller and paler than usual Your GP may also test for a substance called ferritin, a protein that stores iron. If your ferritin levels are low, it means there isnt much iron stored in your body and you mayhave iron deficiency anaemia. Read more about blood tests Vitamin B12 and folate deficiency If your GP thinks your anaemia may be the result of a vitamin B12 and folate deficiency, the levels of these substances may be tested. Folate works with vitamin B12 to help your body produce red blood cells. Vitamin B12 and folate deficiencyanaemia is more common in people who are over the age of75. Finding the cause To determine the underlying cause of your anaemia, your GP may ask questions about your lifestyle and medical history. For example, they may ask you about: your diet to see what you typically eat and whether this includes any iron-rich foods any medicines you take to see if youve been regularly taking a type of medicine that can cause bleeding from the stomach and intestines (gastrointestinal bleeding), such as ibuprofen or aspirin your menstrual pattern if youre a woman, your GP may ask if youve been experiencing particularly heavy periods your family history youll be asked if your immediate family has anaemia ora history of gastrointestinal bleeding or blood disorders Irondeficiency anaemia is common during pregnancy. If youre pregnant, your GP will usually only look for an alternative cause if a blood test has identified a particularly low haemoglobin level, or if your symptoms or medical history suggest your anaemia may be caused by something else. Physical examination Aphysical examination will usually only be needed if the cause of your iron anaemia deficiency hasnt been identified by examining your medical history and asking you about your symptoms. In such cases, your GP may: examine your stomach (abdomen) to check for any physical signs of gastrointestinal bleeding look for signs of heart failure , such asswollen anklesheart failure can have some similar symptoms to iron deficiency anaemia Two other possible types of physical examination you may have are explained below. Rectal examination Arectal examination is usually only needed if youre bleeding from your bottom. Itsa common procedure that can help your GP find out if theres something in your gastrointestinal tract thats causing bleeding. Your GP will insert a lubricatedglovedfinger into your bottom to feel for any abnormalities. A rectal examination isnt something to be embarrassed about, as its a procedure your GP will be used to doing. It shouldnt cause significant pain, but it may cause some slight discomfort this will only last for a minute. Pelvic examination Women may have a pelvic examination if their GP thinks heavy menstrual bleeding (menorrhagia) may be the cause of their anaemia. During a pelvic examination, your GP will examine your vulva and labia (external sex organs) for signs of bleeding or infection. They may also examine you internally. This will involve your GP inserting lubricated gloved fingers into your vagina to feel whether yourwomb (uterus)is tender or enlarged. A pelvic examination wont be carried out without your consent(permission), and you can choose to have someone with you. Referral to a specialist In some cases, your GP may refer you to a gastroenterologist, a specialist in treating digestive conditions. Theyll carry out a more thorough examination. For example, you may be referred to a gastroenterologist if your GP cant identify a cause and you have a particularly low haemoglobin level, or if your GP thinks theres a possibility your symptoms could be caused by stomach cancer or bowel cancer , although this is unlikely. If youre a woman with heavy periods, you may be referred to a gynaecologist if you dont respond to treatment with iron supplements. Treating iron deficiency anaemia Treatment for iron deficiency anaemia usually involves taking iron supplements and changing your diet to increase your iron levels, as well as treating the underlying cause. Iron supplements Your GP will prescribe an iron supplement to restore the iron missing from your body. The most commonly prescribed supplement is ferrous sulphate,which is takenas a tablet, usually twice a day. Some people canexperience side effects when taking iron supplements, including: abdominal (tummy) pain constipation or diarrhoea heartburn feeling sick black stools (faeces) These side effects should settle down over time. However, your GP may recommend taking the tablets with food or shortly after eating if you have troublesome side effects. Your GP may also advise you to only take one or two tablets a day, instead of three, if youre finding side effects difficult to cope with. If you cant take ferrous sulphate because you get severe side effects, you may be prescribed a different iron supplement called ferrous gluconate. This supplement should cause fewer side effects because it contains a less concentrated dose of iron. However, it may take longer for the iron levels in your body to be restored. Ina fewcasesfor example, if you have chronic kidney disease (CKD)  iron injections may be recommended instead of tablets. As with all medications,its important to store iron supplements out of the reach of children. An overdose of iron supplements in a young child can be fatal. Dietary advice If a lack of iron in your diet is thought to be contributing to your iron deficiency anaemia, your GP will tell you how to up your intake. Iron-rich foods include: dark-green leafy vegetables, such aswatercress and curly kale iron-fortified cereals or bread brown rice pulses and beans nuts and seeds white and red meat fish tofu eggs dried fruit,such asdried apricots, prunes and raisins Your diet should include foods from all the major food groups to ensure itshealthy and balanced. In particular,food and drink containing vitamin Care importantas vitamin C helps your body absorb iron. However, consuming large amounts of some foods and drinks, as well as certainmedicines,may make it harder for your body to absorb iron. These include: tea and coffee calciumfound indairy products, such as milk antacidsandproton pump inhibitors (PPIs)medications usedto relieve indigestion wholegrain cerealsalthough wholegrains are a good source of iron themselves, they contain phytic acid, which can stop your body absorbing iron from other foods and pills You may be referred to a nutrition specialist called a dietitian if youre finding it difficult to include iron in your diet. Theyll be able to give you detailed, personalised advice about how you canimprove your diet. Treating the underlying cause Your GP will also need to ensurethe underlying cause of your anaemia is treated soit doesnt happen again. For example, ifnon-steroidal anti-inflammatory drugs (NSAIDs) are causing bleeding in your stomach, your GP may prescribe a different medicine to help minimise the risk of stomach bleeding. Heavy periods canbe treated withmedication or in particularly severe cases surgery. Monitoring Your GP will ask you to return two to four weeks after youve started takingiron supplements to check how well youve responded to the treatment. Youll have a blood test to check your haemoglobin levels. If yourblood test results show an improvement, youll be asked to continue taking iron supplements and return in two to fourmonths for another blood test. Once your haemoglobin levels and red blood cells are normal, your GP will usually recommend continuing totake iron supplements for three months to help build up the iron levels in your body. After this, you should be able to stop taking the supplements, depending on the cause of your iron deficiency anaemia. Your condition will be monitored every three months over the course of a year, and again a year later. Continuing treatment Sometimes after a persons iron levels have been replenished, they start to fall again. This could happen if you dont get enough iron in your diet, youre pregnant, or you have consistently heavy periods. In such cases, you may be prescribed an ongoing iron supplement to help stop your anaemia returning. This will usually be a tablet, which youll have to take once a day. If treatment is ineffective If your iron levels dont improve, your GP will ask how regularly youve been taking your iron supplements. Some people are put off taking the medication because of the side effects. However, your condition wont improve if you dont take the supplements. If youve been taking the supplements as prescribed and your iron levels still havent improved, your GP may refer you to a specialist for an assessment. Complications of iron deficiency anaemia Iron deficiency anaemia rarely causes serious or long-term complications, although some people with the condition find it affects their daily life. Somecommon complications are outlined below. Tiredness Iron deficiency anaemia can make you feel tired and lacking in energy (lethargic). This may result in you being less productive at work, andyou may find it difficult to stay awakeornot feel able to exercise regularly. Increased risk of infections Research has showniron deficiency anaemia can affect your immune system the bodys natural defence system. This increases your vulnerability to infection. Heart and lung problems Adults with severe anaemia may be at risk of developing complications that affect their heart or lungs. For example, you may develop tachycardia , which isan abnormally fast heartbeat,or heart failure , where the heart fails to pump enough blood around your body at the right pressure. Pregnancy complications Pregnant women with severe anaemia have an increased risk of developing complications, particularly during and after birth. They may also develop postnatal depression , which some women experience after having a baby. Research suggests babies born to mothers who have untreated anaemia are more likely to: be born prematurelybefore the 37th week of pregnancy have a low birth weight have problems withiron levels themselves do less well in mental ability tests Restless legs syndrome Some cases of restless legs syndrome are thought to be caused by iron deficiency anaemia. Doctors often refer to this as secondary restless legs syndrome. Restless legs syndromeis a common condition that affects the nervous system, andcauses an overwhelming, irresistible urge to move the legs. It also causes an unpleasant feeling in the feet, calves and thighs. Restless legs syndrome caused by iron deficiency anaemiacan usually be treated with iron supplements. Source: NHS 24 - Opens in new browser window Last updated: 21 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Vitamin B12 or folate deficiency anaemia Stomach ulcer Other health sites NICE: Heavy menstrual bleeding (1) NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Irritable bowel syndrome (IBS),"Irritable bowel syndrome (IBS) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Irritable bowel syndrome (IBS) Irritable bowel syndrome (IBS) Learn about what IBS is and how it can be managed What is IBS? Irritable bowel syndrome (IBS) is a common, long-term condition of the digestive system. The condition is often lifelong, although the symptoms may change over time. With the right strategies, IBS can be successfully managed. IBS does not pose a serious threat to your physical health and does not increase your chances of developing cancer or other bowel-related conditions. The exact cause of IBS is unknown. Many causes have been suggested but none have been proven to lead to IBS. IBS symptoms The symptoms of IBS vary between individuals and affect some people more severely than others. Symptoms can become worse, often during times of stress or after eating certain foods. You may find some of the symptoms of IBS ease after going to the toilet and moving your bowels. Main symptoms The most common symptoms of IBS are: abdominal (stomach) pain and cramping, which may be relieved by moving your bowels a change in your bowel habits  such as diarrhoea , constipation or sometimes both bloating and swelling of your stomach excessive wind ( flatulence ) occasionally experiencing an urgent need to move your bowels Less common syptoms Other less common symptoms may also be experienced, such as: lack of energy (lethargy) feeling sick heartburn The symptoms of IBS can also have a significant impact on a persons day-to-day life and, as a result, some people may experience symptoms of low mood and stress. See your GP if: you think you have IBS type symptoms, so they can try to identify the cause youre feeling anxious or experiencing a change in your mood as this can worsen IBS symptoms See your GP urgently if: You have other symptoms, including: a change in your bowel habits that has lasted for more than 6 weeks, especially if you are over 50 years of age unexplained weight loss a swelling or lump in your stomach or back passage bleeding from your back passage These can sometimes be a sign of a potentially more serious condition. You should also tell your GP if you have these symptoms and a family history of bowel cancer or ovarian cancer . Diagnosing IBS There are no specific tests for IBS. Many cases can be diagnosed based on your symptom history and your GP will undertake some routine blood and stool tests to rule out other conditions. As the symptoms of IBS are similar to other conditions such as coeliac disease and inflammatory bowel disease, it is important to rule these out. It is important not to make any dietary changes until these tests have been done. This is particularly important for the blood test for coeliac disease as the result can be affected by your diet. Private allergy testing (for example hair sampling) is not a reliable way to test for allergies or intolerances. If you are concerned, please talk to your GP. Managing irritable bowel syndrome (IBS) Learn about things that can help IBS symptoms IBS and your mental health Learn about the link between IBS and mental health and what can help Irritable bowel syndrome (IBS) (BSL) What IBS is and how its treated in British Sign Language (BSL) NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Itching,"Itchy skin | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Skin, hair and nails Itchy skin Itchy skin Itching is an unpleasant sensation that compels a person to scratch the affected area. Learn about causes and treatments of itching. About itchy skin Common causes of itchy skin, how to ease it and when to see your GP Causes of itchy skin Common causes of itchy skin, including allergies, skin conditions and other conditions Treatments for itchy skin The types of treatments available to help itchy skin NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Itchy bottom,"Itchy bottom | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Skin, hair and nails Itchy bottom Itchy bottom Itchy bottom is a strong urge to scratch the skin around your bottom (anus). The anus is the opening at the lower end of the digestive system, where solid waste leaves your body. Causes of itchy bottom The cause of itchy bottom isnt always known. If it gets better quickly without treatment, it may be the result of a short term issue. For example, sweating more in hot weather. Its rare for an itchy bottom alone to be a sign of something more serious. If an itchy bottom lasts longer, you may be able to get an idea of the cause from other symptoms you have. But, you should not self-diagnose. Speak to your GP if youre worried. An itchy bottom thats worse at night can be caused by threadworms. This is often the case for children. You cant take medicine for threadworms if youre: pregnant breastfeeding a child under 2 This means you should speak to a GP, midwife or health visitor instead. Conditions with itchy bottom Sometimes an itchy bottom can be a symptom of another problem or condition. This includes: skinconditions like eczema or psoriasis  if you have itching elsewhere on the body too threadworms (especially in children)  symptoms will get worse at night and there will be worms in poo (they look like bits of thread) haemorrhoids (piles)  swellings in and around the anus, as well as pain and blood when pooing bowel incontinence or diarrhoea  can cause poo leaking or pooing you can not control sexually transmitted infection (STI) like genital warts  can cause sores, swelling and irritation ringworm  can cause sores, swelling and irritation Some long-term medications can also cause an itchy bottom. For example, steroid creams or peppermint oil. When to get help A pharmacist can often help to treat an itchy bottom. You can ask if they have a private area to discuss your symptoms. They can suggest treatments like: creams and ointments to relieve itching medication if the symptoms are caused by threadworms Find your nearest pharmacy Speak to your GP if: You have an itchy bottom that: doesnt get better after 3 to 4 days keeps coming back makes you anxious or depressed affects your sleep is painful is accompanied by other symptoms, like itching elsewhere on your body You should also speak to a GP if your itchy bottom is caused by an underlying condition like piles. What to expect at your GP appointment Your GP might need to check your bottom (a rectal examination) to help find out whats causing your itching. You may feel awkward, but this is nothing to be embarrassed or worried about. Its one of the most common examinations GPs carry out. At your appointment, your GP may ask: whether you use creams, powders or soaps around your bottom how long you have had the itching whether the itching gets worse at night or after eating certain foods if you have any other symptoms Your GP will decide on the best treatment for you depending on whats causing your symptoms. They may suggest: things you can do yourself to ease an itchy bottom a stronger medication, cream or ointment How to ease an itchy bottom yourself Do use soft toilet tissue bath or shower daily have shorter, cooler showers and baths keep your bottom clean and dry wear loose-fitting cotton underwear change your underwear daily only put underwear on when your bottom is completely dry use a light duvet at night so you dont get too hot gently wash and dry your bottom after pooing and before bed keep your fingernails short to stop your skin from being damaged by scratching wear cotton gloves while sleeping to avoid damaging the skin if you scratch wear stockings instead of tights eat foods with fibre (fruit, vegetables and wholegrains) to help produce regular, solid poo Dont do not wear tight clothing do not use scented soaps, bubble bath or perfumes do not use scented powders near your bottom do not scratch if you can do not eat food or drink that makes your itching worse, for example caffeine, alcohol, citrus fruit or spicy foods Source: NHS 24 - Opens in new browser window Last updated: 01 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Kaposis sarcoma,"""Kaposi's sarcoma - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Kaposis sarcoma Kaposis sarcoma Kaposis sarcoma is a rare type of cancer caused by a virus. It can affect the skin and internal organs. Its mainly seen in people with a poorly controlled or severe HIV infection. It canalso affect some people who have a weakened immune system for another reason, as well as people who havea genetic vulnerability to the virus. Signs and symptoms The most common initial symptom is the appearance of small, painless, flat and discoloured patches on the skin or inside the mouth. Theyre usually red or purple and look similar to bruises. Over time, the patches may grow into lumps known as nodules and may merge into each other. Internal organs can also be affected, including thelymph nodes, lungs and the digestive system, whichcan cause symptoms such as: uncomfortable swelling in the arms or legs (lymphoedema) breathlessness , coughing up bloodand chest pain nausea, vomiting, stomach pain and diarrhoea The rate at which symptoms progress depends on the type of Kaposis sarcoma you have.Most types get worse quickly in a matter of weeks or months without treatment, but some progress very slowly over many years. When to seek medical advice You should speak to your GP if you have any worrying symptoms you think could be caused by Kaposis sarcoma.If you have HIV, you can also contact your local HIV clinicif you have any concerns. Your doctor will ask about your symptoms and examine your skin to look for the characteristic discoloured patches. If they suspect Kaposis sarcoma, they will refer you for further tests to confirm the diagnosis. These tests may include: an HIV test  a blood test to confirm whether or not you have HIV (if you havent already been diagnosed with the condition) a skin biopsy  where a small sample of cells is removed from an affected area of skin andchecked for Kaposis sarcoma cells anendoscopywhere a thin, flexible tube called an endoscope is passed down your throat to see if your lungs or digestive system are affected a computerised tomography (CT)scan to see ifyour lymph nodes or other parts of your body are affected What causes Kaposis sarcoma? Kaposis sarcoma is caused by a virus called the human herpesvirus 8 (HHV-8), also known as the Kaposis sarcoma-associated herpesvirus (KSHV). This virus is thought to bespread during sex, through saliva, or from a mother to her baby during birth. HHV-8 is a relatively common virus and the vast majority of people who have it will not develop Kaposis sarcoma.It only seems to cause cancer in some people with a weakened immune system and in some people who havea genetic vulnerability to the virus. A weakened immune system allows the HHV-8 virus to multiply to high levels in the blood, which increases the chance it will cause Kaposis sarcoma. Thevirusappears to alter the genetic instructions that control cell growth. This means some cells reproduce uncontrollably and form lumps of tissue known as tumours. Types of Kaposis sarcoma and their treatment There are 4 main types of Kaposis sarcoma. These types affect different groups of people and are treated in different ways. HIV-related Kaposis sarcoma Although its not as common as it used to be, Kaposis sarcoma is still one of the main types of cancer to affect people with HIV. HIV-related Kaposis sarcoma can progress very quickly if not treated. However, it can usually be controlled by taking HIV medication  known as combination antiretroviral therapy (cART)  to prevent HIV multiplying and allow the immune system to recover. The immune system can then reduce the levels of HHV-8 in the body. Read more about treating HIV . Some people may also require treatment with radiotherapy (where high-energy rays are usedto destroy cancer cells) or chemotherapy (where powerful medications are used to destroy cancer cells), depending on the site and extent of the cancer and what symptoms its causing. Classic Kaposis sarcoma Classic Kaposis sarcoma mainly affects middle-aged and elderly men of Mediterranean or Ashkenazi Jewish descent. Ashkenazi Jews are descended from Jewish communities that lived in central and eastern Europe. Most Jewish people inthe UKare Ashkenazi Jews. Its thought people who develop classic Kaposis sarcoma were born with a genetic vulnerability to the HHV-8 virus. Unlike the other types of Kaposis sarcoma,the symptoms of classic Kaposis sarcoma progress very slowly over many years and are usuallylimited to the skin. Immediate treatment isnt usually required because, in many cases, the condition doesnt affectlife expectancy. Youll usually be monitored carefully and only treated if the symptoms get significantly worse. Radiotherapy isoften used if treatment is required, although smallskin patches or nodules may be removed using minor surgery or cryotherapy (freezing). Transplant-related Kaposis sarcoma Transplant-related Kaposis sarcoma is a rare complication of an organ transplant.It occurs because the immunosuppressant medication used to weaken the immune system and help prevent the body rejecting the new organ can allow a previous HHV-8 infection to reactivate, which means levels of the virus increase as it starts multiplying again. Transplant-related Kaposis sarcoma can be aggressive and usually needs to be treated quickly. Itsnormally treated by reducing or stopping the immunosuppressants, if this is possible. If this is unsuccessful, radiotherapy or chemotherapy may be used. Endemic African Kaposis sarcoma Endemic African Kaposis sarcoma is common in parts of Africa and is one of the most widespread types of cancer in that region. Although this type of Kaposis sarcoma is classified separately from HIV-related Kaposis sarcoma, many cases may actually result from an undiagnosed HIV infection. All suspected cases thereforemust have an HIV test, as the most effective treatment in these cases is HIV medication. In cases not caused by HIV infection, this type of Kaposis sarcoma may be the result of a genetic vulnerability to HHV-8. These cases are usually treated with chemotherapy, although sometimes radiotherapy may be used. Outlook With proper treatment, Kaposis sarcoma can usually be controlled for many years. Deaths from the condition are uncommon in the UK. The discoloured patches of skin will often shrink and fade with treatment, although they may not ever disappear completely. A complete cure for any type of Kaposis sarcoma isnt always possible, and theres a chance the condition could recur in the future. If you think this is happening, contact your HIV clinic, hospital specialist or GP as soon as possible. Source: NHS 24 - Opens in new browser window Last updated: 13 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites Cancer Research UK: Kaposi's sarcoma Macmillan Cancer Support: Kaposi's sarcoma Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Kidney cancer,"Kidney cancer - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Kidney cancer Kidney cancer About kidney cancer Symptoms of kidney cancer Causes and risk factors of kidney cancer Diagnosing kidney cancer Treating kidney cancer Preventing kidney cancer About kidney cancer Kidney cancer is the eighth most common cancer in adults in the UK. Signs and symptoms of kidney cancer can include: blood in your urine a constant pain in your side, just below the ribs a lump or swelling in the kidney area (on either side of the body) Speak to your GP as soon as possible if you experience any of these symptoms. They will examine you and may refer you to a specialist clinic for further tests. In around half of all cases of kidney cancer, there are no symptoms, and the condition is detected during tests for other unrelated conditions. Read more about the symptoms of kidney cancer and diagnosing kidney cancer . The kidneys and cancer The kidneys are 2 bean-shaped organs located on either side of the body, just underneath the ribcage. Their main role is to filter out waste products from the blood, in addition to producing urine. Only 1 of the kidneys is usually affected by cancer. The human body is made up of billions of cells, which normally grow and multiply in an orderly way, with new cells being created only when and where theyre needed. In cancer, this orderly process goes wrong and cells begin to grow and multiply uncontrollably. Exactly what triggers this growthis unknown. However, there are certain risk factors that can increase the chances of the condition developing, such as smoking and obesity . Kidney cancer most frequently affects people over 50 years of age and is more common among men. Read more about the causes of kidney cancer . Types of kidney cancer Many different types of cancer can affect the kidneys. The most common type is renal cell carcinoma (RCC), which accounts formore than 80%of all kidney cancers. Rarer types of kidney cancer include: transitional cell cancer  develops in the lining of the kidneys and usually affects men who are 50 years of age or over Wilms tumour  a rare type of kidney cancer that affects children This topic focuses on RCC. Read theCancer Research UKwebsite for more information about transitional cell cancer and Wilms tumour . Treating kidney cancer The earlier kidney cancer is diagnosed, the easier it is to treat. How its treated will depend on the size and spread of the cancer. Surgery to remove the cancerous cells is usually the first course of action. Unlike most other cancers, chemotherapy isnt very effective at treating kidney cancer. However, non-surgical treatments are available, such as radiotherapy or targeted therapies. These are most commonly used in the more advanced stages of kidney cancer, when the cancer has spread beyond the kidney. Read more about treating kidney cancer . Preventing kidney cancer As the causes of kidney cancer arent fully understood, its not possible to fully prevent it. However, leading a healthy lifestyle may reduce the chances of developing the condition. A combination of a healthy diet and regular exercise will help to avoid becoming overweight or obese, which is a significant risk factor for kidney cancer. If youre overweight or obese, you can lose weight and maintain a healthy weight by combining regular exercise with a calorie-controlled diet. Read more about treating obesity . Symptoms of kidney cancer Most cases of kidney cancer dont cause any symptoms in the early stages. The most common symptoms of mid- to advanced-stage kidney cancer are: blood in your urine (haematuria)  the amount of blood is usually high enough to change the colour of your urine to a reddish or dark brown colour apersistentpain in your side, just below the ribs a lump or swelling in the area of yourkidneys (on either side of the body) However, in around half of all cases, the cancer causes no symptoms and is only detected during a routine ultrasound scan . Less common symptoms of kidney cancer include: extreme tiredness (fatigue) or anaemia unintentional weight loss a high temperature of 38C (100.4F) or above night sweats a general sense of feeling unwell swelling of the veins in the testicles (in men) loss of appetite high blood pressure (hypertension) When to seek medical advice Speak to your GP immediately if you have pain or a swelling or lump in your kidney area (on either side of your body, just below your ribcage). You should also speak to your GP if youhave blood in your urine. Although its highly unlikely to be caused by kidney cancer, it couldbea symptom of a less serious condition that still requires treatment, such as a kidney stone or bladder stone. Causes and risk factors of kidney cancer The exact cause of kidney cancer is unknown, but there are risk factors that can increase the chances of developing the condition. The3main risk factors for kidney cancer are: obesity smoking family history and genetics Obesity Obesity isa significant risk factor for kidney cancer. Theres a strong link between someonesbody mass index (BMI) and their risk of developing kidney cancer. Read more about how BMI is calculated ,and work out your BMI. A BMI score of 25 or above has been shown to increase a persons chances of developing kidney cancer. Those with a BMI score of 30 or above are at particularly high risk. This may be because overweight or obese people, particularly women, have higher levels of a hormone called oestrogen in their body. Its thought that excess levels of oestrogen may stimulate the growth of cancerous cells. Cases of kidney cancer have been increasing over the last 40 years, which has been linked to rising obesity levels. Smoking Smoking is also asignificant risk factor for developing kidney cancer, and the more you smoke the greater the risk. For example, research has shown that if you regularly smoke 10 cigarettes a day, youre one-and-a-half timesmore likely to develop kidney cancer compared to a non-smoker. This increases to twice as likelyif you smoke 20 or more cigarettes a day. Its not clear why smoking increases your chances of developing kidney cancer. Family history and genetics If you have a close family member (parents, brothers, sisters or a child) whos been diagnosed with kidney cancer, youre about twice as likely to develop kidney cancer yourself. Examples of inherited genetic conditions and syndromes that increase your risk of developing kidney cancer include: tuberous sclerosis  a rare genetic condition that causes multiple non-cancerous (benign) tumours to grow in the body; its autosomal dominant, which means you only have to inherit the faulty gene from one parent to get it; about 1 in every 100 people with tuberous sclerosis will develop kidney cancer hereditary papillary kidney cancer  a rare form of cancer caused by faulty genes inherited from your parents; its autosomal dominant and causes small, slow-growing, cancerous tumours to develop in the kidneys, which can sometimes spread hereditary leiomyomatosis and renal cell carcinoma (HLRCC)  a rare, autosomal dominant form of cancer, where cancerous tumours develop from smooth muscle tissue (leiomyomatas); people with HLRCC have a 10to 16% increased risk of developing kidney cancer Von Hippel-Lindau syndrome  a rare genetic syndrome that causes small non-cancerous tumours to develop inside the nervous system; VHL is also autosomal dominant and about 4 out of 10 people who have it develop kidney cancer Birt-Hogg-Dub syndrome  an inherited syndrome that causes non-cancerous tumours to develop in the hair follicles of the skin; they usually occur on the face, neck and torso Otherpossible risk factors There are also anumber of other possible risk factors for developing kidney cancer, including: mild painkillers  some mild painkillers have been linked to an increased risk of developing kidney cancer; NSAIDs , such as ibuprofen , may slightly increase the risk, although occasional use or low doses are unlikely to be harmful kidney disease  if you have kidney failure and need to have regular dialysis (treatment to replicate the functions of the kidneys), your risk of developing kidney cysts and kidney cancer is increased high blood pressure (hypertension)  high blood pressure is a known risk factor for kidney disease, and youre up to twice as likely to develop kidney cancer if you have raised blood pressure Diagnosing kidney cancer In many cases, kidney cancer is diagnosed after routine scans and check-ups, as the condition doesnt always have obvious symptoms. You should speak to your GP if you have any symptoms of kidney cancer,such asblood in your urine or a constant pain below your ribs. Your GP will examine you and, if they think your symptoms need further assessment, refer you to a specialist urologist (a doctor whospecialises inconditions that affect the urinary tract). If you notice blood in your urine,your GP will usuallycarry out a blood test and take a urine sample. The results will help rule out otherpossible causes, such as infection or kidney stones . In 2015, the National Institute for Health and Care Excellence ( NICE ) published guidelines to help GPs recognise the signs and symptoms ofrenal (kidney) cancerand refer people for the right tests faster. To find out if you should be referred for further tests for suspectedkidney cancer, read the NICE 2015 guidelines on Suspected Cancer: Recognition and Referral . If you need to be referred urgently, youll usually be seen within 2 weeks. Further tests If your GP refers you to a hospital specialist,further tests will helpdetermine whether you have kidney cancer. Ultrasound scan An ultrasound scan uses high-frequency sound waves to create an image of an organ in the body. It can often detect changes in the shape of the kidney that might becaused bya cancerous tumour. An ultrasound scan may be needed if the cause of the blood in your urine cant be found. Computerised tomography scan You may also be referred for a computerised tomography (CT) scan . During a CT scan, a series of detailed images of the inside of your body are taken and put together by a computer. If you have a CT scan, you may be given a special dye to drink, or it may be injected. The dye makes the results of the CT scan clearer. Image-guided biopsy In some cases of kidney cancer, an image-guided biopsy is carried out. Its a minor surgical procedure performed under local anaesthetic .This means youll be awake during the procedure, but thearea surrounding the affected kidney will be numbed, so that you dont feel anything. During an image-guided biopsy, a radiologist or surgeon will use an ultrasound or CT scan to guide a needle through your skin and into your kidney. A small tissue sample will be removed from your kidney and examined under a microscope to check for cancerous cells. Magnetic resonance imaging (MRI) scan You may also need to have a magnetic resonance imaging (MRI) scan , which can be used toproduce detailed images of your kidneys. The images can help identify a tumour and determineits size. Cystoscopy Acystoscopy is a medical procedure that uses an instrument called a cystoscope to examine theinside of your bladder and urinary system. This proceduredoesnt look atthe kidneys, but it can rule out or confirm whether any bleeding is coming from problems in the bladder. Intravenous pyelogram (IVP) An intravenous pyelogram (IVP) test involves injecting a dye into your bloodstream. X-rays are taken after a short time, with the dye highlighting any growths present in the kidneys. Staging and grading If kidney cancer is confirmed, its usually possible to determine its grade and stage. The stage describes how far the cancer has spread, and the grade describes how aggressive the cancer is and how quickly its likely to spread. Both the stage and grade of your kidney cancer will help determine your recommended treatment and the likelihood of achieving a cure. Healthcare professionals use the TNM systemto stage kidney cancer: T  indicates how large the tumour has grown (a tumour is a lump of cancerous tissue) N  indicates whether nearby lymph nodes are affected (lymph nodes are small, oval-shaped glands found throughout the body, which help protect against infection) M  indicates whether the cancer has spread to another part of the body (M stands for metastases, which is the medical term for cancer that has spread) The stages of tumour size are: T1a  where the tumour is less than 4cm (about 1.6 inches)in diameter T1b  where the tumour is 4to 7cm (about 1.6-2.8 inches) in diameter T2  where the tumour is larger than 7cm (2.8 inches)in diameter, but hasnt spread out of the kidney T3a  where the tumour has spread into the adrenal gland or the layer of fat surrounding the kidney T3b  where the tumour has spread into the renal vein (the vein that carries blood back from the kidney to the heart) or into the vena cava (the vein that carries blood back from the top half of the body) T3c  where the tumour has spread past the diaphragm (the sheet of muscle that separates the top part of the abdomen from the bottom part) T4  where the tumour has spread beyond the tough layer of tissue that surrounds and protects the kidney There are 3 lymph node stages: N0  where no lymph nodes have been affected N1  where there are cancer cells in 1 lymph node N2  where there are cancer cells in 2 or more lymph nodes M0 means that the cancer hasnt spread to another part of the body. M1 means that the cancer has spread. Kidney cancer is graded using a scale of one to four. The higher the grade, the more aggressive the cancer. Coping with cancer Being diagnosed with cancer can be very distressing, particularly if its incurable. The news can often be difficult to take in and comprehend. After cancer has been diagnosed, you may find that talking to a counsellor or psychiatrist helps you deal withfeelings of depression and anxiety . Antidepressants may also be used to help you through this process. Read more about coping with a cancer diagnosis . More information can be found on our pages about living with cancer . Treating kidney cancer The treatment of kidney cancer depends on the size and spread of the cancer. Surgery is the most common first course of action, with the aim of removing the cancer cells. Unlike most other cancers, chemotherapy isnt very effective in treating kidney cancer. However, there are non-surgical treatments available, such as radiotherapy or targeted drug therapies. The main treatments for kidney cancer include: nephrectomy embolisation radiotherapy targeted therapies immunotherapy Your treatment plan You can expect to be cared for by a multidisciplinary team, often comprising a specialist cancer surgeon, an oncologist (who specialises in radiotherapy and chemotherapy ), a radiologist, a nephrologist (a kidney specialist) and a specialist nurse. Youll begiven a key worker, usuallythe specialist nurse, who will be responsible for coordinating your care. Your team will recommend what they think is the best treatment option, but the final decision will be yours. When deciding what treatment is best for you, your doctors will consider: the stage and grade of your cancer (how big it is and how far its spread) your age and general health If the cancer hasnt spread out of your kidney (T1 or T2 kidney cancer), it can usually be cured by removing some or all of the kidney. If the cancer has spread out of your kidney (T3 or T4 kidney cancer), a complete cure may not be possible. However, it should be possible to slow the cancers progression and treat any symptoms. Surgical treatments Nephrectomy A nephrectomy is an operation to remove a kidney. If the tumour is less than 4cm (1.5 inches) in diameter, it may only be necessary to remove some of your kidney. This is known as a partial nephrectomy. A partial nephrectomy may also be required if your remaining kidney is in poor health. If the tumour is more than 4cm in diameter, your entire kidney will need to be removed. Even if the cancer has spread beyond your kidney, you may still benefit from having your kidney removed. Removing the kidney can help resolve the pain, and make other types of non-surgical treatment more effective. Its possible to live a normal life with only 1 kidney, because the other kidney will be able to compensate. During a nephrectomy, the surgeon may also remove nearby lymph nodes to make sure the cancer hasnt spread beyond the kidney. There are 2 ways that both a partial and open nephrectomy can be performed They are an: open nephrectomy  where the kidney is removed through a large incision in your abdomen (stomach) laparoscopic or keyhole nephrectomy  wherea series of smaller incisions are made in your abdomen, and the kidney is removed using small surgical instruments Both techniques have advantages and disadvantages. A laparoscopic nephrectomy has a considerably quicker recovery time than an open nephrectomy. However, the procedure requires surgeons with specialised training, so you may have to wait longer to receive treatment than you would if youdecided to have an open nephrectomy. Some types of kidney cancer, where the tumour is located in the centre of the kidney, may not be suitable for a laparoscopic nephrectomy. One of the main disadvantages of an open nephrectomy is that its a major surgical procedure that can place a considerable strain on the body. This means it may not be suitable for people who are particularly frail or unwell. You should discuss the pros and cons of both procedures with your surgical team. Embolisation If youre unable to have a nephrectomy, you may benefit from an alternativeoperation known as embolisation. During embolisation, the surgeon will insert a small tube called a catheter into your groin, then use X-ray images to guide the catheter into the blood supply of your kidney. A substance will then be injected through the catheter to block the blood supply to your kidney. By blocking blood supply to the kidney, any tumours that are present will become starved of oxygen and nutrients, causing them to shrink. Non-surgical treatments for advanced kidney cancer Kidney cancer is one of the few types of cancer thats less responsive to chemotherapy (where powerful medication is used to kill cancerous cells). However, a number ofclinical trials are underway that are looking at new combinations of chemotherapy medications that appear to be benefiting some people. There are also a number of different non-surgical treatments that can slow the spread of the cancer and help control its symptoms. Radiotherapy Radiotherapy cant usually cure kidney cancer, but it canslow down its progress and help reduce pain. You should only need a few minutes of radiotherapy every day, for a number of days. When radiotherapy is used to control the symptoms of cancer rather than cure it, the side effects tend to be mild. Possible side effects may include fatigue (tiredness), nausea and vomiting. Cryotherapy Cryotherapy involves killing cancer cells by freezing them. It may beused if a person isnt fit enough for surgery, or if their tumour is small. Cryotherapy is usually classed as either percutaneous (where needles arepassed through the skin) or laparoscopic (where needles are placed directly into the kidney through a small incision). Side effects include bleeding around the kidney and injury to the tube that carries urine from the kidney to the bladder (the ureter). Radiofrequency ablation Radiofrequency ablation (RFA) uses heat generated by radio waves to kill cancer cells. This is a percutaneous treatment, meaning no incision is needed. This treatment is only available at specialist centres. Its mainly used if youre not strong enough for surgery or your kidney cancer is in the early stages. RFAcant be used if the cancer is too close to other organs, such as the bowel. Side effects include bleeding in the treatment area, a collection of blood (haematoma) near the kidney, and problems passing urine due to the narrowing of the tube that joins the kidney to the bladder (the ureter). Targeted therapies A number ofnew medicines have been developed for the treatment of kidney cancer. These are: sunitinib pazopanib axitinib sorafenib temsirolimus everolimus bevacizumab These medicines are sometimes referred to as targeted therapies because theyre designed to target and interrupt the functions needed by cancer to grow and spread. At present, only sunitinib, pazopanib and axitinibhave been recommended by the National Institute for Health and Care Excellence (NICE) . Theyre available on the NHS for people who are still relatively healthy and have advanced kidney cancer, or kidney cancer thats spread to other parts of their body. Sorafenib, temsirolimus, everolimus and bevacizumab arent currently recommended by NICE. Sunitinib Sunitinib is the most commonly prescribed treatment for kidney cancer. Its a type of medication known as a tyrosine kinase inhibitor. Tyrosine kinase is an enzyme (protein) that helps cancer cells to grow. Sunitinib works by blocking protein kinase, stopping cancer from growing. Sunitinib is taken as a capsule with or without food. You take it once a day for 4 weeks before having a 2-week break. This 6-week cycle is repeated for as long as the treatment is effective. Its very important that you take sunitinib in the exact dosage thats been prescribed for you. Never stop taking medication for cancer without first consulting your specialist. Common side effects of sunitinib include: nausea diarrhoea high blood pressure (hypertension) hair discolouration mouth soreness skin discolouration skin rashes or blisters The Cancer Research UK website has more information about sunitinib and its side effects . Pazopanib Like sunitinib, pazopanib is a tyrosine kinase inhibitor that can be used to slow down or stop the growth of cancer cells in the kidneys.It also prevents cancer cells from developing blood vessels, which they need to grow. Pazopanib is taken as a tablet once a day with a glass of water. You should take it about the same time each day, either at least an hour before eating or 2 hours afterwards. Its important that you take it in the exact dosage that your specialist has prescribed for you. Common side effects of pazopanib include: nausea diarrhoea high blood pressure hair discolouration abnormal liver function The Cancer Research UK website has more information about pazopanib . Axitinib Axitinib may be recommended for treating advanced kidney cancer if sunitinib and/or pazopanib have stopped working or havent been effective. Like sunitinib and pazopanib, axitinib is a tyrosine kinase inhibitor that blocks tyrosine kinase and stops cancer growing. Axitinib is taken as a tablet with a glass of water twice a day, about 12 hours apart. Your specialist may start you on a low dose which, depending on how you feel, may be increased after 2 weeks. Its very important that you take the exact dose thats been prescribed for you. Common side effects of axitinib include: diarrhoea nausea and vomiting loss of appetite tiredness a decrease in thyroid hormone level ( hypothyroidism ) headaches weight loss loss of fertility The Cancer Research UK website has more information about axitinib . Sorafenib Sorafenib is another tyrosine kinase inhibitor that blocks the protein, tyrosine kinase, which encourages cancer cells to grow. It also prevents cancer cells from developing blood vessels which they need to grow. Sorafenib is taken as a tablet twice a day (at the same time each day) with a glass of water. It can also be taken with a meal, but make sure the food is low-fat, because high-fat foods make it less effective. Again, its very important that you take sorafenib as instructed by your doctor at the exact dosage prescribed for you. Common side effects of sorafenib include: diarrhoea fatigue nausea and vomiting hair thinning (in around one in four people) increased risk of bleeding  such as nosebleeds or bleeding gums loss of fertility flushed skin The Cancer Research UK website has more information about sorafenib. Temsirolimus Temsirolimus is sometimes used to treat advanced kidney cancer. Its a type of medication known as an mTOR inhibitor, which blocks a protein called mTOR, thats usually active in cancer cells, making them reproduce and multiply. Temsirolimus also prevents blood vessels from developing, which cancer cells need to grow. Temsirolimus is a liquid thats delivered directly into the bloodstream, either through a tube thats put into a vein in your arm (catheter), or a tube into a large vein in your chest (a central line). The treatment takes 30to 60 minutes and you have it once a week in hospital. Before each dose, an antihistamine is usually given to prevent an allergic reaction. Common side effects of temsirolimus include: red, dry, itchy skin nausea and vomiting lack of appetite diarrhoea a sore mouth or mouth ulcers sleeping problems loss of fertility Everolimus Everolimus is a medication for advanced kidney cancer thats returned during or following treatment. It stops some of the signals produced within cells that make them grow and divide. Everolimus prevents the mTOR protein from working properly, which plays an important role in the growth of cancer cells. Everolimus is taken as a tablet once a day at the same time each day. It should be swallowed whole with a glass of water, rather than being chewed or crushed. It can be taken with or without food. Its very important that everolimus is taken using the exact dosage and method prescribed. Common side effects of everolimus include: a sore mouth tiredness a rash or itchy, dry skin loss of appetite nausea and vomiting a lack ofperiods in women (this may be temporary) loss of fertility The Cancer Research UK website has more information about everolimus . Immunotherapy As well as medications that prevent, disrupt and slow down the growth and development of kidney cancer (kinase and mTOR inhibitors), there are also treatments that work by encouraging the immune system to attack cancer cells. This type of treatment is known as immunotherapy. Bevacizumab is a medication thats given intravenously (into a vein, through a drip). It blocks a protein called endothelial growth factor (VEGF), which helps cancer to grow. Bevacizumab is usually used in combination withan immunotherapy treatment called interferon. Interferon is taken as an injection just under the skin (subcutaneously), three times a week. It encourages your immune system to attack and destroy the cancer cells. Another medication called aldesleukin is sometimes used to treat kidney cancer thats spread. Its similar to a natural protein the body produces called interleukin-2 (IL-2), which is part of the immune system. IL-2 activates lymphocytes (a type of white blood cell), which fight illnesses and infections. Aldesleukin works in a number of ways. It interferes with how cancer cells grow and multiply, it stimulates the immune system into attacking cancer cells, and it makes cancer cells send out chemicals that attract immune system cells. Like interferon, aldesleukin is usually given as a subcutaneous injection. Immunotherapy treatments are now rarely used to treat advanced kidney cancer. This is because targeted therapies tend to be more effective in controlling the condition, and immunotherapy can sometimes cause serious side effects. The Cancer Research UK website has more information about treatments for advanced kidney cancer . Preventing kidney cancer As the causes of kidney cancer arent fully understood, its not possible to completely prevent it. However,leading a healthy lifestyle may help reduceyour chances of developing the condition. Read about the causes of kidney cancer . Combining a healthy diet and regular exercise will help you avoid becoming overweightor obese, which are both significant risk factors for kidney cancer. If youre overweight or obese, you can lose weight and maintain a healthy weight by combining regular physical activitywith a calorie-controlled diet. Read more about healthy weight loss and treating obesity . Diet A low-fat, high-fibre diet that includes whole grains and plenty of fresh fruit and vegetables (at least 5 portions a day) is recommended for a healthy heart. You should also limit the amount of salt in your diet to no more than 6g (0.2oz or 1 teaspoon) a day. Too much salt will increase your blood pressure. Avoid eating foods high in saturated fat because it will increase your cholesterol level. High-fat foods include: meat pies sausages and fatty cuts of meat butter ghee  a type of clarified butter often used in Indian cooking lard cream hard cheese cakes and biscuits foods that contain coconut or palm oil Theres some evidence that eating a diet that has plenty ofoily fish (at least 1 portion a week) may help reduce the risk of kidney cancer. Examples of oily fish include: salmon mackerel sardines trout herring Oily fish also contains vitamin D , which can reduce the risk of some cancers. You can also getvitamin D from sunlight or by taking supplements. Exercise Its recommended that adults should do a minimum of 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity, such as cycling orbrisk walking , every week. The exercise should be strenuous enough to increase your heart rateand you should feel slightly out of breath afterwards. Examples of activities you could incorporate into your exercise programme include: brisk walking hill climbing running cycling swimming If you find it difficult to do 150 minutes of exercise a week, start at a level you feel comfortable with. However, you should visit your GP for a health check if youve never exercised before or youre returning to exercise after a long period of time. Read more about exerciseand its benefits . Giving upsmoking If you smoke, giving up is the most effective way of preventing kidney cancer, as well as a number of other serious health conditions, such as stroke , heart attack and lung cancer . Your GP can help if you want to stop smoking, by giving you information and advice, and prescribing medication. Our stopping smoking pages haveuseful information and advice about giving up smoking. Alternatively, you can call Quit Your Way Scotland on 0800 84 84 84. Read more about giving up smoking . Alcohol Theres evidence to suggest that drinking a moderate amount of alcohol, such as4to 5 glasses of wine a month, will help reduce your risk of developing kidney cancer. The reasons for this arent fully understood. However, you shouldnt exceed the recommendedlimits for alcohol, because excessive drinking will place you at risk of developing liver disease , liver cancer , and high blood pressure (hypertension) . Read more about drinking and alcohol and alcohol units . Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Chronic kidney disease Radiotherapy Other health sites Macmillan Cancer Support: Kidney cancer Macmillan Cancer Support: Chemotherapy Kidney Research UK National Kidney Federation The Renal Association Kidney Cancer UK Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Kidney infection,"Kidney infection - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Kidneys, bladder and prostate Kidney infection Kidney infection About kidney infections Symptoms of kidney infections Causes of kidney infections Diagnosing kidney infections Treating kidney infections Complications of kidney infections Preventing kidney infections About kidney infections A kidney infection(pyelonephritis) is a painful and unpleasant illnesscaused by bacteria travelling from your bladder into one or both ofyour kidneys. Its more serious than cystitis , a common infection of the bladder that makes urinating painful. If treated promptly, a kidney infection doesnt cause serious harm, but will make you feel very unwell. If a kidney infection isnt treated, it can get worse and cause permanent kidney damage. Symptoms of a kidney infection often come on within a few hours. You can feel feverish, shivery, sick and have a pain in your back or side. Read more about the symptoms of a kidney infection When to see your GP See your GPif you have a fever and persistenttummy, lower backor genital pain,or if you notice a changeto your usual pattern of urination. Most kidney infections needprompt treatment with antibiotics to stop the infection from damaging the kidneys or spreading to the bloodstream. You may also need painkillers. If youre especially vulnerable to the effects of an infection, for example, if youhave a pre-existing health condition or arepregnant, you may be admitted to hospitaland treated with antibiotics through an intravenous drip. After taking antibiotics, you should feel completely better after about 2 weeks. In rare cases, a kidney infection can cause further problems. These include blood poisoning ( sepsis ) and a build-up of pus in the kidney called an abscess. Read more about treating a kidney infection and the complications of a kidney infection What causes a kidney infection? A kidney infection usually happens when bacteriaoften a type calledE. coligets into theurethra (the tube which carries urine out of the body)and travels up through the bladderandinto the kidneys. Read more about the causes of a kidney infection Whos at risk? Kidney infections are relatively rare. Its estimated that one in every 830 people develops a kidney infection each year in the UK. They can happen at any age, but are much more common in women. In fact, women are 6 times more likely to get a kidney infection than men. This is because a womans urethra is shorter, making it easier for bacteria to reach the kidneys. Younger women are most at risk because they tend to be more sexually active, and having frequent sex increases the chances of getting a kidney infection. Younger children are also vulnerable to developing kidney infections because they may be born with an abnormality of the urinary tract or have a condition called vesico-ureteric reflux, where there is a backflow of urine from the bladder up to the kidneys. Can kidney infections be prevented? You can reduce your chances of developing a kidney infection by keeping your bladder and urethra free from bacteria. This can include drinking plenty of fluids, keeping your genitals clean and treating any constipation. Read more about preventing akidney infection Symptoms of kidney infections The symptoms of a kidney infection usually develop quite quickly over a few hours or days. Common symptomsinclude: pain and discomfort in your side, lower backor around your genitals high temperature (it may reach 39.5C or 103.1F) shivering or chills feeling very weak or tired loss of appetite feeling sick or being sick diarrhoea You may have other symptomsif you also have cystitis or urethritis(an infection of the urethra). These additional symptoms may include: pain or a burning sensation during urination need to urinate frequently or urgently feeling that youre unable to urinate fully blood in yoururine cloudy or foul smelling urine pain in your lower abdomen Children Children with a kidney infection may also have additional symptoms, such as: a lack of energy irritability poor feeding and/or vomiting not growing at the expected rate abdominal pain jaundice(yellowing of the skin and whites of the eyes) blood in the urine unpleasant smelling urine bedwetting When to seek medical advice Contact your GP if you have a high temperature, persistent pain, or if you notice a change to your usual pattern of urination. Contact your GP immediately if you think your child may have a kidney infection. If you have blood in your urine, you should always see your GP so the cause can be investigated. Kidney infections require prompt treatment with antibiotics to help relieve symptoms and prevent complications developing . Your GP can carry out some simple tests to help diagnose a kidney infection. See diagnosing kidney infections for more information Causes of kidney infections A kidney infection happens when bacteria infects your kidneys. The bacteria are usually a type called E. coli, which live in your bowel. The bacteriaget inthrough the opening of the urethraand move upwards through your urinary tract, first infecting your bladder and then your kidneys. Its thought the bacteria can get into your urinary tract byaccidentally spreading from your anus to your urethra. This can happen if you wipe your bottom after going to the toilet and the soiled toilet paper comes into contact with your genitals. It can also happen during sex. In rare cases, a kidney infection can develop if bacteria or fungi infect the skin and the infection spreads through your bloodstream into your kidney. However, this type of infection usually only occurs in people with weakened immune systems. Whos most likely to get a kidney infection? Women and children are most at risk of developing a kidney infection, as well as other urinary tract infections (UTIs) such as cystitis . In women, the urethra is closer to the anus than in men, making it easier for bacteria from the anus toenter the urethra accidentally. The female urethra is also much shorter than the male urethra (which runs through the penis). This makes it easier for bacteria to reach the bladder and move into the kidneys. Otherfactors can also put you more at risk of developing a kidney infection, including: having a condition that blocks, or obstructs, your urinary tract, such as kidney stones or an enlarged prostate  children with constipation can also be at an increased risk being born with an abnormality in your urinary tract having a condition that prevents you emptying your bladder fully, such as an injury to your spinal cord this can allow bacteria in your bladder to multiply and spread having a weakened immune system  for example, due to type 2 diabetes or as a side effect of chemotherapy having an infection of the prostate gland called prostatitisthe infection can spread from the prostate gland into the kidneys having aurinary catheter (a thin, flexible tube inserted into your bladder to drain away urine) being female and sexually active sexual intercourse can irritate the urethra and allow bacteria to travel into your bladder being a man who has anal sex bacteria can travel up the urethra into the bladder being pregnant this can cause physical changes that slow the flow of urine out of your body and make it easier for bacteria to spread to the kidneys having undergonefemale genital mutilation (FGM) an illegal practice where awomans genitalsare deliberately cut or changed for cultural, religious and social reasons Diagnosing kidney infections To work out if you have a kidney infection, your GP will ask you about your symptoms and your recent medical history. They will usually also assess your general health by taking your temperature and measuring your blood pressure. Urine test A urine test can help to establishwhether you have a urinary tract infection (UTI) . The test involves taking a small sample of urine and checking it to see ifthere areany bacteria in it. Youll be given a container and told how to collect the urine, which you can do in the surgery or at home. If you do it at home, youll need to label the container, seal it in a plastic bag and store it in the fridge. Ideally, hand it in tothe surgery within four hours. Aurine test canttellwhether the infection ifyou have one is in your kidneys or another part of your urinary system, such as your bladder. For your GP to be confident you have a kidney infection, you need to have a positive urine test pluscertain symptoms, such as a fever or a pain in your side. Hospital scans You may be referred to hospital for further testing if: your symptoms fail to respond to treatment with antibiotics your symptoms suddenly get worse you have additional symptoms that arent usually associated with a kidney infection youreat risk of complications of a kidney infection Children with recurrent UTIs will also be referred to hospital for further testing. In these circumstances,scans can check your urinary tract for signs of problems. This may include: a computer tomography (CT) scan  wherea scanner takes a series of X-rays and a computer is used to assemble them into a detailed image ofyour urinary tract an ultrasound scan  which uses sound waves to buildan image of the inside of your body an isotope scan  wherea dye is injected into the bloodstream and a series of X-rays are taken Read more about treating a kidney infection Treating kidney infections Most people with a kidney infection can be treated at home with a course of antibiotics, and possibly painkillers as well. See your GP if you have a fever and persistent tummy, lower back or genital pain, or if you notice a change to your usual pattern of urination. All children with symptoms of a urinary tract infection (UTI) or kidney infection, including cystitis , should see their GP or out-of-hours emergency service. Medication Antibiotics If youre being treated at home, youll usually be prescribed a course of antibiotic tablets or capsules that lasts between 7 and 14 days. For most peopleapart from pregnant women antibiotics called ciprofloxacinorCo-amoxiclavare recommended. However, other antibiotics may also be used. Common side effects of ciprofloxacin include feeling sick and diarrhoea . Co-amoxiclavcan make the contraceptive pill and contraceptive patches less effective, so you may need to use another form of contraception during the course of treatment. A 14-day course of an antibiotic called cefalexin is recommended for pregnant women. Usually, youll start to feel betterquite soon aftertreatment starts and you should feel completely better after about2 weeks. If your symptoms show no sign of improvement24 hours after treatment starts, contact your GP for advice. Painkillers Takinga painkiller such as paracetamol should help relieve symptoms of pain and a high temperature. However, non-steroidal anti-inflammatories (NSAIDs) such as ibuprofen arent usually recommended to relieve pain during a kidney infection. This is because theymay increase the risk of further kidney problems. Self-help tips If you havea kidney infection, try not to hover over the toilet seat when you go to the loo, because it can result inyour bladder not being fully emptied. Its alsoimportant to drink plenty of fluids, because this will help prevent dehydration and will help to flush out the bacteria from your kidneys. Aim to drink enough so that youre frequently passing pale-coloured urine. Make sure that you get plenty of rest. A kidney infection can be physically draining, evenif youre normally healthy and strong. It may take up to two weeks before youre fit enough to return to work. Treatment at hospital Your GP may refer you to hospital if you have an underlying problem with your urinary tract, which makes you vulnerable to kidney infections. Its standard practice to further investigate all men with a kidney infection simply because the condition is much rarer in men. Only women who have had 2 or more kidney infections tend to be referred.Most children with a kidney infection will be treated in hospital. Hospital treatment may also be neededif: youre severely dehydrated youre unable to swallow or keep down any fluids or medications you have additional symptoms that suggest you may have blood poisoning , such as a rapid heartbeat and losing consciousness youre pregnant and you also have a high temperature youre particularly frail andyour general health is poor your symptoms fail to improve within 24 hours of starting treatment with antibiotics you have a weakened immune system you have a foreign body inside your urinary tract, such as a kidney stone or a urinary catheter you have diabetes youre over the age of 65 you have an underlying condition that affects theway yourkidneys work, such aspolycystic kidney disease or chronic kidney disease If youre admitted to hospital with a kidney infection, youll probably be attached to a drip soyou can be given fluids to help keep you hydrated. Antibiotics can also begiven through the drip. Youll have regular blood and urine tests to monitor your health and how effectively the antibioticsare fighting off the infection. Most people respond well to treatment. As long as there areno complications, theyre usually well enough to leave hospital within three to seven days.Treatment will usually switch to tablets or capsules after you stop receivingantibiotics through a drip. Complications of kidney infections Most kidney infections are treated successfully without complications, although some people may develop further problems. Complications of a kidney infection are rare, but youre more likely todevelop them if you: are a child areover 65 are pregnant have diabetes , chronic kidney disease or sickle cell anaemia have had a kidney transplant (particularly in the first three months after the transplant) havea weakened immune system developed the kidney infection while in hospital Kidney abscess A kidneyabscess isa rare, but serious, complication of a kidney infection, where pus develops inside the tissue of the kidney. Yourethought to be most at risk of developing a kidney abscess if you have diabetes . The symptoms of a kidney abscess are similar to those of a kidney infection. The most common are: a high temperature of 38C (100.4F) or above chills abdominal pain loss of appetite pain when passing urine Kidney abscesses are potentially serious because the bacteria inside the abscess can spread to other parts ofyour body, such asyour bloodstream or lungs, and can be fatal. Smaller abscesses can usually be treated with antibiotics through a drip. Surgery is usually required for larger abscesses. This involves drainingthe pus out of the abscess using a needle thats inserted into the kidney. Blood poisoning Blood poisoning (also called sepsis) is another rare, but potentially fatal, complication of a kidney infection.It happens when bacteria spreads from the kidneys into the bloodstream. Once bacteria arein your blood, the infection can spread to any part of your body, including all of the major organs. Insomeone with a kidney infection, thesymptoms of blood poisoning include: low blood pressure , which makes you feel dizzy when you stand up confusion or disorientation excessive sweating uncontrollable shaking or shivering high temperature or lower body temperature than usual (under 36C, or 96.8F) pale skin rapid heartbeat breathlessness Blood poisoningis a medical emergency that usually requires admission to a hospitalintensive care unit (ICU) while antibiotics are used to fight the infection. If youre taking certain medications for diabetes, such as metformin or angiotensin-converting enzyme (ACE) inhibitors, they may be temporarily withdrawn until you recover. This is because they can cause kidney damage during an episode of blood poisoning. Severe infection Another rare, but potentially fatal, complication of a kidney infection is a condition called emphysematous pyelonephritis (EPN). EPN is a severe infection, where the tissues of the kidneys are rapidly destroyed and the bacteria causingthe infection begin to release a toxic gas, which builds up inside the kidneys. The exact cause of EPN is unclear, but almost all casesare in people with diabetes. The usual treatment is emergency surgery to remove some, or all, of the affected kidney. Its possible to livea full and active lifewith only one kidney. Kidney failure In very rare cases, a kidney infection can cause severe kidney damage that results in kidney failure. This is when the kidneys stop working properly. Kidney failure is potentially fatal, but it can be treated with dialysis or a kidney transplant. Other problems A kidney infection can also cause other complications, including high blood pressure (hypertension) or premature labour or birth. Preventing kidney infections The best way to prevent a kidney infection is to keep your bladder and urethra free from bacteria. These self-help tips explain howyou can do this. Drink plenty of liquids Drinking plenty of liquids, particularly water, will help to wash bacteria from your bladder and urinary tract. Drinking cranberry juice or taking cranberry extracts may also help prevent urinary tract infections (UTIs) .However, you shouldavoid cranberry juice or extracts if youre taking warfarin , a medicine used to prevent blood clots.Cranberry juice can make the effects of warfarin more potent, so theres a risk of excessive bleeding. Toilet tips To help keep yoururinary tractfree from bacteria: go to the toilet as soon as you feel the need to urinate, rather than holding it in wipe from front to back after going to the toilet practice good hygiene by washing your genitals every day and before having sex empty your bladder after having sex if youre a woman,avoid hovering over a toilet seat as this position can often leave urine behind in the bladder Treat constipation Constipation can increase your chances of developing a urinary tract infection(UTI), sotry totreatany constipationpromptly. Recommended treatments for constipationinclude: increasing the amount of fibre in your diet to 20g to 30g of fibre a day using a mild laxative on a short-term basis drinking plenty of fluids Seeyour GP if your symptoms dont improve after 14 days (or 7 days for children with constipation). Read moreabout treatingconstipation Be careful with contraceptives If youkeep gettingUTIs (more than 3 a yearis considered high), avoid using spermicide-coated condoms or diaphragms . This is because spermicide can stimulate the production of bacteria. Stick tolubricated condoms without spermicide,because unlubricated ones can irritate the urethra and make it more vulnerable to infection. Source: NHS 24 - Opens in new browser window Last updated: 01 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Kidney stones Cystitis Urinary tract infection (UTI) in children NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Kidney stones,"Kidney stones - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Kidneys, bladder and prostate Kidney stones Kidney stones About kidney stones Symptoms of kidney stones Causes of kidney stones Diagnosing kidney stones Treating kidney stones Preventing kidney stones About kidney stones Kidney stones can develop in one or both kidneys and most often affect people aged 30 to 60. Theyrequite common, with around 3 in 20 men and up to 2 in 20 women developing them at some stage of their lives. The medicalterm for kidney stones is nephrolithiasis, and ifthey cause severe pain its known as renal colic. Symptoms of kidney stones Small kidney stones maygo undetected and be passed out painlessly in the urine.But its fairly common for a stone to block part of the urinary system, such as the: ureter  the tube connecting the kidney to the bladder urethra  the tube urine passes through on its way out of the body A blockage can cause severe pain in the abdomen or groin and sometimes causes a urinary tract infection(UTI) . Read more about the symptoms of kidney stones . What causes kidney stones? The waste products in the blood can occasionally form crystals that collect inside the kidneys. Over time, the crystals may build up to form a hard stone-like lump. This is more likely to happen if you dont drink enough fluids, if youre takingsome types ofmedication,or if you havea medical conditionthat raises the levels of certain substances in your urine. Read more about the causes of kidney stones . After a kidney stone has formed,your bodywill try to pass itout when you go to the toilet (in the urine). This meansit will often travel through the urinary system (the kidneys, kidney tubes and bladder). Treating and preventing kidney stones Most kidney stonesare small enough to be passed in your urine, and it may be possible to treat the symptoms at home with medication. Larger stones may need to be broken up using ultrasound orlaser energy. Occasionally, keyhole surgery may be needed to remove very large kidney stones directly. Read more about treating kidney stones . Its estimated thatup tohalf of all people who have had kidney stones will experience them again within the following 5 years. To avoid getting kidney stones, make sure you drink plenty of water every dayso you dont become dehydrated . Its very important to keep your urine diluted (clear) to prevent waste products forming into kidney stones. Read more about preventing kidney stones . Symptoms of kidney stones Very small kidney stones are unlikely to cause many symptoms. It may even go undetected and pass out painlessly when you urinate. Symptoms usually occur if the kidney stone: gets stuck in your kidney starts to travel down the ureter (the tube that attaches each kidney to the bladder) the ureter is narrow and kidney stones cancause pain as they try to pass through causes an infection In these cases, the symptoms of kidney stones can include: a persistent ache in the lower back,which is sometimes also felt in the groin men may have pain in theirtesticles and scrotum periods of intense pain in the back or side of your abdomen, or occasionally in your groin, whichmay last for minutes or hours feeling restless and unable to lie still nausea (feeling sick) needing to urinate more often than normal pain when you urinate (dysuria) blood in your urine (haematuria)  thismay be caused by the stone scratching the kidney or ureter Blocked ureter and kidney infection A kidney stone that blocks the ureter can lead to a kidney infection. This is because waste products are unable to pass the blockage, which may cause a build-up of bacteria. The symptoms of a kidney infection are similar to symptoms ofkidney stones, but may also include: a high temperature (fever) of 38C (100.4F) or over chills and shivering feeling very weak or tired diarrhoea cloudy and bad-smelling urine Read more about kidney infections . Causes of kidney stones Kidney stones are usually formed following a build-up of certain chemicals in the body. This build-upmay be any of the following: calcium ammonia uric acid a waste product produced when the body breaks down food to use as energy cysteine an amino acid that helps to build protein Certain medical conditions can lead to an unusually high level of these substances in your urine. Youre alsomore likely to develop kidney stones if you dont drink enough fluids. Recurrent kidney stones Some people are particularly likely to keepon developing kidney stones, including people who: eat a high-protein, low-fibre diet areinactive or bed-bound have a family history of kidney stones have had several kidney or urinary infections have had a kidney stone before, particularly if it was before you were 25 have only one fully working kidney have had an intestinal bypass (surgery on your digestive system), or a condition affecting the small intestine, such as Crohns disease Medication Theres evidence to suggest that certain medications may increase your risk of developing recurrent kidney stones. These include: aspirin antacids diuretics (used to reduce fluid build-up) certain antibiotics certain antiretroviral medication(used to treat HIV ) certain anti-epileptic medication Types of kidney stones Kidney stones can develop for a number of reasons. Calcium stones Calcium stones are the most common type of kidney stone and form if theres too much calcium in the urine, which can be due to: an inheritedcondition called hypercalcuria, which leads tolarge amounts of calcium in urine an overactive parathyroid gland (the parathyroid glands help to regulate the amount of calcium in your body) kidney disease a rare condition called sarcoidosis some cancers Calcium stones are usually either large and smooth or spiky and rough. Struvite stones Struvite stones are often caused by infections, and they most commonly occur after a urinary tract infection thats lasted a long time. Struvite stones are more common in women than men. Uric acid stones Uric acid stones can form if theres a large amount of acid in your urine. They may be caused by: eating a high-protein diet that includes lots of meat a conditionsuch as gout that prevents the body breaking down certain chemicals an inherited condition that causes higher than normal levels of acid in the body chemotherapy Cystine stones Cystine stones are the rarest type of kidney stone. Theyre caused by an inherited condition called cystinuria, which affects the amount of acid that is passed in your urine. Diagnosing kidney stones Your GP will usually be able to diagnose kidney stones from your symptoms and medical history. It will be particularly easy if youve had kidney stones before. You may be given tests, including: urine tests to check for infections and pieces of stones an examination of any stones that you pass in your urine blood tests to check that your kidneys are working properly, and to also check the levels of substances that could cause kidney stones, such as calcium You can collecta kidney stone by urinating through some gauze or a stocking. Having a kidney stone to analyse will make a diagnosis easier, and may help your GP determine which treatment method will be of most benefit to you. If you have severe pain that isnt controlled by painkillers, or if you have a high temperature as well as pain, you may be referred to a urologist (a specialist in treating urinary problems). Imaging tests If yourereferred to hospital for an imaging test,a number of different techniques may be used. Imaging tests can help confirm the diagnosis, or identify precisely where a kidney stone is. These testsinclude: a computerised tomography (CT) scan  where a series of X-rays at slightly different angles are taken and a computer is used to put the images together X-ray  an imaging technique that uses high-energyradiation to highlight abnormalities in body tissue an ultrasound scan uses high-frequency sound waves to create an image of the inside of your body an intravenous urogram (IVU) or intravenous pyelogram (IVP)  a dye that shows up on X-ray is injected into a vein in your arm; the X-ray image highlights any blockages as the kidneys filter the dye out of your blood and into yoururine CT scans are now often used because theyre thought to be more accurate. IVUs were previously the preferred imaging method. The imaging technique you have may depend on whats availableat your local hospital. Treating kidney stones Most kidney stones are small enough (less than 4mm in diameter) to be passed out in your urine and can probably be treated at home. But even small kidney stones can be painful, although thisusually only lasts a couple of days and disappears when the stone has been passed. Medication If you are in severe pain, your GP can give you pain relief by injection. A second dose can be given after half an hour if youre still experiencing pain. Medication can also be injected to treat the symptoms of nausea (feeling sick) and vomiting. This is called an anti-emetic (anti-sickness) medication. You may also be given a prescription for painkillers, anti-emetics, or both, to take at home. Self care You may be advised to wait until you pass your kidney stone when you go to the toilet, and to try to collect it from your urine. You can do this by filtering your urine through gauze or a stocking. Give the stone to your GP so that they can have it analysed to help determine any further treatment you may need. You should drink enough water to make your urine colourless. If your urine is yellow or brown, youre not drinking enough. Admission to hospital If your kidney stone has moved into your ureter (the tube that carries waste products from the kidneys to the bladder), and its causing severe pain, your GP may admit you to hospital for treatment. This may be necessary if: youre at an increased risk of your kidneys failing(for example, because you only have one kidney) your symptoms dont improve within an hour of being given painkillers or anti-sickness medication youredehydrated and vomiting too much to keep fluids down youre pregnant youre over 60 years of age Treating large kidney stones If a kidney stone is too big to be passed naturally 6mm to 7mm(about 0.23in to 0.27in)in diameter or larger  you may need treatment to remove it another way. This could include: extracorporeal shock wave lithotripsy (ESWL) ureteroscopy percutaneous nephrolithotomy (PCNL) open surgery The type of treatment you have will depend on the size and location of your stones. Extracorporealshock wave lithotripsy (ESWL) ESWL is the most common way of treating kidney stones that cant be passed in the urine. It involves using ultrasound (high-frequency sound waves) to pinpoint where a kidney stone is. Ultrasound shock waves are then sent to the stone from a machine to break it into smaller pieces, so it can be passed in your urine. ESWL can be an uncomfortable form of treatment, so its usually carried out after giving painkilling medication. You may need more than one session of ESWL to successfully treat your kidney stones. ESWL is up to 99% effective for stones up to 20mm (0.8in) in diameter. Ureteroscopy If a kidney stone is stuck in the ureter, you may need to have a ureteroscopy, which is also sometimes known as retrograde intrarenal surgery (RIRS). Itinvolves passing a long, thin telescope called a ureteroscope through your urethra (the tubeurine passes through on its way out of the body) andinto your bladder. Its then passed up into your ureter to where the stone is stuck. The surgeon may either try togently remove the stone using another instrument, or they may use laser energy to break it up into small pieces so that it can be passed naturally in your urine. Ureteroscopy is carried out under general anaesthetic (where youre unconscious), so you shouldnt drive or operate machinery for up to 48 hours after the procedure. For stones up to 15mm (0.6in), a ureteroscopy is effective in 50% to 80% of cases. Aplastic tube called a stent may need to betemporarily inserted inside you to allow the stone fragments to drain into the bladder. Percutaneous nephrolithotomy (PCNL) PCNL is an alternative procedure that may be used for larger stones. It may also be usedif ESWL isnt suitable for example, because the person being treated is obese. PCNL involves using a thin telescopic instrument called a nephroscope. A small incision is made in your back and the nephroscope is passed through it and into your kidney. The stone is either pulled out or broken into smaller pieces using a laser or pneumatic energy. PCNL is always carried out under general anaesthetic,so you shouldnt drive or operate machinery for up to 48 hours after the procedure. PCNL is 86% effective for stones that are 21mm to 30mm (0.8in to 1.2in) in diameter. Open surgery Nowadays, open surgery for kidney stones is rare. Less than 1% of cases require this type of surgery. Its only usually used if theres a very large stone or abnormal anatomy. During open surgery, an incision will be made in your back so that your surgeon is able to access your ureter and kidney. The kidney stone can then be removed. Treating uric acid stones If you have a uric acid stone, you may be advised to drink around 3 litres (just over 5 pints) of water each day to try to dissolve it. Uric acid stones are much softer than other types of kidney stone, and they can be made smaller if theyre exposed to alkaline fluids. Youmay need to take some medication to make your urine more alkaline before the uric acid stone starts to dissolve. Complications of treatment Complications can occur following the treatment of large kidney stones. Your surgeon should explain these to you before you have the procedure. Possible complications will depend on the type of treatment you have and the size and position of your stones.Complications could include: sepsis  an infection that spreads through the blood, causing symptoms throughout the whole body a blocked ureter caused by stonefragments; the ureter is the tube that attaches the kidney to the bladder an injury to the ureter a urinary tract infection bleeding during surgery pain Its estimated that 5% to 9% of people may experience complications after having a ureteroscopy. Preventing kidney stones The best way of preventing kidney stones is to make sure you drink plenty of water each day to avoid becoming dehydrated. Keeping your urine diluted helps to stop waste products getting too concentrated and forming stones. You can tell how diluted your urine is by looking at its colour. The darker your urine is, the more concentrated it is. Your urine is usually a dark yellow colour in the morning because it contains a build-up of waste products that your body has produced overnight. Drinks such as tea, coffee and fruit juice can count towards your fluid intake, but water is the healthiest option and is best for preventing kidney stones developing. You should also make sure you drink more when its hot or when youre exercising, to replenish fluids lost through sweating. Read more about preventing dehydration . Diet If your kidney stone is caused by too much calcium, you may be advised to reduce the amount of oxalates in your diet. Oxalates prevent calcium being absorbed by your body, and can accumulate in your kidney to form a stone. Foods that contain oxalates include: beetroot asparagus rhubarb chocolate berries leeks parsley celery almonds, peanuts and cashew nuts soy products grains, such as oatmeal, wheat germ and wholewheat Dont reduce the amount of calcium in your diet unless your GP advises you to. This is because calcium is very important for maintaining healthy bones and teeth. To avoid developing a uric acid stone, you should reduce the amount of meat, poultry and fish in your diet. You may also be prescribed medication to change the levels of acid or alkaline in your urine. Medication If you have a kidney stone, medication will usually be prescribed for pain relief or to prevent infections developing. However, some medication may need to be reviewed by your GP if its thought to be causing your kidney stone. The type of medication your GP prescribes will depend on the type of kidney stone you have. For example, if you have: calcium stones you may be prescribed adiuretic medication if they are caused by hypercalcuria (an inherited condition) struvite stones you may be prescribed antibiotics to help prevent a urinary tract infection or kidney infection , which are the main causes of struvite stones uric acid stones  you may be prescribed allopurinol (a medication used to lower uric acid levels) and medication to help alkalise your urine cystine stones  you may be prescribed medication to lower levels of cystine inyour urine Source: NHS 24 - Opens in new browser window Last updated: 01 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Kidney infection Chronic kidney disease Other health sites Lab Tests Online UK: PTH National Kidney Federation Kidney Research UK UK Kidney Association NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Labyrinthitis,"Labyrinthitis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Ears, nose and throat Labyrinthitis Labyrinthitis Labyrinthitis is an inner ear infection. It causes the labyrinth inside your ear to become inflamed, affecting your hearing and balance. Labyrinthitis usually starts suddenly and can be worrying. You should seek medical advice straight away. What is the labyrinth? The labyrinth is the innermost part of the ear. It contains 2 parts: the cochlea  this sends sounds to the brain so you can hear the vestibular system  a complex set of fluid-filled tubes that affect your balance The labyrinth usually becomes inflamed either because of: a viral infection, such as a cold or flu (viral labyrinthitis) a bacterial infection, which is much less common (bacterial labyrinthitis) Symptoms of labyrinthitis The most common symptoms of labyrinthitis are: vertigo (dizziness)  the sensation that you, or the environment around you, is moving hearing loss (from mild to total loss of hearing) a feeling of pressure inside your ear(s) ringing or humming in your ear(s) ( tinnitus ) feeling sick (nausea) or being sick mild headaches Certain things can make the dizziness worse, including: colds or illness, or anything that makes you feel generally unwell the dark tiredness or jetlag being on your period Avoid driving, using tools and machinery, or working at heights if youre feeling dizzy. When to get medical advice Speak to your GP practice if: you have symptoms of labyrinthitis your symptoms are getting worse Diagnosing labyrinthitis Your GP may: ask about your symptoms check your medical history carry out a physical examination  you may be asked to move your head or body and they can check your ears for signs of inflammation and infection test your hearing  labyrinthitis is more likely if you have hearing loss check your eyes  if theyre flickering uncontrollably your balancing system may not be working properly Treating labyrinthitis Youll usually have already seen your GP about labyrinthitis symptoms and may have started some treatment. There are things you can also do during this time to help manage your symptoms at home. Things you can do to help your symptoms Do drink plenty of water to avoid becoming dehydrated  its best to drink little and often lie still in a dark room if you feel very dizzy lie in a comfortable position (on your side is often best) try to get enough sleep  tiredness can make symptoms worse try to reduce noise and anything that causes stress from your surroundings avoid alcohol avoid bright lights Treatments from your doctor If your symptoms are particularly severe, your GP may prescribe: prochlorperazine  can help with dizziness and sickness antiemetic  can help if youre feeling sick and vomiting corticosteroids  can help by reducing inflammation Vestibular rehabilitation therapy (VRT) A small number of people experience dizziness and vertigo for months or years. This is known as chronic labyrinthitis. Chronic labyrinthitis requires a treatment called vestibular rehabilitation therapy (VRT) . VRT is usually supervised by a physiotherapist. You can ask your GP to refer you or you can pay for private treatment. If you see a private physiotherapist, make sure they are fully qualified and a member of a recognised body. For example, the Chartered Society of Physiotherapy (CSP) . Not all physiotherapists have training in VRT. You should tell them that you need this type of treatment before making an appointment. Who can get labyrinthitis? Most cases of viral labyrinthitis occur in adults aged 30 to 60 years old. Viral labyrinthitis is quite common in adults. Other types of ear infections are usually more common in children. Bacterial labyrinthitis is much less common. Younger children under 2 years old are more vulnerable to developing bacterial labyrinthitis. Vestibular neuronitis Many people diagnosed with labyrinthitis only experience the balance symptoms without hearing loss. This is known as vestibular neuronitis rather than labyrinthitis. Both names are often used to describe the same diagnosis. Source: ENT Scotland - Opens in new browser window Last updated: 28 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Meningitis Hearing loss Vertigo NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Lactose intolerance,"""Lactose intolerance - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Nutritional Lactose intolerance Lactose intolerance About lactose intolerance Causes of lactose intolerance Diagnosing lactose intolerance Treating lactose intolerance Complications of lactose intolerance About lactose intolerance Lactose intolerance is a common digestive problem where the body is unable to digest lactose, a type of sugar mainly found in milk and dairy products. Symptoms of lactose intoleranceusually develop within a few hours of consuming foodor drink that contains lactose. They may include: flatulence (wind) diarrhoea bloated stomach stomach cramps and pains stomach rumbling feeling sick The severity of your symptoms and when they appear depends on the amount of lactose youve consumed. Some people may still be able to drink a small glass of milk without triggering any symptoms, while others may not even be able to have milk in their tea or coffee. When to seek medical advice The symptoms of lactose intolerance can be similar to several other conditions, so its important to see your GP for a diagnosis before removing milk and dairy products from your diet. For example, the symptoms above can also be caused by: irritable bowel syndrome (IBS)  a long-term disorder that affects the digestive system milk protein intolerance  an adverse reaction to the protein in milk from cows (not the same as a milk allergy ) If your GP thinksyouhave lactose intolerance,they may suggest avoiding foods and drinks containing lactose for two weeks to see if your symptoms improve. Read more about diagnosing lactose intolerance What causes lactose intolerance? The body digests lactose using a substance called lactase. This breaks down lactose into two sugars called glucose and galactose, which can be easily absorbed into the bloodstream. People withlactose intolerancedont produce enough lactase, so lactose stays in the digestive system where its fermented by bacteria. This leads to the production of various gases, which cause the symptoms associated with lactose intolerance. Depending on the underlying reason why the body isnt producing enough lactase, lactose intolerance may be temporary or permanent. Most cases that develop in adults are inherited and tend to be lifelong, but cases in young children are often caused by an infection in the digestive system and may only last for a few weeks. Read more about the causes of lactose intolerance Whos affected? In the UK, lactose intolerance is more common in people of Asian or African-Caribbean descent. Lactose intolerance can develop at any age. Many cases first develop in people aged 20 to 40, although babies and young children can also be affected. Is it an allergy? Lactoseintolerance isnt the same as a milk or dairy allergy. Food allergies are caused by your immune system reacting to a certain type of food. Thiscauses symptoms such asa rash, wheezing and itching. If youre allergic to something, even a tiny particle can be enough to trigger a reaction, while most people with lactose intolerance can still consume small amounts of lactose without experiencing any problems (although this varies from person to person). Treating lactose intolerance Theres no cure for lactose intolerance, but limiting your intake of food and drink containing lactose usually helps tocontrol the symptoms. Depending on what dairy products youre able to eat, you may also require additionalcalciumandvitamin Dsupplements to keepyour bones strong and healthy. In some cases, your GP may refer you to a dietitian for further advice. In addition to dietary changes, lactase substitutesmayalso be helpful. These aredrops or tablets you can take with your meals or drinks to improve your digestionof lactose. Read more about treating lactose intolerance Complications of lactose intolerance Milk and other dairy products contain calcium, protein andvitamins such as A, B12 and D. Lactose also helps your body absorb a number of other minerals, such as magnesium and zinc. These vitamins and minerals are important for the development of strong, healthy bones. If youre lactose intolerant, getting the right amount of important vitamins and minerals can prove difficult. This may lead to unhealthy weight loss andput you at increased risk of developing the following conditions: Osteopenia where you have a very low bone-mineral density. If osteopenia is not treated, it can develop into osteoporosis. Osteoporosis  where your bones become thin and weak. If you have osteoporosis, your risk of getting fractures and broken bones is increased. Malnutrition  when the food you eat doesnt give you the nutrients essential for a healthy functioning body. If youre malnourished, wounds can take longer to heal and you may start to feel tired or depressed. If youre concerned that dietary restrictions are putting you at risk of complications, you may find it helpful to consult a dietitian. They can advise you on your diet and whether you require food supplements. Your GP should be able to refer you to an NHS dietitian free of charge. Alternatively, you can contact a private dietician. The British Dietetic Association has information on how to find a private dietitian. Causes of lactose intolerance Lactose intolerance is usually the result of your body not producing enough lactase. Lactase is an enzyme (a protein that causes a chemical reaction to occur) normally produced in your small intestine thats used to digest lactose. If you have a lactase deficiency, it means your body doesnt produce enough lactase. Digesting lactose After eating or drinking something containing lactose, it passes down your oesophagus (gullet) into your stomach, where its digested. The digested food then passes into your small intestine. The lactase in your small intestine should break lactose down into glucose and galactose (other types of sugar), which are then absorbed into your bloodstream. If there isnt enough lactase, the unabsorbed lactose moves through your digestive system to your colon (large intestine). Bacteria in the colon ferment (break down) the lactose, producing fatty acids and gases such as carbon dioxide, hydrogen and methane. The breakdown of the lactose in the colon, and the resulting acids and gases that are produced, cause the symptoms of lactose intolerance such as flatulence and bloating. Types of lactase deficiency The main types of lactase deficiency are outlined below. Primary lactase deficiency Primary lactase deficiency is the most common cause of lactose intolerance worldwide. This type of lactase deficiency is caused by an inherited genetic fault that runs in families. Primary lactase deficiency develops when your lactase production decreases as your diet becomes less reliant on milk and dairy products. This is usually after the age of two, when breastfeeding or bottle-feeding has stopped, although the symptoms may not be noticeable until adulthood. Secondary lactase deficiency Secondary lactase deficiency is a shortage of lactase caused by a problem in your small intestine. It can occur at any age, and may be the result of another condition, surgery to your small intestine, or taking certain medication. Secondary lactase deficiency is the most common cause of lactose intolerance in the UK, particularly in babies and young children. Possible causes of secondary lactase deficiency include: gastroenteritis  an infection of the stomach and intestines coeliac disease  a bowel condition caused by an adverse reaction to a protein called gluten Crohns disease  a long-term condition that causes inflammation of the lining of the digestive system ulcerative colitis  a long-term condition that affects the large intestine chemotherapy  a cancer treatment long courses of antibiotics The decrease in the production of lactase in secondary lactase deficiency is sometimes only temporary, but it may be permanent if its caused by a long-term condition. Its also possible to develop secondary lactase deficiency later in life, even without another condition to trigger it. This is because your bodys production of lactase naturally reduces as you get older. Congenital lactase deficiency Congenital lactase deficiency is a rare condition that runs in families and is found in newborn babies. Its caused by an inheritedgenetic fault that means affected babies produce very little or no lactase. The genetic mutation responsible forcongenital lactase deficiency is passed on in an autosomal recessive inheritance pattern. This meansboth parents must have a copy of the faulty gene to pass onthe condition. Developmentallactase deficiency Some babies born prematurely (before the 37th week of pregnancy) have a temporary lactose intolerance because their small intestine wasnt fully developedby the time they were born. This is known as developmental lactase deficiency and it usually improves asaffected babies get older. Diagnosing lactose intolerance Its important to visit your GP if you think you or your child may have lactose intolerance, as the symptoms can be similar to other conditions. Before seeing your GP, keep a diary of what you eat and drink, and what symptoms you experience. Tell your GP if you notice any patterns, or if there are any foods you seem particularly sensitive to. Your GP may suggest trying toremove lactose from your diet for two weeks to see if it helps to relieve your symptoms. This will provide further evidenceof whetheryoure lactose intolerant. Further testing Other tests arent usually needed, but your GP may sometimes suggest further tests to: help confirm the diagnosis find out how much lactase (the enzyme used to digest lactose) your body is producing try to determine what might be causing your lactose intolerance Some of the main tests that may beusedare described below. Hydrogen breath test A hydrogen breath test is a simple way of determining if you may be lactose intolerant. Youll be asked to avoid eating or drinking during the night before the test. When you arrive for the test, youll be asked to blow up a balloon-like bag.This sample of your breath will be tested to find out how much hydrogen is present, measured in parts per million (ppm). Youll then be given a drink of lactose solutionand your breath will be tested every 15 minutes over the next few hours to see if the level of hydrogen changes. If your breath contains a large amount of hydrogen (more than 20ppm above your baseline) after consuming the lactose solution, its likely that youre lactose intolerant. This isbecauselactose intolerance can cause the bacteria in the colon (large intestine) to produce more hydrogen than normal. Lactose tolerance test In a lactose tolerance test, youll be given a drink of lactose solution and a blood sample will be taken from your arm using a needle. The blood will be tested to see how much glucose (blood sugar) it contains. If youre lactose intolerant, your blood sugar levels will either rise slowly, or not at all. This is because your body is unable to break down the lactose into glucose. Milk tolerance test In a milk tolerance test, youll be given a glass of milk (about 500ml) and your blood sugar levels will be tested. If your blood sugar levels dont rise after drinking the milk, you may be lactose intolerant. Small bowel biopsy Asmall bowel biopsy is rarely used to diagnose lactose intolerance. However, it may be carried out to see if your symptoms are being caused by another condition, such as coeliac disease . In a small bowel biopsy, a sample of your small intestinal lining is taken using anendoscope (a thin, flexible tube with a light and a tiny cutting tool at the end) thats passed down your throat. This will be carried out under local anaesthetic , so it wont hurt. The sample of intestinal lining will be tested to see how much lactase it contains. If it only contains a small amount of lactase,its likely youre lactose intolerant. The sample can also be examined to look for signs of possible underlying conditions such as coeliac disease. Treating lactose intolerance Theres no cure for lactose intolerance, but most people are able to control their symptoms by making changes to their diet. Some cases of lactose intolerance, such as those caused by gastroenteritis , are only temporary and will improve within a few days or weeks. Other cases, such asthose caused by an inherited genetic fault or a long-term underlying condition, are likely to be lifelong. Changing your diet In most cases, cutting down on or avoiding sources of lactose and replacing them with lactose-free alternatives is enough to control the symptoms of lactose intolerance. The exact changes you need to make to your diet depend on how sensitive you are to lactose. Some people are able to tolerate some lactose in their diet without any problems, whereas others experience symptoms after consuming food containing only a tiny amount of lactose. If you decide to experiment with what you can and cant eat, make sureto introduce new foods gradually, rather than all at once. This will help you to get used to any foods you might be sensitive to and identify any that cause problems. Eating fewer products containing lactose, or avoiding them completely, can mean you miss out on certain vitamins and minerals in your diet and increase your risk of complications. Youll also need to make sure youre getting enoughnutrition from either lacto-free foods or dietary supplements. If you or your child are extremely sensitive to lactose, talk to your GP about your diet. Milk products are rich in calcium needed for healthy bones so you may need to have regular bone density checks. You may be referred to a dietitian (an expert in diet and nutrition) whocan advise about what foods should be included in your, or your childs, diet. Sources of lactose Some of the main sources of lactose you may need to cut down on or avoid if youre lactose intolerant are described below. Milk A major source of lactose is milk, including cows milk, goats milk and sheeps milk. Depending on how mild or severe your lactose intolerance is, you may need to change the amount of milk in your diet. For example: you may be able to have milk in your tea or coffee, but not on your cereal some products containing milk, such as milk chocolate, may still be acceptable in small quantities you may find that drinking milk as part of a meal, rather than on its own, improves how the lactose is absorbed If even a small amount of milk triggers your symptoms, there are some alternatives you can try, such as soya or rice milk (see below). Dairy products Other dairy products made from milk, such as butter, ice cream and cheese, can also contain high levels of lactose and may need to be avoided if youre lactose intolerant. Some dairy products however, such as hard cheese and yoghurt, contain lower levels of lactose than milk and other products, so you may still be able to have them. Its worth experimenting with different foods to find out if there are any dairy products you can eat because theyre a good source ofessential nutrients such ascalcium. Other foods and drinks As well as milk and dairy products, there are other foods and drinks that can sometimes contain lactose. These include: salad cream, salad dressing and mayonnaise biscuits chocolate boiled sweets cakes some types of bread and other baked goods some breakfast cereals packets of mixes to make pancakes and biscuits packets of instant potatoes and instant soup some processed meats, such as sliced ham Check the ingredients of all food and drink products carefully, because milk or lactose are often hidden ingredients. The lactose found in some foodswont necessarily be listed separately on the food label, so you need to check the ingredients list for milk, whey, curds and milkproducts such as cheese, butter and cream. Some ingredients may sound like they contain lactose when they dont, such aslactic acid, sodium lactate and cocoa butter. These ingredients dont need to be avoided if youre lactose intolerant. Medication Some prescription medicines, over-the-counter medicines and complementary medicines may contain a small amount of lactose. While this isnt usually enough to trigger the symptoms of lactose intolerance in most people, it may cause problems if your intolerance is severe or youre taking several different medicines. If you need to start taking a new medication, check with your GP or pharmacist in case it contains lactose. Lactose-free foods and drinks There are a number of alternative foods and drinks available in supermarkets to replace the milk and dairy products you need to avoid. Food and drinks that dont usually contain lactose include: soya milks, yoghurts and some cheeses milks made from rice, oats, almonds, hazelnuts, coconut, quinoa, and potato foods which carry the dairy-free or suitable for vegans signs carob bars You can also buy cows milk containing additional lactase (the enzyme used to digest lactose). This means you still get the nutritional benefits of the milk, but youre less likely to experience any symptoms after consuming it. Getting enough calcium If youre unable to eat most dairy products, you may not be getting enough calcium in your daily diet.Calcium has several important functions, including: helping build strong bones and teeth regulating muscle contractions (including heartbeat) ensuring blood clots normally Therefore, its a good ideato choose lactose-free products with added calcium and ensure your diet contains alternative sources of calcium, such as: green leafy vegetables, such as spinach, kale, broccoli, cabbage and okra soya beans tofu nuts bread and anything made with fortified flour fish containing edible bones (for example, sardines, salmon, and pilchards) You can also buy combined calcium and vitamin D supplements from most pharmacists to help maintain good bone health. Its important to check with your GP or dietitian whether you should be taking supplements, however, as taking excessively high levels of calcium can cause side effects. Lactase substitutes In addition to dietary changes, you may also find it useful to takeliquid drops, tablets or capsules that containlactase substitutes. These are available from most health foods shops. Lactase substitutes replace the lactase your small intestine isnt producing, whichcan reduce your symptoms by helping your body break down any lactose in your diet more easily. Lactase substitutescan either be added to milkor taken justbefore eating a meal containing lactose. Lactose intolerance in children If your child is lactose intolerant, they may be able to consume small amounts of lactose without experiencing symptoms. This is quite safe, but you may need to experiment to find out how much they can comfortably eat or drink. If your child is unable to tolerate any lactose, your doctormay refer you to a dietitian for nutritional advice because its importantfor young children to have certain nutrients in their diet to ensure healthy growth and development. In general, the same rules about foods to try or to avoid are similar for children and adults (see above). For babies with lactose intolerance, lactose-free formula milk is available to buy from pharmacies and supermarkets. However, soya formula isnt recommended for children under six months because it contains hormones that may interfere with your babys future physical and sexual development. Breastfed babies may benefit from lactase substitute drops to help their bodies digest the lactose in breast milk. For many children, lactose intolerance is only temporary and will improve after a few weeks. After this point its safe to gradually reintroduce milk and dairy products into their diet. Complications of lactose intolerance Milk and other dairy products are an important part of a healthy diet. They contain calcium, protein and vitamins such as vitamins A, B12 and D. Lactose is also important because it helps your body absorb a number of other minerals, including magnesium and zinc. These vitamins and minerals are important for the development of strong, healthy bones. If you are lactose intolerant, getting the right amount of important vitamins and minerals can prove difficult. This may lead to unhealthy weight loss andput you at increased risk of developing the following conditions. Osteopenia  where you have a very low bone-mineral density. If osteopenia is not treated, it can develop into osteoporosis. Osteoporosis  where your bones become thin and weak. If you have osteoporosis, your risk of getting fractures and broken bones is increased. Malnutrition  when the food you eat does not give you the nutrients essential for a healthy functioning body. If you are malnourished, wounds can take longer to heal and you may start to feel tired or depressed. If you are concerned that dietary restrictions are putting you at risk of complications, you may find it helpful to consult a dietitian. They can advise you on your diet and whether you require food supplements. Your GP should be able to refer you to an NHS dietitian free of charge. Alternatively, you can contact a private dietician. The British Dietetic Association has information on how to find a private dietitian. Source: NHS 24 - Opens in new browser window Last updated: 21 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites Allergy UK: Cow's milk allergy Allergy UK: Cow's milk allergy in adults British Dietetic Association NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Laryngeal (larynx) cancer,"Laryngeal (larynx) cancer - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Laryngeal (larynx) cancer Laryngeal (larynx) cancer About laryngeal cancer Causes of laryngeal cancer Diagnosing laryngeal cancer Treating laryngeal cancer Recovering from laryngeal cancer Preventing laryngeal cancer About laryngeal cancer Laryngeal cancer is a type of cancer that affects the larynx (voice box). The larynx is part of the throat found at the entrance of the windpipe (trachea). It plays an importantrole in helping you breathe and speak. The condition is more common in people over the age of 60. Its about 4 times more common in men than women. Symptoms of laryngeal cancer The main symptoms of laryngeal cancer include: a change in your voice, such as sounding hoarse pain when swallowingor difficulty swallowing a lump or swelling in your neck along-lasting cough a persistent sore throat or earache in severe cases, difficulty breathing Some people may also experiencebad breath, breathlessness , a high-pitched wheezing noisewhenbreathing, unexplained weight loss, or fatigue (extreme tiredness). When to speak to your GP You should speak to your GP if you have hadany of the main symptoms for more than 3 weeks. These symptoms are often caused by less serious conditions, such as laryngitis , but its a good idea to get them checked out. If necessary, your GP can refer you to a hospital specialist for further tests to confirm or rule out cancer. Read more about diagnosing laryngeal cancer . What causes laryngeal cancer? Its not clear exactly what causes laryngeal cancer, but your risk of getting the condition is increased by: smoking tobacco regularly drinking large amounts of alcohol having a family history of head and neck cancer having an unhealthy diet exposure to certain chemicals and substances, such as asbestos and coal dust By adopting a healthy lifestyle, including avoiding alcohol and tobacco, you can significantly reduce your chances of developing laryngeal cancer. Read more about the causes of laryngeal cancer and preventing laryngeal cancer . How laryngeal cancer is treated The main treatments for laryngeal cancerare radiotherapy , surgery and chemotherapy . Radiotherapy or surgery to remove the cancerous cells from the larynx can often cure laryngeal cancer if its diagnosed early. If the cancer is advanced, a combination of surgery to remove part or all of the larynx, radiotherapy and chemotherapy can be used. If you have surgery to remove your larynx, youll no longerbe able to speak or breathe in the usual way. Instead, you will breathe through a permanent hole in your neck (stoma) and you will need additional treatment to help restore your voice. This may include an implant in your throat, or an electrical deviceyou hold against your throat to produce sound. Read more about treating laryngeal cancer and recovering from laryngeal cancer surgery . Causes of laryngeal cancer Laryngeal cancer is caused by changes in the cells of the larynx, although its not clear exactly why this happens. All cancers begin with a change ina cellsDNA.DNA provides our cells with a basic set of instructions, such as when to grow and reproduce. A change inDNA can alter the instructions that control cell growth, which means cells continue to grow instead of stopping when they should. This causes the cells to reproduce in an uncontrollable manner, producing a growth of tissue called a tumour. Its not known why the DNA inside the cells of the larynx is affected in cases of laryngeal cancer. But it appears that exposure tothings that can damage the cells and tissue of the larynx increases the risk of cancer developing. What can increase your risk? Anumber of things can increase your chances of developing laryngeal cancer. Alcohol and tobacco Alcohol and tobacco are the 2 main things that can increase your risk of developing laryngeal cancer. Theyrethought to contain chemicals that can damage the cells of the larynx. Themore you drink or smoke, the higher your risk of developing laryngeal cancer. People who smoke more than 25 cigarettes a day, or people who have smoked for more than 40 years, have been found to be about 40 times more likely to develop laryngeal cancer thanpeople who dont smoke. Compared to people who dont drink, people who regularly drink large amounts of alcohol are about 3 times more likely to develop laryngeal cancer. If you drink and smoke, your risk of laryngeal cancer increases even further. By stopping both drinking and smoking, you can significantly reduce your risk of developing the condition. Read more about preventing laryngeal cancer . Family history People who have a first-degree relative (parent, sibling or child) diagnosed with head or neckcancer are thought to be twice as likely to develop laryngeal cancer as someone without a family history. Diet Theres evidence to suggest that a diet high in red meat, processed food and fried foodmight increase your risk of developing laryngeal cancer. Havinga Mediterranean diet or a diet containing plenty of fruit and vegetables may reduce your risk.Read more about preventing laryngeal cancer . Human papilloma virus (HPV) Human papilloma virus (HPV)is the name given to a group of viruses that affect the skin and moist membranes that line the body, such as those in the cervix (neck of the womb), anus, mouth and throat. HPV is known to cause changes in the cells of the cervix, which can lead to cervical cancer . Its thought the virus may have a similar effect on the cells of the throat. HPV is often spread during sex, including oral sex. Exposure to harmfulsubstances Having a job where youre exposed to high levels of certain substances may also increase your risk of developing laryngeal cancer. These include: asbestos coal or wood dust paint or diesel fumes nickel sulphuric acid fumes formaldehyde (a chemicalused in a wide range of industrial processes, such as paint manufacturing and cosmetics) isopropyl alcohol (often used as a cleaning solvent) Diagnosing laryngeal cancer If you have symptoms of laryngeal cancer, such as a hoarse voice and pain when swallowing, your GP will ask about your symptoms and recent medical history. They may also examine the inside and outside of your throat for abnormalities, such as lumps and swellings. If laryngeal cancer is suspected, youll probably be referred to the ear, nose and throat (ENT) department of your local hospital for further testing. The National Institute for Health and Care Excellence (NICE) recommends thatanyone aged 45or over with persistent unexplained hoarseness or an unexplained lump in their neck should have an appointment with a specialist within 2 weeks. Nasendoscopy A nasendoscopy is a procedure used to get a clear view of your larynx. During the procedure, a small, flexible tube with a light and video camera at one end (endoscope) isinserted into your nostril and passed down the back of your throat. The images from the endoscope are displayed on a monitor. Youll usually be awake while this is carried out and it may feel uncomfortable.A local anaesthetic spray issometimes used to numb your nose and throat beforehand, so you dont feel any pain. Laryngoscopy If it wasnt possible to get a good view of your larynx during a nasendoscopy, or a possible problem is spotted, you may have a further test called a laryngoscopy. Like a nasendoscopy, this procedure involves using an endoscope to examine your larynx. However, the endoscope used during a laryngoscopy is longer and inserted through the mouth. This allows the larynx to be seen in greater detail. A laryngoscopycan be very uncomfortable, so its usually carried out under general anaesthetic (where youre asleep). You should be able to leave hospital as soon as youve recovered from the effects of anaesthetic, which is usually the same day or the day after. Biopsy During anasendoscopy orlaryngoscopy, your doctor may use small instruments to remove a sample of cells from your larynx so it can be examined for signs of cancer. This is known as a biopsy . Alternatively, if you have a lump in your neck, a needle and syringe can be used toremove a tissue sample. This is known as fine needle aspiration. Further testing If the results of the biopsy show you have cancer and theres a risk it may have spread, youll probably be referred for further testing to assess how widespread the cancer is. The tests may include: a computerised tomography (CT) scan  a series of X-rays are taken to build up a more detailed three-dimensional picture of your larynx and the surrounding tissue a magnetic resonance imaging (MRI) scan a strong magnetic field and radio waves are used to produce a more detailed image of your larynx and the surrounding tissue a PET-CT scan a CT scan is used to take pictures of the inside of your body after youve been injected witha mildly radioactive substance that helps to show cancerous areas more clearly an ultrasound scan high-frequency sound waves are used to check for signs of cancer in the lymph nodes (glands found throughout the body) near the larynx Staging and grading After these tests have been completed, your doctor should be able to tell you the extent of the cancer. This is known as the stage and grade of the cancer. Healthcare professionals use a system called the TNM system to stage laryngeal cancer. T describes the size of the tumour, N describes whether cancer has spread to the lymph nodes and M gives an indication of whether the cancer has spread to other parts of the body. the T stage is given as a number from 1to 4  small tumours confined to 1 part of the larynx are described as T1 tumours and large tumours that have grown into tissues outside the larynx are described as T4 the N stage is given as a number from 0to 3  N0 means the lymph nodes are not affected, whereas stages N2 to N3 mean that 1 or more lymph nodes are affected the M stage is given as either M0 or M1  M0 means the cancer has not spread to other parts of the body and M1 means that it has There are also 3 different grades(1to 3) used to describelaryngeal cancer. Lower-grade cancers, such as grade 1, tend to grow more slowly and are less likely to spread.Higher-grade cancers, such as grade 3,grow quickly andare more likely to spread. You can read more about the stages and grades of laryngeal cancer on the Cancer Research UK website. Treating laryngeal cancer The treatment for laryngeal cancer largely depends on the size of the cancer. The main treatments are radiotherapy, surgery and chemotherapy. Most hospitals use multidisciplinary teams (MDTs) of specialists that work together to decidethe best way to proceed with your treatment. Members of your MDT will probably include a surgeon, a clinical oncologist (a specialist in the non-surgical treatment of cancer), and a specialist cancer nurse who will be responsible for co-ordinating your care. Your cancer team will recommend what they think is the best treatment option, but the final decision will be yours. Before visiting hospital to discuss your treatment options, you may find it useful to write a list of questions youd like to askyour care team. For example, you may want to find out the advantages and disadvantages of particular treatments. Your treatment plan Your recommended treatment plan will depend on the stage of thecancer (see diagnosing laryngeal cancer for more information on staging). If you have early-stage laryngeal cancer, it may be possible to remove the cancer using surgery (endoscopic resection) or radiotherapy alone. This may also be the case with slightly larger cancers, although a combination of surgery and radiotherapy is sometimes required. In later-stage laryngeal cancer, more extensive surgery may be needed. Radiotherapy and chemotherapy will probably be used in combination. In some cases, the entire larynx may have to be removed. A medication called cetuximab may be used in cases where chemotherapy is not suitable. Radiotherapy Radiotherapy uses controlled doses of high-energy radiation to destroy cancerous cells. It can be used as a treatment on its own for early-stage laryngeal cancer, or it can be usedafter surgery to stop cancerous cells returning. Its sometimes combined with chemotherapy. The energy beams used during radiotherapy have to be precisely targeted to your larynx.To ensurethe beams are directed at the exact area, a special plastic mask will be made to hold your head in the right position. A mould of your face will be taken so that the mask can be made before treatment starts. Radiotherapy is usually given in short daily sessions from Monday to Friday, with a break from treatment at the weekend. The course of treatment usually lasts for 3 to 7 weeks. As well as killing cancerous cells, radiotherapy can affect healthy tissue and has a number of side effects, including: sore, red skin (similar to sunburn ) mouth ulcers dry mouth loss of taste loss of appetite tiredness feeling sick Your MDT will monitor any side effects and treat them when possible. For example, protective gels can be used to treat mouth ulcers, and medicines are available for a dry mouth. Radiotherapy can sometimes cause your throat tissue to become inflamed. Severe inflammation can cause breathing difficulties. Contact your key worker or visit your local accident and emergency (A&E) department as soon as possible if you have difficulty breathing. Most side effects should pass within a few weeks of treatment finishing. Read more about radiotherapy . Surgery There are 3 types of surgery thatcan be used to treat laryngeal cancer. They are: endoscopic resection partial laryngectomy total laryngectomy Endoscopic resection Endoscopic resection can be usedinearly-stage laryngeal cancer. During the procedure, a surgeon uses a special microscope to get a magnified view of the larynx. This allows them to remove the cancer either with a laser or small surgical instruments. An endoscopic resection is carried out under general anaesthetic , so you willbe unconscious during the procedure and wont feel any pain. Yourmouth and throatmay feel sore for a few weeks after the operation and theres a risk of your voice changing as a result of the procedure, which can be permanent. Partial laryngectomy A partial laryngectomy can be used to treat some laryngeal cancers. The operation involves surgically removing the affected part of your larynx. Some of your vocal cords will be left in place, so you will still be able to talk, but your voice may be quite hoarse or weak. While your larynx is healing, you may find breathing difficult. Your surgeonmay need tocreate a temporary hole in your neck, which will be attached to a tube you can breathe through. This is known as a temporary tracheostomy. Once your larynx has healed, the tube can be removed and the hole will heal, leaving a small scar. This operation isuncommon nowadays,as endoscopic resection is preferred whenever possible. Total laryngectomy A total laryngectomy is usually used to treat advanced laryngeal cancer. The operation involves removing your entire larynx. Nearby lymph nodes (small glands that form part of the immune system) may also need to be removed if the cancer has spread to them. As your vocal cords will be removed, you wont be able to speak in the usual way after the operation. However, there are several ways to help restore your speech. If you have a total laryngectomy, your surgeon will also need to create a permanent hole in your neck (called a stoma) to help you breathe after the operation. You will be given training on how to keep your stoma clean. Having a stoma can seem daunting and frightening at first, but most people get used to it after a few months. See recovering from laryngeal cancer for more information about speaking after surgery and looking after a stoma. Chemotherapy Chemotherapy uses powerful cancer-killing medicines to damage the DNA of the cancerous cells and stop them reproducing. It may be used toshrink a tumour before surgery or radiotherapy, or in combination with radiotherapy to make the radiotherapy more effective. It can also be used totreat laryngeal cancer thats advanced or has come back after treatment. In this situation, it can relieve symptoms and may slow the cancers growth. Chemotherapy medication is usually given as an injection into a vein (intravenously) once every3or 4 weeks, for up to 6 months. You may need to stay in hospital for a few daysduring each treatment or you may just come in for a short visit each time. Chemotherapy can sometimes damage healthy tissue as well as the cancerous tissue. This, unfortunately, means side effects are common, such as: feeling and being sick hair loss loss of appetite diarrhoea sore mouth and mouth ulcers tiredness Chemotherapy can also weaken your immune system, making you more vulnerable to infection and illness. Its therefore important to report any symptoms of potential infection to yourMDT, such as a high temperature, chills or a persistent cough. You should also avoid close contact with peopleknown to have an infection. Theside effects of chemotherapy should improve after your treatment has finished. Read more about chemotherapy . Cetuximab Cetuximab is a type of medication called biological therapy. These medications target and disrupt the processes that cancerous cells use to grow and reproduce. Cetuximab can be used in combination with radiotherapy to treat more advanced laryngeal cancer, when its not possible to use chemotherapy. For example, people with kidney or heart disease, or people with an ongoing infection, may not be able to have chemotherapy, because it could make them very ill. Cetuximab is given slowlythrough a drip into your vein (intravenously) for up to an hour or more. Its usually given weekly forup to 7 weeks. Side effects of cetuximab are usually mild and include: rashes feeling sick diarrhoea breathlessness Cetuximab can also trigger allergic reactions in some people, which can cause problems such as a swollen tongue or throat. In a few cases,the reaction can be severe and potentially life-threatening. Most serious reactions occur within a day of treatment starting, so youll be closely monitored once your treatment begins. If you have symptoms of a severereaction, such as a rapid heartbeat or breathing problems, medication can be used to relieve them (such as corticosteroids ). Recovering from laryngeal cancer If youve had some or all of your larynx removed (laryngectomy), its likely that youll need to spend 1 or 2 days in an intensive care unit until youve recovered. You wont be able to eat until your throat has healed, which for most peopletakes at leasta week or two. While your throat heals, youll need to be fed through a tube thats passedthrough your nose and into your stomach. If youve had all of your larynx removed(total laryngectomy), you wont be able to speak normally, because you will no longer have vocal cords.A number of techniques can be used to replicate the functions of your vocal cords although they can takeweeks or months to learn. Therefore, its likely that youll need to use alternative methods of communicating, such as using a pen or paper,during the first few weeks or months after surgery. This can be a frustrating experience  the loss of something youve previously taken for granted can be difficult to cope with. Try to prepare yourself for strangers reacting in unpredictable and possibly upsetting ways.Some people who have had a laryngectomy have reported that other people sometimes assume theyre deaf or have a learning difficulty because of their inability to speak. Your emotions The emotional impact of living with a laryngectomy can be significant. Many people report experiencing a rollercoaster effect. For example, you may feel down when laryngeal cancer is diagnosed, then feel up after the cancer has been removed, then feel down again as you try to come to terms with the practicalities of living with a laryngectomy. These emotional changes can sometimes trigger feelings of depression . You may be depressed if you have felt very down during the past month and you no longer take pleasure in doingthings you enjoy. Contact your GP or care team for advice if you thinkyou may be depressed. There are a range of effective treatments available. The National Association of Laryngectomee Clubs (NALC) is also a useful resource for people trying to come to terms with living with a laryngectomy. NALC is a patient support group that provides advice on all aspects of living with a laryngectomy. Looking after your stoma If youve had all of your larynx removed, the surgeon will need to create a permanent hole in your throat through which you will breathe (a stoma). During the first few months after surgery, its likely that your stoma will produce a lot of mucus, particularly if youve had radiotherapy . Excessive mucus can cause breathing difficulties, so a tube may be attached to your stoma to help you breathe more easily. Once the production of mucus has settled down, the tube can be removed. Its important to clean your stoma at least once a day, otherwise it can become crusty and may become vulnerable to infection.A specialist nurse can teach you how to keep your stoma clean. Youll be given special filters to place over your stoma that can help keep your stoma moist and free of germs. Its important to remember that youll need to cover your stoma with a tissue when you cough or sneeze, rather than covering your mouth or nose. This is because mucus or saliva will come out of your stoma. Speaking after surgery If your larynx has been completely removed as part of your treatment for laryngeal cancer, youll need additional treatment to help restore your voice. Before your laryngectomy, you may meet a speech and language therapist (SLT) to discuss possible treatment options for restoring your voice. An SLT is a healthcare professional who specialises in helping people who have difficulties speaking and using language. There are several different treatment options. Voice prosthesis A voice prosthesis is an artificial valve implanted into your neck. When you want to speak, you cover the stoma and breathe out through the valve. The valve produces a noise, which you can use to make words by moving your lips and mouth in the usual way. The voice thats produced by the valve sounds natural, although it may be lower-pitched than your previous voice. If you choose to have a voice prosthesis, it can be fitted during the surgery to remove your larynx. Oesophageal speech Oesophageal speech is a technique for speaking that your SLT can teach you. It involves learning to push airthrough your oesophagus (gullet). As the air moves through your oesophagus, it vibrates and makes a noise. You can produce words by moving your lips and mouth. Some people find it quite easy to learn oesophageal speech, whereas others find it difficult. Regular practice by yourself and with your SLT can help youimprove. Electrolarynx An electrolarynx is a small, battery-operated electrical device that vibrates and produces sound. You hold the device under your chin, and as you move your mouth and lips the vibrations translate into spoken words. Your SLT can train you to use it correctly. Preventing laryngeal cancer Its thought that most laryngeal cancers can be prevented by adopting a healthy lifestyle. Avoidingtobacco products, cutting down on how much alcohol you drink andhaving a healthy diet are particularly important in reducing your chances of developing the condition. Avoiding tobacco products Using tobacco products increases your chances of developing several different types of cancer, including laryngeal cancer. Tobacco comes in many forms, including: cigarettes pipe tobacco cigars cigarillos snuff (powdered tobaccosnorted through the nose) chewing tobacco If you smoke or use other tobacco products, stopping will have both short- and long-term health benefits, including significantly reducing your risk of developing laryngeal cancer. If you decide to stop smoking your free NHSstop smoking service can help you give up. You can also call Quit Your Way Scotland on0800 84 84 84 forfree expert advice and support. If you want to stopsmoking, but dont want to be referred to a stop smoking service, your GP should be able to prescribe medical treatment to help with any withdrawal symptoms you may have. Read more about stopping smoking . Cutting down on alcohol Staying within the recommended guidelines for alcohol consumption will also reduce your risk of developing laryngealand liver cancers. Studies have found that your risk of developing laryngeal cancer reduces significantly within 5to 10 years of not drinking, and after 20to 30 years your risk is about the same as someone who has never drunk alcohol. Contact your GP if youre finding it difficult to reduce the amount of alcohol you drink. You may need additional treatment, which could include counselling, group work or medication. Read more about treatments for alcohol misuse and tips on cutting down how much you drink . Healthy diet Research shows a diet that contains plenty of fresh fruits and vegetables, particularly tomatoes, citrus fruit (such as oranges, grapefruits and lemons), olive oil and fish oil,may reduce your risk of getting laryngeal cancer. This type of diet is sometimes known as a Mediterranean diet. Eating plenty of fruitand vegetables each day may help to reduce your chances of developing many types of cancer, including laryngeal cancer. Read about food and diet and healthy eating for more information and advice. Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Radiotherapy Chemotherapy Other health sites Cancer Research UK: Laryngeal cancer Macmillan Cancer Support: Laryngeal cancer National Association of Laryngectomee Clubs Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Laryngitis,"Laryngitis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Ears, nose and throat Laryngitis Laryngitis Laryngitis is inflammation of the larynx (voice box). In most cases, it gets better without treatment in about a week. Symptoms of laryngitis Symptoms of laryngitis can begin suddenly and usually get worse over a period of 2 to 3 days. Common symptoms of laryngitis include: hoarseness difficulty speaking sore throat mild fever irritating cough a constant need to clear your throat The hoarse voice and speaking difficulties usually get worse each day youre ill. They may last for up to a week after the other symptoms have gone. In a few cases, the larynx can swell and cause breathing difficulties. This isnt common in adults but can happen in young children who have smaller, narrower windpipes. Laryngitis is often linked to another illness. For example, a cold , flu , throat infection or tonsillitis . So you might also have other symptoms such as: a headache swollen glands runny nose pain when swallowing feeling tired and achy When to get medical advice Speak to your GP practice if: You or your child: have symptoms that are particularly severe or they last longer than 2 weeks experience breathing difficulties Things you can do to help your symptoms Do drink plenty of water try to rest your voice as much as possible Dont do not smoke do not spend time in smoky or dusty places Treating the underlying cause If you see your GP, theyll discuss the possible causes with you and may refer you for tests or to a specialist in hospital. In some cases, it may be possible to treat the underlying cause of laryngitis. For example, if the symptoms are caused by an allergic reaction, you may be able to: avoid the thing youre allergic to take medication to help control your allergy What causes laryngitis In most cases, laryngitis is caused by either: a viral infection  such as a cold or flu irritation to your larynx  for example by straining your voice or reflux In these cases, most of the symptoms usually pass within a week. This is known as acute laryngitis. Laryngitis can occasionally last much longer. This is known as chronic laryngitis. Chronic laryngitis can be caused by: smoking alcohol misuse reflux How to prevent laryngitis As laryngitis is often caused by a common viral infection, such as a cold or flu, its not always possible to prevent it. There are things you can reduce your risk of developing the condition. Do avoid smoking make sure you have the flu vaccine every year if youre eligible wash your hands often, especially before handling food and after using the toilet avoid close contact with people who have respiratory infections, such as a cold or flu  particularly if youre prone to laryngitis avoid irritants, such as smoke or dust  particularly if you have a cold or other respiratory infection raise your head with pillows when youre sleeping to protect your larynx from any acid reflux from your stomach during sleep avoid regularly clearing your throat as this can irritate the larynx  try small sips of water instead follow the low-risk drinking guidelines when drinking alcohol avoid shouting or singing loudly or for long periods of time Source: ENT Scotland - Opens in new browser window Last updated: 28 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Common cold Flu Tonsillitis NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Leg cramps,"Leg cramps | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Muscle, bone and joints Conditions Leg cramps Leg cramps Leg cramps are a common and usually harmless condition. They cause the muscles in your leg to suddenly become tight and painful. Symptoms of leg cramps A leg cramp is an episode of sudden pain in the muscles of the leg. Its caused by an involuntary contracting (shortening) of the leg muscle. Cramps usually occur in the calf muscles, although they can affect any part of your leg. This includes your feet and thighs. Cramps can last from a few seconds up to 10 minutes. Thigh muscle cramps tend to last the longest. During a cramping episode, the affected muscles will become tight and painful and the feet and toes will be stiff. After the cramping has passed, you may have pain and tenderness in your leg for several hours. Cramps often happen during the night when youre sleeping. When to get help Leg cramps might be a sign of a more serious health condition. Speak to your GP urgently if: leg cramps last longer than 10 minutes and dont get better when you start to move leg cramps develop after youve come into contact with a substance like mercury, lead or dirt that gets in a cut If your GP is closed, phone 111. Speak to your GP if: your leg cramps are affecting your quality of life youre having frequent leg cramps your leg cramps are interfering with your sleep you also have numbness or swelling in your legs your leg muscles are shrinking or becoming weaker Your GP will ask about your symptoms and examine your legs and feet. They may also ask if you have other symptoms, like numbness or swelling. This may be a sign that you have secondary leg cramps caused by an underlying condition. In this case, you may need further tests, like blood tests and urine tests, to rule out other conditions. Causes of leg cramps The cause of leg cramps is sometimes unknown (idiopathic). In other cases, there may be an underlying condition or identifiable cause (secondary leg cramps). Idiopathic leg cramps Idiopathic leg cramps may be caused by: abnormal nerve activity during sleep excessive strain placed on leg muscles, for example during exercise a sudden restriction in the blood supply to the affected muscles Also, tendons naturally shorten over time as a person gets older. This may explain why older people are particularly affected by leg cramps. Tendons are tough bands of tissue that connect muscles to bone. If your tendons become too short, they may cause the muscles connected to them to cramp. Secondary leg cramps Secondary leg cramps are caused by an underlying condition or another identifiable cause like: pregnancy  the extra weight of pregnancy can place strain on the leg muscles, making them more vulnerable to cramping exercise  leg cramps are often experienced when resting after exercise neurological conditions  for example, motor neurone disease or peripheral neuropathy liver disease  if your liver stops working properly, toxins will build up in your blood, which can make your muscles spasm infection  some types of bacterial infection, like tetanus, can cause muscle cramps and spasm toxins  in some people, high levels of toxic (poisonous) substances in the blood, like lead or mercury, can cause leg cramps dehydration  in some people, low levels of water in the body can lead to a drop in your salt levels, which can trigger muscle cramps Treating leg cramps Medication is usually only needed in persistent cases where cramping does not respond to exercise. If you have secondary leg cramps, treating the underlying cause may help relieve your symptoms. Leg cramps that occur during pregnancy should pass after the baby is born. Treating cramps that occur as a result of serious liver disease can be more difficult. Your treatment plan may include using medications like muscle relaxants. Medication Certain medications have been known to cause leg cramps in a small number of people. If you develop leg cramps after starting a new medication, speak to your pharmacist. Never stop taking a prescribed medication unless your GP or healthcare professional advises you to do so. Stretches for leg cramps Most cases of leg cramps can be relieved by exercising the affected muscles. Exercising your legs during the day will often help reduce how often you get cramping episodes. To stretch your calf muscles: Stand with the front half of your feet on a step, with your heels hanging off the edge. Slowly lower your heels so that they are below the level of the step. Hold for a few seconds before lifting your heels back up to the starting position. Repeat a number of times. Preventing leg cramps If you often get leg cramps, regularly stretching the muscles in your lower legs may help prevent the cramps or reduce their frequency. You might find it useful to stretch your calves before you go to bed each night. If you lie on your back, make sure that your toes point upwards. Placing a pillow on its side at the end of your bed, with the soles of your feet propped up against it may help keep your feet in the right position. If you lie on your front, hang your feet over the end of the bed. This will keep your feet in a relaxed position. Itll help stop the muscles in your calves from contracting and tensing. Keep your sheets and blankets loose. Source: NHS 24 - Opens in new browser window Last updated: 23 October 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Lichen planus,"Lichen planus | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Skin, hair and nails Lichen planus Lichen planus About lichen planus Symptoms of lichen planus Causes of lichen planus Diagnosing lichen planus Treating lichen planus Complications of lichen planus About lichen planus Lichen planus is a non-infectious, itchy rash that can affect many areas of the body. Affected areas caninclude the: arms, legs and trunk mouth (oral lichen planus) nails and scalp vulva, vagina and penis The exact cause of lichen planus is unknown. However, the condition isnt infectious and doesnt usually run in families. It cant be passed on to other people, including sexual partners. AGP can usuallydiagnose lichen planus by examining the rash and asking about your symptoms. Oral lichen planus is often diagnosed by a dentist during routine dental check-ups. Lichen planus is an itchy rash that can occur anywhere on the body. Source: https://dermnetnz.org/ Whos affected by lichen planus Lichen planus is thought to affect 1-2% of the worldwide population. Its more common in adults over the age of 40. Lichen planus of the skin affects men and women equally. However, oral lichen planus is more common in women. The mouth is affected in around 50% of all cases of lichen planus (oral lichen planus). Treating lichen planus Theres no single treatment that can cure lichen planus completely. However, treatments are availableto help manage the symptoms and make living with it easier. For example, steroid creams or ointments are often used to help relieve the itch and control the rash. Most cases of lichen planus of the skin clear up on their own within 6to 9months. The rash rarely lasts longer than 18 months.However, oral lichen planus and lichen planus that affects the genital area may be more persistent. Readmoreabout how lichen planus is treated . Erosive lichen planus Erosive lichen planus is a rare form of lichen planus that can last a long time. It causes painful ulcers to develop in the mouth and in the genital areas of bothmales and females. In some cases, long-term erosive lichen planus can increase the chance ofsome types of cancer developing. Read our page on complications of lichen planus for more information about erosive lichen planus. Symptoms of lichen planus The symptoms of lichen planus vary, depending on which area of the body is affected. Areas of the body most commonly affected by the condition include the: skin mouth penis vulva (external female sex organs) and vagina Lichen planus causes symptoms like itchy skin and red, slightly raised, bumps. Source: https://dermnetnz.org/ Lichen planus of the skin The symptoms of lichen planus of the skin are: purple-red coloured bumps (papules) that are slightly raised, shiny and have a flat top. The papules usually measure 3-5mm in diameter and may also have irregular white streaks (Wickhams striae) thicker scaly patches can appear, usually around the ankles  this is known as hypertrophic lichen planus itchy skin Lichen planus of the skin often affects the wrists, ankles and lower back, although other parts of the body can also be affected. Thickened (hypertrophic) lichen planus affects the shins, and ring-shaped lichen planus affects creases in the skin, such as the armpits. After thepapules have cleared, the affected area of skin can sometimes become discoloured. Lichen planus of the mouth (oral lichen planus) The symptoms of oral lichen planus are: a white pattern on the tongue and inner cheeks red and white patches in the mouth burning and discomfort in the mouth while eating or drinking painful red gums Mild cases of oral lichen planus dont usually cause any pain or discomfort. Lichen planus of the penis The symptoms of lichen planus of the penis are: purple or white ring-shaped patches on the tip of the penis (glans) bumps (papules) that are flat-topped and shiny a non-itchy rash Lichen planus of the vulva and vagina The symptoms of lichen planus of the vulva and vagina include: soreness, burning and rawness around the vulva the vulva may be covered in white streaks and be a red, pink or pale white colour if the vagina is affected, sexual intercourse can be painful if the outer layers of skin break down, moist, red patches can form scar tissue can form, which distorts the shape of the vagina a sticky yellow or green discharge,which may be bloodstained the opening of the vagina can become narrowed Other areas Lichen planus can sometimes affect other areas, including: the nails  which can become thinner, ridged and grooved, or they may become darker, thicker or raised; they may sometimes shed or stop growing the scalp  red patches can appear around clusters of hair; in some cases, permanenthair loss can occur Causes of lichen planus The cause of lichen planus is unknown. Its thoughtto be related to the immune system, or an abnormal response of the immune system to certain medicines. Lichen planus isnt infectious, doesnt usually run in families and cant be passed on to others. Autoimmune reaction The immune system protects your body against illness and infectionby producing antibodies (proteins)that attack bacteria and viruses. In people with lichen planus, its thought that the immune system becomes overactive, causing an excess amount of proteins to be produced, which inflame the skin. This is known as an autoimmune reaction and causes the symptoms of lichen planus . Reaction to medication A reaction to certain medications is another possible cause of lichen planus. For example: gold injections  these are disease-modifying anti-rheumatic drugs (DMARDs) that are sometimes injected into the muscles of people with arthritis to help reduce inflammation and painful joints antimalarial tablets  these help treat and prevent malaria (a serious tropical disease spread by mosquitoes) Diagnosing lichen planus Lichen planus is often diagnosed by a GP or dentist examining the affected area. Lichen planus of the skin Your GP may be able to make a diagnosis based on the characteristic rash.However, lichen planus can be mistaken for other skin conditions, such as eczema ,which also causes the skin to become red, flaky and itchy. If your doctoris unable to make a confident diagnosis by examining your skin, they may want to take a small skin sample ( biopsy ), which will be examined under a microscope. If a skin biopsy is required, youll be given a local anaesthetic to numb the affected area so you dont feel any pain or discomfort during the procedure. Lichen planus of the mouth (oral lichen planus) A dentist or doctor can diagnose oral lichen planus by looking at the inside of your mouth. A biopsy may be recommended to confirm the diagnosis. A sampleofmouth tissue will be removed so that it can be examined under a microscope.As with lichen planus of the skin, youll be given a local anaesthetic to numb the pain. Treating lichen planus Theres no cure for lichen planus, so treatments aim to ease the symptoms and clear the rash. Mild lichen planus doesnt require treatment. Self-help Below is some general self-help advice that can help ease your symptoms and prevent them getting worse. Lichen planus of the skin avoid washing with soap or bubble bath  use plain warm water instead wash your hair over a basin to stop affected areas of skin coming into contact with shampoo use anemollient to moisturise your skin Lichen planus of the mouth (oral lichen planus) avoid eating spicy foods and anything acidic, such as fruit juice, because they can irritate oral lichen planus avoid eating sharp food, such as crusty bread avoid drinking alcohol,particularly spirits if areas of your mouth are painful, stick to soft, bland foods, such as mashed potatoes and porridge if possible, continue to use your usual toothpaste avoid using mouthwashes that contain alcohol because they may be too strong, and keep your mouth as clean as possible visit your dentist regularly to help keep your teeth and gums healthy Lichen planus of the genitals avoid washing with soap or bubble bath  use plain warm water or a soap substitute instead, such as aqueous cream use an emollient, such as petroleum jelly, before and after urinating applying ice packs to the affected areas may soothe itchingand swelling (never apply an ice pack directly to your skin  wrapit in a clean tea towel before placingit on your body) women should avoid wearing tights Lichen planus of the skin, hair and nails There are a number ofmedicationsand treatments that may be recommended for lichen planus of the skin, hair and nails. These are outlined below. Corticosteroid creams and ointments Corticosteroid creams and ointmentscontain corticosteroids (artificial hormones) and are used to treat inflammatory skin conditions. They are oftenreferred toas topical corticosteroids . Topical corticosteroids help treat theswelling (inflammation) and redness caused by lichen planus. Strong topical corticosteroids, such as clobetasol propionate, are also effective in reducing any itchiness you may have. Treatment is applied to the red or purple itchy spots, but should be stopped when the colour of the rash changes to brown or grey. This pigment change occurs when the inflammation has settled. Continuing to apply the corticosteroid cream to the brown areas of skin willgradually cause the skin to thin. The side effects of corticosteroids can vary, depending on the: type and severity of treatment being used how long the treatment is used for nature of the condition being treated Potential side effects of topical corticosteroids can include: redness or burning and stinging of the skin skin rash thinning of the skin (atrophy) stretch marks (striae) contact dermatitis  a condition that causes skin inflammation excessive hair growth (hypertrichosis) lightening of the skin Always check the patient information leaflet that comes with your medicine. Corticosteroid tablets Corticosteroid tablets are sometimes used to treat severe cases of lichen planus, when the symptoms arent being effectively controlled with creams or ointments. Possible side effects of corticosteroid tablets used on a short-term basis can include: increased appetite weight gain insomnia fluid retention (inability to pass urine) mood changes, such as feeling irritable or anxious Other treatments Other treatmentsrecommended for lichen planus of the skin are outlined below. Antihistamines  these are often used to treat symptoms of allergies , such as itchy skin. If you have lichen planus of the skin thats causing itchiness, antihistamines may be prescribed to help reduce this. Light treatment  there are 2types of light treatment: ultraviolet B (UVB) and psoralen plus ultraviolet A (PUVA). UVB is the most commonly used light treatment, but PUVA may be recommended in severe or widespread cases of lichen planus that dont respond to other types of treatment. Acitretin  this medication is only prescribed by a specialist and is used to treat severe cases of lichen planus. The tablets have some associated side effects and may not mix well with other medicines. Your specialist can offer advice. Lichen planus of the mouth (oral lichen planus) Mild cases of oral lichen planus wont need any treatment. In more severe cases, treatment includes: a mouthwash that contains an anaesthetic to temporarily numb the mouth, which makes eating easier corticosteroid sprays, mouthwashes, pastes and dissolvable lozenges a mouthwash or gel that contains an antiseptic to help prevent the build-up of plaque in your mouth In more severe cases of oral lichen planus, corticosteroid tablets may also be used on a short-term basis. It can be difficult to prevent oral lichen planus, but to keep the lining of your mouth healthy its recommended that you: stopsmoking (if you smoke) avoid drinking large amounts of alcohol have a healthy, balanced diet , including plenty of fresh fruit and vegetables You should also maintain good oral hygiene by cleaning your teeth at leasttwice a day, and having regular dental check-ups ,so that any problems with your teeth or mouthcan be identified and treated early. Other treatments If corticosteroids are not effective in treating your symptoms, you may be prescribed a medication that suppresses your immune system to try to limit the autoimmune reaction thats thought to cause lichen planus. These types of treatments are known as immunomodulating agents. Depending on which area of your body is affected by lichen planus, treatments that may be recommended for you can include: treatments such as tacrolimus topical immunomodulating agents(used to treat lichen planus of the skin)  treatments such as tacrolimusointment andpimecrolimus cream are rubbed directly onto the skin immunomodulating agents(used to treat lichen planus of the mouth)  these are usually available in the form of tablets or capsules, and can be used to treat severe cases of oral lichen planus These treatments can causea number of different side effects, which your specialist can discuss with you. Youll also need to have regular blood tests while taking immunomodulating agents, particularly inthe early stages of treatment. Further information and support You can find support and information from organisations like: Changing Faces  a charity for people who have a visible difference or facial disfigurement, who can be contacted on 0300 012 0275 for counselling and advice Complications of lichen planus Complications of lichen planus may include discoloured skin and, in some cases, erosive lichen planus may develop into certain types of cancer. Skin pigmentation After the lichen planus rash has cleared up, the affected area of skin may be a different colour to what it was originally. There may be a brown or grey mark, which can sometimes last for months. This is known as post-inflammatory hyperpigmentation, and tends to be more noticeable in people with darker skin. Erosive lichen planus Erosive lichen planus is a long-lasting (chronic) form of lichen planus that causes painful ulcers to develop, as well as burning and discomfort in the genital areas of bothmale and females. Occasionally, in around 2% of cases, long-term cases of erosive lichen planus can develop into certain types of cancer , such as: mouth cancer vulval cancer penile cancer Regularly examining yourself and being aware of any changes that occur will help you to identify any problems at an early stage. Pay close attention to ulcerated areas in your mouth or genitals that dont heal and persist for a long time. Visit your GP immediately if you notice any changes that youre concerned about. You should also visit your dentist regularly to ensure that your teeth and gums remain healthy, and that any ulcers or patches that form in your mouth are examined and treated promptly. Depending on individual circumstances, dentalcheck-ups for adultsare recommended anywhere between every 3 to 24 months. Read more about treating lichen planus , including self-help tips for managing all types of the condition. Source: NHS 24 - Opens in new browser window Last updated: 31 January 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Mouth ulcer Other health sites Changing Faces NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Lipoedema,"""Lipoedema | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Healthy living Women's health Middle years (around 25 to 50 years) Long term conditions Lipoedema Lipoedema Lipoedema is a long term (chronic) condition of fat and connective tissue which builds up in your legs, hips, bottom and sometimes arms. It affects both sides of the body equally. Its more common in women and only very rarely affects men. Its not the same as obesity. For some people, it can have a big impact on daily routine, physical health and emotional wellbeing. Symptoms People with lipoedema usually have a small waist, but large hips and thighs. Their upper body and lower body can be completely different sizes. This makes it difficult to shop for clothes that fit right. Symptoms can include: enlargement of your legs, and in some cases arms, but usually not your feet or hands pain, discomfort, heaviness or tenderness affected areas affected areas of your body can bruise easily, sometimes for no obvious reason dimpled legs with a lumpy texture, fat may bulge at the knees swelling that gets worse in the afternoon, evening, after activity or in hot weather spider veins or varicose veins on your legs difficulty walking due to changes in your leg shape, heavy legs, or flat-feet Lipoedema can be linked to mental health problems, for example depression , anxiety and disordered eating. Speak to your doctor if you are experiencing any of these symptoms. Theyll be able to give you help and advice on how to manage your symptoms. Other conditions Other health conditions, like lymphoedema , can cause large or swollen legs. Sometimes people with lipoedema can also develop this condition. Causes The exact cause of lipoedema isnt known but it may be caused by changes in your hormones: during puberty when youre pregnant when youre going through the menopause when youre taking the contraceptive pill Its not caused by being overweight  you can be a healthy weight and still have lipoedema. Lipoedema can run in families so let your doctor know if you think this is the case for you. Treatment and self-management Treatment will depend on your symptoms and how theyre affecting you. If your doctor thinks you have lipoedema they may refer you to a specialist for treatment. Although theres no cure, there are things which may help. Do maintain a healthy weight by eating a balanced diet  this can also reduce your chances of developing other health conditions such as type 2 diabetes and high cholesterol drink plenty of water take part in activities you enjoy to keep active like swimming, dancing, yoga or walking wear compression garments  tight forms of clothing that help to reduce pain and discomfort, as well as making it easier for you to walk look after your skin  using moisturising cream (emollients) regularly will help to stop your skin drying out manual lymphatic drainage  a specialist type of massage, which may help to reduce discomfort counselling or cognitive behavioural therapy (CBT)  if youre finding it difficult to cope or if its affecting your mental health Compression therapy Compression therapy uses special compression garments to help manage symptoms. This can help to reduce pain, inflammation, and fluid build up (oedema). Compression garments are often available on prescription. This can include stockings, socks, leggings, arm sleeves, adjustable wraps and sometimes bandaging. Your doctor, practice nurse or specialist will recommend the most suitable type of compression garment for you. Theyll also advise you on how to use it. Further support Lipoedema can affect your quality of life and your mental wellbeing . Talking to someone and getting some extra support can really help. Youre not alone. Talk Lipoedema have lots of help and advice about living well with lipoedema. They can also put you in touch with other people with lipoedema, so you can share your experiences of the condition. Source:\r\n                                        Scottish Government Last updated: 23 March 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Keeping active guidelines Health benefits of eating well Other health sites Talk Lipoedema: Liposuction Legs Matter: Lipoedema NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Liver cancer,"Liver cancer | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Liver cancer Liver cancer About liver cancer Causes of liver cancer Diagnosing liver cancer Treating liver cancer About liver cancer Primary liver cancer is an uncommon but serious type of cancer that begins in the liver. This is a separate condition from secondary liver cancer, which occurs when cancer that first develops in another part of the body spreads to the liver. The rest of this article refers to primary liver cancer only. The Macmillan Cancer Support website has more information about secondary liver cancer . Signs and symptoms Symptoms ofliver cancer are often vague and dont appear until the cancer is at an advanced stage. They caninclude: unexplained weight loss loss of appetite feeling very full after eating, even if the meal was small feeling sick and vomiting pain or swellingin your abdomen (tummy) jaundice (yellowing of your skin and the whites of your eyes) itchy skin feeling very tired and weak Speak to your GP if you notice any of these symptoms. Although they are more likely to be the result of a more common condition, such as an infection, its best to have them checked. You should also contact your GP if you have previously been diagnosed with a condition known to affect the liver, such as cirrhosis or a hepatitis C infection, and your health suddenly deteriorates. What causesliver cancer? The exact cause of liver cancer is unknown, but most cases are associated with damage and scarring of the liver known as cirrhosis. Cirrhosis can have a number of different causes, including drinkingexcessive amounts of alcohol overmany years and having a long-term hepatitis B or hepatitis C viral infection. It is also believed obesity and an unhealthy dietcan increase the risk of liver cancer because this can lead to non-alcoholic fatty liver disease . By avoiding or cutting down on alcohol, eating healthily and exercising regularly , and taking steps to reduce your risk of becoming infected with hepatitis B and C, you may be able to significantly reduce your chances of developing liver cancer. Read more about the causes of liver cancer . Who is affected? Despite being a common type of cancer worldwide, liver cancer is relatively uncommon in the UK. However, the chances of developing the condition are high for people with risk factors for the condition. The number of people affected by liver cancer rises sharply with age, with around 8 in every 10 cases diagnosed in people aged 60 or older, although it also affects many people younger than this. Around 2 in every 3 cases affect men. Over the past few decades, rates of liver cancer in the UK have risen considerably, possibly as a result of increased levels of alcohol intake and obesity. Diagnosis and screening Liver cancer is usually diagnosed after a consultation with a GP and a referral to a hospital specialist for further tests, such as scans of your liver. However, regular check-ups for liver cancer (known as surveillance) are often recommended for people known to have a high risk of developing the condition, such as those with cirrhosis. Having regular check-ups helps ensure the condition is diagnosed early. The earlierliver cancer is diagnosed, the more effectivetreatment is likely to be. Readmore about diagnosing liver cancer . How liver cancer is treated Treatment for liver cancer depends on the stage the condition is at. If diagnosedearly, it may be possible to remove the cancer completely. Treatment options in the early stages of liver cancer include: surgical resection  surgery to remove a section of liver liver transplant  where the liver is replaced with a donors liver microwave or radiofrequency ablation  where microwaves or radio waves are used to destroy the cancerous cells However, only a small proportion of liver cancers are diagnosed at a stage where these treatments are suitable. Most people are diagnosed when the cancer has spread too far to be removed or completely destroyed. In these cases, treatments such as chemotherapy will be used toslow downthe spread of the cancer and relieve symptoms such as pain and discomfort. Read more about treating liver cancer . Causes of liver cancer The exact cause of liver cancer is unknown, but many cases are linked to a problem with the liver called cirrhosis . This is where the tissue of the liver has become scarred and cannot perform many of its usual functions. Cancer is a conditionwhere cells in a specific part of the body grow and reproduce uncontrollably, producing a lump of tissue known as a tumour. In cases of liver cancer, it is uncertain why and how the cells of the liver are affected, but it appears that cirrhosis can increase a persons chances of developing the condition. However, most cases of cirrhosis do not lead to liver cancer, and people without cirrhosis canalso develop liver cancer. Common causes of cirrhosis Heavy and harmful drinking The liver is a tough and resilient organ. It can endure a high level of damage that would destroy other organs and is capable of regenerating itself. But despite the livers resilience, excessive alcohol intake over many years can damage it. Every time you drink alcohol, your liver filters out the poisonous alcohol from your blood and some of the liver cells die. The liver can regenerate new cells, but if you drink heavily for many years, your liver will lose the ability to do this and it can become damaged and scarred over time. Non-alcoholic fatty liver disease Non-alcoholic fatty liver disease occurs when small deposits of fat build up inside the tissue of the liver.Its acommon condition and causes no noticeable symptoms in most people. However, in some people, high levels of fat can make the liver inflamed. Over time, the inflammationcan scar the liver. The exact cause of non-alcoholic fatty liver disease is unclear, but it is associated with obesity and type 2 diabetes . Hepatitis C A long-term infection of hepatitis C can cause inflammation and scarring of the liver. Hepatitis C is spread by blood contact. The mostcommon ways this happens worldwideinclude poor medical practice with the use of contaminated needles, or injected drug use, where any item of injecting equipment (not just needles) is shared. If you smoke or regularly drink alcohol and have hepatitis C, your risk of developing liver cancer further increases. Early treatment of long-term hepatitis C with antiviral medication can prevent the liver from becoming scarred. Othercauses of cirrhosis Hepatitis B Hepatitis B is a virus that can be spread through contaminated blood and other types of bodily fluids, such as saliva, semen and vaginal fluids. Like hepatitis C, hepatitis B is spread through blood contact. It is most commonly spread from mother to child at birth or from child to child in early life (usually in areas outside the UK where the infection is very common), and very rarely sexually or through injecting drugs. It affects about1 in every 200 peoplein the UK. Most of those infected were born inparts of the world where the hepatitis Bvirus is very common. As with hepatitis C, hepatitis B can also cause inflammation and scarring of the liver over time. If you smoke or drink and have hepatitis B, your risk of developing liver cancer further increases. Early treatment of long-term hepatitis B with antiviral medication is not always needed, but can substantially reduce the risk of the liver becoming scarred. Haemochromatosis Haemochromatosisis a genetic condition where the body stores too much iron from food. The excess levels of iron have a poisonous effect on the liver and cause scarring over time, although treatment can reduce the risk of the condition leading to liver cancer. Primary biliary cirrhosis Primary biliary cirrhosisis a rare and poorly understood liver condition. One of the main functions of the liver is to create afluid called bile, used by the body to help break down fat. The bile is transported to the digestive system via a series of tubes called bile ducts. For reasons that are unclear, in cases of primary biliary cirrhosis, the bile ducts gradually becomedamaged. This eventually leads to a build-up of bile inside the liver, which damages the liver and causes cirrhosis. Diagnosing liver cancer For many people, the first stage of diagnosing liver cancer is a consultation with a GP, although people at risk are usually tested regularly for the condition. If you visit your GP, they will ask about your symptoms,when they started, and when they are noticeable. They will also examine you. If they feelyou need further tests, they will refer you to a hospital specialist. Surveillance for liver cancer If you are in a high-risk group for developing liver cancer, regular screening known as surveillance is often recommended. This is because the earlier the cancer is diagnosed, the greater the chance there is of curing it. Surveillance is usually carried out every 6 months andoften involves: ultrasound scans  high-frequency sound waves are used to create an image of your liver, which can highlight any abnormalities blood tests your blood is tested for a protein calledalpha-fetoprotein (AFP), which isfound in some people with liver cancer Surveillance is usually recommended if you have cirrhosis (scarring of the liver), although there are other factors that can also affect your risk of livercancer. The potential benefits of surveillance shouldbe discussed with you beforeyou enterany screening programme. Further testing The tests above can also be used to look for liver cancer in people who are not being routinely screened. If these initialtests suggest there is a chance you could have liver cancer, one or multiple tests will usually be recommended to confirm the diagnosis. The further tests include: computerised tomography (CT) scans a series of X-rays of your liver aretaken to givea more detailed three-dimensional image magnetic resonance imaging (MRI) scans  uses a strong magnetic field and radio waves to build up a picture of the inside of your liver biopsy a needle is inserted into your abdomen (tummy)to remove a small sample of liver tissue, which is then tested in a laboratory for cancerous cells laparoscopy a small incision is made in your abdomen under general anaesthetic (where you are asleep) and a flexible camera called an endoscope is used to examine your liver Afterthese tests have been carried out, it will usually be possible to confirm a diagnosis of liver cancer and determine the conditions stage. Staging liver cancer Staging is a term used to describe how far a particular cancer has spread. There are a number of different systems used to stage liver cancer. Many liver cancer specialists use combination staging systems that include features of both the cancer and the underlying liver function to stage a persons condition. This is because the length of time a person lives and how well theytolerate potential treatments will be determined not only by how advanced their cancer is, but also by their level of health and how good their underlying liver function is. One combination system for staging liver cancer is known as the Barcelona Clinic Liver Cancer (BCLC) staging system. The BCLC staging system consists of 5 stages. These are: stage 0 the tumour is less than 2cm (20mm) in diameter and the person is very well and has normal liver function stage A a single tumour has grown but is less than 5cm (50mm) in diameter, or there are 3 or fewer smaller tumoursless than 3cm (30mm) in diameter and the person is very well with normal liver function stage B  there are multiple tumours in the liver, but the person is well and their liver function is unaffected stage C any of the above circumstances, but the person is not so well and their liver function is not so good, or where the cancer has started to spread into the main blood vessel of the liver, nearby lymph nodes or other parts of the body stage D where the liver has lost most of its functioning abilities and the person begins to have symptoms of end-stage liver disease, such as a build-up of fluid inside their abdomen Treating liver cancer The treatment for liver cancer depends on the stage of the condition. Treatment can include surgery and medication. Cancer treatment teams Most hospitals use multidisciplinary teams (MDTs) to treat liver cancer. These are teams of specialists that work together to make decisions about the best way to proceed with your treatment. Deciding which treatment is best for you can often be confusing. Your cancer team will recommend what they think is the best treatment option, but the final decision will be yours. Your treatment plan Your recommended treatment plan will depend on the stage your liver cancer is at. If your cancer is at stage A when diagnosed, a complete cure may be possible. The 3 main ways this can be achieved are: removing the affected section of liver  known as a resection having a liver transplant  an operation to remove the liver and replace it with a healthy one using heat to kill cancerous cells  known as microwave or radiofrequency ablation (RFA) If your cancer is at stage B or C, a cure is not usually possible. However, chemotherapy can slow the progression of the cancer, relieve symptoms, and prolong life for months or, in some cases, years. There is also a medication called sorafenib thatcan help prolong life. If your cancer is at stage D when diagnosed, it is usually too late to slow down the spread of the cancer. Instead, treatment focuses on relievinganysymptoms of pain and discomfort you may have. Surgical resection If damage to your liver is minimal and the cancer is contained in a small part of your liver, it may be possible to remove the cancerous cells during surgery. This procedure is known as surgical resection. As the liver can regenerate itself, it may be possible to remove a large section of it without seriously affecting your health. However, in the majority of people with liver cancer, their livers regenerative ability may be significantly impaired and resection may be unsafe. Whether or not a resection can be performed is often determined by assessing the severity of your cirrhosis (scarring of the liver). If a liver resection is recommended, it will be carried out under a general anaesthetic , which means you will be asleep during the procedure and wont feel any pain as it is carried out. Most people are well enough to leave hospital within a week or two of having surgery. However, depending on how much of your liver was removed, it may take several months for you to fully recover. Risks Liver resection is a complicated surgery and can have a considerable impact on your body. There is a significant risk of complications occurring during and after surgery. Possible complications of liver resection include: infection at the site of the surgery bleeding after the surgery blood clots that develop in your legs  the medical term for this is deep vein thrombosis (DVT) bile leaking from the liver  further surgery may be required to stop the leak jaundice (yellowing of the skin and whites of the eyes) liver failure (where your liver is no longer able to function properly) Liver resection can also sometimes cause fatal complications, such as a heart attack. Liver transplant A liver transplant involves removing a cancerous liver and replacing it with a healthyliver from a donor. This is a major operation and there is a risk of potentially life-threatening complications. A liver transplant may be suitable for you if you: only have a single tumour less than 5cm (50mm) in diameter have 3 or fewer small tumours, each less than 3cm (30mm) have responded exceptionally well to other treatments, with no evidence of tumour growth for 6 months If you have multiple tumours or a tumour larger than 5cm, the risk of the cancer returning is usually so high that a liver transplant will be of no benefit. If you are suitable for a liver transplant, you will normally need to be placed on a waiting list until a donor liver becomes available. The average waiting time for a liver transplant is 142 days for adults. In some cases, a small part of the liver of a living relative can be used. This is known as a living donor liver transplant. The advantage of using a living donor liver transplant is that the person receiving the transplant can plan the procedure with their medical team and relative, and will not usually have to wait very long. Read more about liver transplants . Microwave or radiofrequency ablation Microwave or radiofrequency ablation (RFA) may be recommended as an alternative to surgery to treat liver cancer at an early stage, ideally when the tumour or tumours are smaller than 5cm (50mm) in diameter. They can also be used to treat tumours larger than this, but the treatment may need to be repeated in such cases. These treatments involve heating the tumours with microwaves or radio waves produced by small, needle-like electrodes. This heat kills the cancer cells and causes the tumours to shrink. Similar procedures using lasers or freezing can also achieve the same result. There are 3 main ways microwave ablation or RFA can be carried out: where the needles are passed through the skin (percutaneously) where the needles are inserted through small incisions in your abdomen keyhole surgery (laparoscopy) where the needles are inserted through a single large incision made in your abdomen open surgery Continuous ultrasound or computerised tomography (CT) scans are used to make sure the needles are guided into the correct position. Microwave ablation or RFA can be carried out under general anaesthetic or local anaesthetic (where you are awake but the area being treated is numbed), depending on the technique used and the size of the area being treated. How long it takes to carry out the treatment depends on the size and number of tumours being treated, but it usually takes between 1 and 3 hours in total. Most people need to stay overnight in hospital. You may experience some minor discomfort and flu -like symptoms, such as chills and muscle pains, for a few days after the procedure. The risk of complications occurring with microwave ablation or RFA is low, but possible problems can include bleeding, infection, minor burns and damage to nearby organs. Chemotherapy Chemotherapyuses powerful cancer-killing medications to slow the spread of liver cancer. A type of chemotherapy called transcatheter arterial chemoembolisation (TACE) is usually recommended to treat cases of stage B and C liver cancer. In these cases, the treatment can prolong life, but cannot cure the cancer. TACE may also be used to help prevent cancer spreading out of the liver in people waiting for a liver transplant. Itis not recommended for stage D liver cancer because it can make the symptoms of liver disease worse. TACE procedure During TACE a fine tube called a catheter is insertedinto the main blood vessel in your groin (femoral artery) and passed along the arteryto the main blood vessel that carries blood to the liver (hepatic artery). Chemotherapy medication is injected directly into the liver through the catheter and either a gel or small plastic beads are injected into the blood vessels supplying the tumours to help slow down the speed they grow. TACE usually takes one to 2 hours to complete. After the procedure, you will stay in hospital overnight before returning home. This procedure can be completed several times if necessary. Side effects Injecting chemotherapy medications directly into the liver, rather than into the blood, has the advantage of avoiding the wide range of side effects associated with conventional chemotherapy, such as hair loss and tiredness. However, the procedure is not free of side effects and complications. The most common side effect is post-chemoembolisation syndrome, which can cause abdominal (tummy) pain and a high temperature (fever), as well as making you vomit or feel sick. These symptoms may last for a few weeks after a TACE session. Read more about chemotherapy . Alcohol injections If you only have a few small tumours, alcohol (ethanol) injections may be used as a treatment.A needle passes through the skin to inject alcohol into the cancerous cells. This dehydrates the cells and stops their blood supply. In most cases, this is carried out under a local anaesthetic, meaning you will be awake, but the affected area is numbed so you wont feel any pain. Sorafenib Sorafenib is a medication given in tablet form that can disrupt the blood supply to liver tumours and slow down their growth. It is sometimes used as a treatment for advanced cases of liver cancer, although it is not routinely available on the NHS because the National Institute for Health and Care Excellence (NICE) has said the cost of the medication is high for the limited benefit it offers. Whether or not you are eligible for sorafenib will be decided by your medical team, and will depend on the likelihood of whetheryou will significantly benefit from the medication. For more information, see the NICE guidelines on sorafenib for the treatment of advanced hepatocellular carcinoma . Advanced liver cancer Treatment for advanced liver cancer focuses on relieving symptoms such as pain and discomfort, rather than attempting to slow down the progression of the cancer. Some people with advanced liver cancer require strong painkillers, such as codeine or possibly morphine. Nausea and constipation are common side effects of these types of painkillers, so you may also be given an anti-sickness tablet and a laxative. Read more about end of life care . Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Cirrhosis Other health sites Cancer Research UK: Liver cancer Macmillan Cancer Support: Liver cancer British Liver Trust: liver cancer Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Liver disease,"Liver disease | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Liver disease Liver disease There are more than 100 different types of liver disease, which together affect at least 2 million people in the UK. The liver The liver is the second largest organ in the body. It works hard, performing hundreds of complex functions, including: fighting infections and illness removing toxins (poisons), such as alcohol ,from the body controllingcholesterol levels helping blood to clot (thicken) releasing bile, a liquid that breaks down fats and aids digestion Liver disease doesnt usually cause any obvious signs or symptoms until its fairly advanced and the liver is damaged. At this stage, possible symptoms can include loss of appetite, weight loss and jaundice. Types of liver disease Listedon this page are some specific types of liver disease. The links provide more detailed information about each type: alcohol-related liver disease  where the liver is damaged after years of alcohol misuse, this can lead to cirrhosis (scarring of the liver) Non-alcoholic fatty liver disease  a build-up of fat within liver cells, usually seen in overweight people or those who are obese hepatitis  which is inflammation (swelling) of the liver caused by a viral infection or exposure to harmful substances such as alcohol haemochromatosis  an inherited disorder where theres a gradual build-up of iron in the body, usually around the liver primary biliary cirrhosis  a rare, long-term type of liver disease that damages the bile ducts in the liver All types of liver disease can cause cirrhosis (scarring of the liver), not just alcohol-related liver disease. Significant health problem In the UK, liver disease is on the increase. The 3 main causes of liver disease are: obesity undiagnosed hepatitis infection alcohol misuse These causes of liver disease are all preventable. Do make sure youre a healthy weight for your height avoid drinking excessive amounts of alcohol take the appropriate measures to prevent getting hepatitis, such as getting vaccinated if youre at risk Source: NHS 24 - Opens in new browser window Last updated: 13 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Alcohol-related liver disease Cirrhosis Body mass index (BMI) Low-risk drinking guidelines Other health sites British Liver Trust: diet and liver disease NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Liver tumours,"""Liver tumours | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in children Liver tumours Liver tumours Liver tumours can be non-cancerous (benign) or cancerous (malignant).Boys are affected more commonly than girls. There are 2 main types of primary liver cancer. Hepatoblastoma This usually occurs in children under 5 years old. Hepatocellular carcinoma (HCC) This is rarer and usually occurs in older children. More children than ever are surviving childhood cancer. There are new and better drugs and treatments, and we can now also work to reduce the after-effects of having had cancer in the past. Its devastating to hear that your child has cancer. At times it can feel overwhelming but there are many healthcare professionals and support organisations to help you through this difficult time. Understanding more about the cancer your child has and the treatments that may be used can often help parents to cope. Your childs specialist will give you more detailed information and if you have any questions its important to ask the specialist doctor or nurse who knows your childs individual situation. The liver The liver is the largest organ in the body. Its surrounded by a fibrous capsule and is divided into sections called lobes. It lies across the upper part of the abdomen and is larger on the right-hand side of the body than on the left. Its surrounded, and protected from injury, by the lower ribs. The liver is an extremely important organ that has many functions. One of these functions is to produce proteins that circulate in the blood. Some of the proteins help the blood to clot and prevent excessive bleeding. Others are essential for maintaining the balance of fluid in the body. The liver also destroys harmful substances. It breaks down waste products not used by the body so that they can be passed out in the urine or stools (bowel motions). The liver is responsible for breaking down food containing carbohydrates (sugars) and fats, so they can be used by the body for energy. It stores substances such as glucose and vitamins so that they can be used by the body when needed. The liver also produces bile, a substance that breaks down the fats in food so that they can be absorbed from the bowel (intestine). The liver is connected to the small intestine (duodenum) by a tube called the bile duct. This duct takes the bile produced by the liver to the intestine. The liver has an amazing ability to repair itself. It can function normally even if only a small part of it is working. Causes The cause of most primary liver tumours in the western world is unknown. However, in other parts of the world, hepatocellular cancer (HCC) is commonly related to the presence of liver infection. This happens in countries where mothers commonly have hepatitis B and vaccination is not readily available at birth for their children. Children who are infected with hepatitis B have a higher risk of developing HCC in late childhood than uninfected children. Signs and symptoms The most common symptom is a lump or swelling in the abdomen, which can be painful. Other possible symptoms include weight loss, a loss of appetite, feeling sick (nausea) and being sick (vomiting). How liver tumours are diagnosed A variety of tests and investigations may be needed to diagnose a liver tumour. An ultrasound scan and X-rays will be taken, which can show if there is a tumour in the liver. Further tests, including CT (computerised tomography) scans or MRI (magnetic resonance imaging) scans , will be done to find out the extent of the disease, both inside and outside the liver. Blood tests will also be carried out. Most hepatoblastomas and hepatocellular carcinomas produce a protein that is released into the bloodstream. This protein is known as alpha-fetoprotein (AFP). Its possible to measure levels of AFP in the blood, which can be a useful indicator of whether the liver tumour is responding to treatment or whether it may have come back after treatment. AFP is also known as a tumour marker. Any tests and investigations that your child needs will be explained to you. Grouping To assess the extent of the cancer, a grouping system called PRETEXT (pre-treatment extent of disease) is used. It uses an MRI scan to measure the amount of cancer in the liver at diagnosis. Its also used to help establish the best treatment for each child. This grouping system is unique to liver tumours and is increasingly used all over the world. This grouping process is essential because liver tumours need to be removed surgically. Grouping divides the liver into four surgical areas (sectors) and gives an indication of the kind of surgery that is needed to remove the tumour. Grouping also helps doctors decide whether a liver transplant surgeon needs to be involved from the start or not. PRETEXT 1 1liver sector is affected and the tumour can be removed by straightforward surgery PRETEXT 2  2adjoining sectors are affected and the tumour can be removed with more extensive surgery PRETEXT 3  2or 3 sectors are affected with no 2 adjoining sectors free of disease, and the tumour can be removed with major surgery PRETEXT 4  all 4 sectors of the liver are affected, and the tumour cannot be removed without replacing the liver with a donor liver transplant Doctors also look at the extent of the spread of cancer beyond the liver. In the blood vessels Sometimes the tumour gets into the blood vessels that are entering or leaving the liver. This may affect the type of surgery needed to remove the tumour. In the abdomen Sometimes the tumour spreads outside the liver and into the abdomen (tummy). The tumour cannot be removed completely. In the lungs or other organs If the tumour spreads outside the liver through the bloodstream (metastatic disease), it usually goes to the lungs. About 1 in 5 children are found to have affected lungs when they are diagnosed. Doctors use X-rays and CT or MRI scans to assess whether the lungs are affected. Treatment The diagnosis is made by taking a sample of cells from the tumour ( biopsy ). This is done under a general anaesthetic. Once the diagnosis and staging have been confirmed, plans for treatment will be made. Hepatoblastoma For hepatoblastoma, the type of treatment will depend on the PRETEXT staging and whether the cancer has spread to other parts of the body (metastatic disease). PRETEXT 1, 2 and 3 tumours are called standard risk. PRETEXT 4 is called high risk and includes tumours that have spread to other parts of the body. Treatment is broadly similar for all PRETEXT stages. Chemotherapy (anti-cancer drugs) is given first. The aim of chemotherapy is to shrink the tumour in the liver and hopefully get rid of any metastatic tumours. Surgery to remove any of theremaining tumour will take place after a few weeks of chemotherapy. Further chemotherapy is usually given after surgery. Your childs doctor will give you more detailed information about the chemotherapy drugs and their side effects. Hepatocellular carcinoma For hepatocellular carcinoma, treatment is a little different. The role of chemotherapy is less certain and surgery is the main treatment. Doctors usually recommend removing the tumour (if its small enough) at diagnosis. Chemotherapy may be given afterwards. However in many situations the tumour is too large to remove at first, and so chemotherapy is given to shrink the tumour so that surgery can be done later. Hepatocellular tumours dont always respond to chemotherapy as well as hepatoblastomas. For this reason, other treatments, such as chemoembolisation and targeted treatments, may be used. Chemoembolisation This refers to the giving of drugs directly into the artery going into the liver. Very occasionally, this may be used for hepatocellular cancer. Targeted drugs Targeted drugs are a group of treatments that work in a different way to conventional chemotherapy. Some drugs may cause cancer cells to die directly. Others act to cut off the blood supply to the tumour cells (antiangiogenesis drugs). Some drugs, called multi-targeted agents, work in both ways. Research is looking into how useful targeted treatments are on their own and in combination with chemotherapy. Your childs doctor may talk to you more about this research. Surgery All children, if they are able to, will have surgery following chemotherapy. If theres cancer in the lungs, which hasnt completely disappeared with the chemotherapy, the lungs will be operated on first. If the liver tumour can be surgically removed, the operation to do so will follow, usually a week or two later. If the tumour involves all 4 sectors of the liver (PRETEXT 4), a liver transplant will be necessary. This is recommended for hepatoblastoma but only in particular circumstances for hepatocellular carcinoma. In a transplant, the whole liver is removed and replaced with a liver from another person. This will be discussed with you from the beginning, and you will be given the opportunity to think about donating half of your liver, or for your child to have a liver from a donor. The transplant team will be there to answer all of your questions. A liver transplant is only possible if all the cancer outside the liver has gone. Side effects of treatment Treatment often causes side effects, and your childs doctor will discuss these with you before treatment starts. Side effects can include: feeling sick (nausea) and being sick (vomiting) hair loss an increased risk of infection bruising and bleeding tiredness diarrhoea Late side effects The chemotherapy used to treat liver cancer can cause late side effects. These may include hearing problems, kidney problems and possibly heart problems. There will be a slightly increased risk of your child developing another type of cancer later in life. Most children will develop some late effects and need to have some follow-up tests. Your childs doctor or nurse will tell you more about any possible late side effects. Recurrence If the cancer comes back after initial treatment, this is known as a recurrence. It can come back in the liver or in other parts of the body. If the cancer comes back, often (before anything is seen on scans) the levels of alpha-fetoprotein (AFP) in the childs blood will start to rise again and reaches levels of over 100. Small rises in AFP can occur in the weeks after surgery, as the liver regenerates as much as it can. Clinical trials Many children have their treatment as part of a clinical research trial. Trials aim to improve our understanding of the best way to treat an illness, usually by comparing the standard treatment with a new or modified version. Specialist doctors carry out trials for childrens cancer. If appropriate, your childs medical team will talk to you about taking part in a clinical trial and will answer any questions you have. Written information is often provided to help explain things. Taking part in a research trial is completely voluntary, and youll be given plenty of time to decide if its right for your child. Treatment guidelines Sometimes, clinical trials are not available for your childs tumour. This may be because a recent trial has just finished, or because the tumour is very rare. In these cases, you can expect your doctors and nurses to offer treatment which is agreed to be the most appropriate, using guidelines which have been prepared by experts across the country. The Childrens Cancer and Leukaemia Group (CCLG) is an important organisation which helps to produce these guidelines. Follow-up care When the treatment ends, your child will have regular blood tests to measure the level of AFP in the blood (if appropriate), as well as scans and chest X-rays. More than three quarters of children with hepatoblastoma are cured, and for children with small tumours that are confined to the liver, the outlook is even better. The outcome for hepatocellular carcinoma is not quite as good. The staff at the hospital can give you information about the likely outcome for your child. Your feelings As a parent, the fact that your child has cancer is one of the worst situations you can be faced with. You may have many emotions, such as fear, guilt, sadness, anger and uncertainty. These are all normal reactions and are part of the process that many parents go through at such a difficult time. Its not possible to address here all of the feelings you may have. However, the CCLG booklet Children & Young Peoples Cancer; A Parents Guide talks about the emotional impact of caring for a child with cancer and suggests sources of help and support. Your child may have a variety of powerful emotions throughout their experience with cancer. The Parents Guide discusses these further and talks about how you can support your child. Source: Children's Cancer and Leukaemia Group - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Loss of libido,"Loss of libido | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Sexual and reproductive Loss of libido Loss of libido Loss of libido (sex drive) is a common problem affecting up to 1 in 5 men  and even more women  at some point in their life. Its often linked to professional and personal stress, orimportant life-changing events such as pregnancy, childbirth or breastfeeding. However, an unexpected loss of libidoespecially when it lasts for a long time or keeps returningcan also indicate an underlying personal, medical or lifestyle problem,which can be upsetting to both partners in a relationship. If youre concerned about your libido, especially if your diminished sex drive distresses you or affects your relationship, make an appointment to see your GP to discuss any underlying causes and possible medical or psychological treatments. Doctors at your nearest family planning clinic , Integrated Sexual Health clinic, or Contraceptive and Sexual Health (CASH) clinic may also be able to help. In the meantime, you may find the following information useful. It explains some of the most common reasons for loss of libido. Relationship problems The first thing you should consider is whether youre happy in your relationship. Do you have any doubts or worries that may be the real reason for your loss of sexual desire? If youve been in a relationship for a long time, you may have become overfamiliar with your partner and feel a degree of erotic dissatisfaction. This is quite common and can have a negative effect on your sex drive. Relationship problems are among the most common causes of loss of libido. For help and advice, youmay find it useful to contact the relationship support charity Relationships Scotland . Another thing to consider is whether the problem is a performance issue that makes sex difficult or unfulfilling. For example, many men experience ejaculation problems or erectile dysfunction , and women can experience painful sex or vaginismus (when the muscles around the vagina tighten involuntarily before penetration). See your GP if these problems are an issue, as theyre often treatable. Your GP may feel you will benefit from psychosexual counselling. This is a form of relationship therapy where you and your partner can discuss any sexual or emotional issues that may be contributing to your loss of libido. Stress, anxiety and exhaustion Stress, anxiety and exhaustion can be all-consuming and have a major impact on your happiness. If you feel youre constantly tired, stressed or anxious, you may need to make some lifestyle changes or speak to your GP for advice. For more information and advice read about beating stress at work and 10 stress busters Depression Depression is very different from simply feeling unhappy, miserable or fed up for a short while. Its a serious illness where you may have feelings of extreme sadness that can last for a long time. These feelings are severe enough to interfere with your daily life, including your sex life. Youre probably depressed if youre feeling low or hopeless, or youve lost interest or pleasure in doing things you used to enjoy. In this case its really important to see your GP. They may feel youll benefit from antidepressants . However, low sex drive can also be a side effect of many antidepressants. Speak to your GP if youre already taking antidepressants and think they may be causing your problems, as you may be able to switch to a different medication. Drugs and alcohol Drinking excess amounts of alcohol can reduce your sex drive, so its a good idea to moderate your intake to no more than three to four units a day if youre a man, and no more than two to three units a day if youre a woman. Read more about alcohol misuse and find out how to get support for a drinking problem . Drug misuse is also linked to a loss of sex drive. Read more about drugs for information and advice. Getting older Many people lose some interest in sex as they get older, mainly as a result of falling levels of sex hormones, age-related health problems, or the side effects of medication. Older men especially can develop low testosterone levels, which can cause fatigue, depression and a reduced sex drive. Speak to your GP if youre concerned about this. They may carry out a blood test to check your testosterone level and can tell you about treatments if your level is low. As women start to approach the menopause , levels of the female hormone oestrogen begin to fall, which can affect libido. Women can also suffer from low testosterone levels, especially after a hysterectomy . Testosterone is another hormonethat can affect sex drive. Speak to your GP if youre concerned the menopause may be having an effect on your libido. They may be able to offer you a trial of hormone replacement therapy(HRT) if its suitable for you. Hormonal problems Less commonly, low libido may be caused by an underactive thyroid . This is where your thyroid gland (located in the neck) doesnt produce enough hormones. Common signs of an underactive thyroid are tiredness, weight gain and feeling depressed. An underactive thyroid is easily treated by taking hormone tablets to replace the hormones your thyroid isnt making. Learn more about treating underactive thyroid . A hormonal problem called hyperprolactinaemia can also have a negative effect on your sex drive. This is where you have a raised level of a substance called prolactin in your blood. Contraception Some women have reported a decreased sex drive while usingsome types of hormonalcontraception, such as: combined contraception, including the combined pill , vaginal ring ,or contraceptive patch the progestogen-only pill the contraceptive implant the Depo-Provera injection However, side effects of these contraceptivestend toimprove within a few months and theyre generally well tolerated. Speak to your GP or local contraceptive (or family planning) clinic if youre worriedyour contraceptionis causing a loss of libido. They may suggest trying an alternative method. Read more about choosing a method of contraception Other medical conditions Long-term (chronic) medical conditions such as cardiovascular disease , diabetes and obesity can also have a negative effect on your libido. Medication Certain medications can sometimes reduce libido, such as: medication for high blood pressure , including diuretics medications for depression, including SSRI antidepressants medications for seizures (fits) medications commonly used to treat psychosis (a mental condition where a person cant distinguish between reality and their imagination), such as haloperidol, as well as many other conditions medicines such as cimetidine, finasteride and cyproterone, which block the effects or reduce the production of testosterone See your GP if youre worried that medication youre taking is responsible for your reduced sex drive. They can review your medication and switch your prescription to something less likely to affect your libido if necessary. Find your local GP practice Last updated: 20 January 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Find your local GP practice Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Lung cancer,"Lung cancer - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Lung cancer Lung cancer About lung cancer Symptoms of lung cancer Causes of lung cancer Diagnosing lung cancer Treating lung cancer Living with lung cancer Preventing lung cancer About lung cancer Lung cancer is one of the most common and serious types of cancer. There are usually no signs or symptoms in the early stages of lung cancer, but many people with the condition eventually develop symptoms including: a persistent cough coughing up blood persistent breathlessness unexplained tiredness and weight loss an ache or pain when breathing or coughing You should speak to your GP if you have these symptoms. Read more about the symptoms of lung cancer Types of lung cancer Cancer that begins in the lungs is called primary lung cancer. Cancer that spreads from the lungs to another place in the body is known as secondary lung cancer. Thispage is aboutprimary lung cancer. There are 2 main types of primary lung cancer.These are classified by the type of cells in which the cancer starts. They are: non-small-cell lung cancer  the most common type, accounting for more than 80% of cases; can be eithersquamous cell carcinoma, adenocarcinoma or large-cell carcinoma small-cell lung cancer a less common type thatusually spreadsfaster than non-small-cell lung cancer The type of lung cancer you have determines which treatments are recommended. Read more about diagnosing lung cancer Whos affected Lung cancer mainly affects older people.Itsrare in people younger than 40, and the rates of lung cancer rise sharply with age. Lung cancer is most commonlydiagnosed in people aged 70to 74. Although people who have never smoked can develop lung cancer, smoking is the main cause (accounting for over 85% of cases). This is because smoking involves regularly inhaling a number of different toxic substances. Read more about: causes of lung cancer preventing lung cancer Treating lung cancer Treatment depends on the type of cancer, how far its spread and how good your general health is. If the condition is diagnosed early and the cancerous cells are confined to a small area, surgery to remove the affected area of lung is usually recommended. If surgery is unsuitable due to your general health, radiotherapy to destroy the cancerous cells may be recommended instead. If the cancer has spread too far for surgery or radiotherapy to be effective, chemotherapy is usually used. Read more about treating lung cancer Symptoms of lung cancer Symptoms of lung cancer develop as the condition progresses and there are usually no signs or symptoms in the early stages. The main symptoms of lung cancer are: a cough that doesnt go away after 2 or 3 weeks a long-standing cough thatgets worse persistent chest infections coughing up blood an ache or pain when breathing or coughing persistent breathlessness persistent tiredness or lack of energy loss of appetite or unexplained weight loss Less common symptoms of lung cancer include: changes in the appearance of your fingers, such as becoming more curved or their ends becoming larger (this is known as finger clubbing) a high temperature (fever) of 38C (100.4F) or above difficulty swallowing or pain when swallowing wheezing a hoarse voice swelling of your face or neck persistent chest or shoulder pain If you have any of these, you should speak to your GP. Read further information: Cancer Research UK: Symptoms of lung cancer Macmillan Cancer Support: Signs and Symptoms of lung cancer Causes of lung cancer Most cases of lung cancer are caused by smoking, although people who have never smoked can also develop the condition. Smoking Smoking cigarettes is the single biggest risk factor for lung cancer.Its responsible for more than 85% of all cases. Tobacco smoke contains more than 60 different toxic substances, which canlead tothe development of cancer. These substances are known to be carcinogenic (cancer-producing). If you smoke more than 25 cigarettes a day, you are 25 times more likely to get lung cancer than a non-smoker. While smoking cigarettes is the biggest risk factor, using other types of tobacco products can also increase your risk of developing lung cancer and other types of cancer, such as oesophageal cancer and mouth cancer . These products include: cigars pipe tobacco snuff (a powdered form of tobacco) chewing tobacco Smoking cannabis has also been linked to an increased risk of lung cancer. Most cannabis smokers mix their cannabis with tobacco.While they tend to smoke less than tobacco smokers, they usually inhale more deeply and hold the smoke in their lungs for longer. Its beenestimated that smoking 4 joints (homemade cigarettes mixed with cannabis) may be as damaging to the lungs as smoking 20 cigarettes. Even smoking cannabis without mixing it with tobacco is potentially dangerous. This is because cannabis also contains substances that can cause cancer. Passive smoking If you dont smoke, frequent exposure to other peoples tobacco smoke (passive smoking) can increase your risk of developing lung cancer. For example, research has found that non-smoking women who share their house with a smoking partner are 25% more likely to develop lung cancer than non-smoking women who live with a non-smoking partner. Radon Radon is a naturally occurring radioactive gas thatcomes from tiny amounts of uranium present in all rocks and soils. It can sometimes be found in buildings. If radon is breathed in, it can damage your lungs, particularly if youre a smoker. Occupational exposure and pollution Exposure to certain chemicals and substances used in several occupations and industries has been linked to a slightly higher risk of developing lung cancer. These chemicals and substances include: arsenic asbestos beryllium cadmium coal and coke fumes silica nickel Read more information about asbestosis and silicosis. Researchalso suggests that being exposed to large amounts of diesel fumes for many years may increase your risk of developing lung cancer by up to 50%. One study has shown that your risk of developing lung cancer increases by about a third if you live in an area with high levels of nitrogen oxide gases (mostly produced by cars and other vehicles). Read further information about the causes and risk factors for lung cancer Diagnosing lung cancer Speak to your GP if you have symptoms of lung cancer , such as breathlessness or a persistent cough. Your GP will ask about your general health and what symptoms youve been experiencing. They may examine you and ask you to breathe into a device called a spirometer, which measures how much air you breathe in and out. You may be asked to have a blood test to rule out some of the possible causes of your symptoms, such as a chest infection . In 2015, the National Institute for Health and Care Excellence (NICE) published guidelines to help GPs recognise the signs and symptoms of lung cancer and refer people for the right tests faster. To find out if you should be referred for further tests for suspected lung cancer. Chest X-ray A chest X-ray is usually the first test used to diagnose lung cancer. Most lung tumours show up on X-rays as a white-grey mass. However, chest X-rays cant give a definitive diagnosis because they often cant distinguish between cancer and other conditions, such as a lung abscess (a collection of pus that forms in the lungs). If your chest X-ray suggests you may have lung cancer, you should be referred to a specialist (if you havent already) in chest conditions such as lung cancer. A specialist can carry out more tests to investigate whether you have lung cancer and, if you do,what type it isand how much its spread. CT scan A computerised tomography (CT) scan is usually carried out after a chest X-ray. A CT scanuses X-rays and a computer to create detailed images of the inside of your body. Before having a CT scan, youll be given an injection of a contrast medium. This is a liquid containing a dye that makes the lungs show up more clearly on the scan. The scan is painless and takes 10 to 30 minutes to complete. PET-CT scan A PET-CT scan (which stands for positron emission tomography-computerised tomography) may be carried out if the results of the CT scan show you have cancer at an early stage. The PET-CT scan can show where there are active cancer cells. This can help with diagnosis and treatment. Before having a PET-CT scan, youll be injected with a slightly radioactive material. Youll be asked to lie down on a table, which slides into the PET scanner. The scan is painless and takes around 30 to 60 minutes. Bronchoscopy and biopsy If the CT scan shows there might be cancer in the central part of your chest, youll have a bronchoscopy. A bronchoscopy is a procedurethat allowsa doctor or nurse toremove a small sample of cells from inside your lungs. During a bronchoscopy, a thin tube called a bronchoscope is used to examine your lungs and take a sample of cells ( biopsy ). The bronchoscope is passed through your mouth or nose, down your throat and into the airways of your lungs. The procedure may be uncomfortable, but youll be given a mild sedative beforehand to help you relax and a local anaesthetic to make your throat numb. The procedure is very quick and only takes a few minutes. Other types of biopsy If youre not able to have one of the biopsies described above, or youve had one and the results werent clear, you may be offered a different type of biopsy. This may be a type of surgical biopsy such as a thoracoscopy or a mediastinoscopy, or a biopsy carried out using a needle inserted through your skin. Percutaneous needle biopsy A percutaneous needle biopsy involves removing a sample from a suspected tumour to test it at a laboratory for cancerous cells. The doctor carrying out the biopsy will use a CT scanner to guide a needle to the site of a suspected tumour through the skin. A local anaesthetic is used to numb the surrounding skin, and the needle is passed through your skin and into your lungs. The needle will then be used to remove a sample of tissue for testing. Thoracoscopy A thoracoscopy is a procedure that allows the doctor to examine a particular area of your chest and take tissue and fluid samples. Youre likely to need a general anaesthetic before having a thoracoscopy. Two or three small cuts will be made in your chest to pass a tube (similar to a bronchoscope) into your chest. The doctor will use the tube to look inside your chest and take samples. The samples will then be sent away for tests. After a thoracoscopy, you may need to stay in hospital overnight while any further fluid in your lungs is drained out. Mediastinoscopy A mediastinoscopy allows the doctor to examine the area between your lungs at the centre of your chest (mediastinum). For this test, youll need to have a general anaesthetic and stay in hospital for a couple of days. The doctor will make a small cut at the bottom of your neck so they can pass a thin tube into your chest. The tube has a camera at the end, which enables the doctor to see inside your chest. Theyll also be able to take samples of your cells and lymph nodes at the same time. The lymph nodes are tested because theyre usually the first place that lung cancer spreads to. Staging Once tests have been completed, it should be possible to work out what stage your cancer is, what this meansfor your treatment and whether its possible tocompletely cure the cancer. Non-small-cell lung cancer Non-small-cell lung cancer (the most common type)usually spreads more slowly than small-cell lung cancer and responds differently to treatment. Stage 1 The cancer is contained within the lung and hasnt spread to nearby lymph nodes. Stage 1 can also be divided into two sub-stages: stage 1A  the tumour is less than 3cm in size (1.2 inches) stage 1B  the tumour is 3-5cm (1.2-2 inches) Stage 2 Stage 2 is divided into 2 sub-stages: 2A and 2B. In stage 2A lung cancer, either: the tumour is 5to 7cm the tumour is less than 5cmand cancerous cells have spread to nearby lymph nodes In stage 2B lung cancer, either: the tumour is larger than 7cm the tumour is 5to 7cm and cancerous cells have spread to nearby lymph nodes the cancer hasnt spread to lymph nodes, but has spread to surroundingmuscles or tissue the cancer has spread to one of the main airways (bronchus) the cancer has caused the lung to collapse there are multiple small tumours in the lung Stage 3 Stage 3 is divided into 2 sub-stages: 3A and 3B. In stage 3A lung cancer, the cancer has either spread to the lymph nodes in the middle of the chest or into the surrounding tissue. This can be: the covering of the lung (the pleura) the chest wall the middle of the chest other lymph nodes near the affected lung In stage 3B lung cancer, the cancer has spread to either of the following: lymph nodes on either side of the chest, above the collarbones another important part of the body, such as the gullet (oesophagus), windpipe (trachea), heart or into a main blood vessel Stage 4 In stage 4 lung cancer, the cancer has either spread to both lungs or to another part of the body (such as the bones, liver or brain), or the cancer has caused fluid-containing cancer cells to build up around your heart or lungs. Small-cell lung cancer Small-cell lung cancer is less common than non-small-cell lung cancer. The cancerous cells responsible for the condition are smaller in size when examined under a microscope than the cells that cause non-small-cell lung cancer. Small-cell lung cancer onlyhas 2 possible stages: limited disease  the cancer has not spread beyond the lung extensive disease  the cancer has spread beyond the lung Cancer Research UK has further information on types of lung cancer . Treating lung cancer Treatment for lung cancer is carried out by a team of specialists who will work together to provide the best possible treatment. This team contains all the specialists required to make a proper diagnosis, to stage your cancer and to plan the best treatment. If you want to know more, ask your specialist about this. The type of treatment youll receive for lung cancer depends on several factors, including: the type of lung cancer you have (non-small-cell or small-cell cancer) the size and position of the cancer how far advanced your cancer is (the stage) your overall health Deciding what treatment is best for you can be difficult. Your cancer team will make recommendations, but the final decision will be yours. The main treatment options include surgery, radiotherapy and chemotherapy . Depending on your type of cancer and how advanced it is, you may receive a combination of these treatments. Your treatment plan Your treatment plan depends on whether you have non-small-cell lung cancer or small-cell lung cancer. Non-small-cell lung cancer If you have non-small-cell lung cancer thats confined to one lung and youre in good general health, youll probably have surgery to remove the cancerous cells. This may be followed by a course of chemotherapy to destroy any cancer cells that may have remained in the body. If the cancer hasnt spread too far but surgery isnt possible (for example, if your general health means you have an increased risk of developing complications), radiotherapy to destroy the cancerous cells will usually be recommended. In some cases, this may be combined with chemotherapy (known as chemoradiotherapy). If the cancer has spread too far for surgery or radiotherapy to be effective, chemotherapy is usually recommended. If the cancer starts to grow again after initial chemotherapy treatment, another course of treatment may be recommended. In some cases, a treatment called biological or targeted therapy may be recommended as an alternative to chemotherapy, or after chemotherapy. Biological therapies are medications that can control or stop the growth of cancer cells. Small-cell lung cancer Small-cell lung cancer is usually treated with chemotherapy, either on its own or in combination with radiotherapy. This can help to prolong life and relieve symptoms. Surgery isnt usually used to treat this type of lung cancer. This isbecause the cancer has often already spread to other areas of the body by the time its diagnosed. However, if the cancer is found very early, surgery may be used. In these cases, chemotherapy or radiotherapy may be given after surgery to help reduce the risk of the cancer returning. Surgery There are3 types of lung cancer surgery: lobectomy whereoneor more large parts of the lung (called lobes) are removed  your doctors will suggest this operation if the cancer is just in 1 section of 1 lung pneumonectomy  where the entire lung is removed  this is used when the cancer is located in the middle of the lung or has spread throughout the lung wedge resection or segmentectomy  where a small piece of the lung is removed (this procedure isonly suitable for a small number of patients, as it is only used if your doctors think your cancer is small and limited to one area of the lung  this isusually very early-stage non-small-cell lung cancer) People are naturally concerned that they wontbe able to breathe if some or all of a lung is removed, but its possible to breathe normally with 1 lung. However, if you have breathing problems before the operation, such as breathlessness, its likely that these symptoms will continue after surgery. Tests before surgery Before surgery can take place, youll need to have a number of tests to check your general state of health and your lung function. These may include: an electrocardiogram (ECG)  electrodes are used to monitor the electrical activity of your heart spirometry youll breathe into a machine called a spirometer, which measures how much air your lungs can breathe in and out How its performed Surgery is usually performed by making a cut (incision)in your chest or side, and removing a section or all of the affected lung. Nearby lymph nodes may also be removed if its thought that the cancer may have spread to them. In some cases, an alternative to this approach, called video-assisted thoracoscopic surgery (VATS), may be suitable. VATS is a type of keyhole surgery, where small incisions are made in the chest. A small fibre-optic camera is inserted into one of the incisions, so the surgeon can see images of the inside of your cheston a monitor. After the operation Youll probably beable to go home 5 to 10 days after your operation. However, it can take many weeks to recover fully from a lung operation. After your operation, youll be encouraged to start moving about as soon as possible. Even if you have to stay in bed, youll need to keep doing regular leg movements to help your circulation and prevent blood clots from forming. A physiotherapist will show you breathing exercises to help prevent complications. When you go home, youll need to exercise gently to build up your strength and fitness. Walking and swimming are good forms of exercise that are suitable for most people after treatment for lung cancer. Talk to your care team about which types of exercise are suitable for you. Complications As with all surgery, lung surgery carries a risk of complications. These are estimated to occur in 1 out in 5 cases. These complications can usually be treated using medication or additional surgery, which may mean you need to stay in hospital for longer. Complications of lung surgery can include: inflammation or infection of the lung ( pneumonia ) excessive bleeding a blood clot in the leg ( deep vein thrombosis ), which could potentially travel up to the lung (pulmonary embolism) Radiotherapy Radiotherapy is a type of treatment that uses pulses of radiation to destroy cancer cells. There are a number of ways it can be used to treat people with lung cancer. An intensive course of radiotherapy, known as radical radiotherapy, can be used to try to cure non-small-cell lung cancer if the person isnt healthy enough for surgery. For very small tumours, a special type of radiotherapy called stereotactic radiotherapy may be used instead of surgery. Radiotherapy can also be used to control the symptoms and slow the spread of cancer when a cure isnt possible (this is known as palliative radiotherapy). A type of radiotherapy known as prophylactic cranial irradiation (PCI) is also sometimes used during the treatment of small-cell lung cancer. PCI involves treating the whole brain with a low dose of radiation. Its used as a preventative measure because theres a risk that small-cell lung cancer will spread to your brain. The 3 mainways that radiotherapy can be given are described below: conventional external beam radiotherapy  a machine is used to direct beams of radiation at affected parts of your body stereotactic radiotherapy  a more accurate type of external beam radiotherapy where several high-energy beams are used to deliver a higher dose of radiation to the tumour, while sparing the surrounding healthy tissue as much as possible internal radiotherapy  a catheter (thin tube) is inserted into your lung  asmall piece of radioactive material is placed inside the catheter and positioned against the site of the tumour before being removed after a few minutes For lung cancer, external beam radiotherapy is used more often than internal radiotherapy, particularly if its thought that a cure is possible. Stereotactic radiotherapy may be used to treat tumours that are very small, as its more effective than standard radiotherapy alone in these circumstances. Internal radiotherapy only tends to be used as a palliative treatment when the cancer is blocking or partly blocking your airway. Courses of treatment A course of radiotherapy treatment can be planned in several different ways. Radical radiotherapy is usually given 5 days a week, with a break at weekends. Each session of radiotherapy lasts 10to 15 minutes and the course usually lasts 4 to 7 weeks. Continuous hyperfractionated accelerated radiotherapy (CHART) is an alternative method of delivering radical radiotherapy. CHART is given 3 times a day for 12 days in a row. For stereotactic radiotherapy, fewer treatment sessions are needed because a higher dose of radiation is delivered with each treatment. People having conventional radical radiotherapy are likely to have around 20to 32 treatment sessions, whereas stereotactic radiotherapy typically only requires anything from 3 to 10 sessions. Palliative radiotherapy usually only requires 1 to 5 sessions to control your symptoms. Side effects Side effects of radiotherapy to the chestinclude: chest pain fatigue persistent cough that may bring up blood-stained phlegm (this is normal and nothing to worry about) difficulties swallowing (dysphagia) redness and soreness of the skin, which looks and feels like sunburn hair losson your chest Side effects should pass once the course of radiotherapy has been completed. Chemotherapy Chemotherapy uses powerful cancer-killing medication to treat cancer. There are several different ways that chemotherapy can be used to treat lung cancer. For example, it can be: given before surgery to shrink a tumour, which can increase the chance of successful surgery(this is usually only done as part of a clinical trial) given after surgery to prevent the cancer returning used to relieve symptoms and slow the spread of cancer when a cure isnt possible combined with radiotherapy Chemotherapy treatments are usually given in cycles. A cycle involves taking the chemotherapy medication for several days, then having a break for a few weeks to let your body recover from the effects of the treatment. The number of cycles of chemotherapy you need will depend on the type and the grade of your lung cancer. Most people require four to 6 courses of treatment over 3 to 6 months. Chemotherapy for lung cancer involves taking a combination of different medications. The medications are usually delivered through a drip into a vein (intravenously), or into a tube connected to one of the blood vessels in your chest. Some people may be given capsules or tablets to swallow instead. Side effects Side effects of chemotherapy can include: fatigue nausea vomiting mouth ulcers hair loss These side effects should gradually pass once your treatment has finished, or you may be able to take other medicines to make you feel better during your chemotherapy. Chemotherapy can also weaken your immune system, making you more vulnerable to infection.Tell your care team or GP as soon as possible if you have possible signs of an infection, such as a high temperature (fever) of 38C (100.4F) or more, or you suddenly feel generally unwell. Other treatments As well as surgery, radiotherapy and chemotherapy, there are a number of other treatments that are sometimes used to treat lung cancer. Biological therapies Biological therapiesare newer medications. Theyre sometimes recommended as an alternative treatment to chemotherapy for non-small-cell cancer that has spread too far for surgery or radiotherapy to be effective. Examples of biological therapies includeerlotinib and gefitinib. These are also calledgrowth factor inhibitors because they work by disrupting the growth of the cancer cells. Biological therapies are only suitable for people who havecertain proteinsin their cancerous cells. Your doctor may be able to request tests ona smallsample of cells removed from your lung (biopsy) to determine whether these treatmentsare likely to be suitable for you. Radiofrequency ablation Radiofrequency ablation is a new type of treatment that can treat non-small-cell lung cancer diagnosed at an early stage. The doctor carrying out the treatment uses a computerised tomography (CT) scanner to guide a needle to the site of the tumour. The needle will be pressed into the tumour and radio waves will be sent through the needle. These waves generate heat, which kills the cancer cells. The most common complication of radiofrequency ablation is that a pocket of air gets trapped between the inner and outer layer of your lungs (pneumothorax). This can be treated by placing a tube into the lungs to drain away the trapped air. Cryotherapy Cryotherapy is a treatment that can be used if the cancer starts to block your airways. This is known as endobronchial obstruction, and it can cause symptoms such as: breathing problems a cough coughing up blood Cryotherapy is performed in a similar way to internal radiotherapy, except that instead of using a radioactive source, a device known as a cryoprobe is placed against the tumour. The cryoprobe can generate very cold temperatures, which help to shrink the tumour. Photodynamic therapy Photodynamic therapy (PDT)is a treatment that can be used to treat early-stage lung cancer when a person is unable or unwilling to have surgery. It can also be used to remove a tumour thats blocking the airways. Photodynamic therapy is carried out in 2 stages. Firstly, youll be given an injection of a medication that makes the cells in your body very sensitive to light. The next stage is carried out 24to 72 hours later. A thin tubewill be guided to the site of the tumour, and a laser will be beamed through it. The cancerous cells, which are now more sensitive to light, will be destroyed by the laser beam. Side effects of photodynamic therapy can include inflammation of the airwaysand a build-up of fluid in the lungs. Both these side effects can cause symptoms of breathlessness and lung and throat pain. However, these symptoms should gradually pass as your lungs recover from the effects of the treatment. Living with lung cancer Breathlessness is common in people who have lung cancer, whether it is a symptom of the condition or a side effect of treatment. Inmany cases, breathlessness can beimproved with some simple measures such as: breathing in slowly through your nose and out through your mouth (after treatment for lung cancer, you may see a physiotherapist, who can teach you some simple breathing exercises) making daily activities easier  for example, using a trolley when you go shopping or keeping things you often need downstairs so you dont need to regularly walk up and down the stairs using a fan to direct cool air towards your face eating smaller and more frequent meals, and taking smaller mouthfuls Ifmeasures like these arent enough to control your breathlessness, you may need further treatment.There are a number of medications that can help improve breathlessness. Home oxygen treatmentmay be an option in more severe cases. If your breathlessness is caused by another condition, such as a chest infection ora fluid build-up around the lungs (a pleural effusion), treating thisunderlyingcausemayhelp your breathing. Read further information: Macmillan Cancer Support: Managing breathlessness Cancer Research UK: Coping with breathlessness The Roy Castle Lung Cancer Foundation: Managing lung cancer symptoms Pain Some people with lung cancer have pain, while others never have any. About 1 in 3 people who are treated forcancer experience some pain. Pain isnt related to the severity of the cancer  it varies from person to person. What causes cancer pain isnt thoroughly understood, but there are ways of treating it so the pain can be controlled. Peoplewith advanced lung cancer may need treatment for pain as their cancer progresses. This can be part of palliative care and is often provided by doctors, nurses and other members of the palliative care team. You can have palliative care at home, in hospital, in a hospice or other care centre. Read further information: Macmillan Cancer Support: Controlling cancer pain Macmillan Cancer Support: Pain Emotional effects and relationships Having cancer can lead to a range of emotions. These may include shock, anxiety, relief, sadness and depression. People deal with serious problems in different ways. Its hard to predict how living with cancer will affect you. Being open and honest about how you feel and what your family and friends can do to help you may put others at ease. But dont feel shy about telling people that you need some time to yourself, if thats what you need. Read further information: Macmillan: Cancer and your emotions Talk to others Your GP or specialist nurse may be able to reassure you if you have questions, or you may find it helpful to talk to a trained counsellor, psychologist or specialist phone helpline. Your GP practice will have information on these. You may find it helpful to talk about your experience of lung cancer with others in a similar position at a local support group. Patient organisations have local groups where you can meet other peoplewho have been diagnosed with lung cancer and had treatment. If you have feelings of depression , talk to your GP  they can provide advice and support. Read further information: The Roy Castle Lung Cancer Foundation: Lung cancer support groups Macmillan Cancer Support: Depression Money and financial support If you have to reduce or stop work because of cancer, you may find it hard to cope financially. If you have cancer or youre caring for someone with cancer, you may be entitled to financial support. If you have a job but cant work because of your illness, you are entitled to Statutory Sick Pay from your employer. If you dont have a job and cant work because of your illness, you may be entitled to Employment and Support Allowance . If youre caring for someone with cancer, you may be entitled to Carers Allowance . You may be eligible for other benefits if you have children living at home or you have a low household income. Its a good idea to find out early on what help is available to you. You could ask to speak to the social worker at your hospital, whocangive you the information you need. Read further information: GOV.UK: Carers and disability benefits . Macmillan Cancer Support: Money, finance and insurance Palliative care If you have a lot of symptoms caused by lung cancer, your GP and healthcare team will need to give you support and pain relief. This is called palliative care. Support is also available for your family and friends. As your cancer progresses, your doctor should work with you to establish a clear management plan based on your (and your carers) wishes. This includes whether youd prefer to go to hospital, a hospice, or be looked after at home as you become progressively more ill. It will take account of what services are available to you locally, whats clinically advisable and your personal circumstances. More about palliative care Read further information: NICE: Supportive and palliative care for adults with cancer Macmillan Cancer Support: Looking after ",,,,,,,,,,,,,
omeone with cancer Marie Curie Cancer Care: Support for patients Preventing lung cancer If you smoke, the best way to prevent lung cancer and other serious conditions is to stop smoking as soon as possible. However long you have been smoking, its always worth quitting. Every year you dont smoke decreases your risk of getting serious illnesses, such as lung cancer. After 10 years of not smoking, your chances of developing lung cancer falls to half that of someone who smokes. Quit Your Way Scotland can offer advice and encouragement to help you quit smoking. Your GP or pharmacist can also give you help and advice about giving up smoking. Diet Research suggests that eating a low-fat, high-fibre diet, including at least 5 portions a day of fresh fruit and vegetables and plenty ofwhole grains, can reduceyour risk of lung cancer, as well as other types of cancer and heart disease. More about eating well Exercise Theresstrong evidence to suggest that regular exercise can lower the risk of developing lung cancer and other types of cancer. Adults should do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity each week. More about keeping active Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name," location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites Cancer Research UK: Lung cancer Macmillan Cancer Support: Lung cancer The Roy Castle Lung Cancer Foundation British Lung Foundation: Lung cancer Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,
Lupus,"""Lupus | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Immune system Lupus Lupus About lupus Symptoms of lupus Causes of lupus Diagnosing lupus Treating lupus Complications of lupus About lupus Lupus is a complex and poorly understood condition that affects many parts of the body and causes symptoms ranging from mild to life-threatening. Types of lupus There are some types of lupus that just affect the skin  such as discoid lupus erythematosus and subacute cutaneous lupus erythematosus. Some medications can also cause lupus-like side effects. However, the term lupus is most often used to describe a more severe form of the condition called systemic lupus erythematosus (SLE), which can affect many parts of the body, including the skin, joints and internal organs. Symptoms range from mild to severe, and many people will have long periods with few or no symptoms before experiencing a sudden flare-up, where their symptoms are particularly severe. Even mild cases can be distressing and have a considerable impact on a persons quality of life. The rest of this article will focus on SLE. Signs and symptoms SLE can cause a wide range of symptoms, depending on the areas of the body that are affected. The most common symptoms are: fatigue (extreme tiredness) rashes  particularly on the face, wrists and hands joint painand swelling As thesymptoms of SLE can be similar to a number of other conditions, many of which are more common, it can be difficult to diagnose. If youhave persistent or troublesome symptoms that you think could be caused by SLE, you should see your GP so they can try to determine the cause. Read more about the symptoms of lupus and diagnosing lupus . What causes lupus? SLEis an autoimmune condition, which means it is caused by problems with the immune system. For reasons not yet understood, the immune system in people with SLE starts to attack and inflame healthy cells, tissue and organs. As with other more common autoimmune conditions, such as rheumatoid arthritis , it is thought a combination of genetic and environmental factorsmay beresponsible for triggeringSLE in certain people. Read moreabout the causes of lupus . Who is affected SLE is an uncommon condition where a round 90% of cases occur in women. The condition is most common in women of childbearing age (between the ages of 15 and 50), but it can also affect people of other ages. The condition tends to be less common in people of white European origin and more common in those of African, Caribbean or Asian origin. Howlupus is treated There is currently no cure for SLE, but there are different medications that can help relieve many of the symptoms and reduce the chances of organ damage. These medications include: hydroxychloroquine  a medicine that has historically been used to treat malaria , but can also help treat some symptoms of SLE corticosteroids  anti-inflammatory medications immunosuppressants  a group of medicines that suppress your immune system With good levels of support from friends, family and healthcare professionals, many people with SLE are able to manage their condition effectively. Read moreabout treating lupus . Outlook A few decades ago SLE was regarded as a terminal condition, as many people would die of an associated complication within a few years of being diagnosed. As a result of early diagnosis and advances in treatment, however, the outlook for SLE is now much better. The vast majority of people diagnosed with the condition will have a normal or near-normal life expectancy. However, some people with SLE are still at risk of life-threatening complications as a result of damage to internal organs and tissues, such as heart attack or stroke . SLE, and some of the treatments for it, can also increase your risk of developing potentially serious infections. Read more about the complications of lupus . Symptoms of lupus Symptoms of systemic lupus erythematosus (SLE) can vary widely from person to person. Some people may only experience a few mild symptoms, whereas others may be more severely affected. Even if you usually have mild symptoms, SLE can flare-up, with symptoms becoming more severe or new symptoms developing. Mainsymptoms The 3main symptoms of SLE are fatigue, joint pain andrashes. Fatigue Fatigue is one of the most common symptoms of SLE. You may feel very tired even though youget plenty of sleep. Carrying out everyday tasks, such as housework or office work, can leave you feeling exhausted. Many people with SLE find that fatigue is the most distressing and disruptive aspect of SLE because it has a negative impact ontheir work and social life. Joint pain If you have SLE, you are likely to experience joint pain in your hands and feet. You may find the pain changes from one set of joints to another quite quickly, and is usually worse in the morning. Unlike some other conditions that affect the joints, SLE is unlikely to cause your joints to become permanently damaged or deformed. Rashes Many people with SLE develop rashes on their skin  most commonly on the face, wrists and hands. A rash over the cheeks and the bridge of the nose is particularly common and is known as a butterfly rash or malar rash. Rashes caused by SLE mayget betterafter a few days or weeks, but can last longer or even be permanent. Rashes caused by SLE can sometimes be itchy or painful, and they may get worse if they are exposed to sunlight. This is known as photosensitivity. Other symptoms SLE can also cause a wide range of symptoms.However, youre unlikelyto have all of the symptoms listed below, and many people with the condition will only experiencethe main symptoms. Otherfeatures of SLE may include: a fever (high temperature) swollen lymph glands (small glands found throughout your body, including in your neck, armpits and groin) recurring mouth ulcers hair loss(alopecia) high blood pressure (hypertension) headaches and migraines stomach (abdominal) pain chest pain depression dry eyes memory loss seizures (fits) problems thinking clearly and difficulty telling the difference between reality and imagination ( psychosis ) shortness of breath Raynauds phenomenon a condition that limits the blood supply to your hands and feetwhen it is cold ankle swelling and fluid retention (oedema) When to seek medical advice You should see your GP if you have persistent or troublesome symptoms that you think could be caused by SLE. While it is likely that your symptoms are being caused by a more common condition, it is important to see a doctor for a diagnosis. Read more about diagnosing lupus . Causes of lupus Systemic lupus erythematosus (SLE) is an autoimmune condition, which means it is caused by problems with the immune system. The immune system is the bodys natural defence against illness and infection. When the immune system detects the presence of an infectious agent, such as bacteria or a virus, it sends white blood cells and antibodies to attack it. In cases of SLE, antibodies released by the immune system can attack healthy tissue, cells and organs. Its not clear exactly why this happens, although most experts think SLE has more than one cause. It has been suggested that there may be a number of genetic factors that make people more susceptible to the condition, and that it also takes one or more environmental factors to trigger SLE in those who are susceptible. Possible genetic and environmental factors are discussed in more detail below. Genetic factors Brothers and sisters of people with SLE are much more likely to develop the condition than the population at large. Researchers have identified a number of different genetic mutations that seem to make people more susceptible to developing SLE. A genetic mutation occurs when normal instructions carried in certain genes become scrambled, resulting in the bodys processes not working normally. Most faulty genes are associated with regulating certain functions of the immune system, which may explain why the immune system in people with SLE starts to malfunction. Environmental factors A number of environmental factors may be responsible for triggering SLE in vulnerable individuals, although the evidence for many of these is limited. Possible environmental factors that have been suggested include: exposure to sunlight (ultraviolet light) hormonal changes that occur during a womans lifetime, such as duringpuberty or pregnancy certain infections, such as by theEpstein-Barr virus (EBV)  a common viral infection that doesnt usually cause any symptoms smoking Diagnosing lupus Systemic lupus erythematosus (SLE) can be difficult to diagnose, as it has similar symptoms to several other, far more common, conditions. Diagnosis may also be difficultbecausesymptoms can vary greatly from person to person, and they may change over time. For example, there may be periods where your symptoms are not very noticeable, or times when they flare up and become more severe. For a confident diagnosis of SLE to be made, you will need to have several symptoms of lupus and a number of blood tests may need to be carried out. Blood tests Some of the blood tests that may be carried out are described below. Erythrocyte sedimentation rate (ESR) test A blood test called theerythrocyte sedimentation rate (ESR) test can be used todetermine whether there is any inflammation in your body. This can be useful in diagnosing SLE because the condition can causemany areas of the body to become inflamed (swell), includingthe joints and internal organs. The test works by measuring how long it takes for red blood cells to fall to the bottom ofa test tube. The quicker they fall, the more likely it is that there are high levels of inflammation. Anti-nuclear antibody test An anti-nuclear antibody test checkswhether there is a certain type of antibody cell in your blood, known as the anti-nuclear antibody. Approximately 95% of people with SLE have this antibody. However, it is possible to have the anti-nuclear antibody without having SLE, so the anti-nuclear antibody test is not a definitive way of testing for the condition.Other blood tests will also be needed to confirm the diagnosis. Anti-DNA antibody test An anti-DNA test also checks for a certain type of antibody in your blood, known as the anti-DNA antibody. If you have the anti-DNA antibody, it is highly likely that you have SLE. However, the antibody is only found in around 70% of people with the condition. The level of anti-DNA antibodies increases when SLE is more active, so during a flare-up of symptoms your reading from this test may be greater than normal. Complement level test Complement is a chemical in the blood that forms part of your immune system.The level of this chemical may be tested to check how active your SLE is. The level of complement in your blood decreases when SLE is more active. Other tests Once you have been diagnosed with SLE, you will normally need regularmonitoring to seehow the condition is affecting your body. If you have SLE it is possible you maydevelop other conditions, such as kidney problems. Monitoring your condition will allow your doctor to check for these complications and, if necessary, treat them as soon as possible. You may need to have scans, such as an X-ray , ultrasound scan, magnetic resonance imaging (MRI) scan or a computerised tomography (CT) scan to check whether SLE is affecting your internal organs. Read more about the complications of lupus . Treating lupus There is currently no cure for systemic lupus erythematosus (SLE), but treatments that can ease the symptoms and make it easier to live with are available. In most cases, treatment will involve a combination of self-care measures and medication. Protecting yourself from the sun Exposure to sunlight can sometimes make symptoms such as rashes worse, and itsimportant to protect your skin whenin the sun. This means wearing clothing that covers your skin, a wide-brimmed hat and sunglasses. You will also need to apply sunscreen with a high SPF to prevent sunburn. However, some people with lupusare not sun-sensitive and do not need to take extra precautions. As people get most of theirvitamin Das a result ofdirect sunlight onthe skin, there is a risk youmay not get enough of this vitamin if you need to avoid sun exposure.This means you may need to make an extra effort to include good sources of vitamin D in your diet to avoid problems such as osteoporosis (weakened bones), and you may be advised to take vitamin D supplements. Non-steroidal anti-inflammatory drugs (NSAIDs) Non-steroidal anti-inflammatory drugs (NSAIDs) are a common painkilling medication that reduces inflammation in the body. If you experience joint or muscle pain as a result of SLE, you may be prescribed a NSAID to help ease your symptoms. Commonly prescribed NSAIDs for SLE include ibuprofen , naproxenand diclofenac. You can buy some NSAIDs, such as ibuprofen, over the counter. These NSAIDs may be suitable if your joint or muscle pain is mild. For more severe pain, you will need stronger medication prescribed by your GP. NSAIDs may not be suitable for people who have stomach, kidney or liver problems, or have had these problems in the past. They may also be unsuitable for people with asthma. Your GP will adviseabout which NSAID is rightfor you. Side effects If taken in high doses or over long periods of time, NSAIDs can damage your stomach lining, which may cause internal bleeding. If you need to take NSAIDs on a long-term basis, your GP will carefully monitor you to check for any problems, and you may be prescribed an additional medication called a proton pump inhibitor (PPI) to protect your stomach. Hydroxychloroquine Hydroxychloroquineis a medicinethat has beenused to treat malaria , butis also effective in treating some of the symptoms of SLE, such as rashes, joint and muscle pain, and fatigue. You will usually have to take hydroxychloroquine for 6 to 12 weeks before younotice any benefit. Most expert doctors recommendpeople with SLE take hydroxychloroquine on a long-term basis as a way of controlling their symptoms, helping to prevent flare-ups and to prevent development of more serious problems from lupus. Side effects Side effects of hydroxychloroquine are uncommon, but may include indigestion , diarrhoea , headaches andrashes. Hydroxychloroquine may also cause more serious side effects in a small number of people. For example, in rare cases, this medicine can causeeye damage. Contact your GP or specialist immediately if you experience vision problems while taking hydroxychloroquine. If your GP or specialist feels it is necessary, you may need regular eye examinations. Corticosteroids Corticosteroids area type of medicine that help reduce inflammation quickly. They can be very effective in treating symptoms of SLE, but are usually only prescribed if the condition is severe. If you have severe symptoms of SLE, or if you are experiencing a flare-up, you may be given a large dose of corticosteroids to help bring your symptoms under control. As your symptoms ease, your dosage can gradually be reduced. Side effects When prescribing corticosteroids, the lowest effective dosage is always given. This is because high doses or long-term use of corticosteroids can cause side effects. These may include: thinning of your bones thinning of your skin weight gain high blood pressure (hypertension) Corticosteroids are a safe and effective form of treatment, providedthey are taken correctly and under the supervision of your GP or specialist. They will tailor the steroid dose to your disease activity, to minimise side effects while effectively controlling the condition. Immunosuppressants Immunosuppressants are a type of medicine that suppress your immune system. They can help improve your symptoms of SLE by limiting the damageyour immune system causes when it attacks healthy parts of your body. Commonly prescribed immunosuppressant medicines include azathioprine,methotrexate, mycophenolate mofetiland cyclophosphamide. Immunosuppressants are sometimes used in conjunction with corticosteroids (see above) because these medicines may ease your symptoms more effectively when used together. Alternatively, the use of immunosuppressant medication may allow your corticosteroid dose to be reduced. Side effects Immunosuppressant medication is usually only prescribed if you have severe SLE. This is because this type of medication is powerful and can cause side effects such as: loss of appetite vomiting diarrhoea swollen gums bruising or bleeding more easily headache acne extra hair growth weight gain liver damage an increased risk of infection (see below) Methotrexate, mycophenolate mofetil and cyclophosphamide can also cause birth defects if they are taken during pregnancy, so you should use a reliable form of contraception if you are taking these medications and are sexually active. If you are trying to become pregnant, an alternative medication such as azathioprine can be used. Tell your GP if a side effect becomes particularly troublesome, asit may mean your dose needs to be adjusted. Infection risk Taking immunosuppressant medication can increase your risk of developing an infection. This is a particularly seriousconcern for people with SLE, because the organ damage that can occur as a resultof the condition means infections are more likely to be life-threatening. It is thereforevery important to report anysymptoms of a possible infection to your GP immediately. Symptoms of infection may sometimes be similar to a flare up ofSLE and include: a fever (high temperature) a cough or breathlessness burning when passing urine orpassing blood inyour urine diarrhoea You should also try to avoid contact with anyone known to have an infection  even if it is an infection you were previously immune to, such as chickenpox or measles .This is because your previous immunity to these conditions will probably be suppressed (lowered). Rituximab Rituximabis a new type of medicationused in people with severe SLEthatdoesnt respond to other treatments. Rituximab was originally designed to treat certain types of cancer, such as lymphoma , but it has since proved effective in treating a number of autoimmune conditions, such as SLE and rheumatoid arthritis . Rituximab works by locking on to and killing cells called B-cells, which produce antibodies responsible for the symptoms of SLE. It is administered directly into your vein over the course of several hours, known as an infusion. Rituximab is not currently licensed for treating SLE in the UK, but your specialist may consider it an appropriate treatment for you. If your doctor suggests using rituximab, they should tell you that there are currently some uncertainties about how effective or safeit is in treating SLE. Side effects Common side effects of rituximab include: flu -like symptoms, such as chills and a high temperature dizziness vomiting In rare cases, rituximab can cause a more serious allergy-like reaction. Most reactions occur during or shortly after the treatment is given, so you will be closely monitored once your treatment begins. Belimumab Belimumab is a new medication given to people with active SLE who dont respond to other treatments. Itworks by binding to growth factors that are needed for the survival of B-cells. It is given directly into your vein over several hours, known as an infusion. The first 3doses are given 14 days apart, andthe medication is usually given once a month thereafter. Belimumab is licensed for treating SLE in the UK, and there may be instances where your specialist may consider it an appropriate treatment for you. If your doctor suggests using belimumab, they should tell you that there are currently some uncertainties about how effective or safe it is in treating SLE. Side effects Common side effects of belimumab include: flu-like symptoms, such as chills and a high temperature nausea and diarrhoea headache difficulty sleeping ( insomnia ) a cough, sore throat and blocked or runny nose joint pain increased risk of infections changes in blood pressure In rare cases, belimumab can cause a more serious allergy-like reaction. Most reactions occur during or shortly after the treatment is given, so you will be closely monitored once your treatment begins. Complications of lupus If your symptoms of systemic lupus erythematosus (SLE) are mild or well-controlled, you may find it barely affects your day-to-day life and that you do not have any complications. However, for some people, SLE can be a more serious conditionthat can cause life-threatening complications. Some ofthesecomplications are outlined below. Kidney problems Around 1in every 3people with SLEwill develop a potentially serious kidney disease called lupus nephritis, which is caused by prolonged inflammation of the kidneys. Lupus nephritis tends to develop relatively early in the course of SLE, usually within five years of diagnosis. Symptoms of lupus nephritis can include: swelling of your feet (oedema) headaches dizziness blood in your urine a frequent need to urinate Lupus nephritis can also cause high blood pressure (hypertension). If left untreated, it can put you at risk of developing life-threatening problems such as a heart attack or stroke . In many cases, lupus nephritis does not cause any noticeable symptoms. However, this does not mean the condition is not dangerous, as the kidneys could still be being damaged. If you have SLE, it is likely you will need to have regular blood tests so the condition of your kidneys can be carefully monitored. If you develop lupus nephritis, it can usually be successfully controlled using immunosuppressants such as mycophenolate mofetil or cyclophosphamide. In a small number of cases, the kidney damage can become severe enough to require treatment with dialysis (where a machine is used toreplicates many of the kidneys functions) or a kidney transplant. Cardiovascular disease Cardiovascular disease (CVD) is a general term for any type of health condition that affects the heart and arteries. It is often associated withblood clots andatherosclerosis(hardening and narrowing of the arteries). Examples of CVD include coronary heart disease , angina (chest pain caused by the heartnot receiving enough blood), heart attack and stroke. People with SLE are more likely to develop CVDthan the general population, because SLE can cause your heart and arteries to become inflamed and damaged. If you have SLE, you can reduce your risk of CVD by making health lifestyle chances, such as: stopping smoking if you smoke eating a healthy, balanced diet low in saturated fat, sugar and salt, and containing at least five portions of fruit and vegetables a day maintaining a healthy weight exercising regularly  at least150 minutes (two-and-a-half hours) a week of exercise strenuous enough to leave you slightly out of breath is recommended cutting down on your alcohol consumption Pregnancy complications SLE does not usually affect fertility, but it can increase your risk of experiencing pregnancy complications, such as: pre-eclampsia (a condition that causes high blood pressure during pregnancy) premature delivery miscarriage stillbirth Some children of women with SLE can also be born with heart block (where electrical pulses that control the beating of the heart are disrupted) and rashes. This is known as neonatal lupus syndrome. If you have SLE and are thinking of having a baby, it is best to plan this carefully with your doctors if possible. The risk of complications is higher if you become pregnant during periods where your symptoms are particularly severe, so you will usually be advised to try to avoid getting pregnant until your symptoms are better controlled. If you do become pregnant, you will need to be monitored closely by your specialist andby an obstetrician, so they can check for any problems. Source: NHS 24 - Opens in new browser window Last updated: 22 February 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Arthritis Sjogren's syndrome Other health sites Lupus UK NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Lyme disease,"Lyme disease | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Lyme disease Lyme disease Learn about the symptoms, causes, treatment, and when to speak to your GP. What is Lyme disease? Lyme disease is a bacterial infection spread to humans by infected ticks. Its also known as Lyme borreliosis. Ticks are tiny spider-like creatures found in woodland and moorland areas. They feed on the blood of birds and mammals, including humans. Lyme disease is usually easier to treat the earlier its diagnosed. Find out more about tick bites and how to treat them Symptoms of Lyme disease Many people with early symptoms of Lyme disease develop a circular rash around the tick bite . The rash: usually develops around 3 to 30 days after youve been bitten is often described as looking like a bulls-eye on a dart board will be red and the edges may feel slightly raised may get bigger over several days or weeks is typically around 15 cm (6 inches) across, but it can be much larger or smaller Some people may develop several rashes in different parts of their body. Around 1 in 3 people with Lyme disease wont develop a rash. Other symptoms of Lyme disease Some people with Lyme disease also have flu-like symptoms in the early stages, like: tiredness (fatigue) muscle pain joint pain headaches a high temperature (fever) chills neck stiffness When to contact your GP Speak to a GP if: Youve been bitten by a tick and you: develop a rash have flu-like symptoms Remember to tell them youve been bitten by a tick. Later symptoms of Lyme disease More serious symptoms may develop if Lyme disease is left untreated or is not treated early. These can include: pain and swelling in the joints nerve problems  such as numbness or pain in your limbs memory problems difficulty concentrating heart problems Some of these problems will get better slowly with treatment. But they can persist if treatment is started late. A few people with Lyme disease go on to develop long-term symptoms similar to those of fibromyalgia or chronic fatigue syndrome.This is known as post-infectious Lyme disease. Its not clear exactly why this happens. Its likely to be related to overactivity of your immune system rather than continued infection. How you get Lyme disease If a tick bites an animal carrying the bacteria that cause Lyme disease, the tick can become infected. The tick can then transfer the bacteria to a human by biting them. Ticks dont jump or fly. They climb on to your clothes or skin if you brush against something theyre on. They then bite into the skin and start to feed on your blood. Generally, youre more likely to become infected if the tick is attached to your skin for more than 24 hours. Ticks are very small and their bites are not painful, so you may not realise you have one attached to your skin. Where are ticks found? Ticks are found throughout the UK and in other parts of Europe and North America. There are a high number of ticks in the Scottish Highlands. They can be found in any areas with deep or overgrown plants where they have access to animals to feed on. Theyre common in woodland and moorland areas, but can also be found in gardens or parks. Whos at risk of Lyme disease? The risk of getting Lyme disease is higher: for people who spend time in woodland or moorland areas from March to October because more people take part in outdoor activities Its thought only a small proportion of ticks carry the bacteria that cause Lyme disease. Being bitten doesnt mean youll definitely be infected. However, its important to be aware of the risk and speak to a GP if you start to feel unwell. Diagnosing Lyme disease Diagnosing Lyme disease is often difficult as many of the symptoms are similar to other conditions. There are 2 kinds of blood test use to diagnose Lyme disease. The tests are not always accurate in the early stages of Lyme disease. So you may need tested more than once if you still have symptoms after a negative result. Treating Lyme disease If you have symptoms of Lyme disease, youll normally be given antibiotics . If youre prescribed antibiotics, its important you finish the course even if youre feeling better. Thisll help ensure all the bacteria are killed. If your symptoms are particularly severe, you may need antibiotic injections (intravenous antibiotics). Some of the antibiotics used to treat Lyme disease can make your skin more sensitive to sunlight. You should avoid prolonged exposure to the sun and not use sunbeds until after you have finished the treatment. Theres currently no agreement on the best treatment for post-infectious Lyme disease. This is because the underlying cause is not yet clear. Be wary of internet sites offering alternative diagnostic tests and treatments. These may not be supported by scientific evidence. Preventing Lyme disease Theres currently no vaccine available to prevent Lyme disease. The best way to prevent it is to adopt easy habits when youre in the countryside or near wildlife. Do try to stick to hard paths wear long trousers in overgrown areas tuck your trousers into your socks wear insect repellent check for ticks on your body after walking or camping NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Lymphoedema,"Lymphoedema - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Blood and lymph Lymphoedema Lymphoedema About lymphoedema Symptoms of lymphoedema Causes of lymphoedema Diagnosing lymphoedema Treating lymphoedema Complications of lymphoedema Preventing lymphoedema About lymphoedema Lymphoedema is a chronic (long-term) condition that causes swelling in the bodys tissues. It can affect any part of the body, but usually develops in the arms or legs. Other symptoms of lymphoedema can include an aching, heavy feeling in affected body parts and difficulty moving them. Lymphoedema can get worse if its not treated, so you should speak to a doctor if you think you may have the condition. Read more about the symptoms of lymphoedema and diagnosing lymphoedema What causeslymphoedema? Lymphoedema is caused by a problem with the lymphatic system. This is a network of vessels and glands distributed throughout the body. Its major functions are helping to fight infection and drain excess fluid from tissues. Abnormal development of the lymphatic system, damage to it, and/or an increase in fluid in the body tissues can all lead to lymphoedema. There are two main types of lymphoedema: primary lymphoedema  caused by faulty genes affecting the development of the lymphatic system; it can develop at any age, but usually occurs in early adulthood secondary lymphoedema  caused by damage to the lymphatic system or problems with the movement and drainage of fluid in the lymphatic system, often due to an infection, injury, cancer treatment, inflammation of the limb or a lack of limb movement Read more about the causes of lymphoedema Who is affected A recent study has suggested that over 200,000 people in the UK may be living with lymphoedema. Secondary lymphoedema has been shown to affect approximately one in five women after breast cancer treatment. Primary lymphoedema is less common than secondary lymphoedema, and is estimated to affect around one in every 6,000 people. How lymphoedema is treated There is no cure for lymphoedema, but it is usually possible to control the main symptoms using techniques to minimise fluid build-up and stimulate the flow of fluid through the lymphatic system. These include wearing compression garments, taking good care of your skin, moving and exercising regularly, having a healthy diet and lifestyle, and using specialised massage techniques. Read more about treating lymphoedema and preventing lymphoedema Complications The build-up of fluid in the tissues of people with lymphoedema means they are more vulnerable to infection. In particular, a bacterial infection of the skin called cellulitis is commonly reported in people with the condition. Read more about the complications of lymphoedema Symptoms of lymphoedema The main symptom of lymphoedema is swelling in all or part of a limb or another part of the body, which can cause problems fitting into clothes, or jewellery and watches starting to feel tight. At first, the swelling may come and go. It may get worse during the day and then go down overnight. Without treatment, it will usually become more severe and persistent. Other symptoms in an affected body part can include: an aching, heavy feeling difficulty with movement repeated skin infections the skin becoming hard and tight folds developing in the skin wart-like growths developing on the skin a leakage of fluid through the skin When these symptoms start depends on what is causing the condition. If lymphoedema is caused by abnormal development of the lymphatic system (a network of channels and glands distributed throughout the body that remove unwanted bacteria and particles from the body), the symptoms can develop at any age, but most commonly start during infancy, adolescence or early adulthood. In these cases, the swelling may start on one side of the body to begin with, although the other side will usually become swollen as well over time  particularly the lower leg. If lymphoedema is caused by damage to the lymphatic system, the symptoms can develop at any time. For example, if your lymphatic system is damaged due to treatment for breast cancer , lymphoedema may not develop for several months or even years. Read more about the causes of lymphoedema When to seek medical advice If you are at risk of developing lymphoedema because you have had treatment for cancer , you may be offered an assessment for the condition as part of your treatment aftercare plan. Speak to your consultant or specialist nurse if you have any concerns. If you think you may have lymphoedema, but not as a result of treatment for cancer, see your GP. Read more about diagnosing lymphoedema Causes of lymphoedema There are two types of lymphoedema, called primary and secondary lymphoedema, which have different causes. The main causes of primary and secondary lymphoedema are outlined below. Primary lymphoedema Primary lymphoedema is caused by alterations (known as mutations) in genes responsible for the development of the lymphatic system (a network of channels and glands distributed throughout the body that help fight infection and remove excess fluid from the body). These faulty genes result in the parts of the lymphatic system responsible for draining fluid not developing properly or not working as they should. Primary lymphoedema usually runs in families, but not every child born to someone with the condition will develop it themselves. Secondary lymphoedema Secondary lymphoedema develops in people who previously had a normal lymphatic system. It can have a number of different causes. Some of the most common causes are explained below. Surgical treatment of cancer Cancer cells can spread around the body through the lymphatic system, so part of the treatment for the condition can involve surgically removing sections of the lymphatic system potentially containing cancerous cells. Although the surgeon will try to ensure limited damage to your lymphatic system, this isnt always possible. There is a particular risk of lymphoedema occurring as a complication of treatment for: breast cancer melanoma skin cancer gynaecological cancers  such as cervical cancer and vulval cancer genitourinary cancers  suchas prostate cancer or penile cancer Radiotherapy Radiotherapy uses controlled doses of high-energy radiation to destroy cancerous tissue, but it can also damage healthy tissue. If its necessary to use radiotherapy to destroy cancerous cells in your lymphatic system, there is a risk that the system could become permanently damaged and unable to drain fluid properly. Infections In some cases, an infection can cause lymphoedema. Cellulitis is a bacterial skin infection that can cause lymphoedema. Severe cellulitis can damage the tissue around the lymphatic system, causing it to become scarred. Another infectious cause of lymphoedema is a parasitic infection called filariasis. This is a common cause of lymphoedema worldwide, but is not a risk in the UK. Inflammation Conditions that cause tissue to become inflamed (red and swollen) can also permanently damage the lymphatic system. Medical conditions that can cause lymphoedema include: rheumatoid arthritis  which causes pain and swelling in the joints eczema  which causes the skin to become itchy, reddened, dry and cracked Venous diseases Venous diseases, which affect the flow of blood through the veins, can cause lymphoedema in some people. The abnormal or damaged veins can result in excessive fluid leaking from the blood into the tissue spaces. This overwhelms and eventually exhausts the parts of the lymphatic system responsible for draining this fluid. Some venous diseases that can lead to lymphoedema include: deep vein thrombosis (DVT)  a blood clot in one of the deep veins in the body varicose veins (swollen and enlarged veins)  where poor drainage of blood in the veins causes higher vein pressure, and more fluid passes into the surrounding tissues Obesity People who are obese, particularly those who are severely obese, have an increased risk of developing lymphoedema. Its not clear exactly why this is, but it has been suggested that the extra fatty tissue affects the lymphatic channels in some way, reducing the flow of fluid through them. In these cases, weight loss is an important part of treatment and even just starting to lose weight can make a big difference. Trauma and injury In a small number of cases, lymphoedema can be caused by an accidental injury to the lymphatic system. For example, lymphoedema can sometimes occur after extensive soft tissue loss or bruising. Immobility Movement and exercise helps lymph drainage, as muscle activity surrounding the lymphatic vessels massages fluid into and along them. Therefore, reduced movement can lead to lymphoedema, because the fluid in the lymphatic system does not get moved on, causing swelling. For example, people who are unable to move fully for a long time due to an illness or surgery may be at risk of lymphoedema. Diagnosing lymphoedema If youre being treated for cancer and are at risk of developing lymphoedema, youll be monitored for the condition afterwards. Otherwise, see your GP if you experience symptoms of swelling. There are a number of specialist lymphoedema treatment centres in the UK. Your doctor may refer you to one of these for further assessment. A list of treatment centres near you is available from the Lymphoedema Support Network. In many cases, its possible to make a diagnosis of lymphoedema by: asking about your symptoms and medical history examining the affected body part and measuring the distance around it to see if its enlarged Further tests Although not necessary in most cases, further tests may occasionally be used to assess and monitor your condition. These tests are explained below. Measuring limb volume In some cases, tests to calculate the volume of an affected limb may be carried out. These may include: a tape measure to measure the circumference of the limb at certain intervals, to calculate its volume water displacement  where you place the affected limb in a tank of water and the amount of water that is displaced is measured to calculate the volume of the limb perometry  infrared light is used to measure the outline of an affected limb and calculate its volume Bioimpedance testing During a bioimpedance test, electrodes (small metallic discs) are placed on different parts of your body. The electrodes release a small and painless electric charge that is measured using a handheld device. Changes in the strength of the current can indicate the presence of fluid in your tissue. Imaging tests Imaging tests may also be used to help diagnose and monitor lymphoedema. These include: a lymphoscintigraph  you are injected with a radioactive dye that can be tracked using a special scanner; this shows how the dye moves through your lymphatic system and can check for any blockages a magnetic resonance imaging (MRI) scan  which uses a strong magnetic field and radio waves to produce detailed images of the inside of your body an ultrasound scan  which uses high-frequency sound waves to create an image of the inside of your body a computerised tomography (CT) scan  which uses X-rays and a computer to create detailed images of the lymph nodes These scans can be used to create a clearer picture of the affected tissue. Treating lymphoedema The recommended treatment for lymphoedema is decongestive lymphatic therapy (DLT). DLT is not a cure for lymphoedema, but it can help control the symptoms. Although it takes time and effort, the treatment can be used to effectively control your lymphoedema. Decongestive lymphatic therapy (DLT) There are four components to DLT: compression bandages and garments  to move fluid out of the affected limb and minimise further build-up skin care  to keep the skin in good condition and reduce the chances of infection exercises  to use muscles in the affected limb to improve lymph drainage specialised massage techniques  known as manual lymphatic drainage (MLD)  to stimulate the flow of fluid in the lymphatic system and reduce swelling Each of these components is described in more detail below. DLT usually begins with an intensive phase of therapy, during which you may receive daily treatment for several weeks to help reduce the volume of the affected body part. This is followed by the second phase, known as the maintenance phase. During this, you will be encouraged to take over your own care by carrying out simple self-massage techniques, wearing compression garments and continuing to exercise. This phase of treatment aims to maintain the reduced size of the affected body part. You may then have reviews every few months to check how your treatment is progressing. Compression bandages and garments Unlike the blood circulation system, there is no central pump, such as the heart, to move fluid around the lymphatic system. Instead, the lymphatic system uses the massaging effect of surrounding muscles to move the fluid. If you have lymphoedema, you will have special bandages or garments (such as sleeves, gloves, stockings or tights) fitted over any affected limbs. These will support the affected muscles during exercise and encourage them to move fluid out of the affected limb. These may also be applied after a session of MLD, to prevent fluid accumulating in the limb again. This use of compression bandages and garments is known as multilayer lymphoedema bandaging. Velcro wraps may be used instead of bandages and have the advantage that the person with lymphoedema can apply them themselves. You will be taught how to correctly apply your own bandages and compression garments, so you can continue to use them during the maintenance period. Skin care Taking good care of your skin is important, because it will reduce your risk of developing an infection, such as cellulitis . Read our page on preventing lymphoedema for more skin care advice. Movement and exercises Your lymphoedema care team will help devise an exercise and movement plan designed to strengthen and stimulate the muscles involved in lymph drainage. They will also help you to lose weight, if you are overweight. This will be tailored to your requirements and ability. Your plan may involve specific limb exercises, as well as gentle activities that involve the whole body, such as swimming, cycling and walking. Massage To begin with, you may receive specialised massages called manual lymphatic drainage (MLD)  usually carried out by a specialist therapist  to move fluid from the swollen areas into working lymph nodes, where it can be drained. Your lymphoedema therapist will also teach you a range of simpler massage techniques that you or your carer can use during the maintenance phase of treatment, to help keep the swelling down. These self-massage techniques are known as simple lymphatic drainage (SLD). Surgery In a small number of cases, surgery may be considered to treat lymphoedema. There are three main types of surgery that may be useful for the condition: the removal of sections of excess skin and underlying tissue (debulking) the removal of fat from the affected limb (liposuction)  see below the restoration of the flow of fluid around the affected section of the lymphatic system  for example, by connecting the lymphatic system to nearby blood vessels (lymphaticovenular anastomosis) These treatments may help to reduce the size of areas of the body affected by lymphoedema, but some are still experimental  particularly lymphaticovenular anastomosis  and are not in widespread use. Liposuction Liposuction is where a thin tube is inserted through small incisions in the skin to suck fat out of tissue. It can be used to remove excess fat from an affected limb to help reduce its size. Once the surgery is complete, you will have to wear a compression garment on the affected limb day and night for at least a year to help keep the swelling down. The National Institute for Health and Care Excellence (NICE) states that liposuction for chronic (long-term) lymphoedema appears to be safe, and may be effective in the short term. However, NICE says there is not enough evidence of its long-term effectiveness and safety. Access to liposuction for lymphoedema may be limited, depending on what is available from your local NHS Clinical Commissioning Group (CCG). Complications of lymphoedema Cellulitis is the most common complication of lymphoedema, but psychological issues can also occur as a result of the condition. These complications are explained below. Cellulitis Many people with lymphoedema experience repeated episodes of cellulitis (also known as erysipelas). Cellulitis is a bacterial infection of the deep layer of skin (dermis) and the layer of fat and soft tissues (the subcutaneous tissues) that lie underneath the skin. Cellulitis can occur as a result of lymphoedema and can also cause the condition. Symptoms of cellulitis can include: redness and a feeling of heat in the skin pain in the affected area a high temperature (fever) chills Cellulitis can usually be successfully treated with antibiotics , although severe cases may need to be treated in hospital. In some cases, you may be provided with a short supply of antibiotic tablets to use as soon as you notice symptoms of cellulitis. Alternatively, you may be given a long-term course of antibiotics to take to prevent infection. Psychological impact Living with a chronic (long-term) condition that affects your appearance, such as lymphoedema, can cause a great deal of distress and lead to periods of depression . If you have been feeling particularly down for the last few months and you no longer take pleasure in the things you usually enjoy, you may be depressed. If this is the case, talk to your GP or members of your lymphoedema treatment team, because there are effective treatments for depression. Talking to other people who also have lymphoedema can be reassuring and decrease feelings of isolation, stress and anxiety. The Lymphoedema Support Network offers information and advice, and can put you in touch with a support group in your area. Remember: if you persevere with your treatment plan, your symptoms should eventually become less noticeable. Read more about treating lymphoedema Preventing lymphoedema Its not possible to completely prevent lymphoedema, but the following steps may help reduce your chances of developing the condition. If you already have lymphoedema, this advice may stop it getting worse. Skin care The part of your body affected by lymphoedema is more vulnerable to infection of the build-up of fluid within the tissues. Any cuts in your skin can allow bacteria to enter your body and may quickly develop into an infection. Skin infections can also damage your lymphatic system and cause lymphoedema to develop. You can reduce your chances of developing skin infections by: not having injections or blood pressure readings in the affected area whenever possible treating cuts and scratches immediately with an antiseptic cream using insect repellents to prevent insect bites moisturising the skin daily to keep it supple  your GP can prescribe a suitable cream avoiding very hot baths and showers  the heat from saunas, steam rooms and sun beds may also increase the swelling using sun cream with a high sun protection factor (SPF) to prevent sunburn wearing gloves for gardening and household tasks to avoid cuts, if your upper limbs are affected using anti-fungal powder to prevent fungal infections in your skin or feet, if your lower limbs are affected cutting your nails with nail clippers seeing a chiropodist for foot and nail care  but make sure you tell them you have lymphoedema wearing shoes that fit correctly and provide support on the top of your feet, if your lower limbs are affected using an electric razor if you need to shave to reduce the risk of cutting yourself not wearing tight-fitting clothes or jewellery Contact your GP as soon as possible if you develop symptoms of a possible skin infection, such as redness and a feeling of heat in the skin. Healthy lifestyle Adopting a healthy lifestyle may also help reduce your risk of developing lymphoedema, and may help control the condition if you already have it. This includes: eating a healthy diet maintaining a healthy weight exercising regularly Source: NHS 24 - Opens in new browser window Last updated: 09 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Breast cancer (female) Radiotherapy Other health sites Lymphoedema Support Network Cancer Research UK: Lymphoedema Macmillan Cancer Support: Lymphoedema Breast Cancer Care: lymphoedema NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Lymphogranuloma venereum (LGV),"Lymphogranuloma venereum (LGV) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Sexual and reproductive Lymphogranuloma venereum (LGV) Lymphogranuloma venereum (LGV) British Sign Language (BSL) |  | Polski | Romn | slovenina Lymphogranuloma venereum (LGV) is a sexually transmitted infection. Its caused by a strain of chlamydia bacteria. LGV is rare in Scotland and is mostly found in men who have sex with men . LGV in women is very rare. Symptoms of LGV Most people with LGV dont notice any symptoms and dont know they have it. So its important to get tested if you think youre infected. If you do develop symptoms, you may experience: swollen lymph glands in the groin (in one or both sides) an ulcer or sore on the penis, vagina or around the anus You may notice some anal symptoms such as: blood or pus from the anus on underwear or toilet paper pain in the anal area when pooing or having receptive anal sex constipation, painful straining or diarrhoea when trying to poo a feeling of incomplete emptying after pooing Testing for LGV If you think you might have LGV, get tested for free by: booking an appointment at your local sexual health service contacting your GP practice for an appointment What does the LGV test involve? If you test positive for chlamydia , and your symptoms suggest that you might have LGV, the lab will do a further test for LGV. The test for LGV is simple, painless and very reliable. It involves sending a sample from the area of the body thought to be infected to a lab for analysis. This can take up to 3 weeks. The 2 main ways the sample can be collected are: using a swab  a small cotton bud is gently wiped over the area that might be infected, such as inside the vagina, throat, or inside the anus urine sample  this should ideally be done at least 1 or 2 hours after you last peed Your partner (s) for the past 3 months should also be tested for LGV. Treatment for LGV Antibiotics will treat the LGV infection. The result of the LGV test can take 3 weeks to come back, so your doctor may advise you to start treatment before the final result is available. If left untreated, LGV can cause scarring and swelling of the skin. It can also cause permanent swelling of the genitals. Rectal infection can also cause swelling and scarring resulting in the risk of long-term bowel complications. Rarely the infection may spread via the bloodstream causing inflammation of the joints or liver. To avoid passing LGV on to your partner(s) you should avoid having sex until both you and your partner have finished your treatment. How LGV is passed on You can get LGV by having unprotected vaginal, anal or oral sex (sex without a condom). Your risk of getting LGV may be increased by: chemsex having group sex fisting sharing sex toys that arent washed or covered with a new condom each time theyre used How to prevent LGV The best way to reduce your risk of STIs is to practice safer sex . This means using a condom for vaginal, anal and oral sex. Other STIs If you have been diagnosed with LGV you should get tested for all STIs including: gonorrhoea syphilis HIV Source: Scottish Government - Opens in new browser window Last updated: 26 February 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Other languages and formats British Sign Language (BSL) |  | Polski | Romn | slovenina British Sign Language (BSL) |  | Polski | Romn | slovenina Add this page to\n            Info For Me Also on NHS inform Book a sexual health appointment online Lymphogranuloma venereum (LGV) (BSL) Lymphogranuloma venereum (LGV) (Chinese) Lymphogranuloma venereum (LGV) (Polish) Lymphogranuloma venereum (LGV) (Romanian) Lymphogranuloma venereum (LGV) (Slovak) Other health sites BASHH: sexual health NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Malaria,"Malaria | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Malaria Malaria About malaria Preventing and treating malaria About malaria Malaria is a serious tropical disease spread by mosquitoes. If it isnt diagnosed and treated quickly, it can be fatal. A single mosquito bite is all it takes for someone to become infected. Symptoms of malaria Its important to be aware of the symptoms of malaria if youre travelling to areas where theres a high risk of the disease. This means that you can get medical attention quickly. Symptoms are similar to those of flu and usually appear 6 to 30 days after the mosquito bite, but it can sometimes take up to a year for symptoms to start. The initial symptoms of malaria include: a high temperature (fever) headache sweats chills muscle aches or pains vomiting and or diarrhoea These symptoms can start mild and may be difficult to identify as malaria. When to seek medical attention Malaria is a serious illness that can get worse very quickly. It can be fatal if not treated quickly. The effects of malaria are usually more severe in: babies young children pregnant women older people Phone 111 or go to A&E if: you or your child develop symptoms of malaria during or after a visit to an area where the disease is found, even if it has been several weeks, months or a year after you return from travelling You must tell the healthcare professional that you have been in a country with a risk of malaria, including any brief stopovers. What causes malaria? Malaria is caused by the Plasmodium parasite. The parasite is spread to humans through the bites of infected mosquitoes. There are 5 different types of Plasmodium parasite that cause malaria in humans. They are found in different parts of the world (but do overlap in certain areas) and vary in terms of how severe the infection can be. All malaria infections cause the same symptoms and require immediate medical attention. Its not possible to find out which type of malaria you have from symptoms alone. Types of malaria parasite Plasmodium falciparum  mainly found in Africa, its the most common type of malaria parasite and is responsible for most malaria deaths worldwide, though treatment does cure the infection. Plasmodium vivax  mainly found in Asia and South America, this parasite causes milder symptoms but it can stay in the liver for years which can result in symptoms reoccurring if it isnt treated properly. Plasmodium ovale  fairly uncommon and usually found in West Africa. Plasmodium malariae  this is quite rare and usually only found in Africa. Plasmodium knowlesi  this is very rare and found in parts of southeast Asia. How malaria is spread The Plasmodium parasite is spread by mosquitoes. These are known as night-biting mosquitoes because they most commonly bite between sunset and sunrise. When a mosquito bites a person already infected with malaria, it becomes infected and spreads the parasite to the next person it bites. Malaria cant be spread directly from person to person. When an infected mosquito bites, the parasite enters the blood and travels to the liver. In the liver, it develops for days to weeks before re-entering the blood. This is the point where symptoms develop and urgent treatment is required. Although it is very rare, malaria can also be spread from a person with the infection through blood transfusions and sharing needles. Where is malaria found? Malaria is found in tropical and subtropical regions of the world. It is not found in the UK or Europe. The fitfortravel website has more information about the risk of malaria in individual countries . Complications of malaria Malaria is a serious illness that can be fatal if not diagnosed and treated quickly. Severe complications of malaria can occur within hours or days of the first symptoms. This means it is important to seek urgent medical help as soon as possible. Anaemia The destruction of red blood cells by the malaria parasite can cause severe anaemia . Anaemia is a condition where the red blood cells are unable to carry enough oxygen to the bodys muscles and organs. This can leave you feeling drowsy, weak and faint. Cerebral malaria In rare cases, malaria can affect the brain. This is known as cerebral malaria which can cause your brain to swell, sometimes leading to permanent brain damage. It can also cause fits (seizures) or coma. Other complications Other complications that can arise as a result of severe malaria include: liver failure and jaundice  yellowing of the skin and whites of the eyes shock  a sudden drop in blood pressure pulmonary oedema  a build-up of fluid in the lungs acute respiratory distress syndrome (ARDS) abnormally low blood sugar  hypoglycaemia kidney failure swelling and rupturing of the spleen dehydration Malaria in pregnancy If you get malaria while pregnant, you and your baby have an increased risk of developing serious complications like: premature birth  birth before 37 weeks of pregnancy low birth weight restricted growth of the baby in the womb stillbirth miscarriage death of the mother Pregnant women are advised to avoid travelling to regions with a risk of malaria. Visit your GP, midwife, obstetrician or travel health advisor for a full discussion if youre pregnant and are thinking of travelling to a high-risk area. Not all antimalarial tablets are safe in pregnancy and its important you get specific advice. Preventing and treating malaria If you travel to an area that has malaria, you are at risk of the infection. Its very important that you take precautions to prevent the disease and get treatment immediately if symptoms do develop. Preventing malaria Malaria can often be avoided using the ABCD approach to prevention, which stands for: Awareness of risk  find out whether youre at risk of getting malaria Bite prevention  use insect repellent, cover your skin with clothing, and use a mosquito net to avoid mosquito bites Check whether you need to take antimalarial prevention tablets by visiting a travel health clinic  if you do, make sure you take the right antimalarial tablets at the right dose and finish the course Diagnosis  seek immediate medical advice if you have malaria symptoms, including up to a year after you return from travelling Being aware of the risks Check whether youre travelling to a malaria risk area on the fitfortravel website Visit your local travel clinic for malaria advice as soon as you know that you are travelling to a risk area. If you grew up in a country where malaria is common, any natural protection will be quickly lost when you move. This means you need to protect yourself from infection if youre now travelling to a risk area, even if thats where you grew up. Further information about travel health and vaccinations . Preventing mosquito bites Avoiding mosquito bites is one of the best ways to prevent malaria. This is particularly important during early evening and at night when mosquitoes bite. There are several steps you can take to avoid being bitten. Do mosquitoes cant bite through clothing so wear light, loose-fitting clothing that will cover your arms and legs apply insect repellent to all areas of your skin that are not covered by clothing, including your face and neck remember to reapply insect repellent frequently sleep under a mosquito net thats been treated with an insecticide, or in a room with effective air conditioning The most effective repellents contain 50% diethyltoluamide (DEET). These are available in: sprays roll-ons sticks creams Theres no evidence to suggest that other remedies protect against malaria, such as homeopathic remedies, electronic buzzers, vitamins B1 or B12 , garlic, yeast extract spread (Marmite), tea tree oils or bath oils. Further information on mosquito bite prevention is available from the fitfortravel website. Antimalarial tablets Antimalarial tablets can help prevent you from developing a malaria infection. For the best protection, you must also follow mosquito bite prevention advice. You must start taking antimalarial tablets before travel and continue taking them whilst travelling in the risk area. Antimalarial tablets must also be taken for a period of time after you have left the risk area. How long antimalarial tablets should be taken will depend on which tablet is used. Antimalarial tablets dont stop malaria from entering your body. However, they do stop the infection from developing inside your body and prevent you from getting ill. If you stop taking your antimalarial tablets early (even when you are back in the UK) you could still become ill with malaria. Taking antimalarial medication You may need to take a short trial course of antimalarial tablets before travelling. This is to check that side effects do not occur and that you do not have an adverse reaction. If you do, alternative antimalarials can be prescribed before you leave. Do make sure you get the right antimalarial tablets before you go  visit a travel health clinic for advice on which is the best antimalarial for you follow the instructions included with your tablets carefully make sure you complete the full course of tablets Theres currently no vaccine available that offers protection against malaria. Types of antimalarial medication The type of antimalarial tablets that you will be recommended is based on the following information: where youre going any relevant family medical history your medical history, including any allergies to medication any medication youre currently taking any problems youve had with antimalarial medicines in the past your age whether youre pregnant If youve taken antimalarial medication in the past, dont assume its suitable for future trips. The type of antimalarial that you will need to take depends on which strain of malaria is carried by the mosquitoes in an area. It will also depend on whether theyre resistant to certain types of antimalarial medication. The main types of antimalarials used to prevent malaria are: Atovaquone plus proguanil (also known as Maloff protect or Malarone) Doxycycline (also known as Vibramycin-D) Mefloquine (also known as Lariam) To find out what type of antimalarial medication is best for you, visit your local travel clinic. Treating malaria If malaria is diagnosed and treated quickly, you should fully recover. Treatment should be started as soon as possible. Treatment begins in a hospital to make sure complications dont suddenly develop. Treatment is with tablets or capsules. If someone is very ill, treatment will be given through a drip into a vein in the arm (intravenously). Treatment for malaria can leave you feeling very tired and weak for several weeks. The type of medicine and how long you need to take it will depend on: the type of malaria you have the severity of your symptoms whether you took preventative antimalarial tablets your age whether youre pregnant Source: NHS 24 - Opens in new browser window Last updated: 04 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Malignant brain tumour (cancerous),"Malignant brain tumour (cancerous) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Malignant brain tumour (cancerous) Malignant brain tumour (cancerous) About malignant brain tumours Symptoms of malignant brain tumours Causes of malignant brain tumours Diagnosing malignant brain tumours Treating malignant brain tumours Recovering from malignant brain tumours About malignant brain tumours A malignant brain tumour is a fast-growing cancer that spreads to other areas of the brain and spine. Generally, brain tumours are graded from 1 to 4, according to their behaviour, such as how fast they grow and how likely they are to grow back after treatment. A malignant brain tumour is either grade 3 or 4, whereas grade 1 or 2 tumours are usually classed as benign or non-cancerous. Most malignant tumours are secondary cancers, which means they started in another part of the body and spread to the brain. Primary brain tumours are those that started in the brain. These pages focus on high-grade brain tumours. For information about grade1 or2 tumours, read our pages on low-grade (benign) brain tumours . Signs andsymptoms The symptoms of a malignant brain tumour depend on how big it is and where it is in the brain. Common symptoms include: severe, persistent headaches seizures (fits) persistent nausea, vomiting and drowsiness mental or behavioural changes, such as memory problems or changes in personality progressive weakness or paralysis on one side of the body, vision problems, or speech problems Speak to your GP if you have persistent symptoms of a brain tumour. While its unlikely to be a tumour, its best to be sure by getting a proper diagnosis. Read more about the symptoms ofmalignant brain tumours and diagnosingmalignant brain tumours . Types of malignant tumours Mostmalignant brain tumours develop from the glialtissue, which supports the brains nerve cells.These tumours are known asgliomas. Gliomas can be separated further, depending on the cells they developed from. For example: an astrocytoma develops from cells thought to provide the brains framework an oligodendroglioma develops from the cells that produce the fatty covering of nerves an ependymoma develops from the cells that line the cavities in the brain Its also possible to have a malignant tumour thats a mixture of these types or developed in a different part of the brain. Who is affected Brain tumours can affect people of any age, including children, although they tend to be more common in older adults. The exact cause of primary malignant brain tumours is unknown, although its thought that certain genetic conditions and previous radiotherapy treatment to the head may increase the risk of one developing. Read more about the causes of malignant brain tumours . How malignant brain tumours are treated A primary malignant brain tumour needs to be treated as soon as possible, because it can spread and damage other parts of the brain and spinal cord. Surgery will usually need to be carried out to remove as much of the tumour as possible. This may befollowed byradiotherapyand/or chemotherapy to kill any cancerous cells left behind and reduce the chances of the tumour regrowing. However, malignant tumours will often eventually return after treatment. If this happens, or if you have a secondary tumour, a cure isnt usually possible and treatment can instead be used to improve symptoms and prolong life. Readmore about treating malignant brain tumours . Living with a brain tumour Living with a brain tumour is not easy.You may feelworried and anxious about whats going to happen to you and your family. This is perfectly normal. It can help to seek accurate medical information about your specific tumour and its treatment, make sure youre closely involved in decisions about your care, and ask your care team about anything youre not sure about. You can read more about living with a brain tumour on The Brain Tumour Charitys website . Your doctormay be able torefer you to a counsellor if you want to talk about the emotional aspects of diagnosis and treatment. There are also many organisations and helplines that can help, such as The Brain Tumour Charity and Brain Tumour Research . Support for carers Being a carer is not an easy role. When you are busy responding to the needs of others, it can deplete your reserves of emotional and physical energy, and make it easy for you to forget your own health and mental wellbeing. Research on carers health shows that high numbers of carers suffer health effects through caring. If you are trying to combine caring with a paid job or looking after a family, this can cause even more stress. However, neglecting your own health doesnt work in the long term. If youre caring for someone else, its important to look after yourself and get as much help as possible. Its in your best interests and those of the person you are caring for. For more information on the support available to you and benefits you may be entitled to, visit Care Information Scotland . Symptoms of malignant brain tumours The symptoms of a malignant brain tumour depend on how big it is and where it is in the brain. When symptoms do occur, it is because the brain tumour is either putting pressure on the brain or preventing an area of the brain from functioning properly. Signs of increased pressure on the brain Common symptoms of increased pressure within the skull include: severe, persistent headaches  which are typically worse in the morning or when bending over or coughing persistent nausea and vomiting drowsiness vision problems  such asblurred vision,floaters andloss of vision that may come and go seizures (fits)  which may affect the whole body or just involve a twitch in one area Symptoms caused by the position of a tumour Different areas of the brain control different functions, so the symptoms caused by a brain tumour will depend on where the tumour is located. For example, a tumour affecting: the frontal lobe may cause changes in personality, weakness in one side of the body and loss of smell the temporal lobe may causeforgetfulness,language problems (aphasia) and seizures the parietal lobe may cause aphasia andnumbness or weakness in one side of the body the occipital lobe may cause loss of vision on one side the cerebellum may cause a loss of co-ordination, flickering of the eyes, vomiting and a stiff neck the brain stem may cause unsteadiness and difficulty walking, facial weakness, double vision, and difficulty speaking (dysarthria) and swallowing ( dysphagia ) When to speak to your GP Its important to speak to a doctor if you develop persistent and worrying symptoms that may be caused by a brain tumour. While its unlikely that you have a tumour, its best to be sure by getting a proper diagnosis. If your GP is unable to identify a more likely cause of your symptoms, they may refer you to a neurologist for further assessment and tests, such as a brain scan. Read more about diagnosingmalignant brain tumours . Causes of malignant brain tumours Most malignant brain tumours are caused by a cancer that started somewhere else in the body and spread to the brain, through the bloodstream. These are known as secondary tumours. Cancers that can spread to the brain include lung cancer , breast cancer , bowel cancer and melanoma skin cancer . Some primary malignant brain cancers(cancerous tumours that start in the brain) are caused by a previously benign brain tumour becoming cancerous, but usually the exact reason why a primarytumour develops is unknown. Age Brain tumours affect people of all ages, including children, but the risk tends to increase as you get older. Most tumours affect people over 50 years of age. Family history People with a family history of brain tumours may be at a slightly increased risk of developinga brain tumour themselves. Radiotherapy If your brain is exposed to radiation during radiotherapy , your risk of developingcertain types ofbrain tumour later on is increased. Genetic conditions Some genetic conditions can increase your risk of a brain tumour, such as: neurofibromatosis type 1orneurofibromatosis type 2 tuberous sclerosis Turcot syndrome Li-Fraumeni cancer syndrome von Hippel-Lindau syndrome Gorlin syndrome Unlike most brain tumours, tumours associated with these conditions tend to developin childhood or early adulthood. Can mobile phones cause brain tumours? There have beenreports in the media about a possible connection between brain tumours and the radiofrequency (RF) energy emitted by mobile phones. RF energy produces heat, which can increase body temperature and damage tissue exposed to it. However, its thought that the amount of RF energy people are exposed to from mobile phones is too low to produce significant tissue heating or an increase in body temperature. Research is underway to establish whether RF energy has any long-term health effects, but the balance of evidence currently available suggests that its unlikelymobile phones cause health problems. Diagnosing malignant brain tumours Speak to your GP if you develop any of the symptoms of a malignant brain tumour , such as a persistent and severe headache. Your GP willexamine you and ask about your symptoms. They may also carry out a simple neurological examination. If they suspect you may have a tumour, or they are not sure whats causing your symptoms, youll probably be referred to a neurologist (brain and nerve specialist). Neurological examination Your GP or neurologist maycarry out a test of your nervous system, called a neurological examination, to look for problems associated with abrain tumour. Thismay involve tests of your: hand and limb strength reflexes, such as your knee-jerk reflex hearing and vision skin sensitivity balance and co-ordination memory and mental agility (using simple questions or arithmetic) A neurologist may also recommend one or morefurther tests. Further tests Other tests you may have to help diagnose a brain tumour include: a computerised tomography (CT) scan  this produces a detailed picture of your brain using a series of X-rays a magnetic resonance imaging (MRI) scan  this produces a detailed picture of your brain using a strong magnetic field and radio waves an electroencephalogram (EEG) where electrodes attached to your scalp record your brain activity to look for any abnormalities If a tumour is suspected, a biopsy (surgical removal of a small piece of tissue) may be taken to establish the type of tumour and the most effective treatment. Under anaesthetic, a small hole (known as a burr hole) is made in the skull and a very fine needle is used to obtain a sample of tumour tissue. Youll probably need to stay in hospital for a few days afterwards. Treating malignant brain tumours If you have a malignant brain tumour, youll usually need surgery to remove as much of it as possible. Radiotherapy and/or chemotherapy may then be used to treat any remaining cancerous tissue. The aim of this is to remove or destroy as much of the tumour as possible, ideally getting rid of thecancerous cells completely. However, this isnt always possible and mostmalignantbrain tumours will eventually return after treatment. If your tumour does return after treatment, or youhave a secondary brain tumour (where cancer has spread to your brain from another part of your body), a cure isnt usually possible. Treatmentcan insteadbe usedto control your symptoms andprolong life. Your treatment plan There are a number of different treatments formalignant brain tumours, and deciding on what you feel is the best treatment can be confusing. A group of different specialists called a multidisciplinary team (MDT) will be involved in your care and will recommend what they think is the best treatment option for you, but the final decision will be yours. Before visiting hospital to discuss your treatment options, you may find it useful to write a list of questions that youd like to ask. For example, you may want to find out the advantages and disadvantages of particular treatments. Surgery Surgery will be recommended for most people with a malignant brain tumour. If the size or position of the tumour mean surgery is not possible, one or more of the treatments described below may be recommended instead. The main operation used to treat people with brain tumours is called a craniotomy. You will be given a general anaesthetic so you are asleep while theprocedure is carried out. An area of your scalp will be shaved and a section of the skull is cut out as a flap to reveal the brain and tumour underneath. The surgeon can then remove asmuch of the tumour as possible and secure the flap of skull back in place with metal screws. After surgery, treatment withradiotherapyand/or chemotherapy may be recommended to kill any cancer cells left behind and reduce the risk of the tumour coming back. Radiotherapy Radiotherapy is a treatment where a beam ofhigh-energy radiationis focused on the tumour to kill the cancerous cells. It can be used after surgery or as the main treatment for tumours thatare difficult to remove. Radiotherapy isusually given in several doses (fractions) spread over the course of a week. An entire course of treatment will usually last up to 6 weeks in total. Possible side effects of radiotherapy for a brain tumour include nausea, temporary hair loss, tiredness and red, sore skin. Read more about the side effects of radiotherapy . In a smallnumber of cases, a similar treatment calledproton beam therapy may be recommended. However, this is only suitable in very specific cases and currently, youll need to be referredfor treatment abroad if your doctor thinks its appropriate. Chemotherapy Chemotherapy is a medication used to kill cancerous cells. It may beused alongside radiotherapy or on itsown, eitherto help kill any cancerous cells leftbehind after surgery or to help relieve your symptoms when a cure is not possible. Chemotherapy medication for brain tumours can be given in a number of ways, including as: tablets (orally) temozolomide and procarbazineare given in this way injections into a vein (intravenously) vincristine is given in this way small, disc-likeimplants placed in the brain during surgery  carmustinecan begiven in this way, but isonly recommended if90% or more of the tumour has beenremoved The side effects of chemotherapy largely depend on the specific medication youre taking. Common general side effects include tiredness, headaches, temporary hair loss and nausea. Read more about the side effects of chemotherapy . For more information about some of the treatments used, see the guidelines from theNational Institute for Health and Care Excellence (NICE) on carmustine implants to treat gliomas and temozolomide for recurrent malignant glioma . Radiosurgery Stereotactic radiosurgery (SRS) is a special type of radiotherapy thats sometimes used to treat brain tumours that cant be safely removed with surgery. During the treatment, several small beams of radiation are used to very accuratelydeliver a high dose of radiation to the tumour,usually in a single treatment session. As the radiation beams can be aimed very precisely, a high dose of radiation can be delivered to the tumour with minimal damage to the surrounding healthy cells. This means youre less likely to experience many of the usual side effects of radiotherapy. Recoverytends to be much fasterand an overnight stay isnt usuallynecessary. However, radiosurgery is currently only available in a few specialised centres across the UK and is only suitable for certain people, based on the characteristics of their tumour. Treating symptoms You may also be given medication to relieve some of the symptoms you mayhave as a result of yourbrain tumour. These may include: anticonvulsants to prevent seizures (fits) corticosteroids to reduceswelling and pressure in the brain painkillers to treat headaches anti-emetics to prevent vomiting Depending on your circumstances, these medications may be given before, after, or instead of surgery. Choosing not to have treatment If your tumour is at an advanced stage or in a difficult place in the brain, a cure may not be possible and treatment may only be able to control the cancer for a period of time. This means you will be getting the side effects of treatment without getting rid of the tumour. In this situation, it may be difficult to decide whether or not to go ahead with treatment. Talk to your doctor about what will happen if you choose not to be treated, so you can make an informed decision. If you decide not to have treatment, you will still be given palliative care , which will control your symptoms and make you as comfortable as possible. Recovering from malignant brain tumours After being treated for a brain tumour, you may need additional care to monitor and treat any further problems. Follow-up appointments Malignantbrain tumours often grow back after treatment, so regular follow-up appointments will be recommended to look for signs that this may have happened. These appointments may include a discussion of any worrying new symptoms you experience, a physical examination, andoccasionally a brain scan. You willusuallyhave follow-up appointments at least every few months to begin with, but they may be needed less frequently over time if no problems develop. Supportive treatment Problems caused by a brain tumourdont always resolve as soon asthe tumour is removed or treated. For example, some people have persistent weakness, seizures (fits), difficulty walking and speech problems. In these cases,you may needextra support to help you overcome or adapt toany problems you have. This may includetherapies such as: physiotherapy to help with any movement problems you have occupational therapy  to identify any problems youre having with daily activities andarrange forany equipment or alterations to your home that may help speech therapy  to help you with anycommunication or swallowing problems Some people may also need to continue taking medication for seizures for a few months or more after their tumour has been treated or removed. The National Institute for Health and Care Excellence (NICE) has made recommendations on the standards of care that brain tumour patients should receive. For more information, see the service guidance for improving outcomes for people with brain and other central nervous system tumours. Drivingand travelling You may not be allowed to drive for a while after youve had a brain tumour. This willdepend on things such asthe type of brain tumour you had, where it was in the brain, and what symptoms you have. If you are required to give up your driving licence and notify the DVLA , they will speak to your GP or specialistto determine when you can drive again. With up-to-date scans and advice from your medical team, you may be allowed to drive again once an agreed period has passed and you have successfully completed a medical test to determine your ability to control a vehicle. You can find out about brain tumours and driving on the Cancer Research UK website. Flying is usually possible from 3 months after treatment. Sports and activities After you have been treated for a brain tumour, you must permanently avoid contact sports, such as rugby and boxing. You can start other activities again, with the agreement of your doctor, once you have recovered. Swimming unsupervised is not recommended for around 1 year after treatment, as there is a risk you could have anepileptic fit while in the water. Sex and pregnancy Its safe to have sex after treatment for a brain tumour. Women may be advised to avoid becoming pregnant for 6 months or more after treatment.If youre planning to become pregnant, you should discuss this with your medical team. Going back to work Youll usually tiremore easily following treatment for a brain tumour. You may wish to return to work and normal life as soon as possible, but its probably a good idea to return part-time to begin with and only go back full-time when you feel able to. If youve experienced seizures,you shouldntwork with machinery or at heights. Emotional support A brain tumour is often life-changing. You may feel angry, frightened and emotionally drained. If it will help, your doctor or specialist may be able to refer you to a social worker and counsellor for help with the practical and emotional aspects of your diagnosis. There are also many organisations that canprovide information and support, such as The Brain Tumour Charity and Brain Tumour Research . Social support If you have been diagnosed with a brain tumour, your treatment and medical care will probably be the first thing on your mind. But there are other aspects of your life to think about and it is important to know exactly what kind of assistance is available and where you can get it. If you are finding it hard to cope with day-to-day life, talk about your needs with your doctor or nurse, who will refer you to a social worker. Your social worker will assess exactly the kind of help you need. Help you may need might include: a care attendant, who can help with housework, dressing and washing, or even just keep you company and give your carer a break a meals on wheels service income support, disability living allowance or attendance allowance equipment andadaptationsfor your home For more information about whathelp youmight need and how you can access it, visit Care Information Scotland . Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Brain tumours: Children Brain tumours: Teenagers and young adults Brain tumours Other health sites The Brain Tumour Charity Brain Tumour Research Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Malnutrition,"""Malnutrition | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Nutritional Malnutrition Malnutrition Malnutrition means poor nutrition. Most commonly this is caused by not eating enough (undernutrition) or not eating enough of the right food to give your body the nutrients it needs. A balanced diet should provide enough nutrients like calories, protein and vitamins, to keep you healthy. Without this, you may not be getting all the nutrients you need and this can lead to malnutrition. Malnutrition can result in: unplanned weight loss muscle loss a low body mass index (BMI) vitamin and mineral deficiencies This can leave you feeling tired, weak and affect your ability to recover from an illness. Symptoms of malnutrition Malnutrition can be difficult to recognise. It can happen very gradually, which can make it very difficult to spot in the early stages. Common signs and symptoms of malnutrition include: loss of appetite and lack of interest in food or fluids unplanned weight loss  this might cause clothing, rings, watches or dentures to become loose tiredness or low energy levels reduced ability to perform everyday tasks like showering, getting dressed or cooking reduced muscle strength  for example, not being able to walk as far or as fast as usual changes in mood which might cause feelings of lethargy and depression poor concentration poor growth in children increased risk of infection, recurrent infections, taking longer to recover and poor wound healing difficulty keeping warm dizziness Speak to your GP if: you have any of the symptoms of malnutrition you notice a drop in weight or youve lost weight without trying Conditions that cause malnutrition Sometimes, medical conditions cause your body to need more nutrients. Some medical conditions can lead to your body being unable to absorb or use nutrients. These may include: cancer and liver disease that can cause a lack of appetite, persistent pain or nausea COPD , pulmonary fibrosis and emphysema, which cause your body to need more nutrients but can reduce your appetite mental health conditions, like depression or schizophrenia , which may affect your ability to look after yourself Crohns disease , ulcerative colitis or cystic fibrosis that disrupt your bodys ability to digest food or absorb nutrients burns, fractures and post major surgery, due to increased demand for nutrients dementia  people with dementia may be unable to communicate their needs, may use up a lot of calories pacing or may experience a loss of appetite dysphagia  a condition that makes swallowing difficult or painful persistent vomiting or diarrhoea Some types and combinations of medication can increase your risk of developing malnutrition. Always check your medicines information and speak to a healthcare professional for advice if you have a concern. Do not stop taking your medication without advice from a healthcare professional. Other causes of malnutrition Physical, social and ageing issues can also cause malnutrition. Physical issues Physical issues can contribute to malnutrition. For example: if your teeth are in a poor condition, if your dentures do not fit, or if you have a sore mouth, eating can be difficult or painful you may lose your appetite as a result of losing your sense of smell and taste you may have a physical disability or other physical impairment that makes it difficult for you to cook or shop for food yourself Social factors Social issues that can contribute to malnutrition include: living alone and being socially isolated having limited knowledge about nutrition or cooking reduced mobility alcohol or drug use low income or poverty reliance on food banks Ageing As we get older we might become more likely to experience malnutrition. This might be because of how we feel, and physical and social factors. The risk also increases because were more likely to have one or more medical conditions as we get older. Diagnosing malnutrition A healthcare professional can assess you for malnutrition using a screening tool like Malnutrition Universal Screening Tool (MUST) . Screen yourself for malnutrition Treating malnutrition If youve lost weight or your appetite is poor, you can make simple changes to your meals, snacks and drinks to help treat malnutrition. Choosing nutrient-dense food and drinks can help improve your calorie intake. This might not be suitable for everyone, especially those with other conditions like dysphagia. Ask your GP, dietitian or nurse for further advice if youre unsure. You should speak to a healthcare professional if youve had to limit the fat and sugar you eat in the past due to a health condition like high cholesterol or diabetes. Ways to increase your calories Try the following ideas to help you to increase the amount of calories and protein in your diet. Do eat little and often  3 small meals a day with 2-3 snacks in-between meals include protein like meat, fish, chicken, eggs, beans or lentils in each meal add high calorie ingredients like full cream milk, cheese, butter, ghee, olive oil and cream to meals and drinks include puddings after your lunch and dinner like creamy yoghurts, custards, rice pudding, milk puddings or ice-cream try ready meals if you dont feel like cooking choose nourishing milky drinks like malted drinks, hot chocolate, milky coffee and milkshakes choose high sugar drinks like fruit juice, smoothies, fizzy drinks or squash (you can also add egg powder to juice to increase its nutrients) try including 1 pint of full cream milk each day  you can fortify (add extra nutrients to) this by adding 4 tablespoons of dried milk powder  and use this in drinks, cooking, cereals and puddings Dont do not have drinks just before meals because this can make you feel fuller quicker do not choose low fat, sugar-free, diet foods and drinks  for example skimmed milk If youre using vegan alternatives to cheese, butter, cream or milk, try to choose the highest calorie option. How to add extra nutrients to milk Watch this video to find out how to fortify your milk with milk powder. You can then use this instead of your usual milk. How to add extra nutrients to juice Watch this video to find out how to fortify your juice using egg powder. Easy ways to fortify your food There are ways you can use every day food and drinks to fortify (add extra nutrients to) your food. Butter Add extra butter to: sandwiches or toast mashed potatoes vegetables sauces baked potatoes snacks like pancakes, crumpets and scones biscuits or crackers Sugar, jam and honey Add sugar, jam or honey to: puddings hot drinks milkshakes or smoothies glazed vegetables creamy yogurts fruit porridge or cereal Cream, chocolate spread, peanut butter or nuts Add cream, chocolate spread, peanut butter or nuts to: porridge fruit sauces soups smoothies or milkshakes snacks (toast, pancakes, crumpets, scones, waffles, rice cakes) ice cream or puddings Vegetarian and vegan food If you follow a vegetarian or vegan diet, you can use the following foods to fortify your diet: nut butters vegan cheese vegan cream dairy free milks like oat, soya and nut milks (try to choose the sweetened options that provide the most calories) hemp and pea protein powders avocado plant based spreads Try to choose the highest calorie and protein options available. Snacks Try to eat high calorie and protein snacks like: crackers or oatcakes with cheese, pate, hummus or avocado crumpets, scones and pancakes with butter and jam thick and creamy yoghurts soya yoghurts or desserts milk jelly, chocolate pots and mousses custard, trifle and rice pudding pots dried fruit nuts and seeds cereal bar and flapjacks mini pork pie, sausage roll, scotch egg and spring rolls chocolate, biscuits, pastries and cakes crisps with dip fruit with chocolate spread or peanut butter Food fortification video Watch this video for ideas of how to add extra nutrients to your food. The British Dietetic Association (BDA) Malnutrition factsheet provides more useful practical advice. Watch this video on Vimeo for more tips on how to fortify your food Oral nutritional supplements Oral nutritional supplements (ONS) are a range of liquid and powder products that help support better nutrition. They contain calories, protein, vitamins and minerals to help increase your intake. Theyre designed to be taken alongside your diet and the food first advice above to promote progress with your weight. Tube feeding (enteral feeding) Depending on how severe your symptoms are, your healthcare professional might recommend a feeding tube. There are different types of tubes. Which one is best for you depends on your diagnosis and symptoms. The most common types of feeding tube include: nasogastric  through your nose and into your stomach nasojejunal  though your nose and further into your digestive tract percutaneous endoscopic gastrostomy (PEG)  a tube is placed directly into the stomach via your abdomen Depending on your condition alternative routes of nutrition may be considered. Source:\r\n                                        The Scottish Dietetic Prescribing Support Group - Opens in new browser window Last updated: 21 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Alzheimer's disease Depression Cancer Dysphagia (swallowing problems) Dementia COPD Crohn's disease Ulcerative colitis Cystic fibrosis Liver disease Other health sites Age UK Macmillan Cancer Support: Information and support Alzheimer Scotland NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Measles,"Measles | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Measles Measles Measles is an infection that spreads very easily. Its unpleasant and can sometimes have serious complications. Having the measles, mumps and rubella (MMR) vaccine is the best way to prevent it. Anyone can get measles if they havent been vaccinated or they havent had it before. Its most common in young children. Measles usually clears in around 7 to 10 days. Symptoms of measles The first symptoms of measles develop around 10 days after youre infected. These can include: cold-like symptoms, such as a runny nose, sneezing, and a cough sore, red eyes that may be sensitive to light watery eyes swollen eyes a high temperature (fever), which may reach around 40C (104F) small greyish-white spots in the mouth aches and pains loss of appetite tiredness, irritability and a general lack of energy The measles rash appears around 2 to 4 days after the initial symptoms and normally fades after about a week. The rash: is made up of small red-brown, flat or slightly raised spots that may join together into larger blotchy patches usually first appears on the head or neck, before spreading outwards to the rest of the body is slightly itchy for some people Measles rash Go to A&E or phone 999 if: You or your child have measles and: shortness of breath a high temperature that does not come down after taking paracetamol or ibuprofen is coughing up blood drowsiness confusion fits (convulsions) Phone your GP urgently if: you think you or your child might have measles youve been in close contact with someone who has measles and youve not been fully vaccinated (had 2 doses of the MMR vaccine) or havent had the infection before  even if you dont have any symptoms youve been in close contact with someone who has measles and youre pregnant  measles can be serious in pregnancy you have a weakened immune system and think you have measles or have been in close contact with someone with measles If your GP is closed, phone 111. You should phone your GP first before visiting. They can make arrangements to reduce the risk of spreading the infection to others. Is measles serious? Measles can be unpleasant, but will usually pass in about 7 to 10 days without causing any further problems. Once youve had measles, your body builds up resistance (immunity) to the virus. Its highly unlikely youll get it again. However, measles can lead to serious and potentially life-threatening complications in some people. These include infections of the lungs (pneumonia) and brain (encephalitis). How measles is spread The measles virus is contained in tiny droplets that come out of the nose and mouth when an infected person coughs or sneezes. You can easily catch measles by breathing in these droplets. Or, if the droplets have settled on a surface, by touching the surface and then placing your hands near your nose or mouth. The virus can survive on surfaces for a few hours. People with measles are infectious from when the symptoms develop until about 4 days after the rash first appears. How to prevent spreading measles to others If you have measles: stay off school or work for at least 4 days from when the rash first appears regularly wash your hands with soap use and dispose of tissues when you sneeze avoid close contact with anyone who isnt fully vaccinated How measles can be prevented Measles can be prevented by having the MMR vaccine . This is given in 2 doses as part of the NHS childhood vaccination programme. You can be vaccinated at any age if you havent been fully vaccinated before. If the MMR vaccine isnt suitable for you, a treatment called human normal immunoglobulin (HNIG) can be used if youre at immediate risk of catching measles. Treatment for measles There are things you can do to help relieve your symptoms. Do take paracetamol or ibuprofen to relieve fever, aches and pains  aspirin should not be given to children under 16 years old drink plenty of water to avoid dehydration close the curtains to help reduce light sensitivity use damp cotton wool to clean the eyes In severe cases, especially if there are complications, you or your child may need to be admitted to hospital for treatment. Source: NHS 24 - Opens in new browser window Last updated: 01 February 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform MMR vaccine MMR against measles NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Meningitis,"Meningitis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Meningitis Meningitis About meningitis Causes of meningitis Treating meningitis Complications of meningitis Preventing meningitis About meningitis Meningitis is an infection of the protective membranes that surround the brain and spinal cord (meninges). It can affect anyone, but is most common in babies, young children, teenagers and young adults. Meningitis can be very serious if not treated quickly. It can cause life-threatening blood poisoning (septicaemia) and result in permanent damage to the brain or nerves. A number of vaccinations are available that offer some protection against meningitis. Symptoms of meningitis Symptoms of meningitis develop suddenly and can include: a high temperature (fever) over 37.5C (99.5F) being sick a headache a blotchy rash that doesnt fade when a glass is rolled over it (this wont always develop) a stiff neck a dislike of bright lights drowsiness or unresponsiveness seizures (fits) These symptoms can appear in any order and some may not appear. When to get medical help You should get medical advice as soon as possible if youre concerned that you or your child could have meningitis. Trust your instincts and dont wait until a rash develops. Phone 999 for an ambulance or go to your nearest accident and emergency (A&E) department immediately if you think you or your child might be seriously ill. Phone 111 or your GP practice for advice if youre not sure if its anything serious or you think you may have been exposed to someone with meningitis. How meningitis is spread Meningitis is usually caused by a bacterial or viral infection. Bacterial meningitis is rarer but more serious than viral meningitis. Infections that cause meningitis can be spread through: sneezing coughing kissing sharing utensils, cutlery and toothbrushes Meningitis is usually caught from people who carry these viruses or bacteria in their nose or throat but arent ill themselves. It can also be caught from someone with meningitis, but this is less common. Read more about the causes of meningitis Vaccinations against meningitis Vaccinations offer some protection against certain causes of meningitis. These include the: meningitis B vaccine  offered to babies aged 8 weeks, followed by a second dose at 16 weeks, and a booster at 1 year 6-in-1 vaccine  offered to babies at 8, 12 and 16 weeks of age pneumococcal vaccine  offered to babies at 12 weeks and between 12 and 13 months old meningitis C vaccine  offered at 12 weeks of age, 1 year MMR vaccine  offered to babies at 1 year and a second dose at 3 years and 4 months meningitis ACWY vaccine  offered to teenagers who are in S3 (around 14 years of age) at school. Young people who are in S4-S6 and missed the opportunity to get immunised last year, may also get the vaccine at school this year Read more about the meningitis vaccinations Treatments for meningitis People with suspected meningitis will usually have tests in hospital to confirm the diagnosis and check whether the condition is the result of a viral or bacterial infection. Bacterial meningitis usually needs to be treated in hospital for at least a week. Treatments include: antibiotics given directly into a vein fluids given directly into a vein oxygen through a face mask Viral meningitis tends to get better on its own within 7 to 10 days and can often be treated at home. Getting plenty of rest and taking painkillers and anti-sickness medication can help relieve the symptoms in the meantime. Read more about how meningitis is treated Outlook for meningitis Viral meningitis will usually get better on its own and rarely causes any long-term problems. Most people with bacterial meningitis who are treated quickly will also make a full recovery, although some are left with serious, long-term problems. These can include: hearing loss or vision loss, which may be partial or total problems with memory and concentration recurrent seizures (epilepsy) co-ordination, movement and balance problems loss of limbs  amputation of affected limbs is sometimes necessary Overall, its estimated that up to 1 in every 10 cases of bacterial meningitis is fatal. Read more about the complications of meningitis Causes of meningitis Meningitis is usually caused by a viral or bacterial infection. Viral meningitis is the most common and least serious type. Bacterial meningitis is rare but can be very serious if not treated. Severaldifferent viruses and bacteria can cause meningitis, including: meningococcal bacteriathere are several different types, called A, B, C, W, X, Y and Z pneumococcal bacteria Haemophilus influenzae type b (Hib) bacteria enteroviruses viruses that usually only cause a mild stomach infection the mumps virus the herpes simplex virus a virus that usually causes cold sores or genital herpes A number of meningitis vaccinations provide protectionagainst many of the infections that cancause meningitis. How meningitis is spread The viruses and bacteria that cause meningitis can be spread through: sneezing coughing kissing sharing utensils, cutlery and toothbrushes The infection is usually spread by people who carry these viruses or bacteria in their nose or throat, but arent ill themselves. The infection can also be spread by someone with meningitis, although this is less common. Its possible to get meningitis more than once. Whos most at risk? Anyone can potentially get meningitis, but its more common in: babies and young children teenagers and young adults elderly people people with a weak immune system for example, those with HIV and those having chemotherapy You can reduce therisk of getting meningitis by ensuring all your vaccinations are up-to-date. Read more about meningitis vaccinations Treating meningitis People with suspected meningitis will usually need to have tests in hospital and may need to stay in hospital for treatment. Tests in hospital Several tests may be carried out to confirm the diagnosis and check whether the condition is the result of a viral or bacterial infection. These tests may include: a physical examination to look for symptoms of meningitis a blood test to check for bacteria or viruses a lumbar puncture  where a sample of fluid is taken from the spine and checked for bacteria or viruses a computerised tomography (CT) scan to check for any problems with the brain, such as swelling As bacterial meningitis can be very serious, treatment with antibiotics will usually start before the diagnosis is confirmed and will be stopped later on if tests show the condition is being caused by a virus. Treatment in hospital Treatment in hospital is recommended in all cases of bacterial meningitis, as the condition can cause serious problems and requires close monitoring. Severe viral meningitis may also be treated in hospital. Treatments include: antibiotics given directly into a vein fluids given directly into a vein to prevent dehydration oxygen through a face mask if there are any breathing difficulties steroid medication to help reduce any swelling around the brain, in some cases People with meningitis may need to stay in hospital for a few days, and in certain cases, treatment may be needed for several weeks. Even after going home, it may be a while before you feel completely back to normal. Additional treatment and long-term support may also be required if any complications of meningitis occur, such as hearing loss . Treatment at home Youll usually be able to go home from hospital if you or your child has mild meningitis and tests show its being caused by a viral infection. This type of meningitis will normally get better on its own without causing any serious problems. Most people feel better within 7 to 10 days. In the meantime, it can help to: get plenty of rest take painkillers for a headache or general aches take anti-emetic (anti-sickness) medicine for any vomiting Preventing the spread of infection The risk of someone with meningitis spreading the infection to others is generally low. But if someone is thought to be at high risk of infection, they may be given a dose of antibiotics as a precautionary measure. This may include anyone who has been in prolonged close contact with someone who developed meningitis, such as: people living in the same house pupils sharing a dormitory a boyfriend or girlfriend People who have only had brief contact with someone who developed meningitis wont usually need to take antibiotics. Complications of meningitis Most people make a full recovery from meningitis, but it can sometimes cause serious, long-term problems and can be life threatening. This is why its so important to get medical help as soon as possible if you think you or your child has symptoms of meningitis ,and why meningitis vaccinations are offered to certain groups. Its estimated up to1 person inevery2 or 3 who survives bacterial meningitisis left with 1 or more permanent problems. Complications are much rarer after viral meningitis. Main complications Some of the most common complications associated with meningitis are: hearing loss ,which may be partial or totalpeoplewho have had meningitis will usually have ahearing test after a few weeks to check for anyproblems recurrent seizures (epilepsy) problems with memory and concentration co-ordination, movementand balanceproblems learning difficulties and behavioural problems vision loss, which may be partial or total loss of limbsamputationis sometimes necessary to stop the infection spreading through the body and remove damaged tissue bone and joint problems, such as arthritis kidney problems Overall, its estimated up to 1 in every 10 cases of bacterial meningitis is fatal. Treatment and support Additional treatment and long-term support may berequired if you or your child experience complications of meningitis. For example: cochlear implants, which are small devices that are inserted into the ears to improve hearing,may be needed in cases of severe hearing loss read more about treatment for hearing loss prosthetic limbs and rehabilitation supportmay helpif it was necessary to amputate any limbs read more about recovering after an amputation counselling and psychological support may help if the trauma of having meningitiscauses problems such as disturbed sleep, bedwetting,or fear of doctors and hospitals You may alsofindit useful to get in touch with organisations such as the Meningitis Research Foundation or Meningitis Now forsupport and advice about life after meningitis. Preventing meningitis Meningitis can be caused by a number of different infections, so several vaccinations offer some protection against it. Children should receive most of these as part of the NHS vaccination schedule. Speak to your GP if youre not sure whether your or your childs vaccinations are up-to-date. Meningitis B vaccine The meningitis B vaccine offers protection against meningococcal group B bacteria, which are a common cause of meningitis in young children in the UK. The vaccine is recommended for babies aged8 weeks, followed by a second dose at 16 weeks, and a booster at one year. 6-in-1 vaccine The 6-in-1 vaccine, also known as the DTaP/IPV/Hib/HepB vaccine, offers protection against diphtheria, tetanus, whooping cough , polio, Haemophilus influenzae type b (Hib) and hepatitis B. Hib are a type of bacteria that can cause meningitis. The vaccine is given on three separate occasions when babies are 8, 12 and 16 weeks old. More about the 6-in-1 vaccine Pneumococcal vaccine The pneumococcal vaccine offers protection against serious infections caused by pneumococcal bacteria, including meningitis. Babies receive the pneumococcal vaccine as2 separate injections, at12 weeks and between 12 and 13 months old. More about the pneumococcal vaccine Hib/Men C vaccine The meningitis C vaccine offers protection against a type of bacteria  meningococcal group C bacteria  that can cause meningitis. Babies are offered a combined Hib/Men C vaccine at 1 year of age. Teenagers and first-time university students are also offered vaccination against meningococcal group C bacteria as part of the combined meningitis ACWY vaccine. More about the Hib/Men C vaccine MMR vaccine The MMR vaccine offers protection against measles , mumps and rubella . Meningitis can sometimes occur as a complication of these infections. The vaccine is usually given to babies at 1 year of age. Theyll then have a second dose when theyre 3 years and 4 months old. More about the MMR vaccine Meningitis ACWY vaccine The meningitis ACWY vaccines offers protection against 4 types of bacteria that can cause meningitis  meningococcal groups A, C, W and Y. Young people who are in S3 (around 14 years of age) at school are advised to have the vaccination. Young people who are in S4 to S6 and missed the opportunity to get immunised last year, may also get the vaccine at school this year. More about the meningitisACWY vaccine Source: NHS 24 - Opens in new browser window Last updated: 04 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Sepsis Other health sites Brain and Spine Foundation: Meningitis Meningitis Now Meningitis Research Foundation NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Menopause,"""Later years | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Healthy living Women's health Later years (around 50 years and over) Later years (around 50 years and over) In this period of life, some women experience more complex health needs. Mental health Mental health Includes stress, depression, insomnia and eating disorders Mental health self-help guides Self-help guides that use cognitive behavioural therapy (CBT) Mental wellbeing Advice dealing with low mood, anxiety, phobias, stress and where you can get help Menopause and post menopause health Menopause An overview of menopause, including peri and post menopause Early and premature menopause Information about early and premature menopause Signs and symptoms of menopause Information around the symptoms of menopause After the menopause Find out about how things might change when you are postmenopause Menopause and your mental wellbeing Information about how menopause can impact your mental wellbeing Treating menopause symptoms Information about the options available to treat symptoms of menopause Hormone replacement therapy (HRT) Information about hormone replacement therapy (HRT) Menopause and the workplace Information on menopause and the workplace Sexual wellbeing, intimacy and menopause Information about sexual wellbeing during and after the menopause Supporting someone through the menopause Find out about how you can support someone through the menopause Menopause videos Videos about menopause including common myths and how to talk to your GP Self-help tool: Menopause and mental wellbeing Help with anxiety, stress, depression, anger, self-esteem and sleep Periods and menstrual health Periods (menstruation) Information about periods including pain and PMS Choosing period products Information about period products and where to get them Stuck or lost tampon Learn how to remove a stuck tampon yourself and when to get help Periods (menstruation) videos Videos about periods including irregular periods and PMS Delayed start to periods Information about delayed and irregular periods Periods and pregnancy Information about how periods are linked to fertility Period pain (dysmenorrhoea) Information about period pain including ways to help Premenstrual Syndrome (PMS) Information about PMS and PMDD Heavy periods Information about irregular periods including possible causes and when to speak to your doctor Irregular periods Information about irregular periods including possible causes and when to speak to your doctor Paused periods Information about why you may have stopped your period Adenomyosis Information about adenomyosis including diagnosis and treatment Endometriosis Learn about endometriosis symptoms and treatments Fibroids Learn about fibroids symptoms and treatments Ovarian cyst Learn about ovarian cyst symptoms and treatments Polycystic ovary syndrome (PCOS) Information about polycystic ovary syndrome (PCOS) symptoms and treatment Self-help tool: Periods and mental wellbeing Help with anxiety, low mood, anger, self-esteem, sleep problems and social anxiety Sexual health and contraception Sexual health Information about sexually transmitted infections (STIs) Contraception Find out where to get contraception, how to use it and which types are available Pelvic health Pelvic floor muscles Learn how to exercise your pelvic floor muscles Pelvic organ prolapse Learn about pelvic organ prolapse symptoms and treatments Transvaginal mesh implants Information on transvaginal mesh implants which are used for treating pelvic organ prolapse or stress urinary incontinence Urinary incontinence in women Learn about symptoms and treatments of urinary incontinence in women Urinary tract infection (UTI) Urinary tract infections (UTIs) are common infections that affect the bladder, kidneys and connected tubes. Screening Cervical screening Who'll be offered a smear test in Scotland and what happens next if the test finds changes that need further investigation Bowel screening Who'll be offered bowl screening in Scotland and how it's done Breast screening Who'll be offered breast screening in Scotland and how a mammogram is done Long term conditions Cancer Information on different cancer types and advice on living with cancer Chronic pain Information about pain that lasts longer than 12 weeks, or beyond the natural healing time Irritable bowel syndrome (IBS) Learn about irritable bowel syndrome symptoms and treatments Lipoedema Information about lipoedema, a long term (chronic) condition of fat and connective tissue Thyroid Underactive thyroid Learn about underactive thyroid symptoms and treatments Overactive thyroid Learn about overactive thyroid symptoms and treatments Thyroid cancer Learn about thyroid cancer, a rare type of cancer that affects the thyroid gland located at the base of the neck Women's heart health Womens heart health Heart disease affects women as well as men. It's important to know the symptoms of heart disease and when to get help. Medical devices Breast and cosmetic implants Learn about breast and cosmetic implants and when they're used Breast and Cosmetic Implant Registry Learn about the Breast and Cosmetic Implant Registry and why it's useful Essure contraceptive device Essure is a contraceptive medical device that's no longer offered Vaginal health Managing genital symptoms Advice about common genital symptoms including pain, spots and itching Vaginal discharge Learn about vaginal discharge, changes to look for, and when to speak to a doctor Support after rape or sexual assault Turn to SARCS The NHS Scotland sexual assault self-referral phone service can help to arrange care for you in the days following a rape or sexual assault Where to find support if youve been raped or sexually assaulted Support is available from NHS Scotland, Police Scotland, charities and support organisations Supporting someone who has been raped or sexually assaulted Information to help people support someone who has experienced sexual violence NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Mesothelioma,"Mesothelioma - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Mesothelioma Mesothelioma Mesothelioma is a type of cancer that develops in the lining that covers the outer surface of some of the bodys organs. Its usually linked to asbestos exposure. Mesothelioma mainly affects the lining of the lungs (pleural mesothelioma), although it can also affect the lining of the tummy (peritoneal mesothelioma), heart or testicles. Most cases are diagnosed in people aged 60to 80 and men are affected more commonly than women. Unfortunately, its rarely possible to cure mesothelioma, although treatment can help control the symptoms. Symptoms of mesothelioma The symptoms of mesothelioma tend to develop gradually over time. They typically dont appear until several decades after exposure to asbestos. Symptoms of mesothelioma in the lining of the lungsinclude: chest pain shortness of breath fatigue (extreme tiredness) a high temperature (fever) and sweating, particularly at night a persistent cough loss of appetite and unexplained weight loss clubbed (swollen) fingertips Symptoms of mesothelioma in the lining of the tummyinclude: tummy pain or swelling feeling or being sick loss of appetite and unexplained weight loss diarrhoea or constipation Speak to your GP if you have any persistent or worrying symptoms. Tell them about any exposure to asbestos you may have had in the past. What causes mesothelioma? Mesothelioma is almost always caused by exposure to asbestos, agroup of minerals made of microscopic fibres thatused to be widely used in construction. These tiny fibres can easily get in the lungs, where they get stuck, damaging thelungsover time.It usually takes a while for this to cause any obvious problems, with mesotheliomatypically developing more than20 yearsafter exposure to asbestos. The use of asbestos was completely banned in 1999, so the risk of exposure is much lower nowadays. However,materials containing asbestos are still found in many older buildings. Read more about asbestos and people at risk of exposure and avoiding exposure to asbestos . How mesothelioma is diagnosed If your GP suspects mesothelioma, they will refer you to a hospital specialist for some tests. Anumber of different tests may need to be carried out, including: an X-ray of your chest or tummy a computerised tomography (CT) scan  a number of X-ray images are taken tocreate a detailed image of the inside of the body fluid drainage  if theres a build-up of fluid around the lungs or in the tummy, a sample may be removed using a needle inserted through the skin so the fluid can be analysed a thoracoscopy or laparoscopy  the inside of your chest or tummy is examined with a long, thin camera thats inserted through a small cut (incision) under sedation or anaesthetic ; a sample of tissue ( biopsy ) may be removed so it can be analysed These tests can help diagnose mesothelioma and show how far it has spread. Treatments for mesothelioma The best treatment for mesothelioma depends on several factors, including how far the cancer has spread and your general health. As mesothelioma is often diagnosed at an advanced stage, treatment is usually focused on controlling the symptoms and prolonging life for as long as possible.This is known as palliative or supportive care . Possible treatments include: chemotherapy  this is the main treatment for mesothelioma and involves using medicine to help shrink the cancer radiotherapy  this involves usinghigh-energy radiation to kill cancer cells and it may be used to slow the cancer down and keep it under control surgery an operation to remove the cancerous area can be done if mesothelioma is detected at a very early stage, although its not clear whether surgery is helpful Youll alsoprobably have treatment for your individual symptoms to help you feel as comfortable as possible. For example, regularly draining fluid from your chest may help your breathing and strong painkillers may helprelieveyour pain. Sometimes, a procedure is carried out to stop the fluid coming back again by making the outside of the lungs stick to the inside of your chest (pleurodesis), or a tube is put in your chest to drain the fluid regularly at home. Your doctors should discuss these treatments with you. Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Asbestosis Other health sites Mesothelioma UK Asthma and Lung UK: Mesothelioma Cancer Research UK: Mesothelioma Macmillan Cancer Support: Mesothelioma Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Middle ear infection (otitis media),"Middle ear infection (otitis media) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Ears, nose and throat Middle ear infection (otitis media) Middle ear infection (otitis media) Otitis media is an infection of the middle ear. It causes inflammation (redness and swelling) and a build-up of fluid behind the eardrum. Anyone can develop a middle ear infection, but theyre most common in young children. You do not always need to see a GP as most ear infections get better on their own within 3 to 5 days. Symptoms of a middle ear infection The main symptoms of a middle ear infection include: earache a high temperature (fever) being sick a lack of energy slight hearing loss  if the middle ear becomes filled with fluid In some cases, a hole may develop in the eardrum (perforated eardrum) and pus may run out of the ear. The earache, which is caused by the build-up of fluid stretching the eardrum, then resolves. Signs in young children Young children and babies with an ear infection may also: rub or pull their ear not react to some sounds be irritable or restless be off their food keep losing their balance When to get medical advice Speak to your GP practice if: You or your child has: symptoms that do not improve within 2 or 3 days regular ear infections a lot of pain a discharge of pus or fluid from the ear an underlying health condition, such as cystic fibrosis or congenital heart disease , which could make complications more likely If your GP practice is closed, phone 111. Treatment for middle ear infections Most ear infections get better on their own within 3 to 5 days and do not need any specific treatment. If needed, paracetamol or ibuprofen can be used to relieve pain and a high temperature. Always read the leaflet that comes with your medicine before taking it. Follow the recommended dosage instructions. If youre not sure which treatments are suitable for you or your child, speak to a pharmacist for advice. Placing a warm cloth over the affected ear may also help relieve pain. Antibiotics are not usually used to treat middle ear infections. What causes middle ear infections? Most middle ear infections occur when an infection, such as a cold , leads to a build-up of mucus in the middle ear. This causes the Eustachian tube (a thin tube that runs from the middle ear to the back of the nose) to become swollen or blocked. The mucus cant drain away properly, making it easier for an infection to spread into the middle ear. An enlarged adenoid (soft tissue at the back of the throat) can also block the Eustachian tube. The adenoid can be removed if it often causes ear infections. Middle ear infections are more common in younger children because: the Eustachian tube is smaller in children than in adults a childs adenoids are relatively larger than an adults Certain conditions can also increase the risk of middle ear infections, including: having a cleft palate having Downs syndrome Can middle ear infections be prevented? Its not possible to prevent middle ear infections. There are some things you can do that may reduce your childs risk of developing one. Do make sure your child is up-to-date with their routine vaccinations  particularly the pneumococcal vaccine and the DTaP/IPV/Hib/HepB (6-in-1) vaccine if possible, feed your baby with breast milk rather than formula milk Dont do not expose your child to smoky environments (passive smoking) do not give your child a dummy once theyre older than 12 months old do not feed your child while theyre lying flat on their back Children who go to nursery or school can pick up infections from other children who are unwell. Complications of middle ear infections Complications of middle ear infections are fairly rare, but can be serious. Most complications are the result of the infection spreading to another part of the ear or head. Rarely, infections can leave a perforation or hole in the eardrum. If complications do develop, they often need to be treated immediately with antibiotics in hospital. Source: ENT Scotland - Opens in new browser window Last updated: 07 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Earache Self-help guide: Earache Other health sites Action on Hearing Loss Family Lives NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Migraine,"Migraine | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Migraine Migraine Migraine is a common health condition. It affects around 1 in every 5 women and around 1 in every 15 men. They usually begin in early adulthood. A migraine is usually a moderate or severe headache felt as a throbbing pain on one side of the head. Many people also have symptoms like nausea, vomiting and increased sensitivity to light or sound. There are several types of migraine, including: migraine with aura  where there are warning signs before the migraine begins, like seeing flashing lights migraine without aura  the most common type, where the migraine occurs without warning signs migraine aura without headache, also known as silent migraine  where an aura or other migraine symptoms are experienced, without a headache Some people have frequent migraines up to several times a week. Other people only have occasional migraines. Its possible for years to pass between migraine attacks. Symptoms of a migraine The main symptom of a migraine is usually an intense headache on one side of the head. In some cases, the pain can occur on both sides of your head and may affect your face or neck. The pain is usually a moderate or severe throbbing sensation. The pain gets worse when you move and may prevent you from carrying out normal activities. Other symptoms associated with a migraine include: nausea vomiting increased sensitivity to light and sound  which is why many people with a migraine want to rest in a quiet, dark room Some people experience other symptoms, including: sweating poor concentration feeling very hot or very cold abdominal (tummy) pain diarrhoea dizziness (light headedness) Not everyone with a migraine experiences these additional symptoms. Some people may experience them without having a headache . The symptoms of a migraine usually last between 4 hours and 3 days. You may feel very tired for up to a week afterwards. Symptoms of aura About1 in 3 people with migraines have temporary warning symptoms, known as aura, before a migraine. These include: visual problems  such as seeing flashing lights, zig-zag patterns or blind spots numbness or a tingling sensation like pins and needles  which usually starts in one hand and moves up your arm before affecting your face, lips and tongue difficulty speaking Sometimes, you might also experience: feeling dizzy or off balance loss of consciousness  although this is unusual Aura symptoms typically develop over the course of about 5 minutes and last for up to an hour. The aura might start before the headache or you might experience it at the same time as a headache. Some people may experience aura followed by only a mild headache or no headache at all. Speak to your GP if: you have frequent or severe migraine symptoms Phone 999 if you or someone youre with experiences: paralysis or weakness in one or both arms and/or one side of the face slurred or garbled speech a sudden agonising headache resulting in a blinding pain unlike anything experienced before headache along with a high temperature (fever), stiff neck, mental confusion, seizures, double vision and a rash These symptoms may be a sign of a more serious condition, like a stroke or meningitis . You should be assessed by a doctor as soon as possible. Causes of a migraine The exact cause of migraines is unknown. Theyre thought to be the result of abnormal brain activity temporarily affecting nerve signals, chemicals and blood vessels in the brain. Around half of all people who experience migraines have a close relative with the condition. This suggests that genes may play a role. Migraine triggers It may help to keep a diary to see if you can identify a consistent trigger. It can be difficult to tell if something is a trigger or if what youre experiencing is an early symptom of a migraine attack. There might not always be a trigger for your headache. Possible migraine triggers include: Hormonal changes Some women experience migraines around the time of their period. This might be because of changes in the levels of hormones like oestrogen around this time. These types of migraines usually occur between 2 days before the start of your period to 3 days after. Some women only experience migraines around this time. This is known as pure menstrual migraine. Most women experience them at other times too. This is called menstrual related migraine. Some women find their migraines become worse during perimenopause. However, they might improve or disappear a few years after your last period. Emotional triggers stress anxiety tension shock depression excitement Physical triggers tiredness poor quality sleep shift work poor posture neck or shoulder tension jet lag fasting or low blood sugar ( hypoglycaemia ) strenuous exercise, if youre not used to it Dietary triggers missed, delayed or irregular meals dehydration alcohol the food additive tyramine (found in some cheeses and cured meat) caffeine products, such as tea and coffee lack of caffeine (if youre used to regular caffeine) specific foods such as chocolate, citrus fruit and cheese Some people crave chocolate before a migraine begins. This can be a sign that youre about to have a migraine rather than the chocolate being the trigger for the migraine. Environmental triggers bright lights flickering screens, such as a television or computer screen smoking (or smoky rooms) loud noises strong smells changes in weather (windy weather or stuffy atmosphere) Medication some types of sleeping tablets the combined contraceptive pill hormone replacement therapy (HRT) , sometimes used to relieve symptoms of the menopause There are other types of medications that can cause some people to experience migraines. Speak to your GP if you start to experience migraines after starting to take new medication. Diagnosing migraines Theres no specific test to diagnose migraines. For an accurate diagnosis, your GP must identify a pattern of recurring headaches along with the associated symptoms. Migraines can be unpredictable, sometimes occurring without the other symptoms. Obtaining an accurate diagnosis can sometimes take time. Your GP might do a physical examination and check your vision, co-ordination, reflexes and sensations. These will help rule out some other possible underlying causes of your symptoms. Your GP may ask if your headaches are: on one side of the head a pulsating pain severe enough to prevent you carrying out daily activities made worse by physical activity or moving about accompanied by nausea and vomiting accompanied by sensitivity to light and noise Migraine diary To help with the diagnosis, it can be useful to keep a diary of your migraine attacks for a few weeks. Note down details like: the date time what you were doing when the migraine began how long the attack lasted what symptoms you experienced what medication you took (if any) Taking too many painkillers is a reason why migraines can become difficult to treat. This is called medication overuse headache.Keep a record of what painkillers you take and how often you take them. You shouldnt take painkillers on more than 10 days every month in the long-term. It can be helpful to make a note when your start your period, if you have one. This can help your GP identify potential triggers. Read more about keeping a migraine diary on The Migraine Trust website. Referral to a specialist Your GP may decide to refer you to a neurologist (a specialist in conditions affecting the brain and nervous system). Theyll do further assessments and offer treatment if: a diagnosis is unclear you experience significant migraines not controlled by your current treatment Treating migraines Theres no cure for migraines. There are treatments available to help reduce the symptoms. During an attack, many people find that sleeping or lying in a darkened room can also help. It may take time to work out the best treatment for you. You may need to try different types or combinations of medicines before you find the most effective ones. If you cant manage your migraines using over-the-counter medicines, your GP may prescribe something stronger. Always make sure you read the medication instructions and follow the dosage recommendations. Children under 16 shouldnt take aspirin unless its under the guidance of a healthcare professional. Aspirin and ibuprofen are not recommended for adults who have a history of stomach problems, like stomach ulcers , liver problems or kidney problems. Painkillers Many people find that over-the-counter painkillers, like paracetamol , aspirin or ibuprofen , can help to reduce their symptoms. They tend to be most effective if taken at the first signs of a migraine attack. This gives them time to absorb into your bloodstream and ease your symptoms. You shouldnt wait until the headache worsens before taking painkillers as its often too late for the medication to work. Soluble painkillers (tablets you dissolve in a glass of water) are a good option because theyre absorbed quickly by your body. Taking too many painkillers can lead to medication overuse headache. You should not take them more than 15 days per month. If you cant swallow painkillers because of nausea or vomiting, you should speak to your GP about anti sickness medication or suppository options. Suppositories are capsules that you insert into the anus (back passage). Opiates like codeine should not be prescribed as a treatment for migraines. Theyre not any more effective than triptans and painkillers and can cause nausea and medication overuse headache. Triptans If over the counter medication is not helping your symptoms, your GP might recommend a triptan and/or anti sickness medication. Triptan medicines are a specific painkiller for migraine headaches. Theyre thought to work by reversing the changes in the brain that may cause migraine headaches. Triptans are available as tablets, injections and nasal sprays. Common side effects of triptans include: warm-sensations tightness tingling flushing and light headedness feelings of heaviness in the face, throat, limbs or chest Some people also experience nausea, dry mouth and drowsiness. These side effects are usually mild and improve on their own. Taking too many triptans can lead to medication overuse headache. You should not take them more than 10 days per month. Your GP will usually recommend having a follow-up appointment once youve finished your first course of treatment. This is so you can discuss their effectiveness and whether you had any side effects. If treatment is not effective or causes unpleasant side effects, your GP may try prescribing a different type of triptan. Everyone reacts differently to each type of triptan. Triptans can be taken at the same as painkillers and/or anti-sickness tablets to improve their effectiveness. Your GP will discuss this with you. Anti-sickness medicines Anti-sickness medicines, known as anti-emetics, can treat migraine in some people. They can be effective even if you dont experience nausea or vomiting. They can be taken alongside painkillers and triptans. Anti-sickness medicines work better if taken as soon as your migraine symptoms begin. They usually come in the form of a tablet. Side effects of anti-emetics include drowsiness and diarrhoea . Some anti-sickness medication can cause involuntary movements, normally in the face. Speak to your GP if you experience involuntary movements. Combination medicines You can buy some combination medicines for migraine without a prescription at your local pharmacy. These medicines contain both painkillers and anti-sickness medicines. If youre not sure which one is best for you, ask your pharmacist. It can also be very effective to combine a triptan with another painkiller, like ibuprofen. Many people find combination medicines convenient. However, the dose of painkillers or anti-sickness medicine may not be enough to relieve your symptoms. If this is the case, it may be better to take painkillers and anti-sickness medicines separately. This allows you to control the doses of each. Opiates like codeine should not be prescribed as a treatment for migraines. Theyre not any more effective than triptans and painkillers and can cause nausea and medication overuse headache. Treatment during pregnancy and breastfeeding In general, migraine treatment with medicines should be limited as much as possible when youre pregnant or breastfeeding. Instead, trying to identify and avoid potential migraine triggers is recommended. If medication is essential, paracetamol and sumatriptan are safe to take during pregnancy and when breastfeeding. If youre pregnant or breastfeeding, speak to your GP or midwife: if youre getting regular migraines before taking medication High doses of aspirin should not be taken to treat headaches during pregnancy. Preventing migraines Its important to maintain a generally healthy lifestyle, including: regular exercise, sleep and meals ensuring you stay well hydrated limiting your intake of caffeine limiting your intake of alcohol One of the best ways of preventing migraines is recognising the things that trigger an attack and trying to avoid them. Preventative medication Medication is available to help prevent migraines. These medicines are usually used if your migraines remain frequent (more than 1 migraine per week) following a period of avoiding possible triggers. The following medications can be prescribed by your GP. If theyre not effective, youll be referred to a neurologist. The neurologist will consider what advanced therapies might be best to try next. Medications used to prevent migraines are taken every day to reduce the severity and frequency of headaches. It takes a few weeks to reach the right dose and you might need to take it for several weeks (usually 8 weeks once the right dose is reached) to find out if it works. Propranolol Propranolol is a medication used to treat angina and high blood pressure. Its also effective in preventing migraines. It is taken every day in tablet form, regardless of whether you have a headache or not. Propranolol is not suitable for people with asthma , chronic obstructive pulmonary disease (COPD) and some heart problems. It should be used with caution in people with diabetes . Side effects of propranolol can include: cold hands and feet pins and needles problems sleeping tiredness light headedness Tricyclic antidepressants You might be prescribed tricyclic antidepressants like amitriptyline or nortriptyline. This is a type of medication used for depression but at lower doses can also help prevent migraines. The side effects can include: drowsiness a dry mouth weight gain difficulty passing urine Topiramate Topiramate is a type of medication originally developed to prevent seizures in people with epilepsy . Its now much more commonly used in migraine. Its been shown to help prevent migraines. It is taken every day in tablet form regardless of whether you have a headache or not. Topiramate should be used with caution in people with kidney stones, liver problems or glaucoma. You should not take topiramate during pregnancy as it can harm your unborn baby. You must be on an effective form of contraception when taking topiramate. Topiramate can reduce the effectiveness of hormonal contraceptives. Your GP should discuss alternative methods of contraception if youre prescribed topiramate. Side effects of topiramate can include: decreased appetite and weight loss nausea and vomiting constipation or diarrhoea tingling sensation memory problems and difficulty finding words problems sleeping Candesartan You might be prescribed Candesartan. Candesartan is a medication used for high blood pressure. Candesartan can cause lightheadedness due to low blood pressure, tiredness and cough. It should not be used if youre pregnant or trying for a baby. Other oral preventive medications Other less common options of oral preventative medications for migraine include: pizotifen flunarizine Complementary therapies and supplements There are some complementary therapies and supplements which might help to prevent your migraine symptoms. These include: magnesium vitamin B2 (rivoflavin) coenzyme Q10 acupuncture You should discuss any complementary therapies youd like to try with your GP. Medical devices There are some devices that have been developed that might help treat migraines. These include: transcranial magnetic stimulation external trigeminal nerve stimulator non-invasive vagus nerve stimulation Read more about medical devices Advanced therapies for migraine The following medicines are advanced therapies for migraine that can only be prescribed by a neurologist. Botulinum toxin type A Botulinum toxin type A is used to prevent headaches in some adults with chronic migraines. Chronic migraines mean you have headaches more than 15 days per month and at least half of them are migraines, over a period of 3 months. Botulinum toxin type A is a type of neurotoxin (nerve toxin) that paralyses muscles. Its not exactly clear why this treatment can be effective for migraine. SIGN recommend this treatment as an option for people who have chronic migraine that hasnt responded to at least three previous preventative medical treatments. Botulinum toxin type A should be injected to between 31 and 39 sites around the head and back of the neck. A new course of treatment can be given every 12 weeks. Calcitonin Gene-Related Peptide (CGRP) monoclonal antibodies CGRP might be prescribed if other medication has not prevented your migraines. This medication has been created specifically for migraines. CGRP monoclonal antibodies are given by an injection into the skin on your thigh or abdomen (tummy) once per month. Youll have to self administer this treatment meaning youll need to learn how to deliver the injection yourself. Read more about CGRP Preventing menstrual-related migraines Menstrual-related migraines usually occur between 2 days before the start of your period to 3 days after. They can be preventable using either non-hormonal or hormonal treatments. Non-hormonal treatments The non-hormonal treatments that are recommended are: non-steroidal anti-inflammatory drugs (NSAIDs)  a common type of painkiller (usually naproxen) triptans  a type of medication used to treat a migraine attack (usually naratriptan or frovatriptan) These medications are taken as tablets 2 to 4 times a day from either the start of your period or 2 days before, until the last day of bleeding. Hormonal treatments Hormonal treatments that may be recommended include: combined hormonal contraceptives, like the combined contraceptive pill , patch or vaginal ring (usually taken continuously for at least 3 months) progesterone-only contraceptives, such as progesterone-only pills , implants or injections oestrogen patches or gels, which can be used from 3 days before the start of your period and continued for 7 days Hormonal contraceptives like the combined contraceptive pill or vaginal ring are not used if you have migraines with aura symptoms. This is because this can increase your risk of having a stroke . Migraine clinic If the treatments above arent controlling your migraines, you might be referred to a specialist migraine clinic for further investigation and treatment. A specialist might recommend other treatments like transcranial magnetic stimulation devices or greater occipital nerve blocks. Complications of migraines Migraines are linked to a very small increased risk of mental health problems. Migraines with aura are associated with a small increased risk of ischaemic strokes. Stroke An ischaemic stroke occurs when the blood supply to the brain is blocked by a blood clot or fatty material in the arteries. People who experience migraines with aura have about twice the risk of having an ischaemic stroke compared to people without migraines. However, this risk is still small. The risk increases significantly if you smoke and take the combined contraceptive pill. Its unclear why ischaemic strokes are linked to migraine. Contraceptive pill The risk of having an ischaemic stroke is increased by the use of the combined contraceptive pill . Medical professionals generally advise women who experience migraine with aura not to use the combined contraceptive pill. Women who have migraine without aura can usually take the combined contraceptive pill safely, unless they have other stroke risk factors like high blood pressure or a family history of cardiovascular disease . Talk to your GP about alternative forms of contraception if you experience aura symptoms and are taking the combined contraceptive pill. Mental health problems Migraine is associated with a very small increased risk of mental health problems, including: depression bipolar disorder anxiety disorder panic disorder Source: Scottish Government - Opens in new browser window Last updated: 14 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites The Migraine Trust NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Miscarriage,"Miscarriage | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Pregnancy and childbirth Miscarriage Miscarriage A miscarriage is the loss of your baby before 24 weeks. Early miscarriages happen in the first 12 weeks of pregnancy. Late miscarriages happen between 12 and 24 weeks. Most of the time theres no clear reason why it happens, but its very unlikely to be caused by anything you did or didnt do. About 1 out of 5 pregnancies miscarry. Since many miscarriages arent recorded the figure might be higher. Always get medical help if: youre bleeding from your vagina youve got strong, cramping pain your waters break your babys movements have changed, or you havent felt them move for a while If youre registered, contact your midwife or local maternity unit. If youre not registered, contact your GP or the NHS 24 111 service. What causes a miscarriage? Doctors think most miscarriages are caused when the building blocks controlling the development of a baby (the chromosomes) arent right. Babies with too many or not enough chromosomes wont develop properly. This leads to a miscarriage. Miscarriages can also be caused by: issues with your placenta cervical weakness  when your cervix (neck of your womb) starts to open Early miscarriages An early miscarriage happens in the first 12 weeks of pregnancy. Most women who miscarry do so in the first 12 weeks of their pregnancy. Many women have a miscarriage before they even know theyre pregnant. If this happens it can feel like a late period with heavy bleeding. Symptoms of an early miscarriage You might be having an early miscarriage if: youre bleeding from your vagina youve cramps in your lower abdomen  these can feel like bad period pains theres fluid or tissue coming from your vagina your breasts are no longer tender and any morning sickness has passed Bleeding Having some light bleedings fairly common in the first 12 weeks of pregnancy and doesnt necessarily mean youre having a miscarriage. If you start bleeding, you should always contact your GP or midwife and get advice about what to do. What happens during an early miscarriage If youre in the early weeks of pregnancy: youll probably be asked to go to the early pregnancy unit at your local hospital straight away youll have some tests and usually an ultrasound scan your body usually completes the miscarriage naturally Depending on your stage of pregnancy, you may deliver a small baby. That can be a shock and is an understandably upsetting time. Late miscarriages A late miscarriage happens after 12 weeks and before 24 weeks. For many parents who lose their baby after a late miscarriage, the word miscarriage doesnt properly express the impact of their loss. The loss of a baby at any times a terrible shock and a late miscarriage can be especially hard. Symptoms of a late miscarriage You might be having a late miscarriage if: youre bleeding from your vagina  this can be heavy and you might have blood clots youve strong, cramping pains Always get medical help if: youre bleeding your babys movements have changed or you havent felt any movements for a while. your waters break and your babys born very quickly Contact your midwife or local maternity unit if youre registered with them. If youre not registered, contact your GP or phone the NHS 24 111 service. What happens during a late miscarriage If youre later on in pregnancy: you may be asked to go to the maternity ward youll have some tests and usually an ultrasound scan youre likely to go through labour in hospital and might have your labour induced While you deliver your baby youre likely to have heavier bleeding and labour-like pains. Making difficult decisions If youre having a miscarriage, your doctor or midwife will: talk to you about what will happen next help you, and your partner if you have one, decide what youd like to do You may have many difficult decisions to make at this time and will have overwhelming emotions. Take your time. Your midwife or doctor can help, and there are many organisations that can support you, your babys father and your family. Get support from SANDS Get support from SiMBA After a miscarriage Depending on your circumstances and stage of pregnancy, your midwife or doctor may ask if youd like to see or hold your baby. Some parents decide they dont want to see their baby, and others choose not to for faith or cultural reasons. This is a decision only you can make. It can be very hard when youre feeling overwhelmed. Whatever you decide is okay. If youre worried about what your baby looks like, your midwife or doctor can describe them to help you decide. If your symptoms continue Youll probably have some bleeding for a week or two. If you continue to have symptoms after your miscarriage, it may mean that some of the pregnancy tissues still in your womb. Some women may need medicine or a short operation to treat this. If youre worried about seeking treatment, maybe a friend can come with you. Having supports really important at this difficult time. Taking time off work Many women will want to take time off work after having a miscarriage. If you have a miscarriage before the end of the 24th week, youre entitled to: take sick leave any sick pay youd normally qualify for If you lose your baby after the end of the 24th week, youre entitled to: take maternity leave any maternity pay you qualify for Speak to your employer about which choices may be right for you and your family. Working Families has more about your rights at work after a miscarriage Repeated miscarriages Most women go on to have a successful pregnancy and a healthy baby after a miscarriage. But unfortunately, some women have repeated miscarriages. If youve had: 1 or 2 miscarriages  youre not more likely than anyone else to have another one 3 or more miscarriages  your GP can refer you to a specialist to see whether theres a specific cause Source:\r\n                                        Public Health Scotland - Opens in new browser window Last updated: 07 December 2022 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Motor neurone disease (MND),"""Motor neurone disease (MND) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Motor neurone disease (MND) Motor neurone disease (MND) Motor neurone disease (MND) is a rare condition that progressively damages parts of the nervous system. This leads to muscle weakness, often with visible wasting. Amyotrophic lateral sclerosis (ALS) is the most common form of MND. MND happens when specialist nerve cells in the brain and spinal cord, called motor neurones, stop working properly and die prematurely. This is known as neurodegeneration. Motor neurones control muscle activity like: gripping walking speaking swallowing breathing As MND progresses, it can become more difficult to do some or all of these activities. Symptoms of motor neurone disease The symptoms of MND start gradually over weeks and months. They tend to appear on one side of the body first and get progressively worse. Speak to your GP if: you have early symptoms of MND Being referred to a specialist as early as possible can help you access the right support. There are usually 3 stages of symptoms. Early symptoms Sometimes the early symptoms are mistaken for similar conditions that also affect the nervous system. Limb-onset disease In about two-thirds of people with MND, the first symptoms are in the arm or leg. This is sometimes called limb-onset disease. The symptoms include: a weakened grip, which can cause problems picking up or holding objects weakness at the shoulder, making lifting your arm above your head difficult tripping up over your foot because of weakness at your ankle or hip These symptoms are usually painless. You might also experience widespread twitching of the muscles (fasciculations) or muscle cramps. You might also see wasting of the muscles with significant weight loss. Bulbar-onset disease In 1 out of 4 cases, the first MND symptoms will affect the muscles used for speaking and swallowing. These problems might initially affect the muscles used for speech and swallowing. Increasingly slurred speech (dysarthria) is usually the first sign of this type of MND. It might be misdiagnosed as a stroke . As the condition progresses, it may become increasingly difficult to swallow (dysphagia). This might be misdiagnosed as a blockage in the throat. Respiratory-onset disease In rare cases, MND starts by affecting the lungs, rather than affecting them at the end of the condition. This is called respiratory-onset disease. In some cases the initial symptoms like breathing difficulties and shortness of breath are more obvious. You might suffer from a lack of sleep and a headache in the morning. This might be because your body isnt getting rid of the carbon dioxide you normally breathe out. Advanced symptoms As MND becomes more advanced, more parts and functions of the body are affected. This can make you more likely to experience infections, like chest infections, which can cause your condition to get worse quicker. Muscular symptoms The limbs will become weaker. The muscles in the limbs may become thinner. As a result, the person will find it increasingly difficult to move the affected limbs. The limbs may also become stiff. This is known as spasticity. Both muscle wasting and stiffness can also cause joint aches and pains. Speaking and swallowing difficulties Speaking and swallowing can become increasingly difficult as MND progresses. Choking episodes can be distressing but they arent usually the cause of death. Saliva problems Reduced swallowing can cause excess saliva. This can cause drooling. Thicker saliva can sometimes be difficult to clear from the chest or throat. This is because the muscles that control coughing become weak. Excessive yawning Some people with MND have episodes of uncontrollable excessive yawning. This can happen even when theyre not tired. It can sometimes cause jaw pain. Emotional changes MND can cause changes in your ability to control your emotions. This is more likely when theres weakness in the muscles that control speech and swallowing. One of the most common signs is when a person has episodes of sudden uncontrollable crying or, more rarely, laughter. This is sometimes called emotional lability or emotionality. Changes to mental abilities Sometimes, people with MND have significant difficulties with: concentration planning communication behavioural changes. This is where the condition is causing a type of dementia (usually frontotemporal dementia). Up to 15% of people with MND develop more profound frontotemporal dementia. This usually happens soon after, or sometimes before, their first muscle-related symptoms. Someone with MND might not be aware that there are problems with their behaviour or personality. Breathing difficulties Breathing might become less efficient as the nerves and muscles that help control the lungs become more damaged. This might mean you feel short of breath after doing every day tasks like walking up the stairs. Over time, you might become even more out of breath when youre resting. Shortness of breath can become a problem at night. Some people find it difficult to breathe when theyre lying down. Others might wake in the night because they feel breathless. As breathlessness increases, breathing support can help reduce this symptom. This is usually given by non-invasive ventilatory (NIV) support. It can be useful at night to improve your sleep quality. This can help reduce drowsiness during the day. End-stage symptoms As MND progresses to its final phase, you might experience: increasing body paralysis, which means youll need help with most daily activities significant shortness of breath Eventually, non-invasive breathing assistance wont be enough to make up for the loss of normal lung function. At this stage, more medication can help to reduce symptoms of breathlessness and anxiety related to it. Most people with MND become increasingly drowsy before falling into a deep sleep, where they usually die peacefully. Secondary symptoms Some people with MND have other symptoms that arent directly caused by the condition, but are related to the stress of living with it. These might include depression , insomnia and anxiety . Causes of motor neurone disease MND occurs when specialist nerve cells (motor neurones) in the brain and spinal cord progressively fail. Its not clear why this happens. Genetic causes One known cause of MND is an error in your genes with 20% of cases linked to genetic causes.Half of genetic caseswill be in people who have a family history of MND. The other half of genetic cases will occur in those without a family history. Having a family history of frontotemporal dementia can also increase the risk of inheriting MND. The error in the gene affects the cells ability to perform normally and survive. If you have a genetic form of MND, theres a chance that you could pass the risk of developing MND on to your child. The risk of them developing the condition can be affected by many factors like age. Not everyone who has the genetic mutation will develop MND in their lifetime. Typically, the longer you live, the more likely you are to develop the condition. If you have a parent with MND with no other family history of the disease, youre at a slight increased risk of MND of about 1.4%. The risk to the general population of MND is about 0.3%. Other possible causes of motor neurone disease Its unclear why the motor neurones begin to lose function. Most experts believe that its a combination of factors that affect either the motor neurones or the cells that support them. There are some theories involving different cell processes including: Aggregates and RNA processing Aggregates are abnormal clumps of protein that develop inside motor neurones. Theyre found in nearly all cases of MND and may disrupt the normal working of the motor neurones. It can also be a marker that the cell is under stress. The protein TDP-43 is most commonly found in these aggregates. This is a protein involved in the processing of the genetic instructions for the cell through a molecule known as RNA. Mutations in the gene (TARDBP) coding for this protein can be a cause of genetic cases of MND. Cell transport disruption All cells have transport systems that move nutrients and other chemicals into the cell and waste products out of the cell. Research suggests that the transport systems in motor neurones become disrupted. Over time, toxic waste can build up in cells as a natural by-product of normal cell activity and aging. The body gets rid of the toxic waste by waste disposal systems that can be affected by ageing and the environment. Glial cells Glial cells surround and support motor neurones and provide them with nutrients. When they dont work properly the motor neurones no longer receive the support and nutrition they need to function normally. Their involvement in MND is still being researched. Glutamate Nerve cells use special messenger chemicals called neurotransmitters to pass information between cells. One of the neurotransmitters is called glutamate. It excites neurones and one theory is that too much activity through this causes damage to the neurones. Riluzole, a drug used to treat MND reduces the level of neuronal activity by blocking the action of Glutamate. Mitochondria Mitochondria are the batteries of cells. They provide the energy that a cell needs to carry out its normal function. Mitochondria in the motor neurones of people with MND might not function properly. Diagnosing motor neurone disease Speak to your GP if you experience the initial symptoms of MND. After hearing about your symptoms and an initial exam, your GP might refer you to a neurologist (a doctor who specialises in conditions affecting the brain and nervous system). Diagnosing MND can be difficult during the early stages. This is because many of the first symptoms can be caused by other more common health conditions like: a trapped nerve  wear and tear of the bones in the spine can sometimes cause nerves to become trapped under the spine peripheral neuropathy  where part of the nervous system is damaged by another condition, like type 2 diabetes swallowing difficulties caused by narrowing or inflammation of the gullet speech difficulties due to problems with the voice box damage to the brain by stroke or other neurological conditions like multiple sclerosis (MS) in younger people Initial testing MND is usually diagnosed by a neurologist based on the symptoms and a physical examination. Theres no single test for MND. Various tests might be used to rule out other possible causes of the your symptoms. Tests might include: blood tests  these can be used for several reasons, like checking that organs are working, or to look for a marker of muscle damage (creatinine kinase) magnetic resonance imaging (MRI) scan  to give a detailed picture of your brain and spinal cord electromyography (EMG)  measures the electrical activity in your muscles, which shows how well your motor neurones are working and connecting to the muscles nerve conduction test  similar to an EMG but measures how quickly your nerves can conduct an electrical signal lumbar puncture  a sample of spinal fluid might be tested to exclude an inflammatory or nerve condition caused by an infection muscle biopsy  in rare cases, a small sample of muscle might be removed for testing to determine whether the problem lies in the muscles Gene tests can be used to support the diagnosis in some individuals. They might provide an explanation of why theyve developed the disorder. Your GP can give you more information about specialists who can help with genetic testing. Confirming the diagnosis There are many reasons why there may be delays in diagnosis. The initial symptoms might not appear to be serious. Or symptoms might not be recognised as being related to the nervous system so a neurologist isnt consulted at first. Sometimes, the diagnosis of MND is clear without the need for further tests. Confirming a diagnosis can sometimes be time-consuming even for an experienced neurologist. They might need a period of observation to be sure, particularly in cases where the condition progresses slowly. MND can only be diagnosed if the symptoms are clearly getting worse (progressive). Receiving the diagnosis Being told you have MND can be devastating and the news can be difficult to take in at first. After youre diagnosed you should be provided with contact details of an MND care specialist. These are healthcare professionals with specialist experience caring for people with MND. Theyll be able to give you (and your family) extra support after the diagnosis and during your time with the illness. Talking to a counsellor or a trained clinical psychologist might help with feelings of depression and anxiety . Its not unusual to have thoughts of taking your own life, although very few people with MND go on to do this. You should discuss these thoughts with your doctor. Taking antidepressants or medicines to reduce anxiety may help. Your care team will be able to tell you about this. Treating motor neurone disease Although theres no cure for MND, there are treatments available to help relieve the symptoms. A team of healthcare professionals will work together to help care for you. This multidisciplinary team typically includes: a neurologist and an MND care specialist a specialist in breathing (respiratory specialist) physiotherapists to advise on mobility aids occupational therapists to assess the need for adaptations to living environments speech and language therapist to provide help with communication and swallowing dieticians to support nutrition As the conditions advances, you might also need palliative care. Riluzole Riluzole is the only licensed medication in the UK thats shown a survival benefit for people with MND. Riluzole is thought to slow down the damage to the motor neurone cells by reducing their sensitivity to the nerve transmitter glutamate. In medical research, riluzole extended survival by 2 to 3 months on average. Side effects of riluzole are usually mild and can include nausea, tiredness and, less commonly, a rapid heartbeat. Very rarely, riluzole has been known to cause liver damage. If youre prescribed riluzole youll need to have blood tests for the first few months to check your liver is working properly. If youve had significant liver disease, riluzole may not be suitable for you. Treating symptoms There are treatments available that can help relieve many of the symptoms of MND and improve your quality of life. Muscle cramps Physiotherapy can help muscle cramps. In some cases, a medication called quinine can help treat muscle cramps too. They often improve later in the condition. Quinine can cause side effects like: hearing and vision problems tinnitus  the perception of noise in one ear, both ears or inside the head vertigo  a sensation that you, or the environment around you, is moving Quinine will usually only be used if the potential benefits are thought to outweigh the risks. Muscle stiffness Muscle stiffness, also known as spasticity, can be treated using medication like baclofen. This helps to help relax the muscles. Side effects can include increased weakness or tiredness. Drooling Medication is available to treat drooling of saliva. One option is a hyoscine hydrobromide skin patch. Alternative medicines used to control drooling include: amitriptyline atropine eye drops applied to the tongue glycopyrronium botulinum toxin injections into the glands that produce saliva Communication difficulties Not everyone with MND will have significant speech problems. There are ways to help people who find it hard to communicate. A speech and language therapist can teach you techniques to make your voice as clear as possible. As the disease progresses, you may need assistive technology to help you communicate. A range of communication aids is available. Your therapist will be able to tell you about the most effective communication aids for you. Swallowing difficulties Not everyone with MND will have significant swallowing problems (dysphagia). For those that do, it can prevent normal eating and drinking. This can lead to you feeling more tired. If food or fluid goes down the wrong way into the lungs it can cause chest infections (called aspiration). One common treatment for dysphagia is a feeding tube known as a gastrostomy tube. The tube is surgically implanted into your stomach through a small cut on the surface of the stomach. It shouldnt restrict your daily activities. You can continue to bathe and swim if you wish. Ideally you should have the tube inserted before you become too frail. This is so you can get the best out of it and to give yourself the best chance of recovering from the procedure. If you have thick secretions (fluids) you cant cough up yourself, medicine like carbocisteine and acetylcysteine might help. Breathing difficulties As MND progresses, the muscles that help you breathe will become weaker. Your breathing will become increasingly shallow, with a weaker cough. Breathing difficulties usually develop gradually. Theyre sometimes the first sign of MND, although this is rare. Its important to discuss breathing problems with your GP before they occur. Your GP or neurologist should be able to refer you to a respiratory (breathing) specialist or a palliative care specialist, depending on your needs. You might benefit from non-invasive mechanical ventilation (NIV) to support your breathing. Room air (not oxygen) is sucked into a small box. Its filtered and then gently pumped into the lungs through a face mask or nasal tube each time you take a breath. NIV may not be suitable for everyone with MND. Your healthcare team will be able to discuss the options available to you. Advance decision making Many people with MND draw up an advance decision (sometimes called an advanced directive). This is where you decide your treatment preferences in advance in case you cant communicate your decisions later because youre too ill. Issues that can be covered by an advance decision include: whether you want to be treated at home, in a hospice or in a hospital once you reach the final stages of MND the type of medication youd be willing to take in certain circumstances whether youd be willing to consider a feeding tube if you were no longer able to swallow food and liquid if you have respiratory failure (loss of lung function), whether you wish to have artificial resuscitation, like having a permanent breathing tube inserted into your throat (known as a tracheostomy) whether youd be willing to donate any of your organs after you die (the brain and spinal cord of people with MND are very important for ongoing research) Your care team will be able to provide you with more information and advice about making an advance decision. Read more about end of life care Research and drug trials You might be given the opportunity to take part in research, including drug trials. Your MND care specialist and neurology consultant can provide further information on this. Advice for carers Caring for someone with MND can be both physically and emotionally demanding. Its likely youll need a wide range of support. For information and advice about all aspects of caring, visit Care Information Scotland Source: Scottish Government - Opens in new browser window Last updated: 21 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites Brain and Spine Foundation: Motor neurone disease Motor Neurone Disease Scotland My Name'5 Doddie Foundation NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Mouth cancer,"Mouth cancer - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Mouth cancer Mouth cancer About mouth cancer Symptoms of mouth cancer Causes of mouth cancer Diagnosing mouth cancer Treating mouth cancer Complications of mouth cancer Living with mouth cancer About mouth cancer Mouth cancer, also known as oral cancer, is where a tumour develops on the surface of the tongue, mouth, lips or gums. Tumourscan also occur in the salivary glands, tonsils and the pharynx (the part of the throat from your mouth to your windpipe) but these are less common. Symptoms of mouth cancerinclude: red or white patches on the lining of your mouth or tongue ulcers a lump Speak to your GP if these symptomsdo not heal within 3 weeks, especially if youre a heavy drinker or smoker. Types of mouth cancer A cancer that develops on the inside or outside layer of the body is called a carcinoma and these types of cancer are categorised by the type of cells the cancerstarts in. Squamous cell carcinoma is the most common type of mouth cancer, accounting for nine out of 10 cases. Squamous cells are found in many places around the body, including the inside of the mouth and under the skin. Less common types of mouth cancer include: oral malignant melanoma  where the cancer starts in cells called melanocytes, which help give skin its colour adenocarcinomas  cancers that develop inside the salivary glands What causes mouth cancer? Mouth cancer occurs when something goes wrong with the normal cell lifecycle, causing them to grow and reproduce uncontrollably. Risk factorsfor developing mouth cancer include: smoking or using products that contain tobacco drinking alcohol  smokers who are also heavy drinkers have a much higher risk compared to the population at large infection with the human papilloma virus (HPV), the virus that causes genital warts Read more about the causes of mouth cancer Who is affected by mouth cancer? Mouth cancer is an uncommon type of cancer. Most cases of mouth cancer first develop in older adults who are aged between 50and 74 years old. Mouth cancer can occur in younger adults, but its thought that HPV infection may be responsible for the majority of cases that occur in younger people. Mouth cancer is more common in men than in women. This is thought to be due to the fact that, on average, men drink more alcohol than women. Treating mouth cancer There are 3 main treatment options for mouth cancer. They are: surgery  where the cancerous cells are surgically removed and, in some cases, some of the surrounding tissue chemotherapy  where powerful medications are used to kill cancerous cells radiotherapy  where high energy X-rays are used to kill cancerous cells These treatments are often used in combination. For example, a course of radiotherapy and chemotherapy may be given after surgery to help prevent the cancer returning. Read more about treating mouth cancer Complications of mouth cancer Both surgery and radiotherapy can make speaking and swallowing difficult ( dysphagia ). Dysphagia can be a potentially serious problem. If small pieces of food enter your airways and become lodged in your lungs, it could trigger a chest infection, known as aspiration pneumonia . Read more about the complications of mouth cancer Reducing the risk The three most effective ways to prevent mouth cancer from developing  or prevent it reocurring after successful treatment  are: not smoking keeping to the recommended limits for alcohol consumption eating a Mediterranean-style diet, with plenty of fresh vegetables (particularly tomatoes), citrus fruits, olive oil and fish (read more about healthy eating ) Its also important that you have regular dental check-ups because dentists can often spot the early stages of mouth cancer. Symptoms of mouth cancer Mouth cancer can develop on most parts of the mouth, including the lips, gums and occasionally, the throat. The most common symptoms of mouth cancer include: red or white patches in the mouth or throat a lump ulcers Other symptoms may include: persistent pain in the mouth pain or difficulty when swallowing ( dysphagia ) changes in your voice, or speech problems swollen lymph nodes (glands) in your neck unexplained weight loss bleeding or numbness in the mouth a tooth, or teeth, that becomes loose for no obvious reason difficulty moving your jaw When to seek medical advice Many of these symptoms canbe caused by less serious conditions, such as minor infections. But its strongly recommended that you visit your GP if any of these symptoms have lasted for more than 3 weeks. Its especially important to seek medical advice if youre a heavy drinker or smoker. Dental check-ups Mouth cancer tends not to cause any noticeable symptoms during the initial stages of the disease. This is why its important to have regular dental check-ups, particularly if you are a smoker, a heavy drinker or a betel chewer, because a dentist may often be able to detect the condition during an examination. You should have a dental check-up at least every year. However, more frequent check-ups may be recommended if you have a history of tooth decay or gum disease . Causes of mouth cancer The 2 leading causes of mouth cancer in the UK are drinking too much alcohol and smoking. Both alcohol and tobacco are carcinogenic, which means they contain chemicals that can damage the DNA in cells and lead to cancer . The risk of mouth cancer increases significantly in somebody who is both a heavy smoker and heavy drinker. Exactly what triggers the changes in DNA that lead to mouth cancer and why only a small number of people develop mouth cancer is still uncertain. How mouth cancer spreads There are 2 ways mouth cancer can spread: directly  the cancer can spread out of the mouth and into nearby tissues, such as surrounding skin or into the back of the jaw via the lymphatic system the lymphatic system is a series of glandsfound throughout your body whichproduce many specialised cells needed by your immune system to fight infection Mouth cancer that spreads to another part of the body is known as metastatic oral cancer. Other risk factors Otherrisk factors for mouth cancer mayinclude: chewing tobacco or other smokeless tobacco products like snus chewingbetel nuts with or without tobacco a poor diet the human papilloma virus (HPV) poor oral hygiene Smokeless tobacco There is a range of smokeless tobacco products including: chewing tobacco snuff  powdered tobacco designed to be snorted snus  a type of smokeless tobacco popular in Sweden, which is placed under your upper lip Smokeless tobacco products are not harmless and may increase your risk of developing mouth cancer, as well as other cancers, such as liver cancer, pancreatic cancer and oesophageal cancer. Betel nuts Betel nuts are mildly addictive seeds taken from the betel palm tree, and are widely used in many southeast Asian ethnic communities, such as people of Indian and Sri Lankan origin. They have a stimulant effect similar to coffee. Betel nuts also have a carcinogenic effect, which can increase the risk of mouth cancer. This risk is made worse as many people enjoy chewing betel nuts along with tobacco. Due to the tradition of using betel nuts, rates of mouth cancer are much higher in ethnic Indian and Sri Lankan communities than in the population at large. Diet There is evidence that a poor diet may increase your risk of some types of mouth cancer. A healthy, balanced diet with plenty of fruit and vegetables is thought to reduce your risk of developing mouth cancer. Human papilloma virus (HPV) The human papilloma virus (HPV) is a family of viruses that affect the skin andmoist membranes that line your body, such as those in your cervix, anus, mouth and throat. You can contract an HPV infection by having sexual contact with a person already infected  you do not have to have full sex; just close skin-to-skin contact. There is evidence that in rare cases,certain types of HPV can cause abnormal tissue growth inside the mouth, triggering mouth cancer. Poor oral hygiene There is evidence that poor oral hygiene, such as having tooth decay , gum disease , not brushing your teeth regularly and having ill-fitted dentures (false teeth) can increase your risk of mouth cancer. Diagnosing mouth cancer If you have symptoms of mouth cancer, your GP will carry out a physical examination and ask about your symptoms. If mouth cancer is suspected, you will be referred to hospital for further tests or to speak to a specialist head and neck surgeon. In 2015, the National Institute for Health and Care Excellence (NICE) published guidelines to help GPs recognise the signs and symptoms of mouth cancer and refer people for the right tests faster. To find out if you should be referred for further tests for suspected mouth cancer, read the NICE 2015 guidelines on Suspected Cancer: Recognition and Referral . Biopsy It may be necessary to remove a small sample of affected tissue to check for the presence of cancerous cells. This procedure is known as a biopsy . There are 3 main methods used to carry out a biopsy in cases of suspected mouth cancer. Punch biopsy A punch biopsy may be used if the suspected affected area of tissue is in an easily accessible place, such as your tongue or the inside of your mouth. The area is first injected with a local anaesthetic to numb it. The doctor will then cut away a small section of affected tissue and remove it with tweezers. The procedure is not painful, but can feel a little uncomfortable. Fine needle aspiration (FNA) A fine needle aspiration (FNA) is a type of biopsy used if it is suspecteda swelling in your neck is the result of mouth cancer. Your neck is numbed and aneedle is usedto draw out a small sample of tissue and fluids from the lump. The sample is thenchecked for cancerous cells. FNA is not painful butit can be uncomfortable and cause bruising. Panendoscopy Apanendoscope is used if the suspected tissue is at the back of your throat or inside one of your nasal cavities. This is a long thin tubewith acamera and a lightwhichis guided throughthe nose, then used to remove a small section of tissue for the biopsy. The panendoscope can also check whether cancer has spread from your mouth to further down your throat, such as your larynx (voice box), oesophagus (gullet) or trachea (windpipe). Further tests If the biopsy confirms cancer you will need further tests to check what stage it has reached. If the cancer is diagnosed late it can have spread from your mouth into the lymphatic system  a series of glands throughout your body which produce many of the specialised cells needed by your immune system. Once the cancer reaches the lymphatic system, it is capable of spreading to any other part of your body, including your bones, blood and organs. However, its uncommon for mouth cancer to spread further than the lymph nodes near your mouth, although in some cases it may also spread to surrounding bones, such as the jaw bone, and in some cases your lungs. Therefore, the tests will examine your lymph nodes, bones and the tissue near the site of your initial tumour to check for the presence of other tumours. These tests may include: an X-ray a magnetic resonance imaging (MRI) scan a computerised tomography (CT) scan a positron emission tomography (PET) scan Further biopsies on nearby lymph nodes may also be carried out. Staging and grading Once these tests have been completed it should be possible to tell what stage and grade your cancer is: staging is a measure of how far the cancer has spread the grade describes how aggressive the cancer is and how fast it is likely to spread in future This will help determine whether you have: early mouth cancer (usually curable) intermediate mouth cancer (may be curable) or advanced mouth cancer (not usually curable, but it is usually possible to slow the spread of the cancer and extend lifespan) There are 3 grades of mouth cancer: low-grade (the slowest), moderate-grade and high-grade (the most aggressive). Grading your cancer helps the doctor decide how quickly you need to be treated. Read more about treating mouth cancer . Treating mouth cancer Your treatment will depend on the type and size of the cancer, the grade and how far its spread  as well as your general health. Your treatment plan If the cancer hasnt spread beyond the mouth or the oropharynx (the bit of your throat at the back of your mouth), a complete cure may be possible using a combination of surgery, radiotherapy and chemotherapy. If the cancer has spread to other parts of the body, then a cure is unlikely but it will be possible to slow the progress of the cancer and help relieve symptoms by using surgery, radiotherapy and chemotherapy. Deciding what treatment is best for you can be difficult. Your care team will make recommendations, but the final decision will be yours. Before going to hospital to discuss your treatment options, you may find it useful to write a list of questions to ask the specialist. For example, what are the advantages and disadvantages of particular treatments. Before treatment begins Radiotherapy makes the teeth more sensitive and vulnerable to infection so before treatment begins, youll be given a full dental examination and any necessary work will be carried out. If you smoke or drink, stopping will increase the chances of your treatment being successful. Your specialist nurse and your GP can provide help and support if you are finding it difficult to quit smoking and drinking. Read more about quitting smoking and cutting down on alcohol Surgery For mouth cancer, the aim of surgical treatment is to remove any affected tissue while minimising damage to the rest of the mouth. Photodynamic therapy (PDT) If the cancer is in its very early stages, it may be possible to remove any tumours using a type of laser surgery known as photodynamic therapy (PDT). PDT involves taking a medicine that makes your tissue sensitive to the effects of light. A laser is then used to remove the tumour. Other forms of surgery If your cancer is more advanced, it may be necessary to remove part of your mouth lining and, in some cases, facial skin, which can be replaced using skin grafted from your forearm or chest. If your tongue is affected, part of the tongue will have to be removed. This is known as a partial glossectomy. The tongue is then reconstructed using grafted tissue. If the cancer has spread to your jawbone it will need to be surgically removed. The jawbone can be replaced by taking bone from another part of your body and grafting it in place. Occasionally, other bones, such as cheekbones, may have to be removed to completely remove the cancer. These can be replaced with plastic prosthetic bones which are usually very realistic, leaving your physical appearance largely unaffected. During surgery, your surgeon may also remove lymph nodes near the site of the initial tumour. This is often done as a preventative measure in case they contain small numbers of cancerous cells that cant be detected. Radiotherapy Radiotherapy uses doses of radiation to kill cancerous cells. It may be possible to remove the cancer using radiotherapy alone, but it is usually used after surgery to prevent the cancer from reocurring. The treatment is normally given every day over the course of three to seven weeks, depending on the size of the cancer and how far it has spread. While it kills cancerous cells, radiotherapy can also affect healthy tissue, and it has a number of side effects, including: sore, red skin (like sunburn) mouth ulcers sore mouth and throat dry mouth loss of, or changes in taste loss of appetite tiredness feeling sick stiff jaw bad breath Any side effects will be monitored by your care team and treated where possible. The side effects of radiotherapy can be distressing, but most of them will pass once the radiotherapy is complete. Internal radiotherapy Internal radiotherapy  also called brachytherapy  is often used to treat cancers of the tongue that are in their early stages. It involves placing radioactive implants directly into the tumour while you are under a general anaesthetic. They will be left for between 1 and 8 days during which time the cancer cells will receive a much higher dose of radiation than the rest of your mouth. Visits by friends and family will need to be restricted due to radiation and pregnant women and children wont be able to visit you. The radioactive implants will cause your mouth to become swollen, and you will experience some pain 5 to 10 days after the implants are removed. Chemotherapy Chemotherapy is sometimes used in combination with radiotherapy when the cancer is widespread, or if it is thought there is a significant risk of the cancer returning. Chemotherapy involves the use of powerful cancer-killing medicines. These medicines damage the DNA of the cancerous cells, interrupting their ability to reproduce. Medicines used in chemotherapy can sometimes damage healthy tissue as well as the cancerous tissue. Adverse side effects are common and include: fatigue (tiredness) sore mouth mouth ulcers feeling sick being sick hair loss tiredness The side effects should stop once the treatment has finished. Chemotherapy also weakens your immune system and makes you more vulnerable to infection. Cetuximab Cetuximab is a new type of medication, known as a biologic, used to treat advanced cases of mouth cancer. It is usually used in combination with radiotherapy or chemotherapy. Cetuximab targets proteins on the surface of cancer cells, known as epidermal growth factor receptors. These receptors help the cancer to grow, so by targeting these proteins, cetuximab prevents the cancer from spreading. The National Institute for Health and Care Excellence (NICE) ruled that cetuximab did not represent a cost-effective treatment in most cases and has recommended it only be used in people who: are in a good state of health (likely to make a good recovery if treated) are unable to have chemotherapy for medical reasons (for example, because they have kidney disease or are pregnant) Complications of mouth cancer Complications of treatment for mouth cancer can include dysphagia (difficulty swallowing), speech problems and emotional disruption. Difficulty swallowing Dysphagia is the medical term for difficulty swallowing. Its easy to take your ability to swallow food and liquidfor granted,but in reality, the process relies on a complex interaction of muscles, which can be easily disrupted. Surgery and radiotherapy can affect your tongue, mouth or throat, resulting in dysphagia. Dysphagia is a potentially serious problem because, aside from the risk of malnutrition, there is a chance that small particles of food could enter your airways and become lodged in your lungs. This can trigger a chest infection, known as aspiration pneumonia. If you are having problems swallowing, a speech and language therapist (SLT) will need to assess your swallowing reflex. One way an SLT can do this is to perform a test known as a videofluoroscopy, which involves adding a special dye to liquid and food that you swallow. The dye highlights your swallowing reflexes and by using X-rays your SLT can see if there is a risk of food entering your lungs. If this is the case, it may be necessary for the short term to provide you with a feeding tube, which will be directly connected to your stomach. The SLT will teach you exercises so you can relearn how to swallow properly. Your ability to swallow will improve as you learn the exercises and the damaged tissue is allowed to heal. However, there is a chance your swallowing reflex will never fully recover. In some circumstances, you may have to alter your diet to make swallowing easier. Adietitian can give you dietary advice. Read more detailed information about how dysphagia istreated Speech Much like swallowing, your ability to speak clearly is governed by a complex interaction of muscles, bones and tissue, including your tongue, teeth, lips and soft palate (a section of tissue found at the back of the mouth). Radiotherapy and surgery can affect this process and make it difficult to pronounce certain sounds. In severe cases, you may have problems making yourself understood. An SLT will help you improve your verbal communication skills by teaching you a series of exercises that develop your range of vocal movements and teach you new ways of producing sounds. Emotional impact The emotional impact of living with mouth cancer can be significant. Many people report experiencing a roller coaster effect. For example, you may feel down when you receive a diagnosis, but feel up whenthe cancer responds to treatment.Then you may feel down again as you try to come to terms with the side effects and after effects of your treatment. This type of emotional disruption can sometimes trigger depression. Signs that you may be depressed include: feeling down or hopeless during the past month no longer taking pleasure in the things you used to enjoy Contact your GP for advice if you thinkyou may be depressed. There are a range of effective treatments for depression, including antidepressant medication and talking therapies, such ascognitive behavioural therapy (CBT). Read more about depression and coping with cancer Living with mouth cancer Having mouth cancer doesnt necessarily mean youll have to give up work, but you may need quite a lot of time off, and you may not be able to carry on as you did before treatment. If you have cancer youre covered by the Disability Discrimination Act . This means that your employer is not allowed to discriminate against you because of your illness. They have a duty to make reasonable adjustments to help you cope. Examples of these include: allowing you time off for treatment and medical appointments allowing flexibility with working hours, the tasks you have to perform or your working environment The definition of what is reasonable depends on the situation. For example, how much it would affect your employers business. It will help if you give your employer as much information as possible about how much time you will need off and when. Talk to your human resources department if you have one. Your union or staff association representative should also be able to give you advice. If youre having difficulties with your employer, you may be able to receive help from your union or your local Citizens Advice Bureau . Relationships with others It is not always easy to talk about cancer, either for you or your family and friends. You may sense that some people feel awkward around you or avoid you. Being open about how you feel and what your family and friends can do to help may put them at ease. Do not feel shy about telling them that you need some time to yourself, if that is what you need. Money and financial support If you have to stop work or go part-time because of your cancer, you may find it hard to cope financially. If you have cancer or you are caring for someone with cancer, you may be entitled to financial support: if you have a job, but cannot work because of your illness, you are entitled to Statutory Sick Pay from your employer if you dont have a job and cannot work because of your illness, you may be entitled to Employment and Support Allowance if you are caring for someone with cancer, you may be entitled to Carers Allowance you may be eligible for other benefits if you have children living at home or if you have a low household income Find out as early as possible what help is available to you. Speak to the social worker at your hospital who can give you the information you need. Talk to others If you have questions, your GP or nurse may be able to reassure you. You may find it helpful to talk to a trained counsellor or psychologist, or to someone at a specialist helpline. Your GP surgery will have information on these. Some people find it helpful to talk to other people who have mouth cancer, either at a local support group or in an internet chatroom, such as: Cancer Research UK: Cancer chat Macmillan Cancer Support: Head and neck cancer forum Caring for others with mouth cancer Being a carer is not an easy role. When you are busy responding to the needs of others it can deplete your reserves of emotional and physical energy and make it easy for you to neglect your own health and mental wellbeing. Research on carers health shows that high numbers of carers suffer health effects through caring. If you are trying to combine caring with a paid job or looking after a family, this can cause even more stress. If you are caring for someone else, it is important to look after yourself and get as much help as possible. It is in your best interests and those of the person you are caring for. Look after your health Eat regularly and healthily. If you do not have time to sit down for every meal, try to make time to sit down for at least 1 of your days meals. Instead of relying on fast food snacks, go for healthier options, such as fruit. Look after your emotional health As well as exhaustion, isolation andworries about the person you are caring for, it is understandable if there are times when you feel resentful and then guilty for feeling like this. These feelings are natural. Look for support Friends and family may not always understand what you are going through and it can be helpful to talk to people in the same situation. Care Information Scotland has a lot of useful information on its website. Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites Oral Health Foundation: Mouth cancer awareness month Cancer Research UK: Mouth and oropharyngeal cancer Macmillan Cancer Support: Oropharyngeal cancer Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Mouth ulcer,"Mouth ulcer | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Mouth Mouth ulcer Mouth ulcer Mouth ulcers are painful sores that appear in the mouth. Theyre uncomfortable but theyre usually harmless. Most clear up by themselves within 1 to 2 weeks. Mouth ulcers are common and can usually be managed at home, without seeing your dentist or GP. What does a mouth ulcer look like? Mouth ulcers are usually round or oval sores that commonly appear inside the mouth on the: cheeks lips tongue They can be white, red, yellow or grey in colour and swollen. You may have more than one mouth ulcer at a time and they may spread or grow. Mouth ulcers shouldnt be confused with cold sores , which are small blisters that develop on the lips or around the mouth. Cold sores often begin with a tingling, itching or burning sensation around your mouth. When to get help Speak to a pharmacist if: you have a mouth ulcer They can give you advice and treatment. If you have a dental problem you should always phone your dentist first. If youre not registered with any dental practice then you should read our advice on dental emergencies . Your pharmacist may advise that you see your GP or dentist if: your mouth ulcer has lasted 3 weeks you keep getting mouth ulcers the mouth ulcer grows bigger than usual or is near the back of your throat your mouth ulcer becomes more painful or red  this could be a sign of a bacterial infection, which may need treatment with antibiotics Mouth ulcers are also a possible symptom of hand, foot and mouth disease . Speak to your GP or phone 111 if youre unsure. How to treat mouth ulcers Most mouth ulcers clear up by themselves within 1 to 2 weeks without treatment. However, treatment can help to reduce swelling and ease any discomfort. This may help if you keep getting mouth ulcers or your mouth ulcer affects eating and drinking. Self care There are things you can do to speed up healing. Do use a soft toothbrush to brush your teeth drink cool drinks through a straw eat softer foods get regular dental check-ups eat a healthy, balanced diet try to reduce stress and anxiety Dont do not eat very spicy, salty or acidic food do not eat rough, crunchy food, such as toast or crisps do not drink very hot or acidic drinks, such as fruit juice do not use chewing gum do not use toothpaste containing sodium lauryl sulphate Pharmacy medicines You can get several types of mouth ulcer treatment from a pharmacy. Speak to your pharmacist about the best treatment for you. Treatment from a dentist or GP A GP or dentist may prescribe stronger medicine to treat severe, persistent or infected mouth ulcers. Possible treatments include: steroid mouth spray or steroid tablets that dissolve in your mouth painkilling gels, ointments, sprays or tablets mouthwashes to kill or remove any germs in your mouth What causes mouth ulcers? In many cases, the reason for mouth ulcers is unclear. Most single mouth ulcers are caused by damage to the lining inside of the mouth. For example: accidentally biting the inside of your cheek or a sharp tooth poorly fitting dentures hard food a faulty filling Its not always clear what causes mouth ulcers that keep returning, but triggers are thought to include: stress and anxiety hormonal changes  some women develop mouth ulcers during their monthly period eating certain foods  such as chocolate, spicy foods, coffee, peanuts, almonds, strawberries, cheese, tomatoes and wheat flour toothpaste containing sodium lauryl sulphate stopping smoking  when you first stop smoking, you may develop mouth ulcers Your genes are also thought to have a role. Around 40% of people who keep getting mouth ulcers report that it runs in their family. Medical conditions Mouth ulcers can sometimes be caused by certain medical conditions, such as: viral infections  including the cold sore virus , chickenpox , and hand, foot and mouth disease vitamin B12 or iron deficiency crohns disease  a long-term condition that causes inflammation of the lining of the digestive system coeliac disease  a common digestive condition where a person has an adverse reaction to gluten reactive arthritis  a condition that causes inflammation in various places in the body, usually as a reaction to an infection weakened immune system  for example, due to HIV or lupus behets disease  a rare and poorly understood condition that also causes swelling of the blood vessels Medications and treatments Mouth ulcers can sometimes be caused by certain medications or treatments, such as: non-steroidal anti-inflammatory drugs (NSAIDs)  such as ibuprofen nicorandil  a medication sometimes used to treat angina beta-blockers  used to treat conditions such as angina, high blood pressure and abnormal heart rhythms a side effect of chemotherapy or radiotherapy  this is known as mucositis Is it mouth cancer? In a few cases, a long-lasting mouth ulcer can be a sign of mouth cancer . If mouth cancer is detected early, the chances of a complete recovery are good. Regular dental check-ups are the best way to detect the early signs. Source: NHS 24 - Opens in new browser window Last updated: 20 October 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Search for a pharmacy near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Multiple myeloma,"Multiple myeloma - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Multiple myeloma Multiple myeloma About multiple myeloma Symptoms of multiple myeloma Causes of multiple myeloma Diagnosing multiple myeloma Treating multiple myeloma About multiple myeloma Multiple myeloma, also known as myeloma, is a type of bone marrow cancer. Bone marrow is the spongy tissue found atthe centre of somebones. It produces the bodys blood cells. Multiple myelomaaffects the plasma cells (a type of blood cell) inside the bone marrow. Myeloma does notusually take the form ofa lump or tumour. Instead, the myeloma cells divide and expand within the bone marrow, damaging the bones and affecting the production of healthy blood cells. Myelomaoftenaffects many places in the body, which is why it is called multiple myeloma. Commonly affected areas include the spine, skull, pelvis and ribs. Signs and symptoms In the early stages, myeloma may not cause any symptoms. Its often only suspected or diagnosed aftera routine blood or urine test. However, myeloma will eventually cause a wide range ofproblems, including: a persistent dull ache or specific areas of tenderness in your bones weak bones thatbreak (fracture)easily tiredness, weakness and shortness of breath (caused by anaemia ) repeated infections less commonly, bruisingand unusual bleeding  such as frequent nosebleeds , bleeding gums andheavy periods Read more about the symptoms of multiple myeloma When to speak to your GP Speak to your GP if you have any of these symptoms. While theyre unlikely to be caused by cancer, its best toget aproper diagnosis. Your GP will examine you to check for bone tenderness, bleeding, signs of infection, and any other symptoms that suggest you may have myeloma. They may also arrangebloodand urine tests that can detectabnormal proteins produced by myeloma cells. If myeloma is suspected, you will bereferred to a consultant haematologist (a specialist in blood conditions) for further tests and treatment. Read more about diagnosingmultiple myeloma Who is affected? Multiple myeloma is anuncommontype of cancer. Its not known exactly what causes the condition, although its more common in: people withmonoclonal gammopathy of unknown significance (MGUS)an excess number of protein molecules called immunoglobulins in your blood men adults over 60 most cases are diagnosed at around the age of 70,and cases affecting people under the age of 40 are rare black peoplemultiple myeloma is about twice as common in black populations compared with white and Asian populations Read more about the causes of multiple myeloma . How multiple myeloma is treated There is currently no cure for multiple myeloma, but treatment can often help control it for several years. Treatment will often involve: acombination of anti-myeloma medications todestroy the myeloma cells medicines and procedures to prevent and treat problems caused by myeloma, such as bone pain, fracturesand anaemia anti-myeloma medicines to control the cancerwhen it comes back (relapses) As part of your treatment, you may be asked if you want to take part in a clinical trialto help researchers develop better treatments for multiple myeloma. Read more about treating multiple myeloma Support groups If youve been diagnosed with multiple myeloma, you may find it useful tocontact a local or national support group, such as Myeloma UK . Support groups can offer more information and advice. They can also often put you in touch with other people in a similar situation so you can share advice and talk about your experiences. TheMyeloma UK website has more information about how they can help youand finding a local support group . Symptoms of multiple myeloma In the early stages, multiple myeloma may not cause any symptoms or complications, and may only be diagnosed after a routine blood or urine test. However, it will eventually cause a wide range of problems. Bone pain Multiple myeloma can cause pain in affected bones, most often the back, ribs or hips. The pain isfrequently a persistent dull ache,which may be made worse by movement. Bone fractures and spinal cord compression Multiple myeloma can weaken the bones and make them more likely to break (fracture). The spine and ribs are most often affected. Fractures of the spine can cause the sections of the spine to collapse, leading to pain and occasionally compression of the spinal cord (the main column of nerves running down the back). Compression of the spinal cord can causepins and needles, numbness and weakness in the legs and feet, and sometimes problems controlling your bladder and bowels. Anaemia Multiple myeloma can affect the production of blood cells in our bone marrow, which can lead to a lack of red blood cells ( anaemia ). This can also occur as a side effect of myeloma treatment. If you have anaemia, you may feel very tired, weak and breathless. Repeated infections People with multiple myeloma are particularly vulnerable to infection because the condition interferes with the immune system (the bodys natural defence against infection and illness). You may find you get infections frequently and that they last for a long time. Raised calcium levels in the blood A high level of calcium in the blood (hypercalcaemia) can develop in people with multiple myeloma because too much calcium is released from affected bones into the bloodstream. Symptoms of hypercalcaemia can include extreme thirst , feeling sick, needing to urinate frequently, constipation , confusion and drowsiness. Unusual bleeding Bruising and unusual bleeding (haemorrhage) such as frequent nosebleeds , bleeding gums andheavy periods  sometimes occurs in multiple myeloma because the cancer cells in your bone marrow can stop blood clotting cells called platelets being made. Thickened blood In some people, multiple myeloma can cause the blood to become thicker than normal. This is known as hyperviscosity, which can cause problems such as blurred vision, headaches , dizziness , bleeding from the gums or nose, and shortness of breath . Kidney problems Kidney damage can occur in people with multiple myeloma for several reasons. Abnormal proteins produced bythe cancercells can damage the kidneys, as can other complications, such as hypercalcaemia. Some medications used to treat multiple myeloma can alsocause kidney damage. Eventually, the kidneys may stop working properly. This is known as kidney or renal impairment, or kidney or renal failure. Signs of kidney failure can include: weight lossand poor appetite swollen ankles, feet or hands tiredness and a lack of energy shortness of breath itchy skin feeling sick When to seek medical advice You should speak to your GP if you have symptoms of multiple myeloma. While theyre unlikely to be caused by cancer, its best to be sure by getting a proper diagnosis. You should seek immediate medical help if you have symptoms of spinal cord compression, hypercalcaemia or kidney failure, as these are medical emergencies that need to be investigated and treated as soon as possible. Read more about diagnosing multiple myeloma and treating multiple myeloma Causes of multiple myeloma In multiple myeloma, cells inside the bone marrow called plasma cells become cancerous. Bone marrow is the spongy tissue found at the centre of some bones. It produces the bodys blood cells. Plasma cells are normally produced ina controlled way. In cases of multiple myeloma, large numbers of abnormal plasma cells are produced. These fill up the bone marrow and interfere with the production of other cells, such as red and white blood cells. The exact reason why this happens is unknown, but multiple myeloma is closely associated with a condition called monoclonal gammopathy of unknown significance (MGUS), and there are certain things that can increase your risk of developing it. Monoclonal gammopathy of unknown significance (MGUS) In almost all cases, multiple myeloma occurs in someone who previously had MGUS. MGUS is the name for having an excess number of protein molecules called immunoglobulins in your blood. This does not cause any symptoms and treatment is not required. However, every year around1 in every 100 people with MGUS go on to develop multiple myeloma. There is no known way to delay or prevent this, soongoing outpatienttests to check for cancer will usually be recommended if you have MGUS. Other factors As well as MGUS, certain things can increase your risk of developing multiple myeloma, including: age  your risk of developing multiple myeloma increases as you get older; most cases are diagnosed at around the age of70, and cases affecting people under 40 are rare gender  men are more likely to develop multiple myeloma than women ethnicity  multiple myeloma is about twice as common in black populations compared with white and Asian populations It has also been suggested that having a family history of MGUS or multiple myeloma, having reduced immunity (for example, because of medication or HIV ), being overweight or obese , and being exposed to radiation or certain chemicals may increase your risk of multiple myeloma. However, a link between these factors and the condition is less clear. Diagnosing multiple myeloma Multiple myeloma can be difficult to diagnose because its an uncommon type of cancer that initially has few or no symptoms. Your GP will examine you and ask about your symptoms, medical history and overall health. During the examination, your GP will look for things such as bleeding, signs of infection and specific areas of bone tenderness. You may need urine and blood tests to check for certain types of antibodies and proteins (immunoglobulins). If multiple myeloma is suspected,youwill bereferred to a haematologist (a doctor who specialises in conditions affecting the blood) for further tests andscans. Blood tests A number of blood tests are used to help diagnose multiple myeloma, and they may need to be repeated to monitor the condition. These may include: erythrocyte sedimentation rate (ESR) or plasma viscosity (PV) if you have multiple myeloma, your ESR or PV will usually be raised tests to measure the type and number of abnormal antibodies produced by the cancerous plasma cells a full blood count (FBC) to check levels of different types of blood cells your doctor will be looking for a low number of red blood cells and platelets liver and kidney function blood calcium level Urine tests A urine sample will be checked for the abnormal proteins produced by the cancerous plasma cells. The abnormal proteins are known as monoclonal light chains,or Bence Jones protein. These proteins can damage your kidneys as they pass through them from your blood to your urine. You may be asked to collect your urine over a 24-hour period. This will be used to check the quantity of proteins being produced and how well your kidneys are working. X-rays and other scans You will have X-rays taken of your long bones (arms and legs), skull, spine and pelvis to look for any damage. Other scans, such as computerised tomography (CT) scans and magnetic resonance imaging (MRI) scans , may also be carried out. Bone marrow biopsy A bone marrow biopsy is usually needed to confirm multiple myeloma. A needle will be used to take a small sample of bone marrow from one of your bones, usually the pelvis. A sample of bone may also be removed. This is carried out using a local anaesthetic (the area where the needle is inserted is numbed). The sample of bone marrow and bone will be usedto check for cancerous plasma cells. Treating multiple myeloma If you have multiple myeloma, you will be cared for by a team, which is usually led by a consultant haematologist who specialises in myeloma. The team will discuss your condition and recommend the best treatment for you. However, the final decision will be yours. Before visiting hospital to discuss your treatment options, it may be useful to write a list of questions to ask the specialist. For example, you may want to find out the advantages and disadvantages of a particular treatment. There are 2 main aims in treating multiple myeloma: to bring the myeloma under control to prevent and treat problems associated with myeloma, such as anaemia and bone pain While treatment can often control myeloma and improve quality of life, myeloma usually cant be cured. This means additional treatment is needed when the cancer comes back (a relapse). Not everyone diagnosed with myeloma will need immediate treatment if the condition is not causing any problems. This is sometimes referred to as asymptomatic, or smouldering myeloma . If you dont need treatment, youll be monitored for signs the cancer is beginning to cause problems. If you do need treatment, the following options are most commonly used. Bringing myeloma undercontrol The initial treatment for multiple myeloma may be either: non-intensive  for older or less fit patients (this is more common) intensive  for younger or fitter patients (thought to be too toxic for older or less fit patients) The decision about which treatment is appropriate for you is usually based on your biological age or fitness. As a general rule, people younger than 65 are more likely to be candidates for intensive therapy. For those over 70, non-intensive treatment is more likely to be recommended. Those aged in between will be given careful consideration as to what treatment group they fall into. Both non-intensive and intensive treatments involve taking a combination of anti-myeloma medicines. Intensive treatment involves much higher doses and is followed by a stem cell transplant. The medicines usually include a chemotherapy medicine, a steroid medicine, and either thalidomide or bortezomib. Chemotherapy Chemotherapy medicines kill the myeloma cells. The most common types used to treat myeloma are melphalan and cyclophosphamide. These treatments are mostly taken in tablet form. They are reasonably well tolerated and side effects are mild. Possible side effects include: increased risk of infections feeling sick vomiting hair loss Your clinician will give you advice and information about your risk of developing potentially serious infections, andtell you what you can do to reduce your risk of picking up infections during your treatment. Steroids Steroid medications ( corticosteroids )help destroy myeloma cells and make chemotherapy more effective.The 2 most common types used to treat myeloma are dexamethasone andprednisolone. Steroids are taken orally (by mouth) after eating. Possible side effects include heartburn , indigestion , increased appetite, mood changes and problems falling asleep. Thalidomide Thalidomide can help kill myeloma cells. You takeit as a tablet every day, usuallyin the eveningas it can make you feel sleepy. Other common side effects include: constipation dizziness rashes numbness or tingling in the hands and feet ( peripheral neuropathy ) Thalidomide can cause birth defects, so it should not be taken by pregnant women, and a reliable form of contraception such as a condom must be used during treatment. There is also a risk you may develop a blood clot when taking thalidomide, so you may be given medication to help prevent this. Contact your care team immediately if you develop symptoms of a blood clot, such as pain or swelling in one of your legs, or chest pain and breathlessness . Bortezomib Bortezomib (Velcade) can help kill myeloma cells by causing protein to build-up inside them. There are some limitations as to who can have bortezomib, but a member of your care team will discuss this with you. The medication is given by injection, usually under the skin.Possible side effects include: tiredness nausea diarrhoea numbness or tingling in your hands and feet (peripheral neuropathy) Stem cell transplant After initial therapy with primarily outpatient-based treatments, people receiving intensive treatment will be given a much higher dose of chemotherapy medication as an inpatient to potentially help destroy a larger number of myeloma cells. This aims to achieve a longer period of remission (where there is no sign of active disease in your body). However, these high doses also affect healthy bone marrow, so astem cell transplantwill be needed to help your bone marrow recover. In most cases, the stem cells will be collected from you before treatment (autologous transplantation). In rare cases, they are collected from a sibling or an unrelated donor. Treating relapses Further treatment is needed if myeloma returns. Treatment for relapses is generally similar to initial treatment, although non-intensive treatment is often preferred to further intensive treatment. Additional medications such as lenalidomide, pomalidomide and other chemotherapy medicines may be added, or usedagain as your haematologist feels is appropriate. You may also be asked if you want to participate in clinical trial research intonew treatments for multiple myeloma. Lenalidomide and pomalidomide Lenalidomide and pomalidomide are similar to thalidomide. Theyre both taken by mouth, and both canhave an effect on the cells produced by your bone marrow, which can cause: increased risk of infection  asa result ofa low number of white blood cells anaemia caused bya low number of red blood cells bruising and bleeding because ofa low platelet count They may also increase your risk of developing a blood clot and have other side effects similar to thalidomide. Let your care team know if you experience any problems or unusual symptoms while taking lenalidomide or pomalidomide. Treating symptoms and complications of myeloma As well as the main treatments for multiple myeloma, you may also need treatment to help relieve some of the problems caused by the condition. For example: painkillers  may be given to reduce pain radiotherapy  may be used to relieve bone painor help healing after a bone is surgically repaired bisphosphonate medication  eithergiven as tablets or by injection, this mayhelp prevent bone damage and reduce the levels of calcium in your blood blood transfusions orerythropoietin medication  may be usedto increase your red blood cell count andtreat anaemia surgery  may be carried outto repair or strengthen damaged bones, or treat compression of the spinal cord (the main column of nerves running down the back) dialysis  may berequired if you develop kidney failure plasma exchange treatment to remove and replace a blood component called plasma may be carried out if you have unusually thick blood (hyperviscosity) These treatments can each cause side effects and complications, so make sure you discuss the potential risks and benefits with your treatment team beforehand. Clinical trials and research Research is ongoing to find new treatments for multiple myeloma and work out ways to improve the use of existing ones. To help with this, you may be asked to take part in a clinical trialduring your treatment. Clinical trials usually involve comparing a new treatment with an existing one to see whether the new treatment is more or less effective. Its important to remember, however, that if you are given a new treatment, there is no guarantee it will be more effective than an existing treatment. There will never be any pressure for you to take part in a trial if you do not want to. Search clinical trials for multiple myeloma Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites Cancer Research UK: Myeloma Multiple Myeloma Research Foundation Myeloma UK Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Multiple sclerosis (MS),"Multiple sclerosis (MS) | NHS inform | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Multiple sclerosis (MS) Multiple sclerosis (MS) Multiple sclerosis (MS) is a condition that affects the brain and/or spinal cord. It can cause symptoms like problems with vision, arm or leg movement, sensation or balance. Its a lifelong condition that can sometimes cause serious disability. In many cases, its possible to treat symptoms. Average life expectancy is slightly reduced for people with MS. MS Society estimates that there are more than 130,000 people diagnosed with MS in the UK. Its often diagnosed in people in their 20s and 30s, although it can develop at any age. Its about two to three times more common in women than men. Symptoms of multiple sclerosis Multiple sclerosis (MS) can cause a wide range of symptoms and can affect any part of the body. It affects everyone differently. The symptoms are unpredictable. Some peoples symptoms develop and worsen over time, while for others, they come and go. Periods when symptoms get worse are known as relapses. Periods when symptoms improve or disappear are known as remissions. Some of the most common symptoms include: Muscle spasms, stiffness and weakness MScan cause yourmuscles to: feel weak become stiff and resistant to movement (spasticity) contract tightly and painfully (spasm) Vision problems In around 1 in 4 cases of MS, the first noticeable symptom is a problem with one of your eyes (optic neuritis). You may experience: some temporaryloss of vision in the affected eye, usually lasting for days to weeks colour blindness eye pain, which is usually worse when moving the eye flashes of light when moving the eye You might also experience double vision or involuntary eye movements, which can make it seem as though objects are jumping around. Abnormal sensations You might have persistent numbness or tingling in different parts of your body which can last a few days to weeks. Mobility problems MS can make walking and moving around difficult, particularly if you also have muscle weakness and spasticity. You may experience: clumsiness difficulty with balance and co-ordination (ataxia) shaking of the limbs (tremor) dizziness and vertigo , which can make it feel as though everything around you is spinning Pain Some people with MS experience pain which can take two forms. Pain caused by MS itself (neuropathic pain) This is pain caused by damage to the nervous system, and can include: stabbing pains in the face stabbing sensations in the torso (body) and limbs feeling like youre burning pins and needles feeling like youre being hugged or squeezed Muscle spasms can sometimes be painful. Musculoskeletal pain This can be back, neck and joint pain particularly if you have problems walking or moving around. Bladder problems Bladder problems are common in MS. They may include: having to pee more often having a sudden, urgent need to pee, which can lead to unintentionally passing urine ( urge incontinence ) difficulty emptying the bladder completely having to get up during the night to pee recurrent urinary tract infections These problems can also have a range of causes other than MS. Bowel problems Many people with MS also have problems with their bowel function. Constipation is the most common problem. You may find passing stools (poo) difficult and pass them much less than normal. Bowel incontinence is less common, but is often linked to constipation. If a poo becomes stuck, it can irritate the wall of the bowel, causing it to produce more fluid and mucus that can leak out of your bottom. Some of these problems arent specific to MS and can be the result of medications. Sexual problems MS can have an effect on sexual function. For women, problems include difficulty reaching orgasm. They might experience decreased vaginal lubrication and sensation. Men with MS might find it hard to get or maintain an erection ( erectile dysfunction ). They may also find it takes a lot longer to ejaculate when having sex or masturbating. They might lose the ability to ejaculate altogether. Both men and women with MS may find theyre less interested in sex than they were before. This could be directly related to MS, a mood disorder like depression, or it could be the result of living with the condition. Speech and swallowing difficulties Some people with MS have difficulty chewing or swallowing ( dysphagia ) at some point. They might also slur their speech or be difficult to understand (dysarthria). Fatigue Feeling fatigued is a common and troublesome symptom of MS. It can cause an overwhelming sense of exhaustion that means its a struggle to carry out simple tasks. Fatigue tends to get worse: towards the end of each day in hot weather after exercising during illness Mental health issues Many people with MS experience periods of depression. Its unclear if this is directly caused by MS, or is due to the stress of having to live with a long-term condition, or both. Anxiety can also be a problem for people with MS, possibly due to the unpredictable nature of the condition. In rare cases, people with MS can experience rapid and severe mood swings. Problems with thinking, learning and planning Some people with MS have problems with thinking, learning and planning. This is known as cognitive dysfunction and can include: problems learning and remembering new things although long-term memory is usually unaffected slowness in processing lots of information or multi-tasking a shortened attention span getting stuck on words problems with understanding and processing visual information, such as reading a map difficulty with planning and problem solving  people often report that they know what they want to do, but cant grasp how to do it problems with reasoning, such as mathematical laws or solving puzzles Many of these problems arent specific to MS. They can be caused by other conditions, including depression and anxiety or medication. Speak to your GP if: you think you have symptoms of MS The symptoms can be similar to severalother conditions, so theyre not necessarily caused by MS. What happens when someone has multiple sclerosis MS is an autoimmune condition. This means your immune system mistakes part of your body for a foreign substance and attacks it. In the case of MS, it attacks the myelin sheath in the brain and/or spinal cord. This is the layer that surrounds your nerves, protecting them and helping electrical signals travel from the brain to the rest of the body. The attacks cause the myelin sheath to become inflamed in small patches (plaques or lesions). This can be seen on a magnetic resonance imaging (MRI) scan . These patches of inflammation can disrupt the messages travelling along the nerves. It can slow them down, jumble them, send them the wrong way, or stop them from getting through completely. This disruption leads to the symptoms and signs of MS. When the inflammation goes away, it can leave behind scarring of the myelin sheath (sclerosis). These attacks, particularly if frequent and repeated, can lead to permanent damage. What causes multiple sclerosis? Exactly why someone develops multiple sclerosis (MS) isnt known. Its not caused by anything youve done and its not clear if you can prevent it. Its likely to be partly caused by genes you inherit from your parents and partly by outside factors that may trigger the condition. Some of the factors that might cause MS include: Your genes MS isnt directly inherited, but if youre related to someone withthe condition youre more likely to develop it. The chance of a sibling or child of someone with MS also developing it is around 2-3%. Lack of sunlight and vitamin D MS is more common in countries far from the equator. This couldmean that a lack of sunlight and low vitamin D levels may play a role in the condition. Its not clear whether vitamin D supplements can help prevent MS. Smoking People who smoke are about twice as likely to develop MS compared tothose who dont smoke. Viral infections Infections, particularly those caused by the Epstein-Barr virus, (responsible for glandular fever ), might trigger the immune system, leading to MS in some people. More research will help us understandwhy MS occurs and whether it can be prevented or not. Diagnosing multiple sclerosis It can be hard to tell if you have multiple sclerosis (MS) because some of the symptoms are like other conditions. You may need to rule out other possible causes of your symptoms first. If your GP thinks you could have MS, you should see a neurologist(a specialist in conditions of the nervous system) for a specialist assessment. Some of the tests you may need to confirm MS are: neurological examination magnetic resonance imaging (MRI) scan lumbar puncture blood test Types of multiple sclerosis Once you have a diagnosis of MS, your neurologist might be able to identify which type of MS you have  either relapsing remitting MS or primary progressive MS. This will largely be based on: the pattern of your symptoms  like whether you experience periods when your symptoms get worse (relapses) then improve (remissions), or whether they get steadily worse (progress) the results of an MRI scan It can take some time to find out which type of MS you have because the symptoms are so varied. It can take a few years to make an accurate diagnosis of progressive MS, as the condition usually worsens slowly. Treating multiple sclerosis Phone your specialist MS nurse or GP if: you think youre having a relapse Treatment with disease-modifying therapies Although there isnt a cure for MS, there are medicines that can help to reduce the number and severity of relapses in some people. These are called disease-modifying therapies or disease modifying drugs. These reduce the amount of damage and scarring to the myelin sheath (layer surrounding your nerves), associated with MS relapses. These treatments reduce the chances of developing progressive symptoms of MS. They might also help to slow worsening disability in MS. Disease-modifying therapies are not suitable for everyone with MS. Theyre only prescribed to those with either: relapsing remitting MS secondary progressive MS who meet certain criteria, like the number of relapses theyve had primary progressive MS who meet certain criteria like new lesions found by an MRI scan People without relapses are less likely to benefit from the treatments and could still experience side effects from them. Treatment of a relapse of multiple sclerosis Sometimes an infection can cause a flare up of symptoms rather than a relapse, so your nurse or GP will check for other possible causes. Treatment for a relapse might involve a five-day course of steroid tablets taken at home. Steroids can help speed up your recovery from a relapse. They dont prevent further relapses or stop MS getting worse over time. Steroids are only given for a short period of time to avoid possible steroid side effects . The side effects could include infection, mood disturbance, stomach ulceration, osteoporosis (weak bones) , weight gain and diabetes . Not using steroids more than three times a year (if possible) will help to reduce the risk of side effects. Treatment for multiple sclerosis symptoms There are different treatments available for MS symptoms. Fatigue Your healthcare professional should give you advice about ways to manage fatigue. This might include exercise, keeping healthy sleep patterns and energy-saving techniques. Your healthcare professional might suggest avoiding medications that can worsen fatigue. Specialist fatigue management courses or therapy, such as cognitive behavioural therapy (CBT), might also help. Visual problems MS-related visual problems will often improve on their own, usually within a few weeks. If your symptoms are particularly severe, your healthcare professional might prescribe steroids. If you have problems with involuntary eye movements, medication like gabapentin can sometimes help. Some people with double vision need help from ophthalmologists (eye specialists). Muscle spasms and stiffness Physiotherapy can help improve muscle spasms and stiffness. Techniquessuch as stretching exercises can help if your movement is restricted. If your muscle spasms are more severe, you may be prescribed a medicine that can relax your muscles. This will usually be either baclofen, gabapentin or tizanidine. These medicines all have side effects. You might experience dizziness, weakness, nausea and diarrhoea. Discuss which of these would be best for you with yourspecialist MS nurse. Mobility problems Mobility problems are often the result of muscle spasms and spasticity. Muscle weakness, or problems with balance or dizziness can also cause mobility problems. If you have problems with mobility, your healthcare professional might suggest: an exercise programmesupervised by a physiotherapist special exercises called vestibular rehabilitation, if you have problems with balance medication for dizziness or tremors mobility aids, such as a walking stick, or a wheelchair home adaptations such as stair lifts or railings An occupational therapist can carry out an assessment of your home and suggest adaptations. Musculoskeletal pain Living with MS can cause stresses and strains to the muscles and joints in your body. A physiotherapist might be able to help withthis pain by suggesting exercises or better seating positions. If your pain is more severe, you may be prescribed painkillers. Or, you might have a transcutaneous electrical nerve stimulation (TENS) machine that stimulates your nerves. Neuropathic pain Neuropathic pain is caused by damage to your nerves and is usually sharp and stabbing. It can also occur in the form of extreme skin sensitivity, or a burning sensation. This type of pain can be treated using neuropathic painkillers. Problems with thinking, learning and memory Your MS healthcare professionals can assess your thinking, learning and memory problems and suggest ways to manage them. Emotional problems People with MS who have depression or anxiety can be treated with antidepressants or therapy, such as CBT. If you have emotional outbursts, such as laughing or crying for no clear reason, you should be assessed by a specialist. They may suggest treatment with an antidepressant. Bladder problems Medication might help if you have an overactive bladder or need to pee frequently during the night. If you find it difficult to empty your bladder, advice from a continence nurse or physiotherapist can help. Hand-held external stimulators can help some people to start peeing or to empty the bladder. Sometimes a catheter can empty the bladder when needed. You might be taught how to do intermittent self catheterisation (ISC). In rare cases, people with MS may need a long-term catheter to keep the bladder emptying safely. You might be referred to a continence adviser or urologist, for specialist treatment and advice. Read more about treating urinary incontinence . Bowel problems It might be possible to treat mild to moderate constipation by changing your diet or taking laxatives . More severe constipation may need to be treated with suppositories, which are inserted into your bottom, or an enema. During an enema, liquid medication is rinsed through your bottom and large bowel, which softens and flushes out your stools. Anti diarrhoea medication or pelvic floor exercises might help bowel incontinence. Sexual problems If you experience problems with less interest in sex or difficulty reaching orgasm, relationship counselling or seeing a sex therapist might help. If you have MS and find it hard to get or maintain an erection ( erectile dysfunction ) you may be prescribed medication to increase the blood flow to the penis. Speech and swallowing difficulties Aspeech and language therapist can help you find ways to overcome problems with speech and swallowing. For example, they can offer advice about foods that are easy to swallow. They might recommend exercises to strengthen the muscles used in speech and swallowing. Complementary and alternative therapies for MS Some people with MS find that complementary therapies help them feel better. Complementary treatments and therapies claim to ease symptoms, although scientific evidence is often not clear about how effective they are. Many people think that complementary treatments have no harmful effects. However, people can experience problems. Its not a good idea to use them as an alternative to medicines prescribed by your doctor. If youre considering an alternative treatment, its important to let your doctor know. Clinical trials Clinical trials have helped to improve the treatments available for MS. Speak to your care team if youre interested in taking part in a clinical trial. Support for living with multiple sclerosis Coming to terms with a long-term condition like MS can put a strain on you, your family and your friends. Be honest about how you feel and let your family and friends know what they can do to help. If you have any questions, yourMS nurse or GP can help and will let you know what support is available. If you find it difficult to look after yourself, your local authority may be able to provide you with some help.Ask for a care and support needs assessment. For more information, read about assessing your care and support needs . Having a baby Being diagnosed with MS shouldnt affect your ability to have children. Women with MS can have a normal pregnancy, deliver a healthy baby and breastfeed. Some of the medications prescribed for MS arent suitable for taking during pregnancy or breastfeeding and might affect fertility inmales and females.If youre considering starting a family, discuss it with your healthcare team. Having a baby doesnt affect the long-term course of MS. Relapses can be less common in pregnancy, but they can be more common in the months after giving birth. Money and financial support If you have to stop work or work part-time because of your MS, you may find it hard to cope financially. You might be able to get financial support . Driving If you have MS, you must tell the Driver and Vehicle Licensing Agency (DVLA) and inform your insurance company. You might be able to continue driving, but youll be asked to complete a form providing more information about your condition. Youll be asked for details of your doctors and specialists. The DVLA will use this to decide whether youre fit to drive. Source: Scottish Government - Opens in new browser window Last updated: 21 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites Brain and Spine Foundation: Multiple sclerosis MS Trust MS Society Revive MS Support Neurological Alliance of Scotland NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Mumps,"Mumps | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Mumps Mumps Mumps is an infection that spreads easily. It used to be common in children before the introduction of the measles, mumps and rubella (MMR) vaccine . Mumps usually clears within 1 or 2 weeks. Symptoms of mumps The symptoms of mumps usually develop 14 to 25 days after youre infected. Mumps causes painful swellings at the side of the face under the ears (the parotid glands). It gives a distinctive hamster face appearance. Other symptoms of mumps can include: headaches joint pain feeling sick dry mouth mild stomach (abdominal) pain feeling tired loss of appetite a high temperature (fever) of 38C (100.4F), or above These may develop a few days before the swelling of the parotid glands. Sometimes, mumps doesnt cause any noticeable symptoms. Phone your GP if: you think you or your child might have mumps youve been in close contact with someone who has mumps and youre pregnant, and havent been fully vaccinated Mumps is not usually serious, but it has similar symptoms to more serious types of infection, such as glandular fever and tonsillitis . You should phone your GP first before visiting. They can make arrangements to reduce the risk of spreading the infection to others. Diagnosing mumps Your GP can usually make a diagnosis after: seeing and feeling the swelling looking at the position of the tonsils in the mouth checking your temperature to see if its higher than normal If your GP suspects mumps, they should notify your local health protection team (HPT). Whos affected? Most cases of mumps occur in people aged between 17 and 34 who have not received 2 doses of the MMR vaccine . Once youve had mumps, your body builds up resistance (immunity) to the virus. Its highly unlikely youll get it again. How mumps is spread The mumps virus is contained in tiny droplets that come out of the nose and mouth when an infected person coughs or sneezes. You can easily catch mumps by breathing in these droplets. Or, if the droplets have settled on a surface, by touching the surface and then placing your hands near your nose or mouth. A person is most contagious a few days before the symptoms develop and for a few days afterwards. How to prevent spreading mumps to others If you have mumps: stay off school or work for at least 5 days after your symptoms first develop regularly wash your hands with soap use and dispose of tissues when you sneeze avoid close contact with anyone who isnt fully vaccinated How mumps can be prevented Mumps can be prevented by having the MMR vaccine . This is given in 2 doses as part of the NHS childhood vaccination programme. You can be vaccinated at any age if you havent been fully vaccinated before. Treatment for mumps There are things you can do to help relieve your symptoms. Do get plenty of bed rest drink plenty of water to avoid dehydration use pain relief such as paracetamol or ibuprofen  aspirin shouldnt be given to children under 16 apply a warm or cool compress to the swollen glands to help relieve pain eat foods that dont need a lot of chewing, such as soup, mashed potatoes and scrambled eggs Complications of mumps Mumps usually passes without causing serious damage to a persons health. Serious complications are rare. However, mumps can lead to viral meningitis if the virus moves into the outer layer of the brain. Other complications include swelling of the testicles in males or the ovaries in females if the affected person has gone through puberty. About 1 in 20 cases of mumps lead to acute pancreatitis . This is usually mild, but you may be admitted to hospital so your body functions can be supported until your pancreas recovers. About 1 in 20 people with mumps experience some temporary hearing loss , but permanent loss of hearing is rare. Source: NHS 24 - Opens in new browser window Last updated: 11 January 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform MMR vaccine NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Menieres disease,"""Mnire's disease | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Ears, nose and throat Menieres disease Menieres disease Mnires disease is a rare inner ear condition that can affect your balance and hearing. It cannot be cured, but treatments can usually help your symptoms. Mnires disease most commonly affects people aged 20 to 60. Its slightly more common in women than men. Symptoms of Mnires disease The symptoms and severity of Mnires disease vary widely from person to person. The main symptoms of Mnires disease are: vertigo  the feeling that you, or the environment around you, is moving or spinning tinnitus  hearing sounds from inside your body, rather than from an outside source hearing loss , with a particular difficulty hearing deep or low sounds a feeling of pressure or fullness deep inside the ear feeling or being sick Symptoms typically last around 2 to 3 hours. But it can take a day or two for the symptoms to disappear completely. These symptoms usually only affect one ear at first, but both ears may become affected over time. Other symptoms include: sensitivity to sound (hyperacusis) distorted sound When to get medical advice Speak to your GP practice if: You or your child: have any of the symptoms of Mnires disease Diagnosing Mnires disease Theres no single test for Mnires disease. It can be difficult to distinguish from other conditions with similar symptoms. Your GP will ask you to describe your symptoms to find out if theres a pattern. For Mnires disease to be diagnosed, youll have had: at least 2 episodes of vertigo lasting 20 minutes or more within a single Mnires disease attack tests that confirm that hearing loss is caused by damage to the sensitive hair cells inside the cochlea (the coiled tube in the inner ear) tinnitus or a feeling of pressure in your ear Your GP may also carry out a physical examination to rule out other possible causes of your symptoms. If needed, your GP can refer you to an ear nose and throat (ENT) specialist for further tests. Treatment for Mnires disease Mnires disease cannot be cured, but treatment can usually help your symptoms. Possible treatments include: medicines to treat the symptoms and prevent attacks changes to your eating habits, such as a low-salt diet treatment for tinnitus treatment for hearing loss balance training (vestibular rehabilitation) relaxation techniques surgery  only rarely, in more severe cases Your mental health Some people with Mnires disease also find that it affects their mental health. Speak to your GP practice if youre finding it difficult to cope with the effect Mnires disease is having on your life. There are also support groups that can help you. Safety If you have vertigo, there are some safety issues to consider. For example: you should tell your employer if your job involves operating machinery or climbing ladders you may have a higher chance of falling  read about preventing falls for advice on reducing your risk Driving and vertigo If you drive, you must tell the DVLA about your vertigo. Get more information on driving with vertigo on GOV.UK What causes Mnires disease? The exact cause of Mnires disease is unknown. Its thought to be caused by a problem with pressure deep inside the ear. Factors that can increase your risk of developing Mnires disease include: a family history of the condition a chemical imbalance in the fluid in your inner ear Source: ENT Scotland - Opens in new browser window Last updated: 05 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Myasthenia gravis,"Myasthenia gravis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Myasthenia gravis Myasthenia gravis Myasthenia gravis is a long term (chronic) condition that causes muscle weakness and fatigue. Its a rare condition that commonly affects the muscles that control the eyes and eyelids. It can also affect the face, speaking, chewing, swallowing and other parts of the body. It can affect people at any age, but is most often found in women under 40 and men over 60. There are other rarer types of myasthenia which you can read about on myaware . If you drive, you must inform the DVLA that you have myasthenia gravis. Symptoms of myasthenia gravis The first symptoms of myasthenia gravis are often droopy eyelids or double vision. It usually affects the eyes first and may spread to other parts of the body. It can take weeks, months or years for symptoms to develop in other parts of the body. The severity of the symptoms is different for each person. Its likely that your symptoms will tend to get worse when youre tired. The symptoms might improve after resting. Symptoms can include: Eyes You might experience droopy eyelids affecting one or both eyes, and double vision. In some people, only the eye muscles are affected (ocular myasthenia). In most people, the symptoms will spread to affect other parts of the body over time. Swallowing, speaking and breathing You might experience: slurred speech difficulty swallowing difficulty making facial expressions like smiling problems with chewing a change in your voice choking or accidentally inhaling food which can cause chest infections shortness of breath Limbs and neck The muscle weakness might spread to other parts of the body like your arms, legs and neck. You might experience: weakness in your arms, legs, neck or other parts of your body difficulty holding your head up aching muscles problems with tasks like climbing stairs or washing your hair Myasthenic crisis Some people can experience severe breathing and swallowing difficulties, which require immediate hospital treatment. This is called a myasthenic crisis. Its possible for patients to experience a myasthenic crisis before they know they have myasthenia gravis. Phone 999 for an ambulance if: youre experiencing severe breathing or swallowing problems You might need emergency hospital treatment. You should avoid activities that could become dangerous if you experience sudden weakness, like swimming alone. Diagnosing myasthenia gravis It can be difficult to diagnose myasthenia gravis. Your doctor will ask about your medical history and symptoms. You might need several tests to rule out other causes of your symptoms before you can be diagnosed with myasthenia gravis. Blood test A blood test will look for a high level of antibodies (made by your immune system) which might be causing myasthenia gravis. You might be offered another blood test at a later date if your initial blood test is normal but you continue to experience worsening symptoms. Electromyography You might have electromyography (an EMG) to test your nerves and muscles. During electromyography, youll have small needles inserted into your muscles to measure their electric activity. These are usually inserted around your eyes, forehead or arms. The test will measure the signals from the nerves to the muscles. If the test detects a disruption in the signals, this might be a sign of myasthenia gravis. Scans You might have a computerised tomography (CT) scan to check if the thymus gland in your chest is bigger than expected or has grown abnormally (a thymoma). The thymus gland is part of your immune system. Problems with the thymus gland like inflammation (swelling), can be linked to myasthenia gravis. An magnetic resonance imaging (MRI) scan might be used to check if your symptoms are being caused by an issue in your brain. Treating myasthenia gravis There are treatments available that can help reduce the affects of your symptoms. If your symptoms get worse following certain triggers, you should try to avoid those triggers as much as possible. Triggers might include: stress tiredness infections medicines surgery Treatment might include: Medicine Pyridostigmine Sometimes myasthenia gravis can be treated with pyridostigmine alone. It works by temporarily improving the nerve to muscle transmission to help muscle strength. It can reduce muscle weakness and for some people this is the only medication they need to control the condition. Its effects do not last long and it needs to be taken periodically throughout the day to give the best results. Side effects can include stomach upset, diarrhoea and drooling. Steroids You might be advised to take steroid tablets like prednisolone if pyridostigmine isnt helping. Steroid tablets work by reducing the activity of your immune system to stop it attacking the communication between your nerves and muscles. Its likely youll be advised to take the tablets every other day. Youre likely to start at a low dose which will be built up quickly. This might gradually be reduced once your symptoms are under control. Its important that you do not stop your steroids suddenly, as this can make you very ill. Using steroids long term can cause side effects including osteoporosis (weak bones) , weight gain, infection and diabetes . Read more about the side effects of steroids Immunosuppressants Immunosuppressants work by reducing the activity of your immune system. Your healthcare team might suggest taking immunosuppressants if: steroids arent controlling your symptoms you need a high dose of steroids to control your symptoms Commonly used immunosuppressants include azathioprine, mycophenolate mofetil and methotrexate. Youll need to take the tablets every day and it can take at least 9 months to feel the full effect. Youll be advised to take steroids at first. Immunosuppressants night cause side effects like: loss of appetite and tiredness feeling sick increased risk of infections Youll have regular blood tests to check the the medicine isnt causing any harm. You might be able to stop taking immunosuppressants if they keep your symptoms under control over a few years. Surgery Your healthcare team might recommend surgery to remove the thymus gland (thymectomy). Symptoms should improve within the first few months after surgery and can continue to improve for up to 2 years. Surgery can reduce: the dose of steroids the need to take other immunosuppressants the chances of needing to go to hospital because of worsening symptoms Surgery might not help myasthenia symptoms in someone that has a thymoma. Your healthcare team might still recommend having your thymus gland removed because it can cause problems if it keeps growing. Your thymectomy will usually be carried out through keyhole surgery. The thymus is removed using surgical instruments inserted through small cuts (incisions) in the chest. Plasma exchange and IVIG Plasma exchange and IVIG (intravenous immunoglobulin) can offer a quick improvement (within a few days) for people with myasthenia gravis who are particularly unwell or are having a myasthenic crisis. Plasma exchange is an emergency treatment that removes antibodies from your own blood. This treatment is given in hospital and the benefits can last around 6 weeks. IVIG treatment involves an injection of normal antibodies from donated blood to temporarily change the way your immune system works. The two treatments are similar and your healthcare team will decide which is the best option for you. Although the benefits only last a few weeks, it can give time for the longer term treatments to take effect and help improve symptoms. You might find that, during pregnancy or after having a baby, your myasthenia gravis worsens. If youre planning a pregnancy or become pregnant, you should speak to your healthcare team. Dont stop taking your medications without first speaking to your healthcare professional. Source: Scottish Government - Opens in new browser window Last updated: 25 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites Myaware NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Nasal and sinus cancer,"Nasal & sinus cancer - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Nasal and sinus cancer Nasal and sinus cancer Nasal and sinus cancer affects the nasal cavity (the space behind your nose) and the sinuses (small, air-filled cavities inside your nose, cheekbones and forehead). Its a rare type of cancer that most often affects men aged 50to 60. Nasal and sinus cancer is different to cancer in the area where the nose and throat connect. This is called nasopharyngeal cancer . Symptoms of nasal and sinus cancer The most common symptoms of nasal and sinus cancer are: a persistent blocked nose, which usually only affects 1 side nosebleeds mucus draining from the nose, which may be blood-stained a decreased sense of smell These symptoms can be similar to more common and less serious conditions, such asa cold or sinusitis . At a later stage, symptoms can include: pain or numbness in the face swollen glands in the neck partial loss of vision ordouble vision a bulging or persistently watering eye a lump or growth on yourface, nose or roof ofyour mouth When to speak to your GP Speak to your GP if you notice any unusual or persistent symptoms. Theyre very unlikely to be caused bynasal or sinus cancer, but are worth getting checked out. If your GP thinks you might need some tests to determine whats causing your symptoms, youll usually be referred to an ear, nose and throat (ENT) consultant in hospital. Tests you may have include: a nasalendoscopy where a long, thin, flexible tube attached to a light source is inserted into your nose to examine the area a computerised tomography (CT) scan and a magnetic resonance imaging (MRI) scan a biopsy (where a small sample of tissue is removed and examined)  this may be done during an endoscopy orusing a needle Whos at risk of nasal and sinus cancer Several factors are known to increase the risk of developing nasal and sinus cancer, including: your gender  men are more likely to develop nasal and sinus cancer than women prolonged exposure to certain substances through your work, including wood dust, leather dust, nickel, chromium and formaldehyde smoking  the more you smoke, the higher your risk of developing several types of cancer, including nasal and sinus cancer human papilloma virus (HPV)a group of viruses that affect the skin and moist membranes, such as the mouth and throat The Health and Safety Executive (HSE) has produced a report on the risk of occupational nasal and sinus cancer inGreat Britain(PDF, 2Mb) . Treatments for nasal and sinus cancer The best treatment depends on several factors, including how far the cancer has spread and your general health. Treatment may include: surgery to remove a tumour which can be performed using surgical incisions (open surgery) or as keyhole surgery through the nose (endoscopic microsurgery) radiotherapy wherehigh-energy radiation is usedto kill the cancerous cells, shrink a tumour before surgery, or destroy small amounts of a tumour that may be left after surgery chemotherapy where medicine is usedto help shrink or slow down the growth of a tumour, or to reduce the risk of the cancer returning after surgery Your treatmentwill be organised by a head and neck cancer multidisciplinary team (MDT), who will discuss the treatment options with you.A combination of treatments will often be recommended. Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Nasopharyngeal cancer Other health sites Cancer Research UK: Nasal and paranasal sinus cancer Macmillan Cancer Support: Paranasal sinus cancer Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Nasopharyngeal cancer,"Nasopharyngeal cancer - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Nasopharyngeal cancer Nasopharyngeal cancer Nasopharyngeal cancer is a rare type of cancer that affects the part of the throat connecting the back of the nose to the back of the mouth (the pharynx). Nasopharyngeal cancer shouldnt be confused with other types of cancer that also affect the throat, such as laryngeal cancer and oesophageal cancer . Symptoms of nasopharyngeal cancer Its often difficult to recognise nasopharyngeal cancer because the symptoms are similar to other, less serious conditions. Also, many people with nasopharyngeal cancer dont have any symptoms until the cancer reaches an advanced stage. Symptoms of nasopharyngeal cancer can include: alump in the neck hearing loss  usually only in 1 ear tinnitus  hearing sounds that comefrom inside the body rather than from an outside source a blocked or stuffy nose nosebleeds Speak to your GP if you develop any worrying symptoms, particularly if they dont improve aftera few weeks. While theyre very unlikely to be caused by nasopharyngeal cancer, its best to get them checked out. What causes nasopharyngeal cancer? The exact cause of nasopharyngeal cancer is unknown, buta number of factors can increase your risk of developing the condition. These include: being of south Chinese or north African descent having a diet very high in salt-cured meats and fish being exposed to the Epstein-Barr virus (EBV), a common virus that causes glandular fever having a job where youre regularly exposed to hardwood dust having a first-degree relative, such as a parent, whos had the condition Being exposed to thehuman papilloma virus (HPV)may also increase your risk of developing certain types of nasopharyngeal cancer. About 3 times as many men as women are affected by nasopharyngeal cancer. The average age at diagnosis is about 50. Diagnosing nasopharyngeal cancer If you see your GP with symptoms that could indicate nasopharyngeal cancer, theyll usually ask about your symptoms and carry out some examinations. This may involve examining your throat using a small mirror and a light. If your GP thinks further tests are necessary, theyll refer you to hospital. At hospital, a number of different tests may be carried out to check for nasopharyngeal cancer and rule out other conditions. Some of the tests you may have include: a nasendoscopy where a thin, flexible telescope (endoscope)is inserted up your nose and passed down your throat to look for any abnormalities; its carried out while youre awake, but local anaesthetic can be used to numb your nose and throat imaging scans  magnetic resonance imaging (MRI) scans or computerised tomography (CT) scans can be used to check for tumours and determine whether the cancer has spread a panendoscopy a more detailed examination of your nose and throat carried out under general anaesthetic (where youre unconscious) using a series of small, rigid telescopes connected together a biopsy where a small tissue sample is removed during a panendoscopy so it can be examined in a laboratory Once these tests are complete, your doctors will be able to confirm whether you have nasopharyngeal cancer. Theyll also be able to stage the cancer, which means giving it a score to describe how large it is and how far it has spread. The Cancer Research UK website has more information about the stages of nasopharyngeal cancer . How nasopharyngeal cancer is treated If youre diagnosed with nasopharyngeal cancer, youll be cared for by a team of different specialists who work together called a multidisciplinary team (MDT). Members of your MDT will discuss with you what they think the best treatment option is in your case. The 2 main treatments for nasopharyngeal cancer are: radiotherapy  whereradiationis used to kill cancer cells chemotherapy  where medication is used to kill cancer cells In most cases, a combination of radiotherapy and chemotherapy will be used. Surgery isnt usually used to treat nasopharyngeal cancer as its difficult for surgeons to access the affected area. Radiotherapy Radiotherapy is the most commonly used treatment for nasopharyngeal cancer. It can be used on its own to treat very early-stage cancers, or in combination with chemotherapy for more advanced cancers. In most cases, external radiotherapy is used. This involves using a machine to focus high-energy radiation beams on to the area that requires treatment. In nasopharyngeal cancer, an advanced form of external radiotherapy called intensity-modulated radiation therapy (IMRT) is used. Itinvolves aiming radiation beams of different strengths at a tumour from several different angles. This helps maximise the dose delivered to the tumour, while minimising the effect on the surrounding healthy tissue. Stereotactic radiotherapy is another way of giving radiotherapy externally and may be used to target a specific area where the cancer has returned. External radiotherapy is often given in short sessions, once a day from Monday to Friday, with a break at weekends. This is usually carried out for up to7 weeks. You wont need to stay in hospital overnight betweenthese appointments. In some cases, internal radiotherapy may be requiredwhere nasopharyngeal cancer has returned after initial treatment. A radioactive source is placed into or near the cancerous area and left in place for anywhere from a few minutes to a few days. Depending on the type of treatment you have, you may need to stay in hospital for a short period of time. Radiotherapy itself is painless, but it can have some significant side effects, such as: red and soreskin in the treatment area feeling sick changes to your sense of taste dry mouth hair loss These side effects are usually temporary, but some can be permanent. Let your care team know if you experience these problems as treatment is often available to help. Read more about how radiotherapy is performed and the side effects of radiotherapy Chemotherapy Chemotherapy may be used before or alongside radiotherapy for more advanced nasopharyngeal cancers. Its usually given through a drip into a vein (intravenous chemotherapy), with sessions every 3 to 4 weeks spread over several months. You wont usually need to stay in hospitalovernightduring treatment. Like radiotherapy, chemotherapy can cause a number of significant side effects, such as: feeling sick diarrhoea sore mouth tiredness These side effects are usually temporary, but theres also a risk of longer-term problems, such as infertility.You should discuss any concerns you have about the potential side effects of treatment with your care team before treatment begins. Read more about how chemotherapy is performed and the side effects of chemotherapy Follow-up After your course of treatment ends, youll need to have regular follow-up appointments and scans to monitor your recovery and check for any signs of the cancer returning. To start with, these appointments will be every few weeks or months, but theyll become gradually less frequent over time. Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Oesophageal cancer Laryngeal (larynx) cancer Other health sites Cancer Research UK: Nasopharyngeal cancer Macmillan Cancer Support: Nasopharyngeal cancer Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Neuroblastoma: Children,"""Neuroblastoma: Children | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in children Neuroblastoma: Children Neuroblastoma: Children Most children who have neuroblastoma are younger than 5 years old. Itsthe most common solid tumour in children that occurs outside of the brain and makes up 8% of the total number of childrens cancers. More children than ever are surviving childhood cancer. There are new and better drugs and treatments, and we can now also work to reduce the after-effects of having had cancer in the past. Its devastating to hear that your child has cancer. At times it can feel overwhelming, but there are many healthcare professionals and support organisations to help you through this difficult time. Understanding more about the cancer your child has, and the treatments that may be used, can often help parents to cope. Your childs specialist will give you more detailed information and, if you have any questions, its important to ask the specialist doctor or nurse who knows your childs individual situation. Neuroblastoma develops from the cells left behind from a babys development in the womb. The cells that it develops from are called neuroblasts. Neuro means nerve Blast means cells in early development Oma means a group of cells, or a tumour Neuroblastoma can occur anywhere in the body. The site of origin is either in 1 of the 2 adrenal glands situated in the abdomen (tummy) or in nerve tissue that runs alongside the spinal cord, in the neck, chest, abdomen or pelvis. The adrenal glands are specialised glands that are found above the right and left kidney. The adrenal glands normally release hormones to maintain blood pressure, and enable us to respond to stress. In some cases, neuroblastoma can spread to tissues beyond the original site such as the bone marrow, bone, lymph nodes, liver, and skin. Causes As with most cancers, the cause of neuroblastoma is unknown. It is not infectious and cannot be passed on to other people. Signs and symptoms The symptoms vary, depending on where your childs neuroblastoma tumour is: if the tumour is in the abdomen, your childs tummy may be swollen and they may complain of constipation or have difficulty passing urine (peeing) if the tumour affects the chest area, your child may be breathless and have difficulty swallowing if the tumour occurs in the neck, its often visible as a lump and occasionally affects breathing and swallowing occasionally, there are deposits of neuroblastoma in the skin that appear as small, blue-coloured lumps if the tumour is pressing on the spinal cord, children may have weakness in the legs and walk unsteadily  if your child is not yet walking, you may notice reduced leg movements; they may also have constipation or difficulty passing urine (peeing) your child may be found to have high blood pressure very rarely, children may have jerky eye and muscle movements, and general unsteadiness associated with the neuroblastoma There are often symptoms of tiredness, being pale, loss of appetite, weight loss, bone pain and generalised discomfort. How is neuroblastoma diagnosed? A variety of tests and investigations will be needed to diagnose neuroblastoma. These include a biopsy of the tumour, blood and bone marrow tests, X-rays, CT or MRI scans, and a special nuclear medicine scan called an MIBG scan. These tests are carried out to confirm the diagnosis of neuroblastoma, and to find the exact position of the original site of neuroblastoma within the body and to see whether it has spread. This process is known as staging. A specific type of urine test will also be done. Nearly all children with neuroblastoma (9 out of 10) will have substances called vanillylmandelic acid (VMA), or homovanillic acid (HVA), in their urine. Measuring the VMA and HVA in the urine can help to confirm the diagnosis. Your child will also have their VMA and HVA levels checked during and after treatment. The levels of these substances will fall if the treatment is working. As these chemicals are produced by the tumour cells, and can be used to measure tumour activity, they are sometimes known as tumour markers. Most children will have an MIBG (meta-iodo-benzyl guanidine) scan. MIBG is a substance thats taken up by neuroblastoma cells. Its given by injection into the blood stream. Attaching a small amount of radioactive iodine to the MIBG enables any neuroblastoma tissue to be seen by a radiation scanner. Sometimes MIBG can be used as a treatment. Biopsy A small sample of cells (a biopsy ) is usually taken from the tumour during an operation under a general anaesthetic. These cells are then examined under a microscope. Other tests collectively referred to as tumour biology, look at the chromosomes and biological markers in the tumour cells. One of these markers is called MYCN. The presence of a certain amount of MYCN in the cells (known as MYCN amplification) can suggest that the neuroblastoma may be a more aggressive type. In this situation, the treatment needs to be more intensive. Staging The stage of a cancer is a term used to describe its size and whether it has spread beyond its original site. Knowing the particular type and stage of the cancer helps the doctors to decide on the best treatment for your child. Stage 1 The cancer is contained within 1 area of the body (localised) and theres no evidence of it having spread. It can be completely removed by surgery, or there may be very small (microscopic) amounts of tumour left. Stage 2A The cancer is localised and has not begun to spread, but cannot be completely removed by surgery. Stage 2B The cancer is localised and has begun to spread into nearby lymph nodes. Stage 3 The cancer has spread into surrounding organs and structures, but has not spread to distant areas of the body. Stage 4 The cancer has spread to distant lymph nodes, bone, bone marrow, liver, skin or other organs. Stage 4S (also called special neuroblastoma) This stage of neuroblastoma is found in children under 1 year old. The cancer is localised (as in stage 1, 2A or 2B) and has begun to spread to the liver, skin or bone marrow. A newer staging system has been developed by the International Neuroblastoma Risk Group (INRG). This system is now widely used. It looks at whether or not certain image-defined risk factors are present in a neuroblastoma tumour before treatment. These risk factors can be detected by scans and help doctors understand the extent of the disease. Your doctor can explain more about this. Stage L1 The tumour is localised and has not spread into important areas (vital structures) nearby. It can be removed by surgery. Stage L2 The tumour is localised but has image-defined risk factors and cant be safely removed by surgery. Stage M The tumour has spread to other parts of the body. Stage MS The tumour has spread to the skin, liver and/or the bone marrow in children younger than 18 months old. If the cancer has spread to distant parts of the body, this is known as secondary or metastatic cancer. If the cancer comes back after initial treatment, this is known as recurrent or relapsed cancer. Treatment The treatment of neuroblastoma depends on the age of the child, the size and position of the tumour, the tumour biology (including the MYCN status) and whether the neuroblastoma has spread. Surgery For tumours that have not spread (localised tumours), the treatment is usually surgery. If the tumour is at an early stage and there is no evidence that it has spread to the lymph nodes or any other parts of the body, an operation to remove the tumour, or as much of it as possible, will be undertaken. If the tumour is, at first, too large or in too difficult a position to remove safely, chemotherapy will be given to shrink it before surgery. A cure is usually possible for children with localised tumours. However, if a localised tumour is classed as high-risk, due to the tumour biology results, additional treatment with chemotherapy and usually radiotherapy will be needed. Chemotherapy If the tumour has already spread by the time of diagnosis, or is indicated as being high-risk by the tumour biology result, intensive chemotherapy is needed. Chemotherapy is the use of anti-cancer drugs to destroy cancer cells. Its usually given as an infusion into a vein. Your child will have a semi-permanent cannula called a central venous line inserted under a general anaesthetic to minimise the distress caused by intravenous injections. Your childs specialist will discuss with you the type and amount of chemotherapy needed. High-dose chemotherapy with stem cell rescue If the neuroblastoma has spread to several parts of the body, or is high-risk with MYCN amplification, high dose chemotherapy with peripheral blood stem cell rescue is used after the initial courses of chemotherapy. High-dose chemotherapy will wipe out any remaining neuroblastoma cells but will also wipe out the bodys bone marrow, where blood cells are made. To prevent the problems this causes, stem cells (blood cells at their earliest stages of development) are collected from your child through a drip before the chemotherapy is given. These stem cells are then frozen and stored until required. After the high-dose chemotherapy, the stem cells are given back to your child through a drip. They make their way into the bone marrow, where they grow and develop into mature blood cells over a period of 14 to 21 days. Monoclonal antibody treatment Monoclonal antibodies can destroy some types of cancer cells while causing little harm to normal cells. In the UK, patients with high-risk neuroblastoma treated in the (SIOPEN) European high-risk clinical trial receive immunotherapy with a monoclonal antibody called anti-GD2 after their high dose therapy. There is good evidence from a clinical trial (research study) carried out in America, which was first reported on in 2009, that this may be a promising therapy when given alongside standard treatment for neuroblastoma. The anti GD2 is either given on its own or with cytokines. It is not yet a standard treatment for patients with neuroblastoma as it has very unpleasant side effects, the benefits need to be fully proven and the best way to administer it needs to be established. It is therefore currently only available to patients in the UK who are being treated within a clinical trial. Your childs specialist will be able to tell you much more about this treatment. Radiotherapy External beam radiotherapy may be given if the neuroblastoma is high-risk, or has spread to several parts of the body. This uses high-energy rays to destroy the cancer cells, while doing as little harm as possible to normal cells. External beam radiotherapy is given from a machine outside the body. Internal radiotherapy may sometimes be given using radioactive MIBG. Radioactive MIBG is similar to the MIBG used in an investigation to diagnose neuroblastoma, but uses higher doses of radioactivity to kill the cancer cells. Younger children Children under 18 months old with neuroblastoma often have low-risk tumours, and as long as there is no MYCN amplification, their outlook is excellent. Most children in this age group are cured. Children with Stage 4S disease almost always get better with very little treatment or none at all. These tumours either regress spontaneously or after chemotherapy, which is only given if there are symptoms from the tumour. They disappear completely or develop into a non-cancerous (benign) tumour, called a ganglioneuroma. Many of these children, after their initial diagnostic tests and staging investigations, will just need careful monitoring for some years. Ganglioneuromas are usually harmless and will not cause any problems and do not need any treatment. Side effects of chemotherapy treatment Chemotherapy often causes side effects, and your childs doctor will discuss this with you before the treatment starts. The side effects will depend upon the actual drugs being given. Immediate side effects can include: feeling sick (nausea) and being sick (vomiting) diarrhoea weight loss hair loss increased risk of infection bruising and bleeding tiredness Late side effects A small number of children may develop late side effects, sometimes many years after treatment. These include a change in the way the heart and kidneys work, hearing problems, fertility problems, a possible reduction in bone growth if radiotherapy has been given, and a slightly increased risk of developing another cancer in later life. Your childs doctor or nurse will talk to you about any possible late side effects. Clinical trials Many children have their treatment as part of a clinical research trial. Trials aim to improve our understanding of the best way to treat an illness, usually by comparing the standard treatment with a new or modified version. Specialist doctors organise many trials for childrens cancer. Children in the UK with neuroblastoma can take part in national and European studies. The European research group is called SIOPEN. If appropriate, your childs medical team will talk to you about taking part in a clinical trial, and will answer any questions you have. Written information is provided to help explain things. Taking part in a research trial is completely voluntary, and youll be given plenty of time to decide if its right for your child. Treatment guidelines Sometimes, clinical trials are not available for your childs tumour. This may be because a recent trial has just finished, or because the tumour is very rare. In these cases, you can expect your doctors and nurses to offer treatment which is agreed to be the most appropriate, using guidelines which have been prepared by experts across the country. The Childrens Cancer and Leukaemia Group (CCLG) is an important organisation which helps to produce these guidelines. Follow-up care Follow-up after treatment usually involves regular visits to the hospital outpatients department, with scans and urine tests as necessary. For children who have had chemotherapy and/or radiotherapy, more specialised tests may also be carried our. For example, hearing tests, kidney and heart function tests, and checking hormone levels. These will be repeated until your child is grown up. If you have specific concerns about your childs condition and treatment, its best to discuss them with your childs doctor, who knows their situation in detail. Your feelings As a parent, the fact that your child has cancer is one of the worst situations you can be faced with. You may have many emotions, such as fear, guilt, sadness, anger and uncertainty. These are all normal reactions and are part of the process that many parents go through at such a difficult time. Its not possible to address here all of the feelings you may have. However, the CCLG booklet Children & Young Peoples Cancer; A Parents Guide talks about the emotional impact of caring for a child with cancer and suggests sources of help and support. Your child may have a variety of powerful emotions throughout their experience with cancer. The Parents Guide discusses these further and talks about how you can support your child. Source: Children's Cancer and Leukaemia Group - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Neuroendocrine tumours,"Neuroendocrine tumours - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Neuroendocrine tumours Neuroendocrine tumours Neuroendocrine tumours (NETs) are rare tumours that can occur in the cells of the neuroendocrine system. The neuroendocrine system consists of nerve and gland cells. It produces hormones and releases them into the bloodstream. NETs are tumours (abnormal growths) that develop in the cells of the neuroendocrine system. NETs can be malignant (cancerous) or benign (non-cancerous) and oftenbut not always grow slowly. There are a number of different types of NET, depending on the specific cells affected. Types of neuroendocrine tumours Gastroenteropancreatic neuroendocrine tumours (GEP NETs) are tumours that develop in the gut or pancreas. Gastrointestinal neuroendocrine tumours (GI NETs) develop in the digestive system, which includes the bowel, stomach or oesophagus. Pancreatic neuroendocrine tumours (pNETs) develop in the pancreas. Pulmonary neuroendocrine tumours develop in the lungs. Rarely, NETs can also develop in other parts of the body, including in the liver, gallbladder, bile ducts, kidneys, ovaries, or testicles. Some NETs, known as functioning tumours, produce hormones that cause specific symptoms. Tumours that dont cause symptoms are known as non-functioning tumours. Symptoms of neuroendocrine tumours The symptoms ofaneuroendocrine tumourcan vary depending on where it is and what hormones it produces. For example,atumour in the digestive system may cause diarrhoea , constipation or tummy pains. A tumour in the lung may cause wheezing or a persistent cough . Some tumours (functioning tumours) may cause abnormally large amounts of hormones to be released into the bloodstream. This cancause symptoms such as diarrhoea, flushing, cramps, wheezing, low blood sugar (hypoglycaemia), changes in blood pressure and heart problems. What causesneuroendocrine tumours? What causes neuroendocrine tumours isnt fully understood. However,your chance of developing a NET is increasedif you have one of the following rare conditions or syndromes: multiple endocrine neoplasia type 1 (MEN 1) a rare inherited condition where tumours in the endocrine system develop, most commonly in the parathyroid glands, pituitary gland and the pancreas neurofibrmatosis type 1a group of genetic conditions that cause tumours to grow along your nerves Von Hippel-Lindau syndrome (VHL)  an inherited condition that causes blood vessels to grow abnormally Research has also shown that your risk of developing a NET is slightly increased if one of your parents has had one in the past. Diagnosingneuroendocrine tumours There are many tests that canbe used to diagnose NETs, including blood tests , urine tests, scans, and a biopsy (where a small tissue sample is taken for closer examination). Different types of scans may also be used to identify or examine tumours. These include: ultrasound scans  including echocardiograms and endoscopic ultrasound scans computerised tomography (CT) scans magnetic resonance imaging (MRI) scans positron emission tomography (PET) scans octreotide scans where mild radioactive liquid is injected into your veins anda special camera is used to highlightany cancerous cells Treating neuroendocrine tumours How a neuroendocrine tumour is treated will depend on yourindividual circumstances. For example, your treatment will depend on: where the tumour is how advanced your condition is your overallhealth Unfortunately, many people are only diagnosed after other parts of their body are affected. However, it may still be possible tosurgically remove the tumour, even if it has spread to other parts of your body. If surgery cant be used to completely cure your condition, it may be used to help manage and reduce any symptoms that you have. It may also be possible to shrink the tumour or stop further growth using treatments that block the blood supply to the tumour (embolisation),or chemotherapy , radiotherapy or radiofrequency ablation (where heat is used to destroy the cells). The Cancer Research UK website has more information about neuroendocrine tumours (NETs) . Information about you If you haveneuroendocrine tumours, your clinical team will pass information about you on to the National Congenital Anomaly and Rare Diseases Registration Service (NCARDRS). This helps scientists look for better ways to prevent and treat this condition. You can opt out of the register at any time. Find out more about the register . Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites Cancer Research UK: Neuroendocrine tumours (NETs) Macmillan Cancer Support: Neuroendocrine tumours (NETs) Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Non-alcoholic fatty liver disease (NAFLD),"Non-alcoholic fatty liver disease (NAFLD) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Non-alcoholic fatty liver disease (NAFLD) Non-alcoholic fatty liver disease (NAFLD) Non-alcoholic fatty liver disease (NAFLD) is the term for a range of conditions caused by a build-up of fat in the liver. Its usually seen in people who are overweight or obese. A healthy liver should contain little or no fat. Its estimated that up to 1 in every3 people in the UK has early stages of NAFLD where there are small amounts of fat in their liver. Early-stage NAFLD doesnt usually cause any harm, but it can lead to serious liver damage, including cirrhosis , if it gets worse. Having high levels of fat in your liver is also associated with an increased risk of problems such as diabetes , heart attacks and strokes . If detected and managed at an early stage, its possible to stop NAFLD getting worse and reduce the amount of fat in your liver. Stages of NAFLD NAFLD develops in 4main stages. Most people will only everdevelop the first stage, usually without realising it. In small number of cases itcan progress and eventually lead to liver damage if not detected and managed. The main stages of NAFLD are: simple fatty liver (steatosis)  a largely harmless build-up of fat in the liver cells that may only be diagnosed during tests carried out for another reason non-alcoholic steatohepatitis (NASH) a more serious form of NAFLD, where the liver has become inflamed; this is estimated to affect up to 5% of the UK population fibrosis  where persistent inflammationcauses scar tissue around the liver and nearbybloodvessels, but the liver is still able to function normally cirrhosis  the most severe stage, occurring afteryears of inflammation, where the liver shrinks and becomes scarred and lumpy; this damage is permanent and canlead toliver failure (where your liver stops working properly) and liver cancer It can take years for fibrosis or cirrhosisto develop. Its important to make lifestyle changes toprevent the disease from getting worse. Am I at risk of NAFLD? Youre at an increased risk of NAFLD if you: are obese or overweight particularly if you have a lot of fat around your waist (an apple-like body shape) have type 2 diabetes have high blood pressure have high cholesterol are over the age of 50 smoke However, NAFLD has been diagnosed in people without any of these risk factors, including young children. Although its very similar to alcohol-related liver disease (ARLD) , NAFLD isnt caused by drinking too much alcohol. Symptoms ofNAFLD There arent usually any symptoms of NAFLD in the early stages. You probably wont know you have it unless its diagnosed during tests carried out for another reason. Occasionally, people with NASH or fibrosis (more advanced stages of the disease) may experience: a dull or aching pain in the top right of thetummy (over the lower right side of the ribs) fatigue (extreme tiredness) unexplained weight loss weakness If cirrhosis (the most advanced stage) develops, you can get more severe symptoms such as yellowing of the skin and the whites of the eyes (jaundice), itchy skin, and swelling in the legs, ankles, feetor tummy. Read more about the symptoms of cirrhosis . How NAFLD is diagnosed NAFLD is often diagnosed aftera blood test called aliver function test produces an abnormal result and other liver conditions, such as hepatitis, are ruled out. However, blood tests dont always pick up NAFLD. The condition may also be spotted during an ultrasound scan of your tummy. This is a type of scan where sound waves are used to create an image of the inside of your body. If youre diagnosed with NAFLD, further tests may be needed to determine which stage you have. This may involve a special blood test or having another type of ultrasound scan (Fibroscan). Some people may also need a small sample of liver tissue ( biopsy ) taken using a needle to have it analysed in a laboratory. Treatment for NAFLD Most people with NAFLD wont develop any serious problems, but if youre diagnosed with the condition its a good idea to take steps to stop it getting any worse. Theres currently no specific medication for NAFLD, but making healthy lifestyle choices can help and treatment may be recommended for associated conditions (high blood pressure, diabetes and cholesterol) or complications. You may be advised to have regular appointments with yourdoctor to check your liver function andlook for signs of any new problems. Healthy diet and lifestyle Adopting a healthy lifestyle is the main way of managing NAFLD.The following can allhelp. Lose weight  you should aim for a BMI of 18.5-24.9. Losing more than 10% of your weight can remove some fat from the liver and improve NASH if you have it. Eat a healthy diet  try to have abalanced diethigh in fruits, vegetables, protein and carbohydrates, but low in fat, sugar and salt. Eating smaller portions of food can help too. Exerciseregularly  aim to do at least 150 minutes ofmoderate-intensity activity, such as walking or cycling, a week. All types of exercise can help improve NAFLD, even if you dont lose weight. Stop smoking  if you smoke, stopping can help reduce your risk of problems such as heart attacks and strokes. NAFLD isnt caused by alcohol, butdrinking may make the condition worse. Its therefore advisable to cut down or stop drinking alcohol. Read some tips on cutting down on alcohol . Medication There isnt currently any medication that can treat NAFLD, butvarious medicines can be useful in managing the problems associated with the condition. For example, your doctor may recommend medication to treat high blood pressure , treat high cholesterol , treat type 2 diabetes and/or treat obesity . Liver transplant If you developsevere cirrhosis and yourliver stops working properly, you may need to be put on the waiting list for a liver transplant. For adults,the average waiting time for a liver transplant is 145 days for transplants from recently deceased donors. Alternatively, it may be possible to have a transplant usinga section of liverremoved from a living donor. Asthe liver can regenerate itself, both the transplanted section and the remaining section of the donors liver are able to regrow to a normal size. Read more about liver transplants . Source: NHS 24 - Opens in new browser window Last updated: 29 May 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Non-Hodgkin lymphoma,"Non-Hodgkin lymphoma - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Non-Hodgkin lymphoma Non-Hodgkin lymphoma About non-Hodgkin lymphoma Symptoms of non-Hodgkin lymphoma Causes of non-Hodgkin lymphoma Diagnosing non-Hodgkin lymphoma Treating non-Hodgkin lymphoma Complications of non-Hodgkin lymphoma About non-Hodgkin lymphoma Non-Hodgkin lymphoma is an uncommon cancer that develops in the lymphatic system, which is a network of vessels and glands spread throughout your body. The lymphatic system is part of your immune system. Clear fluid called lymph flows through the lymphatic vessels and contains infection-fighting white blood cells known as lymphocytes. In non-Hodgkin lymphoma, the affected lymphocytes start to multiply in an abnormal way and begin to collect in certain parts of the lymphatic system, such as the lymph nodes (glands). The affected lymphocytes lose their infection-fighting properties, making you more vulnerable to infection. The most common symptom of non-Hodgkin lymphoma is a painless swelling in a lymph node, usually in the neck, armpit or groin. Read more about the symptoms of non-Hodgkin lymphoma . Whos affected? Non-Hodgkin lymphoma can occur at any age, but your chances of developing the condition increase as you get older, with most cases diagnosed in people over 65. Slightly more men than women are affected. What causes non-Hodgkin lymphoma? The exact cause of non-Hodgkin lymphoma is unknown. However, your risk of developing the condition is increased if you: have a medical condition that weakens your immune system take immunosuppressant medication have previously been exposed to a common virus called the Epstein-Barr virus  which causes glandular fever You also have a slightly increased risk of developing non-Hodgkin lymphoma if a first-degree relative (such as a parent or sibling) has had the condition. Read more about the causes of non-Hodgkin lymphoma . How non-Hodgkin lymphoma is diagnosed The only way to confirm a diagnosis of non-Hodgkin lymphoma is by carrying out a biopsy . This is a minor surgical procedure where a sample of affected lymph node tissue is removed and studied in a laboratory. Read more about diagnosing non-Hodgkin lymphoma . Treatment and outlook There are many subtypes of non-Hodgkin lymphoma, but they can generally be put into one of 2 broad categories: high-grade or aggressive non-Hodgkin lymphoma  where the cancer develops quickly and aggressively low-grade or indolent non-Hodgkin lymphoma  where the cancer develops slowly, and you may not experience any symptoms for many years The outlookfor non-Hodgkin lymphoma varies greatly, depending on the exact type,grade and extent of the lymphoma, and the persons age. Low-grade tumours dont necessarily require immediate medical treatment, but are harder to completely cure. High-grade lymphomas need to be treated straight away, but tend to respond much better to treatment and can often be cured. The main treatments used for non-Hodgkin lymphoma are: chemotherapy radiotherapy atype of targeted treatment called monoclonal antibody therapy Overall, most cases of non-Hodgkin lymphoma are considered very treatable. You can read more detailed information about the outlook for non-Hodgkin lymphoma on the Cancer Research UK website. However, theres a risk of long-term problems after treatment, including infertility and an increased risk of developing another type of cancer in the future. Read more about: treating non-Hodgkin lymphoma complications of non-Hodgkin lymphoma Information about you If you havenon-Hodgkin lymphoma, your clinical team will pass information about you on to the National Congenital Anomaly and Rare Diseases Registration Service (NCARDRS). This helps scientists look for better ways to prevent and treat this condition. You can opt out of the register at any time. Find out more about the register . Symptoms of non-Hodgkin lymphoma The most common symptom of non-Hodgkin lymphoma is a painless swelling in a lymph node, usually in the neck, armpit or groin. Lymph nodes, also known as lymph glands,are pea-sized lumps of tissue found throughout the body. Theycontain white blood cells that help to fight against infection. The swelling is caused by a certain type of white blood cell,known aslymphocytes,collecting inthe lymph node. However, its highly unlikely you have non-Hodgkin lymphoma if you have swollen lymph nodes , as these glands often swell as a response to infection. Other symptoms Some people with non-Hodgkin lymphoma also have other more general symptoms. These can include: night sweats unintentional weight loss a high temperature (fever) a persistent cough or feeling of breathlessness persistent itching of the skin all over the body Other symptoms depend on where in the body the enlarged lymph glands are. For example, if the abdomen (tummy) is affected, you may have abdominal pain or indigestion . A few people with lymphoma have abnormal cells in their bone marrow when theyre diagnosed. This may lead to: persistent tiredness or fatigue an increased risk of infections excessive bleeding  such as nosebleeds ,heavy periods and spots of blood under the skin When to seek medical advice Speak to your GP if you have any of these symptoms, particularly if you have persistently swollen glands with no other signs of infection. While the symptoms are unlikely to be caused by non-Hodgkin lymphoma, its best to get them checked out. Causes of non-Hodgkin lymphoma Non-Hodgkin lymphoma is caused by a change (mutation) in the DNA of a type of white blood cell called lymphocytes. The exact reason why this happens isnt known. DNA gives cells a basic set of instructions, such as when to grow and reproduce. The mutation in the DNA changes these instructions, so the cells keep growing. This causes them to multiply uncontrollably. The abnormallymphocytesusually begin to multiply in one or more lymph nodes in a particular area of the body, such as your neck or groin. Over time, its possible for the abnormal lymphocytes to spread into other parts of your body, such as your: bone marrow spleen liver skin lungs However, in some cases, non-Hodgkin lymphoma first develops in an organ orsomewhere else outside the lymphatic system (the network of lymph vessels and glands found throughoutthe body). Whos most at risk? While the cause of the initial mutation that triggers non-Hodgkin lymphoma is unknown, a number of factors can increase your risk of developing the condition. These include: having a medical condition that weakens your immune system, such as HIV having medical treatment that weakens your immune system  for example, taking medication to suppress your immune system after an organ transplant having an autoimmune condition (a condition caused by problems with the immune system), such as rheumatoid arthritis , lupus or Sjogrens syndrome being previously exposed to the Epstein-Barr virus  a common virus that causes glandular fever being previously exposed to the Human T-cell lymphotropic virus (HTLV) having a Helicobacter pylori infection  a common bacterial infection that usually infects the lining of the stomach and small intestine having received chemotherapy or radiotherapy for an earlier cancer having coeliac disease  an adverse reaction to gluten that causes inflammation of the small bowel Non-Hodgkin lymphoma isnt infectious and isnt thought to run in families, although your risk may be slightly increased if a first-degree relative (such as a parent or sibling) has had lymphoma. Non-Hodgkin lymphoma can occur at any age, but most cases are diagnosed in people over 65. The condition is slightly more common in men than women. Diagnosing non-Hodgkin lymphoma If you see your GP because youre concerned about symptoms of non-Hodgkin lymphoma, theyll ask about your health and carry out a simple physical examination. If necessary, your GP will refer you to hospital for further tests. In 2015, the National Institute for Health and Care Excellence (NICE) published guidelines to help GPs recognise the signs and symptoms of non-Hodgkin lymphoma and refer people for the right tests faster. To find out if you should be referred for further tests for suspectednon-Hodgkin lymphoma, read the NICE 2015 guidelines on Suspected Cancer: Recognition and Referral . If youre referred to hospital, a biopsy will usually be carried out, as this is the only way to confirm a diagnosis of non-Hodgkin lymphoma. Biopsy A biopsy involves removing some or all of an affected lymph node, which is then studied in a laboratory. Biopsies are small operations that can often be carried out under a local anaesthetic (where the area is numbed). In some cases,the affected lymph node isnt easily accessible and a general anaesthetic may be required (where youre asleep). A pathologist (an expert in the study of diseased tissue) will then check the tissue sample for the presence of cancerous cells. If they find cancerous cells, they can also identify exactly which type of non-Hodgkin lymphoma you have, which is an important factor in planning your treatment. Types of non-Hodgkin lymphoma There are more than 30 types of non-Hodgkin lymphoma, including: diffuse large B-cell lymphoma follicular lymphoma extranodal marginal zone B-cell (MALT) mantle cell lymphoma Burkitt lymphoma mediastinal large B-cell lymphoma nodal marginal zone B-cell lymphoma small lymphocytic lymphoma lymphoplasmacytic lymphoma peripheral T-cell lymphoma skin (cutaneous) lymphomas anaplastic large-cell lymphoma lymphoblastic lymphoma The Macmillan Cancer Support website has more detailed information on the different types of non-Hodgkin lymphoma . Further testing If a biopsy confirms a diagnosis of non-Hodgkin lymphoma, further testing will be required to check how far the lymphoma has spread. This allows a doctor to diagnose the stage of your lymphoma. Further tests may include: blood tests  samples of blood will be taken throughout your diagnosis and treatment to check your general health, the levels of red and white cells and platelets in your blood, and how well organs such as your liver and kidney are working bone marrow sample  another biopsy may be carried out to see if the lymphoma has spread to your bone marrow; this involves using a long needle to remove a sample of bone marrow from your pelvis and can be done using a local anaesthetic chest X-ray  this can check whetherthe cancerhas spread to your chest or lungs computerised tomography (CT) scan  this scan takes a series of X-rays that build up a 3D picture of the inside of the body to check the spread ofthe cancer magnetic resonance imaging (MRI) scan  this scan uses strong magnetic fields to build up a detailed picture of areas of your body to check the spread of the cancer positron emission tomography (PET) scan this scan measures the activity of cells in different parts of the body andcan check the spread of the cancer and the impact of treatment; its usually taken at the same time as a CT scan to show precisely how the tissues of different sites of the body are working lumbar puncture using a thin needle, a sample of spinal fluid is taken and examined to see if it contains any lymphoma cells Stages ofnon-Hodgkin lymphoma When the testing is complete, it should be possible to determine the stage of your lymphoma. Staging means scoring the cancer by how far its spread. The main stages of non-Hodgkin lymphoma are. stage 1 the cancer is limited to 1 group of lymph nodes, such as your neck or groin nodes either above or below your diaphragm (the sheet of muscle underneath the lungs) stage 2  2 or more lymph node groups are affected, either above or belowthe diaphragm stage 3 thecancer has spread to lymph node groups above and below the diaphragm stage 4 the lymphoma has spread through the lymphatic system and is now present in organs or bone marrow Health professionals also add the letter A or B to your stage to indicate whether or not you have certain symptoms. Ais put after your stage if you have no additional symptoms other than swollen lymph nodes. B is put after your stage if you have additional symptoms of weight loss, fever or night sweats. In some cases, health professionals also use additional letters to indicate where the cancer first developed. For example, E (extranodal) means the cancer developed outside the lymphatic system. Grading non-Hodgkin lymphoma Testing can also help health professionals decide the grade of the cancer. There are two main grades of non-Hodgkin lymphoma: low-grade or indolent non-Hodgkin lymphoma is where the cancer develops slowly, and you may not experience any symptoms for many years high-grade or aggressive non-Hodgkin lymphoma is where the cancer develops quickly and aggressively Low-grade tumours dont necessarily require immediate medical treatment, but are harder to completely cure. High-grade lymphomas need to be treated immediately, but tend to respond much better to treatment and can often be cured. In some cases, low-grade lymphomas can develop into high-grade lymphomas over time. Read more about treating non-Hodgkin lymphoma . Treating non-Hodgkin lymphoma Non-Hodgkin lymphoma is usually treated with cancer-killing medication or radiotherapy, although some people may not need treatment straight away. In a few cases,if the initial cancer isvery smalland can be removed duringa biopsy , no further treatment may be needed. Your treatment plan The recommended treatment plan will depend on your general health and age,as many of the treatments can put atremendous strain on the body. Discussions about your treatment plan will usually take place with several doctors and other health professionals who specialise in different aspects of treating lymphoma. This is known as a multidisciplinary team (MDT). Your MDT will recommend the best treatment options for you. However, you shouldnt be rushed into making a decision about your treatment plan. Before deciding, you may wish to talk to friends, family and your partner. Youll be invited back to see your care team for a full discussion about the risks and benefits of any treatments planned before treatment begins. You can ask yourcare teamif a clinical trialis available to take part in. Wait-and-see approach If the disease is low-grade (slow developing) and youre well, a period of watchful waiting is often recommended. This is because some people take many years to develop troublesome symptoms and starting treatment immediately is often felt to be unnecessary. If watchful waiting is recommended, youll be seen regularly for reviews and invited to come back at any stage if you feel your symptoms are getting worse. Chemotherapy Chemotherapy is a widely used treatment for non-Hodgkin lymphoma, which involvesusing medicine to kill cancer cells. It may be used onits own, combined with biological therapy and/or combined with radiotherapy (see below). The medication can be given in a number of different ways, depending on the stage of your cancer. If doctors think your cancer is curable, youll normally receive chemotherapy through a drip directly into a vein (intravenous chemotherapy).If a cure is unlikely, you may only need to take chemotherapy tablets to help relieve your symptoms. If theres a risk of the cancer spreading to your brain, you may have chemotherapy injections directly into the cerebrospinal fluid around your spine. Chemotherapy is usually given over a period of a few months on an outpatient basis, which means you shouldnt have to stay in hospital overnight. However, there may be times when your symptoms or the side effects of treatment become particularly troublesome, and a longer hospital stay may be needed. Chemotherapy can have several side effects, the most significant of which is potential damage to your bone marrow. This can interfere with the production of healthy blood cells and cause the following problems: fatigue breathlessness increased vulnerability to infection bleeding and bruising more easily If you experience these problems, treatment may need to be delayed so you can produce more healthy blood cells. Growth factor medicines can also stimulate the production of blood cells. Other possible side effects of chemotherapy include: nausea and vomiting diarrhoea loss of appetite mouth ulcers tiredness skin rashes hair loss infertility , which may be temporary or permanent Most side effects should pass once your treatment has finished. Tell your care team if side effects become particularly troublesome, as there are treatments that can help. Read more about the side effects of chemotherapy . High-dose chemotherapy If non-Hodgkin lymphoma doesnt get better with initial treatment (known as refractory lymphoma), you may have a course of chemotherapy at a stronger dose. However, this intensive chemotherapy destroys your bone marrow, leading to the problems mentioned above. Youll need a stem cell orbone marrow transplants to replace the damaged bone marrow. Radiotherapy Radiotherapy ismostoftenused to treat early-stage non-Hodgkin lymphoma, where the cancer is only in 1 part of the body. Treatment is normally given in short daily sessions, Monday to Friday, over several weeks. You should not have to stay in hospital between appointments. Radiotherapy itself is painless, but it can have some significant side effects. These can vary, depending on which part of your body is being treated. For example, treatment to your throat can lead to a sore throat, while treatment to the head can lead to hair loss. Other common side effects include: sore and red skin in the treatment area tiredness nausea and vomiting dry mouth loss of appetite Most side effects are temporary, but theres a risk of long-term problems, including infertility and permanently darkened skin in the treatment area. Read more about: side effects of radiotherapy complications of non-Hodgkin lymphoma Monoclonal antibodytherapy For some types of non-Hodgkin lymphoma, you may have a type of medication called a monoclonal antibody. These medications attach themselvesto the surface of cancerous cells and stimulate the immune system to attack and kill the cells. Theyre often given in combination with chemotherapy to make the treatment more effective. For some types of non-Hodgkin lymphoma, you may continue having monoclonal antibody treatment regularly for up to 2 years after initial treatment, in combination withchemotherapy. This can reduce the chances of the cancer coming back in the future. One of the mainmonoclonal antibody medications used to treat non-Hodgkin lymphoma is called rituximab.This medicationis administered directly into your vein over the course of a few hours. Side effects of rituximab can include: flu -like symptoms, such as headaches , fever and chills tiredness nausea an itchy rash You may be given additional medication to prevent or lessen these side effects. Side effects should improve over time, as your body gets used to rituximab. Asrituximab has been so successful in treating non-Hodgkin lymphoma, scientists are working hard to make more monoclonal antibody treatments for lymphoma, and some of these are already at an advanced stage in clinical trials. You may be asked if you want to participate in one of these trials during your treatment. Steroid medication Steroid medication is commonlyused in combination with chemotherapy to treat non-Hodgkin lymphoma. This is because research has shown that using steroids makes the chemotherapy more effective. The steroid medication is normallygiven as tablets, usually at the same time as your chemotherapy. A short course of steroids, lasting no more than a few months, is usually recommended, as this limits the number of side effects you could have. Common side effects of short-term steroid use include: increased appetite, which can lead to weight gain indigestion problems sleeping feeling agitated On rare occasions, you may have to take steroids on a long-term basis. Side effects of long-term steroid use include weight gain and swelling in your hands, feet and eyelids. The side effects of steroid medication usually start to improve once treatment finishes. Follow-up After your course of treatment ends, you may have a repeat scan to see how well the treatment has worked. Following this, youll need regular follow-up appointments to monitor your recovery and check for any signs of the cancer returning (known as a relapse). These appointments will start off being every few weeks or months, but become less frequent over time. Read furtherinformation: Cancer Research UK: treating non-Hodgkin lymphoma Cancer Research UK: living with non-Hodgkin lymphoma Macmillan: treating non-Hodgkin lymphoma Macmillan: living with non-Hodgkin lymphoma Complications of non-Hodgkin lymphoma Some people treated for non-Hodgkin lymphoma experience long-term problems, even if theyve been cured. Weakened immune system Having a weakened immune system is a common complication of non-Hodgkin lymphoma and it can become more severe while youre being treated. However, your immune system will usually recover in the months and years after treatment. If you have a weak immune system, youre more vulnerable to infections, and theres an increased risk of developing serious complications from infections. In some cases, you may be advised to take regular doses of antibiotics to prevent infections occurring. Its also important to report any symptoms of an infection to your GP or care team immediately, because prompt treatment may be needed to prevent serious complications.This is particularly important in the first few months after treatment. Symptoms of infection include: a high temperature (fever) headache aching muscles diarrhoea tiredness a painful blistering rash Vaccination You should make sure that all of your vaccinations are up to date. However, its important to speak to your GP or care team about this because it may not be safe for you to have live vaccines (vaccines containing a weakened form of the virus or organism being vaccinated against) until several months after your treatment finishes. Examples of live vaccines include the: shingles vaccine BCG vaccine (against tuberculosis) MMR vaccine (against measles , mumps and rubella) Infertility Chemotherapy and radiotherapy for non-Hodgkin lymphoma can cause infertility . This is sometimes temporary, but it can be permanent. Your care team will estimate the risk of infertility in your specific circumstances and let you know your options. In some cases, it may be possible for men to store samples of their sperm and for women to store their eggs before treatment, so these can be used to try for a baby afterwards. Second cancers Having treatment for non-Hodgkin lymphoma can increase your risk of developing another type of cancer in the future. This is known as a second cancer. The risk of getting cancer is particularly increased after cancer treatment because chemotherapy and radiotherapy damage healthy cells, as well as cancer cells. This damage can then cause the affected cells to become cancerous many years after treatment. You can help to reduce your risk of a second cancer by adopting a healthy lifestyle by not smoking, maintaining a healthy weight with a balanced diet, and getting regular exercise. You should report any symptoms that might suggest another cancer to your GP at an early stage and attend any cancer screening appointments youre invited to. Other health problems Treatment for non-Hodgkin lymphoma can increase your risk of getting certainconditionsat a younger age than normal, such as: heart disease lung disease kidney disease thyroid disease diabetes cataracts Having a cancer diagnosis can also increase your risk of depression . You should report unexpected symptoms, such as increased shortness of breath, to your GP. Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Radiotherapy Hodgkin lymphoma Other health sites Cancer Research UK: Non-Hodgkin lymphoma Macmillan Cancer Support: Non-Hodgkin lymphoma Blood cancer UK: Lymphoma Lymphoma Action Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Non-Hodgkin lymphoma: Children,"""Non-Hodgkin lymphoma: Children | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in children Non-Hodgkin lymphoma: Children Non-Hodgkin lymphoma: Children Non-Hodgkin lymphoma is a type of blood cancer. Its more common in boys than girls. More children than ever are surviving childhood cancer. There are new and better drugs and treatments, and we can now also work to reduce the after-effects of having had cancer in the past. Its devastating to hear that your child has cancer. At times it can feel overwhelming and there are many healthcare professionals and support organisations to help you through this difficult time. Understanding more about the cancer your child has and the treatments that may be used can often help parents to cope. Your childs specialist will give you more detailed information. If you have any questions its important to ask the specialist doctor or nurse who knows your childs individual situation. The lymphatic system is part of the immune system, the bodys natural defence against infection and disease. This is a complex system made up of the bone marrow, thymus, spleen, and lymph nodes throughout the body. The lymph nodes are connected by a network of tiny lymphatic vessels. Lymph nodes are also known as lymph glands, and the ones that youre most likely to notice are those in the neck, armpit and groin. The number of lymph nodes varies from one part of the body to another. In some parts there are very few, whereas under your arm there may be 20 to 50 nodes. Cancers that start in the lymphatic system are called lymphomas. There are 2 main types of lymphoma: Hodgkin lymphoma non-Hodgkin lymphoma (NHL) Although theyre both types of lymphoma, there are differences between them, which means they need different treatment. There are 2 main types of NHL. B-cell NHL usually involves the lymph nodes in the abdomen and intestines, but may involve nodes in the head and neck. T-cell NHL usually affects lymph nodes in the chest. Occasionally, NHL can develop in unusual places outside the lymph nodes. This is called extranodal lymphoma. Causes We dont know what causes NHL but there is research going on all the time to try to find out. Its important to remember that nothing you have done has caused the cancer. Signs and symptoms The first sign of NHL is usually a lump somewhere in the body, which is caused by swollen lymph nodes. This can cause different symptoms, depending on where the swollen lymph nodes are. If glands in the abdomen are affected, this may cause a feeling of being full after meals and some stomach pain. Other symptoms of NHL include a high temperature (fever), tiredness, weight loss, and loss of appetite. In a few children, lymphoma cells may be found in the bone marrow or in the fluid around the spinal cord (cerebrospinal fluid). How its diagnosed A variety of tests and investigations may be needed to diagnose NHL. Part, or all, of a swollen lymph gland, may be removed so that the cells can be examined in the laboratory ( biopsy ). This involves a small operation that is usually done under a general anaesthetic. Tests such as X-rays, ultrasound scans, MRI scans, CT scans, blood tests and bone marrow samples may be carried out to find out the extent of the disease. This is known as staging. Any tests and investigations that your child needs will be explained to you.The Childrens Cancer and Leukaemia Group (CCLG) has more information about what the tests and scans involve. Staging The stage of a cancer is a term used to describe its size and whether it has spread beyond its original site. The type of treatment your child receives depends on the stage of the disease. Stage 1 One group of lymph nodes is affected, or theres a single extranodal tumour. Stage 2 Two or more groups of nodes are affected, or there is a single extranodal tumour that has spread to nearby lymph nodes, or there are two single extranodal tumours, but only on one side of the diaphragm (the sheet of muscle under the lungs, which plays a large part in our breathing). Stage 3 Theres lymphoma on both sides of the diaphragm (either in two or more groups of nodes) or there are two single extranodal tumours or the lymphoma is affecting the chest. Stage 4 The lymphoma has spread beyond the lymph nodes to other organs of the body such as the bone marrow or nervous system. Treatment Treatment for NHL has a very good success rate and many people are cured. Chemotherapy is the most important treatment for children with NHL. Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. Its common for a combination of drugs to be used and treatment may last a number of months or years. The treatment will be planned according to your childs particular type of NHL and the stage of the disease. B-cell NHL is treated with 4to 8 courses of intensive chemotherapy. T-cell NHL is treated for about 2 years. Your childs doctor will discuss the treatment options with you. NHL can sometimes affect the brain and spinal cord. To stop this, chemotherapy may be injected directly into the fluid around the spinal cord. This is called intrathecal chemotherapy. Very rarely, radiotherapy is also necessary. Radiotherapy treats cancer by using high-energy rays to destroy the cancer cells, while doing as little harm as possible to normal cells. High-dose chemotherapy with a bone marrow transplant is sometimes used (again very rarely) if the NHL comes back (recurs) after initial treatment. Side effects of treatment Treatment for NHL can cause different side effects, and your childs doctor will discuss these with you before the treatment starts. Any possible side effects will depend on the part of the body thats being treated and what treatment is being used. Some children have just a few side effects, while others experience more. Side effects can include: feeling sick (nausea) and vomiting a sore mouth temporary hair loss a low blood count leading to an increased risk of infection, bruising and bleeding (sometimes blood and/or platelet transfusions are needed) tiredness diarrhoea Late side effects Months or years later some children will develop late side effects from the treatment they have had. These include a possible reduction in bone growth, a change in the way the heart, lungs and kidneys work, and a small increase in the risk of developing another cancer in later life. After treatment with chemotherapy, some children  particularly boys  may become infertile. Older boys, and their parents, should be aware of the option of sperm banking. In this situation, sperm can be stored for possible use in later years. Your childs doctor or nurse will talk to you about any possible late side effects and will keep a close eye on possible long-term side effects in follow-up clinics. Clinical trials Many children have their treatment as part of a clinical research trial. Cancer research trials are carried out to try to find new and better treatments for cancer. Clinical trials mean there are now better results for curing childrens cancers compared with just a few years ago. Your childs medical team will talk to you about taking part in a clinical trial and will answer any questions you have. Written information is provided to help explain things. Taking part in a research trial is completely voluntary, and youll be given plenty of time to decide if its right for your child. Treatment guidelines Sometimes, clinical trials are not available for your childs tumour. This may be because a recent trial has just finished, or because the tumour is very rare. In these cases, you can expect your doctors and nurses to offer treatment which is agreed to be the most appropriate, using guidelines which have been prepared by experts across the country. The Childrens Cancer and Leukaemia Group (CCLG) is an important organisation which helps to produce these guidelines. Follow-up care Once treatment has finished, the doctors will monitor your child closely with regular appointments in the hospital outpatient department. If you have specific concerns about your childs condition and treatment, its best to discuss them with your childs doctor, who knows the situation in detail. Your feelings As a parent, the fact that your child has cancer is one of the worst situations you can be faced with. You may have many emotions, such as fear, guilt, sadness, anger and uncertainty. These are all normal reactions and are part of the process that many parents go through at such a difficult time. Its not possible to address here all of the feelings you may have. However, the CCLG booklet Children & Young Peoples Cancer; A Parents Guide talks about the emotional impact of caring for a child with cancer and suggests sources of help and support. Your child may have a variety of powerful emotions throughout their experience with cancer. The Parents Guide discusses these further and talks about how you can support your child. Source: Children's Cancer and Leukaemia Group - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Norovirus,"Norovirus | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Norovirus Norovirus Norovirus causes diarrhoea and vomiting and is one of the most common stomach bugs in the UK. Its also called the winter vomiting bug because its more common in winter, but you can catch it at any time of the year. Norovirus can be very unpleasant but usually clears up by itself in a few days. You can normally look after yourself or your child at home. Avoid going to your GP, as norovirus can spread to others very easily. Phone your GP practice or NHS 24 on 111 if youre concerned or need advice. Phone 999 or go to A&E if you or your child: vomit blood or have vomit that looks like ground coffee have green vomit (adults) have yellow-green or green vomit (children) might have swallowed something poisonous have a stiff neck and pain when looking at bright lights have a sudden, severe headache or stomach ache Find your nearest A&E Phone 111 now if: youre worried about a baby under 12 months your child stops breast or bottle feeding while theyre ill a child under 5 years has signs of dehydration  such as fewer wet nappies you or your child (over 5 years) still have signs of dehydration after using oral rehydration sachets you or your child keep being sick and cannot keep fluid down you or your child have bloody diarrhoea or bleeding from the bottom you or your child have diarrhoea for more than 7 days or vomiting for more than 2 days Symptoms of norovirus Youre likely to have norovirus if you experience: suddenly feeling sick projectile vomiting watery diarrhoea Some people also have a slight fever, headaches , painful stomach cramps and aching limbs. The symptoms appear 1 to 2 days after you become infected and typically last for up to 2 or 3 days. How is norovirus spread? Norovirus spreads very easily in public places such as hospitals, nursing homes and schools. You can catch it if small particles of vomit or stools (poo) from an infected person get into your mouth through: close contact with someone with norovirus who may breathe out small particles of the virus that you then inhale touching contaminated surfaces or objects, as the virus can survive outside the body for several days eating contaminated food, which can happen if an infected person doesnt wash their hands before preparing or handling food Norovirus is most infectious from the start of symptoms until 48 hours after all symptoms have stopped. You may also be infectious for a short time before and after this. You can get norovirus more than once because the virus is always changing and your body is unable to build up long-term resistance to it. Preventing norovirus Its not always possible to avoid getting norovirus, but following the advice can help stop the virus spreading. You should: stay off work or school until at least 48 hours after the norovirus symptoms have stopped avoid visiting anyone in hospital during this time wash your hands frequently and thoroughly with soap and water particularly after using the toilet and before preparing or handling food be aware alcohol-based hand gels dont kill the virus Maintain basic hygiene and cleaning to help stop the spread of norovirus by: disinfecting any surfaces or objects that could be contaminated, using a bleach-based household cleaner. washing any items of clothing or bedding that could have become contaminated separately on a hot wash (60C) to ensure the virus is killed. not sharing towels and flannels flushing any poo or vomit in the toilet and cleaning the surrounding area with a bleach-based household cleaner avoiding eating raw, unwashed food only eating oysters from a reliable source as they can carry norovirus What to do if you have norovirus If you experience sudden diarrhoea and/or vomiting, the best thing to do is to stay at home until youre feeling better. Theres no treatment for norovirus, so you have to let it run its course. You dont usually need to get medical advice unless theres a risk of a more serious problem. To help ease your own or your childs symptoms drink plenty of fluids to avoid dehydration. You need to drink more than usual to replace the fluids lost from vomiting and diarrhoea  as well as water, adults could also try fruit juice and soup. Avoid giving fizzy drinks or fruit juice to children as it can make their diarrhoea worse. Babies should continue to feed as usual, either with breast milk or other milk feeds. You can also: take paracetamol for any fever or aches and pains get plenty of rest use special rehydration drinks, available from community pharmacies if you have signs of dehydration , such as a dry mouth or dark urine If you feel like eating, try plain foods, such as soup, rice, pasta and bread. Babies and young children, especially under a year old, have a greater risk of becoming dehydrated. When to get medical advice You dont normally need to see your GP if you think you or your child has norovirus, as theres no specific treatment for it. Antibiotics wont help because norovirus is caused by a virus. Source: NHS National Services Scotland - Opens in new browser window Last updated: 01 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Nosebleed,"Nosebleed | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Ears, nose and throat Nosebleed Nosebleed Nosebleeds are not usually a sign of anything serious. You can often treat them at home. During a nosebleed, blood flows from one or both nostrils. It can be heavy or light. It can last from a few seconds to 15 minutes or more. How to stop a nosebleed To stop a nosebleed: Sit down at a table, lean forward and firmly pinch the soft part of your nose, just above your nostrils, for at least 10 to 15 minutes. Lean forward and breathe through your mouth. Spit out any blood that collects in your throat or mouth into a bowl. Do not swallow any blood. Place an ice pack or bag of frozen vegetables covered by a towel on your forehead or back of your neck. Stay upright or seated, rather than lying down, to reduce the blood pressure in the blood vessels of your nose and help reduce further bleeding. If the bleeding eventually stops, you wont usually need to seek medical advice. But in some cases you may need further treatment from your GP or in hospital. When to get medical advice Go to A&E or phone 999 if: the bleeding continues for longer than 20 minutes the bleeding is heavy and youve lost a lot of blood youre having difficulty breathing youre feeling weak or dizzy you swallow a large amount of blood that makes you vomit the nosebleed developed after a serious injury, such as a car crash Speak to your GP practice if: youre taking a blood-thinning medicine (anticoagulant) such as warfarin you have a condition that means your blood cannot clot properly, such as haemophilia you have symptoms of anaemia such as heart palpitations, shortness of breath and a pale complexion a child under 2 has a nosebleed you have nosebleeds that come and go regularly If your GP practice is closed, phone 111. What causes nosebleeds? There are delicate blood vessels in your nose that can become damaged and bleed quite easily. Common causes of nosebleeds include: picking your nose blowing your nose very hard recently drinking alcohol a minor injury to your nose changes in humidity or temperature causing the inside of the nose to become dry and cracked Occasionally, bleeding can come from the blood vessels deeper within the nose. This can be caused by a blow to the head, recent nasal surgery or hardened arteries (atherosclerosis). Who gets nosebleeds? Nosebleeds are fairly common. Most people will get them every now and again. Anyone can get a nosebleed, but they most often affect: children aged between 2 and 10 elderly people pregnant women people who take blood thinning medication such as aspirin or anticoagulants, such as warfarin people with blood clotting disorders, such as haemophilia Preventing nosebleeds There are things you can do to prevent nosebleeds. Do avoid picking your nose and keep your fingernails short blow your nose as little as possible and only very gently keep your home humidified wear a head guard during activities in which your nose or head could get injured always follow the instructions that come with nasal decongestants  overusing these can cause nosebleeds Talk to your GP if you often get nosebleeds and arent able to prevent them. Treatment for nosebleeds If you see your GP or go to hospital with a nosebleed, youll be assessed to find out how serious your condition is and whats likely to have caused it. This may involve: looking inside your nose measuring your pulse and blood pressure carrying out blood tests asking about any other symptoms you have If needed, your doctor will discuss additional treatments with you. For example, ointments for your nose, cautery to seal blood vessels in your nose or nasal packing may be required. Source: ENT Scotland - Opens in new browser window Last updated: 05 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform High blood pressure (hypertension) Iron deficiency anaemia First aid Other health sites St John Ambulance: Nosebleeds NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Obesity,"Obesity causes & treatments - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Nutritional Obesity Obesity About obesity Causes of obesity Diagnosing obesity Treating obesity About obesity The term obese describes a person whos very overweight, with a lot of body fat. Its a common problem in the UK thats estimated to affectaround one in every four adults and around one in every five children aged 10 to 11. Defining obesity There are many ways in which a persons health in relation to their weight can be classified, but the most widely used method is body mass index (BMI). BMI is a measure of whether youre a healthy weight for your height. You can use the BMI healthy weight chart to work out yourscore. For most adults, a BMI of: 18.5 to 24.9 means youre a healthy weight 25 to 29.9 means youre overweight 30 to 39.9 means youre obese 40 or above means youre severely obese BMI isnt used to definitively diagnose obesity, because people who are very muscular sometimes have a high BMI without excess fat.But for most people, BMI is a useful indication of whether theyre a healthy weight, overweight or obese. A better measure of excess fat is waist circumference, which can be used as an additional measure in people who are overweight (with a BMI of 25 to 29.9) or moderately obese (with a BMI of 30 to 34.9). Generally, men with a waist circumference of 94cm (37in) or more and women with a waist circumference of 80cm (about 31.5in) or more are more likely to develop obesity-related health problems. Read more about diagnosing obesity Risks of obesity Its very important to take steps to tackle obesity because, as well as causingobvious physical changes, itcan lead to a number of serious and potentially life-threatening conditions, such as: type 2 diabetes coronary heart disease some types of cancer, such as breast cancer and bowel cancer stroke Obesity can also affect your quality of life and lead to psychological problems, such as depression andlow self-esteem (see below for more information about the health problems associated with obesity). Causes of obesity Obesity is generally caused by consuming more calories  particularly those in fatty and sugary foods  than you burn off through physical activity.The excess energy is stored by the body as fat. Obesity is an increasingly common problem because for many people modern living involves eating excessive amounts of cheap, high-calorie food and spending a lot of time sitting down, at desks, on sofas or in cars. There are also some underlying health conditions that can occasionally contribute to weight gain, such as an underactive thyroid gland (hypothyroidism) , although these type of conditions dont usually cause weight problems if theyre effectively controlled with medication. Read more about the causes of obesity Treating obesity The best way to treat obesity is to eat a healthy, reduced-calorie diet and exercise regularly . To do this you should: eat a balanced, calorie-controlled diet as recommended by your GP or weight loss management health professional (such as a dietitian) join a local weight loss group take up activities such as fast walking , jogging, swimming or tennis for 150 to 300minutes (two-and-a-half to five hours) a week eat slowly and avoid situations where you know you could be tempted to overeat You may also benefit from receiving psychological support from a trained healthcare professional to help change the way you think about food and eating. If lifestyle changes alone dont help you lose weight, a medication called orlistat may be recommended. If taken correctly, this medication works by reducing the amount of fat you absorb during digestion. Your GP will know whether orlistat is suitable for you. In rare cases, weight loss surgerymay be recommended. Read more about how obesity is treated Other obesity-related problems Obesity cancause anumber of further problems, including difficulties with daily activities and serious health conditions. Day-to-day problems related to obesity include: breathlessness increased sweating snoring difficultydoingphysical activity often feeling very tired joint andback pain low confidence and self-esteem feeling isolated The psychological problems associated with being obese can also affect your relationships with family and friends, and may lead to depression. Serious health conditions Being obese can also increase your risk of developing many potentially serioushealth conditions, including: type 2 diabetesa condition that causes a persons blood sugar level to become too high high blood pressure high cholesterol andatherosclerosis (where fatty deposits narrow your arteries), which can lead to coronary heart disease andstroke asthma metabolic syndrome a combination of diabetes, high blood pressure and obesity several types of cancer , including bowel cancer, breast cancerand womb cancer gastro-oesophageal reflux disease (GORD) where stomach acid leaks out of the stomach and into the oesophagus (gullet) gallstones small stones, usually made of cholesterol, that form in the gallbladder reduced fertility osteoarthritis a condition involving pain and stiffness in your joints sleep apnoea a condition that causes interrupted breathing during sleep, which can lead to daytime sleepiness with an increased risk of road traffic accidents, as well as a greater risk of diabetes, high blood pressure and heart disease liver disease and kidney disease pregnancy complications,such as gestational diabetes orpre-eclampsia (when a woman experiences a potentially dangerous rise in blood pressure during pregnancy) Obesity reduces life expectancy by an average of3 to10 years, depending on how severe it is. Its estimated that obesity and being overweight contribute to at least1 in every 13 deaths in Europe. Outlook Theres no quick fix for obesity. Weight loss programmes take time and commitment, and work best when fully completed. The healthcare professionals involved with your care should provide encouragement and advice about how to maintain the weight loss achieved. Regularly monitoring your weight, setting realistic goals and involving your friends and family with your attempts to lose weightcan also help. Remember that even losing what seems like a small amount of weight, such as 3% or more of your original body weight, and maintaining this for life, can significantly reduce your risk of developing obesity-related complications like diabetes and heart disease. Causes of obesity Obesity is generally caused by eating too much and moving too little. If you consume high amounts of energy, particularly fat and sugars, but dont burn off the energy through exercise and physical activity, much of the surplus energy will be stored by the body as fat. Calories The energy value of food is measured in units called calories. The average physically active man needs about 2,500 calories a day to maintain a healthy weight, and the average physically active woman needs about 2,000 calories a day. This amount of calories may sound high, but it can be easy to reach if you eat certain types of food. For example, eating a large takeaway hamburger, fries and a milkshake can total 1,500 calories  and thats just one meal. Another problem is that many people arent physically active, so lots of the calories they consume end up being stored in their body as fat. Poor diet Obesity doesnt happen overnight. It develops gradually over time, as a result of poor diet and lifestyle choices, such as: eating large amounts of processed or fast food  thats high in fat and sugar drinking too much alcohol alcohol contains a lot of calories, and people who drink heavily are often overweight eating out a lot you may be tempted to also have a starter or dessert in a restaurant, and the food can be higher in fat and sugar eating larger portions than you need you may be encouraged to eat too much if your friends or relatives are also eating large portions drinking too many sugary drinks  including soft drinks and fruit juice comfort eating if you have low self-esteem or feel depressed, you may eat to make yourself feel better Unhealthy eating habits tend to run in families. You may learn bad eating habits from your parents when youre young and continue them into adulthood. Read more about eating well Lack of physical activity Lack of physical activity is another important factor related to obesity. Many people have jobs that involve sitting at a desk for most of the day. They also rely on their cars, rather than walking or cycling . Forrelaxation, many people tend to watch TV, browse the internet or play computer games, and rarely take regular exercise . If youre not active enough, you dont use the energy provided by the food you eat, and the extra energy you consume is stored by the body as fat. The Department of Health recommends that adults do at least 150 minutes (two-and-a-half hours) of moderate-intensity aerobic activity, such as cycling or fast walking, every week. This doesnt need to be done allin one go, but can be broken down into smaller periods. For example, you could exercise for 30 minutes a day for five days a week. If youre obese and trying to lose weight , you may need to do more exercise than this. It may help to start off slowly and gradually increase the amount of exercise you do each week. Read more about the physical activity guidelines for adults Genetics Some people claimtheres no point trying to lose weight because it runs in my family or its in my genes. While there are some rare genetic conditions that can cause obesity, such asPrader-Willi syndrome, theres no reason why most people cant lose weight. It may be true that certain genetic traits inherited from your parentssuch as having a large appetitemay make losing weight more difficult, but it certainly doesnt make it impossible. In many cases, obesity is more to do with environmental factors, such as poor eating habits learned during childhood. Medical reasons In some cases, underlying medical conditions may contribute to weight gain. These include: an underactive thyroid gland (hypothyroidism) where your thyroid gland doesnt produce enough hormones Cushings syndromea rare disorder that causes the over-production of steroid hormones However, if conditions such as these are properly diagnosed and treated, they should pose less of a barrier to weight loss. Certain medicines, including some corticosteroids , medications for epilepsy and diabetes , and some medications used to treat mental illness including antidepressants and medicines for schizophrenia can contribute to weight gain. Weight gain can sometimes be a side effect of stopping smoking Diagnosing obesity Body mass index (BMI) is widely used as a simple and reliable way of finding out whether a person is a healthy weight for their height. For most adults, having a BMI of 18.5 to 24.9 means youre considered to be a healthy weight. A person with a BMI of 25 to 29.9 is considered to be overweight, and someone with a BMI over 30 is considered to be obese. While BMI is a useful measurement for most people, its not accurate for everyone. For example, the normal BMI scores may not be accurate if youre very muscular because muscle can add extra pounds, resulting ina high BMI when youre not an unhealthy weight. In such cases, your waist circumference may be a better guide (see below). Whats considered a healthy BMI is also influenced by your ethnic background. The scores mentioned above generally apply to people with a white Caucasian background. If you have an ethnic minority background, the threshold for being considered overweight or obese may be lower. BMI shouldnt be used to work out whether a child is a healthy weight, becausetheir bodies are still developing.Speak to your GP if you want to find out whether your child is overweight. Visiting your GP If youre overweight or obese,visit your GP for advice about losing weight safely and to find out whether you have an increased risk of health problems. Your GPmay ask about: your lifestyle  particularly your diet and how much physical activity you do; theyll also ask you whether you smoke and how muchalcohol you drink any possible underlying causes for your obesity  for example, if youre taking medication or have a medical condition that may contribute toweight gain how you feel about being overweight  for example, if it makes you feel depressed how motivated you are to lose weight your family history  as obesity and other health conditions, such as diabetes , are often more common in families As well as calculating your BMI, your GP may also carry out tests to determine whether youre at increased risk of developing health complications because of your weight. These could includemeasuring your: blood pressure glucose (sugar) and cholesterol levels in a blood sample waist circumference (the distance around your waist) People with very large waists  generally, 94cm (37in) or more in men and 80cm (about 31.5in) or more in women  are more likely to develop obesity-related health problems. Your GP may also take your ethnicity into account because it can affect your risk of developing certain conditions. For example, some people of Asian, African or Afro-Caribbean ethnicity may be at increased risk of high blood pressure (hypertension) . Healthy waist measurements can also be different for people from different ethnic backgrounds. After your assessment, youll be offered an appointment to discuss the results in more detail, ask any questions that you have, and fully explore the treatment options available to you. Treating obesity If youre obese, speak to your GP for advice about losing weight safely. Your GP can advise you about losing weight safely by eating a healthy, balanced diet and regular physical activity . They can also let you know aboutother useful services, such as: local weight loss groups  these could be provided by your local authority, the NHS, or commercial services you may have to pay for exercise on prescription  where youre referred to a local active health team for a number of sessions under the supervision of a qualified trainer If you have underlying problems associated with obesity, such as polycystic ovary syndrome (PCOS), high blood pressure , diabetes or obstructive sleep apnoea , your GP may recommend further tests or specific treatment. In some cases, they may refer you to a specialist. Read more about how your GP can help you lose weight Diet Theres no single rule that applies to everyone, but to lose weight at a safe and sustainable rate of 0.5 to 1kg (1lb to 2lbs) a week, most people are advised to reduce their energy intake by 600 calories a day. For most men, this will mean consuming no more than 1,900 calories a day, and for most women, no more than 1,400 calories a day. The best way to achieve thisis to swap unhealthy and high-energy food choices  such as fast food, processed food and sugary drinks (including alcohol)  for healthier choices. A healthy diet should consist of: plenty of fruit and vegetables plenty of potatoes, bread, rice, pasta and other starchy foods (ideally you should choose wholegrain varieties) somemilk and dairy foods some meat, fish, aggs,beansand other non-dairy sources of protein just small amounts of food and drinks that are high infatandsuagr Try to avoidfoods containing high levels of salt because they can raise your blood pressure, which can be dangerousfor people who are already obese. Youll also need to checkcalorie information for each type of food and drink you consume to make sure you dont go over your daily limit. Some restaurants,cafs and fast food outlets provide calorie information per portion, although providing this information isnt compulsory. Be carefulwhen eating out because some foods can quickly take you over the limit, such as burgers, fried chicken, and some curries or Chinese dishes. Diet programmes andfad diets Avoidfad diets that recommend unsafe practices, such as fasting (going without food for long periods of time) or cutting out entire food groups. These types of dietsdont work, can make you feel ill, and arent sustainable because they dont teach you long-term healthy eating habits. This isnt to say that all commercial diet programmes are unsafe. Many are based on sound medical and scientific principles and can work well for some people. A responsible diet programme should: educate you about issues such as portion size, making behavioural changesand healthy eating not be overly restrictive in terms of the type of foods you can eat be based on achieving gradual, sustainable weight loss rather than short-term rapid weight loss, which is unlikely to last Very low calorie diets Avery low calorie diet (VLCD) is where you consume less than 800 calories a day. These diets can lead to rapid weight loss, butthey arent a suitable or safe method for everyone, and they arent routinely recommended for managing obesity. VLCDs are usually only recommended if you have an obesity-related complication that would benefit from rapid weight loss. VLCDsshouldnt usually be followed for longer than 12 weeks at a time, and they should only be used under the supervision of a suitably qualified healthcare professional. Speak to your GP first ifyoure considering this type of diet. Exercise Reducing the amount of calories in your diet will help you lose weight, but maintaining a healthy weight requires physical activity to burn energy. As well as helping you maintain a healthy weight, physical activity also has wider health benefits. For example, it can help prevent and manage more than20 conditions, such as reducing the risk oftype 2 diabetes by 40%. The Chief Medical Officers recommend that adults should do at least 150 minutes (two-and-a-half hours) of at least moderate-intensity activity a week  for example, five 30-minute bouts a week. Something is better than nothing, and doing just 10 minutes of exercise at a time is beneficial. Moderate-intensity activity is any activity that increases your heart and breathing rate, such as: brisk walking cycling recreational swimming dancing Alternatively, you could do 75 minutes (one hour, fifteen minutes) of vigorous-intensity activitya week, or a combination of moderate and vigorous activity. During vigorous activity, breathing is very hard, your heart beats rapidly and you may be unable to hold a conversation. Examples include: running most competitive sports circuit training You should also do strength and balance training two days a week. This could be in the form of agym workout, carrying shopping bags, or doing an activity such as tai chi .Its also critical that you break up sitting (sedentary) time by getting up and moving around. Read more about strengthandbalance exercises . Your GP, weight loss adviser or staff atyour local sports centre can help you create a plan suited to your own personal needs and circumstances, with achievable and motivating goals. Start small and build up gradually. Its alsoimportant to find activities you enjoy and want to keep doing. Activities with a social element or exercising with friends or family can help keep you motivated. Make a start today  its never too late. Read more about the physical activity guidelines for adults and the physical activity guidelines for older adults . Other useful strategies Evidence has shown that weight loss can be more successful if it involves other strategies, alongside diet and lifestyle changes. This could include things like: setting realistic weight loss goals  if youre obese, losing just 3% of your original body weight can significantly reduce your risk of developing obesity-related complications eating more slowly and being mindful of what and when youre eating  for example, not being distracted by watching TV avoiding situations where you know you may be tempted to overeat involving your family and friends with your weight loss efforts they can help to motivate you monitoring your progress  for example, weigh yourself regularly and make a note of your weight in a diary Getting psychological support from a trained healthcare professional may alsohelp you change the way you think about food and eating. Techniques such as cognitive behavioural therapy (CBT)can be useful. Avoiding weight regain Its important to remember that as you lose weight your body needs less food (calories), so after a few months, weight loss slows and levels off, even if you continue to follow a diet. If you go back to your previous calorie intake once youve lost weight, its very likely youll put the weight back on. Increasing physical activity to up to 60 minutes a day and continuing to watch what you eat may help you keep the weight off. Medication Manydifferent types of anti-obesity medicines have been tested in clinical trials, but only one has proved to be safe and effective: orlistat. You can only use orlistat if a doctor or pharmacist thinks its the right medicine for you. In most cases, orlistat is only available on prescription. Only one product (Alli) is available over the counter directly from pharmacies, under the supervision of a pharmacist. Orlistat works by preventingaround a third of the fat from the food you eat being absorbed. The undigested fat isnt absorbed into your body and is passed out with your faeces (stools). This will help you avoid gaining weight, but wont necessarily cause you to lose weight. A balanced diet and exercise programme should be started before beginning treatment with orlistat, and you should continue this programme during treatment and after you stoptaking orlistat. When orlistat should be used Orlistat will usually only be recommended if youve made a significant effort to lose weight through diet, exercise or changing your lifestyle. Even then, orlistat is only prescribed if you have a: body mass index (BMI) of 28 or more, and other weight-related conditions,such as high blood pressure or type 2 diabetes BMI of 30 or more Before prescribing orlistat, your doctor will discuss the benefits and potential limitations with you, including any potential side effects (see below). Treatment with orlistat must be combined with a balanced low-fat diet and other weight loss strategies, such as doing more exercise.Its important that the diet is nutritionally balanced over three main meals. If youre prescribed orlistat, youll also be offered advice and support about diet, exercise and making lifestyle changes. Orlistat isnt usually recommended for pregnant or breastfeeding women. Dosage and duration of treatment One orlistat capsule is taken with water immediately before, during or up to one hour after, each main meal (up to a maximum of three capsules a day). If you miss a meal, or the meal doesnt contain any fat, you shouldnt need to take the orlistat capsule. Your doctor should explain this to you, or you can check the patient information leaflet that comes with your medicine. Treatment with orlistat should only continue beyond three months if youve lost 5% of your body weight. It usually starts to affect how you digest fat withinone to twodays. If you havent lost weight after taking orlistat forthree months, its unlikely to be an effective treatment for you. Consult your doctor or pharmacist, as it may be necessary to stop your treatment. Taking orlistat with other health conditions See your GP before starting treatment with orlistat if you have another serious health condition, such as type 2 diabetes, high blood pressure, or kidney disease, which youre taking medication for. It may be necessary to change the dose of your medicine. If you havetype 2 diabetes, it may take you longer to lose weight using orlistat, so your target weight loss after three months may therefore be slightly lower. If orlistat has helped you lose weight after three months, your prescription may be continued for up to a year. After that, your GP will carry out a review and decide whether you should continue taking it. Side effects Common side effects of orlistat include: fatty or oily stools needing the toilet urgently passing stools more frequently an oily discharge from your rectum (you may have oily spots on your underwear) flatulence (wind) stomach pain headaches upper respiratory tract infections, such as a cold These side effects are much less likely to occur if you stick to a low-fat diet. Women takingthe oral contraceptive pill should use an additional method of contraception , such as a condom , if they experience severe diarrhoea while taking orlistat. This is because the contraceptive pill may not be absorbed by your body if you have diarrhoea, so it may not be effective. Surgery Weight loss surgery, also called bariatric surgery, is sometimes used to treat people who are severely obese. Bariatric surgery is usually only available on the NHS to treat people with severe obesity who fulfil all of the following criteria: they have a BMI of 40 or more, or between 35 and 40 and another serious health condition that could be improved with weight loss, such as type 2 diabetesorhigh blood pressure all appropriate non-surgical measures have been tried, but the person hasnt achieved or maintained adequate, clinically beneficial weight loss the person is fit enough to have anaesthesia and surgery the person has been receiving, or will receive, intensive management as part of their treatment the person commits to the need for long-term follow-up Bariatric surgery may also be considered as a possible treatment option for people with a BMI of 30 to 35 who have recently (in the last 10 years) been diagnosed with type 2 diabetes. In rare cases, surgery may be recommended as the first treatment (instead of lifestyle treatments and medication) if a persons BMI is 50 or above. Treating obesity in children Treating obesity in children usually involves improvements to diet and increasing physical activity using behaviour change strategies. The amount of calories your child should eat each day will depend on their age and height. Your GP should be able to advise you about a recommended daily limit, and they may also be able to refer you to your local family healthy lifestyle programme. Children over the age of five should ideally get at least one hour (60 minutes) of vigorous-intensity exercise a day, such as running or playing football or netball. Sedentary activities, such as watching television and playing computer games, should be restricted. Read more about the physical activity guidelines for children and young people Referral to a specialist in treating childhood obesity may be recommended if your child develops an obesity-related complication, or theres thought to be an underlying medical condition causing obesity. The use of orlistat in children is only recommended in exceptional circumstances, such as if a child is severely obese and has an obesity-related complication. Bariatric surgery isnt generally recommended for children, but may be considered for young people in exceptional circumstances, and if theyve achieved, or nearly achieved, physiological maturity. Source: NHS 24 - Opens in new browser window Last updated: 21 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites British Dietetic Association NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Obsessive compulsive disorder (OCD),"Obsessive compulsive disorder (OCD) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Mental health Obsessive compulsive disorder (OCD) Obsessive compulsive disorder (OCD) Obsessive compulsive disorder (OCD) is a mental health condition. It causes a person to have obsessive thoughts and carry out compulsive activity. This can be distressing and can have a big impact on your life. Treatment can help you keep it under control. Symptoms of OCD OCD affects people differently. It usually causes a particular pattern of thought and behaviour. This pattern has 4 main steps: Obsession  where an intrusive, distressing thought, image or urge repeatedly enters your mind. Anxiety  the obsession provokes a feeling of intense anxiety or distress. Compulsion  repetitive behaviours or mental acts that you feel you have to do as a result of the anxiety and distress caused by the obsession. Temporary relief  the compulsive behaviour brings temporary relief, but the obsession and anxiety return, causing the cycle to begin again. Obsessive thoughts Almost everyone has unpleasant or unwanted thoughts at some point in their life. This might be a concern that youve forgotten to lock the door of the house or that you might get a disease from touching other people. It could be sudden unwelcome violent or offensive mental images. Most people are able to put these types of thoughts and concerns into context. They can then carry on with their day-to-day life. They do not repeatedly think about worries they know have little substance. If you have persistent and unwanted thoughts that dominates your thinking, you may have developed an obsession. Some common obsessions that affect people with OCD include: fear of deliberately harming yourself or others  for example, fear you may attack someone else, even though this type of behaviour disgusts you fear of harming yourself or others by mistake or accident  for example, fear you may set the house on fire by accidentally leaving the cooker on fear of contamination by disease, infection or an unpleasant substance a need for symmetry or orderliness  for example, you may feel the need to ensure all the tins in your cupboard face the same way Compulsive behaviour Compulsions happen as a way of trying to reduce or prevent the harm of the obsessive thought. However, this behaviour is either excessive or not connected at all. For example, a person who fears becoming contaminated with dirt and germs may wash their hands repeatedly. Or someone with a fear of causing harm to their family may have the urge to repeat an action multiple times to try to neutralise the thought of harm. This type of compulsive behaviour is particularly common in children with OCD. Most people with OCD realise that such compulsive behaviour is irrational. They might know it makes no logical sense, but they cannot stop acting on their compulsion. Not all compulsive behaviours will be obvious to other people. Related problems Some people with OCD may also have or develop other mental health problems, including: depression eating disorders generalised anxiety disorder a hoarding disorder People with OCD and severe depression might also have suicidal feelings. Causes of OCD The exact cause of OCD is not known. There are some factors that could make a person more likely to have OCD. These factors might include: genetics life events personality traits chemical differences in the brain Diagnosing OCD Diagnosis and treatment can help to reduce the impact of OCD on your day-to-day life. Speak to your GP if: you think you might have OCD Many people do not tell their GP about their symptoms because they feel ashamed or embarrassed. They may also try to disguise their symptoms from family and friends. If you have OCD, you should not feel ashamed or embarrassed. Like diabetes or asthma , its a long-term health condition, and its not your fault you have it. Your GP will probably ask you a series of questions to see if its likely you have OCD. If the results of the initial screening questions suggest you have OCD, the severity of your symptoms will be assessed. Either your GP or a mental health professional will carry out the assessment. Its important youre open and honest. Accurate and truthful responses will ensure you receive the most appropriate treatment. If you think someone you know may have OCD, its a good idea to: talk to them carefully about your concerns suggest they speak to their GP Treating OCD Treatment for obsessive compulsive disorder (OCD) depends on the how much the condition is affecting your daily life. The 2 main treatments are: cognitive behavioural therapy (CBT) medication If your OCD has a severe impact on your daily life, youll usually be referred to a specialist mental health service. Here youll likely receive a combination of intensive CBT and a course of antidepressants called selective serotonin reuptake inhibitors (SSRIs) . Children with OCD are usually referred to a healthcare professional with experience of treating OCD in children. It can take several months before a treatment has a noticeable effect. Further treatment You might be offered specialist treatment if youve tried other treatments and your OCD is still not under control. Most people improve after receiving treatment. OCD Action have online support groups where you can connect with other people with similar experiences. Source: NHS 24 - Opens in new browser window Last updated: 04 April 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Obsessive compulsive disorder (OCD) self-help guide Selective serotonin reuptake inhibitors (SSRIs) Depression Anxiety disorders in children Other health sites OCD-UK Choice and Medication: Obsessive compulsive disorder (OCD) OCD Action NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Obstructive sleep apnoea,"Obstructive sleep apnoea (OSA) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Lungs and airways Obstructive sleep apnoea Obstructive sleep apnoea About obstructive sleep apnoea Diagnosing obstructive sleep apnoea Treating obstructive sleep apnoea About obstructive sleep apnoea Obstructive sleep apnoea (OSA) is a relatively common condition where the walls of the throat relax and narrow during sleep, interrupting normal breathing. Thismay lead to regularlyinterrupted sleep, which can have a big impact on quality of life and increases the risk of developing certain conditions. Apnoea and hypopnoea There are two types of breathing interruption characteristic of OSA: apnoea  where the muscles and soft tissues in the throat relax and collapse sufficiently to cause a total blockage of the airway; its called an apnoea when the airflow is blocked for 10 seconds or more hypopnoea a partial blockage of the airway that results in an airflow reduction of greater than 50% for 10 seconds or more People with OSA may experience repeated episodes of apnoea and hypopnoea throughout the night.These events may occur around once every one or twominutes in severe cases. Asmany people with OSA experience episodes of both apnoea and hypopnoea, doctors sometimes refer to the condition as obstructive sleep apnoea-hypopnoea syndrome, or OSAHS. The term obstructive distinguishes OSA from rarer forms of sleep apnoea, such as central sleep apnoea, which is caused by the brain not sendingsignals to the breathing muscles during sleep. Symptoms of OSA The symptoms of OSA are often first spotted by a partner, friend or family member who notices problems while you sleep. Signs of OSA in someone sleeping can include: loudsnoring noisy and laboured breathing repeated short periodswhere breathing is interrupted by gasping or snorting Some people with OSA may also experiencenight sweats and may wake up frequently during the night to urinate. During an episode, the lack of oxygentriggers your brain to pull you out of deep sleep either to a lighter sleep or to wakefulnessso your airway reopens and you can breathe normally. These repeated sleep interruptions can make youfeel very tired during the day. Youll usually have no memory of your interrupted breathing, so youmay be unaware you have a problem. When to seek medical advice See your GP if you think you might have OSA. Theycan check for other possible reasons for your symptoms and can arrange for an assessment of your sleep to be carried out through a local sleep centre. As someone with OSA may not notice they have the condition, it often goes undiagnosed. Read more about diagnosing OSA . Causes of OSA Its normal for the muscles and soft tissues in the throat to relax and collapse to some degree while sleeping. For most people this doesnt cause breathing problems. In people with OSA the airway has narrowed as the result of a number of factors, including: being overweight excessive body fat increases the bulk of soft tissue in the neck, which can place a strain on the throat muscles; excess stomach fat can also lead to breathing difficulties, which can make OSA worse being male its not known why OSA is more common in men than in women, but it may be related to different patterns of body fat distribution being 40 years of age or more  although OSA can occur at any age, its more common in people who are over 40 having a large neck men with a collar size greater than around 43cm (17 inches) have an increased risk of developing OSA taking medicineswith a sedative effect such as sleeping tablets or tranquillisers having an unusual inner neck structure  such as a narrow airway, large tonsils, adenoidsor tongue, or a small lower jaw alcohol drinking alcohol, particularly before goingto sleep,can make snoring and sleep apnoea worse smoking youre more likely to develop sleep apnoea if you smoke the menopause (in women) the changes in hormone levels during the menopause may cause the throat muscles to relax more than usual having a family history of OSA there may be genes inherited from your parents that can make you more susceptible to OSA nasal congestion OSA occurs more often in people with nasal congestion, such as a deviated septum, where the tissue in the nose that divides the two nostrils is bent to one side, or nasal polyps, which may bea result of the airways being narrowed Treating OSA OSA is a treatable condition, and thereare a variety of treatment options that canreduce the symptoms. Treatment optionsfor OSA include: lifestyle changes such aslosing excess weight, cutting down on alcohol and sleeping on your side usingacontinuouspositive airway pressure (CPAP) device  these devicesprevent your airway closing while you sleep by delivering a continuous supply of compressed air through a mask wearing amandibular advancement device (MAD) this gum shield-like device fits around your teeth, holdingyour jaw and tongue forward to increase the space at the back of your throat while you sleep Surgery may also be an option if OSA is thought to be the result of a physical problem that can be corrected surgically, such as an unusual inner neck structure. However, for most people surgery isnt appropriate and may only be considered as a last resort if other treatments havent helped. Read more about treating OSA . Complications of OSA The treatments mentioned above can often help control the symptoms of OSA, although treatment will need to be lifelong in most cases. If OSA is left untreated, it can have a significant impact on your quality of life, causing problems such aspoor performance at work and school, and placing a strain on your relationships with others. Poorly controlled OSAmay alsoincrease your risk of: developing high blood pressure (hypertension) having a stroke or heart attack developing an irregular heartbeat such as atrial fibrillation developing type 2 diabetes  although its unclear if this is the result of an underlying cause, such as obesity Research hasshown someone who has been deprived of sleep because of OSA may be up to 12 times more likely to be involved in a car accident. If youre diagnosed with OSA, itmay mean your ability to drive is affected. Its your legal obligation to inform the Driver and Vehicle Licensing Agency (DVLA) about a medical condition that could have an impact on your driving ability. Once a diagnosis of OSA has been made, you shouldnt drive untilyour symptoms are well controlled. The GOV.UK website has advice about how to tell the DVLA about a medical condition . Preventing OSA Its not always possible to prevent OSA, but making certain lifestyle changesmay reduce your risk of developing the condition. These include: losing weight if youre overweight or obese limitinghow much alcohol you drink and avoiding alcoholin the evening stopping smoking if you smoke avoiding the use of sleeping tablets and tranquillisers Diagnosing obstructive sleep apnoea Obstructive sleep apnoea (OSA) can usually be diagnosed after youve been observed sleeping at a sleep clinic, or by using a testing device worn overnight at home. If you think you have OSA, its important to visit your GP in case you need to be referred to a sleep specialist for further tests and treatment. Before seeing your GP it may be helpful toask a partner, friend or relative to observe you while youre asleep, if possible. If you have OSA, they may be able to spot episodes of breathlessness. It may also help to fill out an Epworth Sleepiness Scale questionnaire. Thisaskshow likely youll be todoze off in a number of different situations, such as watching TV orsitting in a meeting. The final score will help your doctordetermine whether you may have a sleep disorder. For example,a score of 16-24 means youre excessively sleepy and should consider seeking medical attention. A score of eight to nine is considered average during the daytime. An online version of the Epworth Sleepiness Scale can be found on the British Lung Foundation website. Seeing your GP When you see your GP, theyll usuallyask a number of questions about your symptoms, such as whether you regularly fall asleep during the day against your will. Your blood pressure will be measured and a blood sample probably sent off to help rule out other conditions that could explain your tiredness, such asan underactive thyroid gland ( hypothyroidism ). The next step is to observe you while youre asleep at a local sleep centre. Your GP can refer you to specialist clinics or hospital departments that help treat people with sleep disorders. The Sleep Apnoea Trust Association has a list of NHS sleep clinics in Scotland . Observing your sleep The sleep specialists at the sleep centre may ask you about your symptoms and medical history, and carry out a physical examination. This may include measuring your height and weight to work out your body mass index (BMI) , as well as measuringyour neck circumference. This is because being overweight and having a large neck can increase your risk of OSA. The sleep specialists will then arrange foryour sleep tobe assessed overnight, either by spending the night at the clinic or taking some monitoring equipment home with you and bringing it back the next day for them to analyse. Testing at home In many cases the sleep centre will teach you how to use portable recording equipment while you sleep at home. The equipment you are given may include: a breathing sensor sensors to monitor your heart rate bands that are placed around your chest oxygen sensors that are puton your finger The equipment records oxygenlevels, breathing movements, heart rate and snoring through the night. If more information about sleep quality is required, a more detailed investigation calledpolysomnographywill be required, which will be carried out at the sleep centre. Testing at a sleep centre The main test carried out to analyse your sleep at a sleep centre is known aspolysomnography. During the night, several different parts of your body will be carefully monitored while you sleep. Bands and small metallic discs called electrodesare placed on the surface of your skin anddifferent parts of your body. Sensors are also placed on your legs and an oxygen sensor will be attached to your finger. A number of different tests will be carried out during polysomnography, including: electroencephalography (EEG) this monitors brain waves electromyography (EMG)  this monitors muscle tone recordings of movements in your chest and abdomen recordings of airflow through your mouth and nose pulse oximetry  this measures your heart rate and blood oxygen levels electrocardiography (ECG)  this monitors your heart Sound recording and video equipment may also be used. If OSA is diagnosed during the early part of the night, you may be given continuous positive airway pressure (CPAP) treatment. CPAP involves using a mask that delivers constant compressed air to the airway and stops it closing, which prevents OSA. Read about treating OSA for more information about CPAP. Once the tests have been completed, staff at the sleep centre should have a good idea about whether or not you have OSA. If you do, they can determine how much it is interrupting your sleep and recommend appropriate treatment. Determining the severity of OSA The severity of OSA is determined by howoften your breathing is affected over the course of an hour. These episodes are measured using the apnoea-hypopnoea index (AHI). Severity is measured using the following criteria: mild an AHI reading of 5 to 14 episodes an hour moderate an AHI reading of 15 to 30 episodes an hour severe an AHI reading of more than 30 episodes an hour Current evidence suggests treatment is most likely to be beneficial in people with moderate or severe OSA. However, some research has suggested treatment may also help some people with mild OSA. Treating obstructive sleep apnoea Treatment for obstructive sleep apnoea (OSA) may include making lifestyle changes and using breathing apparatus while you sleep. OSA is a long-term condition and many cases require lifelong treatment. Lifestyle changes Inmost cases ofOSA youll be advised to make healthy lifestyle changes,suchas: losing weight if youre overweight or obese stopping smoking if you smoke limiting your alcohol consumption, particularly before going to bed the NHS recommends not regularly drinking more than 14 units of alcohol a week; if you drink as much as 14 units a week, its best to spread this evenly over three or more days avoidingsedative medications and sleeping tablets Losing weight, reducing the amount of alcohol you drink and avoiding sedativeshave allbeen shown tohelp improve the symptoms of OSA. Although itsless clear whether stopping smoking can improve the condition,youll probablybe advised to stop for general health reasons. Sleeping on your side, rather than on your back, may also help relieve the symptoms of OSA. Continuous positive airway pressure (CPAP) As well asthe lifestyle changes mentioned above, people with moderate to severe OSAusuallyneed touse a continuous positive airway pressure (CPAP) device. This is a small pumpthatdelivers a continuous supply of compressed air through a mask thateither covers your nose or your nose and mouth. The compressed air prevents your throat closing. CPAP can feel peculiar to start with andyou may be tempted to stop using it.But people who persevereusually soonget used toit and their symptoms improve significantly. CPAP is available on the NHS and is the most effective therapy for treating severe cases of OSA. As well as reducing symptoms such as snoring and tiredness, it can also reduce the risk ofcomplications of OSA, such as high blood pressure . Possible side effects of using a CPAP device can include: mask discomfort nasal congestion, runny nose or irritation difficulty breathing through your nose headaches and ear pain stomach pain and flatulence (wind) Earlier versions of CPAP also often caused problems such as nasal dryness and a sore throat. However, modern versions tend to include humidifiers, a device that increases moisture, which helps reduce these side effects. If CPAP causes you discomfort, inform your treatment staffas the device can be modified to make it more comfortable. For example, you can try using a CPAP machine that starts with a low air pressure and gradually builds up to a higher air pressure as you fall asleep. Mandibular advancement device (MAD) A mandibular advancement device (MAD) is a dental appliance, similar to a gum shield, sometimes used to treat mild OSA. Theyre not generally recommended for more severe OSA, although they may be an option if youre unable to tolerate using a CPAP device. An MAD is worn over your teeth when youre asleep. Its designed to hold your jaw and tongue forward to increase the space at the back of your throat and reduce the narrowing of your airway that causes snoring. Off-the-shelf MADs are available from specialist websites, but most experts dont recommend them, as poor-fitting MADs can make symptoms worse. Its recommended you have an MAD made for you by a dentist with training and experience in treating sleep apnoea. MADs arent always available on the NHS, so you may need to pay for the device privately through a dentist or orthodontist. An MAD may not be suitable treatment for you if you dont have many or anyteeth. If you have dental caps, crowns or bridgework, consult your dentist to ensure they wont be stressed or damaged by an MAD. Surgery for OSA Surgery to treat OSA isnt routinely recommended because evidence shows its not as effective as CPAP at controlling the symptoms of the condition. It also carriesthe risk of more serious complications. Surgery is usually only considered as a last resort when all other treatment options have failed, and also if the conditionis severely affecting your quality of life. Arange of surgical treatmentshave been used to treat OSA. These include: tonsillectomy  where the tonsils are removed if theyre enlarged and blocking your airway when you sleep adenoidectomy where the adenoids, small lumps of tissueat the back of the throat above the tonsils, are removed if theyre enlarged and are blocking the airway during sleep tracheostomy where a tube is inserted directly into your neck to allow you to breathe freely, even if the airways in your upper throat are blocked weight loss (bariatric) surgery where the size of the stomach is reduced if youre severely obese andthis is making your sleep apnoeaworse Surgery toremove excess tissue in the throat to widen your airway (uvulopalatopharyngoplasty) used to be a common surgical treatment for OSA, but its performed less often nowadays. This isbecause more effective treatments are available, such as CPAP. This type of surgery can mean youre unable to use a CPAP device properly in the future if you need to. Soft palate implants Soft palate implants make the soft palate, part of the roof of the mouth, stiffer and less likely to vibrate and cause an obstruction. The implants are inserted into the soft palate under local anaesthetic . The National Institutefor Health and Care Excellence (NICE) has said soft palate implants are safe, but theyre not currently recommended for treating OSAas theres a lack of evidence about their effectiveness. However, this form of treatment is recommended for treating snoring associated with OSA in exceptional cases. Support groups OSA can have a significant impact on the quality of life for someone with the condition, as well as their friends and families. As well as causing physical problems such as tiredness and headaches, the condition can have a significant emotional impact and affect your relationships with others. For support and advice about living with OSA, you may find it helpful to contact a support group, such as: British Lung Foundation Sleep Apnoea Trust Source: NHS 24 - Opens in new browser window Last updated: 17 January 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites British Lung Foundation: Obstructive sleep apnoea NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Oesophageal cancer,"Oesophageal cancer - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Oesophageal cancer Oesophageal cancer About oesophageal cancer Symptoms of oesophageal cancer Causes of oesophageal cancer Diagnosing oesophageal cancer Treating oesophageal cancer Living with oesophageal cancer About oesophageal cancer Oesophageal cancer is a type of cancer affecting the oesophagus (gullet)  the long tube that carries food from the throat to the stomach. It mainly affects people in their 60s and 70s and is more common in men than women. Symptoms of oesophageal cancer Oesophageal cancer doesnt usually cause any symptoms in the early stages when the tumour is small. Its only when it gets bigger that symptoms tend to develop. Symptoms of oesophageal cancer can include: difficulty swallowing persistent indigestion orheartburn bringing up food soon after eating loss of appetite andweight loss pain or discomfort inyour upper tummy, chest or back Read more about the symptoms of oesophageal cancer When to get medical advice Speak to your GP if you experience: swallowing difficulties heartburn on most days for three weeks or more any other unusual or persistent symptoms The symptoms can be caused byseveral conditions and in many cases wont be caused by cancer but its a good idea to get them checked out. If your GP thinks you need to have some tests, they can refer you to a hospital specialist. Read about how oesophageal cancer is diagnosed Causes of oesophageal cancer The exact cause of oesophageal cancer is unknown, but the following things can increase your risk: persistent gastro-oesophageal reflux disease (GORD) smoking drinking too much alcohol over a long period of time being overweight or obese having an unhealthy diet thats low in fruit and vegetables Stopping smoking, cutting down on alcohol, losing weight and having a healthy diet may help reduce your risk of developing oesophageal cancer. Read more about the causes of oesophageal cancer Treatments for oesophageal cancer If oesophageal cancer is diagnosed at an early stage, it may be possible to cure it with: surgery to remove the affected section of oesophagus chemotherapy , with or without radiotherapy (chemoradiation), to kill the cancerous cells and shrink the tumour If oesophageal cancer is diagnosed at a later stage, acure may not be achievable. But in these cases, surgery, chemotherapy and radiotherapy can be used to help keep the cancer under control and relieve any symptoms you have. Read more about how oesophageal cancer is treated and living with oesophageal cancer Symptoms of oesophageal cancer Oesophageal cancer doesnt usually have any symptoms at first. But as the cancer grows, it can cause swallowing problems and other symptoms. Difficulty swallowing Difficulty swallowing is the most common symptom of oesophageal cancer. The cancer can narrow the oesophagus, making it difficult for food to pass down. It may feel as though food is getting stuck and sometimes swallowing may be uncomfortable or painful. You may have to chew your food more thoroughly, or you can only eat soft foods. If the tumour continues to grow, even liquids may become difficult to swallow. Other symptoms Other symptoms of oesophageal cancer can include: persistent indigestion or heartburn bringing up food soon after eating loss of appetite and weight loss persistentvomiting pain or discomfort inyour upper tummy, chest or back a persistent cough hoarseness tiredness, shortness of breath and pale skin vomiting bloodorcoughing up blood although this is uncommon When to get medical advice Speak to your GP if you experience: swallowing difficulties heartburn on most days for three weeks or more any other unusual or persistent symptoms The symptoms can be caused byseveral conditions and in many cases wont be caused by cancer but its a good idea to get them checked out. Read about how oesophageal cancer is diagnosed Causes of oesophageal cancer The exact cause of oesophageal cancer is unknown, but certain things can increase the risk of it developing. GORD and Barretts oesophagus Gastro-oesophageal reflux disease (GORD) is a condition in which a weakness in the muscles above the stomach means stomach acid can travel up into the oesophagus. In around 1 in 10 people with GORD,repeated damage from stomach acid over many years can eventually cause changes in the cells lining the oesophagus. This is called Barretts oesophagus. These abnormal cells are at an increased risk of becoming cancerous in the future, although the risk is still small.Its estimated that 1 in every 10to 20 people with Barretts oesophagus will develop cancer within 10 to 20 years. Alcohol Drinking too much alcoholcauses irritation and inflammation in the lining of the oesophagus. If the cells in the lining of your gullet become inflamed,theyre more likely to become cancerous. Read more about alcohol and drinking , including tips on cutting down Smoking Tobacco smoke contains many harmful toxins and chemicals. These substances irritate the cells that make up the lining of the oesophagus, which increases the likelihood that they will become cancerous. The longer you smoke, the greater your risk of developing oesophageal cancer. Read more about getting help to stop smoking Obesity If youre overweight or obese , your risk of developing cancer of the oesophagus is higher thanpeopleof a healthy weight.The more overweight you are, the higher the risk. This may be partly because obese people are more at risk of developing GORD and Barretts oesophagus (see above). Read more information and advice about losing weight Diet Not eating enough fruit and vegetables may increase your risk of getting oesophageal cancer. You should aim to eat at least 5 portions of fresh fruit and vegetables every day. Read more about havinga healthy diet Other medical conditions Certain rare medical conditions can also increase your chances of developing cancer of the oesophagus, including: achalasia wheretheoesophagus loses the ability to move food along, causing vomiting and acid reflux Paterson-Brown Kelly syndrome (also called Plummer Vinson syndrome) a condition that can cause iron deficiency anaemia and small growths in the throat tylosis  an inherited skin condition Diagnosing oesophageal cancer Speak to your GP if you experience symptoms of oesophageal cancer . They will carry out an initial assessment and decide whether you need to have any further tests. Seeing your GP Your GP may: ask about the symptoms youre experiencing carry out a physical examination take a look at your medical history Ifyour GPthinks you need to have some tests, they can refer you to a hospital specialist. This will usually be a gastroenterologist (specialist in conditions affecting the digestive system). Tests to diagnose oesophageal cancer The 2 main tests used todiagnose oesophageal cancer are: anendoscopy this is the most common test a barium swallow or barium meal Endoscopy An endoscopy is a procedure that allows your doctor to see inside your oesophagus so they can check forcancer. Athin, flexibletube with alight and camera at the end(an endoscope) is passed into your mouth and down towards your stomach. Small samples of tissue are also removed fromyour oesophagus so they can be checked for cancer under a microscope. This is called a biopsy . Youll be awake whilean endoscopy is carried out. It shouldnt be painful, but may be a bit uncomfortable. Youll normally be given local anaesthetic to numb your throatand possibly asedative to help you relax. Barium swallowor barium meal A barium swallow or barium meal involves drinking a harmless white liquid called barium before several X-rays are taken. The barium coats the lining of your oesophagus so it shows up on the X-ray. This can show whether theres anything blockingyour oesophagus, which may be a sign of cancer. This test isnt used to diagnose oesophageal cancer very often nowadays because the best way to confirm a diagnosis is to use tissue samples taken during an endoscopy. Further tests Ifyou have oesophageal cancer, further tests willberecommended to determine how far the cancer has spread known as called the stage. These tests may include: a computerised tomography (CT) scan  where a series of X-rays are taken and put together by a computer to create a detailed picture of the inside of your body an endoscopic ultrasound scan  where a small probethat produces sound waves is passed down your throat to create an image of your oesophagus and the surrounding area a positron emission tomography (PET) scan  a scan that can help show how far the cancer has spread alaparoscopy a type of keyhole surgery performed under general anaesthetic (where youre asleep), in which a thin tube with a camera at the end is inserted through a cut in your skin to examine the area around your oesophagus Stages of oesophageal cancer The most widely used system for staging oesophageal cancer is the TNM system. This involves scoring the cancer in 3 categories: T (tumour)  the location and size of the tumour N (node)  whether the cancer has spread to the lymph nodes (a network of glands throughout the body) M (metastasis)  whether the cancer has spread to other parts of the body, such as the lungs, liver or bones Scores for eachcategory are then often used in a simpler number system, ranging from stage 1 (early cancer) to stage 4 (advanced cancer). Knowing the stage of your cancer will help yourcare teamwork out the best treatment for you. Read more about treatments for oesophageal cancer Read further information: Cancer Research UK: diagnosing oesophageal cancer Cancer Research UK: stages and grades of oesophageal cancer Macmillan: how oesophageal cancer is diagnosed Macmillan: staging oesophageal cancer Treating oesophageal cancer The main treatments for oesophageal cancer are surgery, chemotherapy and radiotherapy. Your treatment plan Youll be cared for by a group of different healthcare professionals and your team will recommend a treatment plan they feel is most suitable for you,although final treatment decisions will be yours. Your plan will largely depend on how far your cancer has spread known as the stage. stage 1 to 3 oesophageal cancer is usually treatedwith surgery to remove the affected section of oesophagus(oesophagectomy)  chemotherapy and sometimes radiotherapy may be given before surgery to make it more effective or is sometimes used instead of surgery stage 4 oesophageal cancer has usually spread too far for a cure to be possible, but chemotherapy, radiotherapy and other treatments can slow the spread of the cancer and relieve symptoms Surgery There are 3 main types of surgery for oesophageal cancer. Oesophagectomy An oesophagectomy is themain treatment for early-stage oesophageal cancer. During the procedure, your surgeon will remove the section of your oesophagus that contains the tumour and, if necessary, the nearby lymph nodes.A small portion of your stomach may also need to be removed. The remaining section of your oesophagusis thenreconnected to your stomach. To access your oesophagus, your surgeon will either make incisions (cuts) in yourtummy and chest, or in yourtummy and neck. Endoscopic mucosal resection (EMR) A procedure called endoscopic mucosal resection (EMR)may sometimes be an option instead ofan oesophagectomy if oesophageal cancer is diagnosed very early on. It involvescutting outthe tumour using a loop of wire at the end of a thin flexible tube (endoscope). The endoscope is passed down your throat so no incisions are made in your skin. Sometimes radiowaves may also be used to destroy the cancerous tissue (called radiofrequency ablation or RFA). Stents For more advanced cases of oesophageal cancer that are causing swallowing difficulties,a procedure to insert a hollow tube called a stent into the oesophagus may be recommended. The stent expands once in place and holds the oesophagus open. Chemotherapy Chemotherapy involves taking medicines that kill the cancer cells or stop them multiplying. It may be used: before and sometimes after surgery, eitherwith or without radiotherapy to shrink the cancer and reduce therisk of it coming back instead of surgery incombination with radiotherapy (called chemoradiation) to relieve your symptoms ifcurative treatmentisnt possible The medicines can begiven into a veinor taken as tablets. Youll usually have the treatmentevery 3 weeksover aperiod of6to 18 weeks. Side effects Common side effects of chemotherapy include: feeling sick loss of appetite losing weight diarrhoea feeling very tired increased risk ofinfections bleeding and bruising easily These side effects should improve gradually after treatment stops. Read more about the side effects of chemotherapy Radiotherapy Radiotherapy involves usingradiation to kill cancer cells and shrink tumours. It may be used: in combination with chemotherapy before surgery to shrink the cancer and reduce therisk of it coming back instead of surgery usually in combination with chemotherapy (called chemoradiation) to relieveyour symptoms if curative treatment isnt possible Radiotherapy is most often given using an external machine that directs beams of radiation at your oesophagus, or sometimes by temporarily placing a small piece of radioactive material in your oesophagus (brachytherapy). Side effects Common side effects of radiotherapy include: tiredness temporary soreness when swallowing temporary worsening of swallowing difficulties a dry throat feeling or being sick reddening of the skin and loss of body hair in the treatment area These side effects should improve gradually after treatment stops. Read more about the side effects of radiotherapy Read further information: Cancer Research UK: treatments for oesophageal cancer Macmillan: treatments for oesophageal cancer Living with oesophageal cancer Having oesophageal cancer can have a big impact on your life, but support is available to help you cope. Eating and swallowing You may haveswallowing difficultiesduring and after treatment for oesophageal cancer. There are treatments that can help  including surgery to place a hollow tube (stent) in your oesophagus,or a combination of chemotherapy and radiotherapy  although they may not work immediately. You might need to have a temporary feeding tube placed or fluids given through a drip inserted in a vein to begin with, before moving onto fluids by mouth and soft foods. You may eventually be able to eat solid food. Aspeech and language therapist can assess yourability to swallow andsuggest ways to overcome any problems.A dietitian can also help with any changes you need to maketo your diet. Read further information: Cancer Research UK: eating and oesophageal cancer Macmillan: swallowing problems Support and advice Coping with a diagnosis of cancer can be very difficult.You may find ithelpful to: talk to your friends and family be open about how you feel and what your family and friends can do to help may put you and them at ease communicate with others in the same situation you may want to contact a local support group or join a forum such as the HealthUnlocked forum for oesophageal patients or Cancer Chat find out more about your condition check websites such as Cancer Research UK or Macmillan , or speak to yourcare team or GP if you have any questions about your condition take time out for yourself dont feel shy about telling friends and family if you want sometime to yourself Read further information: Cancer Research UK: coping with oesophageal cancer Macmillan: coping with oesophageal cancer Work Having oesophageal cancer doesnt necessarily mean youll have to give up work, althoughyou may need quite a lot of time off. During treatment, you may not be able to carry on as you did before. If you have cancer, youre covered by the Disability Discrimination Act . This means that your employer isnt allowed to discriminate against you because of your illness. They have a duty to make reasonable adjustments to help you cope, such as: allowing you time off for treatment and medical appointments allowing flexibility with working hours, the tasks you have to perform, or your working environment You should give your employer as much information as possible about how much time youll need off and when. Speak toa member of your human resources department, if you have one. If youre having difficulties with your employer youmay be able to get help fromyour union,association representative or local Citizens Advice Bureau . Read further information: Macmillan: work and cancer Money and benefits If you have to reduce or stop work because of your cancer, you may find it difficult to cope financially.You may be entitled to financial support: if you have a job but cant work because of your illness, youre entitled to Statutory Sick Pay from your employer if you dont have a job and cant work because of your illness, you may be entitled to Employment and Support Allowance if youre caring for someone with cancer, you may be entitled to Carers Allowance you may be eligible for other benefits if you have children living at home or you have a low household income Its a good idea to find out what help is available as soon as possible. You could ask to speak to the social worker at your hospital, who can give you the information you need. Read further information: GOV.UK: benefits information Macmillan: benefits and financial support Palliative care If youre told there is nothing more that can be done to treat your oesophageal cancer or you decide to decline treatment, your GP or care team will provide you with support and pain relief. This is called palliative care. You can choose to receive palliative care: at home in a care home in hospital in a hospice Your doctor or care teamshould work with you to establish a clear plan based on your wishes. Read further information: End of life care Cancer Research UK: coping with advanced cancer Caring for someone with cancer Being a carer isnt easy. It can beemotionally andphysically draining, and make it easy for you to forget your own health and mental wellbeing. But putting yourself last doesnt work in the long-term. If youre caring for someone else, its important to look after yourself and get as much help as possible. Its in your best interests, as well as those of the person you are caring for. Read more about getting care and support on the Care Information Scotland website. Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Dysphagia (swallowing problems) Other health sites Cancer Research UK: Oesophageal cancer Macmillan Cancer Support: Oesophageal cancer Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Oral thrush in adults,"Oral thrush in adults | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Oral thrush in adults Oral thrush in adults Oral thrush is a fungal infection of the mouth. Its not contagious and is usually successfully treated with antifungal medication. Its also called oral candidosis (or candiasis) because its caused by a group of yeasts called Candida. Contact your GP practice if: You develop symptoms of oral thrush, which can include: white patches (plaques) in the mouth that can often be wiped off, leaving behind redareas that may bleed slightly loss of taste or an unpleasant taste in the mouth redness inside the mouth and throat cracks at the corners of the mouth a painful, burning sensation in the mouth In some cases, the symptoms of oral thrush can make eating and drinking difficult. If left untreated, the symptoms will often persist and your mouth will continue to feel uncomfortable. In severe cases that are left untreated, there is also a risk of the infection spreading further into your body, which can be serious. Your GP will usuallybe able to diagnose oral thrush simply by examining your mouth. Sometimes they may also recommend blood tests to look for certain conditions associated with oral thrush, such as diabetes and nutritional deficiencies. What causes oral thrush? Low numbers of the fungus Candida are naturally found in the mouth and digestive system of most people. They dont usually cause any problems, but can lead to oral thrush if they multiply. There are a number of reasons why this may happen, including: taking a course of antibiotics , particularly over a long period or at a high dose taking inhaled corticosteroid medication for asthma wearing dentures (false teeth), particularly if they dont fit properly having poororal hygiene having a dry mouth, either because of a medicalcondition or a medication you are taking smoking having chemotherapy or radiotherapy to treat cancer Babies, young children and elderly people are at a particularly high risk of developing oral thrush, as are people with certain underlying conditions, including diabetes, an iron deficiency or vitamin B12 deficiency , an underactive thyroid (hypothyroidism) and HIV . As most people already have Candida fungi living in their mouth, oral thrush is not contagious. This means it cannot be passed to others. Treating oral thrush Oral thrush can usually be successfully treated with antifungal medicines. These usually come in the form of gels or liquid that you apply directly inside your mouth (topical medication), although tablets or capsules are sometimes used. Topical medication will usually need to be used several times a day for around7 to 14 days. Tablet or capsules are usually taken once daily. These medications dont oftenhave side effects, although some can causenausea (feeling sick), vomiting, bloating, abdominal (tummy) pain and diarrhoea . If antibiotics or corticosteroids are thought to be causing your oral thrush, the medicine or the way it is delivered may need to be changed or the dosage reduced. Preventing oral thrush There are a number of things you can do to reduce your chances of developing oral thrush. Do rinse your mouth after meals brush your teeth twice a day with a toothpaste that contains fluoride floss regularly visit your dentist regularly for check-ups, even if you wear dentures or have no natural teeth remove your dentures every night and clean them with paste or soap and water before soaking them in a solution of water and denture-cleaning tablets brush your gums, tongue and inside your mouth with a soft brush twice a day if you wear dentures or have no or few natural teeth visit your dentist if your dentures do not fit properly stop smoking if you smoke rinse your mouth with water and spit it out after using a corticosteroid inhaler, and use a spacer (a plastic cylinder that attaches to the inhaler) when you take your medicine ensure that any underlying condition you have, such as diabetes, is well controlled If you have a condition or are receiving treatment that could put you at a high risk of developing oral thrush, your doctormay recommend taking a course of antifungal medication to prevent this happening. Read more about taking care of your oral health Source: NHS 24 - Opens in new browser window Last updated: 15 June 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Antibiotics Corticosteroids Taking care of your oral health Other health sites Diabetes UK Oral Health Foundation: Thrush Oral Health Foundation: Dentures NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Osteoporosis,"Osteoporosis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Muscle, bone and joints Conditions Osteoporosis Osteoporosis About osteoporosis Causes of osteoporosis Treating osteoporosis Preventing osteoporosis Living with osteoporosis About osteoporosis Osteoporosis is a condition that weakens bones, making them fragile and more likely to break. It develops slowly over several years and is often only diagnosed when a minor fall or sudden impact causes a bone fracture. The most common injuriesin people with osteoporosis are: wrist fractures hip fractures fractures of the spinal bones (vertebrae) However, they can also occur in other bones, such as inthe arm or pelvis.Sometimes a cough or sneeze can cause a rib fracture or the partial collapse of one of the bones of the spine. Osteoporosisisnt usually painful until a fracture occurs,but spinal fracturesare a common cause oflong-term (chronic) pain. Although a fracture is the first sign of osteoporosis,some older people developthe characteristic stooped (bent forward) posture. It happens when the bones in the spinehave fractured, making it difficult to support the weight of the body. Whos affected? Osteoporosis affects over three million people in the UK. More than500,000 people receive hospital treatment for fragility fractures (fractures that occur from standing height or less) every year as a result of osteoporosis. Causes of osteoporosis Losing bone is a normal part of the ageing process, but some people lose bone density much faster than normal. This can lead to osteoporosis and an increased risk of fractures. Women also lose bone rapidly in the first few years after the menopause (whenmonthlyperiodsstop and the ovaries stop producing an egg). Women are more at risk of osteoporosis than men, particularly if the menopause begins early (before the age of 45). Many other factors can also increase the risk of developing osteoporosis, including: long-term use of high-doseoral corticosteroids other medicalconditions such as inflammatory conditions, hormone-related conditions, or malabsorption problems a family history of osteoporosisparticularly history of a hip fracture in a parent long-term use of certain medications which can affect bone strength or hormone levels having a low body mass index (BMI) heavy drinking and smoking Read more about the causes of osteoporosis . Diagnosing osteoporosis Risk assessment tools If your doctor suspects you have osteoporosis, they can make an assessment using anonline programme, such as FRAX or Q-Fracture. These tools help to predicta persons risk of fracture between the ages of40 and 90.The algorithmsused give a 10-year probability of hip fracture and a 10-year probability of amajor fracture in the spine, hip, shoulder or forearm. DEXA scan They may also refer youfor a DEXA (DXA) scanto measure your bone mineral density. Its a short, painless procedure that takesaboutfive minutes, depending on the part of the body being scanned. Your bone mineral densitycan becomparedto the bone mineral density of a healthy young adult and someone whos the same age and sex as you.The difference iscalculated as a standard deviation (SD) and is calleda T score. Standard deviation is a measure of variability based on an average or expected value. A T score of: above -1 SDisnormal between -1 and -2.5 SDis defined as decreased bone mineral density compared withpeak bone mass below -2.5 isdefined as osteoporosis Osteopenia You may be diagnosed with osteopenia if bone density tests show you have decreasedbone density, but not enough to be classed as osteoporosis. Your doctor may still recommend some of the treatments described below,depending on your results and your risk of fracture. Treating osteoporosis Treatment for osteoporosis is based on treating and preventing fractures, and using medication to strengthen bones. The decision about whether you needtreatment depends on your risk of fracture. This will bebased on a number of factorssuch as your age, sexand the results of your DEXA scan. If you need treatment, your doctor can suggest the safest and most effective treatment plan for you. Read moreabout how osteoporosis is treated . Preventing osteoporosis If youre at risk of developing osteoporosis, you shouldtake steps to help keep your bones healthy. This may include: taking regular exercise healthy eating  includingfoods rich in calcium and vitaminD making lifestyle changessuch as giving up smoking and reducing your alcohol consumption Read more about preventing osteoporosis . Living with osteoporosis If youre diagnosed with osteoporosis, there are steps you can taketo reduce your chances of a fall, such asremoving hazards from your home and having regular sight tests and hearing tests. To help you recover from a fracture, you can try using: hot and coldtreatmentssuch as warm baths and cold packs transcutaneous electrical nerve stimulation (TENS)where a small battery-operated device is used to stimulate the nerves and reduce pain relaxation techniques Speak to your GP or nurse if youre worried about living with a long-term condition. They may be able to answer any questions you have. You may also find it helpful to talk to a trained counsellor or psychologist, or other peoplewith the condition. The Royal Osteoporosis Society can put you in touch with local support groups . Read more about living with osteoporosis . Causes of osteoporosis Osteoporosis causes bones to become less dense and more fragile. Some people are more at risk than others. Bones are at their thickest and strongest in your early adult life and their density increases until your late 20s. You gradually start losing bone densityfrom around the age of35. This happensto everyone, but some peopledevelop osteoporosis and lose bone density much faster than normal. This means theyre at greater risk of a fracture. Risk groups Osteoporosis can affect men and women.Its more common in older people, but it can also affect younger people. Women Women are more at risk of developing osteoporosis than men becausethe hormone changes that occur in the menopause directly affect bone density. The female hormone oestrogen is essential for healthy bones. After the menopause (when monthlyperiods stop), oestrogen levels fall. This canlead to a rapid decrease in bone density. Women are at even greater risk of developing osteoporosis if they have: anearly menopause (before the age of 45) ahysterectomy (removal of the womb) before the age of 45, particularly when the ovaries are also removed absent periodsfor more than six months as a result of overexercising or too much dieting Men In most cases, the cause ofosteoporosis in men is unknown. However, theres a link to the male hormone testosterone, which helps keep the bones healthy. Men continue producingtestosterone into old age, but the risk of osteoporosis is increased inmen with low levels of testosterone. In around half of men, the exact cause of low testosterone levelsis unknown, but known causes include: the use of certain medications, such as oral corticosteroids alcohol misuse hypogonadism(a condition that causes abnormally low testosterone levels) Risk factors Many hormones in the body can affect the process of bone turnover. If you have a conditionof the hormone-producing glands, you may have a higher risk of developing osteoporosis. Hormone-related conditions that can trigger osteoporosis include: hyperthyroidism (overactive thyroid gland) disorders of the adrenal glands, such asCushings syndrome reducedamounts of sex hormones (oestrogen and testosterone) disorders of the pituitary gland hyperparathyroidism (overactivity of the parathyroid glands) Other risk factors Other factors thought toincrease the risk of osteoporosis and broken bones include: a family history of osteoporosis a parental history ofhip fracture a body mass index (BMI) of 19 or less long-term use of high-doseoral corticosteroids (widely used for conditions such as arthritis and asthma ), which can affect bone strength having an eating disorder, such as anorexia or bulimia heavy drinking and smoking rheumatoid arthritis malabsorption problems, as experienced in coeliac disease and Crohns disease some medications used to treat breast cancer and prostate cancer which affect hormone levels long periods of inactivity, such as long-term bed rest You can read more about whos at risk of osteoporosis and broken bones on the Royal Osteoporosis Society website . Treating osteoporosis Treatment overview Although a diagnosis of osteoporosis is based on the results of your bone mineral density scan (DEXA or DXA scan), the decision about what treatment you need if any is also based on a number of other factors. These include your: age sex risk of fracture previous injury history If youve been diagnosed with osteoporosis because youve had a fracture, you should still receive treatment to try to reduce your risk of further fractures. You may not need or want to take medication to treat osteoporosis. However, you should ensure youre maintaining sufficientlevels of calcium andvitamin D. To achieve this, your healthcare team will ask you about your diet and may recommend making changes or taking supplements. NICE recommendations The National Institute for Health and Care Excellence (NICE)has made some recommendations about who should be treated with medication for osteoporosis. Anumber of factors are taken into consideration before deciding which medication to use. These include your: age bone mineral density (measured by your T score) risk factors for fracture NICE has summarised its guidance for two groups of people: postmenopausal women with osteoporosis who havent had a fracture (primary prevention) postmenopausal women with osteoporosis who have had a fracture (secondary prevention) You can read the NICE guidance by clicking on the links below. NICE guidance: Alendronate, etidronate, risedronate, raloxifene and strontium ranelate for the primary prevention of osteoporotic fragilityfractures in postmenopausal women NICE guidance: Alendronate, etidronate, risedronate, raloxifene, strontium ranelate and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women Medication for osteoporosis Anumber of different medications are used to treat osteoporosis. Your doctor will discuss the treatments available andmake sure the medicines are right for you. Bisphosphonates Bisphosphonates slow down the rate at which bone is broken down in your body. This maintains bone density and reduces the risk of fracture. There are a number of different bisphosphonates, including alendronate etidronate ibandronate risedronate zolendronic acid Theyre given as a tablet orinjection. You should always take bisphosphonateson an empty stomach with a full glass of water. Stand or sit upright for 30 minutes after taking them. Youll also need to wait between 30 minutes and two hours before eating food or drinking any other fluids. Bisphosphonates usually take 6 to 12 months to work and you may need to take themfor five years orlonger. You may also be prescribed calcium and vitamin D supplements to take at a different time to the bisphosphonate. The main side effects associated with bisphosphonates include: irritation to the oesophagus (the tube that food passes through from the mouth to the stomach) swallowing problems (dysphagia) stomach pain Not everyone will experience these side effects. Osteonecrosis of the jaw is arare side effect thats linked with the use of bisphosphonates, althoughmost frequently with high-dose intravenous bisphosphonate treatment for cancer and not for osteoporosis. Inosteonecrosis, the cells in the jaw bone die, which can lead to problems with healing. If you have a history of dental problems, you may need a check-up before you start treatment with bisphosphonates. Speak to your doctor if you have any concerns. Strontium ranelate Strontium ranelate appears to have an effect on both the cellsthat break down bone and the cellsthat create new bone (osteoblasts). It can be used as an alternative treatment if bisphosphonates are unsuitable. Strontium ranelate is taken as a powder dissolved in water. The main side effects of strontium ranelate are nausea and diarrhoea . A few people have reported a rare severe allergic reaction to the treatment. If you develop a skin rash while taking strontium ralenate, stop taking it and speak to your doctor immediately. Selective oestrogen receptor modulators (SERMs) SERMs are medications that have a similar effect on bone as the hormone oestrogen. They help to maintain bone density and reduce the risk of fracture, particularly of the spine. Raloxifene is the only typeof SERM thats available for treating osteoporosis. Its taken as a tablet every day. Side effects associated with raloxifene include: hot flushes leg cramps a potential increased risk of blood clots Parathyroid hormone (teriparatide) Parathyroid hormone is produced naturally in the body.It regulates the amount of calcium in bone. Parathyroid hormone treatments (human recombinant parathyroid hormone or teriparatide) are used to stimulate cells that create new bone (osteoblasts). Theyre given by injection. Whileother medicationcan only slow down the rate of bone thinning, parathyroid hormone can increase bone density. However, its only used in a small number of people whose bone density is very low and when other treatments arent working. Nausea and vomiting are common side effects of the treatment. Parathyroid hormone treatments should only be prescribed by a specialist. Calcium and vitamin D supplements Calciumis the major mineral found in bone, and having enough calcium as part of a healthy, balanced diet is important for maintaining healthy bones. For most healthy adults, the recommended amount of calcium is 700 milligrams (mg) of calcium a day, which most people should be able to get from a varied diet that contains good sources of calcium. However, if you have osteoporosis you may need more calcium, which will usually be in the form of supplements. Ask your GP for advice about taking calcium supplements. Vitamin Dis needed to help the body absorb calcium. Its difficult to get enough vitamin D from your diet alone because few foods contain vitamin D. In the UK, most healthy adults obtain vitamin D from exposing the skin to summer sunlight. However, for people at risk of not getting enough vitamin D, supplementation with 10 micrograms of vitamin D a day (400 international units [IU]) isrecommended to prevent deficiency. At-risk groups include people over 65 years of age,and people who arent exposed to much sunlight because they cover their skin for cultural reasons, are housebound, or who stay indoors for long periods. If youre found to lack vitamin D, your GP may prescribe supplements at a higher dose than the above recommendation to correct the deficiency. Hormone replacement therapy (HRT) HRT is sometimes recommended for women who are experiencing the menopause , as it can help control symptoms. HRT has also been shown to maintain bone density and reduce the risk of fracture during treatment. However, HRT isnt specifically recommended for treating osteoporosis and it isnt often used for this purpose. This is because HRT slightly increasesthe riskof developing certain conditions, such as breast cancer , endometrial cancer , ovarian cancer , stroke and venous thromboembolism more than it lowers the risk of osteoporosis. Discuss the benefits and risks of HRT with your GP. Read more about the risks of HRT . Testosterone treatment In men, testosterone treatment can be useful when osteoporosis is caused by insufficient production of male sex hormones (hypogonadism). Preventing osteoporosis Your genes are responsible for determining your height and the strength of your skeleton, but lifestyle factors such as diet and exercise influence how healthy your bones are. Regular exercise Regular exerciseis essential.Adults aged 19 to 64 should doat least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity, such as cycling or fast walking , every week. Weight-bearing exercise and resistance exercise are particularly important for improving bone density and helping to prevent osteoporosis. As well as aerobic exercise, adults aged 19 to 64 should also do muscle-strengthening activities on two or more days a week byworking all the major muscle groups, including the legs, hips, back, abdomen, chest, arms and shoulders. If youve been diagnosed with osteoporosis, its a good idea to talk to your GP or health specialist before starting a new exercise programme to make sure its right for you. Read more about the physical activity guidelines for adults . Weight-bearing exercises Weight-bearing exercises are exercises where your feet and legs support your weight. High-impact weight-bearing exercises, such as running , skipping, dancing, aerobics, and even jumping up and down on the spot, are all useful ways to strengthen your muscles, ligaments and joints. When exercising,wear footwear that provides your ankles and feet with adequate support, such as trainers or walking boots. Peopleover the age of 60 can also benefit from regular weight-bearing exercise. This can include brisk walking, keep-fit classes or a game of tennis. Swimming and cycling arent weight-bearing exercises, however. Read more about physical activity guidelines for older adults . Resistance exercises Resistance exercises use muscle strength, where the action of the tendons pulling on the bones boosts bone strength. Examples include press-ups, weightlifting or using weight equipment at a gym. If youve recently joined a gym orhavent been for a while, your gym will probably offer you an induction. This involves being shown how to use the equipment and having exercise techniques recommended to you. Always ask an instructor for help if youre not sure how to use a piece of gym equipment or how to do a particularexercise. Healthy eating Eating a healthy, balanced diet is recommended for everyone. It can help prevent many serious health conditions, including heart disease , diabetes and many forms of cancer , as well as osteoporosis. Calciumis importantfor maintaining strong bones. Adults need 700mg a day, which youshould be able to get from your daily diet. Calcium-rich foods include: leafy green vegetables dried fruit tofu yoghurt Vitamin Dis also important for healthy bones and teeth becauseit helps your body absorb calcium. Vitamin D can be found in: eggs milk oily fish However, most vitamin D is made in the skin in response to sunlight. Short exposure to sunlight without wearingsunscreen (10 minutes twice a day) throughout the summer should provide you with enough vitamin D for the whole year. Certain groups of people may be at risk of not getting enough vitamin D. These include: people who are housebound or particularly frail people with a poor diet people who keep covered up in sunlight because they wear total sun block or adhere to a certain dress code women who are pregnant or breastfeeding If youre at risk of not getting enough vitamin D through your diet or lifestyle, you can take a vitamin D supplement. For adults, 10 micrograms a day of vitamin D is recommended. The recommended amount for children is 7 micrograms for babies under six months, and 8.5 micrograms for children aged six months to three years.Talk to your GP for more information. Read moreabout healthy eating . Other factors Other lifestyle factors that can help prevent osteoporosis include: quitting smoking smoking is associated with an increased risk of osteoporosis limiting your alcohol intake  the NHS recommends not drinking more than 14 units of alcohol a week; its also important to avoid binge drinking Read more about healthy bones on theNational Osteoporosis Society website. Living with osteoporosis Getting support Your GP or nurse may be able to answerany questions you have about living with osteoporosis andcan reassure you if youre worried. You may also find it helpful to talk to a trained counsellor or psychologist, or to someone at a specialist helpline. Your GP surgery will have information about these. Some people find it helpful to talk to others with osteoporosis, either at a local support group or in an internet chat room. Osteoporosis support The Royal Osteoporosis Society providesa helpline service run by nurses with specialist knowledge of osteoporosis and bone health. Call 0808 800 0035. You can also email them at nurses@theros.org.uk They can provide you with details of local support groups . Recovering from a broken bone Broken bones usually take six to eight weeks to recover. Having osteoporosis doesnt affect how long this takes. Recovery depends on the type of fracture you have. Some fractures heal easily, while others mayneed more intervention. If you have a complicatedwrist fracture or hip fracture, you may need an operation to make sure the bone is set properly. Hip replacements are often neededafter hip fractures, and some people may lose mobility as a result of weakened bones. Osteoporosis can cause a loss of height due to fractures in the spinal column. This means the spine is no longer able to support your bodys weight and causes a hunched posture. This can be painful when it occurs, but it may also lead tolong-term (chronic)pain. Your GP or nurse may be able to help with this. During the healing process, you may need the help of a physiotherapist or occupational therapist so you can make as full a recovery as possible. Read more about occupational therapy . Coping with pain Everyone experiences pain differently, so what works for you may differ from what works for someone else. There are different ways to manage pain, including: medication heat treatment,such aswarm baths or hot packs cold treatment,such ascold packs transcutaneous electrical nerve stimulation (TENS) this is thought to reduce pain by stimulating the nerves simple relaxation techniques ,massage or hypnosis You can use more than one of these techniques at the same timeto manage your pain for example, you could combine medication, a heat pack and relaxation techniques. Working and money You should be able to continue working ifyou have osteoporosis. Its very important that you remain physically active and have a fulfilled lifestyle. This will help keep your bones healthy and stop you focusing too much on your potential health problems. However, if your work involves the risk of falling or breaking a bone, seek advice from your employer,GP and the Royal Osteoporosis Society about how to limit your risk of having an accident or injury that could lead to a bone break. If you cant continue working, you may be eligible for the Personal Independence Payment . People over 65 who are severely disabled may qualify for a disability benefit called Attendance Allowance . Help for carers You may also be entitled to certain benefits if you care for someone with osteoporosis. Read more about benefits for carers . More information Care Information Scotland GOV.UK: Carers and disability benefits Money Advice Service Source: MSK Expert Panel - Opens in new browser window Last updated: 20 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Scans and X-rays Keeping active Exercise, diet and healthy living with cancer Other health sites healthtalk.org: osteoporosis real stories Lab Tests Online UK: bone markers Royal Osteoporosis Society Age UK: osteoporosis Menopause Matters: osteoporosis Versus Arthritis NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Osteosarcoma,"""Osteosarcoma | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in children Osteosarcoma Osteosarcoma Osteosarcoma is a type of bone cancer. Osteosarcomas occur more commonly in older children and teenagers and are very rarely seen in children under 5. More children than ever are surviving childhood cancer. There are new and better drugs and treatments. But it remains devastating to hear that your child has cancer, and at times it can feel overwhelming. There are many healthcare professionals and support organisations to help you through this difficult time. Understanding more about the cancer your child has and the treatments that may be used can often help parents to cope. Your childs specialist will give you more detailed information. If you have any questions its important to ask the specialist doctor or nurse who knows your childs individual situation. Osteosarcoma often starts at the end of the long bones, where new bone tissue forms as a young person grows. Any bone in the body can be affected. The most common sites are in the arms and legs, particularly around the knee and shoulder joints. There are several different types of osteosarcoma. Most occur in the centre of the bone. There are also rare subtypes, such as parosteal, periosteal, telangiectatic, and small cell osteosarcoma. Causes There has been a lot of research into the causes of osteosarcoma but, like most childhood cancers, a definite cause is unknown. There are a few risk factors that have been associated with osteosarcoma. Children who have hereditary retinoblastoma (a rare tumour of the eye) have an increased risk of developing osteosarcoma. Children who have previously had radiotherapy and chemotherapy also have an increased risk of developing osteosarcoma. It is not caused by injuries or damage to the bone, although an injury may draw attention to a bone tumour. Signs and symptoms Pain in the affected bone is the most common symptom. This pain may initially come and go, and then gradually become more severe and constant especially at night. There may also be swelling around the affected bone. Osteosarcoma is sometimes discovered when a bone that has been weakened by cancer breaks after the person has had a minor fall or accident. Some patients may develop a limp if the tumour is in the leg or pelvis. These symptoms can be caused by many things other than cancer. However, any persistent bone pain should be checked by your childs doctor. Symptoms are often attributed to a sporting injury. How osteosarcoma is diagnosed Usually you begin by seeing your GP, who will examine your child and may arrange tests or X-rays.If a bone tumour is suspected, the doctor will refer your child directly to a specialist hospital or bone tumour centre for further tests. The doctor at the hospital will take your childs full medical history. They will then do a physical examination. This will include an examination of the painful bone to check for any swelling or tenderness. Your child will probably have a blood test to check their general health. A variety of tests and investigations may be needed to diagnose osteosarcoma. An X-ray of the painful part of the bone will usually identify a tumour, although sometimes they can be difficult to see. A small piece of the tumour will be removed and looked at under a microscope. This is called a biopsy. Its a small operation, performed under a general anaesthetic. Other tests are done to check whether the cancer has spread to other parts of the body. These include a chest X-ray , blood tests , a bone scan and an MRI or CT scan . Any tests and investigations that your child needs will be explained to you. Grading Grading refers to the appearance of the cancer cells under the microscope, and gives an idea of how quickly the cancer may develop. Low-grade cancer cells are usually slow-growing and less likely to spread. In high-grade tumours the cells are likely to grow quickly and are more likely to spread. Most osteosarcomas are high-grade, but a type known as parosteal osteosarcoma is usually low-grade. Staging The stage of a cancer is a term used to describe its size and whether it has spread beyond its original site. Knowing the particular type and stage of the cancer helps the doctors to decide on the most appropriate treatment. Most patients are grouped depending on whether cancer is found in only one part of the body (localised disease), or whether the cancer has spread from one part of the body to another (metastatic disease). A staging system commonly used for osteosarcomas is described below: Stage 1A The cancer is low-grade and is only found within the hard coating of the bone. Stage 1B The cancer is low-grade, extending outside the bone and into the soft tissue spaces that contain nerves and blood vessels. Stage 2A The cancer is high-grade and is completely contained within the hard coating of the bone. Stage 2B The cancer is high-grade and has spread outside the bone and into surrounding soft tissue spaces that contain nerves and blood vessels. Most osteosarcomas are stage 2B. Stage 3 The cancer can be low or high-grade and is either found within the bone or extends outside the bone. The cancer has spread to other parts of the body, or to other bones not directly connected to the bone where the tumour started. If the cancer comes back after initial treatment, this is known as recurrent or relapsed cancer. Treatment Treatment will depend on a number of factors including the size, position, and stage of the tumour. Chemotherapy Chemotherapy is a very important part of treatment for osteosarcoma. Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells, and is usually given to shrink the main tumour before surgery. Its also given after the tumour has been removed by surgery, to help reduce the risk of the cancer coming back (recurring). Its common for a combination of drugs to be used. Radiotherapy Radiotherapy may occasionally be given. This treats cancer by using high energy rays to destroy the cancer cells, while doing as little harm as possible to normal cells. Surgery The type and extent of surgery depends on the position and size of the tumour in the body. This surgery will need to be carried out at a specialist orthopaedic centre, and your child should be referred to one. Surgery may include removing the whole limb (amputation) or part of the affected bone, which is then replaced by some form of false limb (prosthesis). If only part of the affected bone is removed, this is known as limb-sparing surgery. Most children will be considered for limb-sparing surgery. Amputation Sometimes amputation of the limb is unavoidable if the cancer is affecting the surrounding blood vessels and nerves. After amputation, a false limb will be fitted and will be regularly adjusted as your child grows. False limbs can work very well. It should be possible for your child to join in with normal activities and even sports. Limb-sparing surgery There are 2 ways that limb-sparing surgery may be done: replacing the bone with a prosthesis (a specially designed artificial part) replacing the affected bone with bone taken from another part of the body (bone graft) After this type of surgery, children will usually be able to use their limbs almost normally. However, they are advised not to participate in any contact sports. This is because any damage to the bone graft or prosthesis may require another major operation to repair or replace it. If your child is growing, the limb prosthesis will need to be lengthened as the bone grows. This may mean there are extra short stays in hospital, although some prostheses can be lengthened as an outpatient procedure. New treatments for osteosarcoma Mifamurtide, also called Mepact, is a new type of biological therapy treatment. It may be offered to your child if they have had a surgical resection to remove the osteosarcoma and the tumour has not spread. It will be given along with chemotherapy after surgery to try and stop the osteosarcoma coming back. Mifamurtide is a relatively new drug and so more research needs to be done to fully understand its side effects and how to use it best. Side effects of treatment Treatment often causes side effects, and your childs doctor will discuss these with you before the treatment starts. Any possible side effects will depend upon the treatment being given and the part of the body thats being treated. Chemotherapy side effects Some general side effects of chemotherapy can include: feeling sick (nausea) and being sick (vomiting) hair loss increased risk of infection bruising and bleeding tiredness diarrhoea Radiotherapy side effects Radiotherapy can cause irritation or soreness of the skin in the area being treated and general tiredness. Surgery side effects If your child is having surgery, the surgeon will explain the possible complications of the surgery that your child is having. Late side effects A small number of children may develop late side effects, sometimes many years later. These include a reduction in bone growth, reduced fertility, a change in heart function, and a slight increase in the risk of developing another cancer in later life. Your childs doctor or nurse will talk to you and monitor your child for any potential late effects. Clinical trials Many children have their treatment as part of a clinical research trial, if there is a suitable one open. Trials aim to improve our understanding of the best way to treat an illness, usually by comparing the standard treatment with a new or modified version. Specialist doctors carry out trials for childrens cancer. If appropriate, your childs medical team will talk to you about taking part in a clinical trial, and will answer any questions you have. Written information will be provided to help explain things. Taking part in a research trial is completely voluntary, and youll be given plenty of time to decide if its right for your child. Your childs doctor can tell you if there are any trials available that might be suitable for your child. Treatment guidelines Sometimes, clinical trials are not available for your childs tumour. This may be because a recent trial has just finished, or because the tumour is very rare. In these cases, you can expect your doctors and nurses to offer treatment which is agreed to be the most appropriate, using guidelines which have been prepared by experts across the country. The Childrens Cancer and Leukaemia Group (CCLG) is an important organisation which helps to produce these guidelines. Follow-up care Many children with osteosarcoma are cured. However, your child may need to have surgery to lengthen the affected limb as they grow. Your child will have regular check-ups and X-rays in the paediatric or adolescent oncology clinic, and at the orthopaedic centre. If you have specific concerns about your childs condition and treatment, its best to discuss them with your childs doctor, who knows the situation in detail. Source: Children's Cancer and Leukaemia Group - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Outer ear infection (otitis externa),"Outer ear infection (otitis externa) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Ears, nose and throat Outer ear infection (otitis externa) Outer ear infection (otitis externa) Otitis externa is an infection that causes inflammation (redness and swelling) of the ear canal, which is the tube between the outer ear and the eardrum. Otitis externa is often called swimmers ear because regularly getting water in your ear can make inflammation more likely. Symptoms of otitis externa Symptoms of otitis externa include: ear pain itching and irritation in and around your ear canal redness and swelling of your outer ear and ear canal a feeling of pressure and fullness inside your ear scaly skin in and around your ear canal, which may peel off discharge from your ear, which can be either thin and watery or thick and pus-like tenderness when you move your ear or jaw swollen and sore glands in your throat some hearing loss Usually, only one ear is affected. With treatment, these symptoms should clear up within a few days. Some cases can persist for several months or longer. When to get medical advice Pharmacists can give advice and treatment about outer ear infections. Find your local pharmacy Your pharmacist may advise you to speak to your GP practice if needed. Diagnosing otitis externa Your pharmacist or GP will ask about your symptoms and whether you regularly put things into your ears, such as hearing aids or ear plugs. They may also examine inside your ear using an instrument called an otoscope. If you have otitis externa often, and treatment doesnt help, your GP may take a swab of the inside of your ear. This will be tested to help check what type of infection you have, if any, so the right medication can be prescribed. What causes otitis externa? Most cases of otitis externa are caused by a bacterial infection. It can also be caused by: irritation fungal infections allergies There are a things that can make you more likely to develop otitis externa, including: damaging the skin inside your ear  for example by scratching or picking your ear regularly getting water in your ear  for example by swimming Getting water in your ear can cause you to scratch inside your ear, and the moisture also provides an ideal environment for bacteria to grow. Who is affected? Otitis externa is quite common. Its estimated that around 1 in 10 people will be affected by it at some point in their lives. The condition is slightly more common in women than men and is most often diagnosed in adults 45 to 75 years of age. People with certain long-term (chronic) conditions are at greater risk of developing the condition. These include: eczema dermatitis Treatment for otitis externa Otitis externa sometimes gets better without treatment, but it can take several weeks. Things you can do to help your symptoms To help your symptoms and help prevent complications, you should: avoid getting your affected ear wet  wearing a shower cap while showering and bathing if you arent washing your hair can help avoid swimming until the condition has fully cleared remove any discharge by gently swabbing your outer ear with cotton wool  do not stick cotton wool or a cotton bud inside your ear remove anything from your affected ear that may cause an allergic reaction, such as hearing aids, ear plugs and earrings use pain relief such as paracetamol or ibuprofen to relieve ear pain  these arent suitable for everyone, so make sure you check the information leaflet that comes with the medication first and if youre still unsure, check with your GP, practice nurse or pharmacist if your condition is caused by a boil in your ear, placing a warm flannel or cloth over the affected ear can help it heal faster Ear drops Your pharmacist or GP can prescribe ear drops that usually improve symptoms within a few days. There are different types of ear drops that may be used to treat otitis externa. You usually use them several times a day for about a week. Your GP may refer you to a specialist for further treatment and advice if your symptoms are severe, or treatment does not help. How to prevent otitis externa There are things you can do to reduce your chances of developing otitis externa. Do consider wearing a swimming cap or using ear plugs if youre a regular swimmer  but make sure you insert ear plugs carefully and dont use them if they irritate your ears if earwax build-up is a problem, have it removed by a healthcare professional keep your ears dry and clean turn your head from side to side after getting out of water  this helps water drain from your ears Dont do not insert cotton wool buds or other things into your ears (including your fingers)  this can damage the sensitive skin in your ear canal do not swim in polluted water You should also try to avoid getting water, soap or shampoo into your ears when you have a shower or bath. Source: ENT Scotland - Opens in new browser window Last updated: 05 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Self-help guide: Earache Hearing loss Other health sites British Tinnitus Association Action on Hearing Loss NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Ovarian cancer,"Ovarian cancer - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Ovarian cancer Ovarian cancer About ovarian cancer Symptoms of ovarian cancer Causes of ovarian cancer Diagnosing ovarian cancer Treating ovarian cancer Living with ovarian cancer Preventing ovarian cancer About ovarian cancer Ovarian cancer is most common in women and anyone with ovaries who hasbeen throughthe menopause (usually over the age of 50). It can affect women and anyone with ovaries of any age. As the symptoms of ovarian cancer can be similar to those of other conditions, it can be difficult to recognise. However, there are early symptoms to look out for, such aspersistent bloating, pain in the pelvis and lower stomach, and difficulty eating. Its important to speak to your GP if you experience these symptoms, particularly over along period of time. Read more about how ovarian cancer is diagnosed . The ovaries are a pair of small organs in the female reproductive system that contain and release an egg once a month. This is known as ovulation. Different types of ovarian cancer affect different parts of the ovaries. Epithelial ovarian cancer, which affects the surface layers of the ovary, is the most common type. This topic focuseson epithelial ovarian cancer. What causes ovarian cancer? The exact cause of ovarian cancer is unknown, but certain things are thought to increase a womans risk of developing the condition, such as age, the number of eggs the ovaries release and whether someone in your family has had ovarian or breast cancer in the past.However, only 1 in 10 cases of ovarian cancer has a genetic link. Read more about the causes of ovarian cancer Treating ovarian cancer The treatment you receive for ovarian cancer will depend on several things, including the stage of yourcancer and your general health. Chemotherapy is the main treatment for ovarian cancer, but your treatment will usually involve a combination of surgery and chemotherapy. Read more about how ovarian cancer is treated As with most types of cancer, the outlook for ovarian cancer will depend on the stage its at when diagnosed  that is, how far the cancer has advanced. Being diagnosed withovarian cancer can affect daily life in many ways. However, support is available for many aspects ofliving withovarian cancer, including emotional, financial and long-term health issues. Ovarian cancer screening There are methods of screening for ovarian cancer but, currently, they havent been fully tested. Screeningis only available for women and anyone with ovaries who are at high risk of developing the condition due to a strong family history or inheritance of a particular faulty gene.Clinical trials in the UK are currently being carried out to assess the effectiveness of screening in high-risk groups and in the general population. A cervical screening test , which used to be called a smear test, cant detect ovarian cancer. Read more about preventing ovarian cancer Symptoms of ovarian cancer The symptoms of ovarian cancer can be difficult to recognise, particularly in its early stages. This is because they are often the same as symptoms of other less serious conditions, such as irritable bowel syndrome (IBS) or pre-menstrual syndrome (PMS). However, 3 main symptoms are more frequent: increased abdominal size and persistent bloating (not bloating that comes and goes) persistent pelvic and abdominal pain difficulty eating and feeling full quickly, or feeling nauseous Other symptoms, such as back pain,needing to pass urine more frequently than usual, and pain during sex may be the result of other conditions in the pelvic area. However, they may bea sign of ovarian cancer. If you have these types of symptoms, try keeping a diary to record how many of these symptoms you have over a longer period. Bear in mindthat ovarian cancer is rare in women and anyone with ovaries under 40 years of age. Speak to your GP if you have these symptoms regularly (on most days for 3 weeks or more). Although its unlikely theyre being caused by a serious problem, its best to check. If youve already seen your GP and the symptoms continue or get worse, you should go back and explain this. You know your body better than anyone. Causes of ovarian cancer Several possible causes of ovarian cancer have been identified, along with risks that may make developing the condition more likely. Cancer begins with a change (mutation) in the structure of the DNA in cells, which can affect how they grow. This means that cells grow and reproduce uncontrollably, producing a lump of tissue called a tumour. In ovarian cancer, cells in the ovary start to change and grow abnormally. If the cancer isnt identified at an early stage, it can spread to the abdomen and pelvis, including other parts of the female reproductive system. Increased risk The exact cause of epithelial ovarian cancer (the main type) isnt known, but certain things may increase your risk of developing it. Age Your risk of ovarian cancer increases with age, with most cases occurring after the menopause . Most cases of ovarian cancer occur in women and anyone with ovaries who are over 50 years of age. Family history If you have 2 or more close relatives (mother, sister or daughter) who developed ovarian cancer or breast cancer , your risk of also developing the condition may be increased. If your relatives developed cancer before the age of 50, its more likely it was the result of an inherited faulty gene. BRCA1 and BRCA2 are faulty genes that are linked to ovarian cancer. Theyre also known to increase the risk of breast cancer. Having relatives with ovarian cancer doesnt mean you definitely have a faulty gene in the family  the cancer could have happened by chance. Only1 in 10 (10%) of ovarian cancers are thought to be caused by a faulty gene. You may be at high risk of having a faulty gene if you have: 1 relative diagnosed with ovarian cancer at any age and at least 2 close relatives with breast cancer whose average age is under 60; all of these relatives should be on the same side of your family (either your mothersor fathers side) 1 relative diagnosed with ovarian cancer at any age and at least 1 close relative diagnosed with breast cancer under the age of 50; both of these relatives should come from the same side of your family 2 relatives from the same side of the family diagnosed with ovarian cancer at any age If youre at a higher risk of having a faulty gene, your GP can refer you for tests to check for faulty BRCA1 and BRCA2 genes. Ovulation and fertility Every time an egg is released into the reproductive system, the surface of the ovary breaks to let it out. The surface of the ovary is damaged during this process and needs to be repaired. Each time this happens, theres a greater chance of abnormal cell growth during the repair. This may be why the risk of ovarian cancer decreases if you take the contraceptive pill , or have multiple pregnancies or periods of breastfeeding. At these times, eggs arent released. Theres no strong evidence to show that those who have infertility treatment have an increased risk of developing ovarian cancer. However, its thought that infertility itself may increase ovarian cancerrisk and research into this area is being carried out. Hormone replacement therapy (HRT) Women and anyone with ovaries who takehormone replacement therapy (HRT) have been shown to have a small increased risk of developing ovarian cancer. However, if HRT is stopped, after 5 years the risk is reduced to the same level as those whove never taken HRT. Endometriosis Endometriosis may also increase your risk of ovarian cancer. In endometriosis, the cells that usually line the womb grow elsewhere in the body. These endometrial cells behave as if they were in the womb, so thickening and bleeding that usually occurs during menstruation,occurs in other parts of the body. Theres no way for this endometrial tissue to leave the body so it becomes trapped, leading to pain, swelling and bleeding in that area. Read further information: Cancer Research UK: Ovarian cancer risks and causes Diagnosing ovarian cancer Speak to your GP as soon as possible if you have any symptoms of ovarian cancer . Your GP will gently feel your tummy (abdomen) and ask you about your symptoms, general health and whether theres a history of ovarian or breast cancer in your family. They may carry out an internal examination and may take a blood sample or refer you for an ultrasound scan . If needed, you may also be referred to a specialist (a gynaecologist or gynaecological oncologist) at a hospital. In 2015, the National Institute for Health and Care Excellence ( NICE ) published guidelines to help GPs recognise the signs and symptoms of ovarian cancer and refer people for the right tests faster. To find out if you should be referred for further tests for suspected ovarian cancer, read the NICE 2015 guidelines on Suspected Cancer: Recognition and Referral . Blood test (CA125) You may have a blood test to look for a protein called CA125 in your blood. CA125 is produced by some ovarian cancer cells.A very high level of CA125 may indicate that you have ovarian cancer. However, CA125 isnt specific to ovarian cancer and it can be raised in conditions including endometriosis , fibroids , pelvic inflammatory diseaseand pregnancy, soa raised CA125 level doesnt definitely mean you have ovarian cancer. The Lab Tests Online UK website has more informationon the CA125 test . TheNational Institute for Health and Care Excellence (NICE) has producedguidance that recommends testing for CA125 if you frequently experience: bloating feeling full quickly and/or loss of appetite pelvic or abdominal pain needing to urinate urgently and/or frequently Read the full NICE guidance about the recognition and initial management of ovarian cancer (PDF, 179kb) . If you experience unexplained weight loss, fatigue or changes in your bowel habits, such as diarrhoea or constipation , you may also be tested for CA125. If youre 50 or over and youve experienced symptoms that could suggest irritable bowel syndrome (IBS) in the last 12 months, such as bloating, abdominal pain or changes in your bowel habits, your GP should test your CA125 level. Around halfof all women and anyone with ovaries with early-stage ovarian cancerhave a raised level of CA125 in their blood. If your CA125 level is raised,youll be referred for an ultrasound scan. Ultrasound scan An ultrasound scan uses high-frequency sound waves to create an image of your ovaries. You may have an internal ultrasound where the ultrasound probe is inserted into your vagina, or you may have an external ultrasound, where the probe is put next to your stomach. The image produced can show the size and texture of your ovaries, plus any cysts or other swellings that are present. Further tests If youve been diagnosed with ovarian cancer, you may have further tests to see how large the cancer is andif its spread. This is called staging. Other tests you may have include: a chest X-ray a CT scan or MRI scan abdominal fluid aspiration  a thin needleis passed into your abdomen, so that a fluid sample can be taken and tested for cancerous cells laparoscopy  a thin tube with a camera on the endisinserted through a small incision in your lower abdomen, so that your ovaries can be examined; a small tissue sample may also be taken from your ovaries for testing (a biopsy ) Staging helps your doctors to decide on the best kind of treatment for your condition. However, its important to remember that the stage of your ovarian cancer alone cannot predict how your condition will progress. TheCancer Research UK website has more informationon further tests for ovarian cancer . Stages and grades of ovarian cancer Staging If your test results indicate that you have ovarian cancer,it will be given a stage. The stage describes the size of the cancer and how far it has spread. The 4 commonly used stages of ovarian cancer are: stage 1  where the cancer only affects one or both of the ovaries stage 2  where the cancer has spread from the ovary and into the pelvis orwomb stage 3  where the cancer has spread to the lining of the abdomen, the surface of the bowel and the lymph nodes in the pelvis stage 4  where the cancer has spread to other parts of the body, such as theliver, spleen or lungs This is a simplified guide. Each stage is further divided into categories A, B and C.Ask your doctor if youre not sure what stage you have. Grading The grade of cancer refers to the appearance ofcells under a microscope. The grades are as follows: low grade  although abnormal, cells appear to be slow-growing moderate grade  cells look more abnormal than low-grade cells high grade  cells look very abnormal and are likely to be fast-growing TheCancer Research UK website has more informationon the stages and grading of ovarian cancer . Treating ovarian cancer Surgery Most people with ovarian cancer willbe considered forsurgery. It sometimes isnt possible to confirm the stage of the cancer until surgery is carried out. Your doctor will discuss what will happen during surgery. It will probably involve removing: both ovaries and the fallopian tubes (a bilateral salpingo-oophorectomy) the womb(a total abdominal hysterectomy) the omentum  a fatty layer of tissue within the abdomen (an omentectomy) The surgeon may also remove the lymph nodes from your pelvis and abdomen, and samples of nearby tissue, to find out whether the cancer has spread. If it has spread, the surgeon will try to remove as much of it as possible. This is known as debulking surgery. If the cancer is confined to 1 or both ovaries, you may only need to have the ovary or ovaries removed, leaving your womb intact. This means you may still be able to carry a pregnancy. You will probably be ready to go home 3 to 7 days after your operation, but it can take many weeks to fully recover. When you go home, youll need to exercise gently to build up your strength and fitness. Walking and swimming are good exercises that are suitable for most people after treatment for ovarian cancer. Discuss the types of exercise that are suitable for youwith your doctor or physiotherapist. Read further information: Cancer Research UK: Surgery for ovarian cancer Macmillan Cancer Support: Ovarian cancer surgery Chemotherapy Chemotherapy involves using anti-cancer (cytotoxic) medication to kill cancer cells. Its often given after surgery for ovarian cancer. In some cases, it can be given before surgery to help shrink the tumour and make it easier to remove. This is called neoadjuvant chemotherapy. Several different medicines can be used in chemotherapy. A combination is often given. The choice of medicine and how and when its given depends on thestage of your cancer and how much it has spread. The most common treatment for ovarian cancer is a platinum-containing medicine (carboplatin), which is used alone or in combination with another medicine called paclitaxel. Chemotherapy is usually given asa dripinto the vein, but is sometimes given as tablets. Some studies have looked at giving chemotherapy directly into the abdomen  called intraperitoneal chemotherapy. It is not currently established routine practice in the UK, but its being assessed in clinical trials. Youll usually have chemotherapy as an outpatient, but you may sometimes need a short stay in hospital. Its usually given in cycles, with a period of treatment followed by a period of rest, to allow the body to recover. Most women and anyone with ovaries have 6 cycles of chemotherapy. Is chemotherapy working? Over the course of your chemotherapy, youll have tests to monitor how the cancer is responding to treatment. This can be done in a number of ways. For example: if you had higher than normal levels of theprotein CA125 in your blood when diagnosed, you may have blood tests to see whether the levels are falling if you had a tumour visible on a CT scan or ultrasound scan whendiagnosed, you may have repeated scans to see whether it has shrunk you may have another small operation, known as second-look surgery, which is carried out in the same way as a laparoscopy After your chemotherapy treatment, if all of your tests are clear of cancer, youll be in remission. This means the cancer is under control. Side effects of chemotherapy Side effectsof chemotherapyinclude: infections loss of appetite nausea and vomiting tiredness hair loss sore mouth Many side effects can be prevented or controlled with medicines your doctor can prescribe. Chemotherapy for recurring cancer Ovarian cancer can come back (relapse) after treatment. If this happens, you may have another course of chemotherapy. This is called second-line treatment. Read further information: Cancer Research UK: Chemotherapy for ovarian cancer Macmillan Cancer Support: Chemotherapy for ovarian cancer Radiotherapy Radiotherapyuses high energy X-rays . Like chemotherapy, it works by targeting rapidly growing cancer cells. Radiotherapy isnt usually used to treat ovarian cancer. However, the multidisciplinary team may occasionally recommendit to treatovarian cancer under very specific circumstances, such as treating pain and bleeding from a localised tumour mass. Read further information: Cancer Research UK: radiotherapy for ovarian cancer Macmillan Cancer Support: Ovarian cancer treatment Clinical trials In recent years,much progress has been made in ovarian cancer treatment. More women and anyone with ovaries are living longer and experiencing fewer side effects. These advances were discovered throughclinical trials,where new medicines and combinations of medicines are compared with standard treatment. All cancer trials in the UK are subject to careful monitoring,to ensure the trial is worthwhile and safely conducted. Participants in clinical trials canoften do better overall than in routine care. If youre asked about taking part in a trial, youll be offered an information sheet. If you wish to take part, youll be asked to give your consent (permission)by signing a form. Youre always free to refuse or withdraw from a clinical trial without it affecting your care. Read further information: Cancer Research: ovarian cancer research . Psychological help Dealing with cancer can be a huge challenge for patients and their families. It can bring emotional and practical difficulties. It often helps to talk about your feelings or other difficulties with a trained counsellor or therapist. You can ask for this kind of help at any stage of your illness. There are various ways to find help and support. For example: your hospital doctor, specialist nurse or GP can refer you to a counsellor;talk to your GP ifyoure feeling depressed;a course of antidepressants may help, or your GP can arrange for you to see a counsellor or psychotherapist it can help to talk to someone whos been through the same thing as you; many organisations have helplines and online forums; they can also put you in touch with other people who have had cancer treatment Read further information: Macmillan Cancer Support Living with ovarian cancer Recovery and follow-up Many women and anyone with ovaries with ovarian cancer have a hysterectomy. This is a major operation and takes around 6 to 12 weeks to recover from. During this time, youll have to avoid lifting things, such as children and heavy shopping bags, and doing heavy housework. You wont be able to drive for 3 to 8weeks after the operation. Youll usually need 4 to 12 weeks off work after a hysterectomy. If your ovaries have been removed and you havent already been through the menopause , youll experience themenopause after your treatment. You may decide to take hormone replacement therapy (HRT) to control your symptoms. Your GP willhelp you decide whats best for you. Some treatments for ovarian cancer, particularly chemotherapy , can make you feel very tired. You may need a break from your normal activities for a while. Dont be afraid to ask for practical help from family and friends if you need it. Practical help may alsobe available from your local authority. Ask your doctor or nurse who to contact. After your treatment has finished, youll be invited for regular check-ups to see how well you are responding to treatments. These are usually every 2 to 3 months to begin with. Sex and relationships Relationships with friends and family Having cancer isnt always easy to talk about, either for you oryour family and friends. You may sense that some people avoid you or feel awkward around you. Being open about how you feel and what your family and friends can do to helpmay put them at ease. However, dont feel shy about telling them you need some time to yourself. Read further information: Talking to your kids about cancer Macmillan Cancer Support:Talking about cancer Your sex life Ovarian cancer and its treatment can affect your sex life in several ways. Early menopause If you havent already been through the menopause, removing your ovaries means youll have an early menopause. Youre likely to have symptoms of the menopause , which can include vaginal dryness and loss of sexual desire . Not feeling like sex Its common to lose interest in sex after treatment for ovarian cancer. Your treatment may leave you feeling very tired, andyou may feel shocked, confused or depressed about being diagnosed with cancer. You may also feel grief about the loss of your fertility. Its understandable that you may not feel like having sex while coping with all this. Share your feelings with your partner. If your feelings about sex arent improving with time, you may want to consider speaking to a counsellor or sex therapist. Money and benefits If you have to reduce or stop working due to your cancer, you may find it difficult to cope financially. If you have cancer or youre caring for someone with cancer, you may be entitled to financial support. For example: if you have a job but cant work because of your illness, youre entitled to statutory sick pay (SSP) from your employer if you dont have a job and cant work because of your illness, you may be entitled to employment and support allowance (ESR) if youre caring for someone with cancer, you may be entitled to carers allowance you may be eligible for other benefits if you have children living at home, or have a low household income Its a good idea to find outas soon as possiblewhat help is available to you. You could ask to speak to the social worker at your hospital, whocangive you the information you need. Read further information: Money Advice Service Target Ovarian Cancer: Financial hardship for women with ovarian cancer Dealing with dying If youre toldthat nothing more can be done to treat your ovarian cancer,care will focus on controlling your symptoms and helping you feel as comfortable as possible. This is called palliative care . It also includes psychological, social and spiritual support for you and your family or carers. Read further information: Marie Curie Cancer Care: support for people dying at home Preventing ovarian cancer Theres currently no reliable screening test for ovarian cancer. However, there are a number of things that may help to prevent ovarian cancer. Stopping ovulation and the contraceptive pill Each time you ovulate, your ovaries are damaged by the egg as it breaks through the surface of the ovary and isreleased into your reproductive system. The cells that make up the surface of your ovaries divide and multiply rapidly to repair the damage caused by the egg. Its this rapid cell growth that can occasionally go wrong and result in ovarian cancer. Anything that stops the process of ovulation can help to minimise your chances of developing ovarian cancer. This includes: pregnancyand breastfeeding the contraceptive pill hysterectomy surgery (removal of the ovaries) Diet and lifestyle Ovarian cancer may be linked to being overweight or obese . Losing weight through regular exercise and a healthy, balanced diet may help lower your risk of getting ovarian cancer. Aside from this, regular exercise and a healthy, low-fat diet are extremely beneficial to your overall health, and can helpto prevent all forms of cancerand heart disease . Screening for ovarian cancer At present, theres no screening methodfor ovarian cancer that is reliable enough to be used by all women and anyone with ovaries in the UK.Clinical trials into this are continuing. You may be eligible for screening if youre at high risk of developing the condition due to a strong family history, or if youveinherited aspecific abnormal gene. If youre at high risk, your GP can refer you to your local genetics service or family cancer clinic. You may be screened for ovarian cancer when youreover the age of 35, or when youre 5 years away from the age at which your youngest relative was diagnosed with the condition. From this point, youll be screened again once a year. The screening tests for ovarian cancer are the same as those routinely used to diagnose it. The tests are: a blood test for higher-than-normal levels of CA125 (a protein produced by cancer cells) a transvaginal ultrasound  where anultrasound probe is inserted into your vagina so that the size and texture of your ovaries can be seen, as well as any ovarian cysts that may be present The tests are used together to produce results that are as accurate as possible. However, as these screening methods are still in the process of being tested, theres no guaranteetheyll identify every case of ovarian cancer. A cervical screening test , previously known as a smear test, cant detect ovarian cancer. Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites Cancer Research UK: Ovarian cancer healthtalk: Ovarian cancer Macmillan Cancer Support: Ovarian cancer Ovacome Cancer Charity Target Ovarian Cancer The Eve Appeal Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Ovarian cancer: Teenagers and young adults,"Ovarian cancer | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in teenagers and young adults Ovarian cancer: Teenagers and young adults Ovarian cancer: Teenagers and young adults Introduction Germ cell tumours of the ovary Having tests for ovarian cancer Treatment for germ cell tumours of the ovary Introduction This section is for teenagers and young adults. Its about a type of cancer called ovarian cancer. We have more info for young people about: germ cell tumours of the ovary  causes and symptoms having tests for ovarian cancer treating ovarian cancer For more information about ovarian cancer in women of all ages, read our general ovarian cancer section. Ovarian cancer starts in the ovaries, which are part of the reproductive system. This is in the lower part of your tummy (abdomen), in the area between your hips (called the pelvis). Your reproductive system is made up of your vagina and the organs involved in getting pregnant and having a baby. Your reproductive system Your reproductive system is made up of the: vagina the passage from the cervix to outside your body cervix the opening from the womb to the vagina womb (also called uterus) where a baby grows during pregnancy fallopian tubes which connect your ovaries to the womb ovaries which store all your eggs and release one every month after puberty Facts about ovaries You have2 ovaries 1 on each side of your womb. Theyre about 4cm long. At puberty your ovaries start making hormones called oestrogen and progesterone. These cause your breasts to grow and your periods to start. Every month after puberty, your ovaries release an egg, which travels down the fallopian tubes to the womb. The wombs lining gets thicker, ready for an egg to be fertilised by a mans sperm. If this doesnt happen, the wombs lining comes out of your vagina as blood. This is a period. When a woman is about 50 her periods stop because her ovaries have run out of eggs so they stop making hormones. This is called the menopause. Types of ovarian cancer There are 3 types of ovarian cancer: epithelial tumours, germ cell tumours and stromal cell tumours. Teenagers are mostly affected by the germ cell tumour type. You may hear your type of germ cell tumour being called: dysgerminoma teratoma yolk sac tumour Germ cell tumours of the ovary are rare. They start in the egg-producing cells of the ovary. Treatment will usually cure germ cell tumours. Your specialist will explain more about the type of germ cell tumour that you have. If you have a type of ovarian cancer or germ cell tumour thats not listed here, you can talk to one ofMacmillans cancer support specialists to find out more. Germ cell tumours of the ovary This section is for teenagers and young adults. Germ cell tumours of the ovary are the most common type of ovarian cancer in teenagers and young women. If you have a different type of ovarian cancer and want to know more you can talk to Macmillan Cancer Support . Germ cell tumours are a rare type of ovarian cancer. They start in the egg-producing cells of the ovary in girls and young women (aged 10 to 30). Tumours are often only in1 ovary. They can usually be successfully treated, even if theyve spread to other places in the body. Germ cell tumours can also develop in teenage boys or mens testicles, or rarely in other parts of the body. This page is about germ cell tumours that start in the ovary, but we have more information about testicular cancer . Causes The cause of germ cell tumours is unknown. Research into possible causes is going on all the time. Germ cells are a normal part of the ovary, but something causes them to change. This makes them grow too quickly and make a tumour. Signs and symptoms pain or swelling in your tummy (abdomen) afeeling of fullness or bloating in your tummy needing to pee more often irregular periods Remember  these symptoms happen for lots of reasons other than cancer. But if you have any of them its important to speak to your GP. If youre worried about ovarian cancer If you think you might have some of these symptoms, go and see your GP. Theyll be able to talk to you about your symptoms. If they think they could be because of cancer, they can do some tests to find out more. We have more information for young people about: having tests for ovarian cancer treatment of overian cancer If youre looking for information about ovarian cancer in women of all ages, read our general ovarian cancer section. Having tests for ovarian cancer There are some tests that you might have at your doctors or at the hospital, to help them see if you have ovarian cancer. Visiting your GP If you think you might have any symptoms of ovarian cancer , you should speak to your GP. Theyll be able to talk to you about your symptoms. If they think these could be because of cancer they can do tests to find out more. Tests These might include: a blood test an ultrasound of the ovaries an internal examination, to check the organs in your pelvis For an internal examination, you lie on your back with your feet together and your knees apart. The doctor will gently put1 or2 fingers inside your vagina and press a little on your lower tummy. It shouldnt be painful but it can feel uncomfortable. This test might make you feel embarrassed, but doctors are used to doing this investigation and its over quickly. If a male doctor examines you, there will usually be a female nurse present, but if not you can ask for one. You can have someone you feel close to with you during the examination, or if you prefer you can ask whoever is with you to go out until its over. You can do whatever makes you feel most comfortable. After these tests, your GP may arrange for you to see a doctor at the hospital who specialises in problems of the reproductive system (a gynaecologist). At the hospital The specialist will carry out an internal examination to check if theres anything unusual in the shape and position of your ovaries and womb. Your GP may have already done an internal examination. More tests The specialist will arrange for you to have some more tests. Different tests are used to diagnose germ cell tumours of the ovary. Blood tests check for chemicals in the blood called tumour markers. Some germ cell tumours produce high levels of these. Ultrasound scans use sound waves to build up a picture of your ovaries and the area around them on a computer screen. The person doing the scan will rub some gel on your tummy and gently move a small device over your tummy to produce the picture. You may also have an ultrasound scan done through the vagina (transvaginal ultrasound), to get a clearer picture. A small probe about the size of a tampon is gently put inside your vagina. Its not painful but it can be a bit uncomfortable. You can have someone with you during the test if you want to. CT scans take a series of X-rays, which build up a 3D picture of the area of the body being scanned. It can show up the size and position of a tumour. Laparoscopy is a test thats sometimes done to look inside your tummy at your ovaries. Its done under a general anaesthetic. You can usually go home the same day. The surgeon makes 3 to 4 small cuts in the skin in your lower tummy (just above the bikini line). Then they put a thin, flexible tube with a camera on the end (called a laparoscope) through one of the cuts to look at the ovaries. Sometimes the surgeon will remove the ovary at the same time as the laparoscopy but they will discuss this with you before you have the surgery. The removedovarywill be looked at under a microscope to find out exactly what type of tumour it is. Having tests and waiting for the results can be an anxious time. Talking about how you feel and getting support from family, friends, your specialist nurse or your doctor can help. Weve got more information for young people about: germ cell tumours of the ovary causes and symptoms treatment of ovarian cancer living with and after ovarian cancer If youre looking for information about ovarian cancer in women of all ages, read our ovarian cancer section. Treatment for germ cell tumours of the ovary Most girls and young women can be cured of germ cell tumours of the ovary. Your treatment will depend on the type of germ cell tumour you have and whether it has spread outside the ovaries. Treatment is usually a combination of surgery and chemotherapy, although you may only need surgery. Before you have treatment, your specialist needs to know the type of germ cell tumour you have and what stage it is. The stage of a cancer describes the size of the tumour and whether it has spread outside the ovary to any other parts of your body. Your specialist will tell you the exact stage of the cancer after the operation to remove your ovary. Most germ cell tumours are diagnosed early when theyre in one or sometimes both ovaries but havent spread anywhere else in the body. Waiting to hear about the stage of the cancer can be worrying. But this information is important because it helps your doctors plan the right treatment. Another important part of ovarian cancer treatment is to try to make sure it doesnt make you infertile (unable to get pregnant). Your doctors will think very carefully about this when planning your treatment. Surgery You may have an operation to remove the affected ovary and the fallopian tube. If its a very early germ cell tumour this might be the only treatment you need. After your operation youll come back to the clinic for regular checks. If there are any signs of the cancer coming back, its treated straight away. Having the affected ovary and fallopian tube removed wont stop you from having a baby in the future. You can still get pregnant with only1 ovary. Before surgery youll have a general anaesthetic. During the operation, the surgeon will make a cut in the lower tummy. The ovary is removed through this cut. The operation is called a laparotomy. If the cancer has spread, the surgeon may still do an operation to try to remove as much of the tumour as they can. If possible they will try to leave the other ovary and the womb. You will have more treatment after your operation to treat any of the tumour that they could not remove. Removing both ovaries and the womb is only done if theres no other way of successfully treating the cancer. Unfortunately this means you will not be able to get pregnant in the future. This can be very upsetting news. You may not have thought about having children yet, so it may be difficult to take in. If this happens there will be lots of support to help you. Chemotherapy Chemotherapy is given after your operation to: get rid of any cancer cells that werent removed with surgery stop the cancer from coming back Your specialist will explain more about this to you. Germ cell tumours are very sensitive to chemotherapy and this treatment cures most girls. If its a very early germ cell tumour you might not even need chemotherapy. Germ cell tumours are often treated with the drugs bleomycin, etoposide and cisplatin. When these are given together its called BEP for short. Chemotherapy is given in cycles of treatment that usually take 3 weeks. Youll have 3 to 4 cycles. Youll spend the first 3 to 5 days of each cycle having your chemotherapy. Youll usually stay in hospital for those days. Youll come back to the clinic for another injection of chemotherapy a week later, and then again the following week. Different chemotherapy drugs cause different side effects. Some girls just have a few side effects, and others have more. Most side effects are temporary and gradually disappear once treatment stops. The most common side effects are: hair loss tiredness feeling sick or being sick (this can often be controlled with medicine) being more at risk of getting an infection Doctors cant be certain whether youll be able to get pregnant (fertility) in the future after youve had chemotherapy. They may talk to you about storing your eggs before chemotherapy starts. Stored eggs can be used with fertility treatments when youre ready to try to get pregnant. Read more inMacmillans section on fertility in young women . Surgery and chemotherapy Youll usually have chemotherapy after your surgery. You might have more surgery after youve finished chemotherapy if theres still some tumour left behind. Radiotherapy Radiotherapy treats cancer by using high-energy X-rays to destroy cancer cells. Some types of germ cell tumour are sensitive to radiotherapy, but it is rarely used. Wehavemore information about: germ cell tumours of the ovary  causes and symptoms having tests for ovarian cancer If youre looking for information about ovarian cancer in women of all ages, read our general ovarian cancer information. Source: Macmillan - Opens in new browser window Last updated: 20 January 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Ovarian cyst,"""Ovarian cyst | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Healthy living Women's health Middle years (around 25 to 50 years) Periods and menstrual health Ovarian cyst Ovarian cyst An ovarian cyst is a fluid-filled sac that develops on an ovary. Theyre very common and do not usually cause any symptoms. Most ovarian cysts are generally harmless and disappear without treatment in a few months. Small cysts are normal in the ovary. There may only be a problem is there are a large number of cysts, theyre persistent, or become particularly large. Ovarian cysts may affect both ovaries at the same time, or they may only affect one. What are ovaries? The ovaries are part of the female reproductive system. They are 2 small, bean-shaped organs, one each side of the womb (uterus). The ovaries have 2 main functions. They are: to release an egg around every 28 days as part of the menstrual cycle to release the female sex hormones, oestrogen and progesterone Types of ovarian cyst The 2 main types of ovarian are: functional ovarian cysts (most common)  develop as part of the menstrual cycle and are usually harmless and short-lived pathological ovarian cysts (much less common)  occur due to abnormal cell growth Ovarian cysts can sometimes also be caused by an underlying condition, such as endometriosis . The vast majority of ovarian cysts are non-cancerous (benign). But a small number are cancerous (malignant). Signs and symptoms Most cysts are found by chance during a scan. Theyre unlikely to cause any symptoms unless theyre large or abnormal. An ovarian cyst will usually only cause symptoms if it splits (ruptures), is very large, or it blocks the blood supply to the ovaries. Contact your GP practice if: you have sudden, severe pelvic pain If your GP is closed, phone 111. Contact your GP practice if: Youre worried about your symptoms or you regularly have: pelvic pain  this can range from a dull, heavy sensation to a sudden, severe and sharp pain pain during sex difficulty having a poo a frequent need to urinate heavy periods , irregular periods or lighter periods than normal bloating and a swollen tummy feeling very full after only eating a little difficulty getting pregnant If your GP practice is closed, phone 111. Useful information for your doctor It can be helpful to keep a note of your period dates and symptoms using a calendar, a diary or an app. You can then discuss this with your doctor who can decide if any tests or treatments might be needed. If youre seeing your doctor, there are some useful pieces of information to think about beforehand: the first day of your last period (when it started) how many days your period usually lasts what was the shortest time between your periods (from the first day of one period to the first day of the next) what was the longest time between your periods (from the first day of one period to the first day of the next) how often you need to change your period products on a heavy day if you are over 25, when you had your last smear test Diagnosing ovarian cysts If your GP thinks you may have an ovarian cyst, you may be referred for an ultrasound scan . This is carried out by using a probe placed inside your vagina. As this is a very intimate examination, the doctor who performs it will have another person (chaperone) present. You can ask for a female doctor to carry it out. If there isnt a female doctor available, you can ask if theres a female health professional who could carry out the examination. If a cyst is identified during the ultrasound scan, you may need to have this monitored with a repeat ultrasound scan in a few weeks. Or your doctor may refer you to a gynaecologist, who specialises in female reproductive health. Your doctor may also arrange blood tests to check for any other conditions. Treatment In most cases, ovarian cysts disappear in a few months without treatment. A follow-up ultrasound scan may be used to confirm this. Most ovarian cysts do not need treatment or surgery. Treatment will depend on: size and appearance of the cysts whether you have any symptoms whether youre post-menopausal (due to the slightly higher risk of ovarian cancer ) If youre post-menopausal, youll usually have regular ultrasound scans and blood tests over the course of a year to monitor the cyst. Large cysts, those causing symptoms, and those that could be cancerous, may need to be surgically removed. Your care team can talk with you about what to expect, and answer any questions you have. Types of surgery There are 2 types of surgery used to remove ovarian cysts: laparoscopy laparotomy These are usually carried out under general anaesthetic . Laparoscopy Most cysts can be removed using laparoscopy. This is a type of keyhole surgery. Small cuts are made in your tummy and gas is blown into the pelvis to allow the surgeon to access your ovaries. A laparoscopy is a procedure where a camera (a laparoscope) is inserted into the pelvis via a small cut near the belly button so the surgeon can see your internal organs. The surgeon then removes the cyst through the small cuts in your skin. After the cyst has been removed, the cuts will be closed using dissolvable stitches. A laparoscopy is preferred because it causes less pain and has a quicker recovery time. Youll usually be able to go home on the same day or the following day. Laparotomy If your cyst is particularly large, or there is a chance it could be cancerous, a laparotomy may be recommended. During a laparotomy, a single, larger cut is made in your tummy to give the surgeon better access to the cyst. The whole cyst and ovary may be removed and sent to a laboratory to check whether its cancerous. Stitches or staples will be used to close the incision. You may need to stay in hospital for a few days after the procedure. After the surgery After the ovarian cyst has been removed, youll feel pain in your tummy. This should improve in a day or two. If you have had a laparoscopy, youll probably need to take things easy for 2 weeks. Recovery after a laparotomy will usually take longer, possibly around 6 to 8 weeks. If the cyst has been sent for testing, the results should come back in a few weeks. Your doctor will discuss with you whether you need any further treatment. Contact your GP if you notice the following symptoms after surgery, as they may indicate an infection: heavy bleeding severe pain or swelling in your abdomen a high temperature (fever) dark or smelly vaginal discharge Your fertility after surgery If you have not been through the menopause, your surgeon will try to preserve as much of your reproductive system as they can. Make sure you discuss your fertility concerns with your surgeon before your operation. Its often possible to just remove the cyst and leave both ovaries intact, which means your fertility should be largely unaffected. If one of your ovaries needs to be removed, the remaining ovary will still release hormones and eggs as usual. Your fertility shouldnt be significantly affected. But you may find it slightly harder to get pregnant. Occasionally, it may be necessary to remove both ovaries. This will trigger an early menopause . Youll no longer produce any eggs and will not be able to get pregnant. It may still be possible to have a baby by having a donated egg implanted into your womb. You can speak to your doctor for more information about this. If youve been through the menopause, both ovaries may be removed because they no longer produce eggs. Source: Scottish Government - Opens in new browser window Last updated: 03 March 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Menopause Early and premature menopause Women's health Other health sites RCOG: ovarian cysts before the menopause (PDF, 294kb) NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Overactive thyroid,"Overactive thyroid - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Glands Overactive thyroid Overactive thyroid About overactive thyroids Symptoms of an overactive thyroid Causes of an overactive thyroid Diagnosing an overactive thyroid Treating an overactive thyroid Complications of an overactive thyroid About overactive thyroids Overactive thyroid (also known as hyperthyroidism) is a relatively common hormonal condition that occurs when there is too much thyroid hormone in the body. Excess levels of thyroid hormones can then speed up the bodys metabolism, triggering a range of symptoms, such as: nervousness and anxiety hyperactivity  where a person cant stay still and is full of nervous energy unexplained or unplanned weight loss swelling of the thyroid gland, which causes a noticeable lump, known as a goitre, to form in the throat The severity, frequency and range of symptoms can vary from person to person. Read more about the symptoms of an overactive thyroid gland What causes an overactive thyroid gland? The thyroid gland is found in the neck. It produces hormones that are released into the bloodstream to control the bodys growth and metabolism. These hormones are called thyroxine and triiodothyronine. They affect processes such as heart rate and body temperature, and help convert food into energy to keep the body going. In hyperthyroidism, the thyroid gland produces too much thyroxine or triiodothyronine, which speeds up the bodys metabolism. There are several possible underlying causes, the most common being Graves disease, in which the bodys immune system targets the thyroid gland and causes it to produce too much of the thyroid hormones. Read more about the causes of an overactive thyroid gland Treatment An overactive thyroidusually responds well to treatment, and most people are able to control their symptoms. The 3 most widely used treatments for an overactive thyroid gland are: thionamides  a group of medications, includingcarbimazole and methimazole,that stop the thyroid gland producing too much thyroid hormone radioiodine treatment a radioactive substance called iodine that helps shrink the thyroid gland, reducing its activity (the radiation contained in iodine is a very low dose and does not pose a threat to health) surgery in a small number of cases surgery may be required to remove some or all of thethyroid gland, particularly if there is a large goitre Beta-blockers may alsosometimes be usedto temporarily relieve many symptoms of an overactive thyroid gland, although it doesnt target the thyroid gland itself. Its common for treatment to lead to the thyroid not producing enough hormones. This is known as having an underactive thyroid gland (hypothyroidism) .However, anunderactive thyroid is notusually serious andis easily treated. Read more about the treatment of an overactive thyroid gland Complications Around 1 in 20 people with Graves disease will also develop symptoms affecting their eyes, such as: double vision sensitivity to light (photophobia) tearing (excess production of tears) This is known as Graves ophthalmopathy and should be seen by a doctor who specialises in treating eye conditions (an ophthalmologist). A rarer and more serious complication is asudden and severe flare-up of symptoms, known as a thyroid storm. A thyroid stormcan belife-threatening, as it causes severe dehydration and heart problems. Read more about the complications of an overactive thyroid gland Who is affected Women are 10 times more likely to have an overactive thyroid gland than men. In most cases, symptoms will begin somewhere between the ages of 20 and 40, though they can start at any age, including in childhood. An overactive thyroid gland occurs most frequently in white and Asian people, and less frequently inAfrican-Caribbeanpeople. Symptoms of an overactive thyroid An overactive thyroid (hyperthyroidism) has many signs and symptoms, although it is unlikely you would develop all of them. Symptoms of hyperthyroidism If you have hyperthyroidism, you may experience some of the following symptoms: hyperactivity mood swings  such as anxiety , irritability and nervousness difficulty sleeping (insomnia) feeling tired all the time (fatigue) muscle weakness needing to poo or pee morefrequently excess fats in your poo  which can make them greasy and difficult to flush down the toilet (steatorrhoea) sensitivity to heat and excess sweating unexplained or unexpected weight loss  despite having an increased appetite (though in a small number of cases, the increase in appetite can lead to weight gain) very infrequent or light periods, or periods stopping altogether infertility loss of interest in sex If you have diabetes , your diabetic symptoms, such as extreme thirst and tiredness, may be made worse by hyperthyroidism. Signs of hyperthyroidism If you have hyperthyroidism, you may have some of the following physical signs: a swelling in your neck caused by an enlarged thyroid gland (goitre) irregular and/orunusually fast heart rate ( palpitations ) trembling or shaking (tremor) warm, moist skin redness on the palms of your hands loosening of your nails in their nail beds hives (urticaria) patchy hair loss (alopecia) twitching in your face and limbs When to seek medical advice See your GP if you are experiencing any of these symptoms. They may not be the result of an overactive thyroid gland, but they will need further investigation. It might be useful to make a list of your symptoms, as this can often be helpful in determining the correct diagnosis. Causes of an overactive thyroid Overactive thyroid (hyperthyroidism) occurs when your thyroid gland produces too much of the thyroid hormones thyroxine or triiodothyronine. Overproduction of thyroid hormones can be caused by a number of conditions. Graves disease Graves disease is the most common cause of overactive thyroid. It can run in families and can occur at any age, although it is most common in women aged 20 to 40 years old. You are more likely to develop Graves disease if you smoke. Graves disease is an autoimmune condition.This means the immune system mistakessomethingin the body for a toxic substance and attacks it. InGraves disease,it attacks thethyroid gland, whichleads to an overproduction of the thyroid hormones. It is not known what triggers the immune system to do this. Like many autoimmune conditions, it is thought that a combination of both genetic and environmental factors could be involved. If you have Graves disease, your eyes may also be affected, causing discomfort and double vision. This is known as Graves ophthalmopathy. You may findyour eyes bulge out or appear more prominent. For more information on Graves ophthalmopathy, read complications of an overactive thyroid gland . Thyroid nodules It is possible for lumps to develop in your thyroid gland. These are known as nodules. It is not known why nodules develop, but they are usually non-cancerous (benign). However, the nodules can contain abnormal thyroid tissue, which affects the normal production of thyroxine or triiodothyronine, causing an overactive thyroid. Nodules that contain abnormal thyroid tissue are described as toxic. Toxic thyroid nodules account for about1 in 20 cases of hyperthyroidism. Iodine supplements Iodine contained in the food you eat is used by your thyroid gland to produce the thyroid hormones thyroxine and triiodothyronine. However, taking additional iodine in supplements can cause your thyroid gland to produce too much thyroxine or triiodothyronine. This is known as iodine-induced hyperthyroidism  sometimes referred to as Jod-Basedow phenomenon. It usually only occurs if you already have nodules in your thyroid gland. Amiodarone Amiodarone is a type of medication known as an anti-arrhythmic, which helps to control an irregular heartbeat (atrial fibrillation) . If you have non-toxic nodules in your thyroid gland, taking amiodarone can cause hyperthyroidism because it contains iodine. Amiodarone can cause a type of hyperthyroidism usually more severe and difficult to treat through a harmful effect on thyroid tissue. This type of hyperthyroidism is called amiodarone-induced hyperthyroidism. Follicular thyroid cancer In rare cases, you may develop an overactive thyroid as a result of thyroid cancer that starts in your thyroid follicles. This can occur if cancer cells in your thyroid gland begin to produce thyroxine or triiodothyronine. This is also known as functioning thyroid cancer. Diagnosing an overactive thyroid See your GP if you think you may have an overactive thyroid gland (hyperthyroidism). A diagnosis will be based on your symptoms and the results of blood tests that assess how well your thyroid gland is working. These are known as thyroid function tests. Thyroid function tests Your GP will take a sample of your blood and test it for levels of: thyroid-stimulating hormone (TSH) thyroxine and triiodothyronine (the thyroid hormones) TSH is made in the pituitary gland in your brain and controls the production of thyroxine and triiodothyronine. When the level of thyroxine and triiodothyronine in your blood are normal, your pituitary gland releases a normal level of TSH. When thyroid hormone production becomes excessive, the pituitary gland stops releasing TSH. When the level of thyroxine or triiodothyronine drops, the pituitary gland produces more TSH to boost it. If you have an overactive thyroid, the thyroid function test will show that levels of TSH in your blood are consistently lower than normal. Low levels of TSH mean your thyroid gland is overactive andlikely to be makingexcessive thyroid hormones. This is the first part of the thyroid function test. Your GP will then test your blood for levels of thyroxine and triiodothyronine. If you have an overactive thyroid, you will have higher than normal levels of both these hormones. Subclinical overactive thyroid gland In some cases, tests may show you havenormal thyroid hormone levels, but low or suppressed levels of TSH. This is known a subclinical overactive thyroid gland. If you are diagnosed with subclinical overactive thyroid, you may not need treatment. In most cases, the reduced level of TSH in your blood returns to normal within a couple of months and your subclinical hyperthyroidism will resolve by itself. However, you will need a further thyroid function test so your condition can be monitored. Determining the underlying cause If tests confirm an overactive thyroid gland, you may be referred for further tests to determine the underlying cause. An additional test that may be used is an isotope thyroid scan. This involves swallowing small amounts of a radioactive substance (an isotope), usually technetium, in capsule or liquid form. A scan is then used to measure how much of the isotope has been absorbed by your thyroid gland. If your thyroid gland absorbs a high amount of the isotope, it is likelythe underlying cause is either Graves disease or thyroid nodules. If the amount is low, the underlying cause could be due to: swelling (inflammation) of the thyroid gland (thyroiditis), often caused by your immune system mistakenly attacking thyroid tissue or, less commonly, by infection having too much iodine in your diet in rare cases, thyroid cancer Treating an overactive thyroid If you are diagnosed with an overactive thyroid gland (hyperthyroidism), your GP will refer you to a specialist in hormonal conditions (endocrinologist) to plan your treatment. Thionamides Thionamides, such as carbimazole and propylthiouracil, are a common treatment. They are a type of medication that stops your thyroid gland producing excess amounts of thyroxine or triiodothyronine. As thionamides affect the production of thyroid hormone rather than their current levels, you will need to take them for several weeks before you notice an improvement (usually between 4 to 8 weeks). Once the production of thyroid hormones is under control, your specialist may gradually reduce your medication. You may need to continue taking thionamides for a long time, until the condition is under control. Around 1 in 20 people will experience side effects when they first start taking thionamides, such as: itchy skin rash joint pain These side effects should pass once your body is used to the effects of the medication. In rare cases (around 1 in 500), thionamides cause a sudden drop in white blood cells (agranulocytosis), which can make you extremely vulnerable to infection. Symptoms of agranulocytosis include: fever gum pain, swelling and bleeding sore throat mouth ulcers persistent cough shortness of breath If you are taking thionamides and you experience any of the symptoms above, phone your GP immediately for advice and an urgent blood test. If this is not possible, phone 111 or your local out-of-hours service. Beta-blockers Beta-blockers, such as propranolol or atenolol, can relieve some of the symptoms of an overactive thyroid, including tremor (shaking and trembling), rapid heartbeat and hyperactivity. Your specialist may prescribe you a beta-blocker while the condition is being diagnosed, or untilthionamide brings your thyroid gland under control. However, beta-blockers are not suitable if you have asthma. Beta-blockers can sometimes cause side effects, including: feeling sick feeling tired all the time (fatigue) cold hands and feet trouble sleeping, sometimes with nightmares Radioiodine treatment Radioiodine treatment is a form of radiotherapy used to treat most types of overactive thyroid. Radioactive iodine shrinks your thyroid gland, reducing the amount of thyroid hormone it can produce. Radioiodine treatmentisgiven either as a drink or a capsule to swallow. The dose of radioactivity in the radioiodine is very low and is not harmful. Radioiodine treatment is not suitable if you are pregnant or breastfeeding, and may not be suitable if you have eye problems, such as double vision or prominent (bulging) eyes. Women should avoid getting pregnant for at least 6 months after having radioiodine treatment. Men should not father a child for at least 4 months after having radioiodine treatment. Most people only require a single dose of radioiodine treatment. If a further follow-up dose is required, it is usually given 6 to 12 months after the first dosage. A short course of thionamides treatment may be given a few weeks before radioiodine treatment, as this can lead to a more rapid relief of symptoms. Thionamides or radioiodine? In some cases, a particular treatment may be recommended based on factors such as your age, symptoms and the amount of extra thyroid hormone in your blood. However, there may be circumstances when you are offered a choice between a long-term course of thionamides or radioiodine treatment. Both treatments have advantages and disadvantages. Advantages of thionamides include: they are straightforward to take and you do not have to go to hospital to take them there is less risk of getting an underactive thyroid gland (hypothyroidism) as a result of treatment Disadvantages of thionamides include: treatmentmay not be as successful as radioiodine treatment there is a higher risk of side effects Advantages of radioiodine treatment include: treatment is usually very successful Disadvantages of radioiodine treatment include: there isa higher chance of your thyroid gland becoming underactive as a result of treatment radioiodine treatment is usually not suitable for people with additional symptoms affecting their eyes (Graves ophthalmopathy) women have to avoid getting pregnant for at least 6 months, and men should not father a child for at least 4 months after treatment You should discuss the potential risks and benefits of both types of treatment with the specialist in charge of your care. Surgery Surgery to remove all or part of the thyroid gland is known as a total or partial thyroidectomy. It is a permanent cure for recurrent overactive thyroid. Your specialist may recommend surgery if your thyroid gland is severely swollen (a large goitre) and is causing problems in your neck. Other reasons for surgery include: a person cannot be treated with radioiodine treatment as they are pregnant and are unable or unwilling to takethionamides a person has a severe form of Graves ophthalmopathy the symptoms return (relapse) after a previous successful course of treatment with thionamides It is normally recommended that the entire thyroid gland is removed, as this meansthere will be no chance of a relapse. However, you will need to take medication for the rest of your life to compensate for the lack of a functioning thyroid gland  these will be the same medications used to treat an underactive thyroid gland . Complications of an overactive thyroid Several complications can occur with an overactive thyroid (hyperthyroidism), particularly if the condition is not treated. Graves ophthalmopathy If you have Graves disease, you may have problems with your eyes. This is known as Graves ophthalmopathyand is thought to be caused by the immune system mistakenly attacking the tissues of the eyes. Itaffects around1 in 20 people with Graves disease. Symptoms of Graves ophthalmopathy include: eyes feeling dry and gritty sensitivity to light (photophobia) excessive tearing double vision some loss of vision a feeling of pressure behind the eyes In more severe cases, your eyes can bulge prominently from your eye sockets. If you do develop Graves ophthalmopathy, you will probably be referred to an eye specialist (ophthalmologist) for treatment. Treatment options include: eyedrops to ease the symptoms sunglasses to protect the eyes against bright lights corticosteroids to reduce inflammation radiotherapy surgery Pregnancy and overactive thyroid Some women are pregnant when they are first diagnosed with an overactive thyroid gland. Becoming pregnant can lead to a relapse of symptoms, especially in someone with a history of Graves disease. Pregnant women with an overactive thyroid areat an increasedrisk of developing complications during pregnancy and birth, such as miscarriage and eclampsia . They are also more at risk of going into labour prematurely and having a baby with a low birthweight. Pregnant women will need specialist treatment, so the condition should be managed using medicationsthat dont affect the baby. This is likely to be a medication called propylthiouracil. Underactive thyroid In many cases, treatment causes the thyroid gland to releaselevels of hormones that are too low. This is known as having an underactive thyroid gland (hypothyroidism) . Sometimes this will only be a temporary side effect of treatment, but it can often be permanent. Symptoms of an underactive thyroid gland include: being sensitive to cold weight gain constipation depression tiredness An underactive thyroid gland is treated using medications to help replicate the effects of the thyroid hormones. Read more about the treating an underactive thyroid gland Thyroid storm An undiagnosed or poorly controlled overactive thyroid can lead to a rare but serious reaction called a thyroid storm. Itaffects around 1 in 100 people with an overactive thyroid gland. A thyroid storm is a severe and sudden flare-up of symptoms caused by the metabolism going into overdrive, often due to triggers such as: infection pregnancy not taking your medication as directed damage to the thyroid gland, such as a punch to the throat Symptoms of a thyroid storm include: a very rapid heartbeat (over 140 beats a minute) fever (a temperature higher than 38C/100.4F) dehydration , with diarrhoea and vomiting jaundice  a yellow tinge to your skin and eyes severe agitation and confusion hallucinations seeing or hearing things that are not real psychosis  being unable to tell the difference between reality and your imagination excessive sweating chest pain muscle weakness A thyroid storm is a medical emergency. If you think you or someone in your care is experiencing this complication, you need to phone 999 for an ambulance. Source: NHS 24 - Opens in new browser window Last updated: 01 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Underactive thyroid Other health sites British Thyroid Foundation NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Pagets disease of the nipple,"""Paget's disease of the nipple - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Pagets disease of the nipple Pagets disease of the nipple About Pagets disease of the nipple Diagnosing Pagets disease of the nipple Treating Pagets disease of the nipple Preventing Pagets disease of the nipple About Pagets disease of the nipple Pagets disease of the nipple, also known as Pagets disease of the breast, is a rare type of breast cancer. The term Pagets disease of the nipple is used to distinguish the condition fromPagets disease of the bone, whichoccurs when the normal cycle of bone growth is disrupted, leading to the bones becoming weak and deformed. A similar type of skin cancer can also occur in other parts of the body. The rest of this section will use the term Pagets disease to refer to Pagets disease of the nipple or breast. Symptoms of Pagets disease Pagets disease usually affects the skin of one nipple andproduces eczema-like symptoms , appearing as an itchy, red rash on the nipple that can extend to the darker area of surrounding skin (the areola). It can also appear as a small ulcer or dry, red, flaky patches of skin similar to psoriasis . Other possible symptoms include: itchiness or a burning sensation  alongside visible changes to the nipple bleeding from the skin of the nipple If youre experiencing itchiness, burning or bleeding but the nipple looks normal and isnt red, dry or scaly  this is extremely unlikely to be Pagets disease but should still be checked by a doctor. Causes of Pagets disease Pagets disease is usually a sign of breast cancer in tissue behind the nipple, or breast tissue away from the nipple. The breast cancer can either be: invasive where cancerous cells invade the surrounding breast tissue non-invasive where the cancerous cells are contained in one or more areas of the breast and are unable to spread In a small amount of cases, the only evidence of Pagets disease is the nipple changes. In about half of all cases of Pagets disease of the nipple, a lump is found in the breast. The majority of people with a lump will have invasive breast cancer, although this does not necessarily mean it has spread. Most people with Pagets disease of the nipple who dont have a lump will have non-invasive breast cancer. Diagnosing Pagets disease You should visit your GP if you notice any changes in the skin of your nipple or areola (the darker area of skin around the nipple). As Pagets disease is a form of breast cancer, the sooner its diagnosed, the better the outcome is likely to be. Speak to your GP if you develop a lump in your breast. While most breast lumps are not cancerous, its importantyou have it checked out. Read more about: the symptoms of breast cancer how Pagets disease is diagnosed Treating Pagets disease Pagets disease is treated in the same way as breast cancer. Surgery isusually the first line of treatment but unlike other forms of breast cancer, it involves removing breast tissue that includes the nipple and areola. This may be followed by a combination of: chemotherapy  where powerful medication is used to destroy cancerous cells radiotherapy  where controlled doses of high-energy radiation are used to destroy cancerous cells biological or hormone therapy  which can be used to treat certain types of cancer If Pagets disease is detected and treated in its early stages, theres a good chance of recovery. Read more about how Pagets disease is treated. Preventing Pagets disease Modifying certain lifestyle factors, such as reducing alcohol intake and regular exercise, may reduce your risk of developing certain types of cancer , including breast cancer. However, these factors remain controversial. Screening is also used to help detect breast cancer early. The NHS Breast Screening Programme provides free breast screening every 3 years for all women in the UK who are 47 years of age or over. Read more about preventing breast cancer . Risk factors for breast cancer There are a number of factors that can increase your risk of developing breast cancer. These include: age  your risk of developing breast cancer increases as you get older family history  if you have a number of close relatives with breast cancer, your chances of also developing the condition are increased previously being diagnosed with breast cancer previously having a benign breast lump  certain types of benign lump may slightly increase your risk but this is only seen in a small number of women being overweight  which is especially significant in post-menopausal women alcohol  your risk of developing breast cancer can increase with the amount of alcohol you drink Information about you If you have Pagets disease of the nipple, your clinical team will pass information about you on to the National Congenital Anomaly and Rare Diseases Registration Service (NCARDRS). This helps scientists look for better ways to prevent and treat this condition. You can opt out of the register at any time. Find out more about the register . Diagnosing Pagets disease of the nipple As Pagets disease of the nipple is usually a sign of breast cancer, its very important you speak to your GP if you notice changes to the tissue or skin of your breast. In particular, you should tell your GP if you notice any changes to: the skin of your nipple or areola (the darker area of skin around thenipple) your breasts, particularlylumps in your breast Pagets disease of the nipple can sometimes be confused with eczema , a skin condition that alsocauses red, itchy and dry skin. Therefore, you should visit your GP for a diagnosis ratherthan assuming you have eczema. Pagets disease is a formof breast cancer andthe sooner its diagnosed, the better the outcome is likely to be. Your GP will examine both breasts, even if you only have a problem withone of them. They may also ask you: about your symptoms and how long you have had them whether you have a history of eczema, or have eczema anywhere else on your body whether you have a personal or family history of breast cancer your age and whether you have experienced the menopause (when a womans monthly periods stop) whether youre taking any medication, including hormone replacement therapy (HRT) , which is used to treat some of the symptoms of the menopause, or the oral contraceptive pill how much alcohol you drink how much you weigh and if you have recently gained weight If your GP thinks you may have breast cancer, they will refer you to a specialist breast clinic for tests. Breast clinic When you visit a breast clinic you will have tests to find out whether you have breast cancer and, if you have,what type of breast cancer. Staff at the clinic may take photographs of your breasts to record their current appearance and to help identify any further changes that may occur. Tests carried out at the clinic may include the following: an examination of your breast to check for lumps or other abnormalities amammogram (if you are35 years of age or over) an ultrasound scan  which is the first line of investigation used in younger women a skin biopsy will be carried out if Pagets disease is suspected Mammogram A mammogram is a simple procedure that uses X-rays to create an image of the inside of your breasts. It can identify early changes in your breast tissue when it may be difficult to feel a lump. Younger women oftenhave denser breasts than older women, which can make identifying changes more difficult. Therefore, mammograms are not as effective in women under 35 years of age. If youre under 35, your doctor may suggest you have a breast ultrasound instead. However after a diagnosis of Pagets disease has been confirmed, mammography will become an important part of pre-surgery assessment. Duringa mammogram, the radiographer will position 1 of your breasts on a flat X-ray plate. A second X-ray plate will press down on your breast from above, so that it is temporarily compressed and flattened between the 2 plates. An X-ray will be taken, which will give a clear image of the inside of your breast. The procedure will then be carried out on your other breast. Having a mammogram can be slightly uncomfortable or even painful, but the procedure will only take a few minutes. Your doctor will examine the image produced by a mammogram for indications of cancer. Breast ultrasound If you are under35 years of age, a breast ultrasound may be recommended. This is because your breast tissue may be too dense for a mammogram. Your doctor may also suggest a breast ultrasound if they need to find out whether a lump in your breast is solid or contains liquid. Ultrasound uses high-frequency sound waves to produce an image of the inside of your breasts. An ultrasound probe or sensor will be placed over your breasts to create an image on a screen. The image will show any lumps or abnormalitiespresent in your breasts. Skin biopsy Askin biopsy is used to diagnose Pagets disease. A biopsy is where a small sample of tissue is taken for examination under a microscope and tests to see if it is cancerous. Further tests There are a number of other tests that can be used if a diagnosis of breast cancer is confirmed and help determine what types of treatment might be used. Treating Pagets disease of the nipple Pagets disease of the nipple is often associated with other forms of breast cancer. Its usuallytreated in the same way as more common types of breast cancer, either by removing the cancerous section of the breast or sometimes by removing the entire breast  a procedure known as a mastectomy. You can discuss any concerns you have with your oncologist (cancer specialist) who will be able to explain each phase of your treatment. Surgery If youre diagnosed with Pagets disease, surgery is often the first form of treatment you will receive. There are 2 main types of surgery. They are: mastectomy  surgery to remove the whole breast, which can be followed by reconstructive surgery to recreate the removed breast breast-conserving surgery  surgery to remove the cancerous lump (tumour) in your breast These types of surgery will also involve removing your nipple and the darker area of skin surrounding it (the areola). Mastectomy A mastectomy removes all your breast tissue, including your nipple. You may need to have a mastectomy if: the tumour is large or in the centre ofyour breast there is more than one area of breast cancer breast-conserving surgery (see below) is not able to provide acceptable results If lymph nodes (small glands) are removed from your armpit during a mastectomy, the scarring may block the filtering action of the lymph nodes, resulting in a condition called lymphoedema. This is a long-term condition, but can be treated with: massage compression sleeves  tightly fitting bandages that push excess fluid out of your arm Lymphoedema can develop months or sometimes years after surgery. See your breast care nurse or GP if you notice any swelling in your arm or hand on the side of your operation. Breast-conserving surgery Breast-conserving surgery aims to save as much of your breast as possible while removing the cancer with a rim of healthy tissue. If you have Pagets disease, your nipple and areola will be removed. You should be offered reconstructive surgery to improve the appearance of your breast after surgery. If you have breast-conserving surgery, the amount of breast tissue removed will depend on: the size of the tumour in relation to the size of your breast whether the tumour is in one place or scattered throughout your breast Your surgeon will remove an area of healthy breast tissue around the cancer so it can be tested for traces of cancer. If cancer cells are found in the surrounding tissue, you may need to have more tissue surgically removed from your breast. After having breast-conserving surgery, its likely you will need radiation treatment ( radiotherapy ) to destroy any remaining cancer cells. Breast reconstruction If you have a mastectomy, you may be able to have reconstructive surgery to recreate your breast. This can be done by: inserting a breast implant using tissue from another part of your body to create a new breast The reconstruction can be carried out at the time of your mastectomy or at a later stage. You should discuss your options fully with your surgeon and breast nurse before making a decision. For example, it may be possible to have reconstructive surgery after breast-conserving surgery to improve the appearance of your breast and create a nipple. Creating a nipple A nipple can be created by: having a nipple tattooed onto the skin using your own body tissue, such as tissue from your other nipple, although around half of these flatten out and shrink over time using a stick-on latex (rubber) nipple, which can be made from a mould of your other nipple so thatthey are identical; you stick it on every day with glue and it can be removed for washing Prostheses If you decide not to have breast reconstruction, you can wear a false breast or breast prosthesis, which are available free on the NHS. After having a mastectomy, you may have a temporary, fibre-filled prosthesis and a permanent prosthesis made from silicone, which can be replaced every 2 years. Further treatment After your surgery, you may need further treatment if you have invasive breast cancer, where the cancerous cells have spread into other tissue in your breast. If you had non-invasive breast cancer, where the breast cancer cells were contained in one area of your breast, surgery may be all the treatment you need. Other types of treatment for breast cancer include: chemotherapy  cytotoxic medication that prevents cancer cells from dividing and growing is used to destroy cancer cells radiotherapy  where controlled doses of high-energy radiation, usually X-rays , are used to destroy cancer cells biological therapy  if your breast cancer is HER2 positive, biological therapy, usually a medication called trastuzumab, can be used to treat the cancer by stopping the effects of HER2 and helping your immune system fight off cancer cells hormone therapy  if your breast cancer is hormone-receptor positive, hormone therapy can be used to treat the cancer by lowering the levels of hormones in your body or stopping their effects Preventing Pagets disease of the nipple A number of factors can help reduce your risk of developing breast cancer, including Pagets disease of the nipple. Diet and lifestyle Exercising regularly and eating a healthy, balanceddiet are knownto help preventmany forms of cancer, as well as other serioushealth conditions, such as heart disease and diabetes . Studies have looked at the link betweenbreast cancerand diet and, although there are no definite conclusions at the moment, there are benefits for women who maintain a healthy weight , do regular exercise and who have a low intake of saturated fat and alcohol . It has been suggested that exercising regularly (a minimum of 150 minutes or 2 hours 30 minutes a week)can reduce your risk of developing breast cancer byup toa third. If you have been through the menopause (when your monthly periods stop), its particularly important you are not overweight or obese. This is because these conditions cause more oestrogen to be produced, which can increase the risk of breast cancer. Breastfeeding Studies have shown that women who breastfeed are statistically less likely to develop breast cancer than those who dont. The reasons are not fully understood, but it could be because women dont ovulate as regularly while they are breastfeeding and oestrogen levels remain stable. Medication In June 2013, the National Institute for Health and Care Excellence (NICE) announced that two medications, called tamoxifen and raloxifene, would be available on the NHS for women who have an increased risk of developing breast cancer. Either tamoxifen or raloxifene can be used in women who have been through the menopause, but only tamoxifen should be used in women who havent. These medications may not be suitable if in the past you have had blood clotsor womb cancer , or if you have an increased risk of developing these problems in the future. Women who have already had a mastectomy to remove both breasts wont be offered these medications because their risk of developing breast cancer is so small. A course of treatment with tamoxifen or raloxifene will usually involve taking a tablet every day for 5 years. Raloxifene can cause side effects including flu-like symptoms, hot flushes and leg cramps. Side effects of tamoxifen can include hot flushes and sweats, changes to your periods and nausea and vomiting. Your chances of giving birth to a child with birth defects increases while youre taking tamoxifen, so youll be advised to stop taking it at least 2 months before trying for a baby. The medication can also increase your risk of blood clots so you should stop taking it 6 weeks before any planned surgery. Currently, these 2 medications are not licensed for the purpose of reducing the risk of breast cancer in women with an increased risk of developing the condition. However, they can still be used if you understand the benefits and risks and your doctor believes the treatment will be helpful. Breast screening Breast screening can pick up breast cancer before it forms a lump. The procedure uses mammograms, where X-rays are taken,to create an image of the inside of your breasts. TheNHS Breast Screening Programme provides free breast screening every 3 years for all women in the UK who are 50 years of age or over. The NHS has recently extended the breast screening age range so that all women who are 47to 73 years of age will be eligible for breast screening. NHS breast screening is not usually available for women under 47 years of age. This is because younger women tend to have denser breast tissue which makes mammograms less effective at identifying abnormalities. Speak to your GP if you are below screening age, worried about changes in your breasts, orhave a family history of breast cancer. Read more information about breast cancer screening . Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Mastectomy Other health sites Get Checked Early: Breast cancer Macmillan Cancer Support: Family history, genes and cancer risk healthtalk: Breast cancer in women Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Pancreatic cancer,"Pancreatic cancer | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Pancreatic cancer Pancreatic cancer About pancreatic cancer Treating pancreatic cancer Symptoms of pancreatic cancer Causes of pancreatic cancer Diagnosing pancreatic cancer Recovering pancreatic cancer About pancreatic cancer Pancreatic cancer is caused by the abnormal and uncontrolled growth of cells in the pancreas  a large gland thats part of the digestive system. Around half of all new cases are diagnosed in people aged 75 or over. Its uncommonin people under 40 years of age. Symptoms of pancreatic cancer In the early stages, a tumour in the pancreas doesnt usually cause any symptoms, whichcan make it difficult to diagnose. Its important to remember that these symptoms can be caused by many different conditions, and arent usually the result of cancer.But you should contact your GP if youre concerned, or if these symptoms start suddenly. The first noticeable symptoms of pancreatic cancer are often: pain in the back or stomach areawhich may come and go at first and is often worse when you lie down or after youve eaten unexpected weight loss jaundice the most obvious sign is yellowing of the skin and whites of the eyes;it also causes your urine to be dark yellow or orange and your stools (faeces) to be pale-coloured Other possible symptoms of pancreatic cancer include: nausea and vomiting bowel changes fever and shivering indigestion blood clots You may also develop symptoms of diabetes if you havepancreatic cancer, because it can produce chemicals that interfere with the normal effect of insulin. Endocrine pancreatic cancer There are also anumber of different endocrine tumours that cause different symptoms, depending on the hormone the tumour produces. Causes of pancreatic cancer Its not fully understood what causes pancreatic cancer, but a number of risk factors for developing the condition have been identified. Risk factors for pancreatic cancer include: ageit mainly affects people who are 50 to 80 years of age smoking  around 1 in 3 casesis associated with using cigarettes, cigars or chewing tobacco having a history of certain health conditionssuch as diabetes , chronic pancreatitis (long-term inflammation of the pancreas), stomach ulcer and Helicobacter pylori infection (a stomach infection) In about 1 in 10 cases, pancreatic cancer is inherited from a persons parents. Certain genes also increase your chances of getting pancreatitis, which in turn increases your risk of developing cancer of the pancreas. Cancer Research UK has more information on risk factors and causes on their website Diagnosing pancreatic cancer Your GP will first ask about your general health and carry out a physical examination. Theymay examine your tummy (abdomen) for a lump and to see whether your liver is enlarged. Theyll also check your skin and eyesfor signs ofjaundice andmay request a urine sample and blood test . If your GP suspects pancreatic cancer, youll usually be referred to a specialist at a hospital for further investigation. You may have either: an ultrasound scan a computerised tomography (CT) scan a magnetic resonance imaging (MRI) scan apositron emission tomography (PET) scan where youre given an injection of a very small amount of radioactive medication, known as a tracer, which helps to show up cancers in an image Depending on the results of a scan, further tests may include: anendoluminal ultrasonography (EUS)endoscopy a type of endoscopywhich allowsclose-up ultrasound pictures to be taken of your pancreas an endoscopic retrograde cholangiopancreatography (ERCP) a type of endoscopywhich is used to inject a special dye into your bile and pancreatic ducts; the dye will show up on an X-ray and highlight any tumours alaparoscopy a surgical procedure that allows the surgeon to see inside your body using a laparoscopy(a thin,flexible microscope) A biopsy , where a small sample is taken from a suspected tumour, may also be carried out during these procedures. NICE guidelines In 2015, the National Institute for Health and Care Excellence (NICE) published guidelines to help GPs recognise the signs and symptoms of pancreatic cancer and refer people for the right tests faster. To find out if you should be referred for further tests for suspected pancreatic cancer, read the NICE 2015 guidelines on Suspected Cancer: Recognition and Referral . Treating pancreatic cancer Cancer of the pancreas is difficult to treat. Itrarely causes any symptoms in the early stages, so its often not detected until the cancer is fairly advanced. If the tumour islarge, treating the cancer will be more difficult. If youve been diagnosed with pancreatic cancer, your treatmentwill depend on the type and location of your cancer, and how far its advanced. Your age, general health and personal preferences will also be taken into consideration. The first aim will be to completely remove the tumour and any other cancerous cells. If this isnt possible, treatment will focus on preventing thetumour growing and causing further harm to your body. The 3 main treatments for pancreatic cancer are: surgery chemotherapy radiotherapy Some types of pancreatic cancer only require one form of treatment, whereas others may require2types of treatment or a combination of all 3. Read more about treating pancreatic cancer . Recovering from surgery Recovering from pancreatic cancer surgery can be a long and difficult process. Youll probably experience some pain after your operation. The staff at your hospital will make sure you have adequate pain relief. After any type of surgery to your digestive system, your bowel will temporarily stop working. This means you wont be able to eat or drink straight away. Youll gradually be able to sip fluids, before eventually being able to drink and eat more regularly. You maybe referred to a dietitian, who can advise you about what foods you should eat following your operation. After the tumour has been removed, youll probably have a six-month course of chemotherapy , which greatly increases your chance of being cured.But becausecancer of the pancreas is difficult to diagnose and treat, many people dont recovercompletely. Treatment can be very effective in helping to ease symptoms and make you as comfortable as possible. Chemotherapy can help shrink your tumour and slow down its growth. Treating pancreatic cancer Treatment for pancreatic cancer depends on the type, location and stage of your cancer (how far its spread). Your age, general health and personal preferences will also be taken into consideration when deciding on your treatment plan. The first aim will be to completely remove the tumour and any other cancerous cells in your body. If this isnt possible, the focus will be on preventing the tumour growing and causing further harm. Sometimes its notpossible to get rid of the cancer or slow it down,so treatment will aim to relieve your symptoms and make you as comfortable as possible. Cancer of the pancreas is very difficult to treat. In its early stages, this type of cancer rarely causes symptoms, so its often not detected until its quite advanced. If the tumour is large or has spread, treating or curing the cancer is much harder. Discussing your treatment Deciding what treatment is best for you can be a difficult process. Theres a lot to take in, so its important to talk about the possible alternatives with a family member or friend. You should also have an in-depthdiscussion with your doctor, who can tell you the pros andcons of the treatments available to you. If at any stage you dont understand the treatment options being explained to you, make sure you ask your doctor for more details. There are 3 main ways that cancer of the pancreas can be treated: surgery chemotherapy radiotherapy Some types of pancreatic cancer only require one form of treatment, whereas others may require 2 or a combination of all 3. Cancer Research UKhas more information about types of treatment for pancreatic cancer . Surgery Surgery is usually the only waypancreatic cancer can be completely cured. However, as the condition is usually advanced by the time its diagnosed, surgery is only suitable for around 15 to 20% of people. However, this isnt a suitable optionif your tumour has wrapped itself around important blood vessels. If your cancer has spread to other areas of the body, surgically removing the tumour wont cure you. Surgery for pancreatic cancer is usually only an option for people who have a good general level ofhealth. This is because pancreas surgery is often long and complex, and the recovery process can be slow. Sometimesthe risks of surgerycan outweigh the potential benefits. Your doctor will discuss with you whether surgery is a suitable option. Whipple procedure The Whipple procedure is the most common operation used to treat pancreatic cancer, and involves removing the head of the pancreas. Your surgeon must also remove the first part of your small intestine (bowel), your gall bladder (which storesbile)and part of your bile duct. Sometimes, part of the stomach also has to be removed. The end of the bile duct and the remaining part of your pancreas is connected to your small intestine. Thisallows bile and the hormones and enzymes produced by the pancreas to still be released intoyour system. After this type of surgery, about one in three people need to take enzymes to help them digest food. The Whipple procedure involves long and intensive surgery, but its easier to recover from than a total pancreatectomy. Distal pancreatectomy A distal pancreatectomy involvesremoving the tail and body of your pancreas. Your spleen will usually also be removed at the same time. Part of your stomach, bowel, left adrenal gland, left kidney and left diaphragm (the muscle that separates the chest cavity from the abdomen) may also be removed. Like the Whipple procedure, a distal pancreatectomy is a long and complex operationthat wont be carried outunless your doctor thinks its necessary. Total pancreatectomy During a total pancreatectomy, your entire pancreas will be removed. This is sometimes necessary due to the position of the tumour. Your surgeon will also remove your: bile duct gall bladder spleen part of your small intestine part of your stomach (sometimes) surrounding lymph nodes (part of the immune system) After a total pancreatectomy, youll need to take enzymes to help your digestive system digest food. Youll also have diabetes for the rest of your life because the pancreas produces insulinthe hormone that regulates blood sugar. Removing your spleen can increase your risk of developing infections and may also affect your bloods ability to clot. This means youll be on penicillin (or an alternative antibiotic if youre allergic to it) for the rest of your life, and youll need to have regular vaccinations. Sometimes, you may need to take tablets for a short period to stop the platelets in your blood sticking to each other. Platelets are a type of bloodcellthat cause your blood to clot (thicken). Surgery to ease your symptoms Although surgery may not be a suitable way of removing your tumour, you may be offeredit to help ease your symptoms. This type of surgery wont cure your cancer, but will mean that your condition is easier to manage, and it will make you more comfortable. To help control jaundice, a stent can be placed in your bile duct using endoscopic retrograde cholangiopancreatography (ERCP). This will help keep the bile duct open and prevent bilirubinthe yellow chemical in bilefrom building up and causing jaundice. If a stent isnt a suitable option for you, you may need an operation to bypass your blocked bile duct. Your surgeon will cut the bile duct just above the blockage and reconnect it to your intestine, which allows your bile to drain away. These types of surgery are much less intensive than surgery carried out on the pancreas. The recovery time is much quicker, andpeople find that theirjaundice improves significantly. Chemotherapy Chemotherapyis a type of cancer treatment that uses anti-cancer medicines to either kill the cancerous (malignant) cells in your body or stop themmultiplying. Chemotherapy treatment is often used alongside surgery and radiotherapy (see below) to help ensure that as much of the cancer is treated as possible. Chemotherapy may be given: before surgeryto try to shrink the cancer, so theres a greater chance of the surgeon being able to remove all of the cancer after surgeryto help reduce the risk of the cancer coming back when surgery isnt possibleto try to shrink the cancer, slow its growth and relieve your symptoms Some chemotherapy medicines can be taken orally (by mouth), but some need to be given directly into a vein (intravenously). Chemotherapy also attacksnormal, healthy cells, which is why this type of treatment can have many side effects. The most common side effects include: vomiting nausea mouth sores fatigue increased risk of infection These are usually only temporary, and should improve once youve completed your treatment. The chemotherapy medications can also be used in combination, so your doctor may suggest using one medication or a combination of 2 or 3. Combining chemotherapy medications can give a better chance of shrinking or controlling the cancer, but increases the chance of side effects.Sometimes, the risks of chemotherapy can outweigh the potential benefits. Read more about chemotherapy Radiotherapy Radiotherapyis a form of cancer therapy that uses high-energy beams of radiation to help shrink your tumour and relieve pain. Side effects of radiotherapycan include: fatigue skin rashes loss of appetite diarrhoea nausea or vomiting These side effects are usually only temporary, and should improve after your treatment has been completed. Read more about radiotherapy Symptoms of pancreatic cancer In its early stages, pancreatic cancer rarely causes symptoms. The pancreas is actually 2 glands in one, and symptoms depend on which part is affected. This is because: the exocrine pancreas produces digestive enzymes, which break down food so they can be absorbed by your body the endocrine pancreas produces hormones  including insulin, which keeps your blood sugar levels stable Most casesof pancreatic cancer arein the exocrine pancreas, and the 3 most common symptoms are: pain in the stomach orback jaundice weight loss Its important to remember that these symptoms can be caused by many different health conditions and arent usually the result of cancer.However, you should contact your GP if youre concerned, or if yousuddenly develop these symptoms. Pain in the stomach orback Pancreatic cancer can cause a dull pain in your upper tummy (abdomen), which mayspread to your back. To begin with, the pain may come and go, but as the tumour becomes larger and more advanced, the pain may be more constant and last longer. The pain is often worse when you lie down or after youve eaten. You may also have pain or tenderness in your abdomen if your liver, pancreas or gallbladder are enlarged. Weight loss Many types of cancer cause weight loss, because the cancerous cells deprive your healthy cells of the nutrients they need. Pancreatic cancer is more likely to cause weight loss than some other cancers because the pancreas produces digestive enzymes, which help food to be absorbed into your body. If a tumour disrupts that production, your body will find it harder to digest food, particularly high-fat foods. This can cause you to lose weight and becomemalnourished. Jaundice Jaundice is caused by a build-up of a yellowish-brown substance called bilirubin in the blood and tissues of the body. The most obvious sign of jaundice is yellow skin and yellowing of the whites of the eyes. It also causes your urine to be dark yellow or orange and your stools (faeces) to be pale-coloured. Bilirubin is a waste product produced by the liver, and passed out of the body through the bile duct andinto the intestine. Jaundice is more often a sign of conditions such as gallstones or hepatitis than it is of cancer. However, a tumour can sometimes develop in the head of the pancreas and block the bile duct, causing bilirubin to build upin the body. Diabetes The pancreas produces thehormoneinsulin. Without it, the body cant move glucose (sugar) out of the blood and into your cells. The main symptoms of diabetes include: excessive thirst urinating frequently  particularly at night extreme tiredness weight loss and loss of muscle bulk You may develop diabetes if you havepancreatic cancer, because it can produce chemicals that interfere with the normal effect of insulin. Other possible symptoms Other possible symptoms of pancreatic cancer include: itching (if you have jaundice) nausea and vomiting bowel changes fever and shivering indigestion blood clots Endocrine pancreatic cancer Endocrine pancreatic tumours, also known as neuroendocrine tumours, are uncommon. There are a number of different endocrine tumours that cause different symptoms, depending on the hormone the tumour produces. Causes of pancreatic cancer The exact cause of pancreatic cancer isnt fully understood. However, there are a number of risk factorsthat can increase your chances of developing it. Age Pancreatic cancer can affect people of any age, but itmainly affects people who are aged 50 to 80. Almost 50% of people diagnosed with cancer of the pancreas are aged 75 or over. Smoking Research has found that about one in three cases of pancreatic cancer is associated with smoking and other tobacco use. Smoking cigarettes, cigars or chewing tobacco can all increase your risk of developing cancer of the pancreas. This is because tobacco smoke contains harmful chemicals and toxins that can cause irritation and inflammationwithin your bodys organs andtissues. Diabetes If you have diabetes , your risk of developing pancreatic cancer is thought to beincreased. However, its important to remember that diabetes is very common and most people with diabetes wont develop pancreatic cancer. As well as diabetes being a risk factor for pancreatic cancer, its also thought that a cancerous tumour that grows in the pancreas could be responsible for some cases of diabetes. Chronic pancreatitis and hereditary pancreatitis Chronicpancreatitis (long-term inflammation of the pancreas) increases your risk of getting pancreatic cancer, butisnt responsible for many cases. Chronic pancreatitis is often caused by long-term alcohol misuse . Although its a veryrare condition, if you have hereditary pancreatitis, yourrisk of developing pancreatic cancer is 50 times greater than the rest of the population. Helicobacter pylori infection Helicobacter pylori are bacteria that cause stomach ulcers, and is a known risk factor for stomach cancer. Research has shown that a Helicobacter pylori infection may slightlyincrease your risk of getting pancreatic cancer. However, the risk is thought to be small because most people withthis infection dont get cancer of the pancreas. Other known risk factors There are also a number of other factors that have been associated with an increased risk of pancreatic cancer. These are: long-term hepatitis tooth or gum disease heavy alcohol use a previous history of certain types of cancer previously having radiotherapy diet , weight and level of physical activity The Cancer Research UK website hasmore information about these other possible risk factors for pancreatic cancer . Diagnosing pancreatic cancer In the early stages, pancreatic cancer often causes no symptoms. This can make it difficult to diagnose. If you visit your GP with symptoms of pancreatic cancer ,they will probably examine your eyes and skin for signs of jaundice. They may also test your urine for bile, or carry out a blood test . This is because jaundice can sometimes be a sign of pancreatic cancer. Your GP may also examine your tummy (abdomen) to feel for any swelling or abnormality. The pancreas is quite well-hidden within the body because its covered by part of the bowel. This can make it difficult to feel for tumours during a physical examination. Ifyour GP suspects pancreatic cancer, youll be referred for further testing at a hospital. In 2015, the National Institute for Health and Care Excellence ( NICE ) published guidelines to help GPs recognise the signs and symptoms of pancreatic cancer and refer people for the right tests faster. To find out if you should be referred for further tests for suspected pancreatic cancer, read the NICE 2015 guidelines on Suspected Cancer: Recognition and Referral . Ultrasound scan An ultrasound scan is a painless procedure that uses high-frequency sound waves to produce an image of the inside of your body. Ifpancreatic cancer is suspected, youll be referred for an ultrasound scan of your abdomen to see if your pancreas appears abnormal. However, this type of scan can often miss pancreatic cancer, because ultrasound waves arent very goodat penetrating deep into body tissues. Computerised tomography (CT) scan A computerised tomography (CT)scan produces a detailed image of the inside of your body using a series of X-ray images. Your doctor can use the results of a CTscan to check for abnormalities and assess the size of the tumour. Magnetic resonance imaging (MRI) scan A magnetic resonance imaging (MRI) scan also produces an image of the inside of your body, but it uses strong magnetic and radio waves instead of X-rays. MRI scans are carried out in a tube-shapedMRI scanner. Its a noisy procedure thatcan feel claustrophobic. It also takes longer than other types ofscans. Like a CT scan, an MRI scan allows your doctor to check for signs of cancer in other parts of the body. Positron emission tomography (PET) scan A positron emission tomography (PET) scan can help to show where the cancer is and whether it has spread to other parts of the body. Before the scan, youll be given an injection of a very small amount of a radioactive medication, known asa tracer. The amount ofradiation is very small and no more than you would receive from a normal X-ray. The most common tracer used is a radioactive form of glucose (sugar).Youll then rest for about an hour to allow the tracer to travel to areas in your body where glucose is used for energy. The scan itself can take up to an hour and produces an image of the tracer in your body. The tracer shows up cancers because they use glucose in a different way to normal tissue. Endoluminal ultrasonography (EUS) If a small shadow is seen on a CT or MRI scan but its not obvious what itis, another test called endoluminal ultrasonography (EUS) can be carried out. During EUS, a thin, flexibleinstrument calledan endoscope is passed through your mouth and guided towards your stomach. An ultrasound probe attached to the tip of the endoscope will then be used to take close-up pictures of your pancreas. Before the procedure, you may be given a sedative to help you relax. EUS can also be used to take a biopsy for further examination. Endoscopic retrograde cholangiopancreatography (ERCP) Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure used to insert a plastic tube or stent into the bile duct ifsomeone hasjaundice. During ERCP, an endoscope is passed through your mouth and guided towards your stomach. The endoscope can then be used to inject a special dye into your bile and pancreatic ducts. After the dye has been injected, an X-ray will be taken. The dye will show up on the X-ray and will highlight any tumour thats blocking the bile and pancreatic ducts. During the procedure, tissue samples may be taken. These samples can be looked at under a microscope to see whether the cells are cancerous. ERCP can take 30 to 60 minutes. As with EUS, youll usually be given a sedative to help you relax. Laparoscopy Alaparoscopy is a surgical procedure that allows the surgeon to access the inside of your abdomen and pelvis. During the procedure, a smallincision will be made in your abdomen, and a laparoscope (a thin,flexible microscope) will be inserted. This will allow the surgeon to see inside your body and make sure the tumour hasnt spread before recommending its removal. This procedure will be carried outunder a general anaesthetic (where youre put to sleep so you dont feel any pain or discomfort). Biopsy A biopsy involves taking a sample from a suspected tumour, whichcan then be tested to see if its cancerous (malignant) or non-cancerous (benign). A biopsy can be carried out during an EUS, ERCP or laparoscopy usinga small instrument attached to the endoscope to collect a number of cells. Its also possible for abiopsy to be carried out using a long, thin needle thats passed through your abdomen. The needle will be guided towards the tumour using an ultrasound or CT scan. Recovering pancreatic cancer Recovering from pancreatic cancer surgery can be a long and difficult process. Youll probably experience some pain after your operation. The staff at your hospital will make sure you have adequate pain relief. After any type of surgery to your digestive system, your bowel will temporarily stop working. This means you wont be able to eat or drink straight away. Youll gradually be able to sip fluids, before eventually being able to drink and eat more regularly. You maybe referred to a dietitian, who can advise you about what foods you should eat following your operation. After the tumour has been removed, you will probably have a 6-month course of chemotherapy , which greatly increases your chance of being cured. However, as cancer of the pancreas is difficult to diagnose and treat, many people dont recovercompletely. Treatment can be very effective in helping to ease symptoms and make you as comfortable as possible. Chemotherapy can help shrink your tumour and slow down its growth. 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Panic disorder,"Panic disorder | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Mental health Panic disorder Panic disorder Introduction Symptoms Causes Diagnosis Treatment Things you can do to help yourself Complications Introduction Panic disorder is where you have recurring and regular panic attacks, often for no apparent reason. Everyone experiences feelings ofanxiety and panic at certain times during their lifetime. Its a natural response to stressful ordangerous situations. However, for someone with panic disorder, feelings of anxiety, stress and panic occur regularly and at any time. Anxiety Anxiety is a feeling of unease. It can range from mild to severe and can include feelings of worry and fear. There are several conditions that can cause severe anxiety including phobias  an extreme or irrational fear of an object, place, situation, feeling or animal generalised anxiety disorder (GAD)  a long-term condition that causes excessive anxiety and worry relating to a variety of situations post-traumatic stress disorder  a condition with psychological and physical symptoms caused by distressing or frightening events Panic attacks A panic attack occurs when your body experiences a rush of intense psychological (mental) and physical symptoms. You may experience an overwhelming sense of fear, apprehension and anxiety. As well as these feelings, you may also have physical symptoms such as: nausea sweating trembling a sensation that your heart is beating irregularly (palpitations) The number of panic attacks you have will depend on how severe your condition is. Some people may have one or two attacks each month, while others may have several attacks a week. Read more about the symptoms of panic disorder . Panic attacks can be very frightening and intense, but theyre not dangerous. An attack wont cause you any physical harm, and its unlikely that youll be admitted to hospital if youve had a panic attack. What causes panic disorder? As with many mental health conditions, the exact cause of panic disorder isnt fully understood. However, its thought the condition is probably linked to a combination of physical and psychological factors. Read about the possible causes of panic disorder . Its important to be aware that some physical conditions and disorders can have similar symptoms to those of anxiety. For example: mitral valve prolapse postural orthostatic tachycardic syndrome (POTS) anaemia paroxysmal atrial tachycardia  episodes of rapid and regular heartbeats that begin and end abruptly thyrotoxicosis  where large amounts of thyroid hormones are released into the bloodstream, causing rapid heartbeat, sweating , tremor and anxiety poorly controlled diabetes adrenal tumours  growths that develop on the adrenal glands (two triangular-shaped glands that form part of the kidneys) carcinoid syndrome  a set of symptoms caused by some carcinoid tumours that can develop in the cells of the endocrine system (glands that produce and secrete hormones) Zollinger-Ellison syndrome  causes overproduction of insulin and low blood sugar ( hypoglycaemia ) Diagnosing panic disorder See your GP if you have symptoms of anxiety or panic disorder (see above). You may be diagnosed with panic disorder if you experience recurrent and unexpected panic attacks followed by at least one month of continuous worry or concern about having further attacks. Read more about how panic disorder is diagnosed . Treating panic disorder The aim of treating panic disorder is to reduce the number of panic attacks you have and ease the severity of your symptoms. Psychological therapy and medication are the two main types of treatment for panic disorder. Read more about treating panic disorder and things you can do to help yourself during a panic attack . Having panic disorder may affect your ability to drive. Its your legal obligation to inform the Driver and Vehicle Licensing Agency (DVLA) about a medical condition that could have an impact on your driving ability. GOV.UK has further information and advice about driving with a disability or health condition . Complications of panic disorder Panic disorder is treatable, but to make a full recovery its important that you seek medical help as soon as possible. Treatment for panic disorder is much more effective if its given at an early stage. Left untreated, panic disorder can become a very debilitating and isolating illness. It can also increase your risk of developing other mental health conditions, such as agoraphobia or other phobias . Agoraphobia is a fear of being in situations where escape might be difficult, or help wouldnt be available if things go wrong. Read more about the complications of panic disorder . Symptoms The symptoms of a panic attack can be very frightening and distressing. Symptoms tend to occur suddenly, without warning and often for no apparent reason. As well as overwhelming feelings of anxiety, a panic attack can also cause a variety of othersymptoms, including: a sensation that your heart is beating irregularly ( palpitations ) sweating trembling hot flushes chills shortness of breath a choking sensation chest pain nausea dizziness feelingfaint numbness orpins and needles dry mouth a need to go to the toilet ringing in your ears a feeling of dread or a fear of dying a churning stomach a tingling sensation in your fingers shivering shaking The physical symptoms of a panic attack are unpleasant, and they can also be accompanied by thoughts of fear and terror. For this reason, people with panic disorder start to fear the next attack, whichcreates acycle of living in fear of fear and adds to the sense of panic. Sometimes, the symptoms of a panic attack can be so intense they can make you feel like youre having a heart attack . However, its important to be aware that symptoms such as a racing heartbeat and shortness of breath wont result in you having a heart attack. Although panic attacks can often be frightening, they dont cause any physical harm. People who have had panic disorder for some time usually learn to recognise this heart attack sensation andbecome more aware of how to control their symptoms. Most panic attacks last for five to 20 minutes.Some attacks have been reported to have lasted up to an hour. However, its likely that in these cases one attack occurred straight after another or high levels of anxiety were felt after the first attack. Recurrent panic attacks People with panic disorder have panic attacks on a recurring basis. Some people have attacks once or twice a month, while others have them several times a week. People with panic disorder also tend to have ongoing and constant feelings of worry and anxiety. The panic attacks associated with panic disorder can be very unpredictable. If you have panic disorder, you may alsofeelanxious about when your next attack will be. Depersonalisation During a panic attack your symptoms can be so intense and out of your control that you canfeel detached from the situation, your body and your surroundings. It can almost feel as if youre an observer, making the situation seem very unreal. This sense of detachment is known as depersonalisation. Being detached from the situation doesnt provide any relief or make a panic attack less frightening. Instead, it often makes the experience more confusing and disorientating. Causes As with many mental health conditions, the exact cause of panic disorder isnt fully understood. Its thought that panic disorder is probably caused by a combination of physical and psychological factors. Some of these factors are outlined below. Traumatic life experiences A trauma, such as bereavement , can sometimes trigger feelings of panic and anxiety. These feelings may be obvious soon after the event or they may be triggered unexpectedly years later. Genetics Having a close family member with panic disorder is thought to increase a persons risk of developing it. However, the precise nature of the risk isnt known. Neurotransmitters Neurotransmitters are chemicals that occur naturally in the brain. Its thought that an imbalance of these chemicals may increase your risk of developing conditions such as panic disorder. Increased sensitivity to carbon dioxide Some experts believe that panic disorder is linked to an increased sensitivity to carbon dioxide. Breathing in air with high carbon dioxide levels can bring on panic attacks, and breathing techniques can help to relieve or stop panic attacks. Catastrophic thinking Another theory is that people who experience panic attacks tend to focus onminor physical symptoms and interpret them in a catastrophic way. This triggers a nervous system response that causes the panic attack. Diagnosis Everyone who has panic disorder will experience panic attacks. However, not everyone who haspanic attacks is diagnosed with panic disorder. Panic attacks Some people have panic attacks in response to specific situations. For example, they may have a phobia (overwhelming fear) of enclosed spaces (claustrophobia) and have a panic attack when faced with an enclosed space. While most people with phobias only experience panic attacks when faced with the thing thattriggers their fear, the panic attacks of people with panic disorder usually occur without warning and for no obvious reason. This means that panic disorder will only be diagnosed after experiencing recurrent and unexpected panic attacks, and if the attacks are followed by at least one month of continuous worry or concern about having further attacks. Talk to your GP Your GP will ask you to describe the symptoms youve been experiencing. Theyll also ask you how often your symptoms occur and in what situations. Its important to tell your GP about how youve been feeling and how your symptoms have affected you. Although it can sometimes be difficult to talk to someone else about your feelings, emotions and personal life,try not to feel anxious or embarrassed. Your GP needs to gain a good understanding of your symptoms tomake the correct diagnosis and recommend the most appropriate treatment for you. Physical examination Your GP may also want to carry out a physical examination to look for signs of any physical conditions that could be causing your symptoms. For example, an overactive thyroid gland (hyperthyroidism) can sometimes cause similar symptoms to a panic attack. By ruling out any underlying medical conditions, your GP will be able to make the correct diagnosis. Treatment The main aim in treating panic disorder is to reduce the number of panic attacks and ease the severity of symptoms. Psychological therapy and medication are the two main types of treatment for panic disorder. Depending on your individual circumstances, you may need one of these treatment types or a combination of the two. If youre offered psychological therapy, it will probably be in the form of cognitive behavioural therapy (CBT). If this doesnt work, medication may be recommended. Before starting any form of treatment, your GP will discuss all of the options with you, outlining the advantages of each type and making you aware of any possible risks or side effects. No single treatment works for everyone and you may need to try a number of treatments before finding one that works for you. The treatment thats recommended will depend on your general level of health, the severity of your condition and your personal preferences. Its important you understand what your treatment will involve. If you dont understand something your GP has told you, ask them to explain it in more detail. Cognitive behavioural therapy Psychological therapy has proven long-term benefits and its recommended for treating panic disorder. It will usually take the form of cognitive behavioural therapy (CBT). CBT is thought to be one of the most effective psychological treatments for panic disorder. It involves having regular sessions with a therapist. The therapist may discuss with you how you react when you have a panic attack and what you think about when youre experiencing an attack. Once you and your therapist have identified any negative thoughts and beliefs, you can work on replacing them with more realistic and balanced ones. Your therapist can also teach you ways of changing your behaviour, making it easier for you to deal with future panic attacks. For example, they may be able to show you breathing techniques that can be used to help keep you calm during a panic attack. The National Institute for Health and Care Excellence (NICE) recommends a total of seven to 14 hours of CBT to be completed within a four month period. Treatment will usually involve having a weekly one to two hour session. NICE also recommends that in certain situations a shorter programme of CBT may be appropriate. This can involve a reduced number of hours of CBT with homework being set between sessions so that you can practice what youve learnt after each session. You should visit your GP regularlywhile youre having CBT so that they can assess your progress and see how youre doing. Support groups Support groups can provide useful information and advice about how you can effectively manage your panic disorder. Theyre also a good way of meeting other people whove had similar experiences of the condition. Panic attacks can sometimes be frightening and isolating, so it can be helpful to know that other people are experiencing the same feelings and emotions as you. Anxiety UK and Triumph Over Phobia (TOP UK) are UK-based charities that provide information and support for people with anxiety disorders. Support groups often involve face-to-face meetings where you can talk about your problems and difficulties with others. Many can also provide support and guidance over the telephone or in writing. Ask your GP about support groups for panic disorder near you. You can also use the services directory to find anxiety services in your area . Antidepressants Antidepressants are often associated with depression , but they can also be used to treat a number of other psychological conditions. Antidepressants can take two to four weeks before becoming effective. Its therefore important to continue taking them, even if you feel theyrenot working. You should only ever stop taking prescribed medication if your GP specifically advises you to do so. Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants are two types of antidepressants that are often recommended for treatingpanic disorder. When starting a new type of medication, you should be regularly assessed by your GP at two, four, six and 12 week intervals. This will allow you to discuss any issues that you have with your medication, and enables your GP to assess which treatment is most effective. It will also provide you with the opportunity to try a different type of medication if you want to. Selective serotonin reuptake inhibitors (SSRIs) Selective serotonin reuptake inhibitors(SSRIs) are a type of antidepressant that work by increasing the level of a chemical called serotonin in your brain. Theyre the most commonly prescribed type of antidepressant for treating panic disorder. Theyre usually started at a low dose before gradually being increased as your body adjusts to the medicine. Common side effects of SSRIs include: nausea headaches low sex drive(loss of libido) blurred vision diarrhoea or constipation dizziness dry mouth loss of appetite sweating feeling agitated insomnia (sleep problems) abdominal pain When you first start taking SSRIs, your feelings ofanxiety and panic may get slightly worse. In most cases, this is temporary and your symptoms will start to return to normal levels within a few days of taking the medicine. Speak to your GP if you feel that your symptoms have got worse and that theyre not showing signs of returning to normal levels after a few days. After you start to take a SSRI, you should visit your GP after two, four, six, and 12 weeks so that they can check on your progress and see whether youre responding to the medicine. Not everyone responds well to antidepressant medicines, so its important that your progress is carefully monitored. If your GP feels it necessary, you may require regular blood tests or blood pressure checks when taking antidepressants. If after 12 weeks of taking the medication you dont show any signs of improvement, your GP may prescribe an alternative SSRI to see if it has any effect. The length of time that youll have to take a SSRI for will vary depending on how well you respond to the treatment. Even if you feel that your panic disorder has been successfully treated, its likely that youll need to keep taking the medication for at least six to 12 months. If you stop taking your medication before this time, the risk of your symptoms recurring may be increased. Some people may have to take SSRIs for longer than the usual six to 12 month period. When you and your GP decide that its appropriate for you to stop taking SSRIs, you will gradually be weaned off them by slowly reducing your dosage. As with antidepressants, you should never stop taking SSRIsunless your GP specifically advises you to. Stopping your medication straight away without being weaned off, or without seeking advice from your GP, may result in withdrawal symptoms such as: dizziness numbness and tingling nausea and vomiting headache anxiety sleep disturbances sweating These symptoms can also occur if you miss a dose of medication, or if your dose is reduced. The symptoms are usually mild, but they can be severe if the medication is stopped suddenly. For some people, this means having to take SSRIs on a long-term basis. For others, a course of CBT can help to reduce the risk of their symptoms recurring. Contact your GP if you experience troublesome side effects thatdont ease. Tricyclic antidepressants If SSRIs arent suitable, or if your symptoms dont improve after a 12 week course of SSRIs, your GP may try prescribing a different type of antidepressant. Tricyclic antidepressants work in a similar way to SSRIs. They regulate the levels of the chemicals noradrenaline and serotonin in your brain, which has a positive effect on your feelings and mood. Imipramineandclomipramine are two tricyclic antidepressants that are often prescribed to treat panic disorder. Tricyclic antidepressants arent addictive. SSRIs are usually prescribed before tricyclic antidepressants because they have fewer side effects. Common side effects of tricyclic antidepressants include: constipation difficulty urinating blurred vision dry mouth weight gain or weight loss drowsiness sweating lightheadedness skin rash The side effects should ease after seven to 10days as your body starts to get used to the medication. However, see your GP if they become troublesome and dont ease. Pregabalin Pregabalin is another medication thats often used to treat panic disorder. Its an anticonvulsant thats also used to treat epilepsy (a condition that causes repeated seizures). However, its also been found to be beneficial in treating anxiety. Side effects of pregabalin can include: drowsiness dizziness increased appetite and weight gain blurred vision headaches dry mouth vertigo  the sensation that you, or the environment around you, are moving or spinning Pregabalin is less likely to cause nausea or a low sex drive than SSRIs. Clonazepam Clonazepam is another medication thats often used to treat epilepsy and is also sometimes prescribed for panic disorder. It can cause a wide variety of side effects including lethargy (lack of energy), abnormal eye movement (nystagmus), confusion and allergic reactions. Referral You may be referred to a mental health specialist if treatments such as attending a support group, CBT and medication dont improve your symptoms of panic disorder . A mental health specialist will carry out an overall reassessment of your condition. Theyll ask you about your previous treatment and how effective you found it. They may also ask you about things in your life that may be affecting your condition, or how much support you get from family and friends. The specialist will be able to devise a treatment plan for you, which will aim to effectively treat your symptoms. The type of mental health specialist that youll be referred to will depend on your individual situation. For example, you may be referred to a: psychiatrist  a trained medical doctor who specialises in mental health; a psychiatrist is one of the only mental health specialists who is able to prescribe medication clinical psychologist  who is trained in the scientific study of human behaviour and mental processes and focuses solely on the assessment and treatment of mental health conditions; a clinical psychologist will help you to find ways of effectively managing your anxiety and panic attacks Things you can do to help yourself There are several self-help techniques you can use to help treat the symptoms of panic disorder yourself. Some of these techniques are listed below. Stay where you are If possible, you should stay where you are during a panic attack. The attack could last up to an hour, so you may need to pull over and park where its safe to do so if youre driving. Focus If you have a panic attack, remind yourself that the frightening thoughts and sensations will eventually pass. During an attack, try to focus on something thats non-threatening and visible, such as the time passing on your watch or items in a supermarket. Slow deep breathing While youre having a panic attack, try to focus on your breathing. Feelings of panic and anxiety can get worse if you breathe too quickly. Try breathing slowly and deeply while counting to three on each breath in and out. Challenge your fear When you have a panic attack, try to identify what it is you fear and challenge it. You can achieve this by constantly reminding yourself that what you fear isnt real and that it will pass in a few minutes. Creative visualisation Many things can go through your mind during a panic attack  for example, some people think about disaster or death. Instead of focusing on negative thoughts, try to concentrate on positive images. Think of a place or a situation that makes you feel peaceful, relaxed or at ease. Once you have this image in your mind, try to focus your attention on it. It should help distract you from the situation and may also help ease your symptoms. Thinking positively can be difficult, particularly if youve got used to thinking negatively over a long period of time. Creative visualisation is a technique that requires practice, but you may gradually notice positive changes in the way you think about yourself and others. Dont fight a panic attack Fighting a panic attack can often make it worse. Trying to resist the attack and finding youre unable to can increase your sense of anxiety and panic. Instead, during a panic attack, reassure yourself by accepting that although it may seem embarrassing, and your symptoms may be difficult to deal with, the attack isnt life-threatening. Focus on the fact that the attack will evetually end and try your best to let it pass. Relaxation If you have panic disorder, you may feel constantly stressed and anxious, particularly about when your next panic attack may be. Learning to relax can help to relieve some of this tension, and it may also help you to deal more effectively with your panic attacks when they occur. Some people find complementary therapies, such as massage and aromatherapy, help them to relax. Activities, such as yoga and pilates , can also be helpful. You can also practise breathing and relaxation techniques, which you can use during a panic attack to help ease your symptoms. Exercise Regular exercise , particularly aerobic exercise, will help reduce stress and release tension. It can also encourage your brain to release the chemical serotonin, which can help improve your mood. Itsrecommended that adults aged 19-64 years should do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity, such as cycling or fast walking , every week. They should also do muscle-strengthening activities on two or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders and arms). Visit your GP for a fitness assessment before starting a new exercise programme if you havent exercised before or for a long time. Read more about the physical activity guidelines for adults . Diet Unstable blood sugar levels can contribute to the symptoms of a panic attack . Therefore, you should maintain a healthy, balanced diet , eat regularly and avoid eating sugary food and drinks. Also, avoid caffeine, alcohol and smoking because they can all contribute to panic attacks. Complications Panic disorder is a treatable condition, but to make a full recovery its very important you seek medical help as soon as possible. This is because treatment for panic disorder is much more effective if its given at an early stage. Left undiagnosed and untreated, panic disorder can become a debilitating and isolating illness. It can also increase your risk of developing other psychological conditions. Agoraphobia and other phobias Agoraphobiais a fear of being in situations where escape might be difficult, or help wouldnt be available if things go wrong. If you have agoraphobia, leaving home, going out in public and travelling alone can cause intense anxiety. Many people with agoraphobia avoid everyday activities because of their phobia. Agoraphobia isone of theconditions that can develop alongside panic disorder. People with panic disorder can develop agoraphobia because of their fear of having a panic attack in a public place. You may worry that a panic attack in a public place will be embarrassing, or that youll have difficulty getting help if you need it. You may also worry about public places that you would have difficulty leaving, such as a train, if you were to have a panicattack. If you have agoraphobia, you may find it difficult to leave the house, particularly if youre not with a trusted family member or a friend. If you have panic disorder, you may also develop other fears andphobias , which can often seem irrational. For example, you may start to worry about a particular object or action that triggers your attacks and become fearful of those things. Children Panic disorder is more common in teenagers than in younger children. Panic attacks can be particularly debilitating for children and young people. Severe panic disorder may affect their development and learning. The fear of having a panic attack may stop children from going to school and engaging in a social life. They may also find it difficult to concentrate on their schoolwork. Diagnosing panic disorder in children is usually a case of taking a detailed medical history and carrying out a thorough physical examinationto rule out any physical causes for the symptoms. Screening for other anxiety disorders may also be needed to help determine whats causing your childs panic attacks. Panic attacks in children are often dramatic events, including screaming and crying and an increased breathing rate (hyperventilation). If your child displays the signs and symptoms of panic disorder over a prolonged period of time, your GP may refer them to a specialist for further assessment and treatment. The specialist may recommend a course of psychotherapy for your child, such ascognitive behavioural therapy (CBT). Drug and alcohol misuse Some studies have shown that conditions that cause intense anxiety, such as panic disorder, can also increase your risk of developing an alcohol or drug problem. The side effects or withdrawal symptoms of both prescribed medication andillegal drugs can increase the symptoms of anxiety . Smoking and caffeine can also make your anxiety symptoms worse, so you should try to give up smoking (if you smoke) and limit the amount of caffeine in your diet. Source: NHS 24 - Opens in new browser window Last updated: 03 May 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Panic self-help guide Panic disorder (BSL) Panic disorder Coping with money worries NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Parkinsons disease,"""Parkinson's disease | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Parkinsons disease Parkinsons disease About Parkinsons disease Symptoms of Parkinsons disease Causes of Parkinsons disease Diagnosing Parkinsons disease Treating Parkinsons disease Living with Parkinsons disease About Parkinsons disease Parkinsons disease is a condition in which parts of the brain become progressively damaged overmany years. The three main symptoms of Parkinsons disease are: involuntary shaking of particular parts of the body (tremor) slow movement stiff and inflexible muscles A person with Parkinsons disease can also experience a wide range of other physical and psychological symptoms, including: depression and anxiety balance problemsthismay increase the chance of a fall loss of sense of smell anosmis problems sleeping ( insomnia ) memory problems Read more about the symptoms of Parkinsons disease Seeking medical advice See your GP if youre concerned that you may have symptoms of Parkinsons disease. Your GP will ask about the problems youre experiencing and mayrefer you to a specialist for further tests. Read more about diagnosing Parkinsons disease Causes of Parkinsons disease Parkinsons disease is caused by a loss of nerve cells in part of the brain called the substantia nigra. Thisleads to a reductionin a chemical called dopamine in the brain. Dopamine plays a vital role in regulating the movement of the body. A reduction in dopamine is responsible for many of the symptoms of Parkinsons disease. Exactly what causes the loss of nerve cells is unclear. Most experts think that a combination of genetic and environmental factors is responsible. Read more about the causes of Parkinsons disease Whos affected? Its thought around 1 in 500 people are affected by Parkinsons disease, which meansthere are an estimated 127,000 people in the UK with the condition. Most people with Parkinsons start to develop symptoms when theyre over 50, although around 1 in 20 people with the condition first experience symptomswhen theyre under 40. Men are slightly more likely to get Parkinsons disease than women. TreatingParkinsons disease Although theres currently no cure for Parkinsons disease, treatments are available to help reduce the main symptoms and maintain quality of life for as long as possible. These include: supportive treatments such as physiotherapyand occupational therapy medication in some cases, brainsurgery You may not need any treatment during the early stages of Parkinsons disease, as symptoms are usually mild. However, you may need regular appointments with your specialist so your condition can be monitored. Read more about treating Parkinsons disease Outlook As the condition progresses,the symptoms of Parkinsons diseasecan get worse and it can become increasingly difficult to carry out everyday activities without assistance. Manypeople respond well to treatment and only experience mild to moderate disability, whereas the minority may not respond as well and can, in time, becomemore severely disabled. Parkinsons diseasedoesnt directly cause people to die, but the condition can place great strain on the body, and can make some people more vulnerable to serious and life-threatening infections. However, with advances in treatment, most people with Parkinsons disease now have a normal or near-normal life expectancy. Read more about living with Parkinsons disease It may alsobe useful to read your guide to care and support written for people with care and support needs, as well as their carers and relatives. Symptoms of Parkinsons disease The symptoms of Parkinsons disease usually develop gradually and are mild at first. There are many different symptoms associated with Parkinsons disease. Some of the more common symptoms are described below. However,the order in which these develop and their severity is different for each individual.Its unlikely thata personwith Parkinsons disease would experience all ormost of these. Main symptoms The three main symptoms of Parkinsons disease affect physical movement: tremor shaking, which usually begins in the hand or arm and is more likely to occur when the limb is relaxed andresting slowness of movement (bradykinesia)  where physical movements are much slower than normal, which can make everyday tasks difficult and can result in a distinctive slow, shuffling walk with very small steps muscle stiffness (rigidity)  stiffness and tension in the muscles, which can make it difficult to move around and make facial expressions, and can result in painful muscle cramps ( dystonia ) These mainsymptoms are sometimes referred to by doctors as parkinsonism as there can be causes other than Parkinsons disease. Other symptoms Parkinsons disease can also cause a range of other physical and mental symptoms. Physical symptoms balance problems  these can make someone with the condition more likely to have a fall and injure themselves loss of sense of smell (anosmia) sometimes occurs several years before other symptoms develop nerve pain can cause unpleasant sensations, such as burning, coldness or numbness problems with urination  such as having to get up frequently during the night to urinate orunintentionally passing urine ( urinary incontinence ) constipation an inability to obtain or sustain an erection ( erectile dysfunction )in men difficulty becoming sexually aroused and achieving an orgasm(sexual dysfunction) in women dizziness , blurred vision or faintingwhen moving from a sitting or lying position to a standing onecaused by a sudden drop in blood pressure excessive sweating ( hyperhidrosis ) swallowing difficulties ( dysphagia )this can lead to malnutrition and dehydration excessive production of saliva (drooling) problems sleeping ( insomnia ) this can result in excessive sleepiness during the day Cognitive and psychiatric symptoms depression and anxiety mild cognitive impairment  slight memory problems and problems with activities that require planning and organisation dementia  a group of symptoms, including more severe memory problems, personality changes,seeing things that arent there (visual hallucinations) andbelieving things that arent true (delusions) When to seek medical advice See your GP if youre concerned you may have symptoms of Parkinsons disease. Your GP will ask about your symptoms and your medical history to help them decide whether its necessary to refer you to a specialist for further tests. Read more about diagnosing Parkinsons disease Causes of Parkinsons disease Parkinsons disease is caused by a loss of nerve cells in the part of the brain called the substantia nigra. Nerve cells in this part of the brain are responsible for producing a chemical called dopamine. Dopamine acts as a messenger between the parts of the brain and nervous system that help control and co-ordinate body movements. If these nerve cells die or become damaged, the amount of dopamine in the brain is reduced. This means the part of the brain controlling movement cant work as well as normal, causing movements to become slow and abnormal. The loss of nerve cells is a slow process.The symptoms of Parkinsons diseaseusually only start to develop when around 80% of the nerve cells in the substantia nigra have been lost. What causes the loss of nerve cells? Its not known why the loss of nerve cells associated with Parkinsons disease occurs, although research is ongoing to identify potential causes. Currently, its believed a combination of genetic changes and environmental factors may be responsible for the condition. Genetics A number of geneticfactors have been shown toincrease a persons risk of developing Parkinsons disease, although exactly how these make some people more susceptible to the condition is unclear. Parkinsons disease can run in families as a result of faulty genes being passed toa child by their parents. However, its rare for the disease to be inherited this way. Environmental factors Some researchers also feel environmental factors may increase a persons risk of developing Parkinsons disease. Its been suggested that pesticides and herbicides used in farmingand traffic or industrial pollution may contribute to the condition. However, the evidence linking environmental factors to Parkinsons disease is inconclusive. Other causes of parkinsonism Parkinsonism is the umbrella term used to describe the symptoms of tremors, muscle rigidity and slowness of movement. Parkinsons disease is the most common type of parkinsonism, but there are also some rarer types where a specific cause can be identified. These include parkinsonism caused by: medication (drug-induced parkinsonism)  where symptoms develop after taking certain medications, such as some types of antipsychotic medication, and usually improve once the medication is stopped other progressive brain conditions  such as progressive supranuclear palsy, multiple systems atrophy, andcorticobasal degeneration cerebrovascular disease  where a series of small strokes cause several parts of the brain to die You can read more about parkinsonism on the Parkinsons UK website. Diagnosing Parkinsons disease No tests can conclusively show that you have Parkinsons disease. Your doctor will base a diagnosis on your symptoms, medical history and a detailed physical examination. Your GP willtalk toyouabout the problems youre experiencing and mayask you to perform some simple mental or physical tasks, such as moving or walking around,to help with the diagnosis. In the early stages, your GP may find it difficult to say whether you definitely have the condition because symptoms are usually mild. Referral to a specialist If your GP suspects Parkinsons disease, youll be referred to a specialist. This will usually be: a neurologist  a specialist in conditions affecting the brain and nervous system a geriatrician  a specialist in problems affecting elderly people If your GP thinks you may be in the early stages of Parkinsons disease, you should see a specialist within six weeks. If they think you may be in the later stages, you should see a specialist within two weeks. The specialist will most likely ask you to perform a number of physical exercises so they can assess whether you have any problems with movement. A diagnosis of Parkinsons disease is likely if you have at least two of the three following symptoms: shaking or tremor in a part of your body that usually only occurs at rest slowness of movement (bradykinesia) muscle stiffness (rigidity) If your symptoms improve after taking a medication called levodopa, its more likely you have Parkinsons disease. Special brain scans, such as asingle photon emission computed tomography (SPECT) scan, may also be carried out in some casesto try torule outother causes ofyour symptoms. Receiving the diagnosis Being told you have Parkinsons disease can be emotionally distressing, and the news can often be difficult to take in. This means its important that you have the support of your family and a care team who will be able to help you come to terms with the diagnosis. You may find it useful to contactParkinsons UK,the Parkinsons support and research charity. They can be contacted by: free helpline on 0808 800 0303 (Monday to Friday, 9am to 7pm, and 10am to 2pm onSaturdays) email: hello@parkinsons.org.uk Parkinsons UKbrings people with Parkinsons, their carers and families together througha network of local groups , as well as online resources and a confidential helpline. The Parkinsons UK website provides information and support on every aspect of living with Parkinsons. Treating Parkinsons disease There are several therapies that can make living with Parkinsons disease easier and help you deal with your symptoms on a day-to-day basis. There are efforts underway to try to increase the availability of these supportive therapies for Parkinsons patients on the NHS. Your local authority may be able to advise and help you. Ask your local authority for a care and support needs assessment. Physiotherapy A physiotherapist can work with you to relieve muscle stiffness and joint pain through movement (manipulation) and exercise. The physiotherapist aims to make moving easier, and improve your walking and flexibility. They also try to improve your fitness levels and ability to manage things for yourself. Occupational therapy An occupational therapist can identify areas of difficulty in your everyday lifefor example, dressing yourself or getting to the local shops. They can help you work out practical solutions, and ensure your home is safe and properly set up for you. This will help you maintain your independence for as long as possible. Read more about occupational therapy Speech and language therapy Many people with Parkinsons disease have swallowing difficulties ( dysphagia )and problemswith their speech. A speech and language therapist can often helpyou improve these problems by teaching speaking and swallowing exercises, or by providing assistive technology. Diet advice For some people with Parkinsons disease, making dietary changes can help improve some symptoms. These changescan include: increasing the amount of fibre in your diet and making sure youre drinking enough fluid to reduce constipation increasing the amount of salt in your diet and eating small, frequent meals to avoid problems with low blood pressure , such as dizziness when you stand up quickly making changes to your diet to avoidunintentional weight loss You may see a dietitian, a healthcare professional trained to give diet advice, if your care team thinks youmay benefit from changing your diet. Medication Medicationcan be used toimprove the main symptoms of Parkinsons disease, such as shaking (tremors) and movement problems. However, not all the medications available are useful for everyone, and the short- and long-term effects of each are different. Three main types of medication are commonly used: levodopa dopamine agonists monoamine oxidase-B inhibitors Your specialist can explain your medication options, including the risks associated with each medication, and discuss which may be best for you. Regular reviews will be required as the condition progresses and your needs change. Read on to learn about the treatments you may be offered. You can also see a summary of the pros and cons of treatments for Parkinsons disease, where you can compare your options. Levodopa Most people with Parkinsons disease eventually need a medication called levodopa. Levodopa is absorbed by the nerve cells in your brain and turned into the chemical dopamine, which is used to transmit messages between the parts of the brain and nerves that control movement. Increasing the levels of dopamine using levodopa usually improves movement problems. Itis usually taken as a tablet or liquid, and is often combined with other medication, such as benserazide or carbidopa. These medications stop the levodopa being broken down in the bloodstream before it has a chance to get to the brain. They also reduce the side effects of levodopa, which include: feeling sick (nausea) or vomiting tiredness dizziness If youre prescribed levodopa, the initial doseis usually very small and will be gradually increased until it takes effect. At first, levodopa can cause a dramatic improvement in the symptoms. However, its effects can be less long-lasting over the following yearsas more nerve cells in the brain are lost, there are fewer of them to absorb the medicine. This means the dose may need to be increased from time to time. Long-term use of levodopa is also linked to problems such as uncontrollable, jerky muscle movements (dyskinesias) and on-off effects, where the person rapidly switches between being able to move (on) and being immobile (off). Dopamine agonists Dopamine agonists act as a substitute for dopamine in the brain and have a similar but milder effect comparedwith levodopa. They can often be given less frequently than levodopa. Theyare often taken as a tablet, but are also available as a skin patch (rotigotine). Sometimes dopamine agonists are taken at the same time as levodopa, as this allows lower doses of levodopa to be used. Possible side effects of dopamine agonists include: nausea or vomiting tiredness and sleepiness dizziness Dopamine agonists can also cause hallucinations andincreased confusion, so they need to be used with caution, particularly in elderly patients, who are more susceptible. For some people, dopamine agonists have been linked to the development of compulsive behaviours,especially at high doses, including addictive gambling and an excessively increased libido. Talk to your healthcare specialist if you think you may be experiencing these problems. As the person themselves may not realise the problem, its key that carers and family members also note any abnormal behaviour and discuss it with an appropriate professional at the earliest opportunity. If youre prescribed a course of dopamine agonists, the initial dose is usually very small to prevent nausea and other side effects. The dosage is gradually increased over a few weeks. If nausea becomes a problem, your GP may prescribe anti-sickness medication. A potentially serious, but uncommon, complication of dopamine agonist therapy is sudden onset of sleep. This generally happens as the dose is being increased and tends to settle once the dose is stable. People areusually advised toavoid driving while the dose is being increased in case this complication occurs. Monoamine oxidase-B inhibitors Monoamine oxidase-B (MAO-B) inhibitors, including selegiline and rasagiline, are another alternative to levodopa for treating early Parkinsons disease. They block the effects of an enzyme orbrain substance that breaks downdopamine (monoamine oxidase-B), increasing dopamine levels. Both selegiline and rasagiline can improve the symptoms of Parkinsons disease, although their effects are small compared with levodopa. They can be used alongside levodopa or dopamine agonists. MAO-B inhibitors are generally very well tolerated, but can occasionallycause side effects, including: nausea headache abdominal pain high blood pressure Catechol-O-methyltransferase inhibitors Catechol-O-methyltransferase (COMT) inhibitors are prescribed for people in later stages of Parkinsons disease. They prevent levodopa from being broken down by the enzyme COMT. Side effects of COMT inhibitors include: nausea or vomiting diarrhoea abdominal pain Non-oral therapies When Parkinsons symptoms become difficult to control with tablets alone, a number of other treatments can be considered. Apomorphine A dopamine agonist called apomorphine can be injected under the skin (subcutaneously) eitherby: a single injection, when required a continuous infusionusing a small pump carried around on your belt, under your clothing, or in a bag Duodopa If you have severe on-off fluctuations, a type of levodopa called duodopa may be used. This medication comes as a gel thats continuously pumped into your gut through a tube inserted through your abdominal wall. Theres an external pump attached to the end of the tube, which you carry around with you. About 25 specialist neuroscience centres in the UK offer this treatment.This treatment is only available if you have very severe on-off fluctuations or involuntary movements. Surgery Most people with Parkinsons disease are treated with medication, although a type of surgery called deep brain stimulation isused in some cases. This surgery is also available in specialist neuroscience centres around the UK, but its not suitable for everyone. Ifsurgery isbeing considered, your specialist will discuss the possible risks and benefits with you. Deep brain stimulation Deep brain stimulation involves surgically implanting a pulse generator similar to a heart pacemaker into your chest wall. This is connected to one or two fine wires placed under the skin, and isinserted precisely into specific areas in your brain. A tiny electric current is producedby the pulse generator, which runs through the wire and stimulates the part of your brain affected by Parkinsons disease. Although surgery doesnt cure Parkinsons disease, it can ease the symptoms for some people. Treating additional symptoms As well asthe main symptoms of movement problems, people with Parkinsons disease can experience a wide range of additional symptoms that may need to be treated separately. These include: depression and anxiety  this can be treated with self care measures such as exercise, psychological therapy or medication; read more about treating depression problems sleeping (insomnia)  this can be improved by making changes to your normal bedtime routine; read more about treating insomnia erectile dysfunction  this can be treated with medication; read more about treating erectile dysfunction excessive sweating (hyperhidrosis)  this can be reduced using a prescription antiperspirant,or surgery in severe cases; read more about treating hyperhidrosis swallowing difficulties (dysphagia) this can be improved by eating softened food, or by using a feeding tube in more severe cases; read more about treating dysphagia excessive drooling  this can be improved with swallowing exercises, or surgery or medication in severe cases urinary incontinence  this can be treated with exercises to strengthen the pelvic floor muscles, medication, or surgery in severe cases; read more about treating urinary incontinence dementia this can be treated with cognitive therapies and medication in some cases; read more about treating dementia Clinical trials Much progress has been made in the treatment of Parkinsons diseaseas the result ofclinical trials,where new treatments and treatment combinations are compared with standard ones. All clinical trials in the UK are carefully overseen to ensure they are worthwhile and safely conducted. Participants in clinical trials sometimes do better overall than those in routine care. If you are asked if you want to take part in a trial, you will be given an information sheet about the trial. If you want to take part, you will be asked to sign a consent form. You can refuse to take part or withdraw from a clinical trial without it affecting your care. Complementary and alternative therapies Some people with Parkinsons disease findcomplementary therapies help them feel better. Many complementary treatments and therapies claim to ease the symptoms of Parkinsons disease. However, theres no clinical evidence theyre effective in controlling the symptoms of Parkinsons disease. Most people think complementary treatments have no harmful effects. However, some can be harmful and they shouldnt be used instead of the medicines prescribed by your doctor. Some types of herbal remedies, such as St Johns wort, can interact unpredictably if taken with some types of medication used to treat Parkinsons disease. If youre considering using an alternative treatment along with your prescribed medicines, check with your care team first. Living with Parkinsons disease Its important to do what you can to stay physically and mentally healthy if you have Parkinsons disease. Exercise and healthy eating Regular exercise is particularly important in helping relieve muscle stiffness, improving your mood, and relieving stress. There are many activities you can do to help keep yourself fit, ranging from more active sports like tennis and cycling , to less strenuous activities such as walking , gardening and yoga . You should also try to eat a balanced diet containing all the food groups to give your body the nutrition it needs to stay healthy. Vaccinations Everyone with a long-term condition is encouraged to get a yearly flu jab each autumn. The pneumococcal vaccination is also usually recommended, which is a one-off injection that protects against a serious chest infection called pneumococcal pneumonia. Relationships and support Being diagnosed with a long-term conditionlike Parkinsons disease can put a strain on you, your family and friends. It can be difficult to talk to people about your condition, even if theyre close to you. Dealing with the deterioration of symptoms, such as increasing difficulty with movement, may make you feel frustrated and depressed. Spouses, partners or carers will inevitably feel anxious or frustrated as well. Be open about how you feel, and let your family and friends know what they can do to help. Dont feel shy about telling them you need some time to yourself, if thats what you want. Support If you have any questions about your condition, your GP or Parkinsons disease specialist nurse may be able to help. You may also find it helpful to talk to a trained counsellor or psychologist, or someone at a specialist helpline. Your GP surgery will have details of these. Some people find it helpful to talk to others with Parkinsons disease, either at a local support group or in an internet chat room. Care and support services Its worth taking time to think about your specific needs and what would help you achieve the best quality of life. For example, you may wish to consider equipment, help in your home,and home adaptations. Parkinsons UK Parkinsons UK is the main Parkinsons support and research charity in the UK. They can offer thesupport and advice you may need if youre living with Parkinsons disease, and can let you know about support groups in your local area. They can becontacted by: free confidential helpline on 0808 800 0303 (Monday to Friday, 9am to 7pm, and 10am to 2pm on Saturdays) email: hello@parkinsons.org.uk The Parkinsons UKwebsite also features all the latest news, publications and research updates, as well as an online community where you can share your experiences of living with Parkinsons. Work and finances Being diagnosed with Parkinsons doesnt mean you have to stop working. Many people with the condition keep working for years after their diagnosis. You may find it hard to cope financially if you do have to stop work or work part-time because of your condition. However, you may be entitled to one or more of the following types of financial support: You are entitled to Statutory Sick Pay from your employer if you have a job but cant work because of your illness. You may be entitled to Employment and Support Allowance (ESA) if you dont have a job and cant work because of your illness. You may be eligible for Personal Independence Payment (PIP) , which replaced the Disability Living Allowance (DLA) , if youre aged 64 and under and need help with personal care or have walking difficulties. You may be able to get Attendance Allowance if youre aged 65 or over. You may be entitled to Carers Allowance if youre caring for someone with Parkinsons disease. You may be eligible for other benefits if you have children living at home or if you have a low household income. Driving If youve been diagnosed with Parkinsons disease, you must inform the Driver and Vehicle Licensing Agency (DVLA) and your insurance company. You wont necessarily have to stop driving. Youll be asked to complete a form providing more information about your condition, as well as details of your doctors and specialists. The DVLA will use this to decide whether youre fit to drive. Complex Parkinsons disease and palliative care ComplexParkinsons disease is defined as the stage when treatment is unable to consistently control symptoms, or the person has developeduncontrollable jerky movements (disabling dyskinesia). These problems can still be helped by adjustment or addition of some of the medications used to treat Parkinsons disease ,under thesupervisionof a doctor with a specialist interest in Parkinsons disease. As Parkinsons disease progresses, youll be invited to discuss the care you wantwith your healthcare team as you near the end of your life. This is known as palliative care. When theres no cure for an illness, palliative care tries to alleviate symptoms, and is also aimed at making the end of a persons life as comfortable as possible. This is done by attempting to relieve pain and other distressing symptoms, while providing psychological, social and spiritual support for you and your family. Palliative care can be provided at home orin a hospice, residential home or hospital. You may want to consider talking to your family and care team in advance about where youd like to be treated and what care you wish to receive. Source: NHS 24 - Opens in new browser window Last updated: 16 June 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites Brain and Spine Foundation: Parkinson's disease Healthtalk.org: Parkinson's disease Parkinson's UK NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Pataus syndrome,"""Patau's syndrome | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Chromosomal conditions Pataus syndrome Pataus syndrome Pataus syndrome, also known as Trisomy 13, is a rare but serious genetic condition. It begins to affect babies when theyre in the womb, and will continue to cause health problems throughout their life. In the UK, around 2 in every 10,000 births are affected by Pataus syndrome. What is Pataus syndrome? When a baby is conceived (made), they inherit genetic material from both their parents. This genetic material is called a chromosome. Humans normally have 23 pairs of chromosomes. In each pair, 1 of the chromosomes is inherited from the mother and 1 is inherited from the father. If a baby has Pataus syndrome, they have inherited an extra copy of chromosome 13. This extra copy can be present in some or all of the babys cells and can lead to health problems for the baby. There are 3 different forms of Pataus syndrome: Full form In full form Pataus syndrome, the baby has inherited a complete extra copy of chromosome 13. This extra copy is present in all of the babys cells. Around 80% of babies born with Pataus syndrome have the full form of the syndrome. Mosaic form In mosaic form Pataus syndrome, the baby has inherited a complete extra copy of chromosome 13, but the copy is only present in some of the babys cells. Partial form In partial form Pataus syndrome, the baby has only inherited part of an extra copy of chromosome 13. This is a very rare form of Pataus syndrome. Why does Pataus syndrome happen? Most cases result from a random change in the egg or sperm in healthy parents. This change is not caused by anything the parents did before or during pregnancy. Effects of Pataus syndrome on pregnancy Screening for Pataus syndrome Youll be offered screening for Pataus syndrome when youre between 11 and 14 weeks pregnant. The screening test will show if your baby has a high or low chance of having Pataus syndrome. If screening shows that theres a high chance your baby has Pataus syndrome,you can choose to have a further diagnostic test if you wish. No test can tell if your baby has full, mosaic or partial Pataus syndrome, or how theyll be affected. Risk of miscarriage and stillbirth Around 7 in 10 (70%) of pregnancies diagnosed with Pataus syndrome from screening tests will end in miscarriage or stillbirth . The risk of miscarriage decreases as the pregnancy progresses, but theres still a risk of stillbirth. Effects of Pataus syndrome on babies If your baby is affected by Pataus syndrome, its likely they will have some health conditions. Exactly how your baby is affected will depend on the form of Pataus syndrome they have. Babies with full form Pataus syndrome Full form Pataus syndrome is considered to be a life-limiting condition. This means it can affect how long a baby can live. Around 4 in 10 (43.1%) babies with full form Pataus syndrome will live longer than 1 week. Around 1 in 10 (9.7%) will live longer than 5 years. Babies born with full form Pataus syndrome will have a learning disability that may be severe. Theyre also likely to have a wide range of health conditions, some of which can be serious. Statistically: around 8 in 10 (80%) will have heart issues around 6 in 10 (60%) will have cleft lip and/or palate around 6 in 10 (60%) will have issues with brain development around 5 in 10 (50%) will have seizures around 5 in 10 (50%) will have hearing loss around 5 in 10 (50%) will have joint contractures (shortening of muscle tissue that can cause a deformity) around 5 in 10 (50%) will have eye issues or an absent eye Babies with mosaic form and partial form Pataus syndrome Currently we cant predict how babies with mosaic or partial forms of Pataus syndrome will be affected. This is because it depends on: how many cells contain the extra chromosome (mosaic) how much of the extra chromosome they have (partial) Some babies may have severe health problems like those seen in full form Pataus syndrome. Other babies may have much less serious health issues. There are even cases where the baby seems to have no health issues at all. Most babies with a form of Pataus syndrome will have some form of learning disability. The life expectancy for babies with mosaic or partial forms of Pataus syndrome is also very variable. Some will live long lives, while others will have a much shorter life expectancy. Living with Pataus syndrome Each child is unique, and Pataus syndrome will affect each child differently. Like all children they will have their own personalities, likes and dislikes, and things that make them who they are. Babies with full form Pataus syndrome usually have a low birthweight and are considered medically fragile. This means they are at high risk of infections and complications that require treatment in hospital. They may also: have difficulty feeding and may need fed by a tube have difficulty breathing and have apnoea (pauses in their breathing) Despite their complex needs, children with Pataus syndrome can make progress with their development, although slowly. Many children are reported to be able to communicate their needs, show awareness of surroundings, and some can sit and stand supported. There are also cases of older children attending school. Feedback from many parents suggests that children with Pataus syndrome have a good quality of life and are valued members of the family. Congenital and rare condition register Babies with Pataus syndrome are included in the secure congenital and rare condition (CARDRISS) register. The register is maintained by Public Health Scotland. The register records how many babies have this condition, and some relevant personal information. Its also used to support the planning and improvement of health, care, and other public services. Read more about CARDRISS Further information and support You can find out more information about Pataus syndrome, including stories from parents of a child with the syndrome, at SOFT UK (Support Organisation for Trisomy 13/ 18) Source:\r\n                                        SOFT UK - Opens in new browser window Last updated: 21 February 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Screening for Downs syndrome, Edwards syndrome and Pataus syndrome Other health sites SOFT UK NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Pelvic inflammatory disease,"Pelvic inflammatory disease | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Sexual and reproductive Pelvic inflammatory disease Pelvic inflammatory disease British Sign Language (BSL) |  | Polski | Romn | slovenina Pelvic inflammatory disease (PID) is a bacterial infection. It affects the female reproductive system including the womb, fallopian tubes and ovaries. Symptoms of PID PID often does not cause any obvious symptoms. Most symptoms are mild, making it difficult to diagnose. Symptoms include: pain around the pelvis or lower tummy discomfort or pain during sex that is felt deep inside the pelvis pain when peeing bleeding between periods or after sex heavy periods painful periods unusual vaginal discharge Less common symptoms include: severe tummy pain a high temperature (fever) feeling and being sick When to get medical advice Speak to your GP practice or local sexual health clinic if: you have symptoms of PID youre worried about your symptoms Testing for PID If you think you might have PID, get checked for free by: booking an appointment at your local sexual health service contacting your GP practice for an appointment What does a PID test involve? There is no single test for diagnosing PID. Your doctor or nurse will discuss your symptoms before you have an internal examination. This shouldnt be painful, but you may experience some discomfort. When your doctor examines you, theyll look for tenderness in your pelvic region and an abnormal vaginal discharge. The doctor will usually take swabs from inside your vagina and cervix. These will be sent to a lab for analysis. However, a swab test cant be relied on to diagnose PID, as some women with PID have a negative swab result. You may have an ultrasound scan. Scans can identify severe PID but will not show up mild disease. Its possible to have a normal scan and still have PID. Treatment for PID If its diagnosed at an early stage, oral antibiotics will treat PID. Youll probably be given these to take for at least 2 weeks. In more severe cases, you may be admitted to hospital for observation and treatment with antibiotic injections. Always see your doctor or nurse if you think you might have PID, as the sooner you are treated, the better. If youre given treatment, always make sure that you take all of your antibiotics and finish the entire course. Your partner(s) should also be treated and you should avoid sex until your treatment is completed. How PID is passed on Most cases of PID are caused by a bacterial infection thats spread from the vagina or the cervix to the reproductive organs higher up. Many different types of bacteria can cause PID. However, most cases are the result of a chlamydia or gonorrhoea infection. In some cases, the cause of the infection that leads to PID is unknown. Such cases may be the result of normally harmless bacteria found in the vagina. These bacteria can sometimes get past the cervix and into the reproductive organs. Complications of PID If left untreated, PID can cause serious conditions including: pelvic abscesses long-term pelvic pain, or pelvic pain that keeps coming back reduced fertility or infertility ectopic pregnancy How to prevent PID The best way to reduce your risk of STIs is to practice safer sex . This means using a condom for vaginal, anal and oral sex. STIs If you have been diagnosed with PID you should get tested for all STIs including: chlamydia gonorrhoea syphilis Find your local sexual health clinic Source: Scottish Government - Opens in new browser window Last updated: 26 February 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Other languages and formats British Sign Language (BSL) |  | Polski | Romn | slovenina British Sign Language (BSL) |  | Polski | Romn | slovenina Add this page to\n            Info For Me Also on NHS inform Book a sexual health appointment online Pelvic inflammatory disease (PID) (BSL) Pelvic inflammatory disease (PID) (Chinese) Pelvic inflammatory disease (PID) (Polish) Pelvic inflammatory disease (PID) (Romanian) Pelvic inflammatory disease (PID) (Slovak) Other health sites BASHH: sexual health NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Pelvic organ prolapse,"""Pelvic organ prolapse | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Sexual and reproductive Pelvic organ prolapse Pelvic organ prolapse Pelvic organ prolapse is when one or more of the pelvic organs (your womb, bladder or bowel) slip from their usual position. This causes the vaginal wall to bulge into, or out of, the vagina. Pelvic organ prolapse isnt life-threatening. In some cases it can cause little or no problems. However, in more severe cases, it may feel very uncomfortable. It might stop you doing the things that you enjoy, and affect your quality of life. Like incontinence, prolapse isnt inevitable part of ageing. Speak to your doctor if you think you might have a prolapse. You dont need to suffer or feel embarrassed. Many women can experience prolapse, but it can be treated. Symptoms Some women with a pelvic organ prolapse dont have any symptoms at all. The condition may only discovered during an internal examination for another reason. For example, during a cervical screening test (smear test) . Other women will experience symptoms. Its normal for your symptoms to feel more or less severe at different times of the day. Speak to your doctor if: You think you might have a prolapse or you have symptoms of a prolapse such as: a feeling of a bulge or something coming down the vagina a feeling of a bulge or something coming out the vagina, which sometimes needs pushed back up (you may be able to see this with a mirror) discomfort during sex problems peeing  a slow stream, a feeling of not emptying your bladder fully, needing to go to the toilet a lot or leaking Diagnosis A prolapse is a common condition. Seeing your doctor earlier may help you manage it more easily. Your doctor will need to carry out a pelvic examination, which will include an internal examination of your vagina. Your doctor will discuss this with you and you can ask any questions that you might have. As this is an intimate examination, the doctor may have another person (chaperone) present. You can ask for a female doctor or health professional if you prefer. The internal examination is similar to a smear test and should only take a few minutes. Your doctor will discuss with you if they think any further tests are needed. Types of prolapse Pelvic organ prolapse can affect the front, top or back of vagina. The main types of prolapse are: anterior prolapse (cystocele)  where the bladder bulges into the front wall of the vagina prolapse of the womb and / or cervix (the opening between the vagina and the womb)  where the womb and / or cervix bulges down in to the vagina vault prolapse  this can be as a result of a total hysterectomy where the new top of the vagina bulges downwards posterior wall prolapse (rectocoele or enterocoele)  when the bowel bulges forward into the back wall of the vagina You can have more than one of these types of prolapse at the same time. A number system of 1 to 4 is usually used to describe how severe a pelvic organ prolapse is. For example, a 4 means a severe prolapse. You can ask your healthcare professional what this means for you, and any other questions you may have. Causes There isnt usually one cause, but the risk of developing pelvic organ prolapse is increased by: age  prolapse is more common as you get older, but its not an inevitable part of ageing childbirth  particularly if you had a long or difficult labour, or have given birth to a large baby or multiple babies menopause  related to lower levels of oestrogen or weaker tissue being overweight having large fibroids or pelvic cysts which create a lot of pressure in the pelvis previous surgery on the pelvis  such as a hysterectomy repeated heavy lifting or manual work long term coughing or sneezing (caused by smoking, a lung condition or allergies) straining too much when going to the toilet for a poo because of long term constipation Prevention There are things you can do to reduce the risk of pelvic organ prolapse. Exercising your pelvic floor Do regular pelvic floor exercises to strength pelvic floor muscles maintain a healthy weight eat a high-fibre diet to avoid constipation or straining when you go to the toilet for a poo adopt good toilet habits avoid heavy lifting How to exercise your pelvic floor muscles Treatment Treatment will depend on how much the issue is affecting your normal day to day activities. In mild cases of prolapse, your doctor may recommend lifestyle changes. For example, regular pelvic floor exercises and maintaining a healthy weight. Vaginal pessary A vaginal pessary is a device inserted into your vagina, which holds your vaginal walls in place and so pushes the prolapse back. Pessaries are usually made of latex (rubber) or silicone, and come in different shapes and sizes. A pessary might not be right for everyone. Your doctor will discuss with you to find out if its the best option, and you can ask any questions you may have. Some side effects can include: vaginal discharge irritation, bleeding or sores inside your vagina stress incontinence difficulty with bowel movements difficulty having sex (although most women can have sex without problems) an imbalance of the usual bacteria found in your vagina If you have a pessary and experience any of these symptoms, speak to your healthcare professional. They can usually be treated. Hormone Replacement Therapy (HRT) HRT replaces the female hormones that are at a lower level as you experience the menopause. There is little evidence that HRT can directly treat pelvic organ prolapse, but it can relieve some of the symptoms associated with it. For example, vaginal dryness or discomfort during sex. Depending on your symptoms, you may wish to ask your doctor for more advice on whether this would be a suitable treatment option for you. Surgery Depending on your circumstances and how severe your symptoms are, your doctor may discuss with you whether a surgery might be helpful. They will go through the options with you. Its ok to ask any questions about your care to help you get the information you might need. You can then take some time to decide what the best option is for you. Source: Scottish Government - Opens in new browser window Last updated: 25 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Pelvic floor muscles It's OK to Ask Other health sites Pelvic Organ Prolapse: A physiotherapy guide for women Pelvic, Obstetric and Gynaecological Physiotherapy: Mens pelvic health NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Penile cancer,"Penile cancer - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Penile cancer Penile cancer Penile cancer is a rare type of cancer that occurs on the skin of the penis or within the penis. Over the last 30 years, the number of penile cancer cases has increased by more than 20%, possibly due to changes in sexual practices. However, improvements in diagnosis, staging and treatment have led to a similar reduction in the number of deaths resulting from the condition. Signs and symptoms Youshould be aware of any abnormalities or signs of penile cancer, including: a growth or sore on the penis that doesnt heal within 4 weeks bleeding from the penis or from under the foreskin a foul-smelling discharge thickening of the skin of the penis or foreskin that makes it difficult to draw back the foreskin (phimosis) a change in the colour of the skin of the penis or foreskin a rash on the penis If you experience these symptoms, its important that theyre checked by your GP as soon as possible. Its unlikely theyll becaused by cancer of the penis, but they need tobe investigated. Any delay in diagnosing penile cancer could reduce the chances of successful treatment. Types of penile cancer The penis is made up of many different types of tissue. The type ofpenile cancer you have will depend on the typeof cell thecancer developed from. The most common types of penile cancer include: squamous cell penile cancer  which accounts for more than 90% of cases and starts in the cells that cover the surface of the penis carcinoma in situ (CIS)  a particular type of squamous cell cancer where only the cells in the skin of the penis are affected and it hasnt spread any deeper adenocarcinoma  cancer that starts in the glandular cells of the penis that produce sweat melanoma of the penis  where the cancer develops in the skin cells that give the skin its colour The Cancer Research UK website has more information about the different types of penile cancer . What causes penile cancer? The cause of penile cancer isnt known, but certain risk factors can increase your chances of getting it. Men who carry thehuman papilloma virus (HPV)have an increased risk of developing penile cancer, which is the virus that causes genital warts . Age is also a risk factor for cancer of the penis. The condition rarely affects men and anyone with a penis under 40 years of age. It most commonly occurs in men and anyone with a penis aged over 60. Smoking is the mostsignificant lifestyle factor associated with penile cancer. Chemicals found in cigarettes can damage cells in the penis, which increases yourrisk of getting the condition. Conditions that affect the penis, such as phimosis, whichmakes the foreskindifficult to retract, increase your chances of developing infections such as balanitis. Repeated infections are linked to a higher risk of developing some types of penile cancer, because they can weaken your immune system. The Cancer Research UK website has more information about the risks and causes of penile cancer . Diagnosing penile cancer Your GP will ask you about any symptoms you have and when they occur. Theyll also examine your penis for signs of penile cancer. In 2015, the National Institute for Health and Care Excellence ( NICE ) published guidelines to help GPs recognise the signs and symptoms of penile cancer and refer people for the right tests faster. To find out if you should be referred for further tests for suspected penile cancer, read the NICE 2015 guidelines on Suspected Cancer: Recognition and Referral . If your GP suspects penile cancer, theymay refer you toa specialist  usually a urologist (a doctor who specialises in conditions that affect the urinary system and genitals). The specialist will ask about your symptomsand check your medical history. They may also check for any physical signs of penile cancer. A blood test may be carried out to check your general health and the number of blood cells. To confirm a diagnosis of penile cancer, you may need to have a biopsy . Asmall tissue sample will be removed so it can be examined under a microscopefor cancerous cells. Treating penile cancer Treatment for penile cancer will depend on the size of the affected area and the rate at which the cancer hasspread. For example, in most cases of carcinoma in situ (CIS), where only the skin cells of the penis are affected, treatment will usually involve either using achemotherapy cream or having laser surgery to remove the affected area of skin. You will usually haveaskin graft after surgery. The main treatments for penile cancer that isnt at a very early stage are: surgery radiotherapy chemotherapy Surgery will involve removing the cancerous cells and possibly some of the surrounding tissue. In most cases, any physical changes to your penis after an operation can be corrected with reconstructive surgery. Skin and muscle can be taken from elsewhere in the body to recreate a functioning penis. However, with early diagnosis and modern surgical techniques, your surgeon will usually be able to preserve as much penile tissue as possible. As part of most treatments for penile cancer, the lymph glands (small organs that are part of the immune system) in the groin will be assessed to determine if the cancer has spread. The test thats used, known as a sentinel nodebiopsy, is widely available in the UK. In some cases, the lymph glands may need to be surgically removed. As with most types of cancer, the outlook for individual cases depends largely on how far the cancer has advanced at the time of diagnosis. The Cancer Research UK website has more information about staging penile cancer and the types of treatment for cancer of the penis . You can also read about penile cancer on the male cancer website Orchid . They also have a helpline you can phone  0203 465 5766 (Monday to Friday, 9amto 5.30pm). Prevention It isnt always possible to prevent penile cancer, but you can reduce your chances of getting it. Oneof the mainways you can reduceyour chances of developing penile cancer is to give up smoking (if you smoke). Its also important to maintaingood penis hygiene to prevent the bacterial and viral infections thatcan increase the risk of penile cancer. This is easier if you were circumcised as a child, but there are steps you can take if you havent been circumcised. Simple penis hygiene can include: using condoms to help reduce the possibility of catching HPV regularlywashing your penis with warm water, including under the foreskin Theres little evidence to suggest that being circumcised as an adult will reduce your chances of developing penile cancer. However, if you have sores that dont heal, or if its becoming increasingly difficult toclean under your foreskin, seek advice from your GPabout the possibility of circumcision. Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites Cancer Research UK: Penile cancer Macmillan Cancer Support: Penile cancer Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Peripheral neuropathy,"Peripheral neuropathy - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Peripheral neuropathy Peripheral neuropathy About peripheral neuropathy Symptoms of peripheral neuropathy Causes of peripheral neuropathy Diagnosing peripheral neuropathy Treating peripheral neuropathy Complications of peripheral neuropathy About peripheral neuropathy Peripheral neuropathy develops when nerves in the bodys extremities  such as the hands, feet and arms  are damaged. The symptoms depend on which nerves are affected. In the UK, its estimated that almost1 in 10 peopleaged 55 or over are affected by some degree of peripheral neuropathy. The peripheral nervous system Theperipheral nervous system is the network of nerves that lieoutside the central nervous system (the brain and spinal cord). It includes different types of nerves with their own specific functions, including: sensory nerves  responsible for transmitting sensations, such as pain and touch motor nerves  responsible for controlling muscles autonomic nerves  responsible for regulating automatic functions of the body, such as blood pressure and bladder function Symptoms of peripheral neuropathy The main symptoms can include: numbness and tingling in the feet or hands burning, stabbing or shooting pain in affected areas loss of balance and co-ordination muscle weakness, especially in the feet These symptoms are usually constant, but may come and go. Read more about symptoms of peripheral neuropathy When to see your GP Its important to see your GP if you experience the early symptoms of peripheral neuropathy, such as: pain, tingling or loss of sensation in the feet loss of balance or weakness a cut or ulcer on your foot that isnt getting better Its recommended that people at highest riskof peripheral neuropathy, such as people withdiabetes, have regular check-ups. Your GP will ask about your symptoms and may arrange some teststo help identify the underlying cause. You may be referred to a hospital to see a neurologist(a specialist in conditions affecting the nervous system). Generally, the sooner peripheral neuropathy is diagnosed, the better the chance of limiting the damage and preventing further complications. Read more about diagnosing peripheral neuropathy Causes of peripheral neuropathy In the UK,diabetes (both type 1 and type 2) is the most common cause of peripheral neuropathy. Over time, the high blood sugar levels associated with diabetes can damage the nerves. This type of nerve damage is known as diabetic polyneuropathy. Peripheral neuropathy can also have a wide range of other causes. For example, it can be caused by: physical injury to the nerves aviral infection such as shingles a side effect of certain medications ordrinking too muchalcohol People who are known to be at anincreased risk of peripheral neuropathy may have regular check-ups so their nerve function can be assessed. Read more about thecauses of peripheral neuropathy Treatingperipheral neuropathy Treatment for peripheral neuropathy depends on the symptoms and underlying cause. Only some of the underlying causes of neuropathy can be treated. For example, if you have diabetes it may help to gain better controlof yourblood sugar level, stop smoking, and cut down on alcohol. Nerve pain may be treated with prescribed medications called neuropathic pain agents, as standard painkillers are often ineffective. If you have other symptoms, these may need to be treated individually. For example, treatment for muscle weakness may involve physiotherapyand the use of walking aids. Read more about treating peripheral neuropathy . Complications of peripheral neuropathy The outlook for peripheral neuropathy varies, depending on the underlying cause and which nerves have been damaged. Some cases may improve with time if the underlying cause is treated, whereasin some people the damage may be permanent or may get gradually worse with time. If the underlying cause of peripheral neuropathy isnt treated, you may be at risk of developing potentially serious complications, such as a foot ulcer that becomes infected. This can lead to gangrene (tissue death) if untreated, and in severe cases may mean the affected foot has to be amputated. Peripheral neuropathy mayaffect the nerves controlling the automatic functions of the heart and circulation system (cardiovascular autonomic neuropathy). You may need treatment to increase your blood pressure or,in rare cases, a pacemaker . Read more about complications of peripheral neuropathy Symptoms of peripheral neuropathy Symptoms vary according to the type of peripheral neuropathy and may develop quickly or slowly. The main types of peripheral neuropathy include: sensory neuropathydamage to the nerves that carry messages of touch, temperature, pain and other sensations to the brain motor neuropathydamage to the nerves that control movement autonomic neuropathydamage tothe nerves that control involuntary bodily processes, such as digestion, bladder function and control of blood pressure mononeuropathy damage to a single nerve outside of the central nervous system In many cases, someone with peripheral neuropathy may have more than one of these types at the same time. Acombination of sensory and motor neuropathy is particularly common (sensorimotor polyneuropathy). The symptoms of the main types of peripheral neuropathy are described below. Sensory neuropathy Symptoms of sensory neuropathy can include: prickling and tingling sensation in the affected body partpins and needles numbness and less of an ability to feel pain or changes in temperature, particularly in your feet a burning or sharp pain, usually in the feet feeling pain from something that should not be painful at all, such as a very light touch (allodynia) loss of balance or co-ordination caused by less ability to tell the position of the feet or hands (sensory ataxia) Motor neuropathy Symptoms of motor neuropathy can include: twitching and muscle cramps muscle weakness orparalysis affecting one or more muscles thinning (wasting) of muscles foot drop difficulty lifting up the front part of your foot and toes, particularly noticeable when walking Autonomic neuropathy Damage to the autonomic nerves can result in a wide range of symptoms depending on where in the body the damage occurs. Symptoms of autonomic neuropathy caninclude: constipation or diarrhoea , particularly at night feeling sick, bloating and belching low blood pressure (postural or orthostatic hypotension), which can make you feel faint or dizzy when standing up rapid heartbeat (tachycardia) excessive sweating or a lack of sweating problems with sexual function, such as erectile dysfunction in men difficulty fully emptying your bladder of urine bowel incontinence (loss of bowel control) Mononeuropathy Depending on the specific nerve affected, symptoms of mononeuropathy can include: altered sensation or weakness in the fingers double vision or other problems with focusing your eyes, sometimes with eye pain weakness of one side of your faceBells palsy foot or shin pain, weakness or altered sensation The most common type of mononeuropathy iscarpal tunnel syndrome (CTS). The carpal tunnel is a small tunnel in your wrist. In CTS, the median nerve becomes compressed where it passes through this tunnel, which may cause tingling, pain or numbness in the fingers. Causes of peripheral neuropathy Diabetes is the most common cause of peripheral neuropathy in the UK. Neuropathy can also be caused by other health conditions andcertain medications. In some cases, no causecan beidentifiedand this is termed idiopathic neuropathy. Diabetes Peripheral neuropathycaused byeither type 1 diabetes or type 2 diabetes is called diabetic polyneuropathy.Its probably caused by high levels of glucose in your blood damaging the tiny blood vessels that supply your nerves. Peripheral neuropathy becomes more likely the longer youve had diabetes. Up to1 in every4 people with the condition experience some pain caused by nerve damage. If you have diabetes, your risk of polyneuropathy is higher if your blood sugar is poorly controlled or you: smoke regularly consume large amounts of alcohol are over 40 years old If you have diabetes, you should examine your own feet regularly to check for ulcers (open wounds or sores) or chilblains. Other causes As well as diabetes, there are many other possible causes of peripheral neuropathy. Health conditions Some of the health conditions that can cause peripheral neuropathy include: excessive alcohol drinking for years low levels of vitamin B12 or other vitamins physical damage to the nervessuch as from an injury or during surgery an underactive thyroid gland (hypothyroidism) certain infectionssuch as shingles , Lyme disease , diphtheria, botulism and HIV inflammation of the blood vessels (vasculitis) chronic liver disease or chronic kidney disease monoclonal gammopathy of undetermined significance (MGUS) the presence of an abnormal protein in the blood certain types of cancer, such as lymphoma (a cancer of the lymphatic system) and multiple myeloma (a type of bone marrow cancer) Charcot-Marie-Tooth (CMT) diseaseand other types of hereditary motor sensory neuropathygenetic conditions that cause nerve damage, particularly in the feet having high levels of toxins in your body, such as arsenic, lead or mercury Guillain-Barr syndromea rare condition that causes rapid onset of paralysis within days amyloidosisa group of rare but serious conditions caused by deposits of abnormal protein called amyloid in tissues and organs throughout the body conditions caused by overactivity of the immune system such as rheumatoid arthritis , lupus or Sjogrens syndrome Medication A few medications may sometimes cause peripheral neuropathy as a side effect in some people. These include: some types of chemotherapy for cancer especially for bowel cancer , lymphoma or myeloma some antibiotics, if taken for months such as metronidazole ornitrofurantoin phenytoin used to treat epilepsy if taken fora long time amiodarone and thalidomide Diagnosing peripheral neuropathy A number of tests may be used to diagnose peripheral neuropathy and its underlying cause. When you see your GP,theyllask about your symptoms and examine the affected area of your body. This may involve testing sensation, strength and reflexes. Your doctor mayalso arrange blood tests, especially to check forcauses such as diabetes or vitamin B12 deficiency . Confirming if you have a neuropathy Some people may need to see a neurologist (a specialist in conditions affecting the nervous system)in hospital for further tests such as: a nerve conduction test (NCS)wheresmall metal wires called electrodes are placed on your skin which release tiny electric shocks that stimulate your nerves; the speed and strength of the nerve signal is measured electromyography(EMG)where a small needle is inserted through your skin into your muscle and used to measure the electrical activity of your muscles NCS and EMGare usually carried out at the same time. Identifying the cause of a neuropathy Your GP can usually identify the underlying cause of a peripheral neuropathy. If diabetes is suspected, they can usually make a confident diagnosis based onyour symptoms, a physical examination and checking the levels of glucose in your blood and urine. If youre taking a medication known to cause peripheral neuropathy, your GP maytemporarily stop or reduce your dose to see whether your symptoms improve. If the cause is uncertain, you may be referred to a neurologist for more extensive blood tests to check: whether you have a rare acquired cause that may be responsible whether you have a genetic abnormality, such as Charcot-Marie-Tooth disease You may need a lumbar puncture to test the cerebrospinal fluid (a clear, colourless fluid that surrounds and supports the brain and spinal cord) for inflammation. Further tests Occasionally, a nerve biopsy may be carried out as part of your diagnosis. This is a minor surgical procedure where a small sample of a peripheral nerve is removed from near your ankle so it can be examined under a microscope. Its then checked for changesthat could be a sign of certain types of peripheral neuropathy. However, nerve biopsies are rarely needed. You may also needa scan to look for any underlying cause of your neuropathy, such as: an X-ray a computerised tomography (CT) scan a magnetic resonance imaging (MRI) scan Treating peripheral neuropathy Treatment for peripheral neuropathymay includetreating any underlying cause or any symptoms youre experiencing. Treatment may be more successfulfor certain underlying causes.For example,ensuring diabetes is well controlled may help improve neuropathy or at least stop it getting worse. Treating the underlying cause There are many different possible causes of peripheral neuropathy , some of which can be treated in different ways. For example: diabetes can sometimes be controlled by lifestyle changes, such as stopping smoking, cutting downon alcohol, maintaining a healthy weight and exercising regularly vitamin B12 deficiency can be treated with B12 injections or tablets peripheral neuropathy caused by a medication youre taking may improve if the medication is stopped Some less common types of peripheral neuropathy may be treated with medication, such as: corticosteroids  powerful anti-inflammatory medication immunosuppressants medications that reduce the activity of the immune system injections of immunoglobulin mixture of blood proteins called antibodies made by the immune system However, the underlying cause may not always be untreatable. Relieving nerve pain You may also require medication to treat any nerve pain (neuropathic pain)youre experiencing. Unlike most other types of pain, neuropathic pain doesnt usually get better with common painkillers, such as paracetamol and ibuprofen and other medications areoften used. These should usually be started at the minimum dose, with the dose gradually increased until you notice an effect, becausethe ideal dose for each person is unpredictable. Higher doses may bebetter at managing the pain, but are also more likely to cause side effects. The most common side effects are tiredness, dizziness or feeling drunk. If you get these, it may be necessary to reduce your dose. Dont drive or operate machineryif you experience drowsiness or blurred vision. You also may become more sensitive to the effects of alcohol. The side effects should improve after a week or two as your body gets used to the medication. However, if your side effects continue, tell your GPas it may be possible to change to a different medication that suits you better. Even if the first medication tried doesnt help, others may. Many of these medications may also be used for treating other conditions, such as depression, epilepsy, anxiety or headaches. If youre given an antidepressant , this may treat pain even if youre not depressed.This doesnt mean your doctor suspects youre depressed. The main medications recommended for neuropathic pain include: amitriptyline also used for treatment of headaches and depression duloxetinealso used for treatment of bladder problems and depression pregabalin and gabapentin also usedto treat epilepsy , headaches or anxiety There are also some additional medications that can be used to relieve pain in a specific area of the body or to relieve particularly severe pain for short periods. These are described below. Capsaicin cream If your pain is confined to a particular area of your body and you cant, or would prefer not to,take the medications above, you may benefit from using capsaicin cream. Capsaicin is the substance that makes chilli peppers hot and is thought to work in neuropathic pain by stopping the nerves sending pain messages to the brain. A pea-sized amount of capsaicin cream is rubbed on the painful area of skin three or four times a day. Side effects of capsaicin cream can include skin irritation and a burning sensation in the treated area when you first start treatment. Dont use capsaicin cream on broken or inflamed skin and always wash your hands after applying it. Lidocaine plaster This is a large sticking plaster that contains a local anaesthetic. Its useful when pain affects only a small area of skin. Its stuck over the area of painful skin and the local anaesthetic is absorbed into the skin thats covered. Tramadol Tramadol is a powerful painkiller related to morphine that can be used to treat neuropathic pain that doesnt respond to other treatments your GP can prescribe. Like all opioids, tramadol can be addictive if its taken for a long time. It will usually only be prescribed for a short time.Tramadol can be useful to take at times when your pain is worse. Common side effects of tramadol include: feeling sick orvomiting dizziness constipation Treating other symptoms In addition to treating pain, you may also require treatment to help you manage other symptoms youre experiencing as a result of peripheral neuropathy. For example, if you have muscle weakness, you may need physiotherapyto learn exercises to improve your muscle strength. You may also need to wear splints to support weak ankles or use walking aids to help you get around. Other problems associated with peripheral neuropathymay be treatable with medication, such as: erectile dysfunction constipation the slow movement of food through your stomach (gastroparesis) In some cases, you may need more invasive treatment, such as botulinum toxin injections for hyperhidrosis or urinary catheterisation if you have problems emptying your bladder. Complications of peripheral neuropathy Peripheral neuropathy can sometimes cause other medical problems, such as foot ulcers and heart rhythm changes, and blood circulation problems. These complications vary depending on the underlying cause of the condition. Diabetic foot ulcer A diabetic foot ulcer is an open wound or sore on the skinthats slow to heal. These are common in people with diabetic polyneuropathy. If you have numb feet, its easy to cut your foot by stepping on something sharp. An ulcer can also occur if you unknowingly develop a blister caused bybadly fitting shoes. If you dont feel any pain, you may continue walking without protecting the blister. If the cut or blister gets worse, it may develop into an ulcer. High blood sugar can damage your blood vessels, causing the blood supply to your feet to become restricted. A reduced blood supply to the skin on your feet means it receives a lower number of infection-fighting cells, which can mean wounds take longer to heal and can lead to gangrene. Gangrene If you do develop a wound infection in one of your feet as a result of peripheral neuropathy, theres a risk this couldlead to gangrene(death of part of the skin or underlying tissues). If gangrene does develop, you may need surgery to remove the damaged tissue (known as debridement) and antibiotics to treat any underlying infection. In severe cases your toe or foot may need to be amputated. If you have diabetes, you should take extra care of your feet. Get your feet checked regularly by a podiatrist (a medical professional, also known as a chiropodist, who specialises in foot care). Cardiovascular autonomic neuropathy (CAN) Cardiovascular autonomic neuropathy (CAN) is another potentially serious problem thats common in people with diabetic polyneuropathy. CAN occurs when damage to the peripheral nerves disrupts the automatic functions that control your blood circulation and heartbeat. The two main noticeable symptoms of CAN are: an inability to exercise for more than a very short period of time orthostatic hypotension  a type of low blood pressure that can make you feel dizzy or faint when you stand up Treating CAN You may be able to control the symptoms of orthostatic hypotension by using a number of self care techniques, such as: standing or sitting up slowly and gradually drinking plenty of fluids to increase the volume of your blood and raise your blood pressure wearing compression stockings to help prevent blood falling back down into your legs tilting your bed by raising it at the head end In some cases, medication may be required to treat orthostatic hypotension. Two widely used medications are: fludrocortisonewhich works by increasing the volume of your blood midodrinewhich works by tightening your blood vessels A more serious concern with CAN is that your heart may suddenly develop an abnormal pattern of beating (arrhythmia), which could lead to a cardiac arrest,where your heart stops beating altogether. To prevent this, you may be prescribed medication to help regulate the beating of your heart, such as flecainide, beta-blockers or amiodarone. If you have CAN, youll probably need to have regular check-ups so your heart function can be monitored. Source: NHS 24 - Opens in new browser window Last updated: 16 June 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Trigeminal neuralgia Other health sites Pain Concern Trigeminal Neuralgia Assocation UK Diabetes UK: neuropathy NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Personality disorder,"Personality disorder | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Mental health Personality disorder Personality disorder Personality disorders are conditions where an individual differs significantly from an average person. This may be related to how they: think perceive feel relate to others Changes in how a person feels and distorted beliefs about other people can lead to odd behaviour. This can be distressing and may upset others. Common features of a personality disorder Common features of a personality disorder include: being overwhelmed by negative feelings like distress, anxiety, worthlessness or anger avoiding other people feeling empty and emotionally disconnected odd behaviour difficulty maintaining stable and close relationships, especially with partners, children and professional carers periods of losing contact with reality Some people may also have difficulty managing negative feelings without self-harming. This can include abusing drugs and alcohol or taking overdoses. In rare cases, it may include threatening other people. People with personality disorders often experience other mental health problems. This includes depression and substance misuse. Symptoms typically get worse with stress . When and why personality disorders occur Personality disorders are common mental health problems. They usually emerge in adolescence and continue into adulthood. They may be mild, moderate or severe. People may have periods of remission where they function well. Personality disorders may be associated with genetic and family factors. Experiences of distress or fear during childhood, like neglect or abuse, are common. Many people have only mild conditions so only need help at times of stress (such as bereavement). People with more severe problems may need specialist help for longer. Types of personality disorder There are different types of personality disorders. Paranoid personality disorder A person with a paranoid personality disorder is extremely distrustful and suspicious. Other features include: thinking other people are lying to them or trying to manipulate them feeling they cannot trust their friends and associates worrying that any confidential information shared with others will be used against them thinking there are hidden meanings in remarks most would regard as innocent worrying that their spouse or partner is unfaithful, despite a lack of evidence Schizoid personality disorder Someone with a schizoid personality disorder may appear cold and detached. They may also avoid making close social contact with others. Other features include: preferring to take part in activities that do not need interaction with others having little desire to form close relationships, including sexual relationships being uninterested when receiving criticism or praise having a limited ability to experience pleasure or joy Schizotypal personality disorder A person with a schizotypal personality disorder is likely to: have poor social skills have delusional thoughts behave in unusual ways Other features include: believing in special powers  like telepathy or the ability to influence other peoples emotions and actions having unusual ways of speaking  like long, rambling vague sentences or going off on a tangent experiencing excessive anxiety in social situations  even if theyve known a particular person or group of people for a long time A person may also attach undue and misguided significance to everyday events. For example, thinking newspaper headlines are secret messages to them. Antisocial personality disorder A person with an antisocial personality disorder sees other people as vulnerable. This means they may intimidate or bully others without remorse. Symptoms include: lack of concern, regret or remorse about other peoples distress irresponsibility and disregard for normal social behaviour difficulty in sustaining long-term relationships little ability to tolerate frustration and control their anger lack of guilt, or not learning from their mistakes blaming others for problems in their lives Borderline personality disorder A person with borderline personality disorder: is emotionally unstable has impulses to self-harm has very intense and unstable relationships with others Histrionic personality disorder A person with a histrionic personality disorder is anxious about being ignored. As a result, they feel an overwhelming urge to be noticed. They also have the urge to be the centre of everyones attention. Features include: displaying excessive emotion, yet appearing to lack real emotional sincerity dressing provocatively and engaging in inappropriate flirting or sexually seductive behaviour moving quickly from one emotional state to another being self-centred and caring little about other people constantly seeking reassurance and approval from other people Symptoms and signs may co-exist with borderline and narcissistic personality disorders. Narcissistic personality disorder A person with narcissistic personality disorder swings between: seeing themselves as special, and fearing theyre worthless They may act as if they have an inflated sense of their own importance. They may also show an intense need for other people to look up to them. Other symptoms include: exaggerating their achievements and abilities thinking theyre entitled to be treated better than other people exploiting other people for their own personal gain lacking empathy for other peoples weaknesses looking down on people they feel are beneath them feeling deeply envious of people they see as being above them Avoidant personality disorder A person with avoidant personality disorder: appears painfully shy is socially inhibited feels inadequate is extremely sensitive to rejection Unlike people with schizoid personality disorders, they desire close relationships with others. However, they lack the confidence and ability to form them. Dependent personality disorder A person with dependent personality disorder feels they cant be independent. They may show an excessive need for others to look after them and are clingy. Other features include: finding it difficult to make decisions without other peoples guidance needing others to take responsibility over what should be their own life choices not being able to express disagreement with other people finding it difficult to start new activities due to a lack of confidence going to extremes to get support and comfort feeling helpless and uncomfortable when alone urgently needing to start a new relationship when one comes to an end having an unrealistic and constant fear theyll be left alone to fend for themselves Obsessive compulsive personality disorder A person with obsessive compulsive personality disorder is: anxious about issues that seem out of control or messy preoccupied with orderliness and ways to control their environment They may come across to others as a control freak. Other features include: having an excessive interest in lists, timetables and rules perfectionism  being so focused on completing a task perfectly that they struggle to finish it being a workaholic having very rigid views about issues like morality, ethics and how a person should behave hoarding items that seem to have no monetary or sentimental value being unable to delegate tasks to other people disliking spending money, as they think its always better to save for a rainy day Differences to obsessive compulsive disorder (OCD) This personality disorder differs from obsessive compulsive disorder (OCD) . People with OCD are aware that their behaviour is abnormal and are anxious about it. Whereas, most people with obsessive compulsive personality disorder think their behaviour is acceptable. They usually have no desire to change it. Some people with OCD feel the need to carry out rituals. For example, having to touch every second lamppost as they walk down the street. This is not usually the case with people with obsessive compulsive personality disorder. People with OCD may feel the need to make lists or organise items in their house, but feel anxious about doing so. People with obsessive compulsive personality disorder feel less anxiety through such tasks. They may become irritated when prevented from doing so. Treating a personality disorder Many people recover from personality disorders over time. Treatment usually involves a course of psychological therapy tailored to the individual. This treatment usually lasts at least 6 months. But, it may last longer depending on the severity of the condition and other problems. Psychological therapies Psychotherapy involves discussing thoughts, emotions and behaviours with a trained professional. The aim is to improve peoples ability to regulate their thoughts and emotions. Some therapies focus on dysfunctional thoughts. Others focus on self-reflection and being aware of how your mind works. Some therapies, especially group therapies, help people understand social relationships better. Psychological therapies can be effective for many personality disorders. But, they should only be delivered by a trained professional. They should have experience working with personality disorders and other conditions. This is because personality disorders can be associated with high-risk behaviours, like self-harm. The psychotherapist will listen and discuss important issues with you. They can also suggest strategies to resolve problems. If necessary, theyll help you change your attitudes and behaviour. A range of different psychotherapies are used to treat personality disorders. Read more about types of counselling and therapy Medication No medications are currently licensed for the treatment of any personality disorder. But, medications may be prescribed to treat associated problems, like: depression anxiety psychotic symptoms Source: NHS 24 - Opens in new browser window Last updated: 12 May 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Pleurisy,"Pleurisy | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Lungs and airways Pleurisy Pleurisy About pleurisy Causes of pleurisy Treating pleurisy About pleurisy Pleurisy is inflammation of the sheet-like layers that cover the lungs (the pleura). The most common symptom of pleurisy is a sharpchest pain when breathing deeply. Sometimes the pain is also felt in the shoulder. The pain may be worse when you cough, sneeze or move around, and it may be relieved by taking shallow breaths. Other symptoms can includeshortness of breathand a dry cough . Visit your GP if youexperience the above symptoms.Seek immediate medical help if your chest pain is severe, particularly if you also have other symptoms, such as coughing up blood, nausea or sweating. Seeing your GP Pleurisy can usually be diagnosed by studying your symptoms. Your GP can listen to your chest to check for the distinctive dry, crunching sound that suggests you may have pleurisy. Further tests may beneeded to identify the underlying cause of your pleurisy and to assess how severe it is. These can include: blood tests to determine whether you have an infection or an autoimmune condition chest X-rays an ultrasound scan a computerised tomography (CT) scan a biopsy  a small sample of pleural or lung tissue is removed for further testing What causes pleurisy? Most cases are the result of aviral infection (such as the flu ) ora bacterial infection (such as pneumonia ). In rarer cases, pleurisy can be caused by conditionssuch asa blood clot blocking the flow of blood into the lungs (pulmonary embolism)or lung cancer . Pleurisy can affect people of all ages, but people of 65 years and over are most at risk, because theyre more likely to develop a chest infection . Read more about the causes of pleurisy . How is pleurisy treated? Treatment for pleurisy depends on the underlying cause. For example, pleurisy caused by a viral infection will often resolve itself without treatment.However, pleurisy caused by a bacterial infection is usually treated with antibiotics , and people who are frail or already in poor health may be admitted to hospital. Non-steroidal anti-inflammatory drugs (NSAIDs) , such as ibuprofen , are often used to relieve the chest pain associated with pleurisy. If excess fluid builds up between the pleural layers, it may be necessary to drain the fluid to prevent breathing difficulties. Read more about treating pleurisy . Causes of pleurisy Pleurisy is inflammation of the pleura. Its usually caused by another condition, such as an infection, but sometimes no cause can be identified. The pleura are two thin sheets of tissuethat separate the lungs and ribcage. One is attached to the ribcage and the other is attached to the lungs. Between the pleural sheets is a thin layer of liquid that lubricates the pleura, helping to reducefriction when you breathe in and out. When theres inflammation, the surfaces of the two layers can become rough and the fluid can become sticky. This can cause the layers to rub together, resulting in pain and discomfort. Infection An infection is the most common cause of pleurisy.Any type of infection has the potential to spread to the pleura, but viral infections are usually responsible. Viruses known tocausepleurisy include: the influenza (flu) virus the Epstein-Barr virus  whichcauses glandular fever cytomegalovirus (CMV)  a common virus found in most people, which doesnt usually cause any noticeable symptoms parainfluenza  the virus that causes the childhood condition croup In some cases, pleurisy is caused by bacteria, such as: streptococcal bacteria  often associated with pneumonia , throat infections and some types of skin infections, such as impetigo and cellulitis staphylococcal bacteria  often associated with skin infections, food poisoning and, more seriously, blood poisoning (sepsis) Meticillin-resistant Staphylococcus aureus (MRSA) can cause pleurisy, especially inhospital patients. MRSA is a type of bacteriawith a resistance to a number of commonly used antibiotics. Other causes Other possible causes of pleurisy include: injury  if the ribs are bruised or fractured, the pleura can become inflamed pulmonary embolism  a blood clot developing inside the lungs sickle cell anaemia  a blood disorder that usually affectspeople of African or Caribbean descent chemotherapy and radiotherapy HIV or AIDS lung cancer mesothelioma  a type of cancer caused by inhaling asbestos Autoimmune conditions, such as rheumatoid arthritis and lupus , are other possible causes of pleurisy. In these conditions, something goes wrong with the immune system (the bodys natural defence against infection and illness)and it begins to attack healthy tissue. Treating pleurisy Treatment for pleurisy usually involves relieving pain and treating the underlying cause of the condition. If treated promptly, pleurisyoften resolves without any lasting damage to the lungs. Treating pain The chest pain associated with pleurisy can be treated usinga type of painkiller known as non-steroidal anti-inflammatory drugs (NSAIDs) . Most often, ibuprofen is used. If NSAIDs are ineffective or unsuitable, you may be prescribed another painkiller, such as paracetamol or codeine. It may seem strange, but lying down on the side of your chest that hurts may also helpto reduce the pain. Treating the underlying cause It may also be necessary to treat the underlying cause of your pleurisy. If you have pleurisycaused by a bacterial infection, youll need a course of antibiotics . Depending on the severity of your symptoms, this may be eithertablets or injections. Combinations of different antibiotics are sometimes used. However, ifyour pleurisy is caused by a viral infection, further treatment may not be required,as the infection usually resolves itself after a few days. In cases where your symptoms are particularly severe or youre already in poor health, you may need to be admitted to hospital soyour bodys functions can be supported until your condition stabilises. Pleural effusion In some cases, pleurisy causes a build-up of excess fluid around the lungs called pleural effusion. Pleural effusion canresult inshortness of breath that gets progressively worse. Thisis more likely in cases of pleurisy caused by pulmonary embolism or a bacterial infection. If pleural effusion doesnt clear up as your pleurisy is treated, or if youre very short of breath, a tube will need to be inserted so the fluidcan be drained away. The tubemaybe inserted usingeither general anaesthetic (where youre asleep) or local anaesthetic (the area where the tube is inserted is numbed). If a lot of fluid has to be drained away,you may need to stay in hospital for a few days. Source: NHS 24 - Opens in new browser window Last updated: 02 February 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Flu Pneumonia Pleurisy NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Pneumonia,"Pneumonia | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Lungs and airways Pneumonia Pneumonia About pneumonia Treating pneumonia About pneumonia Pneumonia is swelling (inflammation) of the tissue in one or both lungs. Its usually caused by a bacterial infection. At the end of the breathing tubes in your lungsare clusters of tiny air sacs. If you have pneumonia, these tiny sacs become inflamed and fill up with fluid. Symptoms of pneumonia The symptoms of pneumoniacan develop suddenly over 24 to 48 hours, or they may come on more slowly over several days. Commonsymptomsof pneumoniainclude: a cough which may be dry, or produce thick yellow, green, brown or blood-stainedmucus (phlegm) difficulty breathing your breathing may be rapid and shallow, and you may feel breathless, even whenresting rapid heartbeat fever feeling generally unwell sweating and shivering loss of appetite chest pain which gets worse when breathing or coughing Less common symptoms include: coughing up blood (haemoptysis) headaches fatigue nausea or vomiting wheezing joint and muscle pain feeling confused and disorientated, particularly in elderly people When to see your GP See your GP if youfeel unwell and you have typical symptoms of pneumonia. Seek urgent medical attention if youre experiencing severe symptoms, such asrapid breathing,chest painor confusion. Whos affected? In the UK, pneumonia affects around8in 1,000 adults each year. Its more widespreadin autumn and winter. Pneumonia can affect people of any age, but its more common and can be more seriousin certain groups of people, such as the very young or the elderly. People in these groups are more likely to need hospital treatment if they develop pneumonia. What causes pneumonia? Pneumonia is usually the result ofapneumococcal infection, caused by bacteria calledStreptococcus pneumoniae. Many different types of bacteria, includingHaemophilus influenzae and Staphylococcus aureus, can also cause pneumonia, as well as viruses and, more rarely, fungi. As well as bacterial pneumonia, other types include: viral pneumonia  most commonly caused by the respiratory syncytial virus (RSV) and sometimes influenza type A or B; viruses are a common cause of pneumonia in young children aspiration pneumonia  caused by breathing in vomit,a foreign object, such as a peanut,or a harmful substance, such as smoke or a chemical fungal pneumonia rare in the UK and more likely to affect people with a weakened immune system hospital-acquired pneumonia  pneumonia that develops in hospital while being treated for another condition or having an operation; people in intensive careon breathing machines are particularly at risk of developing ventilator-associated pneumonia Risk groups The following groups have an increased risk of developing pneumonia: babies and very young children elderly people people who smoke people with other health conditions, such as asthma , cystic fibrosis , or a heart, kidney or liver condition people with a weakened immune system for example, as a result of a recent illness, such as flu , having HIV or AIDS , having chemotherapy ,or taking medication following an organ transplant Diagnosing pneumonia Your GP may be able to diagnose pneumonia by asking about your symptoms and examining your chest. Further tests may be needed in some cases. Pneumonia can be difficult to diagnose because it shares many symptoms with other conditions, such as the common cold , bronchitis and asthma . To help make a diagnosis, your GP may ask you: whetheryou feel breathless or youre breathing faster than usual how long youve had your cough,and whether youre coughing up mucus and what colour it is if the pain in your chest is worse when you breathe in or out Your GP may also take your temperature and listen to your chest and back with a stethoscope to check for any crackling or rattling sounds. They may also listen to your chest by tapping it. Lungs filled with fluid produce a different soundfrom normal healthy lungs. If you have mild pneumonia, you probably wontneed to have a chest X-ray or any other tests. You may need a chestX-ray or other tests, such as a sputum (mucus) test or blood tests ,if your symptoms havent improved within 48 hours of starting treatment. Treating pneumonia Mild pneumonia can usually be treated at home by: getting plenty of rest taking antibiotics drinking plenty of fluids If you dont have any other health problems, you should respond well to treatment and soon recover, although your cough may last for some time. As pneumonia isnt usually passed from one person to another, its safe to be around others, including family members. However, people with a weakened immune system should avoid close contact with a person with pneumonia until they start to get better. For at-risk groups, pneumonia can be severe and may need to be treated in hospital. This is because it can lead to serious complications, which in some cases can be fatal, depending on a persons health and age. Read more about treating pneumonia . Complications of pneumonia Complications of pneumonia are more common in young children, the elderlyand those with pre-existing health conditions, such as diabetes . Possible complications of pneumonia include: pleurisy  where the thin linings between your lungs and ribcage (pleura) become inflamed, which can lead to respiratory failure a lung abscess a rare complication thats mostly seen in people with a serious pre-existing illness or a history of severe alcohol misuse blood poisoning (septicaemia)  also a rare but serious complication Youll be admitted to hospital for treatment if you develop one of these complications. Preventing pneumonia Although most cases of pneumonia are bacterial and arent passed on from one person to another, ensuring good standards of hygiene will help prevent germs spreading. For example, you should: cover your mouth and nose with a handkerchief or tissue when you cough or sneeze throw away used tissues immediately germs can live for several hours after they leave your nose or mouth wash your hands regularly to avoid transferring germs to other people or objects A healthylifestyle can also help prevent pneumonia. For example, you should avoid smokingas it damages your lungs and increases the chance of infection. Find outhow to stop smoking . Excessive and prolongedalcohol misuse also weakens your lungs natural defences against infections, making you more vulnerable to pneumonia. People at high risk of pneumoniashould be offered the pneumococcal vaccineand flu vaccine. Treating pneumonia Mild pneumonia can usually be treated at home with rest, antibiotics and by drinking plenty of fluids. More severe cases may need hospital treatment. Unless a healthcare professional tells you otherwise, you should always finish taking a prescribed course of antibiotics, even if you feel better. If you stop taking an antibiotic part way through a course, the bacteria can become resistant to the antibiotic. After starting treatment, your symptoms should steadily improve. However, how quickly they improve will depend on how severe your pneumonia is. As a generalguide, after: one week  fever should have resolved four weeks chest pain and mucus production should have substantially reduced six weeks  cough and breathlessness should have substantially reduced three months  most symptoms should have resolved, but you may still feel very tired (fatigue) six months  most people will feel back to normal Treatment at home Visit your GP if your symptoms dont improve within three days of starting antibiotics . Symptoms may not improve if: the bacteria causing the infection is resistant to antibiotics  your GP may prescribe a different antibiotic, or they may prescribe a second antibiotic for you to take with the first one avirus is causing the infection, rather than bacteria  antibiotics have no effect on viruses, andyour bodys immune system will have to fight the viral infection by creating antibodies Painkillers, such as paracetamol or ibuprofen , may help relievepain and reducefever. However, you shouldnt take ibuprofen if you: are allergic to aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) have asthma , kidney disease, a history of stomach ulcers or indigestion Cough medicines arent recommended as theres also little evidence they are effective. A warm honey and lemon drink can help relieve discomfort caused by coughing. Yourcough may persist for two to three weeks after you finish your course ofantibiotics,and you may feel tired for even longer as your body continues to recover. Drink plenty of fluids to avoid dehydration , and get plenty of rest to help your body recover. If you smoke,its more important than ever to stop, as smoking damages your lungs. Read more about stop smoking treatments and how to stop smoking . See your GP if, after following the above self-help measures, your condition is deteriorating or isnt improving as expected. Pneumonia isnt usually passed from one person to another, so its safe to be around others, including family members. However, its best for people with a weakened immune system to avoid close contact with a person with pneumonia until they start to get better. Follow-up Your GP will probably arrange a follow-up appointment for you about six weeks after you start your course of antibiotics. In some cases, they may arrange follow-up tests, such as a chest X-ray , if: your symptoms havent improved your symptoms have come back you smoke youre over the age of 50 Some people may be advised to have a flu vaccination or pneumococcal vaccination after recovering from pneumonia. Read more about preventing pneumonia . Treatment in hospital You mayneed treatment inhospital ifyour symptoms are severe. Youll be given antibiotics and fluids intravenously through a drip, and you may need oxygen to help breathing. In very serious cases of pneumonia, breathing assistance through a ventilator in an intensive care unit (ICU)may be required. Read more about the complications of pneumonia . Source: NHS 24 - Opens in new browser window Last updated: 07 December 2022 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Quit Your Way Scotland Pneumonia Pleurisy Shortness of breath NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Polycystic ovary syndrome (PCOS),"""Polycystic ovary syndrome (PCOS) Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Healthy living Women's health Girls and young women (puberty to around 25) Periods and menstrual health Polycystic ovary syndrome (PCOS) Polycystic ovary syndrome (PCOS)  |  | Polski |  |  | Easy Read Return to Symptoms Enter age Last Updated: Next Review Date: Review my answers Find your local services Search for a service near you by entering your postcode below. Please input your postcode in the following format: A12 1BC GP Practices Dental Services Pharmacies Opticians Postcode Search NHS inform has more information on this condition. Read more Previous Start guide Review my answers  You told us your credentials were: : You said: Based on the information you gave us, we made the following recommendation: Close Keep a copy View PDF Polycystic ovary syndrome (PCOS) is a condition that affects how your ovaries work. Despite the name, there are no cysts on the ovaries. During ovulation, an egg is released once a month. PCOS can have an impact on this and cause irregular ovulation, or no ovulation at all. If you want to have a family, PCOS can make it difficult to get pregnant. PCOS can also affect your metabolism (the chemical reactions in the bodys cells that change food into energy) making it easier to gain weight and more difficult to lose weight. Symptoms You are born with PCOS, but symptoms often start during puberty although for some people this can be later, up to their early twenties. There are lots of different symptoms that can be caused by PCOS. The main symptoms are: irregular periods  you should have at least 3 or 4 periods a year to keep the womb healthy if youre not using hormonal contraception excess facial or body hair which is caused by slightly higher levels of male hormones in your body (androgen) Other symptoms can include: weight gain hair loss or hair thinning oily skin or acne difficulty or delays getting pregnant People who have PCOS can also struggle with depression and with their mental health as a result of the condition. PCOS can increase your risk of certain health conditions, including type 2 diabetes and high cholesterol. You should speak to your doctor if you are experiencing these symptoms and you are not pregnant or on hormone treatment. Causes The exact cause of PCOS isnt known but its thought to be caused by a hormone and metabolic (the chemical reactions in the bodys cells that change food into energy) imbalance in the body. PCOS can run in families so if someone in your family has the condition, its more likely you may have it too. You should let your doctor know if this is the case for you. People with PCOS have a higher risk of developing health problems in later life, such as type 2 diabetes and high cholesterol levels, as PCOS can make it easier to gain weight and more difficult to lose weight. Diagnosis Your doctor will talk to you about your symptoms to help rule out any other health conditions. It can be helpful to keep a note of your period dates and symptoms using a calendar, a diary or an app. This can help you track how the symptoms are affecting your life, and will give your doctor more of an insight. Your doctor might recommend you have some hormone and/or blood tests, to rule out any other hormone-related conditions. You might also need to have an ultrasound scan, as this will help them to diagnose PCOS. If youre diagnosed with PCOS, you may be referred to a specialist. Treatment Treatment can vary depending on your symptoms. Although theres no cure, there are lots of treatment options available to help manage your symptoms. Treatments can also help prevent complications and, if you want to have a family, improve your chances of getting pregnant. If you dont want to become pregnant you should still use contraception as you may still ovulate sometimes. Your doctor can discuss the options so that you can decide whats best for you, and you can ask any questions that you might have. Having a healthy diet and exercising regularly can significantly help your PCOS symptoms. It can also reduce your chances of developing other health conditions, including type 2 diabetes and high cholesterol. You should try to: eat lots of fruit and vegetables eat more fibre drink plenty of water eat oilyfish reduce meat and dairy products avoid sugary food and drink avoid or limit alcohol going for regular walks keeping active, in particular aerobic exercise If youre struggling with managing your symptoms, your doctor can provide further support. Source: Scottish Government - Opens in new browser window Last updated: 30 May 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Other languages and formats  |  | Polski |  |  | Easy Read  |  | Polski |  |  | Easy Read Add this page to\n            Info For Me Also on NHS inform Type 2 diabetes High cholesterol Food and nutrition Keeping active Self-help tool: Periods and mental wellbeing Other health sites Verity UK British Fibroid Trust PCOS Relief PCOS Relief: video NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Polymyalgia rheumatica,"Polymyalgia rheumatica | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Muscle, bone and joints Conditions Polymyalgia rheumatica Polymyalgia rheumatica About polymyalgia rheumatica Symptoms of polymyalgia rheumatica Diagnosing polymyalgia rheumatica Treating polymyalgia rheumatica About polymyalgia rheumatica Polymyalgia rheumatica (PMR) is a condition that causes pain, stiffness and inflammation in the muscles around the shoulders, neck and hips. The main symptom is musclestiffness in the morning that lasts longer than 45 minutes. It may also causeother symptoms, including: high temperature (fever) and sweating extreme tiredness (fatigue) loss of appetite weight loss depression If you have pain and stiffness that lasts longer than a week, you should see your GP so the cause can be investigated. Diagnosing polymyalgia rheumaticacan be difficult because the symptoms are similar to those of many other conditions, including rheumatoid arthritis . These conditions will need to be ruled out before polymyalgia rheumatica is diagnosed. Read more about the symptoms of polymyalgia rheumatica and diagnosing polymyalgia rheumatica . What causes polymyalgia rheumatica? The cause of polymyalgia rheumatica is unknown, but a combination of genetic and environmental factorsis thought to be responsible. Polymyalgia rheumatica is relatively common in the UK. Its estimated that one in every 1,200 people develop the condition every year. Polymyalgia rheumatica isage-related. Most people who are diagnosed with the condition are over 70. Its extremely rare in people younger than 50. Its also more common in women than men. Treating polymyalgia rheumatica The main treatment forpolymyalgia rheumatica is a coritcosteroid medication called prednisolone, which is used to help relieve the symptoms. Youllinitiallybe prescribed a high dose of prednisolone, which will be reduced gradually over time. Most people with polymyalgia rheumatica will need to take a long-term course of corticosteroid treatment(lasting 18 months to two years) to prevent their symptoms returning. Read more about treating polymyalgia rheumatica . Symptoms of polymyalgia rheumatica The most common symptom of polymyalgia rheumatica (PMR) is pain and stiffness in the shoulder muscles, which develops quickly over a few days or weeks. The muscles in the neck andhips are also often affected. Both sides of the body are usually affected. The stiffness often feelsworse first thing in the morning after you wake up and starts to improve after about 45 minutes as you become more active. Some people withpolymyalgia rheumatica have additional symptoms, including: a mild high temperature (fever) of 37-38C (98.6-100.4F) depression fatigue (extreme tiredness) loss of appetite weight loss When to seek medical advice If you have symptoms of pain and stiffness that last longer than a week, you should make an appointment to see your GP so that the cause can be investigated. When to seek immediate medical advice You should seek immediate medical advice if you have been diagnosed with polymyalgia rheumatica (or the condition is suspected) and you suddenly develop: a persistent and severe headache jaw pain or cramping in your jaw muscles which is worse when youre eating pain in the tongue when chewing vision lossor vision disturbances, such asdouble vision These symptoms may indicate a more serious condition called giant cell arteritis (temporal arteritis). Call your GP immediately for adviceif you have any of the above symptoms. If this isnt possible,contact your local out of hours service or call theNHS 24 111 service. Diagnosing polymyalgia rheumatica Diagnosing polymyalgia rheumatica (PMR) can often be quite a lengthy process that involves several different tests. This is because the condition shares many symptoms with more common health conditions, such as rheumatoid arthritis , which need to be ruled out first. Tests Theres no specific test for polymyalgia rheumatica, but its likely that a series of blood tests will be carried out. Two blood tests  erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)  can be used to check the levels of inflammation in your body. If the ESR and CRP test results are normal, its unlikely that polymyalgia rheumatica will be diagnosed because your doctor wont want to prescribe a long-term course of steroids if the diagnosis is uncertain. Sometimes, the ESR may be normal and CRP may be raised, which would be more likely to indicate a positive diagnosis. This is why both tests are usually carried out at the same time. As inflammation is a characteristic of many conditions, high levels dont automatically mean that you have polymyalgia rheumatica. Further tests may be needed to help rule out other conditions that cause inflammation. For example, a test for rheumatoid factor and anti-CCP antibodies , may be carried out to rule out rheumatoid arthritis. Blood tests can also help determine: whether theres an infection in your blood how well some of your organs, such as your kidneys, are working whether you have an overactive thyroid gland or an underactive thyroid gland (both conditions can cause muscle pain) You may also have a urine test to check how well your liver is functioning. X-rays and ultrasound scans may also be used to look at the condition of your bones and joints. Symptom checklist After other possible causes of your symptoms have been ruled out, a checklist can be used to see whether your symptoms match those most commonly associated with polymyalgia rheumatica. A confident diagnosis of polymyalgia rheumatica can usually be made if you meet all of the following criteria: youre over 50 years of age you have pain in your shoulders or your hips you have stiffness in the morning that lasts longer than 45 minutes your symptoms have lasted longer than two weeks blood tests show raised levels of inflammation in your body your symptoms rapidlyimprove after treatment with corticosteroids Read more about treating polymyalgia rheumatica . Treating polymyalgia rheumatica Steroid medication ( corticosteroids ) is the preferred treatment for polymyalgia rheumatica (PMR). A type of corticosteroid calledprednisolone is usually prescribed. Prednisolone Prednisolone works by blocking the effects of certain chemicals that cause inflammation inside your body. It doesnt cure polymyalgia rheumatica, but it can helprelieve the symptoms. When used to treat polymyalgia rheumatica, prednisolone is taken as a tablet. Most people will be prescribed several tablets to take once a day. Youll be prescribed a high dose of prednisolone initially, and the dose will be gradually reduced every one to two months. Although your symptoms should improve within a few days of starting treatment, youll probablyneed to continue takinga low dose of prednisolone forabout two years. In many cases, polymyalgia rheumatica improves on its own after this time. However, theres a chance that the condition will return (relapse)once treatment stops. Dont suddenly stop taking steroid medication unless a doctor in charge of your care tells you its safe to do so. Suddenly stopping treatment with steroids can make you feel very ill. Side effects of prednisolone Aboutone in 20 people who take prednisolone will experience changes in their mental state when they take the medication. You may feel depressed and suicidal , anxious or confused. Some people also experience hallucinations (seeing or hearing things that arent there). Contact your GP as soon as possible if you experience changes to your mental state. Other side effects of prednisolone include: increased appetite that often leads to weight gain increased blood pressure mood changes, such as becoming aggressive orirritable with people weakening of the bones ( osteoporosis ) stomach ulcers increased risk of infection, particularly with thevaricella-zoster virus (the virus that causes chickenpox and shingles ) Seek immediate medical advice if you think youve been exposed to the varicella-zostervirus, or if a member of your household develops chickenpox or shingles. The risk of these side effects should improve as your dose of prednisolone is decreased. See side effects of corticosteroids for more information about how these side effects may affect you and how theyre treated. Other medications Sometimes, other medicines may be combined with corticosteroids to help prevent relapses or to allow your dose of prednisolone to be reduced. Some people are prescribed immunosuppressant medication, such as methotrexate. This is used to reduce or suppress the immune system (the bodys defence against infection and illness). It may be helpful for people with polymyalgia rheumatica who have frequent relapses or dont respond to normal steroid treatment. Your doctor may recommend painkillers, such as paracetamol , or non-steroidal anti-inflammatory drugs (NSAIDs) , to help relieve pain and stiffness while your dose of prednisolone is reduced. Follow-up Your GP will ask you to attend regular follow-up appointments to check how well youre responding to treatment, whether your dose of prednisolone needs to be adjusted, and how well youre coping with the side effects of the medication. During these appointments, youll have blood tests to check the levels of inflammation inside your body. Follow-up appointments are usually recommended every few weeks for the first three months and then at three- to six-monthly intervals after this time. Contact your GP if your symptoms returnduring any part of your treatment. Your dosage may need to be adjusted. Source: MSK Expert Panel - Opens in new browser window Last updated: 13 June 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Corticosteroids Other health sites Versus Arthritis: PMR NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Post-polio syndrome,"Post-polio syndrome | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Post-polio syndrome Post-polio syndrome Post-polio syndrome is a slow progressive condition that affects some people that have had polio . Its not life threatening but it can cause problems in your ability to carry out daily activities. Polio is a serious viral infection that used to be common in the UK and worldwide. Its rarer now because it can be prevented with vaccination. In around 1 in 100 people, the polio virus causes paralysis, which in rare cases can be life threatening. Cases of polio in the UK fell dramatically when routine vaccination was introduced in the mid-1950s. Symptoms of post-polio syndrome The symptoms of post-polio syndrome include: muscle weakness shrinking of the muscles (atrophy) tight joints (contractures) pain in muscles or joints chronic fatigue including physical tiredness and brain fatigue swallowing and speech problems respiratory problems like breathlessness and sleep apnoea cramps and muscle twitching being sensitive to cold temperatures The muscle weakness and atrophy usually affects muscles that were previously affected by polio. Sometimes it affects other muscles. This can impact your mobility and your ability to do everyday tasks like brushing your teeth or drying your hair. Chronic fatigue is one of the most common and troublesome symptoms of post-polio syndrome. This can be physical fatigue (tiredness) and brain fatigue. Brain fatigue can cause problems with concentration, attention and memory. MRI scans can show white spots in the brains of polio survivors which may be related to brain fatigue. The symptoms can gradually get worse over many years. There are supportive treatments that can help with symptoms. Although post-polio syndrome is rarely life threatening, some people can develop breathing and swallowing difficulties that can lead to serious problems like chest infections . Some people experience a sensitivity to some types of anaesthesia causing them to take longer to recover from having anaesthesia. Causes of post-polio syndrome Post-polio syndrome is caused by the polio virus. It only affects people whove had polio although it can take 15  40 years after the infection for it to develop. Its not known if theres anything that can be done to prevent it. The exact cause behind wholl experience post-polio syndrome after having the polio virus is unclear. It could be because of gradual degeneration (breaking down) of nerve cells (motor neurones) in the brainstem or spinal cord that were damaged by the polio virus. This gradual change explains why it can take years for post-polio syndrome symptoms to appear. During recovery from polio, surviving motor neurone cells grow new nerve ends to connect with other muscle fibres. This helps to regain muscle strength as someone recovers from the polio virus. Over time, these new nerve ends put the motor neurone cell under stress. The cells slowly break down, resulting in the loss of muscle strength. People who have had severe polio at a young age or during adolescence (teenage years) might be more likely to experience post-polio syndrome. People who had a more serious infection in early adulthood are also more likely to develop post-polio syndrome. Post-polio syndrome is not contagious. Diagnosis of post-polio syndrome It can be difficult to diagnose post-polio syndrome. There are no specific tests for it, and it can be mistaken for other conditions. Your GP might suspect post-polio syndrome if: you had polio followed by a long period of stable symptoms (usually 15 years) your symptoms have developed gradually The symptoms of post-polio syndrome are slow and progressive. The sudden appearance of symptoms is more likely to be caused by something else. A prolonged period of bed rest as a result of another illness or serious injury can trigger post-polio syndrome symptoms. There are some tests that can be done to rule out conditions with similar symptoms. You might be offered blood tests and scans of your spine. Other tests that might be offered include: electromyography (EMG) tests  these will measure the electrical activity in your nerves and muscles and detect damage that may have been caused by having polio sleep studies  if youre experiencing sleep apnoea or youre feeling unusually tired tests to check your heart function and heart rate a magnetic resonance imaging (MRI) scan or computerised tomography (CT) scan of your brain, spine and muscles lung function tests like a spirometry to measure your breathing test to investigate dysphagia (swallowing problems) Treatment of post-polio syndrome As theres no cure for post-polio syndrome, treatment will help you manage your symptoms and quality of life. Its likely youll have a multidisciplinary team of healthcare professionals working together to care for you including: neurologists respiratory specialists physiotherapists orthotists psychologists pain management specialists occupational therapists Theyll discuss the most suitable plan for your care which might include a mixture of the following: Exercise and rest Exercise can help slow down the progressive muscle weakness that post-polio syndrome causes. However, being active can become difficult because your symptoms might become worse after exercise or activity. Any exercise should be pain free because too much exercise can cause more damage. You should pace yourself to avoid becoming exhausted from exercise. Your healthcare team might suggest you try using pacing techniques. This might involve: prioritising tasks finding different ways of doing tasks which prevent pain or exhaustion getting help from others to do particularly exhausting tasks taking regular breaks and having rest periods regularly throughout your day doing some regular gentle exercise that you can gradually build up and stopping before you become exhausted Pacing can help you prevent becoming worn out. It can help to space out activities throughout the day to allow for rest periods where you can recover in between. Making effective and efficient use of your muscles and strength in this way can help them to last longer. Painkillers Medication to relieve pain might be used in addition to pacing techniques. Your healthcare team might suggest over the counter painkillers like aspirin, paracetamol or ibuprofen . Other stronger anti-inflammatory drugs and opiates might be considered too depending on individual needs. Talk to your GP if youre taking over the counter medicines as they shouldnt be used long term. They can cause complications like stomach ulcers if taken over a long period of time. Your healthcare team or GP might suggest medication like gabapentin or pregabalin for your pain if over the counter medications arent working. When taking medication for your pain, you might not feel the damage being caused to your muscles and joints through too much activity. This means its important you follow your pacing routine even when you dont feel tired or arent in any pain. Mobility aids You might benefit from a mobility aid like: braces to support weakened muscles and joints, prevent falls and improve posture walking sticks to help you balance and prevent falls an electric scooter a wheelchair Your healthcare team will discuss the most suitable options for you depending on your needs. Many mobility aids are provided for free by the NHS. Treatment of breathing problems If you have breathing problems, you might benefit from treatment or lifestyle changes. Your breathing problems will be assessed to identify the cause. For example, your breathing problems might be caused by stiff ribs, scoliosis or weak respiratory muscles. Finding the cause will help to choose the correct treatment for you. You might be offered a machine to deliver pressurised air into your lungs through a mask during sleep. This is to help stop your airways closing if you have sleep apnoea . There are exercises you can do to increase the strength of your breathing muscles. A respiratory physiotherapist will help you to find suitable and safe exercises for you. Your healthcare team might suggest you have the pneumococcal vaccination , COVID-19 vaccines and annual flu jab . This is to reduce your risk of getting chest infections which can cause further complications. If you smoke, stopping smoking can help improve your breathing too. Healthy eating and weight control If youre overweight, you might be putting your weakened muscles under further pressure. This can cause problems with your energy levels and overall health. Losing weight (if youre overweight) can help improve your symptoms and general health. Your healthcare team can tell you about specific exercises suitable for you. Eating a healthy, balanced diet can help you reduce and control your weight. Itll also improve your general health. Following a plan that includes healthy foods that provide energy thats released slowly over time can help improve your symptoms. Read our Eatwell Guide: How to eat a healthy balanced diet Coping with psychological factors The symptoms of post-polio syndrome can be distressing. Developing post-polio syndrome after living with the polio virus as a child can cause anxiety, isolation and stress. This can lead to depression . Speak to your GP if youre feeling down and you no longer enjoy things you used to. Source: Scottish Government - Opens in new browser window Last updated: 16 June 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Polio Coping with fatigue Anxiety self-help guide Depression self-help guide Other health sites Scottish Muscle Network Scottish Post-Polio Network NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Post-traumatic stress disorder (PTSD),"Post-traumatic stress disorder (PTSD) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Mental health Post-traumatic stress disorder (PTSD) Post-traumatic stress disorder (PTSD) Introduction Symptoms Causes Treatment Complex PTSD Self-help guide Introduction Post-traumatic stress disorder (PTSD) is an anxiety disorder caused by very stressful, frightening or distressing events. Someone with PTSD often relives the traumatic event through nightmares and flashbacks, and may experience feelings of isolation, irritability and guilt. They may also have problems sleeping, such as insomnia, and find concentrating difficult. These symptoms are often severe andpersistent enough to have a significant impact on the persons day-to-day life. Read more about the symptoms of PTSD . Causes of PTSD The type of events that can cause PTSD include: serious road accidents violent personal assaults, such as sexual assault, mugging or robbery prolonged sexual abuse, violence or severe neglect witnessing violent deaths military combat being held hostage terrorist attacks natural disasters, such as severe floods, earthquakes or tsunamis PTSDcan develop immediatelyafter someone experiences adisturbing event or itcan occur weeks, months or even years later. PTSD is estimated to affect about 1 in every 3 people who have a traumatic experience, but its not clear exactly why some people developthe conditionand others dont. Read more about the causes of PTSD . Complex PTSD People who repeatedly experience traumatic situations such as severe neglect, abuse or violence may be diagnosed with complex PTSD. Complex PTSD can cause similar symptoms to PTSD and may not develop until years after the event. Its often more severe if the trauma was experienced early in life as this can affect a childs development. Read more about complex PTSD . When to seek medical advice Its normal to experience upsetting and confusing thoughts after a traumatic event, but most people improve naturally over a few weeks. You should visit your GP if you or your child are still having problems about four weeks after the traumatic experience, or if the symptoms are particularly troublesome. If necessary, your GP can refer you to mental health specialists for further assessment and treatment. HowPTSD is treated PTSD can be successfully treated, even when itdevelops many years aftera traumatic event. Any treatment depends on the severity ofsymptoms and how soon theyoccur after the traumatic event.Any of the following treatment options may be recommended: Watchful waiting  monitoring yoursymptoms to see whether they improve or get worse without treatment. Psychotherapy  such as trauma-focusedcognitive behavioural therapy (CBT)or eye movement desensitisation and reprocessing (EMDR). Antidepressants  such asparoxetine ormirtazapine. Read more about treatingPTSD . Symptoms The symptoms of post-traumatic stress disorder (PTSD) can have a significant impact on your day-to-day life. In most cases, the symptoms develop during the first month after a traumatic event. However, in a minority of cases, there may be a delay of months or even years before symptoms start to appear. Some people with PTSD experience long periods when their symptoms are less noticeable, followed by periods where they get worse. Other people have constant, severe symptoms. The specific symptoms of PTSD can vary widely between individuals, but generally fall into the categories described below. Re-experiencing Re-experiencing is the mosttypical symptom of PTSD. This is when a person involuntarily and vividly re-lives the traumatic eventin the form of: flashbacks nightmares repetitive and distressing images or sensations physical sensations  such as pain, sweating, nausea or trembling Somepeople haveconstant negative thoughts about their experience, repeatedly asking themselves questions that prevent them from coming to terms with the event. For example, they may wonder why the event happened to them and if they could have done anything to stop it, which can lead to feelings of guilt or shame. Avoidance and emotional numbing Trying to avoid beingreminded of the traumatic eventis anotherkey symptom of PTSD. This usuallymeans avoiding certain people or places that remind you of the trauma, or avoiding talking to anyone about your experience. Many people withPTSD try to push memories of the event out of their mind, often distracting themselves with work or hobbies. Some people attempt to deal with their feelings by trying not to feel anything at all. This is known as emotional numbing. This can lead to the person becoming isolated and withdrawn, and they may also give up pursuing activities they used to enjoy. Hyperarousal (feeling on edge) Someone withPTSD may be veryanxious and find it difficult to relax. Theymay be constantly awareof threats and easily startled.This state of mindis known ashyperarousal. Hyperarousaloftenleads to: irritability angry outbursts sleeping problems ( insomnia ) difficulty concentrating Other problems Many people with PTSD also have a number of other problems, including: other mental health problems  such as depression , anxietyor phobias self-harming or destructive behaviour such as drug misuseor alcohol misuse other physical symptoms  such as headaches , dizziness,chest pains and stomach aches PTSD sometimes leads to work-related problems and the breakdown of relationships. PTSD in children PTSDcan affect children as well as adults. Children withPTSD can have similar symptoms to adults, such as having trouble sleeping and upsetting nightmares. Like adults, children with PTSD may also lose interest in activities they used to enjoy and may have physical symptoms such as headaches and stomach aches . However, there are some symptoms that are more specific to children with PTSD, such as: bedwetting beingunusually anxious about being separated froma parent or other adult re-enactingthe traumatic event(s) through their play When to seek medical advice Its normal to experience upsetting and confusing thoughts after a traumatic event, but in most people these improve naturallyover a few weeks. You should visit your GP if you or your child are still having problems about four weeks afterthe traumatic experience, or ifthe symptoms areparticularly troublesome. Your GP will want to discuss your symptoms with you in as much detail as possible. Theyll ask whether youve experienced a traumatic event in the recent or distant past and whether youve re-experienced the event through flashbacks or nightmares. Your GP can refer you to mental health specialists if they feel youd benefit from treatment. See treating PTSD for more information. Causes Post-traumatic stress disorder (PTSD) can develop after a very stressful, frightening or distressing event, or after a prolonged traumatic experience. Types of events that can lead to PTSD include: serious road accidents violent personal assaults, such as sexual assault, mugging or robbery prolonged sexual abuse, violence or severe neglect witnessing violent deaths military combat being held hostage terrorist attacks natural disasters, such as severe floods, earthquakes or tsunamis a diagnosis of a life-threatening condition an unexpected severe injury or death of a close family memberor friend PTSDisnt usually related tosituations that are simply upsetting, such as divorce, job loss or failing exams. PTSD develops in about 1 in 3 people who experience severe trauma. It isnt fully understood why some people develop the condition while others dont. However, certain factors appear to make some people more likely to develop PTSD. If youve had depression oranxiety in the past, or you dont receive much support from family or friends, youre more susceptible to developing PTSD after a traumatic event. There may also be a genetic factor involved in PTSD. For example, having a parent with a mental health problemis thought to increase your chances of developing the condition. Possible causes Although its not clear exactly why people develop PTSD, a number of possible reasons have been suggested. These are described below. Survival mechanism One suggestion is that the symptoms of PTSD are the result of an instinctivemechanismintended tohelp you survive further traumatic experiences. For example, the flashbacks many people with PTSD experience may force you to think about the event in detail so youre better prepared if it happens again. The feeling of being on edge (hyperarousal) may develop to help you react quickly in another crisis. However, whilethese responses may be intended to help you survive, theyre actually very unhelpful in reality because you cant process and move on fromthe traumatic experience. Adrenaline levels Studies have shown that people with PTSD have abnormal levels of stress hormones. Normally, when in danger,the body produces stress hormones such as adrenaline totrigger a reaction in the body. This reaction,often known as the fight or flight reaction, helps to deaden the senses and dull pain. People with PTSD have been found to continue to produce high amounts of fight or flight hormones even when theres no danger. Its thought this may be responsible for the numbed emotions and hyperarousal experienced by some people with PTSD. Changes in the brain In people with PTSD, parts of the brain involved in emotional processing appear different in brain scans. One part of the brain responsible for memory and emotions is known as the hippocampus. In people with PTSD, the hippocampus appears smaller in size. Its thought thatchanges in this part of the brain may be related to fear and anxiety, memory problems and flashbacks. The malfunctioning hippocampus may prevent flashbacks and nightmares from being properly processed, so the anxiety they generate doesnt reduce over time. Treatment of PTSD results in proper processing of the memories so, over time, the flashbacks and nightmares gradually disappear. Treatment The main treatments for post-traumatic stress disorder (PTSD) are psychotherapy and medication. Traumaticevents can be very difficult to come to terms with, but confronting your feelings and seeking professional help is often the only way of effectively treating PTSD. Its possible for PTSD to besuccessfully treated many years after the traumatic event occurred, which means its never too late to seek help. Assessment Before having treatment forPTSD, a detailed assessment of your symptoms will be carried out to ensure treatment is tailored to your individual needs. Your GP will often carry out an initial assessment, but youll be referred to a mental health specialist for further assessment and treatmentifyouve had symptoms of PTSD for more than four weeks or your symptoms are severe. There are a number of mental health specialists you may see if you have PTSD, such as: a psychologist  an expert in how the mind works a community psychiatric nurse  a nurse who specialises in mental healthcare a psychiatrist  a mental health specialist who diagnoses and treats mental health conditions Watchful waiting If you have mild symptoms of PTSD, or youve had symptoms for less than four weeks, an approach called watchful waiting may be recommended. Watchful waiting involves carefully monitoring your symptoms to see whether they improve or get worse. Itssometimes recommended because 2 in every 3 people whodevelop problems after a traumatic experience get better within a few weeks without treatment. If watchful waiting is recommended, you should have a follow-up appointment within one month. Psychotherapy If you have PTSD that requires treatment, psychotherapy is usually recommended first. A combination ofpsychotherapy and medication may be recommendedif you have severe or persistent PTSD. Psychotherapyis a type of therapy oftenused totreat emotional problems and mental health conditions such as PTSD, depression , anxiety and obsessive compulsive disorder . The treatmentis carried out bytrained mental health professionals who listen to you and helpyou come upwith effective strategies to resolve your problems. The main types of psychotherapy used to treat people with PTSD are described below. Cognitive behavioural therapy (CBT) Cognitive behavioural therapy (CBT) is a type of therapy that aims to help you manage your problems by changing how you think and act. Trauma-focused CBT uses a range of psychological treatment techniques to help you come to terms with the traumatic event. For example, your therapist may ask you to confront your traumatic memories by thinking about your experience in detail. During this process your therapist helps you cope with any distress youfeel, whileidentifying any unhelpful thoughts or misrepresentations you have about the experience. Your therapist can help you gain control of your fear and distress by changing the negative way you think about your experience. For example,feelingyoureto blame for what happened or fear that it may happen again. You may also be encouraged to gradually restart any activities youve avoided since your experience, such as driving a car if you had an accident. Youll usually have8-12 weekly sessions of trauma-focused CBT, although fewer may be needed. Sessions usually last for around 60-90 minutes. Eye movement desensitisation and reprocessing (EMDR) Eye movement desensitisation and reprocessing (EMDR) is a relatively new treatment which has been found to reduce the symptoms of PTSD. It involves making side-to-side eye movements, usually by following the movement of your therapists finger, while recalling the traumatic incident.Other methodsmay includethe therapist tapping their finger or playing a tone. Its not clear exactly how EMDR worksbut it may help you to change the negative way you think about a traumatic experience. Group therapy You may also be offered group therapy as some people find it helpfulto speak about their experiences with other peoplewho also have PTSD. Group therapy can be used to teach you ways to manage your symptoms and help you understand the condition. There are also a number of charitieswhich providecounselling and support groups for PTSD. For example: Combat Stress  a military charity specialising in helping ex-servicemen and women Rape Crisis  a charity providing a range of services for women and girls who have experienced abuse, domestic violence and sexual assault Victim Support  providing support and information to victims or witnesses of crime CRUSE  a UK charity providing support and information for people who have experienced bereavement Medication Antidepressants such asparoxetine, sertraline, mirtazapine, amitriptyline or phenelzineare sometimes used to treat PTSD in adults. Of these medications, paroxetine and sertraline are the only ones licensed specifically for the treatment of PTSD. However, mirtazapine, amitriptyline and phenelzine have also been found to be effective and may berecommended as well. However, thesemedications will only be used if: you choose not to have trauma-focused psychological treatment psychological treatment wouldnt be effective because theres an ongoing threat of further trauma (such as domestic violence) youve gained little or no benefit from a course of trauma-focused psychological treatment you have an underlying medical condition, such as severe depression, that significantly affects your ability to benefit from psychological treatment Amitriptyline or phenelzine will usually only be used under the supervision of a mental health specialist. Antidepressantscan also be prescribed to reduce any associated symptoms of depression and anxiety and to help with sleeping problems. However,theyre not usually prescribedfor people younger than18 unless recommended by a specialist. If medication for PTSD is effective, its usually be continued for a minimum of 12 months before being gradually withdrawn over the course of four weeks or longer. If a medicationisnt effective at reducing your symptoms,your dosage may be increased. Before prescribing a medication, your doctor should inform you about possible side effects you may have while taking it, along with any possible withdrawal symptoms when the medication is withdrawn. For example, commonside effects of paroxetine include feeling sick, blurred vision, constipation and diarrhoea. Possible withdrawal symptoms associated with paroxetine include sleep disturbances, intense dreams, anxiety and irritability. Withdrawal symptoms are less likely if the medication is reduced slowly. Children and young people Forchildren and young people with PTSD, trauma-focused CBT is usually recommended. This normally involvesa course of 8-12 sessions that have been adapted to suit the childs age, circumstances and level of development. Where appropriate, treatment includes consulting with and involving the childsfamily. Treatment with medication isnt usually recommended for children and young people with PTSD. Complex PTSD Complex PTSD may be diagnosed in adults or children who have repeatedly experienced traumatic events, such as violence, neglect or abuse. Complex PTSD is thought to be more severe if: the traumatic events happened early in life the trauma was caused by a parent or carer the person experienced the trauma for a long time the person was alone during the trauma there is still contact with the person responsible for the trauma Asitmay take years for the symptoms of complex PTSD to be recognised,a childsdevelopment, including their behaviour and self-confidence, can be altered as they get older. Adults with complex PTSD may lose their trust in people and feel separated from others. Symptoms of complex PTSD The symptoms of complex PTSD are similar to symptoms of PTSD but may include: feelings of shame or guilt difficulty controlling your emotions periods of losing attention and concentration  this is known as dissociation physical symptoms  such as headaches, dizziness, chest pains and stomach aches cutting yourself off from friends and family relationship difficulties destructive or risky behaviour  such as self-harm, alcohol misuse or drug abuse suicidal thoughts Treating complex PTSD One of the key symptoms of complex PTSD is losing trust in people. If possible, people with complex PTSD are recommended to slowly start doing regular activities such as: finding friends getting a job regular exercise taking on hobbies Its important to try and develop some feelings of trust.It may take some time, but atrusting relationship with a therapistwill helptreat complex PTSD. Treatment from a therapist may be given in three stages, described below. Stabilisation One of the first steps in treating complex PTSD may involve speaking with a therapist to learn how to control feelings of distrust and lose the feeling of being disconnected from friends and family. Certain techniques, known as grounding techniques, may be able to help you separate an abusive or traumatic past from the present. The aim is to make the past seem less frightening and reduce the amount of flashbacks you experience. With time, you can begin to experience less anxiety and learn to cope with daily life. Trauma-focused therapy Trauma-focused therapymay include: certain types of psychotherapy cognitive behavioural therapy (CBT) eye movement desensitisation and reprocessing (EMDR) These treatments may help you to control any distressing thoughts but must be approached carefully to avoid making the situation worse. Reintegration The final stage is to begin to use these skills and techniques todevelop better relationships with other people. Medication, such as antidepressants , may still be recommended if psychotherapy isnt possible or you feel unsafe. You can read more information about complex PTSD on the Royal College of Psychiatrists website . Self-help guide If you think youre experiencing post-traumatic stress disorder (PTSD) or complex post-traumatic stress disorder (CPTSD), its important for you to visit your GP and discuss your concerns. The PTSD and CPTSD self-help guide can help with managing symptoms while you wait for an assessment by your GP or a mental health professional. This guide aims to help you: consider whether youre experiencing symptoms of PTSD or CPTSD understand more about PTSD andCPTSD think about ways to manage or recover from PTSD or CPTSD The PTSD and CPTSD self-help guide is based on Trauma-Focused Cognitive Therapy (TF-CT). TF-CT aims to help people who have been through trauma and adversity to make sense of what theyve experienced, and become less distressed and affected by it. PTSD and CPTSD self-help guide Work through a self-help guide for PTSD and CPTSD based on Trauma-Focused Cognitive Therapy (TF-CT). PTSD and CPTSD self-help guide Source: NHS 24 - Opens in new browser window Last updated: 27 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Post-traumatic stress disorder (PTSD) (BSL) PTSD and CPTSD self-help guide Anxiety Depression Counselling and psychotherapy Other health sites BABCP - What is CBT? PTSD Resolution: Veteran outreach programme NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Postnatal depression,"Postnatal depression | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Mental health Postnatal depression Postnatal depression Postnatal depression is a type of depression. Many parents experience it after having a baby. Its a common problem, affecting more than 1 in every 10 mothers within a year of giving birth. It can also affect fathers and partners, although this is less common. With the right support, which can include self-help strategies and therapy, most people make a full recovery. Symptoms of postnatal depression Postnatal depression affects everyone differently. It can start at any point in the first year after giving birth. It can continue from depression in pregnancy. It may develop suddenly or gradually. Many people feel a bit down, tearful or anxious in the first week after giving birth. This is often called the baby blues and is so common that its considered normal. The baby blues dont last for more than 2 weeks after giving birth. If your symptoms last longer or start later, you could have postnatal depression. The main symptoms of postnatal depression include: a persistent feeling of sadness and low mood loss of interest in the world around you no longer enjoying things that used to give you pleasure lack of energy and feeling tired all the time trouble sleeping at night feeling sleepy during the day feeling that youre unable to look after your baby problems concentrating and making decisions loss of appetite or an increased appetite (comfort eating) feeling agitated, irritable or very apathetic (you cant be bothered) feelings of guilt, hopelessness and self-blame difficulty bonding with your baby  feeling of indifference and no sense of enjoyment in their company frightening thoughts, for example, about hurting your baby  these can be scary, but theyre very rarely acted upon thinking about suicide and self-harm These symptoms can affect your day-to-day life and your relationships with your baby, family and friends. Speak to your GP or health visitor as soon as possible if: you think you have postnatal depression Dont struggle on alone and hope the problem will go away. It can take a lot longer to feel better if its not addressed. Spotting the signs of postnatal depression Postnatal depression can develop gradually and it can be hard to recognise. Some parents may avoid talking to family and friends about how theyre feeling. This may be because they worry theyll be judged for not coping or not appearing happy. Signs for partners, family and friends to look out for in new parents include: frequently crying for no obvious reason having difficulty bonding with their baby getting no pleasure from playing with them or feeling no good as a parent withdrawing from contact with other people speaking negatively all the time and claiming that theyre hopeless neglecting themselves, like not washing or changing their clothes losing all sense of time, like being unaware whether 10 minutes or 2 hours have passed losing their sense of humour constantly worrying that something is wrong with their baby, regardless of reassurance from others If you think someone you know is depressed, encourage them to talk about their feelings. This could be to talk to you, a friend, their GP or their health visitor. Causes of postnatal depression The cause of postnatal depression isnt completely clear. Some of the factors it has been associated with include: a history of mental health problems, particularly depression, earlier in life or during pregnancy having no close family or friends to support you a poor relationship with your partner recent stressful life events, like a bereavement experiencing the baby blues Even if you dont have any of these symptoms, having a baby is a life-changing event that can sometimes trigger depression. It often takes time to adapt to becoming a new parent. Looking after a small baby can be stressful and exhausting. Treating postnatal depression Postnatal depression can be lonely, distressing and frightening. But, support and treatments are available. With the right treatment and support, most people make a full recovery, although it can take time. Talk to your GP about the pros and cons of different treatments so you can decide together whats best for you. Your GP might also want to check your physical health to see if there are any problems that may need to be addressed as well. For example, you may be anaemic after giving birth. This could add to any feelings of depression you might have. Psychological treatments for postnatal depression Psychological therapies are usually the first treatment recommended for postnatal depression. Guided self-help Guided self-help involves working through a book or an online course. You can do this on your own or with some help from a therapist. It focusses on the issues you might be facing, with practical advice on how to deal with them. The courses typically last 9 to 12 weeks. Cognitive behavioural therapy Cognitive behavioural therapy (CBT) is a type of talking therapy. Its based on the idea that unhelpful and unrealistic thinking leads to negative behaviour. CBT aims to break this cycle and find new ways of thinking that can help you behave in a more positive way. CBT can be carried out either one-to-one with a therapist or in a group. Treatment will often last 3 to 4 months. Interpersonal therapy Interpersonal therapy (IPT) involves talking to a therapist about the problems youre experiencing. It aims to identify problems in your relationships with family, friends or partners. It then looks at how they might relate to your feelings of depression. Treatment also usually lasts 3 to 4 months. Antidepressants Antidepressants may be recommended if: you have moderate or severe depression you dont want to try psychological treatment psychological treatment doesnt help you have mild postnatal depression and a previous history of depression They can help ease symptoms like: low mood irritability lack of concentration sleeplessness This helps you to function normally and helps you cope better with your new baby. Antidepressants usually need to be taken for at least a week before the benefit starts to be felt. This means its important to keep taking them even if you dont notice an improvement straight away. Youll usually need to take them for around 6 months after you begin to feel better. If you stop too early, your depression may return. If youre breastfeeding, talk to your doctor about suitable medicines. Some types of antidepressants are safe to take while breastfeeding. Your doctor should explain any risks of taking antidepressants. You should be offered the type with the least risk for you and your baby. Self-help There are many things you can try yourself to improve your symptoms and help you cope. Do talk to your partner, friends and family to help them understand how youre feeling talk to your loved ones about what they can do to support you accept help from others when its offered ask your loved ones if they can help look after the baby and do tasks like housework, cooking and shopping make time for yourself  try to do activities that you find relaxing and enjoyable rest when you can  although it can be difficult when youre looking after a baby, try to sleep whenever you get the chance follow good sleeping habits ask your partner to help with the night-time work exercise regularly  this has been shown to help boost mood in people with mild depression eat regular, healthy meals Dont do not go for long periods without eating do not drink alcohol or take drugs, as this can make you feel worse Support groups Ask your health visitor about support services in your area. They may be able to put you in touch with a social worker, counsellor or local support group. It can be reassuring to meet other people who are going through something similar. Find postnatal depression support and information in your area Treatments for severe postnatal depression You might be referred to a specialist perinatal mental health team if your depression: is very severe doesnt respond to treatment like antidepressants, self-help or therapy Your team might be able to offer other treatments, like: more intensive CBT other psychological treatments, like psychotherapy therapies such as baby massage which can improve depression and help build your relationships with your baby different medications electroconvulsive therapy (ECT) where electrodes are placed on your head and pulses of electricity are sent through the brain For a small number of people, coming into hospital can help speed up recovery. You may be offered a place in a Mother and Baby Unit , where you can continue to look after your baby while you get the best treatment for your illness. Source: NHS 24 - Opens in new browser window Last updated: 24 October 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Depression Depression self-help guide Other health sites SIGN: Mood disorders during pregnancy and after the birth of your baby NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Pregnancy and baby,"""Ready Steady Baby! 0 Home Ready Steady Baby! Ready Steady Baby! Your guide to pregnancy, labour and birth and early parenthood up to 8 weeks Pregnancy Health problems in pregnancy Including common ailments and conditions that occur before and during pregnancy Looking after yourself and your baby Including how to eat well, keep active and prevent illness in pregnancy Preparing for parenthood Including benefits, housing support and your rights at work during and after pregnancy Relationships and wellbeing in pregnancy Including looking after your mental wellbeing and bonding with baby during pregnancy Your antenatal care Including tests, scans and checks and who'll be looking after you and your baby Your babys development Including the first signs of pregnancy and how your baby develops week to week Labour and birth After the birth Including newborn tests and examination and help for babies born sick or premature Assisted birth Including assisted birth by forceps or ventouse delivery, or caesarean section Getting ready for the birth Including making a birth plan and deciding where to give birth Giving birth Including what happens during the birth at full term and if your labour's premature Labour Including signs that labour has started and options for pain relief during labour and birth Meeting your new baby Including having skin-to-skin contact with your baby and the first feeds Early parenthood Caring for your new baby Including how to bathe your baby, change their nappies and soothe them when they cry Getting to know your baby Including how to bond with your baby and talk, sing and read to them Going home Including keeping your baby safe at home and how to help them sleep safely If your baby's ill When to see your GP or pharmacist, or phone 999 if your baby's unwell Your babys development from 2 to 12 months Your baby will develop many new skills in its first year Your growing family Including how and when to introduce your baby to friends and family Your wellbeing after the birth Including looking after your mental health and helping your body recover after the birth Other languages and formats Easy Read Ready Steady Baby information in Easy Read Other languages Ready Steady Baby information in other languages NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Pressure ulcers,"Pressure ulcers - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Skin, hair and nails Pressure ulcers Pressure ulcers About pressure ulcers Symptoms of pressure ulcers Causes of pressure ulcers Diagnosing pressure ulcers Treating pressure ulcers Complications of pressure ulcers Preventing pressure ulcers About pressure ulcers Pressure ulcers are an injury that breaks down the skin and underlying tissue. They are caused when an area of skin is placed under pressure. They are sometimes known as bedsores or pressure sores. Pressure ulcers can range in severity from patches of discoloured skin to open wounds that expose the underlying bone or muscle. Read more about the symptoms of pressure ulcers . How pressure ulcers develop Pressureulcers candevelop when a large amount of pressure is applied to an area of skin over a short period of time. They can also occur when less pressure is applied over a longer period of time. The extra pressure disrupts the flow of blood through the skin. Without a blood supply, the affected skin becomes starved of oxygen and nutrients, and begins to break down, leading to an ulcer forming. Pressure ulcers tend to affect people with health conditions that make it difficult to move, especiallythose confined to lying ina bed or sitting for prolonged periods of time. Conditions that affect the flow of blood through the body, such as type 2 diabetes , can also make a person more vulnerable to pressure ulcers. Learn moreabout the causes of pressure ulcers . Who is affected? Its estimated that just under half a million people in the UK will develop at least 1pressure ulcer in any given year. This is usually people with an underlying health condition  for example, around1 in 20 people who are admitted to hospital with a sudden illness will develop a pressure ulcer. People over 70 years old are particularly vulnerable to pressure ulcers, as they are more likely to have mobility problems and ageing skin. Treating and preventing pressure ulcers Treatment for pressure ulcers includes the use of dressings, creams and gels designed to speed up the healing process and relieve pressure. Surgery is sometimes recommended for the most serious cases. For some people, pressure ulcers are an inconvenience that require minor nursing care. For others, they can be seriousand lead to life-threatening complications, such as blood poisoning organgrene. Read more about the complications of pressure ulcers . Pressure ulcers can be unpleasant, upsetting and challenging to treat. Therefore, a range of techniquesis used to prevent them developing in the first place. These include: regularly changing a persons position using equipment to protect vulnerable parts of the body  such as specially designed mattresses and cushions Read about treating pressure ulcers and preventing pressure ulcers for more information. Unfortunately, even with the highest standards of care, its not always possible to prevent pressure ulcers in particularly vulnerable people. Symptoms of pressure ulcers The parts of the body most at risk of developing pressure ulcers are those that are not covered by a large amount of body fat and are in direct contact with a supporting surface, such as a bed or a wheelchair. For example, if you are unable to get out of bed, you are at risk of developing pressure ulcers on your: shoulders or shoulder blades elbows back of your head rims of your ears knees, ankles, heels or toes spine tail bone (the small bone at the bottom of your spine) If you are a wheelchair user, you are at risk of developing pressure ulcers on: your buttocks the back of your arms and legs the back of your hip bone Severityof pressure ulcers Healthcare professionals use several grading systems to describe the severity of pressure ulcers. The most common is the European Pressure Ulcer Advisory Panel (EPUAP) grading system. The higher the grade, the more severe the injury to the skin and underlying tissue. Grade1 A grade 1pressure ulcer is the most superficial type of ulcer. The affected area of skin appears discoloured  it is red in white people, and purple or blue in people with darker-coloured skin. Grade 1pressure ulcers do not turn white when pressure is placed on them. The skin remains intact, but it may hurt or itch. It may alsofeel either warm and spongy, or hard. Grade2 In grade 2pressure ulcers, some of the outer surface of the skin (the epidermis) or the deeper layer of skin (the dermis) is damaged, leading to skin loss. The ulcer looks like an open wound or a blister. Grade3 In grade 3pressure ulcers, skin loss occurs throughout the entire thickness of the skin. The underlying tissue is also damaged, although the underlying muscle and bone are not. The ulcer appears as a deep, cavity-like wound. Grade4 A grade 4pressure ulcer is the most severe type of pressure ulcer. The skin is severely damaged and the surrounding tissue begins to die (tissue necrosis). The underlying muscles or bone may also be damaged. People with grade 4pressure ulcers have a high risk of developing a life-threatening infection. Causes of pressure ulcers Pressure ulcers are caused by sustained pressure being placed on a particular part of the body. This pressure interrupts the blood supply to the affected area of skin. Blood contains oxygen and other nutrients that are needed to help keep tissue healthy. Without a constant blood supply, tissue isdamagedand will eventually die. The lack of blood supply also means that the skin no longer receives infection-fighting white blood cells. Once an ulcer has developed, it can become infected by bacteria. People with normal mobility do not develop pressure ulcers, as their body automatically makes hundreds of regular movements that prevent pressure building up on any part of their body. For example, you may think that you are lying still when asleep, but you may shift position up to 20 times a night. Pressure ulcers can be caused by: pressure from a hard surface  such as a bed or wheelchair pressure that is placed on the skin through involuntary muscle movements  such as muscle spasms moisture  which can break down the outer layer of the skin (epidermis) The time it takes for a pressure ulcer to form will depend on: the amount of pressure how vulnerable a persons skin is to damage Grade 3or 4pressure ulcers can develop quickly. For example, in susceptible people, a full-thickness pressure ulcer can sometimes develop in just 1or 2hours. However, in some cases, the damage will only become apparent a few days after the injury has occurred. Increased risk There areseveral factorsthat increase the risk ofdeveloping pressure ulcers. These include: mobility problems anything that affects your ability to move some or all of your body poor nutrition for your skin to remain healthy, it requires nutrients that can only be supplied by eating a nutritious diet an underlying health condition that disrupts your blood supply or makes your skin more vulnerable to injury and damage being over 70 years old urinaryincontinence and/or bowel incontinence serious mental health conditions These are discussed in more detail below. Mobility problems Possible reasons for having a mobility problem are: having a spinal cord injury that causes some or all of your limbs to beparalysed brain damage caused by an event such as a stroke or severe head injury , which results in paralysis having a condition that is causing progressive damage to the nerves your body uses to move parts of the body  such as Alzheimers disease , multiple sclerosis (MS) or Parkinsons disease having severe pain that makes it difficult to move some or all of your body having a fractured or broken bone recovering from the effects of surgery being in a coma having a conditionthat makes it difficult to move your joints and bones  such as rheumatoid arthritis Poor nutrition Reasons that your diet may lack nutrition include: anorexia nervosa a mental health condition where a person has an unhealthy obsession with maintaining a low body weight dehydration you do not have enough fluids in your body dysphagia difficulty swallowing food Health conditions Health conditions that can make you more vulnerable to pressure ulcers include: type 1 diabetes and type 2 diabetes the high levels of blood sugar associated with diabetes can disrupt normal blood flow peripheral arterial disease (PAD) blood supply in the legs becomes restricted due to a build-up of fatty substances in the arteries heart failure previous damage to the heart means it is no longer able to pump enough blood around the body kidney failure the kidney loses most or all of its functions,which can lead to a build-up of dangerous toxins (poisons) in the blood thatcan cause tissue damage chronic obstructive pulmonary disease (COPD)  a collection of lung diseases; the low levels of oxygen in the blood associated with COPD can make the skin more vulnerable to damage Ageing skin There are several reasons why ageing skin is more vulnerable to pressure ulcers. These include: with age, the skin loses some of its elasticity (stretchiness), which makes it more vulnerable to damage reduced blood flow to the skin, due to the effects of ageing the amount of fat under the skin tends to decrease as people get older Incontinence Both urinary incontinence (inability to control your bladder) and bowel incontinence (inability to control your bowels) can cause certain areas of the skin to become moist and vulnerable to infection. This can cause pressure ulcers to form. Mental health conditions People with severe mental health conditions such as schizophrenia (a condition where people have problems telling the difference between reality and imagination) or severe depression have an increased risk of pressure ulcers for a number of reasons. These include: their diet tends to be poor they often have other physical health conditions, such as diabetes or incontinence they may neglect their personal hygiene, making their skin more vulnerable to injury and infection Diagnosing pressure ulcers Pressure ulcers are easily diagnosed by looking at them. However, health professionals prefer to prevent ulcers developing in the first place, so its important to assess a persons risk of developing them. As part of the risk assessment process, the following will be considered: your general health your ability to move whether you have any problems that may affect your posture whether you have any symptoms that may indicate an infection your mental health whether you have had pressure ulcers in the past whether you have urinary incontinence or bowel incontinence your diet how well your blood circulation system is working As part of the risk assessment, you may be referred for blood and urine tests. Blood tests can be a good way of assessing your general state of health and whether your diet is providing enough nutrition. Urine tests can be used to check how well your kidneys are working and whether you have a urinary tract infection , which can be a causefor concern if you are incontinent or if you have had spinal damage. Self-assessment If you are thought to be at risk of developing pressure ulcers, but you are not staying in a hospital or care home, you may be advised to regularlycheck for early signs of the condition. Look out for areas of discolouration and patches of skin that feel unusually spongy or tough to the touch. Use a mirror to check parts of your body that can be difficult to see, such as your back or buttocks. Contact your GP or your healthcare team if you notice any signs of damage. Treating pressure ulcers Treatment for pressure ulcers can vary, depending on the grade of the ulcer. Treatment options may include regularly changing your position, or using special mattresses and dressings to relieve pressure or protect the skin. In some cases, surgery may be needed. Your care team Pressure ulcers are a complex health problem arising from many interrelated factors. Therefore, your care may be provided by a team comprising different types of healthcare professionals. This type of team is sometimes known as a multidisciplinary team (MDT). Your MDT may include: a tissue viability nurse (a nurse who specialises in wound care and prevention) a social worker a physiotherpist an occupational therapist a dietitian medical and surgical experts with experience in pressure ulcer management Changing position Its important to avoid putting pressure on areas that are vulnerable to pressure ulcers or where pressure ulcers have already formed. Moving and regularly changing your position helps to prevent pressure ulcers developing and relieves the pressure onthe ulcers that have developed. After your risk assessment is completed, your care team will draw up a repositioning timetable, which states how often you need to be moved. For some people, this may be as often as once every 15 minutes. Others may need to be moved only once every 2hours. The risk assessment will also consider the most effective way of avoiding putting any vulnerable areas of skin under pressure whenever possible. You may also be given training and advice about: correct sitting and lying positions how you can adjust your sitting and lying position how often you need to move or be moved how best to support your feet how to maintain good posture the special equipment you should use and how to use it Mattresses and cushions There are a range of special mattresses and cushions that can relieve pressure on vulnerable parts of the body. Your care team will discuss the types of mattresses and cushions most suitable for you. Thosethought to be at risk of developing pressure ulcers, or who have pre-existing grade 1or 2pressure ulcers, usually benefit from aspecially designed foam mattress, which relieves the pressure on their body. People with a grade 3or 4pressure ulcer will require a more sophisticated mattress or bed system. For example, there are mattresses that can be connected to a constant flow of air, which is automatically regulated to reduce pressure as and when required. Dressings Specially designed dressings and bandagescan be used to protect pressure ulcers and speed up the healing process. Examples of these types of dressings include: hydrocolloid dressings these contain a special gel that encourages the growth of new skin cells in the ulcer, while keeping the surrounding healthy area of skin dry alginate dressings these are made from seaweed and contain sodium and calcium, which are known to speed up the healing process Creams and ointments Topical preparations, such as creams and ointments, can be used to help speed up the healing process and prevent further tissue damage. Antibiotics If you have a pressure ulcer, you will not routinely be prescribed antibiotics. These are usually only prescribed to treat an infected pressure ulcer and prevent the infection from spreading. Antiseptic cream may also be applied directly to pressure ulcers to clear out any bacteria that may be present. Nutrition Certain dietary supplements, such as protein, zinc and vitamin C, have been shown to accelerate wound healing. If your diet lacks these vitamins and minerals, your skin may be more vulnerable to developing pressure ulcers. As a result of this, you may be referred to a dietitian so that a suitable dietary plan can be drawn up for you. Debridement In some cases, it may be necessary to remove dead tissue from the ulcer to help stimulate the healing process. This procedure is known as debridement. If there is a small amount of dead tissue, it may be possible to remove it using specially designed dressings and paste. Larger amounts of dead tissue may be removed using mechanical means. Some mechanical debridement techniques include: cleansing and pressure irrigation where dead tissue is removed using high-pressure water jets ultrasound  dead tissue is removed using low-frequency energy waves laser dead tissue is removed using focused beams of light surgical debridement dead tissue is removed using surgical instruments, such as scalpels and forceps A local anaesthetic will be used to numb the area of skin and tissue around the ulcer so that debridement does not cause any pain or discomfort. Maggot therapy Maggot therapy, also known as larvae therapy, is an alternative method of debridement. Maggots are ideal for debridement because they feed on dead and infected tissue without touching healthy tissue. They also help to fight infection by releasing substances that kill bacteria and stimulate the healing process. During maggot therapy, the maggots are mixed into a wound dressing and the area is covered with gauze. After a few days, the dressing is taken off and the maggots are removed. Many people may find the idea of maggot therapy off-putting, but research has found that it is often more effective than more traditional methods of debridement. Surgery Its not always possible for a grade 3or 4pressure ulcer to heal. In such cases, surgery will be required to seal the wound and prevent any further tissue damage occurring. Surgical treatment involves cleaning the wound and closing it by bringing together the edges of the wound (direct closure), or by using tissue moved from a nearby part of the body (flap reconstruction). Pressure ulcer surgery can be challenging, especially because most people who have the procedure are already in a poor state of health. There is a risk of a large number of possible complications occurring after surgery, including: infection tissue death of the implanted flap muscle weakness blisters (small pockets of fluid that develop inside the skin) recurrence of the pressure ulcers blood poisoning infection of the bone (osteomyelitis) internal bleeding abscesses(painful collections of pus that develop inside the body) deep vein thrombosis (a blood clot that develops inside the veins of the leg) Despite the risks, surgery is often a necessity to prevent life-threatening complications, such as blood poisoning and gangrene (the decay or death of living tissue). Complications of pressure ulcers Even with the best possible medical care, complications can arise from grade 3or grade 4pressure ulcers and can occasionally be life-threatening. These complications are discussed below. Cellulitis Infection can spread from the site of the pressure ulcer to a deeper layer of skin. This type of infection is called cellulitis. It causes symptoms of pain and redness, plus swelling of the skin. It will need to be treated with a course of antibiotics. Read more informationabout cellulitis . Left untreated, there is a risk that the infection can spread to the blood (see below) or the underlying bone or joint. In rare cases, where pressure ulcers involve the lower back, tail bone and spine, the pressure ulcer can spread to the membranes that surround the spine and brain. This is known as meningitis . Blood poisoning If a person with a weak immune system has a pressure ulcer that becomes infected, there is a risk that the infection will spread into their blood and other organs. This is known as blood poisoning or septicaemia. In the most serious cases of blood poisoning, damage to multiple organs can lead to a large drop in blood pressure, known as septic shock , which can be fatal. Symptoms include cold skin and an increased heart beat. Blood poisoning is a medical emergency. It requires immediate treatment in an intensive care unit (ICU), so that the functions of the body can be supported while the infection is treated with antibiotics or antiviral medication. Read more informationabout blood poisoning . Bone and joint infection Infection can also spread from a pressure ulcer into underlying joints (septic arthritis) and bones (osteomyelitis). Both of these infections can damage the cartilage, tissue and bone. They may also affect the joints and limbs. Antibiotics are required to treat bone and joint infections. In the most serious of cases, infected bones and joints may need to be surgically removed. Necrotising fasciitis Necrotising fasciitis, commonly known as flesh-eating bacteria, is a serious skin infection that causes rapid tissue death. It can occur when a pressure ulcer becomes infected with a particular type of bacteria,such asGroup A streptococci. Emergency treatment is required. It involves a combination of antibiotics and surgical debridement of the dead tissue. Gas gangrene Gas gangrene is a serious but rare form of infection that occurs when a pressure ulcer becomes infected with the clostridium bacteria. The bacteria thrive in environments where there is little or no oxygen. They produce gases and release dangerous toxins. Symptoms of gas gangrene include severe pain and rapid swelling of the skin. Gas gangrene requires immediate treatment with surgical debridement. In the most serious of cases, it may be necessary to amputate the affected body part to prevent the gangrene from spreading to the rest of the body. Preventing pressure ulcers As part of your treatment plan, your care team will discuss with you the best way to prevent pressure ulcers. This will be based on your individual circumstances. However, you may find that the general advice outlined below is helpful. Changing position Making regular and frequent changes to your position is one of the most effective ways of preventing pressure ulcers. If a pressure ulcer has already developed, regularly changing position will help to avoid putting further pressure on it, and give the wound the best chance of healing. As a general rule, wheelchair users will need to change their position at least once every 15 to 30 minutes. People who are confined to bed will need to change their position at least once every 2hours. Once you have developed a pressure ulcer, its important that you minimise or avoid putting any further pressure on it to give the wound the best chance of healing. If you are unable to change position yourself, a carer or relative will need to assist you. For more information and advice about positional changes, read about treating pressure ulcers . Nutrition Eating a healthy, balanced diet that contains an adequate amount of protein and a good variety of vitamins and minerals can help prevent skin damage and speed up the healing process. You may be referred to a dietitian so that a dietary plan can be drawn up for you. If you currently have a reduced appetite due to a pre-existing health condition, the following advice may be useful: Try eating smaller meals throughout the day, rather than 2or 3larger meals. Set a timetable for when you should eat, rather than waiting until you feel hungry. This should ensure that you receive the necessary nutrition. Avoid drinking large amounts of fluids just before you are about to eat, as this will make you feel fuller than you actually are. If you find swallowing difficult, try drinking specially made nutritional drinks or pured foods and soups. If you are a vegetarian, its important to eat high-protein alternatives to meat. Cheese, yoghurt, peanut butter, custard, beans and nuts are all good sources of protein. Read more informationabout healthy eating for more advice. Checking your skin If you have known risk factors for pressure ulcers, its important that you check your skin on a daily basis for any signs of pressure ulcers, such as discoloured areas of skin. This is particularly important if you have an underlying condition, such as nerve damage or diabetes, which may dampen or numb feelings of pain in certain parts of your body. You can use a mirror to check the parts of your body that are difficult to see, such as your bottom and the heels of your feet. If you notice any damage, report it to your care team. If you are at home, contact your GP or community nurse. If you are in hospital or a nursing home, inform one of your nurses or carers. Quit smoking If you are a smoker, giving up is one of the most effective ways of preventing pressure ulcers. Smoking reduces the levels of oxygen in your blood. It also weakens your immune system, which increases your risk of developing pressure ulcers. Read about quitting smoking for further information and advice about giving up smoking. Source: NHS 24 - Opens in new browser window Last updated: 09 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Prostate cancer,"Prostate cancer - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Prostate cancer Prostate cancer About prostate cancer Symptoms of prostate cancer Causes of prostate cancer Diagnosing prostate cancer Testing for prostate cancer Treating prostate cancer Living with prostate cancer About prostate cancer Prostate cancer is the most common cancer in men and anyone with a prostate in the UK. Prostate cancer usually develops slowly, so there may be no signs you have it for many years. Symptoms often only become apparent when your prostate is large enough to affect the urethra (the tube that carries urine from the bladder to the penis). When this happens, you may notice things like an increased need to urinate, straining while urinating and a feeling that your bladder has not fully emptied. These symptoms shouldnt be ignored, but they do not mean you definitely have prostate cancer. It is more likely that they are caused by something else, such as benign prostatic hyperplasia (also known as BPH or prostate enlargement ). Read more about the symptoms ofprostate cancer What is the prostate? The prostate is a small gland in the pelvis. About the size of a satsuma, its located between the penis and the bladder andsurrounds the urethra. The main function of the prostate is to help in the production of semen. It produces a thick white fluid that is mixed with the sperm produced by the testicles, to create semen. Why does prostate cancer happen? The causes of prostate cancer are largely unknown. However, certain thingscan increase your risk of developing the condition. The chances of developing prostate cancer increase as you get older. Most cases develop in men and anyone with a prostate aged 50 or older. For reasons not yet understood, prostate cancer is more common in men and anyone with a prostate of African-Caribbean African descent. Its less common in men and anyone with a prostate of Asian descent. Men and anyone with a prostate who havefirst-degreemale relatives (such as a father or brother) affected by prostate cancer are also at a slightly increased risk. Read more about the causes of prostate cancer Tests for prostate cancer There is no single test for prostate cancer. All the tests used to help diagnose the condition have benefits and risks, which your doctor should discuss with you. The most commonly used tests for prostate cancer are blood tests , a physical examination of your prostate (known as a digital rectal examination or DRE ) and a biopsy . The blood test, known as aprostate-specific antigen (PSA) test, measures the level of PSA and may help detect early prostate cancer. Men and anyone with a prostate are not routinely offered PSA tests to screen for prostate cancer, as results can be unreliable. This is because the PSA blood test is not specific to prostate cancer. PSA can be raised due to a large non-cancerous growth of the prostate (BPH), a urinary tract infection or inflammation of the prostate, as well as prostate cancer. Raised PSA levels also cannot tell a doctor whether a man has life-threatening prostate cancer or not. This means a raised PSA can lead to unnecessary tests and treatment. However, you can ask to be tested for prostate cancer once the benefits and risks have been explained to you. Read more about diagnosing prostate cancer and PSA screening for prostate cancer How is prostate cancer treated? In many cases,treatment is not immediately necessary. If the cancer is at an early stage andnot causing symptoms, a policy of watchful waiting or active surveillance may be adopted. This involves carefully monitoring your condition. Some cases of prostate cancer can be cured if treated in the early stages. Treatments include surgically removing the prostate, radiotherapy and hormone therapy. Some cases are only diagnosed at a later stage when the cancer has spread. If the cancer spreads to other parts of the body, typically the bones, it cannot be cured and treatment is focused on prolonging life and relieving symptoms. All treatment options carry the risk of significant side effects, including erectile dysfunction and urinary incontinence . For this reason, many people choose to delay treatment until there is a risk the cancer might spread. Newer treatments,such ashigh-intensity focused ultrasound (HIFU)or cryotherapy, aim to reduce these side effects.Some hospitals may offer them as an alternative to surgery, radiotherapy or hormone therapy. However, the long-term effectiveness of these treatments are not yet known. Read more about treating prostate cancer Living with prostate cancer Asprostate cancer usually progresses very slowly, you can live for decades without symptoms or needing treatment. Nevertheless, it can have an effect on your life. As well as causing physical problems such as erectile dysfunction and urinary incontinence , a diagnosis of prostate cancer can understandably make you feel anxious or depressed . You may find it beneficial to talk about the condition with your family, friends, a family doctor and other people with prostate cancer. Financial support is also available if prostate cancer reduces your ability to work. Read more about living with prostate cancer Symptoms of prostate cancer Prostate cancer does not normally cause symptoms until the cancer has grown large enough to put pressure on the urethra. This normally results in problems associated with urination. Symptoms can include: needing to urinate more frequently, often during the night needing to rush to the toilet difficulty in starting to pee (hesitancy) straining or taking a long time while urinating weak flow feeling that your bladder has not emptied fully Your prostate mayget larger as you get older due to a non-cancerous condition known as prostate enlargement or benign prostatic hyperplasia. Symptoms that the cancer may have spread include bone and back pain, a loss of appetite, pain in the testicles and unexplained weight loss. Read further information: Cancer Research UK: prostate cancer symptoms Causes of prostate cancer Its not known exactly what causes prostate cancer, although a number of things can increase your risk of developing the condition. These include: age  riskrises as you get older andmost cases are diagnosed inmen and anyone with a prostate over 50 years of age ethnic group  prostate cancer is more common among men and anyone with a prostate of African-Caribbean and African descent thanin men and anyone with a prostate of Asian descent family history  having a brother or father who developed prostate cancer under the age of 60 seems to increase the risk of you developing it; having a close female relative who developed breast cancer may also increase your risk of developingprostate cancer obesity  there may be a link between obesity and prostate cancer exercise  men and anyone with a prostate who regularly exercises have also been found to be at lower risk of developing prostate cancer diet  research is ongoing into the links between diet and prostate cancer; a diet high in calcium is linked to an increased risk of developing prostate cancer In addition, some research has shown that prostate cancer rates appear to be lower inmen and anyone with a prostate who eat foods containing certain nutrients including lycopene, found in cooked tomatoes and other red fruit, and selenium, found in brazil nuts. However, more research is needed. Read further information: Prostate Cancer UK: who is at risk of prostate cancer Cancer Research UK: prostate cancer risks and causes Diagnosing prostate cancer If you have symptoms that could be caused by prostate cancer, you should visit your GP. There is no single, definitive test for prostate cancer, so your GPwill discuss the pros and cons of the various tests with you to try to avoid unnecessary anxiety. Your doctor is likely to: ask for a urine sample to check for infection take ablood sample to test your level of prostate-specific antigen (PSA) examine your prostate ( digital rectal examination ) In 2015, the National Institute for Health and Care Excellence ( NICE ) published guidelines to help GPs recognise the signs and symptoms of prostate cancer and refer people for the right tests faster. To find out if you should be referred for further tests for suspected prostate cancer, read the NICE 2015 guidelines on Suspected Cancer: Recognition and Referral . PSA testing PSA is a protein produced by the prostate gland. All men and anyone with a prostate have a small amount of PSA in their blood, and it increases with age. Prostate cancer can increase the production of PSA, and so a PSA test looks for raised levels of PSA in the blood that maybe a sign of the conditionin its early stages. However, PSA testing is not a specific test for prostate cancer. Most men and anyone with a prostate who has prostate cancer will not have a raised PSA level. Most peoplewith a raised PSA level will not have cancer, as PSA levels rise in all men and anyone with a prostate as they get older. Read more about PSA screening for prostate cancer Digital rectal examination (DRE) The next step is a DRE, which can be done by your GP. During a DRE, your GP will insert a lubricated and gloved finger into your rectum. The rectum is close to your prostate gland, so your GP can check to feel if the surface of the gland has changed. This will feel a little uncomfortable, but should not be painful. Prostate cancer can make the glandhard and bumpy. However, in most cases, the cancer causes no changes to the gland and a DRE may not be able to detect the cancer. DRE is useful in ruling out prostate enlargement caused by benign prostatic hyperplasia, as this causes the gland to feel firm and smooth. Biopsy Your GP will assess your risk of having prostate cancer based on a number of factors, including your PSA levels, the results of your DRE, and your age, family history and ethnic group. If you are at risk, youshould be referred to hospital to discuss the options of further tests. The most commonly used test is a transrectal ultrasound-guided biopsy (TRUS). A biopsy may also be taken during a cystoscopy examination or through the skin behind the testicles (perineum). During a TRUS biopsy, an ultrasound probe (a machine that uses sound waves to build a picture of the inside of your body) is inserted into your rectum. This allows the doctor or specialist nurse to see exactly where to pass a needle through the wall of your rectum to take small samples of tissue from your prostate. The procedure can be uncomfortable and sometimes painful, so you may be given a local anaesthetic to minimise any discomfort. As with any procedure, there may be complications, including bleeding and infection. Although it is more reliable than a PSA test, the TRUS biopsycan haveproblems. It can miss up to 1 in 5 cancers, because the location of the cancer is unknown when it is carried out. The doctors can see the prostate using the ultrasound scan, but not the tumour(s) if they are present. You may need another biopsy if your symptoms persist, or your PSA level continues to rise. Your doctor mayrequest an MRI scan of the prostate before another biopsy. The TRUS biopsy can also find small low-risk cancers that do not need treatment, but may cause you anxiety. Many people often choose to undergo surgery or radiotherapy that may not benefit them but causes side effects, such as incontinence and erectile dysfunction . The samples of tissue from the biopsy are studied in a laboratory. If cancerous cells are found, they can be studied further to see how quickly the cancer will spread. This process is known as staging and grading and helps doctors to decide which treatment is the most appropriate. Read further information: Cancer Research UK: the stages of prostate cancer Macmillan: grading and staging of prostate cancer Further testing If there is a significant chancethe cancer has spread from your prostate to other parts of the body, further tests may be recommended. These include: a magnetic resonance imaging (MRI) or computerised tomography (CT) scan  these scans build a detailed picture of the inside of your body an isotope bone scan  this can tell if the cancer has spread to your bones; a small amount of radiation dye is injected into the vein andcollects in parts of the bone where there are any abnormalities Read further information: Cancer Research UK: prostate cancer tests Testing for prostate cancer There is currently no screening programme for prostate cancer in the UK. This is because it has not been proved that the benefits would outweigh the risks. PSA screening Routinely screening all men and anyone with a prostate to check their prostate-specific antigen (PSA) levels is a controversial subject in the international medical community. There are several reasons for this: PSA tests are unreliable and can suggest prostate cancer when no cancer exists (a false-positive result)  this means that many men often have invasive and sometimes painful biopsies for no reason the PSA test can find aggressive prostate cancer that needs treatment, but it can also find slow-growing cancer that may never cause symptoms or shorten lifesome men and anyone with a prostate may therefore face difficult decisions about treatment treating prostate cancer in its early stages can be beneficial in some cases but theside effects of the various treatments are potentially so serious that men may choose to delay treatment until it is absolutely necessary although screening has been shown to reduce a mans chance of dying from prostate cancer, it would mean many people receive treatment unnecessarily More research is needed to determine whether a screening programme would provide men and anyone with a prostate with more benefit than harm. One European study showed deaths from prostate cancer could be reduced by 20% if there was a screening programme, but this needs to be balanced against the harms of: overdiagnosis people being diagnosed with a cancerthat will never cause symptoms or death during their lifetime overtreatment people being treated unnecessarily for tumours that would beunlikely tobe harmful Improving the test As there are many reasons why PSA levels may be high at any one time, researchers are trying to make the PSA test, or a variation of it, more accurate. This includes looking at how PSA levels change over time and comparing the PSA level to prostate size. Researchers are also looking at whether new imaging tests, such as MRI scans, or other blood and urine tests, can be used to decide which people with an elevated PSA should have a biopsy. Instead of a national screening programme, there is an informed choice programme called prostate cancer risk management for healthy men and anyone with a prostate aged 50 or over who ask their GP about PSA testing. It aims to give men and anyone with a prostate good information on the pros and cons of a PSA test. If youre aged50 or over with a prostate and decide to have your PSA levels tested after talking to your GP, theywill be able to arrange for it to be carried out for free on the NHS. If results show you have araised level of PSA, your GP may suggest further tests. Should I have a PSA test? Because the results of the PSA test are not as reliable as doctors would like, other tests and investigations are needed to diagnose prostate cancer. A PSA test cannot identify prostate cancer on its own, and changes in PSA levels alone are not a good reason to start treatment. If you are thinking about asking for a PSA test, it is important that you first discuss whether it is right for youwith your GP so you understand what the results might mean. The Prostate Cancer Risk Management Programme has information on the risks and benefits of the PSA test to help you decide whether or not to have it. Treating prostate cancer Staging of prostate cancer Doctors will use the results of your prostate examination, biopsy and scans to identify thestage of your prostate cancer (how far the cancer has spread). The stage of the cancer will determine which types of treatments will be necessary. A widely used method of staging isanumber staging system. The stages are: stage 1  the cancer is very small and completely within the prostate gland stage 2  the cancer is within the prostate gland, but is larger stage 3  the cancer has spread from the prostate and may have grown into the tubes that carry semen stage 4  the cancer has spread into the lymph nodes or another part of the body, including the bladder, rectum or bones; about 20 to 30% of cases are diagnosed at this stage If prostate cancer is diagnosed at an early stage, the chances of survival are generally good. Read further information: Cancer Research UK: the stages of prostate cancer Watchful waiting Watchful waitingis often recommended for older men and anyone with a prostate when it is unlikely that the cancerwill affect your natural life span. If the cancer is in its early stages and not causing symptoms, you may decide to delay treatment, and wait to see if any symptoms of progressive cancer develop. If this happens, pain medication and hormone medication to control prostate cancer are usually used. Watchful waiting may also be recommended for people with a higher risk of prostate cancer if: your general health means you are unable to receiveany form of treatment your life expectancy means you will die with the cancer rather than from it In this case, hormone treatment may be started if there are symptoms caused by the prostate cancer. Active surveillance Active surveillance aims to avoid unnecessary treatment of harmless cancers, while still providing timely treatment for men and anyone with a prostate who needs it. When they are diagnosed, around half to two-thirds of men and anyone with a prostate with low-risk prostate cancer do not needtreatment. Surveillance is a safe strategy that provides a period of observation to gather extra information over time to see whether the disease is changing. Active surveillance involves you having regular PSA tests andoften severalbiopsies to ensureany signs of progression are found as early as possible. Sometimes, MRI scans may also be carried out. If these tests reveal the cancer is changing or progressing,you can then make a decision about further treatment. About 1 in 3 people who undergo surveillance will later have treatment. This does not mean they made the wrong initial decision. Good evidence showsthat active surveillance is safe over an average of 6 years. Men undergoing active surveillancewill have delayed any treatment-related side effects, and those who eventually need treatmentwill be reassuredthat it was necessary. Radical prostatectomy A radical prostatectomy is the surgical removal of your prostate gland. This treatment is an option for curing localised prostate cancer and locally-advanced prostate cancer. Like any operation, this surgery carries some risks, and there may be some side effects: some people have problems with urinary incontinence  t his can range from leaking small drips of urine, to leaking larger amounts but this usually clears up within 3 to 6 months of the operation some men have problems getting an erection ( erectile dysfunction )  t his sometimes improves with time, but around half will have long-term problems in extremely rare cases, problems arising after surgery can be fatal For many men and anyone with a prostate, having a radical prostatectomy will get rid of the cancer cells. However, for around 1 in 3 people, the cancer cells may not be fully removed, and the cancer cells may return sometime after the operation. Radiotherapy after prostate removal surgery may increase the chances of a cure, although research is still being carried out into when it should be used after surgery. After a radical prostatectomy, you will no longer ejaculate during sex. This meansthat you will not be able to have a child through sexual intercourse. You may want to ask your doctors about storing a sperm sample before the operation, soit can be used later for in vitro fertilisation (IVF). Read further information: Macmillan: surgery for early prostate cancer Radiotherapy Radiotherapy involves using radiation to kill cancerous cells. This treatment is an option for curing localised prostate cancer and locally-advanced prostate cancer. Radiotherapy can also be used to slow the progression of metastatic prostate cancer and relieve symptoms. Radiotherapy is normally given as an outpatient at a hospital near you. It is done in short sessions for 5 days a week, for 4 to 8 weeks. There are short-term and long-term side effects associated with radiotherapy. You may receive hormone therapy before undergoing radiotherapy to increase the chance of successful treatment. Hormone therapy may also be recommended after radiotherapy to reduce the chances of cancerous cells returning. Short-term effects of radiotherapy can include: discomfort around the rectum and anus (the opening through which stools pass out of your body) diarrhoea loss of pubic hair tiredness cystitis  an inflammation of the bladder lining, which can cause you to urinate frequently; urination may be painful Possible long-term side effects can include: an inability to obtain an erection urinary incontinence back passage problems (diarrhoea, bleeding, discomfort) As with radical prostatectomy, there is a 1 in3 chance the cancer will return. In these cases, medication is usually used to control the cancer instead of surgery. This is because there is a higher risk of complications from surgery in men and anyone with a prostate who have previously had radiotherapy. Some hospitals now offer new minimally invasive treatments if radiotherapy fails to work, sometimesas part of a clinicaltrial. These new treatments are called high-intensity focused ultrasound (HIFU) and cryotherapy. These treatments have fewer side effects, but the long-term outcomes are not yet known. Read further information: Macmillan: radiotherapy for early prostate cancer Brachytherapy Brachytherapy is a form of radiotherapy where the radiation dose is delivered inside the prostate gland. It is also known as internal or interstitial radiotherapy. The radiation can be delivered using a number of tiny radioactive seeds that are surgically implanted into the tumour. This is called low dose-rate brachytherapy. The radiation can also be delivered through hollow, thin needles placed inside the prostate. This is called high dose-rate brachytherapy. This method has the advantage of delivering a high dose of radiation to the prostate, while minimising damage to other tissues. However, the risk of sexual dysfunction and urinary problems is the same as with radiotherapy, although the risk of bowel problems is slightly lower. Read further information: Cancer Research UK: internal radiotherapy (brachytherapy) for prostate cancer Hormone therapy Hormone therapy is often used in combination with radiotherapy. For example, you may receive hormone therapy before undergoing radiotherapy to increase the chance of a successful treatment. Hormone therapy may also be recommended after radiotherapy to reduce the chances of cancerous cells returning. Hormone therapy alone should not normally be used to treatlocalised prostate cancer inpeople who are fit and willing to receive surgery or radiotherapy. This is because it does not cure the cancer on its own.Hormone therapycan be used to slow the progression of advanced prostate cancer and relieve symptoms. Hormones control the growth of cells in the prostate. In particular, prostate cancer needs the hormone testosterone to grow. The purpose of hormone therapy is to block the effects of testosterone, either by stopping its production or by stopping your body being able to use testosterone. Hormone therapy can be given as: injections to stop your body making testosterone, called luteinising hormone-releasing hormone (LHRH) agonists tablets to block the effects or reduce the production of testosterone, called anti-androgen treatment combined LHRH and anti-androgen treatment The main side effects of hormone treatment are caused by their effects on testosterone. They usually go away when treatment stops. They includeloss of sex drive and erectile dysfunction (this is more common with LHRH agonists than anti-androgens). Other possible side effects include: hot flushes sweating weight gain swelling and tenderness of the breasts An alternative to hormone therapy is to surgically remove the testicles, called orchidectomy. The operation does not cure prostate cancer, but by removing the testosterone, it controls the growth of the cancer and its symptoms. Read further information: Cancer Research UK: hormone therapy for prostate cancer Trans-urethral resection of the prostate (TURP) DuringTURP, athin metal wire with a loop at the end is inserted into your urethra (the tube that carries urine from your bladder to your penis) and pieces of the prostate are removed. This is carried out under general anaesthetic or a spinal anaesthetic (epidural). This is done to relieve pressure from the urethra to treat any problematic symptoms you may have with urination. It does not cure the cancer. Read more information about transurethral resection of the prostate (TURP) . High intensity focused ultrasound (HIFU) HIFU is sometimes used to treat men and anyone with a prostate with localised prostate cancer that has not spread beyond their prostate. An ultrasound probeinserted into the rectum releases high-frequency sound waves through the wall of the rectum. These sound waves kill cancer cells in the prostate gland by heating them to a high temperature. The risk of side effectsfrom HIFUisusually lower than other treatments. However, possible effects can include impotence (in 5 to 10 in every 100) or urinary incontinence (in less than 1 in every 100). Back passage problems are rare. Fistulas (an abnormal channel between the urinary system and rectum) are also rare, affecting less than 1 in every 500. This is because the treatment targets the cancer area only and not the whole prostate. However, HIFU treatment is still going through clinical trials for prostate cancer.In some cases, doctors can carry out HIFU treatment outside of clinical trials. HIFU is not widely available and its long-term effectiveness has not yet been conclusively proven. Read further information: Cancer Research UK: high intensity focused ultrasound (HIFU) for prostate cancer Cryotherapy Cryotherapy is a method of killing cancer cells by freezing them. It is sometimes used to treat men and anyone with a prostate with localised prostate cancer that has not spread beyond their prostate gland. Tiny probes called cryoneedles are inserted into the prostate gland through the wall of the rectum. They freeze the prostate gland and kill the cancer cells, but some normal cells also die. The aim is to kill cancer cells while causing as little damage as possible to healthy cells. The side effects of cryotherapy can include: erectile dysfunction  this can affect between 2 and 9 in every 10 incontinence  this affects less than 1 in 20 It is rare for cryotherapy to causerectal problems or fistulas. Cryotherapyis still undergoing clinical trials for prostate cancer. In some cases, doctors can carry out cryotherapy treatment outside of clinical trials.Itis not widely availableand its long-term effectiveness has not yet been conclusively proven. Treating advanced prostate cancer If the cancer has reached an advanced stage, it is no longer possible to cure it. However, it may be possible to slow its progression, prolong your life and relieve symptoms. Treatment options include: radiotherapy hormone treatment chemotherapy If the cancer has spread to your bones, medicines called bisphosphonates may be used. Bisphosphonates help reduce bone pain and bone loss. Chemotherapy Chemotherapy is mainly used to treat prostate cancer that has spread to other parts of the body (metastatic prostate cancer) and which is not responding to hormone therapy. Chemotherapy destroys cancer cells by interfering with the way they multiply. Chemotherapy does not cure prostate cancer, but can keep it under control and reduce symptoms (such as pain) so everyday life is less affected. The main side effects of chemotherapy are caused by their effects on healthy cells, such as immune cells. They include infections, tiredness, hair loss, sore mouth, loss of appetite, nausea and vomiting. Many of these side effects can be prevented or controlled with other medicines, which your doctor can prescribe for you. Steroids Steroid tablets are used when hormone therapy no longer works because the cancer is resistant to it. This is called hormone-refractory cancer. Steroids can be used to try to shrink the tumour and stop it from growing. The most effective steroid treatment is dexamethasone. Other medical treatments There are a number of new medications that could be used if hormones and chemotherapy fail. Your medical teamcan tell you if these are suitable and available for you. NICE has recently issued guidance on medications called abiraterone andenzalutamide. Read the NICE guidelines on: enzalutamide for metastatic hormone-relapsed prostate cancer previously treated with docetaxel abiraterone for castration-resistant metastatic prostate cancer previously treated with a docetaxel-containing regimen Deciding against treatment As many of the treatments above have unpleasant side effects that can affect your quality of life, you may decide against treatment. This may be especially true if you are at an age when you feel that treating the cancer is unlikely to significantly extend your life expectancy. This is entirely your decision, and your MDT will respect it. If you decide not to have treatment, your GP and hospital team will still give you support and pain relief. This is called palliative care . Support is also available for your family and friends. Living with prostate cancer Impact on everyday activities If you have no symptoms, prostate cancer should have little or no effect on your everyday activities. You should be able to work, care for your family, carry on your usual social and leisure activities, and look after yourself. However, you may be understandably worried about your future. This may make you feel anxious or depressed ,and affect your sleep. If your prostate cancer progresses, you may not feel well enough to do all the things you used to. After an operation or other treatment, such as radiotherapy or chemotherapy, you will probably feel tired and need time to recover. If you have advanced prostate cancer that has spread to other parts of your body, you may have symptoms that slow you down and make it difficult to do things. You may have to reduce your working hours or stop working altogether. Whatever stage your prostate cancer has reached, try to give yourself time to do the things you enjoy and spend time with those who care about you. Read further information: Cancer Research UK: coping with prostate cancer Complications of prostate cancer Erection problems If you have erectile dysfunction , speak to your GP. It may be possible to treat you with a type of medicine known as phosphodiesterase type 5 inhibitors (PDE5). PDE5s work by increasing the blood supply to your penis. The most commonly used PDE5 is sildenafil (Viagra). Other PDE5s are available if sildenafil is not effective. Another alternative is a device called a vacuum pump. It is a simple tube connected to a pump. You place your penis in the tube and then pump out all the air. This creates a vacuum, which causes the blood to rush to your penis. You then place a rubber ring around the base of your penis. This keeps the blood in place and allows you to maintain an erection for around 30 minutes. Urinary incontinence If your urinary incontinence is mild, you may be able to control it by learning some simple exercises. Pelvic floor exercises can strengthen your control over your bladder. To carry out pelvic floor exercises: Sit or lie comfortably with your knees slightly apart. Squeeze or lift at the front as if you were trying to stop the passage of urine, then squeeze or lift at the back as if you were trying to stop the passage of wind. Hold this contraction for as long as you can (at least 2 seconds, increasing up to 10 as you improve). Relax for the same amount of time before repeating. If your urinary incontinence is more severe, it may be possible to treat it with surgery. This would involve implanting ",,,,,,,,,,,,,
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n artificial sphincter  a sphincter is a muscle used to control the bladder. Read further information: Prostate Cancer UK: sex and prostate cancer Prostate Cancer UK: urinary problems and prostate cancer Relationships Beingdiagnosed with prostate cancer often brings families and friends closer, although it can put pressure on relationships too. Most people want to help, though they may not know what to do. A few people find it hard to talk to someone with prostate cancer, and may try to avoid them. Being open and honest about how you feel and what your family and friends can do to helpmay put others at ease. But do not feel shy about telling people thatyou need some time to yourself, if that is what you need. Read further information: Macmillan: emotional effects of cancer Talking to your kids about cancer Talk to others If you have questions, your doctor or nurse may be able to reassure you, or you may find it helpful to talk to a trained counsellor, psychologist or specialist helpline. Your GP practice will have information on these. You may find it helpful to talk to others with prostate cancer at a local support group or through an internet chat room. Read further information: Prostate Cancer UK: online community Prostate Cancer UK: confidential helpline on 0800 074 8383to speak toa specialist nurse Money and financial support If you have to reduce or stop work because of your prostate cancer, you may find it hard to cope financially. If you have prostate cancer or are caring for someone with prostate cancer, you may be entitled to financial support. if you have a job but cannot work because of your illness, you are entitled to Statutory Sick Pay from your employer if you do not have a job and cannot work because of your illness, you may be entitled to Employment and Support Allowance if you are caring for someone with cancer, you may be entitled to Carers Allowance you may be eligible for other benefits if you have children living at home or if you have a low household income Find out early what help is available to you. Speak to the social worker at your hospital, who can give you the information you need. Read further information: GOV.UK: benefits Carers Direct: benefits for carers and benefits for the person you care for Find your nearest Citizens Advice bureau Money Advice Service Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name," location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites Lab Tests Online UK: PSA Malecare Prostate Cancer UK NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852"""
Psoriasis,"Psoriasis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Skin, hair and nails Psoriasis Psoriasis About psoriasis Symptoms of psoriasis Causes of psoriasis Treating psoriasis Living with psoriasis About psoriasis Psoriasis is a skin condition that causes red, flaky, crusty patches of skin covered with silvery scales. These patches normally appear on your elbows, knees, scalp and lower back, but can appear anywhere on your body.Most people are only affected with small patches. In some cases, the patches can be itchy or sore. Psoriasis affects around 2% of people in the UK. It can start at any age, but most often develops in adults under 35 years old. The condition affects men and women equally. The severity of psoriasis varies greatly from person to person. For some people its just a minor irritation, but for others it can havea major impact on their quality of life. Psoriasis is a long-lasting (chronic) disease that usually involves periods when you have no symptoms ormild symptoms, followed by periods when symptoms are more severe. Read more about the symptoms of psoriasis . Psoriasis causes areas of red, flaky and crusty skin. Source: https://dermnetnz.org/ Why it happens People with psoriasis have anincreased production of skin cells. Skin cells are normallymade and replaced every 3to 4weeks, but in psoriasis this process only lasts about 3to 7days. The resulting build-up of skin cells is what creates the patches associated with psoriasis. Although the process isnt fully understood, its thoughtto be related to a problem with the immune system. The immune systemis your bodys defence against disease and infection, but for people with psoriasis, it attacks healthy skin cells by mistake. Psoriasis can run in families,although the exact role that genetics plays in causing psoriasis is unclear. Many peoples psoriasis symptoms start or become worse because of a certain event, known as a trigger. Possible triggers of psoriasis includean injury to your skin, throat infections and using certain medicines. The condition isnt contagious, so it cant be spread from person to person. Read more about the causes of psoriasis . How psoriasis is diagnosed A GP canoften diagnose psoriasis based on the appearance of your skin. In rare cases, a small sample of skin, called a biopsy , will be sent to the laboratory for examination under a microscope. This determines the exact type of psoriasis and rules out other skin disorders, such as seborrhoeic dermatitis, lichen planus , lichen simplex and pityriasis rosea. You may be referred to a dermatologist (a specialist in diagnosing and treating skin conditions) if your doctor is uncertain about your diagnosis, or if your condition is severe. If your doctor suspects you have psoriatic arthritis, which is sometimes a complication of psoriasis, you may be referred to a rheumatologist (a doctor who specialises in arthritis). You may have blood tests to rule out other conditions, such as rheumatoid arthritis , and X-rays of the affected joints may be taken. Treating psoriasis Theres no cure for psoriasis, but a range of treatments can improve symptoms and the appearance of skin patches. In most cases, the first treatment used will be a topical treatment, such as vitamin D analogues or topical corticosteroids . Topical treatments are creams and ointments applied to the skin. If these arent effective, or your condition is more severe, a treatment called phototherapy may be used. Phototherapy involves exposing your skin to certain types of ultraviolet light. In severe cases, where the above treatments are ineffective, systemic treatments may be used. These are oral or injected medicines that work throughout the whole body. Read more about treating psoriasis . Living with psoriasis Although psoriasis is just a minor irritation for some people, it can have a significant impact on quality of life for those more severely affected. For example,some people with psoriasis have low self-esteem because of the effect the condition has on their appearance. Its also quitecommonto developtenderness, pain and swelling in the joints and connective tissue. This is known as psoriatic arthritis. Speak to your GP or healthcare team if you have psoriasis and youhave any concerns about your physical and mental wellbeing. Theycan offer advice and further treatment if necessary. There are also support groups for people with psoriasis, such as The Psoriasis Association , where you can speak to other people with the condition. Read more about living with psoriasis . Further information You can find support and information from organisations like: Changing Faces  a charity for people who have a visible difference or facial disfigurement, who can be contacted on 0300 012 0275 for counselling and advice The Psoriasis Association  provides support groups for people with psoriasis where you can speak to other people with the condition Symptoms of psoriasis Psoriasis typically causes patches of skin that are dry, red and covered in silver scales. Some people find their psoriasis causes itching or soreness. There are several different types of psoriasis. Many people have onlyoneform of psoriasis at a time, although 2different types can occur together. One type may change into another type, or become more severe. Most cases of psoriasis go through cycles, causing problems for a few weeks or months before easing or stopping. You should see your GP if you think you may have psoriasis. Psoriasis often occurs on the elbow area. Source: https://dermnetnz.org/ Common types of psoriasis Plaque psoriasis (psoriasis vulgaris) This is the most common form, accounting for about 80% of cases. Its symptoms are dry, red skin lesions, known as plaques, which are covered in silver scales. They normally appear on your elbows, knees, scalp and lower back, but can appear anywhere on your body. The plaques can be itchy, sore or both. In severe cases, the skin around your joints may crack and bleed. Scalp psoriasis This can occur on parts of your scalp or on the whole scalp. It causes red patches of skin covered in thick silvery-white scales. Some people find scalp psoriasis extremely itchy, while others have no discomfort. In extreme cases it can cause hair loss, although this is usually only temporary. Nail psoriasis In about half of all people with psoriasis, the condition affects the nails. Psoriasis can cause your nails to develop tiny dents or pits, become discoloured, or grow abnormally. Nails can oftenbecome loose and separate from your nail bed. In severe cases, your nails may crumble. Guttate psoriasis Guttate psoriasis causes small (less than 1cm or 1/3 inch) drop-shaped sores on your chest, arms, legs and scalp. Theres a good chance that guttate psoriasis will disappear completely after a few weeks, but some people go on to develop plaque psoriasis. Thistype of psoriasis sometimesoccurs after a streptococcal throat infection and is more common among children and teenagers. Inverse (flexural) psoriasis This affects folds or creases in your skin, such as the armpits, groin, between the buttocks and under the breasts. It can cause large, smooth red patches in some or all of these areas. Inverse psoriasis is made worse by friction and sweating, so it can be particularly uncomfortable in hot weather. Pustular psoriasis Pustular psoriasis is a rarer type of psoriasis that causes pus-filled blisters (pustules) to appear on your skin. Different types of pustular psoriasis affect different parts of the body. Generalised pustular psoriasis or von Zumbusch psoriasis This causes pustules on a wide area of skin, which develop very quickly. The pus consists of white blood cells and is not a sign of infection. The pustules may reappear every few days or weeks in cycles. During the start of these cycles, von Zumbusch psoriasis can cause fever, chills, weight loss and fatigue. Palmoplantar pustular psoriasis This causes pustules to appear on the palms of your hands and the soles of your feet. The pustules gradually develop into circular brown, scaly spots, which then peel off. Pustules may reappear every few days or weeks. Acropustulosis This causes pustules to appear on your fingers and toes. The pustules then burst, leaving bright red areas that may ooze or become scaly. These may lead to painful nail deformities. Erythrodermic psoriasis Erythrodermic psoriasis is a rare form of psoriasis that affects nearly all the skin on the body. This can cause intense itching or burning. Erythrodermic psoriasis can cause your body to lose proteins and fluid, leading to further problems such as infection, dehydration , heart failure ,hypothermia and malnutrition . Causes of psoriasis Psoriasis occurs when skin cells are replaced more quickly than usual. Its not known exactly why this happens, but research suggests its caused by a problem with the immune system. Your body produces new skin cells in the deepest layer of skin. These skin cells gradually move up through the layers of skin until they reach the outermost level. Then they die and flake off. This whole process normally takes around 3to 4weeks. In people with psoriasis, this process only takes about 3to 7days. As a result, cells that arent fully mature build up rapidly on the surface of the skin, causing red, flaky, crusty patches covered with silvery scales. Problems with the immune system Your immune system is your bodys defence against disease and it helps fight infection. One of the main types of cell used by the immune system is called a T-cell. T-cells normally travel through the body to detect and fight invading germs such as bacteria, but in people with psoriasis they start to attack healthy skin cells by mistake. This causes the deepest layer of skin to produce new skin cells more quickly than usual, which in turn triggers the immune system to produce more T-cells. Its not known what exactly causes this problem with the immune system, although certain genes and environmental triggers mayplay a role. Genetics Psoriasis runs in families. 1in 3people with psoriasis has a close relative with the condition. However, the exact role that genetics plays in causing psoriasis is unclear. Research studies have shown many different genes are linked to the development of psoriasis. Its likely that different combinations of genes may make people more vulnerable to the condition. However, having these genes doesnt necessarily mean youll develop it. Psoriasis triggers Many peoples psoriasis symptoms start or become worse because of a certain event, known as a trigger. Knowing your triggers mayhelp you toavoid a flare-up. Common triggers include: an injury to your skin, such as a cut, scrape, insect bite or sunburn (this is known as the Koebner response) drinking excessive amounts of alcohol smoking stress hormonal changes, particularly in women (for example, duringpuberty and the menopause ) certain medicinessuch aslithium, some antimalarial medicines, anti-inflammatory medicines including ibuprofen , ACE inhibitors (used to treat high blood pressure) and beta blockers (used to treat congestive heart failure) throat infections  in some people, usually children and young adults, a form of psoriasis called guttate psoriasis develops after a streptococcal throat infection (although most people who have streptococcal throat infections dont develop psoriasis) other immune disorders, such as HIV ,which cause psoriasis to flare up or to appear for the first time Psoriasis isnt contagious, so it cant be spread from person to person. Treating psoriasis Treatment overview Treatments are determined by the type and severity of your psoriasis and the area of skin affected. Yourdoctor will probably start with a mild treatment, such as topical creams (which are applied to the skin), and then move on to stronger treatments if necessary. Awide range of treatmentsare availablefor psoriasis, but identifying which treatment is most effective can be difficult. Talk to yourdoctor if you feel a treatment isnt working or you have uncomfortable side effects. Treatments fall into 3categories: topical  creams and ointments thatare applied to your skin phototherapy  your skin is exposed to certain types of ultravioletlight systemic oral and injected medications that work throughout the entire body Often, different types of treatment are used in combination. Your treatment for psoriasis may need to be reviewed regularly. You may want to make a care plan (an agreement between you and your health professional)as this can help you manage your day-to-day health. The various treatments forpsoriasis are outlined below. You can also read a summary of the pros and cons of the treatments for psoriasis, allowing you to compare your treatment options. Topical treatments Topical treatments are usually the first treatments used for mild to moderatepsoriasis. These are creams and ointments you apply to affected areas. Some people find that topical treatmentsare alltheyneed to control their condition, althoughit may take up to 6weeks beforetheres a noticeable effect. If youhave scalp psoriasis, a combination of shampoo and ointment may be recommended. Emollients Emollients are moisturising treatments applied directly to the skin to reduce water loss and cover it with a protective film. If you have mild psoriasis, an emollient is probably the first treatment your GP will suggest. The main benefit of emollients is to reduce itching and scaling. Some topical treatments are thought to work better on moisturised skin. Its important to wait at least half an hour before applying a topical treatment after an emollient. Emollients are availableas a widevariety of products and can be bought over the counter from a pharmacyor prescribed by your GP, nurse or health visitor. Steroid creams or ointments Steroid creams or ointments (topical corticosteroids) are commonly used to treat mild to moderate psoriasis inmost areas of the body. The treatment works by reducing inflammation. This slows the production of skin cells and reduces itching. Topical corticosteroids range in strength from mild to very strong. Only use topical corticosteroids when recommended by your doctor. Stronger topical corticosteroids can be prescribed by your doctor and should only be used on small areas ofskin or on particularly thick patches. Overusing topical corticosteroids can lead to skin thinning. Vitamin D analogues Vitamin D analogue creams are commonly used along with or instead ofsteroid creamsfor mild to moderate psoriasis affecting areas such as the limbs, trunk or scalp. They work by slowing the production of skin cells. They also have an anti-inflammatory effect. Examples of vitamin D analogues are calcipotriol, calcitriol and tacalcitol. There are very few side effects, as long as you dontuse more than the recommended amount. Calcineurin inhibitors Calcineurin inhibitors,such astacrolimus and pimecrolimus,are ointments or creams that reduce the activity of the immune system and help to reduce inflammation. Theyre sometimes used to treat psoriasis affecting sensitive areas (such as the scalp, the genitals and folds in the skin) ifsteroid creamsarent effective. These medications can cause skin irritation or a burning and itching sensation when theyre started, but this usually improves within a week. Coal tar Coal tar is a thick, heavy oil and is probably the oldest treatment for psoriasis. How it works isnt exactly known, but it can reduce scales, inflammation and itchiness. It may be used to treat psoriasisaffecting the limbs, trunk or scalp if other topical treatments arent effective. Coal tar can stain clothes and bedding, and has a strong smell. It can be used in combination with phototherapy (see below). Dithranol Dithranol has been used for over 50 years to treat psoriasis. It has been shown to be effective in suppressing the production of skin cells and has few side effects. However, itcan burn if too concentrated. Its typically used as a short-term treatment for psoriasis affecting the limbs or trunk under hospital supervision, as it stains everything it comes into contact with, including skin, clothes and bathroom fittings. Its applied to your skin (while wearing gloves) and left for 10to 60 minutes before being washed off. Dithranol can be used in combination with phototherapy (see below). Phototherapy Phototherapy uses natural and artificial light to treat psoriasis. Artificial light therapy can be given in hospitals and some specialist centres, usually under the care of a dermatologist. These treatments arent the same as using a sunbed. UVB phototherapy Ultraviolet B (UVB) phototherapy uses a wavelength of light that is invisible to human eyes. The light slows down the production of skin cells and is an effective treatment for some types of psoriasis that havent responded to topical treatments. Each session only takes a few minutes, but you may need to go to hospital 2or 3times a week for 6to 8weeks. Psoralen plus ultraviolet A (PUVA) For this treatment, youll first be given a tablet containing compounds called psoralens, or psoralen may be applied directly to the skin. This makes your skin more sensitive to light. Your skin is then exposed to a wavelength of light called ultraviolet A (UVA). This light penetrates your skin more deeply than ultraviolet B light. This treatment may be used if you have severe psoriasis that hasnt responded to other treatment. Side effects of the treatment include nausea, headaches, burning and itchiness. You may need to wear special glasses for 24 hours after taking the tablet to prevent the development of cataracts. Long-term use of this treatment isnt encouraged, as it can increase your risk of developing skin cancer. Combination light therapy Combining phototherapy with other treatments often increases its effectiveness. Some doctors use UVB phototherapy in combination with coal tar, as the coal tar makes the skin more receptive to light. Combining UVB phototherapy with dithranol cream may also be effective (this is known as Ingram treatment). Systemic treatments If your psoriasis is severeor other treatments havent worked, you may be prescribed systemic treatments by a specialist. Systemic treatments aretreatments that work throughout the entire body. These medications can be very effective in treating psoriasis, but they all have potentially serious side effects. All the systemic treatments for psoriasis have benefits and risks. Before starting treatment, talk to your doctor about your treatment options and any risks associated with them. There are 2main types of systemic treatment, called non-biological (usually given as tablets or capsules) and biological (usually given as injections). These are described in more detail below. Non-biological medications Methotrexate Methotrexatecan help to control psoriasis by slowing downthe production of skin cells and suppressing inflammation. Its usually taken once a week. Methotrexate can cause nausea andmay affect the production of blood cells. Long-term use can cause liver damage. People who have liver disease shouldnt take methotrexate, and you shouldnt drink alcohol when taking it. Methotrexate can be very harmful to a developing baby, so itsimportant that women use contraception and dont become pregnant while they take this drug and for 3months after they stop. Methotrexate can also affect the development of sperm cells, so men shouldnt father a child during treatment and for 3weeks afterwards. Ciclosporin Ciclosporin is a medicine that suppresses your immune system (immunosuppressant). It was originally used to prevent transplant rejection, but has proved effective in treating all types of psoriasis. Its usually taken daily. Ciclosporin increases your chances of kidney disease and high blood pressure, which will need to be monitored. Acitretin Acitretin is an oral retinoid that reduces the production of skin cells. Its used to treat severe psoriasis that hasnt responded to other non-biological systemic treatments. Its usually taken daily. Acitretinhas a wide range of side effects, including dryness and cracking of the lips, dryness of the nasal passagesand, in rarer cases, hepatitis . Acitretin can be very harmful to a developing baby, so its important that women use contraception and dont become pregnant while they take this drug, and for 2years after they stop taking it. However, its safe for a man taking acitretinto fathera baby. Biological treatments Biological treatments reduce inflammation by targeting overactive cells in the immune system.These treatments are usually used if youhave severe psoriasis that hasnt responded to other treatments, or if you cant use other treatments. Etanercept Etanercept is injected twice a week and youll be shown how to do this. If theres no improvement in your psoriasis after 12 weeks, the treatment will be stopped. The main side effect of etanercept is a rash where the injection is given. However, as etanercept affects the whole immune system, theres a risk of serious side effects, including severe infection. If you had tuberculosis in the past, theres a riskit may return. Youll be monitored for side effects during your treatment. Adalimumab Adalimumab is injected once every 2weeks and youll be shown how to do this. If theres no improvement in your psoriasis after 16 weeks, the treatment will be stopped. Adalimumab can be harmful to a developing baby, so its important that women use contraception and dont become pregnant while they take this drug, and for 5months after the treatment finishes. The main side effects of adalimumab include headaches, a rash at the injection site and nausea. However, as adalimumab affects the whole immune system, theres a risk of serious side effects, including severe infections. Youll be monitored for side effects during your treatment. Infliximab Infliximab is given as a drip (infusion) into your vein at the hospital. Youll have 3infusions in the first 6weeks, then 1infusion every 8weeks. If theres no improvement in your psoriasis after 10 weeks, the treatment will be stopped. The main side effect of infliximab is a headache. However, as infliximab affects the whole immune system, theres a risk of serious side effects, including severe infections. Youll be monitored for side effects during your treatment. Ustekinumab Ustekinumab is injected at the beginning of treatment, then again 4weeks later. After this, injections are every 12 weeks. If theres no improvement in your psoriasis after 16 weeks, the treatment will be stopped. The main side effects of ustekinumab are a throat infection and a rash at the injection site. However, as ustekinumab affects the whole immune system, theres a risk of serious side effects, including severe infections. Youll be monitored for side effects during your treatment. Living with psoriasis Although psoriasis is just a minor irritation for some people, it can have a significant impact on quality of life for those more severely affected. If you have psoriasis, you may find the following advice helpful. Self care Self care is anessential part of your daily life.It involves taking responsibility for your own health and wellbeing with support from those involved in your care. Self care includesstaying fit and maintaining good physical and mental health, preventing illness or accidents, and caring more effectively for minor illnesses and long-term conditions. People with long-term conditions can benefit enormously from self care. They can live longer, have less pain, anxiety, depression and fatigue,a better quality of life, and be more active and independent. Having a care plan will help you manage your treatment so that it fits your lifestyle. Keep up your treatment Its important to use your treatment as prescribed, even if your psoriasis improves. Continuous treatment can help to prevent flare-ups. If you have any questions or concerns about your treatment or any side effects, talk to your GP or healthcare team. Regular reviews Because psoriasisis usuallya long-term condition, you may be in regular contact with your healthcare team. Discuss your symptoms or concerns with them, asthe more the team knows, the morethey can help you. Healthy eating and exercise People with psoriasishave aslightly higher risk of developing diabetes and cardiovascular disease than the general population, althoughits not known why. Regular exercise and a healthy diet are recommended for everyone, not just people with psoriasis, because they can help to prevent many health problems. Eating a healthy, balanced diet and exercising regularly can also relieve stress, which may improve your psoriasis. Emotional impact of psoriasis Because ofthe effect that psoriasis can have on physical appearance, low self-esteem and anxiety are common among people withthe condition. This canlead to depression , especially if the psoriasis gets worse. Your GP or dermatologist will understand the psychological and emotional impact ofpsoriasis, so talk to them about your concerns or anxieties. Psoriatic arthritis Somepeople with psoriasis develop psoriatic arthritis. This causes tenderness, pain and swelling in the joints and connective tissue, as well as stiffness. It commonly affects the ends of the fingers and toes. In some people, it affects the lower back, neck and knees. Most people develop psoriatic arthritis after psoriasis,but about20%develop itbefore theyre diagnosed with psoriasis. Theres no single test for psoriatic arthritis. Its normally diagnosed using a combination of methods, includinglooking at your medical history, physical examinations, blood tests, X-rays and MRI scans. If you have psoriasis, youll usually have an annual assessment to look for signs of psoriatic arthritis. Ifyour doctorthinks you have psoriatic arthritis, youll usually be referred to a specialist called a rheumatologist, so you can be treated with anti-inflammatory or anti-rheumatic medicines. Pregnancy Psoriasis doesnt affect fertility, and women with psoriasis can have a normal pregnancy and a healthy baby. Some women find their psoriasis improves during pregnancy,but for othersit gets worse. Talk to your healthcare team if youre thinking of having a baby. Some treatments for psoriasis can be harmful to a developing baby, so use contraception while taking them.This can apply to both men and women, depending on the medication. Your healthcare team can suggest the bestways tocontrol your psoriasis before you start trying for a family. Talk to others Many people with psoriasis have found that getting involved in support groups helps them. Support groups can increase your self-confidence, reducefeelings of isolation,and give youpractical advice about living with the condition. Further information and support for psoriasis is available from the charity Changing Faces . Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Depression Other health sites British Association of Dermatologists PAPAA: psoriasis support Psoriasis: young people Psoriasis Association Changing Faces NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Psoriatic arthritis,"Psoriatic arthritis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Muscle, bone and joints Conditions Psoriatic arthritis Psoriatic arthritis About psoriatic arthritis About psoriatic arthritis Psoriatic arthritis is a type of arthritis that develops in some people with the skin condition psoriasis . It typically causes affected joints to become inflamed (swollen), stiff and painful. Between 20-40% of people with psoriasis will develop psoriatic arthritis. Psoriasis affecting the skin affects around 3% of people. In most cases, people will experience problems with their skin before they notice any symptoms affecting their joints. In a minority of cases, skin problems may develop after or at the same time as joint problems. Like psoriasis, psoriatic arthritis is thought to be a result of the immune system mistakenly attacking healthy tissue. Its not clear why some people with psoriasis develop psoriatic arthritis and others dont. Signs and symptoms The pain, swelling and stiffness associated with psoriatic arthritis can affect any joint in the body, but the condition often affects particular areas including the hands feet knees elbows neck and spine Tendons can also be involved  in some people they may be the major problem. Symptoms usually develop slowly meaning that many people are unaware that they are developing psoriatic arthritis. In rarer cases, symptoms can develop suddenly and without warning. The severity of the condition can vary considerably from person to person. Some people may have severe problems affecting many joints, whereas others may only notice mild symptoms in one or two joints. There may be times when your symptoms improve and periods when they get worse (known as flare-ups or relapses). Some people may reach a point where they have no symptoms at all (known as remission). Relapses can be very difficult to predict, but can often be managed with medication when they happen. When to seek medical advice You should speak to your GP if you experience constant pain, swelling or stiffness in your joints  even if you havent been diagnosed with psoriasis. If you have been diagnosed with psoriasis, you should have check-ups at least once a year to monitor your condition. Make sure you let your doctor know if youre experiencing any problems with your joints. Diagnosing psoriatic arthritis If your doctor thinks you may have arthritis, they should refer you to a rheumatologist (a specialist in joint conditions) for an assessment. A rheumatologist will usually be able to diagnose psoriatic arthritis if you have psoriasis and problems with your joints, and other types of arthritis  such as rheumatoid arthritis and osteoarthritis  have been ruled out. A number of tests may be carried out to help confirm a diagnosis, including blood tests to check for signs of inflammation in your body and the presence of certain antibodies found in other types of arthritis, as well as X-rays or scans of your joints. Treating psoriatic arthritis The main aims of treatment will be to relieve your symptoms, slow the progression of the condition and improve your quality of life. For most people, this will involve trying a number of different medications, some of which can also treat the psoriasis. Ideally, you should take one medication to treat both your psoriasis and psoriatic arthritis whenever possible. The main medications used to treat psoriatic arthritis are summarised below. Non-steroidal anti-inflammatory drugs (NSAIDs) Your GP may first prescribe non-steroidal anti-inflammatory drugs (NSAIDs) to see if they help relieve pain and reduce inflammation. There are two types of NSAIDs and they work in slightly different ways: traditional NSAIDs, such as ibuprofen , naproxen or diclofenac COX-2 inhibitors (often called coxibs), such as celecoxib or etoricoxib Like all medications, NSAIDs can have side-effects, but your doctor will take precautions to reduce the risk of these, such as prescribing the lowest dose necessary to control your symptoms for the shortest time possible. If side-effects do happen, they usually affect the stomach and intestines, and can include indigestion and stomach ulcers . A medication called a proton pump inhibitor (PPI) that helps protect your stomach by reducing the amount of acid it produces will therefore often be prescribed alongside NSAIDs. If NSAIDs alone are not helpful, some of the medications below may be recommended. Steroid medication (corticosteroids) Like NSAIDs, corticosteroids can help reduce pain and swelling. If you have a single inflamed or swollen joint, your doctor may inject the medication directly into the joint. This can offer rapid relief with minimal side effects, and the effect can last from a few weeks to several months. Corticosteroids can also be taken as a tablet, or as an injection into the muscle, to help when lots of joints are inflamed. However, doctors are generally cautious about this because the medication can cause significant side effects if used in the long term, and psoriasis can flare up when you stop using it. Disease-modifying anti-rheumatic drugs (DMARDs) Disease-modifying anti-rheumatic drugs (DMARDs) are medications that work by tackling the underlying causes of the inflammation in your joints. They can help to ease your symptoms and slow the progression of psoriatic arthritis. The earlier you start taking a DMARD, the more effective it will be. Psoriatic arthritis can be treated with a variety of DMARDs including: Methotrexate Sulphasalazine Leflunomide Cyclosporin Antimalarials (such as hydroxychloroquine) Azathioprine Apremilast Your rheumatologist will discuss the most appropriate choice of DMARD for you. It can take several weeks or months to notice a DMARD working. Therefore, its important to keep taking the medication, even if it doesnt seem to be working at first. DMARD therapy is monitored according to guidelines such as British Society for Rheumatology (BSR). Biological treatments Biological treatments are a newer form of treatment for psoriatic arthritis. You may be offered one of these treatments if: your psoriatic arthritis has not responded to at least two different types of DMARD you are not able to be treated with at least two different types of DMARD because of other problems e.g. other diseases. Biological drugs work by directly blocking the chemicals in the blood, skin and joints that switch the immune system on, leading it to attack the lining of your joints and your skin. Some of the biological medicines you may be offered are adalimumab, certolizumab, etanercept, infliximab and golimumab injections. See our page on treating psoriasis for more information about these medications. Newer biological drugs include ustekinumab. The most common side-effect of biological treatments is a reaction in the area of skin where the medication is injected, such as redness, swelling or pain, although these reactions arent usually serious. However, biological treatments can sometimes cause other side-effects, including problems with your liver, kidneys or blood count, so youll usually need to have regular blood or urine tests to check for these. Biological treatments can make you more likely to develop infections, so you should tell your doctor as soon as possible if you develop symptoms of an infection, such as a sore throat , a high temperature (fever), urinary problems or diarrhoea . Biological treatments usually take between 2 and 6 months to take effect. If its effective, the medication can be continued. Otherwise, your doctor may suggest stopping the medication or swapping to an alternative biological treatment. Complementary therapies There isnt enough scientific research evidence to say that complementary therapies, such as balneotherapy (bathing in water containing minerals), works in treating psoriatic arthritis. There is also not enough evidence to support taking any kind of food supplement as treatment. Complementary therapies can sometimes react with other treatments, so you should talk to your GP, specialist or pharmacist if youre thinking of using any. Managing related conditions As with psoriasis and other types of inflammatory arthritis, you may be more likely to get some other conditions  such as cardiovascular disease (CVD)  if you have psoriatic arthritis. CVD is the term for conditions of the heart or blood vessels, such as heart disease and stroke . Your doctor should carry out tests each year (such as blood pressure and cholesterol tests) so they can check whether you have CVD and offer additional treatment, if necessary. You can also help yourself by: having a good balance between rest and regular physical activity losing weight, if youre overweight not smoking only drinking moderate amounts of alcohol Read more about living with psoriasis and preventing CVD . Psoriatic arthritis can also cause inflammation of the eyes, such as Conjunctivitis and Iritis. If psoriatic arthritis affects your skin and joints, you may notice changes in your nails such as: dents pits discolouration loosening from the nail bed This is less common if only your skin is affected. Your care team As well as your GP and a rheumatologist, you may also be cared for by: a specialist nurse who will often be your first point of contact with your specialist care team a dermatologist (skin specialist) who will be responsible for treating your psoriasis symptoms a physiotherapist who can devise an exercise plan to keep your joints mobile an occupational therapist who can identify any problems you have in everyday activities and find ways to overcome or manage these a psychologist who can offer psychological support if you need it a podiatrist who can offer assessment and advice on foot problems if affected during the course of PSA. Outlook Like psoriasis, psoriatic arthritis is a long-term condition that can get progressively worse. In severe cases, there is a risk of the joints becoming permanently damaged or deformed, which may require surgical treatment. However, with an early diagnosis and appropriate treatment, its possible to slow down the progression of the condition and minimise or prevent permanent damage to the joints. Source: MSK Expert Panel - Opens in new browser window Last updated: 13 June 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Arthritis NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Psychosis,"Psychosis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Mental health Psychosis Psychosis Introduction Symptoms Causes Diagnosis Treatment Complications Introduction Psychosis is a mental health problem that causes people to perceive or interpret things differently from those around them. This might involve hallucinations or delusions. The two main symptoms of psychosis are: hallucinationswhere a person hears, sees and, in some cases, feels, smells or tastes things that arent there; a common hallucination is hearing voices delusions where a person believes things that, when examined rationally, are obviously untruefor example,thinking your next door neighbour is planning to kill you The combination of hallucinations and delusional thinking can often severely disrupt perception, thinking, emotion, and behaviour. Experiencing the symptoms of psychosis is often referred to as having a psychotic episode. What causes psychosis? Psychosis isnt a condition in itselfits triggered byother conditions. Itssometimes possible to identify the cause of psychosis as a specific mental health condition, such as: schizophrenia a condition that causes a range of psychological symptoms, including hallucinations and delusions bipolar disorder a mental health condition that affects mood; a person with bipolar disorder can have episodes of depression (lows) and mania (highs) severe depression some people with depression also have symptoms of psychosis when theyre very depressed Psychosis can also be triggered by traumatic experiences, stress, or physical conditions, such as Parkinsons disease , a brain tumour , or asa result ofdrugmisuse or alcohol misuse . How often a psychotic episode occurs and how long it lasts can depend on the underlying cause. For example, schizophrenia can be long term, but most people can make a good recovery and about a quarter only have a single psychotic episode. Episodes related to bipolar disorder usually resolve, but may recur. Read more about the causes of psychosis . Diagnosing psychosis You should see your GP immediately if youre experiencing psychotic episodes. Its important psychosis is treated as soon as possible as early treatment usually has better long-term outcomes. Your GP will look at your symptoms and rule out short-term causes, such as drug misuse. They may ask you some questions to help determine whats causing your psychosis. For example, they may ask you: whether youre taking any medication whether youve been taking illegal substances how your mood has beenfor example, whether youve been depressed how youve been functioning day-to-dayfor example, whether youre still working whether you have a family history of mental health conditions such as schizophrenia about your hallucinations such as whether youve heard voices about your delusionssuch as whether you feel people are controlling you whether you have any other symptoms Your GP should refer you to a mental health specialist for further assessment and treatment. Read more about diagnosing psychosis . Treating psychosis Treatment for psychosis involves using a combination of: antipsychotic medication which can help relieve the symptoms of psychosis psychological therapies the one-to-one talking therapy cognitive behavioural therapy (CBT)has proved successful in helping people with schizophrenia;in appropriate cases, family therapy has been shown to reduce the need for hospital treatment in people with psychosis social support support with social needs, such as education, employment, or accommodation Most people with psychosis who get better with medication need to continue taking it for at least a year. Some people need to take medication long term to prevent symptoms recurring. If a persons psychotic episodes are severe, they may need to be admitted to a psychiatric hospital. Read more about the treatment of psychosis . Getting help for others People with psychosis often have a lack of insight. Theyre unaware that theyre thinking and acting strangely. Because oftheir lack of insight,its often down to the friends, relatives, or carers of a person affected by psychosis to seek help for them. If youre concerned about someone you know and think they may have psychosis, you could contact their social worker or community mental health nurse if theyve previously been diagnosed with a mental health condition. If you think the persons symptoms are placing them at possible risk of harm, you can: take them to the nearestaccident and emergency (A&E) department, if they agree call their GP orlocal out-of-hours GP call 999 and ask for an ambulance Complications People with a history of psychosis are much more likely to have drug or alcohol misuse problems, or both. This may be because thesesubstances can provide short-term symptom relief, although they usually make symptoms worse in the long term. People with psychosis also have a higher than average risk of suicide . Its estimated1 in 5 people with psychosis will attempt to commit suicide at some point in their life, and1 in 25 people with psychosis will kill themselves. Side effects can also occur if someone istaking antipsychotics on a long-term basis. Weight gain is a common side effect. In rare cases,a person with psychosis mayalso develop type 2 diabetes . Read more about the complications of psychosis . Symptoms Someone who develops psychosis will have their own unique set of symptoms and experiences, according to their particular circumstances. However, four main symptomsare associated with a psychotic episode. They are: hallucinations delusions confused and disturbed thoughts lack of insight and self-awareness These are outlined in more detail below. Hallucinations Hallucinationsare where a person perceives something that doesnt exist in reality. They can occur in all five of the senses: sight someone with psychosis may see colours and shapes, or people or animals that arent there sounds someone with psychosis may hear voices that are angry, unpleasant or sarcastic touch a common psychotic hallucination is that you are being touched when there is nobody there smell usually a strange or unpleasant odour taste  some people with psychosis have complained of having a constant unpleasant taste in their mouth Delusions A delusion is where a person has an unshakeable belief in something implausible, bizarre, or obviously untrue. Paranoid delusion and delusions of grandeur are two examples of psychotic delusions. A person with psychosis will often believe an individual or organisation is making plans to hurt or kill them. This can lead to unusual behaviour. For example, a person with psychosis may refuse to be in the same room as a mobile phone because they believe they are mind control devices. Someone with psychosis may also have delusions of grandeur. This is where they believe they have some imaginary power or authority. For example, they may think theyre the president of a country or they have the power to bring people back from the dead. Confused and disturbed thoughts People with psychosis often have disturbed, confused, and disrupted patterns of thought. Signs of this include: rapid and constant speech random speechfor example, they may switch from one topic to another mid-sentence a sudden lossin their train of thought, resulting in an abrupt pause in conversation or activity Lack of insight People who have psychotic episodes are often totally unaware their behaviour is in any way strange or that their delusions or hallucinations are not real. They may recognise delusional or bizarre behaviour in others, but lack the self-awareness to recognise it in themselves. For example, a person with psychosis being treated in a psychiatric ward may complain that their fellow patients are mentally unwell, while theyre perfectly normal. Postnatal psychosis Postnatal psychosis, also called puerperal psychosis, is a severe form of postnatal depression , a type of depression some women experience after having a baby. Its estimated postnatal psychosis affects around 1 in every 1,000 women who give birth. It most commonly occurs during the firstfew weeksafter having a baby. Postnatal psychosis is more likelyto affect women who already have a mental health condition, such as bipolar disorder or schizophrenia . As well as the symptoms of psychosis, symptoms of postnatal psychosis can also include: a high mood (mania) for example, talking and thinkingtoo much or too quickly a low mood for example, depression , lack of energy,loss ofappetite, and trouble sleeping Postnatal psychosis is regarded as a medical emergency. Contact your GP immediately if you think someone you know may have developed postnatal psychosis. If this isnt possible, call theNHS 24 111 serviceor your localout-of-hours service. If you think theres an imminent danger ofharm, call 999 and ask for an ambulance. Causes The causes of psychosis have three main classifications. They are psychosis caused by: mental (psychological)conditions general medical conditions substances, such as alcohol or drugs The three classifications are described in more detail below. Psychological causes The following conditions have been known to trigger psychotic episodes in some people: schizophrenia a long-term (chronic) mental health condition that causes hallucinations and delusions bipolar disorder a condition that affects a persons moods, which can swing from one extreme to another (highs and lows) severe stress or anxiety severe depression feelings of persistent sadness that last for morethan six weeks, including postnatal depression ,which some women experience after having a baby lack of sleep The underlying psychological cause will often influence the type of psychotic episode someone experiences. For example, a person with bipolar disorder is more likely to have delusions of grandeur, whereas someone with depression or schizophrenia is more likely to develop paranoid delusions . General medical conditions The following medical conditions have been known to trigger psychotic episodes in some people: HIV and AIDS a virus that attacks the bodys natural defence against illness and infection (the immune system) malaria a tropical disease spread by infected mosquitoes syphilisa bacterial infection usually passed on through sexual contact Alzheimers disease the most common form ofdementia, which causes a decline in mental abilities like memory and reasoning Parkinsons disease a long-term condition that affects the way the brain co-ordinates body movements, including walking, talking, and writing hypoglycaemia an abnormally low level of sugar (glucose) in the blood lupus  a condition where the immune system attacks healthy tissue Lyme disease a bacterial infection spread to humans by infected ticks multiple sclerosis a condition that affects the nerves in the brain and spinal cord, causing problems with muscle movement, balance, and vision brain tumour a growth of cells in the brain that multiply in an abnormal and uncontrollable way Substances Alcohol misuse anddrug misuse can trigger a psychotic episode. A person can also experience a psychotic episode if they suddenly stop drinkingalcohol ortaking drugs after using them for a long time. This is known as withdrawal. Its also possible to experience psychosis after drinking large amounts of alcohol or if youre high on drugs. Drugs known to trigger psychotic episodes include: cocaine amphetamine (speed) methamphetamine (crystal meth) mephedrone (MCAT or miaow) MDMA (ecstasy) cannabis LSD (acid) psilocybins (magic mushrooms) ketamine In rare situations, psychosis can also occur as a side effect of some types of medication or as a result of an overdose of that medication. For example, levodopa, a medication used to treat Parkinsons disease , can sometimes cause psychotic episodes. However, any medicine that acts on the brain can cause psychosis with an overdose. Never stop taking a prescribed medication unless advised to do so by your GP or another qualified healthcare professionalresponsible for your care. See your GP if youre experiencing psychotic side effectscaused bymedication. The brain Theres been a great deal of research into how psychosis affects the brain and how changes in the brain can trigger symptoms of psychosis . Grey matter Research has revealed several physical and biological changes occur in the brainduring a psychotic episode. Grey matter is the part of the brain responsible for processing thoughts. The results of magnetic resonance imaging (MRI) scans have shown some people with a history of psychosis have less grey matter than most other people. However, its not yet fully understood why this is. Dopamine Researchers also believe dopamine plays an important role in psychosis. Dopamine is a neurotransmitter,one of many chemicals the brain uses to transmit information from one brain cell to another.It is associated with how we feel whether something is significant, important, or interesting. Its thoughtlevels of dopamine in the brain become too highin people with psychosis. The excess dopamine interrupts specific pathways in the brain that are responsible for some of its most important functions, such as: memory emotion social behaviour self-awareness Disruption to these important brain functions may explain the symptoms of psychosis. Evidence for the role of dopamine in psychosis comes from several sources, including brain scans andthe fact medicationsknown to reduce the effects of dopamine in the brain also reduce thesymptoms of psychosis. However, illegal drugsknown to increaselevels of dopamine in the brainsuch as cannabis, cocaine and amphetaminescan trigger psychosis. Diagnosis You should visit your GP if youre experiencing psychotic episodes. Its important to speak to your GP as soon as possible as the early treatment of psychosis usually has better long-term outcomes. Initial assessment Theres no test to positively diagnose psychosis. However, your GP will look at your symptoms and rule out short-term causes, such as drug misuse. Your GP may ask questions to determine the cause of your psychosis. For example, they may askyou: whether youre taking any medication whether youve been takingillegal substances how your moods have beenfor example, whether youve been depressed how youve been functioning day-to-dayfor example, whether youre still working whether you have a family history of mental health conditions, such as schizophrenia about the details of your hallucinations, such as whether youve heard voices about the details of your delusions, such as whether you feel people are controlling you about any other symptoms you have Referral The evidence supporting the early treatment of psychosis means youre likely to be referred to a specialist urgently. This will either be during or after your first episode of psychosis. Who youre referred to will depend on the services available in your area. You may be referred to: a community mental health team a team of different mental health professionals who provide support to people with complex mental health conditions a crisis resolution team a team of different mental health professionals who treat people currently experiencing a psychotic episode who would otherwise require hospitalisation an early intervention team a team of mental health professionals who work with people who have experienced their first episode of psychosis These teams are likely to include some or all of the following healthcare professionals: a psychologist a healthcare professional who specialises in the assessment and treatment of mental health conditions a psychiatrist a qualified medical doctor who has received further training in treating mental health conditions a community mental health nurse a nurse with specialist training in mental health conditions Your psychiatrist will carry out a full assessment to help identify and diagnose any underlying mental health condition that could be causing your symptoms. This will helpwhen planning your treatment for psychosis . Helping others The lack of insight associated with psychosis means people experiencingit arent always able to recognise their strange behaviour. They may be reluctant to visit their GP if they believe theres nothing wrong with them, and you may need to get help for them. Someone who has had psychotic episodes in the past may have been assigned a mental health worker, who works in social services,so try to contact them to express your concerns. Someone who is having a psychotic episode for the first time may need a friend, relative or someone else close to them to persuade them to visit their GP. If theyre having a psychotic episode thats rapidly getting worse, you should contact their crisis team or,if the team isnt available,the duty psychiatrist at their nearest accident and emergency (A&E) department. If a person who is having a psychotic episode refuses to seek help andis believed to present a risk to themselves or others, their nearest relative can request a psychological assessment. Your local mental health trust can advise you about this. If someone has very severe psychosis, they can be compulsorily detained at hospital for assessment and treatmentunder the Mental Health (Scotland) Act 2015 . Treatment Treatment for psychosis involves a combination of antipsychotic medicines, psychological therapies, and social support. Your care team Your treatment is likely to be co-ordinated by a team of mental health professionals working together. If this is your first psychotic episode, you may be referred to an early intervention team. Early intervention teams An early intervention team is ateam of healthcare professionals set up specifically to work with people who have experienced their first episode of psychosis. Some early intervention teams only focus on a certain age range, such as people who are 14 to 35 years old. Depending on your care needs, early intervention teams aim to provide: a full assessment of your symptoms prescriptions for medications psychological services social, occupational, and educational interventions Treatment for psychosis will vary, depending on the underlying cause. Youll receive specific treatment if youve been diagnosed with an underlying mental health condition as well. For example, treatment for bipolar disorder uses a variety of medications, which could include antipsychotics to treat symptoms of mania, lithium and anticonvulsants to help stabilise mood, as well as psychological therapy, such as cognitive behavioural therapy (CBT). Treatment for schizophrenia usually involves a combination of antipsychotic medication and social support. CBT or another type of psychotherapy called family therapyare also often used. Psychosis related to drug or alcohol intoxication or withdrawal may only require a short course of antipsychotics or tranquillisers, which have a calming effect. Referral to an addiction counsellor may then be recommended. Antipsychotics Antipsychotic medicines, also known as neuroleptics, are usually recommended as the first treatment for psychosis. Theywork by blocking the effect of dopamine, a chemical that transmits messages in the brain. However, theyre not suitable or effective for everyone, as side effects can affect people differently. In particular, antipsychotics will be monitored closely in people who also have epilepsy , a condition that causes seizures or fits. People who have cardiovascular disease  conditions that affect the heart, blood vessels, or circulation, such as heart disease  will also be closely monitored. Antipsychotics can usually reduce feelings of anxiety or aggression within a few hours of use, but they may take several days or weeks to reduce other psychotic symptoms, such as hallucinations or delusional thoughts. Antipsychotics can be taken by mouth (orally) or given as an injection. There are several slow-release antipsychotics, where you only need one injection every two to six weeks. Depending on the underlying cause of your psychosis, you may only need to take antipsychotics until your psychosis subsides. However, if you have a condition like schizophrenia or bipolar disorder, you may need to take antipsychotics on a long-term basis to prevent further episodes of psychosis. Side effects Antipsychotics can have side effects, although not everyone will experience them and their severity will differ from person to person. Side effectscan include: drowsiness this may affect your ability to drive shaking and trembling restlessness muscle twitches and spasms where your muscles shorten tightly and painfully blurred vision dizziness constipation loss of sex drive (libido) dry mouth See the patient information leaflet that comes with your medicine for a full list of possible side effects. In addition,long-term use of antipsychotics can lead to complicationslikeweight gain and diabetes . Read more aboutthe complicationsof psychosis . Tell your GP if you haveside effects that are becoming particularly troublesome. There may be an alternative antipsychotic medicine you can take. Never stop taking medication prescribed for you unlessadvised to do so by a qualified healthcare professionalresponsible for your care. Suddenly stopping prescription medication could trigger a returnof your symptoms (relapse). When its time for you to stop taking your medication, it will be done gradually and under close observation. Psychological treatment Psychological treatment can help reduce the intensity and anxiety caused by psychosis. Some possible psychological treatments are discussed below. Cognitive behavioural therapy Cognitive behavioural therapy (CBT) for psychosis is based on an understanding of how people make sense of their experiences and why some people become distressed by them. The aim of CBT is to identify unhelpful thinking patterns and emotions that may be causing your unwanted feelings and behaviours. Its then possible to learn to replace this thinking with more realistic and balanced thoughts. A CBT therapist may encourage you to consider different ways of understanding whats happening to you. The aim is to help you achieve goals that are meaningful and important to you, such as reducing your distress, returning to work or university, or regaining a sense of control. Family therapy Family therapy is known to be an effective form of treatment for people with psychosis. Its a way of helping both you and your family cope with your condition. After having an episode of psychosis, you may rely on your family members forcare and support. While most family members are happy to help, the stress of caring for somebody can place a strain on any family. Family therapy involves a series of informal meetings that take place over a period of six months. Meetings may include: discussing your conditionand how it might progress, plus the available treatments exploring ways of supporting someone with psychosis deciding how to solve practical problems caused by psychosis, such asplanning how to manage future psychotic episodes Self-help groups If youre experiencing episodes of psychosis, you may benefit from being around other people whove had similar experiences. Complications Someone experiencing a psychotic episode may self-harm. Suicidal thoughts and an increased risk of suicide are also common. Self-harm Self-harming behaviour is a relatively common complication in people with psychosis. A study found 1 in 10 people with psychosis also had a history of self-harm. The risk of self-harm is thought to be highest in people who are experiencing their first episode of psychosis butarent receiving treatment. See your GPif youre self-harming. You can also call the Samaritans on 08457 90 90 90 for support. If you think a friend or relative is self-harming, look out for signs of unexplained cuts, bruises or cigarette burns, usually on the wrists, arms, thighs, and chest. People who self-harm may keep themselves covered upat all times, even in hot weather. A personwhos self-harming may feel deep shame and guilt, or they may feel confused and worried by their own behaviour. Its important to approach them with care and understanding. They may not want to discuss their self-harming behaviourwith you, but you could suggest they speak totheir GP ora counsellor ona support helpline. Suicide People with psychosis also have an increased risk of suicide . Its estimated 1 in 5 people with psychosis will attempt suicide at some point in their life, and 1 in 25 people with psychosis will kill themselves. If youre feeling suicidal, you can: callthe Samaritans support service on 08457 90 90 90 go to your nearest accident and emergency (A&E) department and tell the staff how youre feeling contactthe NHS 24 111 service speak toa friend, family member, or someone you trust make an urgent appointment to see your GP,psychiatrist, or care team Read more about getting helpif youre feeling suicidal . If youre worried that someone you know may be considering suicide, recommend that they contact one or more of the organisations above and encourage them, in a non-judgemental way, to talk about how theyre feeling. If the person has previously been diagnosed with a mental health condition, such as depression , you can speak to a member of their care team for help and advice. Read more about the warning signs of suicide and supporting someone whos feelingsuicidal . Antipsychotics Using antipsychotics on a medium- to long-term basis can cause a number of complications. Some of the more commoncomplications are discussed below. Weight gain Weight gain is a complication of many commonly used antipsychotics. There are two main reasons why weight gain is thought to occur. Antipsychotics can: lead to an increase in appetite make you less active Youll probably be advised to take more exercise tohelp burn off the excess fat. Read about getting started with exercise and how to lose weight safely . Metabolic syndrome Metabolic syndrome is a term describing a number of related conditions linked to weight gain, such as: high blood sugar (hyperglycaemia) high cholesterol high blood pressure (hypertension) obesity These health conditions can also increase your risk of developing type 2 diabetes , heart disease and, most seriously, heart attack or stroke . Because ofthe risk of metabolic syndrome, youll usually need to haveregular blood tests and blood pressure tests while taking antipsychotics. If your test resultsshow you have an increased risk of developing a condition such as heart disease, a number of preventative treatments, such as statins ,are available to help lower cholesterol levels. Tardive dyskinesia (TD) Tardive dyskinesia (TD) is another common complication of long-term antipsychotic use. TD is a movement disorder where a person experiences involuntary movements, such as twitching, tics, grimaces, tremors, and spasms. It usually starts in the face and mouth before spreading to the rest of the body. In some cases, stopping taking an antipsychotic will provide relief from TD symptoms, but in other cases it makes the symptoms worse. However, stopping medication isnt always safe andhastobe balanced against the risk of having a relapse. In some cases, TD can be a permanent condition. There are also a number of treatments that can sometimes improve thesymptoms of TD, including: clonazepam a medication used to treat epilepsy , a condition that affects the brain and causes seizures or fits vitamin E supplements check with the doctor in charge of your care before taking vitamin supplementsas theyre not safe or suitable for everyone Source: NHS 24 - Opens in new browser window Last updated: 27 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Schizophrenia Counselling and psychotherapy Bipolar disorder Psychosis (BSL) Other health sites YoungMinds Turning Point: Mental health support Mental Health Foundation: Psychosis Choice and Medication: Psychosis SIGN: Managing schizophrenia NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Pubic lice,"Pubic lice | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Sexual and reproductive Pubic lice Pubic lice British Sign Language (BSL) |  | Polski | Romn | slovenina Pubic lice, also known as crabs, are tiny insects that live on coarse human body hair, such as pubic hair around the penis or vagina. Pubic lice are not linked to poor personal hygiene. Symptoms of pubic lice It can take up to 3 weeks after coming into contact with pubic lice before you notice any symptoms. The most common symptom of pubic lice is itchy red spots. The itching is caused by an allergy to the lice saliva or poo. It can take 1 to 3 weeks for itching to develop after the first infestation, and itll usually be worse at night. Public lice are very small (2mm long) and grey-brown in colour. Theyre hard to spot, but sometimes you may be able to see them in your hair. They live mostly on pubic hair, but can also be found in hair on the chest, armpits, face and eyelashes. They do not affect hair on your head. You may also notice the following symptoms: small red or blue spots on your skin (lice bites) white or yellow dots attached to your hair (lice eggs) dark red or brown spots in your underwear (lice poo) crusty or sticky eyelashes, if theyre infected When to get medical advice Speak to your GP practice, local pharmacy or local sexual health clinic if: you think you might have pubic lice Testing for pubic lice If you think you might have pubic lice, get checked for free by: booking an appointment at your local sexual health service contacting your GP practice for an appointment What does a pubic lice test involve? There is no test for pubic lice. Your doctor or nurse will check your hair for lice. They may check your pubic hair around your penis or vagina and any other areas that could be affected. To help spot any pubic lice, your doctor or nurse may use a comb and a magnifying lens. You can also buy treatment over the counter at your local pharmacy although they will not be able to diagnose the infestation. Treatment for pubic lice Pubic lice are treated with medicated creams or shampoos that kill the lice. Youll usually need to use treatment on your whole body and leave it on for a few hours before washing it off. Youll need to repeat this a week later to make sure all the lice have been killed. You may be asked to come back to your GP practice or sexual health clinic once youve finished treatment to check the treatment has worked. Your partner(s) should also be treated, even if they do not have symptoms. Resistance Some pubic lice can be resistant to treatment. Resistance means that the lice will not be affected by a particular treatment. If your symptoms dont settle, you may need to try more than one type of treatment. Speak to your GP practice or local sexual health clinic if your first treatment hasnt worked. Treatment of lice in the eye area Treatment of lice in the eye area is usually different from elsewhere. Certain creams and lotions are not safe for use near the eye area. Lice here can be removed with tweezers or Vaseline can be used to suffocate the lice before removal. Things you can do While youre being treated for pubic lice, there are some things you can do to help stop the lice from spreading. Do wash your clothes and bedding on a hot wash (50 degrees or higher), have them dry cleaned or put them in a plastic bag for at least a week  this will help kill any lice hoover your mattress to remove any lice Dont do not share clothes, bedding or hygiene products (including razors) do not have any close body contact (including sexual contact) with anyone during treatment How pubic lice are passed on Pubic lice are spread through close body contact with someone who has them, most commonly sexual contact. The lice crawl from hair to hair but cant fly or jump. They need human blood to survive, so generally only leave the body to move from one person to another. Pubic lice dont live on other animals such as cats or dogs. If you or your partner has pubic lice, you should avoid having sex (vaginal, anal or oral). You should also avoid close bodily contact. Do this until youve both finished treatment, including any follow-up treatment. How to prevent pubic lice Pubic lice are easily spread, and condoms dont protect against them. To reduce the risk of getting pubic lice, you should limit the number of people you have intimate or sexual contact with. Other STIs If you have been diagnosed with pubic lice you should get tested for other STIs including: gonorrhoea chlamydia syphilis Find your local sexual health clinic Source: Scottish Government - Opens in new browser window Last updated: 26 February 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Other languages and formats British Sign Language (BSL) |  | Polski | Romn | slovenina British Sign Language (BSL) |  | Polski | Romn | slovenina Add this page to\n            Info For Me Also on NHS inform Book a sexual health appointment online Pubic lice (BSL) Pubic lice (Chinese) Pubic lice (Polish) Pubic lice (Romanian) Pubic lice (Slovak) Other health sites Sexual Health Scotland BASHH: sexual health Sexual Health Scotland: Contraception NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Rare tumours,"""Rare tumours in children | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in children Rare tumours Rare tumours More children than ever are surviving childhood cancer. There are new and better drugs and treatments, and we can now also work to reduce the after-effects of having had cancer in the past. Its devastating to hear that your child has cancer, and at times it can feel overwhelming, but there are many healthcare professionals and support organisations to help you through this difficult time. Understanding more about the cancer your child has and the treatments that may be used can often help parents to cope. Your childs specialist will give you more detailed information, and if you have any questions its important to ask the specialist doctor or nurse who knows your childs individual situation. Types of rare cancers in children Rare cancers in children make up fewer than 1 in 30 of all childhood cancers and can broadly be grouped as: rare cancers that only affect children, such as pancreatoblastoma, malignant rhabdoid tumours and melanotic neuroectodermal tumours of infancy cancers that usually only affect adults, such as cancers of the digestive system, the thyroid and the adrenal gland rare cancers in the head and neck area, such as nasopharyngeal cancer rare hormonal/endocrine cancers, such as phaeochromocytoma rare brain tumours, such as meningioma rare skin cancers, such as melanomas Causes The causes of most rare childhood cancers are unknown. But if other family members have had particular types of cancer, this may sometimes suggest that there is an inherited faulty gene in the family. If this is a possibility, your childs specialist will talk to you about it. Treatment Rare cancers are treated with the same treatments used for other childhood cancers. This includes surgery, radiotherapy and chemotherapy. Your child may need a combination of these treatments. Surgery Usually an operation is done to remove all or as much of the cancer as possible. Other treatments, such as radiotherapy or chemotherapy, may be given after or sometimes before surgery. They may also be used if an operation is not possible. Radiotherapy Radiotherapy uses high-energy rays to destroy the cancer cells, while doing as little harm as possible to normal cells. It can be used to treat any cancer cells that may be left behind after surgery, or to shrink a cancer. Chemotherapy Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It is usually given as injections and drips (infusions) into a vein. Chemotherapy may be used to lower the risk of the cancer coming back or to treat cancer that has spread to other parts of the body. Research Clinical trials are usually not available as the number of children with rare cancers is so small. The Childrens Cancer and Leukaemia Group (CCLG) aims to improve the care and treatment of children with cancer and it develops guidelines on the best ways of treating and managing those with rare tumours. Doctors communicate with specialist colleagues in other countries to promote research in rare tumours and develop new forms of treatment. Your feelings As a parent, the fact that your child has cancer is one of the worst situations you can be faced with. You may have many emotions, such as fear, guilt, sadness, anger and uncertainty. These are all normal reactions and are part of the process that many parents go through at such a difficult time. Its not possible to address here all of the feelings you may have. However, the CCLG booklet Children & Young Peoples Cancer; A Parents Guide talks about the emotional impact of caring for a child with cancer and suggests sources of help and support. Your child may have a variety of powerful emotions throughout their experience of cancer. The Parents Guide discusses these further and talks about how you can support your child. Source: Children's Cancer and Leukaemia Group - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Raynauds phenomenon,"""Raynaud's phenomenon - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Heart and blood vessels Conditions Raynauds phenomenon Raynauds phenomenon About Raynauds phenomenon Causes of Raynauds phenomenon Diagnosing Raynauds phenomenon Treating Raynauds phenomenon Complications of Raynauds phenomenon About Raynauds phenomenon Raynauds phenomenon is a common condition that affects the blood supply to certain parts of the body  usually the fingers and toes. Its often referred to as Raynauds syndrome, Raynaudsdisease or just Raynauds. Why does it happen? Raynauds is usually triggered by cold temperatures, anxiety or stress. The condition occurs because your blood vessels go into a temporary spasm, which blocks the flow of blood. This causes the affected area to change colour to white, then blue and then red, as the bloodflow returns.You may also experience numbness, pain, and pins and needles. Symptoms of Raynauds can lastfrom a few minutes to several hours. IIts nota serious threat to your health, but can be painful and difficult to live with. If can affect your ability to move your fingers and hands.People with Raynauds often go for long periods without any symptoms, and sometimes the condition goes away altogether. Other parts of the body that can be affected by Raynauds include the ears, nose, nipples and lips. Treating Raynauds In many cases, it may be possible to control the symptoms of Raynauds yourself by avoiding the cold, wearing gloves and using relaxation techniques when feeling stressed. Stopping smoking can also improve symptoms, as smoking can affect your circulation. If youre unable to control your symptoms yourself, then a medication called nifedipine may be recommended. Read more about treating Raynauds . Types of Raynauds There are two types of Raynauds: primary  when the condition develops by itself (this is the most common type) secondary  when its caused byanother health condition Most cases of secondary Raynauds are associated with conditions that cause the immune system to attack healthy tissue (autoimmune conditions), such as sclerodermaand lupus . The causes of primary Raynaudsare unclear. However1 in 10 people with primary Raynauds goes on to develop a condition associated with secondary Raynauds, such as lupus. Your GP can help to determine whether you have primary or secondary Raynaudsby examining your symptoms and carrying out blood tests . Read more about what causes Raynauds and diagnosing Raynauds . Possible complications Secondary Raynauds can severely restrict theblood supply, so it carries a higher risk of complications, such as ulcers, scarring and eventissue death (gangrene) in the most serious cases. However, severe complications are rare. Read more about the complications of Raynauds . Who gets Raynauds? Raynauds phenomenon is a common condition. It affects up to 20% of the adult population worldwide. There may be as many as 10 million people with the condition in the UK. Primary Raynauds usually begins in your 20s or 30s. Secondary Raynauds can develop at any age, depending on the cause. Raynauds is slightly more common in women than men. Causes of Raynauds phenomenon Raynauds phenomenon is the result of over-sensitive blood vessels in the bodys extremities. In many cases, no cause is identified, although its sometimes linked to other health conditions. When your body is exposed to cold temperatures, the extremities, such as your fingers and toes, lose heat. This is because the small blood vessels under the skin spasm, slowing down the blood supply that is helping to preserve your bodys core temperature. In people with Raynauds, the sensitive blood vessels overreact to cold temperatures and become narrower than usual, significantly restricting the blood flow. Symptoms can be triggered by mildly cool weather, getting something out of the freezer, or running your hands under a cold tap. Strong emotions such as stress or anxiety may also trigger symptoms. Primary Raynauds The most common form of Raynauds is primary Raynauds phenomenon. This means the condition occurs by itself, without being associated with another health condition. It seems thatprimary Raynauds is caused by disruptions in how the nervous system controls blood vessels. Exactly what causes these disruptions is unclear. Theres some evidence that primary Raynauds may be an inherited condition, as cases have been known to run in families. Secondary Raynauds In some cases, an underlyinghealth condition couldbe causing the blood vessels to overreact. This is called secondary Raynauds. Autoimmune conditions The majority of cases of secondary Raynauds are associated with autoimmune conditions, which cause the immune system to attack healthy tissue. Autoimmune conditions known to be associated with secondary Raynauds include: scleroderma  a condition that causes hardening and thickening of the skin rheumatoid arthritis  which causes joint pain and swelling Sjogrens syndrome  where the immune system attacks the bodys sweat and tear glands lupus  which causes tiredness, joint pain and skin rashes Around1 in 10 people with primary Raynauds go on to develop an autoimmune condition. Infections Blood-born viral infections, hepatitis B and hepatitis C , can occasionally trigger Raynauds in some people. Cancer Some types of cancer can cause secondary Raynauds. These areusually cancers that develop inside the blood, bone marrow or immune system, such as: acute lymphoblastic leukaemia  a cancer of the white blood cells that mainly affects children lymphoma  a cancer that develops inside one or more of the glands that are part of the immune system multiple myeloma  a cancer that develops inside bone marrow Medicines Secondary Raynauds can also be a side effect of taking certain medicines, including: some types of anti- migraine medication  such as sumatriptan and ergotamine beta-blockers  which are used to treat high blood pressure and heart disease some chemotherapy medicines decongestants the contraceptive pill medicines used in hormone replacement therapy some types of medicines usedto treathigh blood pressure Illegal drugs, such as cocaine and amphetamines, can also cause secondary Raynauds. Injury and overuse Raynauds sometimes results from a physical injury. It can also affect musicians, people who type a lot, or other people who use their fingers and hands more than usual. Skin and tissue damage caused byfrostbite can also lead to Raynauds. Smoking Smoking cigarettes also increases your risk of developing Raynauds. Readabout the support available to help you quit smoking . Vibration white finger Vibration white finger is a term used when secondary Raynauds has been caused by vibration. This typically happens to people who regularly use certain types of vibrating tools, such as: sanders, grinders and disc cutters hammer drills chainsaws, hedge trimmers and power mowers Any vibrating tool that causes tingling or numbness in your fingers could lead to vibration white finger. Your employer has a responsibility to protect you from vibration white finger. If the job cant be done without vibrating tools: ask to use suitable low-vibration tools make sure youre using the right tool for the job check tools are properly maintained keepcutting tools sharp reduce the amount of time you use the tool in one go by doing other jobs in between keep warm at work wear anti-vibration gloves store toolsindoors, so they dont have cold handles when next used encourage your blood circulation by keeping warm, stopping smoking and massaging and exercising your fingers during your breaks If youre diagnosed with the condition, tell your employer as soon as possible. If you stop using vibrating tools at an early stage, you may recover fully. By law, your employer must contact the Health and Safety Executive about your condition. You may be entitled to an Industrial Injuries Disablement Benefit, which is a payment given to people who have become ill or injured as a result of their work. See the GOV.UK website for more information about the Industrial Injuries Disablement Benefit . Diagnosing Raynauds phenomenon Raynauds phenomenon can usually be diagnosed after an examination of your symptoms and some blood tests. Your GP may place your hands in cold water or cool air to see if you show symptoms of Raynauds. Further testing is usually recommended to find out whether you have primary or secondary Raynauds. Secondary Raynauds may require more treatment and, in some cases, referral to a specialist. Secondary Raynauds may be suspected if: your symptoms only started when you were over 30 years of age  most cases of primary Raynauds begin between the ages of 20 to 30 youre experiencing severe pain during an attack of Raynauds only one side of your body is affected Your GP may also check the tiny blood vessels, known as capillaries, found where your nail meets the finger. These capillaries are oftenlarger in people with secondary Raynauds, and look like red pen marks. Blood tests Your GP may also refer you for blood tests to check for other health conditionsthat could be causing your symptoms. These tests may include: a full blood count to check forinfection or, much less commonly, a cancer of the blood, such as leukaemia an antinuclear antibodies (ANA) test tocheck for anoveractive immune system, which is common in people with autoimmune conditions such as sclerodermaand lupus erythrocyte sedimentation rate to check for an autoimmune disorder Scleroderma & Raynauds UK (SRUK) If youve been diagnosed with Raynauds, Scleroderma & Raynauds UK (SRUK) may be helpful. It is the UKs leading charity for people affected by the condition. Treating Raynauds phenomenon You can usually treat Raynauds phenomenon yourself, although medication is sometimes necessary. If youve been diagnosed with secondary Raynauds, you may be referred to a specialist in the treatment of the underlying condition. If your secondary Raynauds may be a side effect of a medication, you may be asked to stop taking it, to see if your symptoms improve. Self-help The following advice is recommended forboth primary and secondary Raynauds. Keep your whole body warm, especially your hands and feet. Wear gloves and warm footwear in cold weather. If you smoke, stop. Quitting smoking will improve your circulation, which should help to improve symptoms. Exercise regularly, as this helps to improve your circulation and reduce stress levels (see below). For most people, 150 minutes of vigorous exercise a week is recommended. Read more about exercise . Try to minimise your stress levels. Regular exercise, eating a healthy diet , and relaxation techniques , such as deep breathing or activities such as yoga , can help. You may find it useful to avoid stimulants such as coffee, tea and cola. If you find it difficult to control feelings of stress, you may require additional treatment, such as counselling. Read more about therapies for stress . Medication Nifedipine If your symptoms fail to improve, you may be prescribed nifedipine. This is the only medicine licensed to treat Raynauds phenomenon in the UK. It doesnt cure Raynauds, but can help to relieve the symptoms. Nifedipine is a calcium channel blocker  a type of medication that encourages the blood vessels to widen. Depending on the pattern of your symptoms and how well you respond to treatment, you may be asked to take your medication every day. Alternatively, you may only need to take it as prevention; for example, duringa sudden snap of cold weather. Side effects are common and include: oedema  swelling of certain parts of the body, such as your hands and feet, due to a build-up of fluid headaches heart palpitations dizziness constipation Dont drink grapefruit juice when taking nifedipine, as this could make side effects worse. The side effects should improve as your body gets used to the medicine, but tell your GP if you find them particularly troublesome. There are alternative calcium channel blockers that may suit you better. Other medications Other medications have been used to treat Raynauds, but their use is controversial, as there is limited evidence to show theyre effective in most people. However, some people have claimed to benefit from treatment. These medications include: fluoxetine  which was widely used in the treatment of depression sildenafil  which is used to treat erectile dysfunction (inability to get or maintain an erection) These medicines are not licensed for the treatment of Raynauds in the UK, but you may be prescribed them if its thought the potential benefit outweighs the possible risks. Surgery Surgery for Raynauds is rare. Its usually only recommended if your symptoms are so severe that theres a risk the affected body part, such as your fingers, could lose their blood supply and begin to die. Read more about the complications of Raynauds phenomenon. A type of surgery called sympathectomy is sometimes used. It involves cutting the nerves causing the affected blood vessels to spasm. The results of a sympathectomy are often only temporary and further treatment and possibly more surgery may be required after a few years. Complications of Raynauds phenomenon People with Raynauds phenomenon have an increased risk of developing other problems, such as scleroderma. Scleroderma Around1 in 16 women and1 in 50 men with Raynauds develop a condition called scleroderma, usually between the ages of 25 and 55. Scleroderma is when the body produces excessively high levels of collagen. Scleroderma is a Greek word meaning hard skin, but it can affect other areas of the body, such as the kidneys, heart and lungs. Symptoms of scleroderma include: puffy and itchy skin tight and uncomfortable joints small calcium spots and red spots under the skin trouble swallowing, known as dysphagia diarrhoea , bloating or constipation Theres no cure for scleroderma, but there are ways of overcoming problems it may cause. For example, medicines can reverse or slow down the processes that cause damage around the body. For more information, visit Scleroderma & Raynauds UK (SRUK) , a UK charity dedicated to improving the lives of people affected by Scleroderma and Raynauds. Ulcers and gangrene In severe cases of Raynauds, the blood supply to an affected body part can become severely diminished. Without a constant supply of blood, the tissue in the body part will begin to die. This problem is rare and normally only occurs in secondary Raynauds. The initial sign is an open sore, known as an ulcer, which develops on the surface of the body part. If you suspect a skin ulcer, contact your GP for advice. Left untreated, the tissue can die, which is known as gangrene (specifically, dry gangrene). The symptoms of dry gangrene normally begin with a red line on the skin that marks the edges of the affected tissue. The tissue becomes cold and numb, and can be painful as the tissue dies. However, many people, particularly the elderly, experience no sensations. The affected area changes colour from red, to brown, to black. The dead tissue will then shrivel up, separate from the healthy tissue and fall off. These complications normally require admission to hospital, where youll be given medication designed to thin your blood, which should help to restore blood flow. If you fail to respond to treatment, you may need surgery to unblock or repair damaged blood vessels. Source: Chest Heart & Stroke Scotland - Opens in new browser window Last updated: 05 May 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Reactive arthritis,"Reactive arthritis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Muscle, bone and joints Conditions Reactive arthritis Reactive arthritis About reactive arthritis Symptoms of reactive arthritis Causes of reactive arthritis Treating reactive arthritis About reactive arthritis Reactive arthritis, formerly known as Reiters syndrome, is a condition that causes inflammation (redness and swelling) in various places in the body. It usually develops following an infection, and in most cases clears up in a few months withoutcausing long-term problems. The three most common placesaffected by reactive arthritisare: the joints ( arthritis ), which can causepain, stiffness and swelling the eyes ( conjunctivitis ), which can causeeye pain and redness the urethra(non-gonococcal urethritis), which can cause pain when urinating (the urethrais the tube that carries urine out of the body) However,most people will not experience all of these problems. Read more about the symptoms of reactive arthritis . What causes reactive arthritis? Reactive arthritis usually develops within four weeks of an infection, typically after a sexually transmitted infection (STI)such as chlamydia, or an infection of the bowel. For reasons that are still unclear, the immune system (the bodys defence against infection) appears to malfunction in response to the infection and starts attacking healthy tissue, causing it to become inflamed. Read more about the causes of reactive arthritis . Seeking medical advice Seeyour GP ifyou haveswollen and painful joints, especially if you have recently hadsymptoms of an infection such as diarrhoea or pain when passing urine. There is no single test for reactive arthritis, although blood and urine tests, genital swabsand X-rays may be used to check forinfection and rule out other causes of your symptoms. Your GP will also want to know about your recent medical history,such as whether you may have recently had abowel infection or an STI. How reactive arthritis is treated There is currently no cure for reactive arthritis, but most people get better in around six months. Meanwhile, treatment can help to relieve symptoms such as pain and stiffness. Symptoms canoften be controlled using non-steroidal anti-inflammatory drugs (NSAIDs) and painkillers such as ibuprofen . Severe symptomsmayrequire more powerful steroid medication ( corticosteroids ) or disease-modifying anti-rheumatic drugs (DMARDs). Read more about treating reactive arthritis . Who is affected Reactive arthritis can occur at any age, but it most commonly affects young adults aged 20-40. Men are generally affected more than woman particularly in cases linked to STIs, which are estimated to be about 10 times more common in men. People who have a certain gene called HLA-B27, which is found in around one in every 10 people in theUK,are about thought to be around 50 times more likely to develop reactive arthritis than those who dont have this gene. Preventing reactive arthritis The most effective way to reduce your risk of reactive arthritis is to avoid the STIs andbowel infections that most commonlycause the condition. The most effective way of preventing STIs is to always use a barrier method of contraception , such as a condom , during sex with a new partner. Read adviceon contraception and sexual health . Symptoms of reactive arthritis The symptoms of reactive arthritis usually develop within four weeks of an infection. In most cases, reactive arthritis follows a sexually transmitted infection (STI)such as chlamydia, or abowel infection such as food poisoning . The three parts of the body most commonly affected by reactive arthritisare the: joints andtendons urinary system eyes However, most people wont experience problems inall of these areas. Joints and tendons Reactive arthritis usually involves inflammation of the joints ( arthritis ) and tendons, which can cause: joint pain, tenderness and swelling  usually in weight-bearing joints such as your knees, feet and ankles lower back and buttock pain swelling of your fingers and toes joint stiffness  particularly in the morning See your GP if you have any swollen and painful joints, especially if you have recently had diarrhoea or problems passing urine. The urinary system Reactive arthritis can sometimes alsoinvolve inflammation of the urethra (non-gonococcal urethritis), which is the tube that carries urine out of the body. Symptoms of urethritis caninclude: pain or a burning sensation when you pee urinating more often than usual having a sudden urge topee a discharge of fluid from the penis or vagina blood in your urine (less commonly) The eyes Reactive arthritis may occasionallyinvolve inflammation of the eyes ( conjunctivitis ). Symptoms of conjunctivitis caninclude: red eyes watery eyes eye pain swollen eye lids In rare cases, a type ofuveitis called iritis can develop.Iritis can cause the eyes to becomepainful, red and sensitive to light.See your doctor or an eye specialist as soon as possible if you have these symptoms. Other symptoms Reactive arthritis can also cause symptoms, including: feeling unusually tired ahightemperature(fever) weight loss mouth ulcers painless whitepatchesinside your mouth a rash thick and crumbly nails abdominal (tummy) pain bouts ofdiarrhoea Causes of reactive arthritis Its not known exactly what causes reactive arthritis, but its thought to be the result of the immune system reacting to an infection. The immune system Your immune system is your bodys defence against illness and infection. When it senses a virus or bacteria, itsends antibodies and cells to fight the infection. This causes tissues to swell, known as inflammation, which makesit harder for theinfection to spread. In cases of reactive arthritis, something goes wrong with the immune system and it causes inflammation in parts of the body that were not infected, often after the infection has already passed. Infection The two most common types of infection linked to reactive arthritis are: sexually transmitted infections (STIs) such as chlamydia or gonorrhoea , although many casesoccur afternon-gonococcal urethritis infections of thebowel and digestive system (gastrointestinal infections)  usuallycaused by either campylobacter or salmonella bacteria, both of which can cause food poisoning Genetic factors Research has shown that people with a specific gene known as HLA-B27 have a significantlyincreased chance of developing reactive arthritis, as well as related conditions such as ankylosing spondylitis (a type of arthritis that affects the spine) . In the UK, its estimated thataround1 in every 10 people have the HLA-B27 gene. Around3out of every4 cases of reactive arthritis develop in people with the gene. People withthe HLA-B27 gene also tend to have more severe and longer-lasting symptoms, with a greater risk of their symptoms recurring. Exactly how the gene contributes to the development of reactive arthritis is unclear. Treating reactive arthritis Theres no cure for reactive arthritis, but the condition is usually temporary and treatment can help to relieve your symptoms. Most people will make a full recovery in about six months, although around one in five cases lasts a year or more, and a small number of people experience long-term joint problems. There is also a risk you could develop the condition again after another infection. Self-care In the initial stages of reactive arthritis, its recommendedthat you get plenty of rest and avoid using affected joints. As your symptoms improve, you should begin a gradual programme of exercisedesigned to strengthen affected muscles and improve the range of movement in your affected joints. Your GP or specialist may recommend a suitable exercise programme for your arthritis . Alternatively, you may be referred to a physiotherapist for physical therapy. You might also find ice packs and heat pads useful in reducing joint pain and swelling, although these should not be directly placed on yourskin. Antibiotics Antibiotics may not help to treat reactive arthritis itself, but they are sometimes prescribed if you have an ongoing infection particularly if you have asexually transmitted infection (STI). Your recent sexual partner(s) may also need treatment. Non-steroidal anti-inflammatory drugs (NSAIDs) Non-steroidal anti-inflammatory drugs (NSAIDs) , such as ibuprofen ,are the main medication used for reactive arthritis, as they can help to reduce inflammation and relieve pain. However, taking a regular dose of a NSAID on a long-term basis can increase your risk of problems such as stomach ulcers . If you are at an increased risk of developing stomach ulcers, your GP may recommend an additional medication known as a proton pump inhibitor (PPI), which can protect your stomach by reducing the production of stomach acid. Rarely, long-term use of NSAIDscan also slightly increase your risk of having a heart attack or stroke . Read more about the side effects of NSAIDs . Steroid medication Steroid medication ( corticosteroids ) may be recommended if your symptoms dont respond to NSAIDs, or youre unable to use NSAIDs. Steroids work by blocking the effects of many of the chemicals the body uses to trigger inflammation. A corticosteroid called prednisolone is usually the preferred choice. Prednisolone can be given as an injection into a joint or as a tablet. Eye drops are also available if you have inflamed eyes ( conjunctivitis ). Around1 in 20 people who take prednisolone will experience changes in their mental state, such as depression or hallucinations. Contact your GP as soon as possible if you notice any changes in your thoughts or behaviour. Other side effects can include weight gain, acne , stomach ulcers and osteoporosis ,although these should improve as your dose is decreased. Read more about the side effects of corticosteroids . Disease-modifying anti-rheumatic drugs (DMARDs) If your symptoms persist despite treatment with NSAIDs and/or corticosteroids, you may be prescribed a medication known as a disease-modifying anti-rheumatic drug (DMARD). Like corticosteroids, DMARDs work byblocking the effects of some of the chemicals your immune system uses to trigger inflammation. It can take a few months before you notice a DMARD working, so its important to keep taking medication even if you dont see immediate results. A DMARD called sulfasalazine is usually the preferred option. Common side effects of sulfasalazine include feeling sick, loss of appetite and headaches , although these usually improve once your body gets used to the medication. DMARDs may alsocause changes inyour blood or liver, so its important to have regular bloodtests while taking these medicines. Source: MSK Expert Panel - Opens in new browser window Last updated: 20 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Arthritis Other health sites The Pain Toolkit Pain Concern Versus Arthritis: reactive arthritis NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Restless legs syndrome,"""Restless legs syndrome - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Restless legs syndrome Restless legs syndrome About restless legs syndrome Symptoms of restless legs syndrome Causes of restless legs syndrome Diagnosing restless legs syndrome Treating restless legs syndrome About restless legs syndrome Restless legs syndrome, also known as Willis-Ekbom disease, is a common condition of the nervous system that causes an overwhelming, irresistible urge to move the legs. It can also cause an unpleasant crawling or creeping sensationin the feet, calves and thighs. The sensation is often worse in the eveningor at night. Occasionally, the arms are affected too. Restless legs syndrome is also associated with involuntary jerking of the legs and arms, known as periodic limb movements in sleep (PLMS). Some people havethe symptoms of restless legs syndrome occasionally, while others have them every day. The symptoms can vary from mild to severe. In severe cases, restless legs syndrome can be very distressing and disrupt a persons daily activities. What causes restless legs syndrome? In the majority of cases, theres no obvious cause ofrestless legs syndrome. This known as idiopathic or primary restless legs syndrome, and it can run in families. Some neurologists (specialists in treating conditions that affect the nervous system) believe the symptoms of restless legs syndrome may have something to do with how the body handlesa chemical called dopamine. Dopamine is involved in controlling muscle movement andmaybe responsible forthe involuntary leg movements associated withrestless legs syndrome. In some cases, restless legs syndrome is caused by an underlying health condition,such as iron deficiency anaemia or kidney failure. This is known as secondaryrestless legs syndrome. Theres also a link betweenrestless legs syndrome and pregnancy. About 1 in5 pregnant women will experience symptoms in the last three months of their pregnancy, although its not clear exactly why this is. In such cases,restless legs syndrome usually disappears after the woman has given birth. Read more about the causes of restless legs syndrome Treating restless legs syndrome Mild cases ofrestless legs syndrome that arent linked to an underlying health condition may not require any treatment, other than making a few lifestyle changes, such as: adoptinggood sleep habits for example, following a regular bedtime ritual, sleeping regular hours, and avoiding alcohol and caffeine late at night quitting smoking if yousmoke exercising regularly during the daytime If your symptomsare more severe, you may need medication to regulate the levels of dopamine and ironin your body. Ifrestless legs syndrome is caused by iron deficiency anaemia, iron supplements may be all thats needed to treat the symptoms. Read more about treating restless legs syndrome Whos affected by restless legs syndrome? As many as 1 in 10 people are affected byrestless legs syndrome at some point in their life. Women are twice as likely to developrestless legs syndrome than men. Its also more common in middle age, although the symptoms can develop at any age, including childhood. Outlook Thesymptomsofrestless legs syndrome will usually disappear if its possible to address an underlying cause. However, if the causeis unknown, the symptoms can sometimes get worse with time and severely affect the persons life. Restless legs syndrome isnt life threatening, but severe cases can severely disrupt sleep (causing insomnia )and trigger anxiety and depression . Symptoms of restless legs syndrome Restless legs syndrome typically causes an overwhelming urge to move your legs and an uncomfortable sensation in your legs. The sensation may also affect your arms, chest and face, too. It has been described as: tingling, burning, itching or throbbing a creepy-crawly feeling feeling like fizzy water is inside the blood vessels in the legs a painful, cramping sensation in the legs, particularly in the calves These unpleasant sensationscan range from mild to unbearable, and are usually worse in the evening and during the night. They can often be relieved by moving or rubbing your legs. Some people experience symptoms occasionally,while others have them every day. You may find it difficult tosit for long periods of time for example, ona long train journey. Just over half of people withrestless legs syndrome also experience episodes of lowerback pain. Periodic limb movements in sleep (PLMS) Up to 80% of people withrestless legs syndrome also have periodic limb movements in sleep (PLMS). If you have PLMS, your leg will jerk or twitch uncontrollably,usuallyat night while youre asleep. The movements are brief and repetitive, and usually occur every 10 to 60 seconds. PLMS can be severe enough to wake up both you and your partner. The involuntary leg movementscan also occur when youre awake and resting. Causes of restless legs syndrome In many cases, the exact cause of restless legs syndrome is unknown. When no cause can be found, itsknown as idiopathic or primary restless legs syndrome. Research has identified specific genes related to restless legs syndrome, andit can run in families. In these cases, symptoms usually occur before the age of 40. Dopamine Theres evidence to suggest restless legs syndrome is related to a problem with part of the brain called the basal ganglia. The basal ganglia uses a chemical (neurotransmitter) called dopamine to help control muscle activity andmovement. Dopamine acts as a messenger between the brain and nervous system to help the brain regulate and co-ordinate movement. Ifnerve cells become damaged, the amount of dopamine in the brain is reduced, which causes muscle spasms andinvoluntary movements. Dopamine levels naturally fall towards the end of the day, which may explain why the symptoms of restless legs syndrome are often worse in the evening and during the night. Underlying health condition Restless legs syndrome can sometimes occuras a complication of another health condition, or it can be the result of another health-related factor. This is known as secondaryrestless legs syndrome. You candevelop secondaryrestless legs syndrome if you: have iron deficiency anaemia low levels of iron in the blood can lead to a fall in dopamine, triggeringrestless legs syndrome have a long-term health condition such as chronic kidney disease , diabetes , Parkinsons disease , rheumatoid arthritis , an underactive thyroid gland , or fibromyalgia are pregnant particularly from week 27until birth; in most cases the symptoms disappear within four weeks of giving birth Triggers There are a number of triggers that dont causerestless legs syndrome, but can make symptoms worse. These include medications such as: some antidepressants antipsychotics lithium used in the treatment of bipolar disorder calcium channel blockers used in the treatment of high blood pressure some antihistamines metoclopramide used to relieve nausea Other possible triggers include: excessive smoking , caffeine or alcohol being overweight or obese stress lack of exercise Diagnosing restless legs syndrome Theres no single test for diagnosing restless legs syndrome. A diagnosis will be based on your symptoms, your medical and family history, a physical examination, and your test results. Your GP should be able to diagnose restless legs syndrome, but they may refer you to a neurologist if theres any uncertainty. There are four main criteria your GP or specialist will look for to confirm a diagnosis. These are: an overwhelming urge to move your legs, usually with an uncomfortable sensation such asitching or tingling your symptoms occur or get worse when youre resting or inactive your symptoms are relieved by moving your legs or rubbing them your symptoms are worse during the evening or at night Assessing your symptoms Your GP or specialist will ask you about the pattern of your symptoms to help assess their severity. For example, they may ask you: how often you have symptoms how unpleasant you find your symptoms whether your symptoms cause significant distress whether your sleep is disrupted, making you tired during the day Keeping asleep diary may help your doctor assess your symptoms. You can use the diary to record your daily sleeping habits, such as the time you go to bed, how long it takes you to fall asleep, how often you wake during thenight, and episodes of tiredness during the day. Mild symptoms of restless legs syndrome can usually be treated by making lifestyle changes for example, establishing a regular sleeping pattern and avoiding stimulants, such as caffeine, alcohol or tobacco, in the evening. If your symptoms are more severe, you may need medication to bring them under control. Read more about treating restless leg syndrome Blood tests Your GP may refer you for blood tests to confirm or rule out possible underlying causes of restless legs syndrome.For example, you may have blood tests to rule out conditions such as anaemia , diabetes and kidney function problems. Its particularly important to find out the levels of iron in your blood because low iron levels can sometimes cause secondary restless legs syndrome. Low iron levels can be treated withiron tablets. Sleep tests If you haverestless legs syndrome and your sleep is being severely disrupted, sleep testssuch as asuggested immobilisation test may be recommended. The test involveslyingon a bed for a set period of time without moving your legs while anyinvoluntary leg movements are monitored. Occasionally, polysomnography may be recommended. This is a test that measures your breathing rate, brain waves and heartbeat throughout the course of a night. The results will confirm whether you have periodic limb movements in sleep (PLMS). Treating restless legs syndrome Mild restless legs syndrome that isnt linked to an underlying health condition can be managed with just a few lifestyle changes. If symptoms are more severe, medication may be needed. Restless legs syndrome caused by an underlying health conditioncan often be cured bytreating that condition. For example, iron deficiency anaemia can be treated by taking iron supplements. If its associated with pregnancy, itusually disappears on its own within four weeks of the birth. Lifestyle changes Anumber of lifestyle changes may be enough to ease the symptoms of restless legs syndrome, including: avoiding stimulants in the evening  such as caffeine, tobacco and alcohol not smoking  read more about quitting smoking taking regular daily exercise  but avoid exercising near bedtime practising good sleep habits  for example, going to bed and getting up at the same time every day, not napping during the day, taking time to relax before going to bed, and avoiding caffeine close to bedtime avoiding medicines that trigger the symptoms or make them worse  if you think medication is causing your symptoms, continue to take it and make an appointment to see your GP During an episode ofrestless legs syndrome, the following measures may help relieve yoursymptoms: massaging your legs taking a hot bath in the evening applying a hot or cold compress to your leg muscles doing activities that distract your mind, such as reading or watching television relaxation exercises, such as yoga ortai chi walking and stretching Asmall medical trial carried out in 2011 found a type of osteopathic exercise technique called positional release manipulation could be of benefit to people withrestless legs syndrome. It involves holding different parts of the body in positions found to reduce feelings of pain and discomfort. Medication Dopamine agonists Dopamine agonists may be recommended if youre experiencing frequent symptoms of restless legs syndrome. They work by increasing dopamine levels, which are often low. Dopamine agonists that may be recommendedinclude: ropinirole pramipexole rotigotineskin patch These medications can occasionally make you feel sleepy, so you should be cautious whendriving or using tools or machinery after taking them. Other possible side effectscan include nausea, dizziness and headaches . If you experience nausea while taking a dopamine agonist, you may be given medication to help with this (antiemitic medication). Impulse control disorder (ICD) is a less common side effect sometimes associated with dopamine agonists. People with ICD are unable to resist the urge to do something harmful to themselves or others. For example, this could be anaddiciton to alcohol , drugs, gambling, shopping, or sex(hypersexuality). However, the urges associated with ICD will subside once treatment with the dopamine agonist is stopped. Painkillers A mild opiate-based painkiller, such as codeine or tramadol, may be prescribed to relieve pain associated withrestless legs syndrome. Gabapentin and pregabalin are also sometimes prescribed to help relieve painful symptoms of restless legs syndrome. Side effects of these medicationsinclude dizziness, tiredness and headaches. Aiding sleep Ifrestless legs syndromeis disrupting your sleep, a short-term course of medication may be recommended to help you sleep. These types of medication are known as hypnotics, and include temazepam and loprazolam. Hypnotics are usually only recommended for short-term use (typically no longer than a week). You may find you still feel sleepy or hungover the morning after taking your medication. Levodopa Levodopa may be recommended if you only have occasional symptoms of restless legs syndrome. This is because if you took levodopa every day, theres a high risk it would actually make your symptoms worse. Levodopa is available in tablet or liquid form, and you should take it once you feel the symptoms ofrestless legs syndrome coming on. The medication will make you feel very sleepy (often suddenly), so you should never drive or use tools or machinery after taking levodopa. Source: NHS 24 - Opens in new browser window Last updated: 23 October 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Iron deficiency anaemia Parkinson's disease Insomnia Other health sites NICE: Restless legs syndrome NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Retinoblastoma: Children,"""Retinoblastoma in children | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in children Retinoblastoma: Children Retinoblastoma: Children Retinoblastoma is an uncommon eye cancer that usually affects children under 5, although it can affect children of any age. Treatment is very effective and nearly all children with retinoblastoma are cured. More children than ever are surviving childhood cancer. There are new and better drugs and treatments, and we can now also work to reduce the after-effects of having had cancer in the past. Its devastating to hear that your child has cancer, and at times it can feel overwhelming. There are many healthcare professionals and support organisations to help you through this difficult time. Understanding more about the cancer your child has and the treatments that may be used can often help parents to cope. Your childs specialist will give you more detailed information and if you have any questions its important to ask the specialist doctor or nurse who knows your childs individual situation. Retinoblastoma develops in the light-sensitive lining of the eye (called the retina). There are 2 forms of retinoblastoma: aheritable form  this is genetic or inherited; there are often tumours in both eyes (bilateral) or sometimes only in 1 eye anon-heritable form  this is not passed on in the family; theres 1 tumour in only 1 eye (unilateral) Causes The heritable form of retinoblastoma, which accounts for about 2 in every 5 cases, is caused by a genetic abnormality. This means that an abnormal gene allows the tumour to develop. This abnormal gene may either be inherited from a parent or happen for the first time at an early stage of development in the womb. Genetic counselling and support is available for families in which a member has retinoblastoma. Not all children of a parent with retinoblastoma will inherit this gene, but children born into families with a history of retinoblastoma are offered blood testing. They are also usually checked (screened) soon after birth for signs of retinoblastoma. This means that treatment can be started early if a tumour does develop. Screening usually starts shortly after birth and is repeated every few months for 5 years. An eye specialist examines the eye, while shining a light into it with an ophthalmoscope. In younger children, this may need to be done under a general anaesthetic . The genetic abnormality in the heritable form of retinoblastoma is now well-understood. But we dont know what causes non-heritable retinoblastoma. Signs and symptoms Some children with a family history of retinoblastoma are picked up by screening before they have any symptoms. If theres no family history of retinoblastoma, the first sign of the condition is often a white pupil that does not reflect light (leukocoria). This may be picked up when a picture of your child is taken using flash photography. The pupil of the affected eye may look white in the photograph. Some children may have a squint or, if the tumour is large, they may have a painful red eye. How retinoblastoma is diagnosed Tests are likely to involve an examination under anaesthetic (EUA) where an eye specialist (ophthalmologist) examines your childs eye while theyre asleep. Unlike nearly all other types of cancer, retinoblastomas can be diagnosed just by their appearance. So its not usually necessary to take a sample of tissue (a biopsy ). Your child will have several more EUAs to check how treatment is progressing. When retinoblastoma is diagnosed, your child may have some other tests to check the exact position and size of the tumour, and whether it has begun to spread into surrounding structures. This is known as staging. They may have some of the following tests: an ultrasoundscan  this is a painless scan that uses sound waves to examine the eye and the surrounding area an MRI (magnetic resonance imaging) scan  this uses magnetism to build up a detailed picture of the eye and the head alumbar puncture  the doctor inserts a fine needle between the bones in the lower spine to remove a sample of the fluid from around the brain and spinal cord (cerebrospinal fluid)then the fluid is examined under a microscope to check whether there are any cancer cells present abone marrow sample  this may be taken to check whether there are any cancer cells in the bone marrow (where our blood cells are made); the doctor inserts a needle into the hip bone and draws some of the bone marrow out with a syringe so that it can be checked for any cancer cells abone scan  this involves taking a series of X-rays to check for signs of any spread to the bones ablood test  this may be taken for genetic testing for the Rb gene; the results of this test can take some months The doctor or a specialist nurse will explain more about the tests that your child needs. Staging The stage of a cancer is a term used to describe its size and whether it has spread from where it first started. Knowing the stage of your childs retinoblastoma helps the doctors to decide on the most appropriate treatment. The following staging system is commonly used for retinoblastoma. Intraocular retinoblastoma There is cancer in 1 or both eyes, but it has not spread to other parts of the eye or the tissues surrounding the eye. This stage may be sub-divided into 5 grades (AE), depending on the size and position of the cancer and on whether theres any damage to the eye. Extraocular retinoblastoma The cancer has spread outside the eye into surrounding tissue, or to other parts of the body. Treatment Treatment depends on the number, position and size of the tumours in the eye. The aim of treatment is to first get rid of the cancer, and secondly to try to keep the sight in the eye. Some treatments may cause changes to the vision in the affected eye. Your childs specialist will talk to you about the possible risks as well as the advantages of the treatment. Smaller tumours For smaller tumours, treatment is given to the eye itself (called local therapy), while your child is asleep and under anaesthetic. Cryotherapy This is used to freeze the tumours. More than 1 session may be necessary, in which case they are usually done at monthly intervals. Laser therapy A laser is used to heat the tumour. Your child may need a number of sessions at intervals of 3to 4 weeks. Plaque A small radioactive disc is stitched over the tumour on the outside of the eye. The disc needs to stay in place for up to 4 days while the radiation destroys the cancer cells. This is done for slightly larger tumours, or tumours that have not been successfully treated with other methods. Thermotherapy This process uses heat to destroy the cancer cells and may be combined with chemotherapy or radiotherapy, as heat can improve the effectiveness of these treatments. The heat is produced by a laser, which is directed at the tumour. Larger tumours Chemotherapy This is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It may be given before the local treatments mentioned above, to help shrink the tumour and make treatment more successful. Chemotherapy can also be used if the cancer has spread to other parts of the body, or if theres a risk that it may spread. The chemotherapy drugs most commonly used to treat retinoblastoma are carboplatin, etoposide, and vincristine. Newer techniques include giving chemotherapy directly into the artery (the blood vessel) that supplies the eye (intra-arterial chemotherapy) or injecting chemotherapy into the central gelatinous part of the eye (intra-vitreal chemotherapy). Surgery If the tumour is very large and the vision in the eye is lost, your child is likely to need an operation to remove the eye. The specialist will only do this if it is absolutely necessary. An artificial eye is then fitted. Radiotherapy Radiotherapy treats cancer by using high energy rays from a machine to destroy the cancer cells, while doing as little harm as possible to normal cells. It can be given to the whole eye but does have some effect on the surrounding tissue. Radiotherapy for retinoblastoma is normally only used when other treatments have not worked well. Side effects of treatment The side effects will depend on the treatment your child is having. The immediate side effects will usually improve when treatment finishes. But unfortunately, some treatments may cause side effects that develop many years later. The specialist will explain all of this to you before treatment starts. Your childs follow-up will include checking for any long-term effects of treatment. Clinical trials Many children have their treatment as part of a clinical research trial. Trials aim to improve our understanding of the best way to treat an illness, usually by comparing the standard treatment with a new or modified version. Specialist doctors carry out trials for childrens cancers. If appropriate, your childs medical team will talk to you about taking part in a clinical trial, and will answer any questions you have. Written information is provided to help explain things. Taking part in a research trial is completely voluntary, and youll be given plenty of time to decide whether its right for your child. Treatment guidelines Sometimes, clinical trials are not available for your childs tumour. This may be because a recent trial has just finished, or because the tumour is very rare. In these cases, you can expect your doctors and nurses to offer treatment which is agreed to be the most appropriate, using guidelines which have been prepared by experts across the country. The Childrens Cancer and Leukaemia Group (CCLG) is an important organisation which helps to produce these guidelines. Follow-up care At least 9 out of every 10 children with retinoblastoma are cured. Following treatment, the eye specialist will frequently examine your childs eye under anaesthetic to check that the retina is healthy, the cancer has not come back, and no new tumours have developed. Follow-up is usually in a clinic for childhood cancers, called a paediatric oncology clinic. Children with heritable retinoblastoma will be given genetic counselling when they are old enough to understand it. Having the heritable form of retinoblastoma means an increased risk of developing other types of cancer later in life. Your child will be followed up closely into adulthood. They will be encouraged to get any new symptoms, such as a lump, checked early, and to have a healthy lifestyle to help to reduce cancer risk. Your feelings As a parent, the fact that your child has cancer is one of the worst situations you can be faced with. You may have many emotions, such as fear, guilt, sadness, anger and uncertainty. These are all normal reactions and are part of the process that many parents go through at such a difficult time. Its not possible to address here all of the feelings you may have. However, the CCLG booklet Children & Young Peoples Cancer; A Parents Guide talks about the emotional impact of caring for a child with cancer and suggests sources of help and support. Your child may have a variety of powerful emotions throughout their experience with cancer. The Parents Guide discusses these further and talks about how you can support your child. Source: Children's Cancer and Leukaemia Group - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Rhabdomyosarcoma,"""Rhabdomyosarcoma | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in children Rhabdomyosarcoma Rhabdomyosarcoma Rhabdomyosarcoma is a type of soft tissue sarcoma (tumour). Most children with rhabdomyosarcoma areyounger than 10 years old. Its more common in boys than girls. More children than ever are surviving childhood cancer. There are new and better drugs and treatments, and we can now also work to reduce the after-effects of having had cancer in the past. Its devastating to hear that your child has cancer, and at times it can feel overwhelming. There are many healthcare professionals and support organisations to help you through this difficult time. Understanding more about the cancer your child has and the treatments that may be used can often help parents to cope. Your childs specialist will give you more detailed information and if you have any questions it is important to ask the specialist doctor or nurse who knows your childs individual situation. Sarcomas are rare types of tumour that develop in the supporting tissues of the body, such as bone, muscle or cartilage. There are 2 main types of sarcomas: soft tissue sarcomas can develop in muscle, fat, blood vessels, or in any of the other tissues that support, surround and protect the organs of the body bone sarcomas can develop in any of the bones of the skeleton Rhabdomyosarcoma is the most common of soft tissue sarcomas in children. These tumours develop from muscle or fibrous tissue and can grow in any part of the body. The most common areas of the body to be affected are around the head and neck, bladder, testes, womb, or vagina. Sometimes tumours are also found in a muscle or a limb, in the chest or in the abdominal wall. If the tumour is in the head or neck area, it can occasionally spread into the brain or the fluid around the spinal cord. Causes The causes of rhabdomyosarcoma are unknown but research is going on all the time. Children with certain rare genetic disorders, such as Li-Fraumeni syndrome, have a higher risk of developing rhabdomyosarcoma. Symptoms The most common symptom is a lump or swelling. Other symptoms will depend on the part of the body thats affected by the rhabdomyosarcoma: atumour in the head or neck area can sometimes cause a blockage (obstruction) and discharge from the nose or throat; occasionally, an eye may appear swollen and protruding atumour in the abdomen (tummy) can cause pain or discomfort in the abdomen and difficulty going to the toilet (constipation) atumour in the bladder may cause symptoms such as blood in the urine and difficulty passing urine (peeing) How rhabdomyosarcoma is diagnosed Different tests are usually needed to diagnose a rhabdomyosarcoma. Your child may need a small operation to remove a sample from the tumour (a biopsy ) so that it can be examined under a microscope. This is usually done under a general anaesthetic. Tests may be done to check the exact size of the tumour and to find out if it has spread to any other part of the body. These may include: a chest X-ray to check the lungs an ultrasound CT or MRI scans blood tests and bone marrow Any tests and investigations that your child needs will be explained to you Staging The stage of a cancer is a term used to describe its size and whether it has spread from where it first started. Knowing the stage helps the doctors decide on the most effective treatment for your child. The staging system for rhabdomyosarcoma is based on: where in the body the tumour started if it is in only one part of the body (localised disease), or if it has spread to another part of the body (metastatic disease). There are different ways of staging rhabdomyosarcoma, and your childs specialist doctor will explain more about the system they are using. Treatment Rhabdomyosarcomas are rare tumours and should be treated at specialist centres. Treatment will depend on the size of the tumour, its position in the body and whether it has spread. The 3 main types of treatment for soft tissue sarcomas are chemotherapy, surgery and radiotherapy. Your child may have a combination of treatments. Chemotherapy Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It can be given: to shrink the tumour before surgery after surgery to reduce the risk of rhabdomyosarcoma coming back The drugs used and the length of treatment depends on the type and stage of the rhabdomyosarcoma. Surgery If it is possible, your child will have an operation to remove all or as much as possible of the tumour, without damaging surrounding tissue or organs. The operation will depend on the size of the tumour and where it is in your body. The surgeon will explain what is involved. Chemotherapy is usually given before surgery to shrink the tumour and make it easier to remove with surgery. If an operation isnt possible, both chemotherapy and radiotherapy are given. Radiotherapy Radiotherapy treats cancer by using high energy rays, which destroy the cancer cells while doing as little harm as possible to normal cells. It may be given after surgery to the area where the rhabdomyosarcoma started. Side effects of treatment The side effects will depend on the treatment being given and the part of the body that is being treated. Your childs doctor will discuss this with you before treatment starts. Most side effects are short-term (temporary) and gradually disappear once treatment stops. Chemotherapy may cause side effects such as feeling sick, hair loss , tiredness , and an increased risk of infection. But it can also make your child feel better by relieving any symptoms the tumour is causing. Radiotherapy can make your child feel tired, and the skin in the area thats being treated may go red or get darker. Other side effects will depend on the area of the body that is being treated. Your childs specialist doctor or nurse will explain this. Late side effects A small number of children may develop long-term side effects many years after treatment for rhabdomyosarcoma. This depends on the type of treatment your child had. Your childs doctor or nurse will talk to you about any possible risk of late side effects. Follow-up for children whove had cancer includes close monitoring for any signs of any late effects. Late effects may include a possible reduction in bone growth, infertility, a change in the way the heart and the kidneys work, and a slight increase in the risk of developing another cancer in later life. Clinical trials Many children have their treatment as part of a clinical research trial. Trials aim to improve our understanding of the best way to treat an illness, usually by comparing the standard treatment with a new or modified version. Specialist doctors carry out trials for childrens cancer. If appropriate, your childs medical team will talk to you about taking part in a clinical trial, and will answer any questions you have. Written information is provided to help explain things. Taking part in a research trial is completely voluntary, and youll be given plenty of time to decide if its right for your child. Before any trial is allowed to take place, it must be approved by an ethics committee, which protects the interests of the patients taking part. If you decide to take part in a trial, your doctor or a research nurse must discuss the treatment with you so that you understand the trial and what it means for your child to take part. You may decide not to take part, or you can withdraw from a trial at any stage. You will then receive the best standard treatment available. Treatment guidelines Sometimes, clinical trials are not available for your childs tumour. This may be because a recent trial has just finished, or because the tumour is very rare. In these cases, you can expect your doctors and nurses to offer treatment which is agreed to be the most appropriate, using guidelines which have been prepared by experts across the country. The Childrens Cancer and Leukaemia Group (CCLG) is an important organisation which helps to produce these guidelines. Follow-up care After treatment, the doctors will regularly check your child to be sure that the cancer has not come back and there are no complications. After a while, you will not need to visit the clinic so often. If you have specific concerns about your childs condition and treatment, its best to discuss them with your childs doctor, who knows their situation in detail. Your feelings As a parent, the fact that your child has cancer is one of the worst situations you can be faced with. You may have many emotions, such as fear, guilt, sadness, anger and uncertainty. These are all normal reactions and are part of the process that many parents go through at such a difficult time. Its not possible to address here all of the feelings you may have. However, the CCLG booklet Children & Young Peoples Cancer; A Parents Guide talks about the emotional impact of caring for a child with cancer and suggests sources of help and support. Your child may have a variety of powerful emotions throughout their experience with cancer. The Parents Guide discusses these further and talks about how you can support your child. Source: Children's Cancer and Leukaemia Group - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Rheumatoid arthritis,"Rheumatoid arthritis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Muscle, bone and joints Conditions Rheumatoid arthritis Rheumatoid arthritis About rheumatoid arthritis Symptoms of rheumatoid arthritis Causes of rheumatoid arthritis Diagnosing rheumatoid arthritis Treating rheumatoid arthritis Living with rheumatoid arthritis Complications of rheumatoid arthritis About rheumatoid arthritis Rheumatoid arthritis is a long-term condition that causes pain, swelling and stiffness in the joints. The hands, feet and wrists are commonly affected, but it can also cause problems in other parts of the body. There may be periods where your symptoms become worse, known as a flare-up or flare. A flare can be difficult to predict, but with treatment it is possible to decrease the number of flares and minimise or prevent long-term damage to the joints. Read more about the symptoms of rheumatoid arthritis and living with rheumatoid arthritis . When to seek medical advice You should see your GP if you think you have symptoms of rheumatoid arthritis, so your GP can try to identify the underlying cause. Diagnosing rheumatoid arthritis quickly is important because early treatment can help stop the condition getting worse and reduce the risk of further problems such as joint damage. Read more about diagnosing rheumatoid arthritis . What causes rheumatoid arthritis? Rheumatoid arthritis is an autoimmune disease. This means that your immune system  which usually fights infection  attacks the cells that line your joints by mistake, making them swollen, stiff and painful. Over time, this can damage the joint itself, the cartilage and nearby bone. Its not clear what triggers this problem with the immune system, although you are at an increased risk if you are a woman, you have a family history of rheumatoid arthritis, or you smoke. Read more about the causes of rheumatoid arthritis . Who is affected Rheumatoid arthritis affects around 400,000 people in the UK. It can affect adults at any age, but most commonly starts between the ages of 40 and 50. About three times as many women as men are affected. Howrheumatoid arthritis is treated There is no cure for rheumatoid arthritis, but early diagnosis and appropriate treatment enables many people with rheumatoid arthritis to have periods of months or even years between flares and to be able to lead full lives and continue regular employment. The main treatment options include: medication that is taken in the long-term to relieve symptoms and slow the progress of the condition supportive treatments, such as physiotherapyand occupational therapy, to help keep you mobile and find ways around any problems you have with daily activities surgery to correct any joint problems that develop Read more about treating rheumatoid arthritis . Possible complications Having rheumatoid arthritis can lead to several other conditions that may cause additional symptoms and can sometimes be life-threatening. Possible complications include carpal tunnel syndrome, inflammation of other areas of the body (such as the lungs, heart and eyes), and an increased risk of heart attacks and strokes . Ensuring that rheumatoid arthritis is well controlled helps reduce your risk of complications such as these. Read more about the complications of rheumatoid arthritis . Symptoms of rheumatoid arthritis Rheumatoid arthritis mainly affects the joints, although it can cause problems in other parts of the body too. The symptoms of rheumatoid arthritis often develop gradually over several weeks, but some cases can progress quickly over a number of days. The symptoms vary from person to person. They can come and go, and may change over time. Youmay occasionally experience flares when your condition deteriorates and your symptoms become more severe. Symptoms affecting the joints Rheumatoid arthritis is primarily a condition that affects the joints. It can cause problems in any joint in the body, although the small joints in the hands and feet are often the first to be affected. Rheumatoid arthritis typically affects the joints symmetrically (both sides of the body at the same time and to the same extent), but this is not always the case. The main symptoms of rheumatoid arthritis affecting the joints are outlined below. Pain Thejoint pain associated with rheumatoid arthritisis usually a throbbing andaching pain. It is often worse in the mornings and after a period of inactivity. Stiffness Joints affected by rheumatoid arthritis can feel stiff. For example, if your hands are affected, you may not be able to fully bend your fingers or form a fist. Like joint pain, the stiffnessis oftenmore severe in the morning or after a period of inactivity. Morning stiffness associated with another type of arthritis called osteoarthritis usually wears off within 30 minutes of getting up, but rheumatoid arthritis morning stiffness oftenlasts longer than this. Swelling, warmth and redness The lining ofjoints affected by rheumatoid arthritis become inflamed, which can cause the joints to swell, and become hot and tender to touch. In some people, firm swellings called rheumatoid nodules can also develop under the skin around affected joints. Additional symptoms As well as problems affecting the joints, some people with rheumatoid arthritis experience a range of more general symptoms, such as: tiredness and a lack of energy a high temperature (fever) sweating a poor appetite weight loss The inflammation associated with rheumatoid arthritis can also sometimes cause problems affecting other areas of the body, includingdry eyes if the eyes are affected andchest pain if the heart or lungs are affected. Read more about the complications of rheumatoid arthritis . When to seek medical advice You should see your GP if you think you have symptoms of rheumatoid arthritis. There are a number of conditions that can cause problems such as joint pain and stiffness, so its important to get a proper diagnosis. Diagnosing rheumatoid arthritis as soon as possible is particularly important because early treatment can helpstop the condition getting worse and reduce the risk offurther problems such as joint damage. Read more about diagnosing rheumatoid arthritis . Causes of rheumatoid arthritis Rheumatoid arthritis is an autoimmune condition, which means it is caused by the bodys immune system attacking itself. However, it is not yet known what triggers this. Normally, your immune system makes antibodies that attack bacteria and viruses, helping fight infection.But if you have rheumatoid arthritis, your immune system mistakenly sends antibodies to the lining of your joints, where they attack the tissue surrounding the joint. This causes the thin layer of cells (synovium) covering your joints to become sore and inflamed. This inflammation in turn causes chemicals to be released that thicken the synovium and damage nearby: bones cartilage  the stretchy connective tissue between bones tendons  the tissue that connects bone to muscle ligaments  the tissue that connects bone and cartilage If the condition is not treated, these chemicals gradually cause the joint to lose its shape and alignment and, eventually, can destroy the joint completely. Various theories of why the immune system starts to attack the joints have been suggested, including that an infection orvirus may trigger this, but none of these theories has been proven. Possible risk factors There are a number of things that may increase your risk of developing rheumatoid arthritis, including: your genes there is some evidence that rheumatoid arthritis can run in families, although the risk of inheriting the condition is thought to be low as genes are only thought to play a small role in the condition hormones  rheumatoid arthritis is more common in women than men, which may be due to the effects of a hormone called oestrogen that is found at higher levels in women, although this has not been conclusively proven smoking  some evidence suggests that people who smoke are at an increased risk of developing rheumatoid arthritis Want to know more? National Rheumatoid Arthritis Society (NRAS): Possible causes and risk factors Diagnosing rheumatoid arthritis Rheumatoid arthritis can be difficult to diagnose because many conditions cause joint stiffness and inflammation and there is no definitive test for the condition. You should see your GP if you have these symptoms so they can try to determine the cause. Seeing your GP Your GP willcarry out a physical examination, checking your joints for any swelling and to assess how easily they move. Your GP will also ask you about your symptoms. It is important to tell your GP about allyour symptoms, not just ones you think are important, as this will helpthe doctor make the correct diagnosis. If your GP thinks you have rheumatoid arthritis,they will refer you to a specialist (rheumatologist). Your GP may arrange blood tests to help confirm the diagnosis after conducting a physical examination and consulting your medical history, or they may refer you at the same time as requesting tests. Blood tests Noblood test candefinitively prove or rule out a diagnosis ofrheumatoid arthritis, buta number of tests can show possible indications of the condition. Some of the main tests usedare outlined below. Erythrocyte sedimentation rate (ESR) In an ESR test, a sample of your red blood cellsis placed into a test tube of liquid. The cells are then timed to see how fast they fall to the bottom of the tube (measured in millimetres per hour). If they are sinking faster than usual, you may have an inflammatory condition, such as rheumatoid arthritis. C-reactive protein (CRP) A CRP test can indicate if there is inflammation anywhere in the body by checking how much CRP is present in your blood. CRP is produced by the liver. If there is more CRP than usual, there is inflammation in your body. Full blood count The full blood count will measure your red cells to rule out anaemia. Anaemia is a condition where the blood is unable to carry enough oxygen, due to a lack of blood cells. Anaemia is common in people withrheumatoid arthritis, althoughthe problem canhave many causes, so having anaemiadoes not prove that you have rheumatoid arthritis. Rheumatoid factor and anti-CCP antibodies Specific blood tests can help to diagnosis rheumatoid arthritis, but are not accurate in every person. About half of all people with rheumatoid arthritis have a positive rheumatoid factor present in their blood when the disease starts, but about one in every 20 people without rheumatoid arthritis also tests positive for this. Another antibody test known as anti-CCP (anti-cyclic citrullinated peptide) is also available. People who test positive for anti-CCP are very likely to develop rheumatoid arthritis, but not everybody found to have rheumatoid arthritis has this antibody. Those who test positive for both rheumatoid factor and anti-CCP may be more likely to have severe rheumatoid arthritis requiring higher levels of treatment. Joint imaging A number of different scans may also be carried out to check for joint inflammation and damage. These can help differentiate between different types of arthritis and can be used to monitor howyour condition is progressing over time. Scans that may be carried out to diagnose and monitor rheumatoid arthritis include: X-rays  where radiation is passed through your body to examine your bones and joints ultrasound scans  where high frequency sound waves are used to create an image of joints magnetic resonance imaging (MRI) scans  where strong magnetic fields and radio waves are used to produce detailed images of your joints Treating rheumatoid arthritis Stopping the condition progressing There are a number of medications available that can be used to help stop rheumatoid arthritis getting worse and reduce your risk of further problems. These are often divided into two types of medication: disease-modifying anti-rheumatic drugs (DMARDs) and biological treatments. Disease-modifying anti-rheumatic drugs (DMARDs) If you have been diagnosed with rheumatoid arthritis, you will normally be offered a combination of DMARD tablets as part of your initial treatment, asthese medications are particularly effective ineasing symptoms of the condition and slowing down its progression. DMARDs work byblocking the effects of the chemicals released when the immune system attacks the joints, which could otherwisecause further damage to nearby bones, tendons, ligaments and cartilage. There are many different DMARDs that can be used, including methotrexate, leflunomide, hydroxychloroquine and sulfasalazine. Methotrexate isnormally the firstmedicine given for rheumatoid arthritis, often alongside another DMARD anda short-course of corticosteroids to relieve anypain (seebelow). It may also be combined with the biological treatments mentionedbelow. Common side effects of methotrexate include feeling sick, loss of appetite, a sore mouth, diarrhoea , headaches and hair loss.The medicationcan also sometimes have an effect on your blood count and your liver,so you will have regular blood tests to monitor this. Less commonly, methotrexate can affect the lungs, so you will usually have a chest X-ray and possibly breathing tests when you start taking methotrexate, to provide a comparison if you develop shortness of breath or a persistent dry cough while taking it. However, most people tolerate methotrexate well. It can take a few months to notice a DMARD working. It is important to keep taking the medication, even if you do not notice it working at first. You may have to try two or three types of DMARD before you find the one that is most suitable for you. Once you and your doctor work out the most suitable DMARD, you will usually have to take the medicine in the long term. Biological treatments Biological treatments are a newer form of treatment for rheumatoid arthritis. They include etanercept, infliximab, adalimumab, certolizumab, golimumab, rituximab, abatacept and tocilizumab. They are usually taken in combination with methotrexate or another DMARD and are normally only used if these medications alone have not been effective. Biological medications are given by injection and they work by stopping particular chemicals in the blood from activating your immune system to attack your joints. Side effects from biological treatments are usually mild and include skin reactions at the site of the injections, infections, feeling sick, a high temperature (fever) and headaches. Some people may alsobe at risk of getting more serious problems, including the reactivation of infections such as tuberculosis (TB) in people who have had them in the past. Relieving pain In addition to the medications used to control the progression of rheumatoid arthritis, you may also need to take medication specifically to relieve pain. Some of the different medicines thatmay be used to relieve painare outlined below. Painkillers In some cases, you may be advised to use painkillers such as paracetamol , or a combination of paracetamol and codeine (co-codamol) to relieve the pain associated with rheumatoid arthritis. These medications dont help treat the underlying inflammation of your joints, but they can sometimes be helpful in relieving pain. For example, they may be recommended while you are waiting to see a specialist or during periods where your symptoms are particularly bad (flare-ups). Non-steroidal anti-inflammatory drugs (NSAIDs) In addition to  or instead of  the painkillers mentioned above, your doctor may prescribe a non-steroidal anti-inflammatory drug (NSAID) . This may be a traditional NSAID (such as ibuprofen , naproxen or diclofenac) or an alternative type called a COX-2 inhibitor (such as celecoxib or etoricoxib). These medications can help relieve pain while also reducing inflammation in the joints, although they will not stop rheumatoid arthritis getting worse over time. Your doctor will discuss with you what type of NSAID you should take and the benefits and risks associated with each of them. Although uncommon, taking an NSAID tablet can increase the risk of serious stomach problems  such as internal bleeding  because the medications can break down the lining that protects the stomach against damage from stomach acids. If you are prescribed an NSAID tablet, you will often have to take another medicine, such as a proton pump inhibitor (PPI), as well. Taking a PPI reduces the amount of acid in your stomach, which greatly reduces the risk of damage to your stomach lining. Corticosteroids Corticosteroids are powerful medications that can help reduce pain, stiffness and inflammation. They can be used as a tablet (for example, prednisolone), as an injection directly into a painful joint, or as an injection into the muscle (to help lots of joints). They are usually used to provide short-term pain relief  for example, while you are waiting for DMARD medication to take effect or during a flare-up. Corticosteroids are normally only used in this way because long-term use of corticosteroids can have serious side effects, such as weight gain, osteoporosis (thinning of the bones), easy bruising, muscle weakness and thinning of the skin. Supportive treatments Your doctor may also refer you to other services that might be able to help you with your rheumatoid arthritis symptoms. Physiotherapy A physiotherapistmay help you improve your fitness and muscle strength, and make your joints more flexible. They may also be able to help with pain relief using heat or ice packs, or transcutaneous electrical nerve stimulation (TENS). A TENS machine applies a small pulse of electricity to the affected joint, whichnumbs the nerve endings and can help ease the pain of rheumatoid arthritis. Occupational therapy If rheumatoid arthritis causes youproblems with everyday tasks, occupational therapy may help. An occupational therapist can provide training and advice that will help you to protect your joints, both while you are at home and at work. Some type of support for your joints, such as a splint, may also be recommended, or devices that can helpopen jars or turn on taps. Podiatry If you have problems with your feet, a podiatrist may be able to help. You may also be offered some type of support for your joints or shoe insoles that can ease pain. Surgery Sometimes, despite medication, damage to your joints may occur. In such cases, you may need surgery to help restore your ability to use your joint. Surgery may also be recommended to reduce painor correct deformities. Finger, hand and wrist surgery There are different types of surgery to correct joint problems in the hand. Examples include: carpal tunnel release (cutting a ligament in the wrist to relieve pressure on a nerve) release of tendons in the fingers to treat abnormal bending removal of inflamed tissue that lines the finger joints Arthroscopy Arthroscopy is a procedure to remove inflamed joint tissue. During the operation, a thin tube with a light source and camera (arthroscope) is inserted into the joint through a small cut in the skin so that the surgeon can see the affected joint. Special surgical instruments are inserted through other small cuts in the skin to remove the damaged tissue. You usually do not have to stay overnight in hospital for this kind of surgery, but the joint will need to be rested at home for several days. Joint replacement Some people with rheumatoid arthritis will need surgery toreplace part or all of a joint, such as the hip, knee or shoulder joint. This is known as a joint replacement or arthroplasty. Replacement of these joints is a major operation that involves several days in hospital followed by months of rehabilitation. Thelatest joints have a limited lifespan of 10-20 years. They are not perfect and some function may not be restored after the damaged joint is replaced by a new one. Read more about knee replacement and hip replacement . Complementary and alternative therapies Many people with rheumatoid arthritis try complementary therapies, such as: massage acupuncture osteopathy chiropractic In most cases, there is little or no evidence these are effective in the long-term, although some people may experience a short-term benefit from them. Nutritional supplements and dietary changes There is no strong evidence to suggest that specific dietary changes can help improve rheumatoid arthritis, although some people with rheumatoid arthritis feel that their symptoms get worse after they have eaten certain foods. If you think this may be the case for you, it may be useful to try avoiding problematic foods for a few weeks to see if your symptoms improve. However, it is important to ensure your overall diet is still healthy and balanced. There is also little evidence supporting the use of supplements in rheumatoid arthritis, although some can be useful in preventing side effects of medications you may be taking. For example,calciumandvitamin Dsupplements may help prevent osteoporosis if you are taking steroids andfolic acid supplements may help prevent some of the side effects of methotrexate. However, there is some evidence to suggest that taking fish oil supplements may help reduce joint pain and stiffness caused by rheumatoid arthritis. Living with rheumatoid arthritis Self-management Taking control of rheumatoid arthritis will help you cope with its impact on your lifestyle. Arthritis Care offers self-management training courses to teach techniques for living positively with arthritis. Techniques include relaxation and breathing exercises to help pain control, goal-setting exercises and positive thinking to help give you some control over your condition. A self-management programme specifically for people with rheumatoid arthritis has been developed by the National Rheumatoid Arthritis Society (NRAS). The course helps people learn more about their condition and provides practical tips on how to manage everyday life. Talk to others Many people find it helpful to talk to others in a similar position, and you may find support from an individual or group of people with rheumatoid arthritis. Patient organisations have local support groups where you can meet others diagnosed with the same condition. Call theNRAS helpline freeon0800 298 7650 to speak to a trained rheumatoid arthritis adviser. NRAS also has a team of medical advisers. You can also call Arthritis Cares free, confidential helpline on 0808 800 4050 (Monday-Friday,10am-4pm). Your feelings It can be hard to deal with the unpredictable nature of rheumatoid arthritis. Some days, the pain and stiffness will be much worse than others, and there is no way of knowing when a flare-up will occur. The difficult nature of rheumatoid arthritis can mean that some people develop depression or feelings of stress and anxiety. Sometimes, these feelings can be related to poorly controlled pain or fatigue. Living with any long-term condition makes you more likely to have a range of emotions such as frustration, fear, pain, anger and resentment. Speak to your healthcare team if you are struggling to deal with your condition emotionally. They may be able to offer medication or psychological interventions to help. Starting and raising a family If you are taking medicines for rheumatoid arthritis, let your healthcare team know if you want to start a family or ifyou are worried about becoming pregnant while on medication. Some medications, such as methotrexate, leflunomide and biological treatments, should not be taken by men or women while they are trying for a baby. The doctors and nurses will work with you to ensure your rheumatoid arthritis is controlled while you are trying to get pregnant. Babies and young children are physically and mentally demanding for any parent, but particularly so if you have rheumatoid arthritis. If you are struggling to cope, it may help to talk to other people in the same situation as you. You may also be able to get additional support from your health visitor or occupational therapist to help you manage your young family. Sex and relationships Pain, discomfort and changes in the way you feel can affect your sex life. Your self-esteem or thoughts about how you look may affect your confidence. Although many people find it difficult to talk about such private issues, there are resources that might help you. Talking to your partner or GP about the impact of rheumatoid arthritis on your sexuality and sexual relationships may help. Money and benefits If you have to stop work or work part time because of your rheumatoid arthritis, you may find it hard to cope financially. You may be entitled to one or more of the following types of financial support: If you have a job, but cannot work because of your illness, you are entitled to Statutory Sick Pay from your employer. If you do not have a job and cannot work because of your illness, you may be entitled to Employment and Support Allowance . If you are aged 64 or under and need help with personal care or have walking difficulties, you may be eligible for a Personal Independence Payment . If you are aged 65 or over, you may be able to get Attendance Allowance . If you are caring for someone with rheumatoid arthritis, you may be entitled to Carers Allowance . You may also be eligible for other benefits if you have children living at home or if you have a low household income. Telecare Self-Check online tool Visit the Telecare Self-Check online tool to find the right support for you in your area. This easy to use online tool allows you to find helpful information on telecare services that could help you live independently at home for longer. Complications of rheumatoid arthritis Having rheumatoid arthritis can put you at a higher risk of developing other conditions, particularly if it isnt well controlled. Carpal tunnel syndrome C arpal tunnel syndrome isa common condition in people with rheumatoid arthritis. It is the result of compression of the nerve that controls sensation and movement in the hands (median nerve) and can cause symptoms such as aching, numbness and tingling in your thumb, fingers and part of the hand. Symptoms of carpal tunnel syndrome can sometimes be controlled with wrist splints or corticosteroid injections, although surgery to release the pressure on the median nerve may beneeded in severe cases. Widespread inflammation Asrheumatoid arthritis is an inflammatory condition, it can cause inflammation to develop in other parts of your body, such as the: Lungs inflammation of the lungs or lung lining can lead to pleurisy or pulmonary fibrosis , which can cause chest pain , a persistent cough and shortness of breath . Heart  inflammation of the tissue around the heart can lead to pericarditis, which causes chest pain. Eyes  inflammation of the eyes can lead to scleritis or Sjogrens syndrome . Scleritis can cause eye redness and pain, whereas Sjogrens syndrome can cause dry eyes. Blood vessels inflammation of the blood vessels is known as vasculitis. This can lead to the thickening, weakening, narrowing and scarring of blood vessel walls. In serious cases, it can affect blood flow to your bodys organs and tissues and can be life-threatening. However, thanks to early treatment, inflammation due to rheumatoid arthritis affecting other parts of the body is becoming less common. Joint damage If rheumatoid arthritis is not treated early or is not well controlled, the inflammation in your joints could lead to significant and permanent damage. Problems that can affect the joints include: damage to nearby bone and cartilage (a tough, flexible tissue that covers the surface of joints) damage to nearby tendons (flexible tissue that attach muscle to bone), which could cause them to break (rupture) joint deformities These problems will sometimes need to be treated with surgery to prevent loss of function in the affected joints. Cardiovascular disease If you have rheumatoid arthritis, you are at a higher risk of developing cardiovascular disease (CVD) than the population at large. CVD isa general term that describes conditions affecting the heart or blood vessels, and it includes life-threatening problems such as heart attacks and strokes . Its not clear exactly why people with rheumatoid arthritis are at an increased risk of these problems, but you can reduce your risk by ensuring your arthritis is well controlled and by reducing the impact of other factors that contribute to CVD, such as by stopping smoking, eating healthily and exercising regularly. Read more about preventing CVD . Cervical myelopathy If you have had rheumatoid arthritis for some time, you are at increased risk of developing cervical myelopathy and you may need a special assessment of your neck before any operation where you are put to sleep. This condition is caused by dislocation of joints at the top of the spine, which put pressure on the spinal cord. Although relatively uncommon, it is a serious condition that can greatly affect your mobility and can lead to permanent spinal cord damage if not treated promptly with surgery. Source: MSK Expert Panel - Opens in new browser window Last updated: 13 June 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Arthritis Other health sites The Pain Toolkit Pain Concern Versus Arthritis: rheumatoid arthritis National Rheumatoid Arthritis Society (NRAS) NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Ringworm and other fungal infections,"Ringworm | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Ringworm and other fungal infections Ringworm and other fungal infections About ringworm and other fungal infections Symptoms of ringworm and other fungal infections Causes of ringworm and other fungal infections Diagnosing ringworm and other fungal infections Treating ringworm and other fungal infections Preventing ringworm and other fungal infections About ringworm and other fungal infections Ringworm is a common fungal infection that can cause a red or silvery ring-like rash on the skin. Ringworm commonly affects arms and legs, but it can appear almost anywhere on the body. Despite its name, ringworm doesnt have anything to do with worms. Other similar fungal infections can affect the scalp, feet, groin and nails. These fungal infections, medically known as tinea, are not serious and are usually easily treated. However,they arecontagious and easily spread. Tinea fungal infections There are different types of tinea fungal infection, based on the affected area of the body: ringworm(tinea corporis)  affecting the body fungal nail infection (onychomycosis)  affecting the nails athletes foot (tinea pedis)  affecting the feet jock itch (tinea cruris)  affecting the groin tinea capitis  affecting the scalp Ringworm usually looks like a round, red or silvery patch of skin that may be scaly, inflamed and itchy, but other fungal infections may present themselves slightly differently. Read more about the symptoms of ringworm and other tinea fungal infections . When to see a doctor See your GP if you or your child has a fungal scalp infection, as its treated with antifungal tablets, which are only available on prescription. Symptoms of a fungal scalp infection include small patches of scaly scalp skin (which may be sore), patchy hair loss and itchiness. Other types of fungal infections (including ringworm) are generally treated with antifungal cream from the pharmacy, and you dont need to see a doctor unless it persists. However, pharmacists often prefer children to see a GP to confirm a diagnosis. Whats the cause? Fungal spores are passed between people through direct skin contact and by sharing objects such as towels, hairbrushes and bedding. Athletes foot is commonly spread in gym and swimming pool changing rooms. Pets, such as dogs and cats, can have ringworm, and you can catch it by stroking them. Read more about the causes of ringworm . Who is affected? Its estimated that 10% to 20% of people will haveringworm in their lifetime. Although children are more likely to get this, people of all ages can be affected. Groin infections are more common in young men. Fungal scalp infections (tinea capitis) are most common in children who have not reached puberty, particularly African-Caribbean children and those who live in urban areas. Treatment Most ringworm infections are mild and can be treated using a pharmacy antifungal cream. Scalp infections can be treated with antifungal tablets, sometimes combined with antifungal shampoo. If the skin is irritated or broken, it can lead to other bacterial infections, which may need treatment with antibiotics . Read more about how to treat fungal infections . Stopping it spreading Its important to prevent the infection spreading. You should avoid sharing towels, bedding or clothes with someone with a fungal infection. If you think your pet has ringworm, take it to the vet. If your pet is treated quickly, youll be less likely to catch it. If your child has a fungal infection, they can go to school, but you should inform their teacher. In addition to treatment, your child should maintain a good level of personal hygiene to prevent the infection spreading. Read more about how to stop the spread of fungal infections . Symptoms of ringworm and other fungal infections The symptoms of a tinea fungal infection depend on where the infection is. Ringworm (on the skin) The symptoms of ringworm include: a ring-like red or silvery rash on your skin  your skin will look red and irritated around the ring, but healthy inside scaly, itchy and inflamed skin In more severe cases: the rings may multiply, grow in size and merge together the rings may feel slightly raised and the skin underneath may be itchy blisters and pus-filled sores may form around the rings The ring spreads outwards as it progresses. You can have one patch or several patches of ringworm, and in more serious cases, your skin may become raised and blistered. Face and neck ringworm Ringwormon the face and neck may not appear ring-shaped, but may be itchy and swollen, and it can become dry and crusted. If you have a beard, you may notice patches of hair breaking away. Hand ringworm Ringworm on the hand often causes the skin to become thicker on the palm and in between the fingers. It may affect one hand or both and normally only appears on one side. Fungal scalp infection (tinea capitis) The symptoms of a fungal scalp infection include: small patches of scaly skin on the scalp, which may be sore patchy hair loss an itchy scalp In more severe cases: small, pus-filled sores on the scalp crusting on the scalp bald patches (if your hair is affected) In very severe cases, a large inflamed sore called a kerion may form on your scalp. This can ooze pus, and you may also have a fever and swollen lymph glands. Athletes foot (tinea pedis) The main symptom of athletes foot is an itchy, dry, red and flaky rash, usually in the spaces between your toes. In more severe cases, you may have: cracked skin in the affected area blisters , which may ooze or crust swelling of the skin a burning or stinging sensation in your skin scaling patterns around your sole, between your toes and on the side of your foot Jock itch (tinea cruris) The symptoms of jock itch include: red-brown sores, which may have blisters or pus-filled sores around the edge itchiness and redness around your groin area, such as your inner thighs and bottom (the genitals are not usually affected) scaly, flaky skin on your inner thighs Exercising, walking and wearing tight clothing or underwear can make the symptoms of a groin infection worse. Fungal nail infection (onychomycosis) The symptoms of a fungal nail infection include: a whitish thickening of the nail discolouration (the nail can turn white, black, yellow or green) the nail can become brittle and start to fall off the skin around the nail may be sore and irritated Read more about fungal nail infection When to seek medical advice Make an appointment to see your GP if you: or your child develop the symptoms of a fungal scalp infection have ringworm that has not improved after two weeks of treatment with antifungal cream have another medical condition, or youre having medical treatment that is known to weaken your immune system, such as chemotherapy or steroid tablets Read more about how fungal infections are diagnosed . Causes of ringworm and other fungal infections Tinea fungal infections are caused by a particular type of fungi, called dermatophytes, which live off keratin. Keratin is a tough, waterproof tissue found in many parts of your body, including your skin, hair and nails. This explains why fungal infections mostly affect your skin, scalp or nails. How it spreads The fungi are tiny spores tough enough to survive for months on your skin, in soil or on household objects, such as combs or towels. They thrive in heat and moisture, which helps them to grow and explains why they are often spread in swimming pool changing rooms and communal showers. The spores can be spread in four different ways: human-to-human contact human-to-animal contact  for example, by stroking an infected dog or cat human-to-object contact  both animals and humans can leave traces of fungi spores on objects and surfaces, such as towels, clothing, bed linen, combs or brushes human-to-soil contact  less commonly, it can develop after lengthy exposure to infected soil As an adult, you can become a carrier of a scalp infection without developing any symptoms. This is because your body has usually developed a defence against the infection by the time you reach adulthood. If youre a carrier of a fungal infection, you can unknowingly pass the condition on to children, who may then go on to develop symptoms. Risk groups You are more likely to develop a fungal infection if you: are very young or very old are African-Caribbean (in the case of scalp infections) have type 1 diabetes are very overweight ( obese ) have a medical condition that weakens your immune system, such as HIV or AIDS are receiving medical treatment that weakens your immune system, such as chemotherapy or steroid tablets have had fungal infections in the past have hardened arteries (atherosclerosis) have poor circulation (specifically, a condition called venous insufficiency, where the veins in your legs have trouble moving blood back to your heart) Diagnosing ringworm and other fungal infections Ringworm and other tinea fungal infections are usually easy to diagnose from their appearance and location. Fungal scalp infections Your GP will usually be able to diagnose a scalp infection after examining your scalp. Knowing exactly which fungus is causing the infection is useful, because some antifungal medications are better at treating certain types. Your GP will take a small scraping of skin from your scalp to test in a laboratory. You may be given an antifungal medication before you receive your test results. If the tests show that a different antifungal medication would work better, you will be prescribed that instead. Ringworm and other fungal infections Most fungal infections can be diagnosed by your GP after examining your skin and asking whether you have other related symptoms. Further tests will usually only be needed if your symptoms are severe or if they fail to respond to antifungal treatment. If this happens, your GP may take a small scraping of affected skin for analysis in a laboratory. Microscopic analysis will show if fungi are present and the specific type that is causing your infection. Read about how to treat ringworm and other fungal infections . Treating ringworm and other fungal infections Most tinea fungal infections, including ringworm, are easily treated by using antifungal creams, tablets or shampoo. You can also help to get rid of fungal infections and stop them from spreading by: washing areas of affected skin daily and drying thoroughly, paying particular attention to skin folds and between your toes in the case of a groin or foot infection, changing your underwear or socks daily, because fungi can persist in flakes of skin with a scalp infection, not sharing combs, hairbrushes or hats washing clothes, towels and bed linen frequently wearing loose-fitting clothes, preferably made of cotton or other natural materials Read more about preventing ringworm . Ringworm, groin infections and athletes foot Most cases of ringworm, groin infections and athletes foot can be treated using an over-the-counter antifungal cream, gel or spray. There are lots of different types, so ask your pharmacist to help you choose the right one for you. You usually apply antifungal creams, gels and sprays daily to the affected areas of skin for 2 weeks. The cream, gel or spray should be applied over the rash and to one inch of skin beyond the edge of the rash. Read the manufacturers instructions first. You may be advised to use the treatment for a further 2 weeks, to reduce the risk of re-infection. See your GP if your symptoms have not improved after 2 weeks of treatment, because you may need to take antifungal tablets. Both terbinafine and griseofulvin tablets can be used to treat ringworm infections, as well as another antifungal medicine called itraconazole. Treat groin and feet together Groin infections can sometimes occur at the same time as athletes foot. Its vital to treat both infections at the same time to avoid being re-infected with either condition. Fungal scalp infections Scalp infections are usually treated using antifungal tablets, often alongside an antifungal shampoo. There are 2 main types of antifungal tablet: terbinafine griseofulvin The antifungal medicine that your GP prescribes will depend on the type of fungi causing the infection. Terbinafine tablets Most people with fungal scalp infections are prescribed terbinafine tablets to take once a day for 4 weeks. Its an effective treatment for most cases. Side effects of terbinafine can include: nausea diarrhoea indigestion rashes These side effects are usually mild and short-lived. Some people have also reported that terbinafine temporarily affected their sense of taste. Terbinafine is not suitable for people with a history of liver disease or lupus (where the immune system attacks healthy tissue). Griseofulvin Griseofulvin is a type of antifungal medicine that prevents fungi from growing and multiplying. Its available in the form of a spray and is usually taken daily for 8 to 10 weeks. Side effects of griseofulvin can include: nausea vomiting mild diarrhoea headache indigestion However, these side effects should improve as your body gets used to the medicine. Griseofulvin can cause birth defects, so it shouldnt be taken during pregnancy, or if you intend to become pregnant soon after stopping treatment. Men shouldnt father a child within 6 months of stopping treatment. Griseofulvin is also not suitable for women who are breastfeeding, and those with severe liver disease or lupus. Griseofulvin can interfere with both the combined contraceptive pill and the progestogen-only pill, so women need to use an alternative barrier form of contraception, such as a condom , while taking it. Griseofulvin may also affect your ability to drive and can enhance the effects of alcohol. Antifungal shampoo Antifungal shampoo cannot cure scalp infections, but it can help to prevent the infection spreading and may speed up recovery. Antifungal shampoos, such as selenium sulphide and ketoconazole shampoo, are available from your pharmacist. Ideally, antifungal shampoo should be used twice a week during the first 2 weeks of treatment. There is no evidence that shaving a childs head will reduce the risk of an infection or speed up recovery. Itraconazole Itraconazole is usually prescribed in the form of capsules for 7 or 15 days. It is not recommended for use in children, elderly people or those with severe liver disease. Side effects of itraconazole can include: nausea vomiting indigestion diarrhoea headache Read about how to stop ringworm spreading or coming back . Fungal nail infections Fungal nail infections can be treated with antifungal nail paint, but it also often requires antifungal tablets. These tend to work better than nail paints, although they can cause side effects, such as headache, nausea and diarrhoea. Read more about treating fungal nail infections . Preventing ringworm and other fungal infections The following advice will help to stop fungal infections from spreading. The fungi that cause tinea infections can survive on items such as furniture, hairbrushes, clothing and towels, and can be spread through contact with these items. Therefore, if someone in your household has a fungal infection, you should: avoid sharing personal items  such as combs, hairbrushes, towels, clothing and bed linen avoid scratching the affected areas of your skin or scalp, because it could spread the infection to other parts of your body Its important that other household members check themselves for signs of infection and get treatment if necessary. If you suspect that your pet is the source of the infection, take them to your vet for treatment. Patches of missing fur is a sign that an animal has ringworm. Always wash your hands after touching a pet with the infection. If someone in your family has a fungal infection, there is no need for them to stay off work or school. However, treatment should be started as soon as possible. Good personal hygiene should also be followed to stop it spreading to other children. Wearing something on your feet in gym and swimming pool changing rooms will reduce your chances of getting athletes foot. Find out how to treat fungal infections . Source: NHS 24 - Opens in new browser window Last updated: 04 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. 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Rosacea,"Rosacea | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Skin, hair and nails Rosacea Rosacea About rosacea Symptoms of rosacea Causes of rosacea Treating rosacea Preventing rosacea About rosacea Rosacea is a common but poorly understood long-term skin condition that mainly affects the face. It can be controlled tosome degree with long-term treatment, but sometimes the changes inphysical appearance can havea significant psychological impact. Symptoms of rosacea Symptoms often begin with episodes of flushing,where the skin turns red for a short period, but other symptoms can develop as the condition progresses, such as: burning and stinging sensations permanent redness spots (papules and pustules) small blood vessels in the skin becoming visible Rosacea is a relapsing condition, which means there are periods when symptoms are particularly bad, but less severe at others. Read about the symptoms of rosacea Rosacea symptoms include redness and flushing, as well as stinging and spots. Source: https://dermnetnz.org/ When to see your GP See your GP if you have persistent symptoms that could be caused by rosacea. Early diagnosis andtreatment can help stop the condition getting worse. Theres no specific test for rosacea, but your GP will often be able to diagnose the condition by: examining your skin asking about your symptoms asking about possible triggers you may have In some circumstances your GP may arrange further teststo rule out other conditions with similar symptoms, such as lupus or the menopause . For example, these could be a blood test orskin biopsy, where a small scraping of skin is removed and examined. Causes of rosacea The exactcause of rosacea is unknown, although a number of possible factors have been suggested, including abnormalities in the blood vessels of the face and a reaction to microscopic mites commonly found on the face. Although theyre not thought to be direct causes of the condition, several triggers have been identified that may make rosacea worse. These include: exposure to sunlight stress strenuous exercise hot or cold weather hot drinks alcohol and caffeine certain foods, such as spicy foods Read about causes of rosacea Treating rosacea Theres currently no cure for rosacea, but treatment can help control the symptoms. Long-term treatmentis usually necessary, although there may be periods when your symptoms improve and you can stop treatment temporarily. For most people, treatment involves a combination of self-help measures and medication, such as: avoiding known triggers  for example, avoiding drinks containing alcohol or caffeine creams and gels  medications applied directly to the skin to reduce spots and redness oral medications  tablets or capsules that canhelp clear up more severe spots, such as oral antibiotics In some cases procedures such as laser and intense pulsed light (IPL) treatment may be helpful.These involvebeams of lightbeing aimed at the visible blood vessels in the skin to shrink them and make them less visible. Read about more about treating rosacea and self-help measures for rosacea Living with rosacea Any long-term (chronic) condition can have an adverse psychological effect, but rosacea can be particularly troublesomeas it affects your appearance. This can change how you feel about yourself and how you interact with others. Many people with rosacea have reported feelings of low self-esteem, embarrassment and frustration. Its important to try to come to terms with the fact you have a chronic condition that, although incurable, is controllable. Persevering with your treatment plan and avoiding your individual triggers are the best ways of controlling your symptoms. As your physical symptoms improve, youmay start to feel better psychologically and emotionally. If you have rosacea, take comfort in knowing youre not alone. There are millions of people living with the conditionin the UK and across the world. You can find support and information from organisations like: Changing Faces  a charity for people with a visible difference or facial disfigurement, who can be contacted on0300 012 0275 for counselling and advice Speak to your GP if youre feeling depressed as a result of your condition. They may recommend further treatment if necessary. Ocular rosacea Rosacea that affects your eyes (ocular rosacea) can lead to a number of eye problems, some of which can be serious. Symptoms of ocular rosacea can include: feeling like there is something in your eyes dry eyes irritated and bloodshot eyes inflammation of the eyelids (blepharitis) Rosacea can sometimes cause the cornea, the transparent layer at the front of the eyeball, to become inflamed and damaged. This is known as keratitis. This damage can make the cornea vulnerable to ulceration and infection, which could potentially threaten your sight. Symptoms of serious problems with your corneas include: eye pain sensitivity to light (photophobia) deterioration in your vision Contact your GP immediately if you think you may have a problem with your corneas. If this isnt possible, visit your nearest accident and emergency (A&E) department . If keratitis isnt treated promptly by an ophthalmologist, a doctor who specialises in treating eye conditions, theres a risk of permanent vision loss. Symptoms of rosacea Rosacea causes a range of symptoms, although not everyone will experience them all. Most people with rosacea have periods when their symptoms are particularly troublesome, followed by periodswhen their symptoms are less so. The main symptoms of rosacea include: flushing persistent facial redness visible blood vessels papules and pustules thickened skin These are discussed in more detail below. Other symptoms associated with rosacea include: sensitive skin burning, itching, stinging andpain dry, rough skin raised red patches (plaques) on your skin facial swelling (lymphoedema) Rosacea can cause different symptoms, including facial redness and flushing. Source: https://dermnetnz.org/ Permanent damage to the face (scarring) almost never occurs in rosacea. Flushing Flushingis when your skin turns red for a short period usually a few minutes. It tends to mainly affect the face, although it can spread to your neck and chest. In some cases the redness may be accompanied by an unpleasant feeling of heat. In rosacea flushingis often caused by a certain trigger, such as sun exposure, hot drinks or exercise. See causes of rosacea for more information about possible triggers. Persistent facial redness Persistent facial redness (erythema) islikea blush or a patch of sunburn that doesnt go away, or the sort of blotchy skin often associated with drinking too much alcohol. This can be upsetting for those with rosacea as people can mistakenly assume they are heavy drinkers. The redness usually affects the cheeks, nose and chin, but may spread to other areas, such as the forehead, neck and chest. Visible blood vessels Over time the blood vessels in the skin may become permanently widened(dilated) and visible. The medical name for visible blood vessels is telangiectasia. Papules and pustules If you have rosacea, you may develop round red bumps that rise from your skin (papules) and pus-filled swellings(pustules). These spots appear on your face and are similar to acne . Rosacea used to be called acne rosacea, but the 2conditions are quite different. In rosacea there are no blackheadsandthe skin is not greasy, but dry and peeling. Rosacea spots also dont cause scarring. Thickened skin In the most serious cases of rosacea the skin can thicken and form excess tissue, usually around the nose. This causes the nose to take on a large, bulbous appearance (rhinophyma). Rhinophyma is an uncommon,severesymptom of rosacea and takes several years to develop. Italmost exclusively affects men. Causes of rosacea The exact cause of rosacea is unknown, although a number of potential factors have been suggested. Its possible a combination of these factors may be responsible for the condition, although there isnt enough evidence to say this for certain. Some of the main factors that have been suggested are outlined below. Blood vessel abnormalities Some experts believe abnormalities in the blood vessels of the face may be a major contributing factor for rosacea. This may explain symptoms of flushing, persistent redness and visible blood vessels. Its not known what causes these abnormalities. But sun damage may be responsible for degeneration of the elastic tissue of the skin and the dilation of blood vessels. Skin peptides Recent research has shown external triggers such as ultraviolet (UV) light, spicy food, alcohol (particularly red wine), exercise, stress, heat and cold can lead to theactivation of certain molecules within the skin called peptides. Increased levels of these peptides may in turn affect the immune system ornerves and blood vessels(neurovascular system) of the skin. Activation of these systems can cause dilation of blood vessels, redness and inflammation. Microscopic mites Microscopic mites called demodex folliculorum usually live harmlessly on human skin, but people with rosacea have particularly large numbers, which may play a role in the condition. It is currently uncertain whether the mite is a cause or an effect of rosacea, although someresearchers have suggested the symptoms may be caused by the skin reacting tobacteria in the mites faeces. Helicobacter pylori bacteria Helicobacter pylori bacteria are bacteriafound in the digestive system. Its been suggested these bacteria may be a possible cause of rosacea, althougha linkhasnt been proven. One theory is the bacteria may stimulate the production of a protein called bradykinin, which is known to cause blood vessels to expand. Genetics Rosacea seems to be more common in families, although its not clear which genes if any are involved or how theyre passed on. Triggers of rosacea Although theyre not thought to be direct causes ofthe condition, many people with rosacea find certain triggers make their symptoms worse. Different people can have different triggers, but triggers that have been commonly reported include: exposure to sunlight stress hot or cold weather strongwinds strenuous exercise alcohol hot baths spicy foods hot drinks humidity caffeine found in tea, coffee and cola the menopause dairy products othermedical conditions certain medicines such as amiodarone, corticosteroids and high doses of vitamins B6 and B12 Treating rosacea Although rosacea cant be cured, treatment can help keep the symptoms under control. Long-term treatment is usually necessary, although there may be periods where your symptoms improve and you can stop treatment temporarily. Treatment choices depend onwhich type of symptom is most troublesome, but usually involves a combination ofself-help measures and medication, and areoutlined below. Self-help measures There are a number ofthings you can do yourself to help keep the symptoms of rosacea under control, including: avoiding things that trigger your symptoms  for example, by using sun cream and covering yourself up if direct sunlight makes your symptoms worse taking good care of your skin  for example, byusingproducts suitable for sensitive skin using make-up patches of persistent red skin can be disguised using specially designed camouflage make-up keeping your eyelids clean  if rosacea is causing your eyelids to become inflamed (blepharitis) Treating papules and pustules If you haveround red bumps that rise from your skin (papules) and pus-filled swellings (pustules) caused by rosacea, there are a number of different medications that can be effective. These can be divided into topical treatments that are applied to the skin, or oral treatments, which are taken by mouth. Topical treatments Topical medications are usually prescribed first. These include: metronidazole cream or gel azelaic acid cream or gel ivermectin cream Ivermectin is a relatively new medicine. Theres some evidence to suggest it may be more effective and perhaps less irritating to the skin than metronidazole, although its not currently available on the NHS everywhere and may only be recommended if the other treatments dont work. Youll usually need to apply these topical treatments once or twice a day, taking care not to get them in your eyes or mouth. It may be several weeks before you notice any significant improvement in your symptoms. Side effects of these treatments can include a burning or stinging sensation, itchiness and dry skin. Oral antibiotics If your symptoms are more severe, an oral antibiotic medication may be recommended as these can help reduceinflammation of the skin. Antibiotics often used to treat rosacea include tetracycline, oxytetracycline, doxycycline and erythromycin. These medications are usually taken for 4to 6weeks, but longer courses may be necessary if the spots are persistent. For example, a low-dose doxycycline capsule is available if oral antibiotics need to be taken long term. Common side effects of these medications include: feeling and being sick diarrhoea bloating and indigestion tummy (abdominal)pain loss of appetite Some of the medications used can alsomake your skin sensitive to sunlight and artificial sources of light, such as sun lamps and sunbeds. As with the topical treatments mentioned above, these medications usually need to be takenonce or twice a day and you may not notice a significant improvement in your symptoms for several weeks. Oralisotretinoin Isotretinoin is a medicine often used to treat severe acne ,but at lower doses its also occasionally used to treat rosacea. As isotretinoin is a strong medication that can cause a range of side effects, it can only be prescribed by aspecialistin treating skin conditions (dermatologist) and not your GP. Common side effects of isotretinoin include: dryness and cracking of the skin, lips and nostrils inflammation of your eyelids (blepharitis) oreyes (conjunctivitis) headaches muscle orjoint pain back pain blood in your urine (haematuria) mood changes Isotretinion can also cause birth defects if taken during pregnancy. Treating facial redness Treatingfacial redness andflushing caused by rosaceais generally more difficult than treating papules and pustules caused by the condition. But as well asthe self-help measures mentioned above, there are some medications that can help. Brimonidine tartrate Brimonidine tartrate is a relatively new medication for facial redness caused by rosacea. It comes in the form of agel thats applied to the face once a day. The medication works by restricting the widening (dilation) of the blood vessels in your face. Researchhas shown it can start to have an effect about 30 minutes after its first used, and this can last for around 12 hours. Common side effects ofbrimonidine tartrate include itchiness and a burning sensation where the gel is applied. Less common side effects can include: a dry mouth headaches pins and needles dry skin A rebound effect, where flushing becomes worse, has also been reported with this medication. Oral treatments Alternatively, there are a number of oral medications that may help improve redness caused by rosacea. These include: clonidine a medication that relaxes the blood vessels beta-blockers  medications that decrease the activity of the heart anxiety medications medications sometimes used to help calm the person and reduce blushing Its not clear how effective these medications are at treating redness caused by rosacea, but they may sometimes be prescribed under the supervision of a dermatologist. Laser and intense pulsed light (IPL) treatment Redness and visible blood vessels (telangiectasia) can also sometimes be successfully improved with vascular laser or intense pulsed light (IPL) treatment. These treatments may also improve flushing. A referral to a dermatologist is usually required before having these treatments and theyre not usually available on the NHS, so you may need to pay for them privately. Around 2to 4treatments may be needed, so the overall cost may be significant. Laser and IPL machines produce narrow beams of light that are aimed at the visible blood vessels in the skin. The heat from the lasers damages the dilated veins and causes them to shrink so theyre no longer visible, with minimal scarring or damage to thesurrounding area. Laser treatment can cause pain, but most people dont need an anaesthetic. Side effects of laser treatment are usually mild and can include: bruising crusting of the skin swelling and redness of the skin blisters (in rare cases) infection (in very rare cases) These side effects usually only last a few days and are rarely permanent. Treating thickened skin In some people with rosacea the skin of the nose can become thickened. This is known asrhinophyma. If you have severe rhinophyma, your GP may refer you to a dermatologist or plastic surgeon todiscussways the appearance of your skin can be improved. A number of surgical treatments are available to remove any excess tissue and remodel the nose into a more pleasing shape. This may be done with alaser, a scalpel or specially designed abrasive instruments using a technique called dermabrasion. Treating eye problems If rosaceais affecting your eyes (ocular rosacea), you may require further treatment. For example, you may need to use lubricating eye drops or ointment if you have dry eyes, or oral antibiotics if you have blepharitis. Ifinitial treatment isnteffective or you develop any further problems with your eyes, youll need to be referred to an eye specialist called an ophthalmologist for further assessment and treatment. Preventing rosacea If you have rosacea, there are a number of things you can do to help keep the condition under control. Avoid triggers Many people with rosacea notice certain triggers make their symptoms worse. Although its not always practical or possible, takingstepsto avoid these triggers canhelp reduce the severity and frequency of your symptoms. If youre not sure whether your symptoms have a specific trigger, it may be useful to keep a diary to identify whether your symptoms get worse depending on thingslike the activities you do and foods or drinks you have. Advice about how to avoid some common triggers can be foundbelow. Sunlight As sunlight is the most commonly reported trigger of rosacea, you should use sun cream whenever possible, even when its overcast. A sun cream with a sun protection factor (SPF) of at least 30 is recommended. A broad-spectrum sun cream that protects against UVA and UVB light should be used. Using sun creams specifically designed for children may help reduce skin irritation. Covering exposed skin with clothes or a sun hat may also help. Try to minimise your exposure to the sun during the summer months, particularly in the middle of the day when the sun is at its hottest. But remember, sun can also be strong in the morning and evening, so take adequate precautions at these times as well. Stress Stress is also a commonlyreported trigger of rosacea. Successfully managing your stress levels can help control your symptoms. Ways you can reduce stress include: learning relaxation techniques, such asdeep breathing exercises, meditation and yoga taking regular exercise As strenuous exercise can sometimes make rosacea symptoms worse, a low-intensity exercise programme, such as walking or swimming, may be better than high-intensity activities, such as running or aerobics. Readabout stress management . Food and drink Some of the mostcommonly reported food- and drink-related triggers are alcohol and spicy foods. You may want to try completely removing these from your diet to see if your rosacea improves. Butthere are many other dietary triggers that can also affect some people with rosacea. Its a good idea to include information about how your diet affects your rosacea symptoms inyour rosacea diary. Cold weather Covering your face and nose with a scarf can help protect your skin from cold temperatures and wind. If you need to spend considerable time outside during cold weather, protect your facewith a balaclava. Skincare techniques The advice below about skincare techniques may also help control your rosacea symptoms. Clean your skin every morning and evening using a gentle, non-abrasive cleanser. Use soap-free cleansers with non-alkaline or neutral pH. Avoid scented soaps and alcohol-based skin cleansers Rinse your face with lukewarm water and allow skin to dry thoroughly before you apply medication or make-up Look for products suitable for sensitive skin. These are usually described as mild, hypoallergenic, fragrance-free and non-comedogenic (will not block pores) Use a moisturiser to soothe skin if it feels sore Avoid oil-based or waterproof cosmetics requiring solvents for removal. Use water-based make-up and skin productsinstead Avoid astringents, toners and other facial or hair products that contain ingredients that might irritate your skin, such as fragrances, alcohol, menthol, witch hazel,eucalyptus oil, camphor, clove oil, peppermint, sodium lauryl sulphate and lanolin You may want to avoid using anything on your skin that you arent sure of. You can then graduallyreintroduce products once your symptoms have been treated and cleared to see if you can use them again without any problems Men may find that using an electric razor, rather than a blade, helps reduce skin irritation Some people find regular gentle facial massage reduces swelling (lymphoedema) Dont use steroid cream unless youre specifically instructed to by your GP, as it may make your symptoms worse Skin camouflage It may be possible to disguise patches of persistent red skin using specially designed camouflage make-up. The charity Changing Faces offers a skin camouflage service , available nationally and free of charge, to help with the use of these creams. Your GP or dermatologist can refer you to the skin camouflage service and prescribe skin camouflage make-up. Eyelid hygiene If your eyelids are inflamed as a result of rosacea (blepharitis), cleaning your eyelids every day withwarm water and a small amount of cleaning solution can help ease your symptoms. Avoidingeye make-up can also help reduce your symptoms, but if you do choose towear eye make-up, make sure it is a type that washes off easily so you can still clean your eyelids. Source: NHS 24 - Opens in new browser window Last updated: 10 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites Changing Faces NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Scabies,"Scabies | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Skin, hair and nails Scabies Scabies About scabies Symptoms of scabies Causes of scabies Diagnosing scabies Treating scabies Complications of scabies About scabies Scabies is a contagious skin condition caused by tiny mites that burrow into the skin. The main symptom of scabies is intense itching thats worse at night. It also causes askin rash on areas where the mites have burrowed. Read more about the symptoms of scabies . Scabies mites Scabies mites are called Sarcoptes scabiei. They feed using their mouths and front legs to burrow into the outer layer of skin (epidermis), where they lay eggs. After 3to 4days, the baby mites (larvae) hatch and move to the surface of the skin, where they mature into adults. Scabies like warm places, such as skin folds, between the fingers, under fingernails, or around the buttock or breast creases. They can also hide under watch straps, bracelets or rings. Read more about the life cycle of the scabies mite . How scabies is spread Scabies is usually spread through prolonged periods of skin-to-skin contact with an infected person, or through sexual contact. Its also possible but rare for scabies to be passed on by sharing clothing, towels and bedding with someone whos infected. It can take up to 8weeks for the symptoms of scabies to appear after the initial infection. This is known as the incubation period. Read more about the causes of scabies . Scabies outbreaks Scabies is widespread in densely populatedareas with limited access to medical care, and is most common in the following tropical and subtropical areas: Africa Central and South America northern and central Australia Caribbean Islands India southeast Asia In developed countries, scabies outbreaks can sometimes occur in places where there are lots of people, such as schools, nurseries andcare homes. In the UK, most outbreaks of scabies occur in the winter. This may be because people tend to spend more time indoors and closer to each other at this time of year. Its difficult to know exactly how many cases of scabies there are in the UK. This is because many people dont visit their GP and treat the condition with non-prescription medicines. Treating scabies Visityour GP if you thinkyou have scabies.Its not usually a serious condition, but it does need to be treated. The 2most widely used treatments for scabies are permethrin cream andmalathion lotion.Both medications contain insecticides that kill the scabies mite. Permethrin 5% cream is usually recommended as the first treatment. Malathion 0.5% lotion is used if permethrinis ineffective. If your partnerhas been diagnosed with genital scabies, to avoid reinfection you should visit your nearest sexual health clinic so you can be checkedand, if necessary, treated. Avoid having sex and other forms of close bodilycontact until both you and your partner have completed the full course of treatment. Read more about diagnosing scabies and treating scabies . Complications of scabies Scabies can sometimes lead to a secondary skin infection if your skin becomes irritated and inflamed through excessive itching. Crusted scabies is arare but more severe form of scabies, wherea large number ofmites are in the skin. This can develop inolder people and those with a lowered immunity. Read more about complicationsof scabies . Symptoms of scabies The main symptoms of scabies are intense itching and a rash in areas of the body where the mites have burrowed. The itching is often worse at night, when your skin is warmer.It may take 4to 6weeks before the itching starts because this is how long it takes for the body to react to mite droppings. Symptoms will start within 1to 2days if youve had a scabiesinfection in the past. This is because your immune system will have learned to respond to a scabies infection. What does a scabies rash look like? The scabiesrash consists of tiny redspots. Scratching the rash may cause crusty sores to develop. Burrow marks can be found anywhere on the body. Theyre short (1cm or less), wavy, silver-coloured lines on the skin, with a black dot at one end that can be seen with a magnifying glass. Scabies cause burrow marks of short, wavy and silver-coloured lines. Source: https://dermnetnz.org/ A scabies rash often appears on the palms of the hands. Source: https://dermnetnz.org/ Where does a scabies rash develop? In adults, burrow marks often appear in the following areas: the folds of skin betweenfingers and toes the palms of the hands the soles and sides of the feet the wrists the elbows around thenipples (in women) around the genital area (in men) The rash usually affects the whole body, apart from the head.The following areas can be particularly affected: the underarm area around the waist the inside of the elbow the lower buttocks the lower legs the soles of the feet theknees the shoulder blades the female genital area the groin around the ankles Elderly people, young children and those with a low immune system (immunocompromised) may also develop a rash on their head and neck. Men usually have 1or more very itchy, lumpy, 3 to 10mm spots on the skin of the genitals (on the penisand scrotum). In infants and young children, burrow marks tend to appear in differentplaces on their body, including onthe: face head neck scalp palms of the hands soles of the feet Scabies mites leave small red blotches and silver-coloured lines on the skin. These marks are caused by the mites burrowing into the skin. In infants with scabies, blisters and pustules (small blisters that contain pus) may develop onthe soles of the feet and palms of the hands. Causes of scabies Scabies is a skin condition caused by the parasite Sarcoptes scabiei. The intense itching associated with scabies is thought to be caused by the immune system reacting to the mites and their saliva, eggs and faeces. The scabies mite life cycle A scabies infestation starts when a female mite burrows into your skin. Male mites move between different burrow sites looking to mate. After mating, the male mite dies and the female begins to lay eggs, whichhatch around 3to 4days later. After hatching, the young mites move to the surface of the skin, where they mature into adults after 10 to 15 days. Male mites stay on the surface of the skin, whilefemale mites burrow back into the skin to create a new burrow. The life cycle is then repeated. Without effective treatment, the life cycle of the scabies mite can continue indefinitely. Scabies mites are resistant to soap and hot water and cant be scrubbed out of the skin. How scabies is spread Scabies mites cant fly or jump, which means they can only move from one human body to another if 2people have direct and prolonged physical contact. For example, scabies mites can be transmitted by: holding hands with aninfected person for a prolonged period of time having sex with aninfected person sharingclothing, towels and bedding with an infected person (althoughthis is rare) Its unlikely that scabies will be transmitted through brief physical contact, such as shaking hands or hugging. Scabies mites can survive outside the human body for 24 to 36 hours, making infection by coming into contact with contaminated clothes, towelsor bed linen a possibility. However, itsrare for someone to be infected in this way. Scabies infestations can spread quickly because people are usually unawaretheyhave the condition until 2to 3weeks after the initial infection. Theres an increased risk of catching scabies in confined environments, such as schools and nursing homes, where people are in close proximity to one another. Diagnosing scabies Your GP should be able to diagnose scabies from the appearance of your skin, and by looking for the burrow marks of the Sarcoptes scabiei mite. However, as scabiesis spread very easily, its often possible to make a confident diagnosis if more than one family member has the same symptoms. Your GP will also want to rule out other skin conditions that may be causing your symptoms, such as eczema or impetigo (a highly contagious bacterial skin infection). Read more about the symptoms of scabies . Ink test The burrows of scabies mites can be identified by using an ink test. Ink is rubbed around an area of itchy skin before being wiped off with an alcohol pad. If scabies burrows are present, some of the ink will remain and will have tracked into the burrows, showing up as a dark line. To confirm the diagnosis, a skin sample may be gently scraped from the affected area soit can be examined under a microscope for evidence of scabies mites, their eggs and faeces (poo). Where to get help with scabies Visit your GP if you think you have scabies. If you think you have genital scabies or your partner has been diagnosed with it, visit your nearest sexual health clinic , where youll be examined and, if necessary, treated. If you decide to treat scabies yourself, youll need to have a full sexual health check to make sure you dont have any sexually transmitted infections (STIs) . To prevent reinfection, its important that all members of your household are treated, as well as any sexual partners youve had over the last 6weeks (in the case of genital scabies). If youve had genital scabies in the past, anyone youve had sex with in the previous 48 hours will need to be treated. If youre embarrassed about contacting previous sexual partners, your GP surgery or local sexual health clinic may be able to inform them that theyve been exposed to scabies on your behalf without disclosing your identity. Sexual health clinics Some sexual health clinics operate on a walk-in basis. Others work byappointment only. Its therefore a good idea to call first. When you attend a clinic, youll be asked for your name, date of birth and contact details. These details will be treated confidentially and wont be passed on to your GP without your agreement. Youll also be asked about your sexual history, including: when you last had sex whether you used condoms whether youve had an STI in the past whether youre taking any medication If youre attending a clinic for scabies, you may also be offered tests for STIs. Treating scabies See your GP immediately if you have scabies and you havent had a previous infection. Delaying treatment places other people at risk. As other more serious skin conditions can sometimes cause similar symptoms to the symptoms of scabies , your GP will need to rule these out. If you have scabies, your partner will also need to be treated regardless of whether or not they have any symptoms. This is because its highly likely that scabies will have been transmitted through close bodily contact, such as duringsex. To reduce the risk of reinfection, avoid having sex and other forms of prolonged close bodily contact, such as holding hands,until both you and your partner have completedthefull course of treatment. If youve been diagnosed with scabies, you may be advised to visit your nearest sexual health clinic to be checked and, if necessary, treated for other sexually transmitted infections (STIs) . Lotions and creams Lotions and creams are commonly used to treat scabies. Your GP, pharmacist or nurse will be able to advise you about which treatment to use. Applying the cream or lotion To prevent reinfection, all members of your household and any close contacts, including recent sexual partners, should betreated at the same time as you, even if they dont have any symptoms. The cream or lotion should be applied to theskin ofall of your body, except your head.Before you apply it, make sure your skin iscool and dry. Dont apply it after having a hot bath. If you apply it when your body is hot, it will quickly be absorbed into your skin and wont remain on the area where the scabies burrows are. When using a cream or lotion to treat scabies, you should also: read the patient leaflet that comes with the cream or lotion for details of where to apply it  some products need to be applied to the whole body, including the scalp and face, whereas others must only be applied from the neck down pay particular attention to difficult-to-reach areas, like your back, the soles of your feet, in between your fingers and toes, under fingernails, and on your genitals use a cotton bud or old toothbrush to apply the treatment under fingernails and toenails  put the cotton bud or toothbrush in a bag and throw it away afterwards leave the treatment on your skin for 8 to 24 hours (depending on the preparation used) before washing it off thoroughly  follow the manufacturers instructions regarding how long to leave the cream or lotion on for reapply the cream or lotion immediately to any areas of skin that are washed during the period of application wash bed linen, nightwear and towels after the first application repeat the treatment process 7 days after the first application to ensure its successful  the second application will ensure any mites hatched from existing eggs are killed It can take a month after treatment for the general itching to subside completely, and longer for the lumpy genital lesions to resolve. Your GP may recommend repeating thetreatment or they may prescribe a different lotion. Speak to your GP if: the itching hasnt improved after 2 weeks of treatment and you notice new burrows on your skin you experience any persistent side effects Managing a scabies infection On the day you first apply the cream or lotion, you shouldwash all bed linen, nightwearand towels ata temperature above 50C (122F). If youre unable to wash certain items,place them in a plastic bag for at least 72 hours. After this time, the scabiesmites will have died. In cases of crusted scabies, you should cleanthe floors in your house and thoroughly vacuum your carpetsand furniture, including the armchairs and sofa. If youve been diagnosed with scabies,avoid close and prolonged physical contact with others until youve applied the cream or lotion. You should alsoavoid close contact with other members of your household until their treatment has been completed. Children and adults can return to school or work after the first treatmenthas been completed. Treating the itch Your GP should be able to prescribe treatments, such as a mild steroid cream,to reduce the itchiness. Menthol cream or gel, availablefrom pharmacies without a prescription, may alsohelp relieve itchy skin. Oralsedative antihistamines are also available from your local pharmacy and can be used to control itching and help you get a better nights sleep. As this type of antihistamine can cause drowsiness, you should avoid driving or operating heavy machinery if youre affected in this way. Non-sedating antihistamines dont help relieve the itching of scabies.Check with your GP or pharmacistif youreunsure. You may continue to experience itchiness for a couple of weeks after your treatment has been completed. This is because your immune system will still be reacting to the presence of dead mites and their droppings. Visit your GP if youre still experiencing itchiness 6weeks after completingyour treatment. Complications of scabies A secondary infection and crusted scabies are 2possible complications of scabies. Secondary infection Repeatedly scratchingitchy skincaused byscabies may break the skins surface. This willmake youmore vulnerable to developing a bacterial skin infection, such as impetigo . Antibiotics may be recommended to control a secondary infection. Scabies has been known tomake some pre-existing skin conditions, such as eczema ,worse. However, other skin conditions should settle down afterthe scabies infection has been successfully treated. Crusted scabies Crusted scabies, also known as Norwegian scabies, is a more severe form of scabies. This means thousands or even millions of scabies mites are present. Normal scabies can develop into crusted scabiesafter a skin reaction. The condition affects all parts of the body, including your head, neck, nails and scalp. However, unlike normal scabies, the rash associated with crusted scabies usually doesnt itch. In crusted scabies, the increase in the number of mites causes thick, warty crusts to develop on the skin. Its often mistaken for psoriasis (a skin condition that causes red, flaky, crusty patches of skin covered with silvery scales). Crusted scabies affects people with a weakened immune system (the bodys natural defence against infection andillness). This includes: the very young people with brain disorders (neurological disorders, such as Parkinsons disease ) people with Downs syndrome pregnant women elderly people people with a condition that affects their immune system, such as HIV or AIDs people who are taking steroids to treat other medical conditions people who are having chemotherapy treatment Research has found a healthy immune system appears to interrupt the reproductive cycle of the scabies mite . For example, most people with scabies will only have 5 to 15 mites on their body at any one time. However, if you have a weakened immune system, the number of scabies mites can increase significantly. People with crusted scabies can have thousands or millions of scabies mites on their body at any one time. Because ofthe high number of scabies mites, crusted scabies is highly contagious. Even minimal physical contact with a person with crusted scabies, or with their bed linen or clothes, can lead to infection. However, contact withsomeone with crusted scabies willonly lead to the normal type of scabies in people with a healthy immune system. Crusted scabies can be treated using insecticide creams or a medicine called ivermectin, which is taken by swallowing a tablet. Ivermectin kills the mites by stopping their nervous system working. Source: NHS 24 - Opens in new browser window Last updated: 05 February 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Impetigo Self-help guide: Rash Other health sites BAD: scabies BAD: impetigo BASHH: sexual health Brook: advice for under 25s NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Scarlet fever,"Scarlet fever | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Scarlet fever Scarlet fever Scarlet fever is a bacterial illness that mainly affects children. It causes a distinctive pink-red rash. The illness is caused by Streptococcus pyogenes bacteria, also known as Group A Streptococcus , which are found on the skin and in the throat. Scarlet fever symptoms Scarlet fever usually follows a sore throat or a skin infection, like impetigo , caused by particular strains of Streptococcus bacteria. The symptoms of scarlet fever usually develop 2 to 5 days after infection. However, the incubation period (the period between exposure to the infection and symptoms appearing) can be as short as one day or as long as 7 days. Speak to your GP if: You or your child: have symptoms of scarlet fever do not get better in a week (after seeing a GP) have scarlet fever and chickenpox at the same time are ill again weeks after scarlet fever got better  this can be a sign of a complication like rheumatic fever are feeling unwell and have been in contact with someone who has scarlet fever Rash The distinctive rough pink-red rash caused by scarlet fever. https://dermnetnz.org/ The distinctive rough texture rash caused by scarlet fever. https://dermnetnz.org/ The distinctive pink-red rash caused by scarlet fever develops 12 to 48 hours after symptoms like a sore throat or headache. Red blotches are the first sign of the rash. These turn into a fine pink-red rash that feels like sandpaper to touch and looks like sunburn . It may also be itchy. On darker skin the rash may be more difficult to see although its rough texture should be apparent. The rash usually starts on the chest and stomach, but soon spreads to other parts of the body, like the: ears neck elbows inner thighs groin The rash doesnt usually spread to the face. However, the cheeks become flushed and the area just around the mouth stays quite pale. The rash will turn white if you press a glass on it. The rash usually fades after about a week, but the outer layers of skin, usually on the hands and feet, may peel for several weeks afterwards. In milder cases, sometimes called scarlatina, the rash may be the only symptom. Other symptoms of scarlet fever Other symptoms of scarlet fever may include: swollen neck glands loss of appetite nausea or vomiting red lines in the folds of the body, such as the armpit, which may last a couple of days after the rash has gone a white coating on the tongue, which peels a few days later leaving the tongue red and swollen (this is known as strawberry tongue) a general feeling of being unwell When to seek medical advice If you think you or your child may have scarlet fever, see your GP for a proper diagnosis and appropriate treatment. It usually clears up after about a week Your GP should be able to diagnose scarlet fever by examining the distinctive rash and asking about other symptoms. They may also decide to take a sample of saliva from the back of the throat so it can be tested in a laboratory to confirm the diagnosis. Theres no evidence to suggest that catching scarlet fever when pregnant will put your baby at risk. However, if youre heavily pregnant, tell the doctors and midwives in charge of your care if youve been in contact with someone who has scarlet fever. How scarlet fever spreads Scarlet fever is very infectious and can be caught by: breathing in bacteria in airborne droplets from an infected persons coughs and sneezes touching the skin of a person with a Streptococcal skin infection, such as impetigo sharing contaminated towels, baths, clothes or bed linen It can also be caught from people who have the bacteria in their throat or on their skin but dont have any symptoms. Whos affected by scarlet fever Most cases of scarlet fever occur in children under 10 (usually between 2 and 8 years of age). However, people of any age can get the illness. As its easily spread, scarlet fever is likely to affect someone in close contact with a person with a sore throat or skin infection caused by Streptococcus bacteria. Outbreaks can occur in nurseries and schools where children are in close contact with one another. The symptoms of scarlet fever will only develop in people susceptible to toxins produced by the Streptococcus bacteria. Most children over 10 years of age will have developed immunity to these toxins. Its possible to have scarlet fever more than once, but this is rare. Treating scarlet fever Most cases of scarlet fever clear up after about a week without treatment. However, your GP may recommend treatment as it: reduces the length of time youre infectious speeds up recovery lowers the risk of complications of scarlet fever With treatment, most people recover in about 4 to 5 days and can return to nursery, school or work 24 hours after starting antibiotic treatment. Without treatment, youll be infectious for 1 to 2 weeks after symptoms appear. Antibiotics Scarlet fever is usually treated with a 10-day course of antibiotics . This is often in the form of penicillin or amoxicillin tablets, although liquid may be used for young children. For people who are allergic to penicillin, alternative antibiotics like erythromycin can be used instead. The symptoms usually improve within 24 hours of starting antibiotics, with the other symptoms disappearing within a few days. However, its important that the whole course of treatment is completed to ensure the infection is fully cleared and reduce the potential for antibiotic resistance . Keep your child away from nursery or school for at least 24 hours after starting antibiotic treatment. Adults with scarlet fever should also stay off work for at least 24 hours after starting treatment. Self care Many of the symptoms of scarlet fever can be relieved using some simple self care measures. Do drink plenty of cool fluids eat soft foods (if your throat is painful) take paracetamol to bring down a high temperature use calamine lotion or antihistamines to relieve itching Complications of scarlet fever Most cases of scarlet fever dont cause complications, particularly if the condition is properly treated. However, theres a small risk of the infection spreading to other parts of the body and causing more serious infections, like: an ear infection a throat abscess (painful collection of pus) sinusitis (inflammation of the sinuses) pneumonia (inflammation of the lungs) Very rare complications that can occur at a later stage include: bacteraemia (an infection of the bloodstream) septic arthritis meningitis necrotising fasciitis (a severe infection involving death of areas of soft tissue below the skin) Streptococcal toxic shock syndrome (rapidly progressive symptoms with low blood pressure and multi-organ failure) Speak to your GP immediately if: You or child develop any of these symptoms in the first few weeks after the main infection has cleared up: feeling very unwell severe pain severe headaches vomiting diarrhoea If your GP is closed, phone the 111 service. Preventing scarlet fever from spreading Theres currently no vaccine for scarlet fever. If your child has scarlet fever, keep them away from nursery or school for at least 24 hours after starting treatment with antibiotics. Adults with the illness should also stay off work for at least 24 hours after starting treatment. GPs, schools and nurseries should be aware of the current high levels of scarlet fever and inform local health protection teams if they become aware of cases, particularly if more than one child is affected. Do cover your mouth and nose with a tissue when coughing or sneezing wash your hands with soap and water after using or disposing of tissues. Dont do not share contaminated utensils, cups and glasses, clothes, baths, bed linen or towels Source: NHS 24 - Opens in new browser window Last updated: 01 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Self-help guide: Sore throat Self-help guide: Fever in adults Self-help guide: Fever in babies Fever in adults Fever in children Streptococcus A (strep A) Other health sites Group A strep in Scotland NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Schizophrenia,"Schizophrenia | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Mental health Schizophrenia Schizophrenia Introduction Symptoms Causes Diagnosis Treatment Living with Introduction Schizophrenia is a long-term mental health condition that causes a range of different psychological symptoms, including: hallucinations hearing or seeing things that do not exist delusionsunusual beliefs not based on reality that often contradict the evidence muddled thoughts based on hallucinations or delusions changes in behaviour Doctors often describe schizophrenia as a psychotic illness.This means sometimes a person may not be able to distinguish their own thoughts and ideas from reality. Read more about the symptoms of schizophrenia . Why does schizophrenia happen? The exact cause of schizophrenia is unknown. However, most experts believethe condition is caused by a combination of genetic and environmental factors. It is thought certain things make you more vulnerable to developing schizophrenia, andcertain situations cantrigger the condition. Read more about the causes of schizophrenia . Who is affected? Schizophrenia is one of the most common serious mental health conditions. About1 in 100 people will experience schizophrenia in their lifetime, with many continuing to lead normal lives. Schizophrenia is most often diagnosed between the ages of 15 and 35. Men and women are affectedequally. There is no single test for schizophrenia. It is most often diagnosed after an assessment by a mental health care professional, such as a psychiatrist. It is important that schizophrenia is diagnosed as early as possible, as the chances of recovery improve the earlier it is treated. Read more about diagnosing schizophrenia . How is schizophrenia treated? Schizophrenia is usually treated with a combination of medication and therapyappropriate to each individual. In most cases, this will be antipsychoticmedicines and cognitive behavioural therapy (CBT). People with schizophrenia will usually receive help from a community mental health team (CMHT), which will offer day-to-day support and treatment. Many people recover from schizophrenia, although they may have periods when symptoms return (relapses). Support and treatment can helpreduce the impactthe condition hason your life. Read more about treating schizophrenia. Living with schizophrenia If schizophrenia is well managed, it is possible to reduce the chances of severe relapses. This can include: recognising the signs of an acute episode taking medication as prescribed talking to others about the condition There are many charities and support groups offering help and advice on living with schizophrenia. Most peoplefind it comfortingtalking to others with a similar condition. Read more about living with schizophrenia . Symptoms Changes in thinking and behaviour are the most obvious signs of schizophrenia, but people can experience symptoms in different ways. The symptoms of schizophrenia are usually classified into one of two categoriespositive or negative. positive symptoms  represent a change in behaviour or thoughts, such as hallucinations or delusions negative symptoms  represent a withdrawal or lack of function that you would usually expect to see in a healthy person; for example, people with schizophrenia often appear emotionless, flat and apathetic The conditionmay develop slowly. The first signs of schizophrenia, such as becoming socially withdrawn and unresponsive or experiencing changes in sleeping patterns, can be hard to identify. This is because the first symptoms often develop during adolescence and changes can be mistaken for an adolescent phase. People often have episodes of schizophrenia, during which their symptoms are particularly severe, followed by periods where they experience few or no positive symptoms. This is known as acute schizophrenia. If you are experiencing symptoms of schizophrenia, see your GP as soon as possible.The earlier schizophrenia is treated, the more successful the outcome tends to be. Read more information about how schizophrenia is diagnosed . Positive symptoms of schizophrenia Hallucinations A hallucination is when a person experiences a sensation but there isnothing ornobody there to account for it. It can involve any of the senses, but the most common is hearing voices. Hallucinations are very real to the person experiencing them, even though people around themcannot hear the voices or experience the sensations. Research using brain-scanning equipment shows changes in the speech area in the brains of peoplewith schizophreniawhen they hear voices. These studies show the experience of hearing voices as a real one, as if the brain mistakes thoughts for real voices. Some people describe the voices they hear as friendly and pleasant, but more often they are rude, critical, abusive orannoying. The voices might describe activities taking place, discuss the hearers thoughts and behaviour, give instructions, or talk directly to the person. Voices may come from different places orone place in particular, such as the television. Delusions A delusion is a beliefheld with complete conviction, even though it is based on a mistaken, strange or unrealistic view. It may affect the way people behave. Delusions can begin suddenly, or may develop over weeks or months. Some people develop a delusional idea to explain a hallucination they are having. For example, if they have heard voices describing their actions, they may have a delusion that someone is monitoring their actions. Someone experiencing a paranoid delusion may believethey are being harassed or persecuted. They may believe they are being chased, followed, watched, plotted against or poisoned, often by a family member or friend. Some people who experience delusions find different meanings in everyday events or occurrences. They may believepeople on TV or in newspaper articles are communicating messages to them alone, or that there are hidden messages in the colours of cars passing on the street. Confused thoughts (thought disorder) People experiencing psychosis often have trouble keeping track of their thoughts and conversations. Some people find it hard to concentrate and will drift from one idea to another. They may have trouble reading newspaper articles or watching a TV programme. People sometimes describe their thoughts as misty or hazy when this is happening to them. Thoughts and speech may become jumbled or confused, making conversation difficult and hard for other people to understand. Changes in behaviour and thoughts A persons behaviour may become more disorganised and unpredictable, and their appearance or dress may seem unusual to others. People with schizophrenia may behave inappropriately or become extremely agitated and shout or swear for no reason. Some people describe their thoughts as being controlled by someone else, that their thoughts are not their own, or that thoughts have been planted in their mind by someone else. Another recognised feeling is that thoughts are disappearing, as though someone is removing them from their mind. Some people feel their body is being taken over and someone else is directing their movements and actions. Negative symptoms of schizophrenia The negative symptoms of schizophrenia can oftenappear several years before somebody experiences their first acute schizophrenic episode. These initial negative symptoms are often referred to as the prodromal period of schizophrenia. Symptoms during the prodromal period usually appear gradually and slowly get worse. They include becoming more socially withdrawn and experiencing an increasing lack of care about your appearance and personal hygiene. It can be difficult to tell whether the symptoms are part of the development of schizophrenia or caused by something else. Negative symptoms experienced by people living with schizophrenia include: losing interest and motivation in life and activities, including relationships and sex lack of concentration, not wanting to leave the house, and changes in sleeping patterns being less likely to initiate conversations and feeling uncomfortable with people, or feeling there is nothing to say The negative symptoms of schizophrenia can often lead to relationship problems with friends and family because they can sometimes be mistaken for deliberate laziness or rudeness. Causes The exact causes of schizophrenia are unknown, but research suggests that a combination of physical, genetic, psychological and environmental factors can make people more likely to develop the condition. Current thinking is that some people may be prone to schizophrenia, and a stressful or emotional life event might trigger a psychotic episode. However, its not known why some people develop symptoms while others dont. Increased risk Things that increase the chances of schizophrenia developing include: Genetics Schizophrenia tends to run in families, but noone gene is thought to be responsible. Its more likelythat different combinations of genes make people more vulnerable to the condition. However, having these genes doesnt necessarily mean you will develop schizophrenia. Evidence the disorder is partly inherited comes from studies of twins. Identical twins share the same genes. Inidentical twins, if one twin develops schizophrenia, the other twin has a one in two chance of developing it too. This is true even if they are raised separately. In non-identical twins, who have different genetic make-ups, when one twin develops schizophrenia, the other only has a one in seven chance of developing the condition. While this is higher than in the general population (where the chance is about 1 in a 100), it suggests genes are not the only factor influencing the development of schizophrenia. Brain development Studies of people with schizophrenia have shown there are subtle differences in the structure of their brains. These changes arent seen in everyone with schizophrenia andcan occur in people who dont have a mental illness. But they suggestschizophrenia may partly be a disorder of the brain. Neurotransmitters These are chemicals that carry messages between brain cells. There is a connection between neurotransmitters and schizophrenia because drugs that alter the levels of neurotransmitters in the brain are known to relieve some of the symptoms of schizophrenia. Research suggestsschizophrenia may be caused by a change in the level of two neurotransmitters: dopamine and serotonin. Some studies indicatean imbalance between the two may be the basis of the problem. Others have found a change in the bodys sensitivity to the neurotransmitters is part of the cause of schizophrenia. Pregnancy and birth complications Research has shown that people who develop schizophrenia are more likely to have experienced complications before and during their birth, such as a low birth weight, premature labour, or a lack of oxygen (asphyxia) during birth. It may be that these things have a subtle effect on brain development. Triggers Triggers are things that can cause schizophrenia to develop in people who are at risk. These include: Stress The main psychological triggers of schizophrenia are stressful life events, such as a bereavement, losing your job or home, a divorce or the end of a relationship, or physical, sexual, emotional or racial abuse. These kinds of experiences, though stressful, do not cause schizophrenia, but can trigger its development in someone already vulnerable to it. Drug abuse Drugs do not directly cause schizophrenia, but studies have shown drug misuse increases the risk of developing schizophrenia or a similar illness. Certain drugs, particularly cannabis, cocaine, LSDor amphetamines, may trigger symptoms of schizophrenia in people who are susceptible. Using amphetamines or cocaine can lead to psychosis and can cause a relapse in people recovering from an earlier episode. Three major studies have shown teenagers under 15 who use cannabis regularly, especially skunk and other more potent forms of the drug, are up to four times more likely to develop schizophrenia by the age of 26. Want to know more? Mind: what causes schizophrenia? Rethink Mental Illness: Schizophrenia Royal College of Psychiatrists: cannabis and mental health Diagnosis There is no single test for schizophrenia. The condition is usually diagnosed after assessment by a specialist in mental health. If you are concernedyou may be developing symptoms of schizophrenia, see your GP as soon as possible. The earlier schizophrenia is treated, the more successful the outcome tends to be. Your GP will ask about your symptoms and check they are not the result of other causes, such as recreational drug use. Community mental health team (CMHT) If a diagnosis of schizophrenia is suspected, your GP should refer you promptly to your local community mental health team (CMHT). CMHTs are made up of different mental health professionals who support people with complex mental health conditions. A member of the CMHT team, usually a psychiatrist or a specialist nurse, will carry out a more detailed assessment of your symptoms. They will also want to know your personal history and current circumstances. To make a diagnosis, most mental healthcare professionals use a diagnostic checklist. Schizophrenia can usually be diagnosed if: you have experienced one or more of the following symptoms most of the time for a monthdelusions, hallucinations,hearing voices, incoherent speechor negative symptoms, such as a flattening of emotions your symptoms have had a significant impact on your ability to work, study or perform daily tasks all other possible causes, such as recreational drug use or bipolar disorder, have been ruled out Related illnesses Sometimes it might not be clear whether someone has schizophrenia. If you have other symptoms at the same time, a psychiatrist may have reason to believe you have a related mental illness. There are severalrelated mental illnesses similar to schizophrenia. Your psychiatrist will askhow your illness has affected you so they can confidently confirm you have schizophrenia and not another mental illness, such as: bipolar disorder (manic depression) people with bipolar disorder swing from periods of mania (elevated moods and extremely active, excited behaviour) to periods of deep depression; some people also hear voices or experience other kinds of hallucinations, or may have delusions schizoaffective disorder this is often described as a form of schizophrenia because its symptoms are similar to schizophrenia and bipolar disorder, but schizoaffective disorder is a mental illness in its own right; it may occur just once in a persons life orrecur intermittently, often when triggered by stress. You should also be assessed for post-traumatic stress disorder and other conditions,suchasdepression, anxiety and substance misuse. Getting help for someone else As a result oftheir delusional thought patterns, people with schizophrenia may be reluctant to visit their GP if they believe there is nothing wrong with them. It is likelysomeone who has had acute schizophrenic episodes in the past will have been assigned a care co-ordinator. If this is the case, contact the persons care co-ordinator to express your concerns. If someone is having an acute schizophrenic episode for the first time, it may be necessary for a friend, relative or other loved one to persuade them to visit their GP. In the case of a rapidly worsening schizophrenic episode, you may need to go to the accident and emergency (A&E) department, where a duty psychiatrist will be available. If a person who is having an acute schizophrenic episode refuses to seek help, their nearest relative can request that a mental health assessment is carried out. The social services department of your local authority can advisehow to do this. In severe cases of schizophrenia, people can be compulsorily detained in hospital for assessment and treatmentunder the Mental Health (Scotland) Act 2015 . After diagnosis If you or a friend or relative are diagnosed with schizophrenia, you may feel anxious about what will happen. You may be worried about the stigma attached to the condition, or feel frightened and withdrawn. It is important to remember that a diagnosis can be a positive step towards getting good, straightforward information about the illness and the kinds of treatment and services available. Treatment Community mental health teams Most people with schizophrenia are treated by community mental health teams (CMHTs). The goal of the CMHT is to provideday-to-day support and treatment while ensuring you have as much independence as possible. A CMHT can be made up of and provide access to: social workers community mental health nurses a nurse with specialist training in mental health conditions occupational therapists pharmacists counsellors and psychotherapists psychologists and psychiatrists the psychiatrist is usually the senior clinician in the team After your first episode of schizophrenia, you should initially be referred to an early intervention team.These specialist teams provide treatment and support, and are usually made up of psychiatrists, psychologists, mental health nurses, social workers and support workers. Care programme approach (CPA) People with complex mental health conditions, such as schizophrenia, are usually entered into a treatment process known as a care programme approach (CPA). A CPA is essentially a way of ensuring you receive the right treatment for your needs. There are four stages to a CPA: assessment  your health and social needs are assessed care plan a care plan is created to meet your health and social needs care co-ordinatorappointed  acare co-ordinator, sometimes known as a key worker, is usually a social worker or nurse, and is your first point of contact with other members of the CMHT reviews your treatment will be regularly reviewed and, if needed, changes to the care plan can be agreed Not everyone uses the CPA. Some people may be cared for by their GP, while others may be under the care of a specialist. You will work together with your healthcare team to develop a care plan. The care plan may involve an advance statement or crisis plan, which can be followed in an emergency. Your care plan should includea combined healthy eating and physical activity programme and, if you smoke,supportfor giving up. Your care co-ordinator will be responsible for making sure all members of your healthcare team, including your GP, have a copy of your care plan. Want to know more? Rethink Mental Illness: Care programme approach fact sheet (PDF, 483kb) Acute episodes People who have serious psychotic symptoms asthe result of an acute schizophrenic episode may require a more intensive level of care than a CMHT can provide. These episodes are usually dealt with by antipsychotic medication and special care. Crisis resolution teams (CRT) One treatment option is to contact a home treatment or crisis resolution team (CRT). CRTs treat people with serious mental health conditions who are currently experiencing an acute and severe psychiatric crisis. Without the involvement of the CRT, these people would require treatment in hospital. The CRT aims to treat people in the least restrictive environment possible, ideally in or near their home. This can be in your own home, in a dedicated crisis residential home or hostel, or in a day care centre. CRTs are also responsible for planning aftercare once the crisis has passed to prevent a further crisis from occurring. Your care co-ordinator should be able to provide you and your friends or family with contact information in the event of a crisis. Voluntary and compulsory detention More serious acute schizophrenic episodes may require admission to a psychiatric ward at a hospital or clinic. You can admit yourself voluntarily to hospital if your psychiatrist agrees it is necessary. People can also be compulsorily detained at a hospital under the Mental Health (Scotland) Act 2015 . It is only possible for someone to be compulsorily detained at a hospital if they have a severe mental disorder, such as schizophrenia, and if detention is necessary: in the interests of the persons own health and safety toprotect others People with schizophrenia who are compulsorily detained may need to be kept in locked wards. All people being treated in hospital will stay only as long as is absolutely necessaryfor them toreceive appropriate treatment and arrange aftercare. An independent panel will regularly review your case and progress. Once they feel you are no longer a danger to yourself and others, you will be discharged from hospital. However, your care team may recommendyou remain in hospital voluntarily. Advance statements If it is felt there is a significant risk of future acute schizophrenic episodes occurring, you may want to write an advance statement. An advance statement is a series of written instructions about what you would like your family or friends to do in case you experience another acute schizophrenic episode. You may also want to includecontact details for your care co-ordinator. If you want to make an advance statement, talk to your care co-ordinator, psychiatrist or GP. Antipsychotics Antipsychotics are usually recommended as the initial treatment forthe symptoms of an acute schizophrenic episode. They work by blocking the effectof the chemical dopamineon the brain. Antipsychotics can usually reduce feelings of anxiety or aggression within a few hours of use, butmay take several days or weeks to reduce other symptoms, such as hallucinations or delusional thoughts. Its important that your doctor gives you a thorough physical examination before you start taking antipsychotics, and that you work together to find the right one for you. Antipsychotics can be taken orally (as a pill) or given as an injection (known as a depot). Several slow-release antipsychotics are available.These require you to haveone injection every two to four weeks. You may only needantipsychotics until your acute schizophrenic episode has passed. However, most people take medication for one or two years after their first psychotic episode to prevent further acute schizophrenic episodes occurring, and for longer if the illness is recurrent. There are two main types of antipsychotics: typical antipsychotics  the first generation of antipsychoticsdeveloped during the 1950s atypical antipsychotics  newer-generation antipsychoticsdeveloped in the 1990s The choice of antipsychotic should be made following a discussion between you and your psychiatrist about the likely benefits and side effects. Both typical and atypical antipsychotics can cause side effects, although not everyone will experience them and the severity will differ from person to person. The side effects of typical antipsychotics include: shaking trembling muscle twitches muscle spasms Side effects of both typical and atypical antipsychotics include: drowsiness weight gain, particularly with some atypical antipsychotics blurred vision constipation lack of sex drive dry mouth Tell your care co-ordinator, psychiatristor GP if your side effects become severe. There may be an alternative antipsychotic you can take or additional medicinesthat will help you deal with the side effects. If you do not benefit from one antipsychotic medication after taking it regularly for several weeks, an alternative can be tried. It is important that you work with your treatment team to find the right one for you. Do not stop taking your antipsychotics without first consulting your care co-ordinator, psychiatrist or GP.If you stop taking them,you couldhave a relapse of symptoms. Your medication should be reviewed at least once a year. Want to know more? Mind: antipsychotics Royal College of Psychiatrists: depot medication Psychological treatment Psychological treatment can help people with schizophrenia cope with the symptoms of hallucinations or delusions better. They can also help treat some of the negative symptoms of schizophrenia, such as apathy or a lack of enjoyment. Psychological treatments for schizophrenia work best when they are combined with antipsychotic medication. Common psychological treatments include: Cognitive behavioural therapy (CBT) Cognitive behavioural therapy (CBT) aims to help you identify the thinking patterns that are causing you to have unwanted feelings and behaviour, and learn to replace this thinking with more realistic and useful thoughts. For example, you may be taught to recognise examples of delusional thinking. You may then receive help and advice about how to avoid acting on these thoughts. Most people will requirebetween 8 and 20 sessions of CBT over the space of6 to 12 months. CBT sessions usually last for about an hour. Your GP or care co-ordinator should be able to arrange a referral to a CBT therapist. Family therapy Many people with schizophrenia rely on family members for their care and support. While most family members are happy to help, caring for somebody with schizophrenia can place a strain on any family. Family therapy is a way of helping you and your family cope better with your condition. It involves a series of informal meetingsover a period of around six months. Meetings may include: discussing information about schizophrenia exploring ways of supporting somebody with schizophrenia deciding how to solve practical problems that can be caused by the symptoms of schizophrenia If you think you and your family could benefit from family therapy, speak toyour care co-ordinator or GP. Arts therapy Arts therapies are designed to promote creative expression. Working with an arts therapist in a small group or individually can allow you to express your experiences with schizophrenia. Some people find expressing things in a non-verbal way through the arts can provide a new experience of schizophrenia and help them develop new ways of relating to others. Arts therapies have been shown to alleviate the negative symptoms of schizophrenia in some people. NICE recommendsthat arts therapies are provided by an arts therapistregistered with the Health and Care Professions Council who has experience of working with people with schizophrenia. Want to know more? Mind: understanding talking treatments Living with As well as monitoring your mental health, your healthcare team and GP should monitor your physical health. A healthy lifestyle,including a balanced diet with lots of fruits and vegetables and regular exercise, is good for you and can reduce your risk of developing cardiovascular disease or diabetes . You should also try to avoid too much stress and get a proper amount of sleep. You should have a check-up with your GP at least once a year to monitor your risk of developing cardiovascular disease or diabetes. This will include recording your weight, checking your blood pressure, and any appropriate blood tests. Stop smoking Rates of smokingin people with schizophrenia are three times higher than in the general population. If you are a smoker, you are at a higher risk of developing cancer, heart disease and stroke. Stopping smoking has clear physical health benefits but it has also been shown to improve the mental health of people with schizophrenia. Research has shown you are up to four times more likely to quit smoking if you use NHS support as well as stop-smoking medicines, such as patches, gum or inhalators. Ask your doctor about this or phone Quit Your Way Scotland on 0800 84 84 84. If you take antipsychotic medicines and want to stop smoking its very important that you talk to your GP and/or psychiatrist before you stop as the dosage of your prescription drugs may need to be monitored and the amount you have to take could be reduced. Want to know more? Healthy eating Rethink Mental Illness: wellbeing and physical health Royal College of Psychiatrists: smoking and mental health Who is available to help me? In the course of your treatment for schizophrenia, you will be involved with many different services. Some are accessed through referral from your GP, others through your local authority. These services may include the following: community mental health teams (CMHTs)  these provide the main part of local specialist mental health services, and offer assessment, treatment and social care to people living with schizophrenia and other mental illnesses trained peer support  this involves the support of someone who has had schizophrenia themselvesand is now stable, andmay be availablethrough your CMHT early intervention teams  these provide early identification and treatment for people with the first symptoms of psychosis; your GP may be able to refer you directly to an early intervention team crisis services specialist mental health teams that help with crises that occur outside normal office hours and allow people to be treated at home for an acute episode of illnessinstead of in hospital acute day hospitals an alternative to inpatient care in a hospital, where you can visit every day or as often as necessary assertive outreach teams  deliver intensive treatment and rehabilitation in the community for people with severe mental health problems and provide rapid help in a crisis situation; staff often visit people at home, act as advocates, liaise with other services (such as your GP or social services), andcan also help with practical problems (such as helping to find housing and work), and daily tasks (such as shopping and cooking) advocates  trained and experienced workers who help people communicate their needs or wishes, get impartial information, and represent their views to other people; they can be based in your hospital or mental health support groups, or you can find an independent advocate to act on your behalf Want to know more? Mind: Mind in your area Rethink Mental Illness: treatment and support Employment and financial support Avoid too much stress, including work-related stress. If you are employed, you may be able to work shorter hours or in a more flexible way. Under the Equality Act 2010 , all employers must make reasonable adjustments for people with disabilities, including people diagnosed with schizophrenia or other mental illnesses. Severalorganisations provide support, training and advice for people with schizophrenia who wish to continue working. Your community mental health team is a good first point of contact to find out what services and support are available for you. Mental health charities such as Mind or Rethink Mental Illness are also an excellent source of information on training and employment. If you are unable to work as a result of your mental illness, you are entitled to financial support, such as Incapacity Benefit. Want to know more? GOV.UK: disability and the Equality Act 2010 GOV.UK: Incapacity Benefit Money Advice Service Talk to others Many people find it helpful to meet other people with the same experiences for mutual support and to share ideas. It is also an important reminder that you are not alone. Charities and support groups allow individuals and families to share experiences and coping strategies, campaign for better services, and provide support. Useful charities, support groups and associations include: Hearing Voices Network Mind Rethink Mental Illness SANE There are also other places that offer support to people with schizophrenia and other mental illnesses. Day centres Even if you do not have a job or are unable to work, it is still important to go out and do everyday things andgive a structure to your week. Many people regularly go to a day hospital, day centre or community mental health centre. These offer a range of activities thatallow you to get active again and spend some time in the company of other people. Work projects These provide training to help you develop your work skills and support you back into work. They often have contacts with local employers. Supported accommodation This could be a bedsit or flat where there is someone around who is trained to support you and help you deal with day-to-day problems. Peer support You may be offeredthe chance tomeet regularlywith a trained peer support worker who has recovered from psychosis or schizophrenia themselves. Want to know more? Mind: housing and mental health What can family, friends and partners do to help? Friends, relatives and partners have a vital role in helping people with schizophrenia recover and make a relapse less likely. It is very important not to blame the person with schizophrenia or tell them to pull themselves together, or to blame other people.It is importa",,,,,,,,,,,,,
Schizophrenia,"to stay positive and supportive when dealing with a friend or loved ones mental illness. As well as supporting the person with schizophrenia	 you may want to get support to cope with your own feelings.Several voluntary organisations provide help and support for carers. Friends and family should tryto understand what schizophrenia is	 how it affects people	 and how they can help.You can provide emotional and practical support	 and encourage people to seek appropriate support and treatment. As part of someones treatment	 you may be offered family therapy. This can provide information and support for the person with schizophrenia and their family. Friends and family can play a major role by monitoring the persons mental state	 watching out for any signs of relapse	 and encouraging them to take their medication and attend medical appointments. If you are the nearest relative of a person who has schizophrenia	 you have certain rights that can be used to protect the patients interests. These include requesting that the local social services authority ask an approved mental health professional to consider whether the person with schizophrenia should be detained in hospital. Want to know more? Mind: how to cope as a carer Depression and suicide Many people with schizophrenia experience periods of depression . Do not ignore these symptoms.Ifdepression is not treated	it can worsen and lead to suicidal thoughts. Studies have shown thatpeople with schizophrenia have a higher chance of committing suicide. If you have been feeling particularly down over the last month and no longer take pleasure in the things you used to enjoy	 you may be depressed. See your GP for advice and treatment. Immediately report any suicidal thoughts to your GP or care co-ordinator. The warning signs of suicide The warning signs that people with depression and schizophrenia may be considering suicide include: making final arrangementssuch as giving away possessions	 making a will or saying goodbye to friends talking about death or suicide this may be a direct statement such as	 I wish I was dead	 or indirect phrases such as	 I think that dead people must be happier than us	 or Wouldnt it be nice to go to sleep and never wake up? self-harmsuch as cutting their arms or legs	 or burning themselves with cigarettes asudden lifting of mood thiscould mean a person has decided to commit suicide and feels better because of their decision Helping a suicidal friend or relative If you see any of these warning signs: get professional help for the person	 such as from a crisis resolution team (CRT) or the duty psychiatrist at your local A&E department let them know they are not alone and you care about them offer your support in finding other solutions to their problems If you feel there is an immediate danger of the person committing suicide stay with them or have someone else stay with them. Remove allavailable means of suicide such as sharp objects and medication. ",,,,,,,,,,,,,
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Scoliosis,"Scoliosis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Muscle, bone and joints Conditions Scoliosis Scoliosis About scoliosis Causes of scoliosis Diagnosing scoliosis Treating scoliosis in children Treating scoliosis in adults Possible complications of scoliosis About scoliosis Scoliosis is the abnormal twisting and curvature of the spine. It is usually first noticed by a change in appearance of the back. Typical signs include: a visibly curved spine one shoulder being higher than the other one shoulder or hip being more prominent than the other clothes not hanging properly a prominent ribcage a difference in leg lengths Back painis common in adults with scoliosis. Young people with scoliosis may also experience some discomfort but its less likely to be severe. When to get professional help If you or your childhave signs of scoliosis, make an appointment to see your GP.They can examine your back and can refer you for an X-ray for confirmation. If you or your child are diagnosed with scoliosis, its important to see a scoliosis specialist to talk about treatment options. Read more about diagnosing scoliosis . Rarely scoliosis can cause a condition called cauda equina syndrome to develop. Cauda equina syndrome is a rare but serious back condition which can lead to permanent damage or disability. If you develop this condition youll need to be seen by an emergency specialist spinal team. Phone 111 if: there has been a new, significant trauma within the last 7 days, for example a fall from height or direct blow to the back Or you have experienced a new onset of the following symptoms: loss of feeling/pins and needles between your inner thighs or genitals numbness in or around your back passage or buttocks altered feeling when using toilet paper to wipe yourself increasing difficulty when you try to urinate increasing difficulty when you try to stop or control your flow of urine loss of sensation when you pass urine leaking urine or recent need to use pads not knowing when your bladder is either full or empty inability to stop a bowel movement or leaking loss of sensation when you pass a bowel motion change in ability to achieve an erection or ejaculate loss of sensation in genitals during sexual intercourse What causes scoliosis? In aroundeight out of every 10 cases, a cause for scoliosis is not found. This is known as idiopathic scoliosis. A small number of cases are caused by other medical conditions, including: cerebral palsya condition associated with brain damage muscular dystrophy a genetic condition that causes muscle weakness Marfan syndrome a disorder of the connective tissues Rarely, babies can be born with scoliosis,as a result ofa problem with the development of the spine in the womb. In adults, age related changes in the discs and joints of the spine and a reduction in bone density may cause scoliosis. Adults can also experience worsening over time of previously undiagnosed or untreated scoliosis. Read moreabout the causes of scoliosis . Who is affected It used to be thought that scoliosis was only a childhood condition, but its now increasingly recognised as a condition that affects older adults as well. It can developat any age, but is most common in children aged 10-15. In the UK, around three or four in every 1,000childrenneed treatment for scoliosis. Its more common in females than males. How scoliosis is treated Treatment for scoliosis depends on your age,how severe it is, and whether its thought it will worsen with time. In very young children, treatment is not always necessary because the curvature of the spine may improve naturally as they get older. If treatment is necessary, bracing or casting may be used to attempt to halt the curves progression. If the infant or younger childs curve continues to progress despite bracing or casting, an operation may be necessary. This will usually involve inserting metal rods into the back to stabilise the spine, which are lengthened at regular intervals as your child grows. In older children and adults, it is unlikely that scoliosis will improve with time, and in some it may progressively worsen. The main treatments for older children are: a back brace worn until they stop growing, to prevent the spine from curving further surgery to correct the curvature  where the spine is straightened using rods attached to the spine by screws, hooks and/or wires In adults, treatment primarily aims to relieve any pain. Non-surgical options, such as painkillers and exercises are often tried first, with correctional surgery seen as a last resort. Read more about treating scoliosis in children and treating scoliosis in adults . Further problems Scoliosis can sometimes lead tofurther emotional and physical problems. Having a visibly curved spine or wearing a back brace can cause problems related to body image, self-esteem and overall quality of life. This is particularly the case for children and teenagers with scoliosis. If this is a problem for you or your child, you may find it useful to contact a scoliosis support group, such as Scoliosis Association UK . These groups are a good source ofinformation and support for people with scoliosis. In rare cases, scoliosis can lead to physical problems if its severe. For example, significant curvature of the spine can sometimes put increased pressure on the heart and lungs. Read more about the possible complications of scoliosis . Causes of scoliosis In most cases, the cause of scoliosis is unknown and it cannot usually be prevented. It is notthought to be linkedwith things such as bad posture, exercise or diet. If the cause of scoliosis is unknown,it is called idiopathic scoliosis. About eight out of every 10 cases of scoliosis are idiopathic. However, researchers have foundthere isa family history of the condition in someidiopathic cases,which suggestsa possible genetic link. Idiopathic scoliosis can affect adults and children.Some casesmay only become noticablein later life. Known causes In a small number of cases, a cause is identified. Other health conditions Some cases of scoliosis are caused by conditions that affect the nerves and muscles (neuromuscular conditions), such as: cerebral palsy a condition thataffects the brain and nervesand occurs during or shortly after birth muscular dystrophy a genetic condition that causes muscle weakness neurofibromatosisagenetic condition that causes benign tumours to grow along your nerves Scoliosis can also develop as part of a pattern of symptoms called a syndrome. This is known as syndromic scoliosis. Conditions that can cause syndromic scoliosis include: Marfan syndrome  a disorder of the connective tissues inherited by a child from their parents Rett syndrome  a genetic disorder, usually affecting females, which causes severe physical and mental disability These conditions are usually diagnosed at a young age and children with them are often monitored for problemssuch asscoliosis. Birth defects In rare cases, babies can be born with scoliosis. This is known as congenital scoliosis. Congenital scoliosis is caused by the bones in the spine developing abnormally in the womb. Long-term damage In adults, scoliosis can sometimes be caused by gradual deterioration to the parts of the spine. This is known as degenerative scoliosis. This can occur because some parts of the spine become narrower and weaker ( osteoporosis ) with age. Diagnosing scoliosis Scoliosis can usually be diagnosed after a physical examination of the spine, ribs, hips and shoulders. You may be asked to bendforward to see if any areas areparticularly prominent. For example, one of your shoulders may be higher than the other or there may be a bulge in your back. Initial examinations are usually carried out by a GP. If scoliosis is suspected, you should be referred to an orthopaedic specialist (a specialist in conditions that affect the skeleton) for further tests and to discuss treatment. Scans The orthopaedic specialist will take an X-ray to confirm the diagnosis of scoliosis. The X-ray images will also help determine the shape, direction, location and angle of the curve. The medical name for the anglethe spine curvesis known as the Cobb angle. In some cases,scans such as a magnetic resonance imaging (MRI) scan or a computerised tomography (CT) scan may also be recommended. Treating scoliosis in children If your child has scoliosis, their treatment will depend on their age and how severe it is. The main treatment options are: observation casting bracing surgery These are described below. There is a separatepageabout treating scoliosis in adults . Observation Treatment is not always necessary for very young children because their condition often corrects itself as they grow. However, if the curve does not correct itself, it can reduce the space for the internal organs to develop in, so careful monitoring by a specialist is important. Your specialist will usually recommend having regular X-rays to monitor the curvature to see if it improves, stays the same, or gets worse. Casting In some cases affecting young children, the spine may need to be guided during growth in an attempt to correct the curve. In a child aged under two years of age, this can sometimes be achieved by using a cast. A cast is an external brace to the trunk made out of a lightweight combination of plaster and modern casting materials. The cast is worn constantly and cannot be removed, but is changed regularly to allow for growth and remodelling. The cast will be changed under anaesthetic every two to three months with the aim of gradually straightening the spine. However, your child may still need to use a removable brace (see below) after treatment. Bracing If the curve of your childs spine is getting worse, your specialist may recommend they wear a back brace while they are growing. A brace cannot cure scoliosis or correct the curve, but it may stop the curve from getting worse. However, while there is some evidence bracing may be of benefit in certain cases, its not recommended by all scoliosis specialists. If a brace is used, it will need to be carefully fitted to your childs spine. To do this, a cast of your childs back may need to be taken. This can be done as an outpatient which means that your child will not have to stay overnight in hospital. Braces are often made of rigid plastic, although flexible braces are sometimes available. In general, modern back braces are designed so they are difficult to see under loose-fitting clothing. Its usually recommended that the brace is worn for 23 hours a day, and is only removed for baths and showers. The brace should not interfere with normal everyday activity and can be worn during most non-contact sports. However, it should be removed during contact sports and swimming. Regular exercise is important for children wearing a brace. This helps improve muscle tone and body strength, and will help make wearing the brace more comfortable. The brace will usually have to be worn for as long as your childs body is still growing. For most children, this will mean they can stop wearing it when they are around 16 or 17 years old. Surgery If your child has stopped growing and their scoliosis is severe, or other treatments have been unsuccessful, corrective surgery may be recommended. They type of surgery will depend on your childs age. Surgery in children For younger children, generally those under the age of ten, an operation may be carried out to insert growing rods. These rods aim to allow for continued controlled growth of the spine while partially correcting the scoliosis. After surgery to insert the rods, your child will need to return to their specialist every 4-6 months to have the rods lengthened to keep up with the childs growth. This procedure will be done through a small incision, and takes place often as a day case or an overnight stay. In some cases, rods that can be lengthened using external magnets during an outpatient appointment may be used. Many children will also have to wear a brace to protect the growth rods. When your child stops growing, the adjustable rods can be removed and a spinal fusion (see below) will be carried out. Surgery in teenagers and young adults In teenagers and young adults whose spine has stopped growing, an operation called a spinal fusion may be carried out. This is a major operation where the spine is straightened using metal rods attached with screws, hooks, and/or wires, and bone grafts are used to fuse the spine in place. This metalwork will usually be left in place permanently, unless they cause any problems. The surgery will take several hours. After surgery, your child will be transferred to an intensive care unit (ICU) or high dependency unit (HDU), where they will be given fluids through a vein (intravenously) and pain relief. Most children are well enough to leave intensive care after a day or two, although they will often need to spend another five to 10 days in hospital. After the operation, most children can return to school after a few weeks and can play sports after a few months. Contact sports should be avoided for 9-12 months. Occasionally a back brace may need to be worn to protect the metal rods after surgery. Risks of surgery Spinal fusion surgery is a major operation which, like any surgical procedure carries a risk of complications. It will not be recommended unless the surgeon feels the benefits outweigh these risks. Some of the main risks the spinal fusion procedure include: bleeding  if this is severe your child may need ablood transfusion wound infection  this can usually be treated with antibiotics the implants moving or the grafts failing to fuse properly  additional surgery may be required to correct this in rare cases, damage to the nerves in the spine  this can lead to permanent numbness in the legs, and can sometimes cause paralysis of the legs and loss of control of the bowels and bladder Its important that parents and children understand the risks of spinal fusion surgery so that they can make an informed decision about treatment. Make sure you discuss the potential complications with your childs surgeon. Additional therapies There is no reliable evidence to suggest that other therapies such as osteopathy and chiropractic can be used to correct the curvature of the spine or stop it progressing. The role of scoliosis specific exercises is currently under investigation. Physiotherapy may be beneficial when used in combination with a back brace. Exercise can help significantly with any muscular pain experienced with scoliosis, and back health in general. Treating scoliosis in adults Back painis one of the main problems caused by scoliosis in adults, so treatment is mainly aimed at pain relief. In some cases, surgery may be carried out to improve the shape of the spine as a way of helping with back and leg pains. Medication Painkilling medication is usually recommendedto help relieve the painthat can be associated with scoliosis. Over-the-counter painkillers, such as paracetamol and ibuprofen , are often recommended initially. See your GP if these dont work. They may prescribe stronger painkillers or refer you to a specialist pain management clinic. In some cases, corticosteroids or local anaesthetic may be injectedinto your back to relieve pain caused by the bones in your spinecompressing or irritating nearby nerves. However, these injections onlywork in theshort-term and are mostly useful in helping work out where your pain iscomingfrom. If its thought that osteoporosis of your spine is contributing to your symptoms, you may be given medication and supplements to strengthen your bones. Read more about treating osteoporosis . Exercise General strengthening and stretching exercises canimprove your general posture and flexibility,and may help control any back pain. Exercises can also help you maintain a healthy weight, which can reduce the strain on your back. Some people may benefit from physiotherapy, where they are taught specific exercises to carry out. Bracing Braces are not often used to treat scoliosis in adults, although they canprovide pain relief in some cases. A bracemay be considered as an alternative to surgery if you are not well enough to undergo an operation. Surgery Surgery for adults with scoliosis is usually only recommended if the curve in the spine is severe, if its getting significantly worse, for back pain related to standing in an abnormal posture, or if the nerves in the spine are being compressed. There are two types of surgery: decompressionsurgery if a disc or bone is pressing down on a nerve, it can be removed to reduce the pressure on the nerve spinal fusion surgery  where the position of the spine isimproved using metal rods, plates and screws before being fused into place using bone grafts These are major operationsand it can take up to a year or more to fully recover from them. They also carry a risk of potentially serious complications, including: failureto reducepain surgery is generally better at relieving pain that radiates to the legs, rather than back pain theimplants becoming displaced, broken or loose infection blood clots rarely, damageto the nerves in the spine in severe cases this can result inpermanent leg numbness and the loss of bladder or bowel control Read more about lumbar decompression surgery . Possible complications of scoliosis Physical complications of scoliosis are rare, although serious problems can develop if its left untreated. Emotionalissues Having a visibly curved spine orwearing a back brace may cause problems related to body image, self-esteem and overall quality of life. This is particularly the case for children and teenagers with scoliosis. Modern back braces are designed to bedifficult to see under loose-fitting clothing, but your child may still worry that they look different or unusual. Encouraging your child to talk with other teenagers who have scoliosis can helpimprove their confidence and lessen any feelings they are alone with their condition. There are several support groups, such as the Scoliosis Association UK , that provide information and support for people with scoliosis. Some also host message boards soteenagers from across the world can compare experiences, share tips and exchange messages of encouragement. Lung and heart problems In particularly severe cases of scoliosis the ribcage can be pushed against the heart and lungs, causing breathing problems and making it difficult for the heart to pump blood around the body. This can also increase the chances of lung infections, such as pneumonia , and lead to problems such as heart failure . Nerve compression In some cases of scoliosis, particularly those affecting adults, the bones in the spine compress nearby nerves. In severe cases, this can cause problems such as: back and leg pain numbness or weakness in the legs When to get professional help Rarely scoliosis can cause a condition called cauda equina syndrome to develop. Cauda equina syndrome is a rare but serious back condition which can lead to permanent damage or disability. If you develop this condition youll need to be seen by an emergency specialist spinal team. Phone 111 if: there has been a new, significant trauma within the last 7 days, for example a fall from height or direct blow to the back Or you have experienced a new onset of the following symptoms: loss of feeling/pins and needles between your inner thighs or genitals numbness in or around your back passage or buttocks altered feeling when using toilet paper to wipe yourself increasing difficulty when you try to urinate increasing difficulty when you try to stop or control your flow of urine loss of sensation when you pass urine leaking urine or recent need to use pads not knowing when your bladder is either full or empty inability to stop a bowel movement or leaking loss of sensation when you pass a bowel motion change in ability to achieve an erection or ejaculate loss of sensation in genitals during sexual intercourse Source: MSK Expert Panel - Opens in new browser window Last updated: 20 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Septic shock,"Septic shock | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Blood and lymph Septic shock Septic shock Septic shock is a life-threatening condition that happens when your blood pressure drops to a dangerously low level after an infection. Any type of bacteria can cause the infection. Fungi such as candida and viruses can also be a cause, although this is rare. At first the infection can lead to a reaction called sepsis. This begins with: weakness chills a rapid heart and breathing rate Left untreated, toxins produced by bacteria can damage the small blood vessels, causing them to leak fluid into the surrounding tissues. This can affect your hearts ability to pump blood to your organs, which lowers your blood pressure and means blood doesnt reach vital organs, such as the brain and liver. Phone 999 immediately if: You think that you or someone in your care has symptoms of septic shock like: low blood pressure (hypotension) that makes you feel dizzy when you stand up a change in your mental state, like confusion or disorientation diarrhoea nausea and vomiting cold, clammy and pale skin Who is more at risk of developing septic shock? People with a weakened immune system have an increased risk of developing septic shock. This includes: newborn babies elderly people pregnant women people with long-term health conditions, such as diabetes, cirrhosis or kidney failure people with lowered immune systems, such as those with HIV or AIDS or those receiving chemotherapy Treating septic shock Youll usually be admitted to an intensive care unit (ICU) so your bodys functions and organs can be supported while the infection is treated. In some cases treatment may start in the emergency department. Treatment may include: oxygen therapy fluids given directly through a vein (intravenously) medication to increase your blood flow antibiotics surgery (in some cases) Oxygen therapy To help you breathe more easily, youll be given oxygen through a face mask, a tube inserted into your nose, or an endotracheal tube inserted into your mouth. If you have severe shortness of breath , a mechanical ventilator may be used. Increasing blood flow Youll probably be given fluids directly into a vein. This will help raise your blood pressure by increasing the amount of fluid in your blood. To increase the blood flow to your vital organs, such as your brain, liver, kidneys and heart, you may be prescribed inotropic medicines or vasopressors. Inotropic medicines Inotropic medicines (inotropes), such as dobutamine, stimulate your heart. They increase the strength of your heartbeat, which helps get oxygen-rich blood to your tissues and organs, where its needed. Vasopressors Vasopressors include: dopamine adrenaline noradrenaline These medicines will cause your blood vessels to narrow, increasing your blood pressure and the flow of blood around your body. This will allow your vital organs to start functioning properly. Antibiotics Antibiotics are often used to treat the associated bacterial infection. The type of antibiotic used depends on the type of bacterial infection and where in the body the infection started. You may be started on antibiotics immediately to increase your chances of survival. Initially, two or three types of antibiotics may be used. The most effective type of antibiotic can be used once the bacterium responsible for the infection is identified. Surgery In severe cases of sepsis or septic shock, the large decrease in blood pressure and blood flow can kill organ tissue. If this happens, surgery may be required to remove the dead tissue. Complications of septic shock The chances of surviving septic shock will depend on: the cause of infection the number of organs that have failed how soon treatment is started Complications of septic shock can include: inability of the lungs to take in enough oxygen (respiratory failure) the heart not being able to pump enough blood around the body (heart failure) kidney failure or injury abnormal blood clotting These are serious health conditions that will need to be treated urgently. Septic shock can be fatal because of complications like these. Source: NHS 24 - Opens in new browser window Last updated: 18 January 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Sepsis Heart failure Other health sites Surviving Sepsis Campaign UK Sepsis Trust healthtalk.org: patient experiences British Heart Foundation: Heart failure Chest Heart & Stroke Scotland: Heart failure Intensive Care Society NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Shingles,"Shingles | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Shingles Shingles Shingles, also known as herpes zoster, is an infection of a nerve and the skin around it. Its caused by the varicella-zoster virus, which also causes chickenpox. Symptoms of shingles The main symptom of shingles is pain, followed by a rash that develops into itchy blisters . These look like chickenpox . Sometimes shingles causes symptoms that develop a few days before the painful rash. This includes symptoms like: a headache burning, tingling, numbness or itchiness of the skin in the affected area a feeling of being generally unwell a high temperature (fever) Shingles rash The shingles rash usually appears on one side of your body. It develops on the area of skin related to the affected nerve. New blisters can appear for up to a week. A few days after appearing they become yellowish in colour, flatten and dry out. Scabs then form where the blisters were, which may leave some slight scarring. Examples of the shingles rash Shingles on the back Shingles on the chest Shingles on the face Shingles on back of neck Shingles pain Most people with shingles experience a localised band of pain in the affected area. The pain may be a constant, dull or burning sensation and its intensity can vary from mild to severe. You may have sharp stabbing pains from time to time, and the affected area of skin will usually be tender. Getting advice from a GP or pharmacist Contact your GP practice if: You havent had chickenpox before, youve been exposed to someone who has chickenpox or shingles and you: are pregnant have a weakened immune system (the bodys natural defence system) are under 18 years old If your GP is closed, phone 111. Speak to a pharmacist if: youre 18 years or over and have symptoms of shingles If the pharmacist cannot treat you they may recommend you see your GP. Find your nearest pharmacy Causes of shingles When you catch chickenpox the virus stays in your body. It can become active again later on if your immune system is lowered and cause shingles. Your immune system can be lowered by things like: stress other illnesses or conditions treatments like chemotherapy Its possible to have shingles more than once, but its very rare to get it more than twice. Treating shingles Theres no cure for shingles. But, there are ways to ease your symptoms until the condition improves. Shingles symptoms usually get better in 2 to 4 weeks. Speak to your GP or pharmacist as soon as you get symptoms of shingles. Early treatment may help to reduce the severity of the condition and complications. Treating symptoms at home Do keep the rash as clean and dry as possible wear loose-fitting clothing use a cool damp cloth to soothe the skin and keep blisters clean try calamine lotion to help relieve itching Dont do not let dressings or plasters stick to the rash do not use antibiotic cream  this slows healing Other treatments for shingles Your GP or pharmacist may recommend painkillers to ease discomfort caused by shingles. This includes: paracetamol non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen opioids  used for more severe pain antidepressants  used for severe pain anticonvulsants  used for severe pain Some people with shingles may also be prescribed antiviral tablets. Preventing the spread of shingles You cant give shingles to other people. But, other people can catch chickenpox from you if they havent had it before. If you have shingles, youre contagious until the last blister has dried and scabbed over. To help prevent the virus being passed on: Dont do not share towels or flannels do not go swimming do not play contact sports do not go work or school if your rash is weeping (oozing fluid) and cant be covered Chickenpox Chickenpox can be particularly dangerous for certain groups of people. If you have shingles, avoid: pregnant women who havent had chickenpox before people with a weak immune system, for example someone with HIV or AIDS babies less than 1 month old (unless its your own baby) Complications of shingles Complications can sometimes occur as a result of shingles. They are more likely if your immune system is low, (the bodys natural defence system), or are elderly. Shingles is rarely life threatening. Complications, though, can mean that around 1 in every 1,000 cases in adults over the age of 70 is fatal. Complications can include: postherpetic neuralgia eye problems Ramsay Hunt syndrome the rash becoming infected with bacteria white patches (a loss of pigment) or scarring in the area of the rash inflammation of the lungs (pneumonia) , liver (hepatitis), brain (encephalitis), spinal cord (transverse myelitis), or protective membranes that surround the brain and spinal cord (meningitis)  these complications are rare. The shingles vaccine Read about the shingles vaccine and find out if youre eligible Source: NHS 24 - Opens in new browser window Last updated: 16 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Shingles vaccine Other health sites The Pain Toolkit Pain Concern British Pain Society: FAQs Age UK Find your nearest pharmacy Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Shortness of breath,"Shortness of breath | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Lungs and airways Shortness of breath Shortness of breath Sudden shortness of breath, or breathing difficulty (dyspnoea), is the most common reason for visiting a hospital accident and emergency department. Its also one of the most common reasons people phone 999 for an ambulance. Its normal to get out of breath when youve overexerted yourself, but when breathlessness comes on suddenly and unexpectedly, its usually a warning sign of a medical condition. The information below outlines the most common reasons for: sudden shortness of breath long-term shortness of breath This guide shouldnt be used to self-diagnose your condition, but should give you an idea of whats causing your breathlessness. When to phone a doctor You should phone your GP immediately if you have sudden unexpected shortness of breath, as there may be a problem with your airways or heart. Your GP will assess you over the phone, and may either visit you at home or admit you to hospital. If your shortness of breath is mild or the result of anxiety, you may be asked to come to the surgery rather than a home visit. If youve struggled with your breathing for a while, dont ignore it. See your GP as its likely you have a long-term condition, such as obesity , asthma or chronic obstructive pulmonary disease (COPD) , which needs to be managed properly. Your doctor may ask you some questions, such as: Did the breathlessness come on suddenly or gradually? Did anything trigger it, such as exercise? How bad is it? Does it only happen when youve been active, or when youre not doing anything? Is there any pain when you breathe? Do you have a cough? Do certain positions make it worse  for example, are you unable to lie down? Feeling like you cant get enough air can be terrifying, but doctors are well trained in managing this. You may be given extra oxygen to breathe if this is needed. Causes of sudden shortness of breath Sudden and unexpected breathlessness is most likely to be caused by one of the following health conditions. Click on the references at the end for more information about these conditions. A problem with your lungs or airways Sudden breathlessness could be an asthma attack. This means your airways have narrowed and youll produce more phlegm (sticky mucus), which causes you to wheeze and cough. Youll feel breathless because its difficult to move air in and out of your airways. Your GP may advise you to use a spacer device with your asthma inhaler. This delivers more medicine to your lungs, helping to relieve your breathlessness. Pneumonia (lung inflammation) may also cause shortness of breath and a cough. Its usually caused by an infection, so youll need to take antibiotics . If you have COPD, its likely your breathlessness is a sign this condition has suddenly got worse. A heart problem Its possible to have a silent heart attack without experiencing all the obvious symptoms, such as chest pain and overwhelming anxiety. In this case, shortness of breath may be the only warning sign youre having a heart attack. If you or your GP think this is the case, theyll give you aspirin and admit you to hospital straight away. Heart failure can also cause breathing difficulties. This life-threatening condition means your heart is having trouble pumping enough blood around your body, usually because the heart muscle has become too weak or stiff to work properly. It leads to a build-up of fluid inside the lungs, which makes breathing more difficult. A combination of lifestyle changes and medicines or surgery will help the heart pump better and relieve your breathlessness. Breathlessness could also relate to a problem with your heart rate or rhythm, such as atrial fibrillation (an irregular and fast heart rate) or supraventricular tachycardia (regular and fast heart rate). Panic attack or anxiety A panic attack or anxiety can cause you to take rapid or deep breaths, known as hyperventilating. Concentrating on slow breathing or breathing through a paper bag can bring your breathing back to normal but should only be done when you are certain anxiety is the cause of your breathlessness. More unusual causes These include: a severe allergic reaction (anaphylaxis) pneumothorax  partial collapse of your lung caused by a small tear in the lung surface, which allows air to become trapped in the space around your lungs pulmonary embolism  a blockage in one of the blood vessels in the lung idiopathic pulmonary fibrosis  a rare and poorly understood lung condition that causes scarring of the lungs pleural effusion  a collection of fluid next to the lung diabetic ketoacidosis  a complication of diabetes where acids build up in your blood and urine Causes of long-term breathlessness Long-term breathlessness is usually caused by: obesity or being unfit poorly controlled asthma chronic obstructive pulmonary disease (COPD)  permanent damage to the lungs usually caused by years of smoking anaemia  a low level of oxygen in the blood caused by a lack of red blood cells or haemoglobin (the part of red blood cells that carries oxygen) heart failure  when your heart is having trouble pumping enough blood around your body, usually because the heart muscle has become too weak or stiff to work properly a problem with your heart rate or rhythm, such as atrial fibrillation (an irregular and fast heart rate) or supraventricular tachycardia (regular and fast heart rate) More unusual causes of long-term breathlessness are: bronchiectasis  a lung condition where the airways are abnormally widened and you have a persistent phlegmy cough pulmonary embolism  a recurrent blockage in a blood vessel in the lung partial collapse of your lung caused by lung cancer pleural effusion  a collection of fluid next to the lung narrowing of the main heart valve, restricting blood flow to the rest of the body frequent panic attacks , which can cause you to hyperventilate (take rapid or deep breaths) Source: NHS 24 - Opens in new browser window Last updated: 01 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Heart failure Shortness of breath Asthma Chronic obstructive pulmonary disease Home oxygen treatment Other health sites Asthma UK NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Sickle cell disease,"Sickle cell disease | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Blood and lymph Sickle cell disease Sickle cell disease About sickle cell disease \u200bSymptoms and diagnosis \u200bTreating sickle cell disease \u200bLiving with sickle cell disease \u200bCauses of sickle cell disease \u200bSickle cell disease carriers and screening About sickle cell disease Sickle cell disease is the name for a group of blood disorders. The most severe is sickle cell anaemia. These disorders are inherited, meaning they are passed on through your genes. You can have a blood test at any time to find out if you carry the gene for sickle cell disease, or if you have sickle cell disease. Sickle cell disease affects how your body produces red blood cells. Normal red blood cells are round  red blood cells affected by sickle cell disease harden and become sickle-shaped, like a crescent moon. This causes them to die too quickly and block blood vessels, leading to symptoms that are often painful. People from particular ethnic backgrounds are more likely to have sickle cell disease or carry the gene. You are more likely to have sickle cell disease if you are from one of these ethnic backgrounds: African Asian Caribbean Eastern Mediterranean Middle Eastern There are treatments to manage sickle cell disease, but no cure yet  its a lifelong condition. Find out about symptoms and diagnosis Find out about treating sickle cell disease Find out about living with sickle cell disease Find out about screening to see if youre a sickle cell carrier \u200bSymptoms and diagnosis The main symptoms of sickle cell disease are sickle cell crises (very painful episodes affecting different parts of the body), infections, and anaemia. Getting immediate medical advice There are a number of serious problems that can appear suddenly as a result of sickle cell disease. If you experience any of the following symptoms, you should get medical advice immediately: high temperature (a fever) going to 38C (100.4F) or higher difficulty breathing drowsiness, confusion, or slurred speech a severe headache, stiff neck, or dizziness skin or lips that are very pale fits (seizures) serious pain that isnt responding to treatments at home sudden swelling in the tummy priapism  a painful erection lasting two hours or more weakness on one or both sides of your body sudden vision loss, or changes in your vision If you develop any of the symptoms listed above, phone your GP or care team immediately. If you cant contact your GP or care team, go to your closest Accident and Emergency (A&E) department. Dial 999 for an ambulance if you arent able to travel yourself. Its important to make sure that the medical team looking after you know that you have sickle cell disease. Sickle cell crises Episodes of pain known as sickle cell crises happen when the blood vessels that go to one part of your body become blocked. The pain can be severe. Sickle cell crises are one of the most common symptoms of sickle cell disease and, on average, occur once a year and last up to seven days. Some people have sickle cell crises every few weeks  others experience them less than once a year. A sickle cell crisis typically affects one part of the body at a time. The most common parts affected are: hands or feet (this is especially common in young children) ribs and breastbone spine pelvis tummy legs and arms Sickle cell crises have different causes. They can be triggered by cold, rainy or windy weather, stress, dehydration, or exercise that leaves you severely out of breath. Infection Sickle cell disease leaves people  especially children  extra vulnerable to infection because their bodies arent as effective at dealing with bacteria and viruses. This leaves them more vulnerable to viruses like the common cold, as well as severe and potentially life-threatening conditions like meningitis. As well as keeping up to date with their vaccinations, many people with sickle cell disease take daily doses of antibiotics in order to prevent infections. Anaemia Almost everyone with sickle cell disease has anaemia. Haemoglobin is found in red blood cells  its the substance that transports oxygen around the body. People with anaemia have low levels of haemoglobin in their blood. Most of the time anaemia doesnt cause symptoms, but if youre infected with parvovirus, the virus that causes slapped cheek syndrome, the anaemia can get worse. When that happens, it causes: headaches a fast heartbeat fainting dizziness If these symptoms occur, the anaemia is usually treated with a blood transfusion. Sudden anaemia can happen in young children if they experience swelling of the spleen. This is also treated with a blood transfusion. Other sickle cell disease symptoms Theres a wide range of other issues that can be caused by sickle cell disease. These include: a serious lung condition called acute chest syndrome that can cause chest pain, a cough, breathing difficulties and fever pain in bones and joints delayed puberty delayed growth in childhood kidney or urinary problems, including bedwetting and blood in the urine gallstones  these are stones in the gallbladder that can cause jaundice (yellow eyes and skin) and abdominal (tummy) pain ulcers on the lower legs (open sores that can be very painful) priapism  a painful, persistent erection that can last for several hours high blood pressure (pulmonary hypertension) transient ischaemic attacks (TIAs) or strokes  these happen when blood flow to the brain is interrupted or blocked enlarged spleen  this can cause a fast heartbeat, worsening of anaemia, a swollen tummy, shortness of breath and abdominal pain vision problems like floaters, worsened night vision, blurred vision, patchy vision and, occasionally, sudden vision loss These symptoms can be treated  see Treating sickle cell disease for more information. Diagnosing sickle cell disease You can have a blood test any time to find out if you have sickle cell disease, or find out if youre a carrier who could have a child with the condition. Sickle cell disease is usually diagnosed during pregnancy  free screening to find out if a baby is at risk of having the condition is offered to every pregnant woman in Scotland. Even if your family background doesnt make it likely your child will have sickle cell disease, you can still request a test. If possible, screening should be done before the tenth week of pregnancy, so that theres time to think about further tests that can find out if your baby will be born with sickle cell disease. Newborn babies are screened for sickle cell disease as part of the newborn blood spot test  the heel prick test. There are a few reasons for this: if a babys parents werent screened during pregnancy, this test identifies if the child has sickle cell disease if screening during pregnancy showed that the baby had a high risk of having sickle cell disease, but no more testing was done, the heel prick test will determine if the child has the condition or not this test shows if the baby is a carrier of sickle cell, and could one day have children of their own who have the condition (find out more about sickle cell carriers here ) the heel prick test identifies other inherited conditions, like cystic fibrosis Another blood test will be used to confirm the diagnosis if the heel prick test suggests that the baby could have sickle cell disease. Learn about being tested to see if you carry the sickle cell gene \u200bTreating sickle cell disease People of all ages with sickle cell disease are supported by a team of medical professionals in a specialist sickle cell centre. A specialised care plan will be developed with you that helps you to fully understand the condition and find the best way of managing it. Treating and preventing sickle cell crises Sickle cell crises can usually be managed at home. The following steps are recommended for adults or children experiencing a sickle cell crisis: over the counter painkillers like paracetamol and ibuprofen can help  although aspirin should not be given to anyone under 16  and if needed, your GP may prescribe stronger painkillers heating pads or warm towels can be placed on the area and massaged to ease the pain  pharmacies usually sell heating pads you can use for this drink plenty  staying hydrated will help relaxing distractions like reading, videos, and computer games are a good way to distract your mind, or your childs mind, from the pain If none of the above measures help, or the pain is very severe, phone your GP. You or your child should go to the local accident and emergency (A&E) if its not possible to contact your GP. It may be necessary for you or your child to spend a few days in hospital being treated with stronger pain relief. The best way to prevent a sickle cell crisis is by being aware of potential triggers and avoiding them. Prevent dehydration by drinking plenty of fluids especially water. Avoid alcohol  alcohol causes dehydration. Stay warm with enough layers of clothing to avoid getting cold, and avoid extreme temperatures. Dont expose yourself to sudden changes in temperature  for example, avoid swimming in cold water. The lack of oxygen at high altitudes can trigger a sickle cell crisis, so be careful if youre at high altitude for any reason. However, plane travel shouldnt be an issue because planes maintain a consistent oxygen level due to being pressurised. Make sure to stay active, but avoid activities that leave you severely out of breath. Dont smoke  smoking can trigger acute chest syndrome. Stay relaxed as much as you can  sickle cell crises can be triggered by stress, so consider learning relaxation techniques like breathing exercises . Your care team may recommend a medication called hydroxycarbamide (hydroxyurea) if you keep experiencing sickle cell crises. This is a capsule that is taken once a day. It works by reducing how many other types of blood cell, like white blood cells and platelets (clotting cells) there are in the body. This means that youll need regular blood tests to make sure youre healthy. Treating and preventing infections Children who have sickle cell disease should be kept up to date on all of their routine vaccinations, and may also need additional vaccinations like the hepatitis B vaccine and the annual flu vaccine. If you have sickle cell disease, youll most likely need to take a dose of antibiotics every day, usually penicillin. This will not pose serious health risks. Reduce risk in day-to-day life by being careful about activities that can make you vulnerable to infection. Always follow good food hygiene measures , for example. If youre planning to go abroad, talk to your GP as far in advance as you can. You might need extra vaccinations or medication, such as anti-malarials if youre going to a place where malaria is a risk. It may also be a good idea to take extra precautions when it comes to food and water. Treating anaemia Most of the time, anaemia doesnt have any symptoms and you wont require any treatment for it. However, children with sickle cell anaemia who are also on a restricted diet (such as a vegan or vegetarian diet) may need folic acid supplements. Folic acid helps your body to create more red blood cells, so it can help to improve anaemia. Its important to be aware that this type of anaemia isnt the same as the anaemia caused by iron deficiency, so dont take iron supplements without talking to your care team first. Taking iron supplements with the anaemia caused by sickle cell disease can be dangerous. Blood transfusions or hydroxycarbamide may be necessary for serious or persistent anaemia. Treating other sickle cell disease-related issues There are a range of treatments for other problems that can be caused by sickle cell disease, depending on the type of symptom and how severe it is: people with acute chest syndrome need emergency treatment  this involves oxygen, blood transfusions, antibiotics, and fluids given through a vein, as well as possibly hydroxycarbamide to prevent it happening again painkillers can treat joint and bone pain a short course of hormones can be given to children in order to trigger delayed puberty gallbladder removal surgery is used to treat gallstones for persistent priapism, medication can stimulate blood flow, or a needle can be used to drain blood from the penis regular blood transfusions or hydroxycarbamide are given to people who have had a stroke or who are at greater risk of having one In addition to the treatments above, chelation therapy involves taking medication to make the level of iron in your blood lower, bringing it to safe levels. This treatment is given to people who need a lot of blood transfusions. Learn more about living with sickle cell disease here \u200bLiving with sickle cell disease Sickle cell disease is a lifelong illness, which can be managed well with treatment and self-help. In addition to preventing symptoms and crises as much as possible, there are a few things you can do that will make it easier to live with the condition and stay in the best possible health. Getting surgery when you have sickle cell disease If youre due to have surgery, or youre brought in for surgery in an emergency, its very important you take some precautions. You should tell your care team about any surgeries you have planned that involve a general anaesthetic. Tell your surgeon on the day that you have sickle cell disease. General anaesthetic can cause a number of problems, including increasing the risk of a sickle cell crisis. Its important that youre monitored closely during the surgery, and are given plenty of fluids as well as being kept warm. It might be necessary to have a blood transfusion before the surgery to reduce the chances of complications. Pregnancy and birth with sickle cell disease You can have a healthy pregnancy if you have sickle cell disease, but its a good idea to talk to your care team before planning a pregnancy, for a number of reasons: theres a bigger chance of complications such as miscarriage, pre-eclampsia, anaemia and sickle cell pain while youre pregnant you may have to stop taking some of the medications for sickle cell disease, like hydroxycarbamide, before getting pregnant, as these can harm a foetus it may be a good idea to find out if your partner is a sickle cell carrier and talk with a counsellor about what this could mean extra monitoring during pregnancy, as well as extra treatment, might be necessary Its important to use a reliable form of contraception if you arent planning a pregnancy. Learn about pregnancy and newborn screening for sickle cell disease The outlook for people with sickle cell disease Most children with sickle cell disease lead normal, happy lives. However, sickle cell disease can be very different from person to person, and its still a serious condition. Sickle cell disease can have a big impact on someones life. It can lead to serious infections, strokes and transcient ischaemic attacks (TIAs), and lung problems, which can be fatal. The overall live expectancy for people with sickle cell disease is shorter than normal, but this changes depending on the type of sickle cell disease, what problems they experience, and how the condition is treated. Milder types of sickle cell disease may not impact life expectancy. People with sickle cell anaemia have a typical life expectancy of between 40 and 60 years of age. As newer treatments are developed, its hoped that the outlook will get better. \u200bCauses of sickle cell disease Sickle cell disease is caused by a gene problem that is inherited from your parents. It isnt something you can catch, and its not caused by anything the parents did during or before pregnancy. Inheriting sickle cell disease You inherit one set of genes from your mother, and one from your father. Genes always come in pairs. Children born with sickle cell disease inherit a copy of the sickle cell gene from both of their parents, so each one of the pair of genes is faulty. This happens when both parents are carriers  they carry the faulty gene for sickle cell. This is also known as having the sickle cell trait. Carriers dont have sickle cell disease, but if their partner is a carrier too they may have a child with the condition. When both of a childs parents are sickle cell carriers: theres a 25% (one in four) chance that each of their children wont inherit any faulty genes  they wont have sickle cell disease, and they wont be able to pass it on to their children theres a 50% (one in two) chance that each child will inherit a copy of the faulty gene from just one parent, and be a sickle cell carrier theres a 25% (one in four) chance that each child will inherit copies of the sickle cell gene from both of their parents, and have sickle cell disease when theyre born You can find more information about how sickle cell disease is inherited from the Sickle Cell Society . Learn more about sickle cell carriers and screening \u200bSickle cell disease carriers and screening Sickle cell disease carriers are people who carry the faulty gene that causes sickle cell disease, but do not have the disease. This is also called having the sickle cell trait. If you have the sickle cell trait, you wont develop sickle cell disease. However, theres a risk that youll have a child with the condition, or who is also a sickle cell disease carrier. Sickle cell disease carriers The sickle cell gene can be carried by anyone, but people from certain ethnic backgrounds are much more likely to be carriers. You are more likely to be a carrier if you have family from one of these areas : Africa Asia The Caribbean The Eastern Mediterranean The Middle East Most sickle cell carriers in the UK have an African or Caribbean family background  its estimated around one in ten people with this background may be a sickle cell carrier. Finding out if you are a sickle cell carrier You can request a blood test from your GP at any time to find out if youre a sickle cell carrier. This is a particularly good idea if your family background makes it more likely that you have the gene. Both men and women are able to get the test. Every pregnant woman in Scotland is offered screening to check if their baby is at risk of being born with sickle cell disease. You can ask for a test even if your family background doesnt suggest your child will have sickle cell disease. Its a good idea to have your partner screened for the gene too. If possible, screening should be done before the tenth week of pregnancy, so that theres time to think about further tests that can find out if your baby will be born with sickle cell disease. Read more about diagnosis and screening for the sickle cell disease gene here Other health risks for sickle cell carriers Youre not at risk of developing sickle cell disease if you carry sickle cell. The only time you may be at risk of health problems is in rare cases where you might not get enough oxygen, such as: having surgery under general anaesthetic  make sure your medical team knowyou carry sickle cell before your operation so they can ensure you get enough oxygen during extreme sports such as deep sea diving and climbing at high altitudes  if you do sports like these, ensure youre never short of oxygen during regular, intensive physical activity  make sure you drink plenty of fluids during training and avoid extreme exhaustion Theres also a very small risk of developing kidney problems associated with carrying sickle cell. Apart from these uncommon situations, you can lead a completely normal and healthy life if youre a sickle cell carrier. Other blood disorders Sickle cell carriers are also at risk of having a child with a blood disorder if their partner is a carrier of a different type of blood disorder. You can find more detailed information about some of the other types of carrier in the following pages: Your baby carries a gene for Sickle Cell Your baby carries a gene for unusual haemoglobin Source: NHS 24 - Opens in new browser window Last updated: 12 April 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Sinusitis,"Sinusitis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Ears, nose and throat Sinusitis Sinusitis Sinusitis is inflammation (redness and swelling) of the sinuses. The sinuses are small, air-filled spaces in your cheekbones and forehead. Inflammation blocks the sinuses so mucus cannot drain into your nose as usual. Sinusitis is usually caused by a viral infection. Its common and usually gets better within 2 to 3 weeks. Symptoms of sinusitis Sinusitis usually occurs after an infection, such as a cold . Symptoms of sinusitis include: a green or yellow discharge from your nose a blocked nose pain and tenderness around your cheeks, eyes or forehead a high temperature (fever) of 38C (100.4F) or more toothache a reduced sense of smell bad breath (halitosis) Children with sinusitis may: be irritable breathe through their mouth have difficulty feeding sound nasal when they speak, as though they have a stuffy cold The symptoms of sinusitis often clear up within a few weeks (acute sinusitis). Occasionally they can last 3 months or more (chronic sinusitis). When to get medical advice If your symptoms are mild and getting better, you can often treat sinusitis without seeing a GP. Speak to your GP practice if: your symptoms are severe or getting worse your symptoms havent started to improve after around 7 to 10 days you keep getting sinusitis Diagnosing sinusitis Your GP will usually be able to diagnose sinusitis from your symptoms and by examining the inside of your nose. If you keep getting sinusitis, or its severe, they may refer you to an ear, nose and throat (ENT) specialist. Treatment for sinusitis Sinusitis usually gets better on its own within 2 or 3 weeks. Things you can do to help your symptoms Do get plenty of rest drink plenty of fluids take over-the-counter painkillers such as paracetamol or ibuprofen (do not give aspirin to children under 16) use nasal decongestants  these shouldnt be used for more than a week, as this might make things worse hold warm packs to your face clean your nose with a salt water solution  you can make yourself or buy sachets from a pharmacy Always read the leaflet that comes with your medicine before taking it. Follow the recommended dosage instructions. If youre not sure which treatments are suitable for you or your child, speak to a pharmacist for advice. How to clean your nose with a homemade salt water solution Boil a pint of water, then leave it to cool. Mix 1 teaspoon of salt and 1 teaspoon of bicarbonate of soda into the water. Wash your hands. Stand over a sink, cup the palm of 1 hand and pour a small amount of the solution into it. Sniff the water into 1 nostril at a time. Breathe through your mouth and allow the water to pour back into the sink. Try not to let the water go down the back of your throat. Repeat the first 5 steps up to 3 times a day until your nose feels more comfortable. You do not need to use all of the solution, but make a fresh solution each time you clean your nose. Treatments from your doctor If your symptoms arent improving or are getting worse, your GP may prescribe antibiotics tablets or corticosteroid spray or drops. If your symptoms still dont get better, you may be referred to an ENT specialist for surgery to improve the drainage of your sinuses. What causes sinusitis? Sinusitis is usually caused by a cold or flu virus spreading to the sinuses from the upper airways. Only a few cases are caused by bacteria infecting the sinuses. An infected tooth or fungal infection can also occasionally cause the sinuses to become inflamed. Chronic sinusitis Its not clear exactly what causes sinusitis to become chronic (long-lasting), but it may be related to: allergies and related conditions, including allergic rhinitis, asthma and hay fever nasal polyps (benign growths inside the nose) smoking a weakened immune system Controlling underlying conditions like allergies may improve the symptoms of chronic sinusitis. Source: ENT Scotland - Opens in new browser window Last updated: 05 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Flu Common cold Other health sites NICE: Balloon catheter dilation for chronic sinusitis NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Sjogrens syndrome,"""Sjgren's syndrome - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Immune system Sjogrens syndrome Sjogrens syndrome About Sjogrens syndrome Symptoms of Sjogrens syndrome Causes of Sjogrens syndrome Diagnosing Sjogrens syndrome Treating Sjogrens syndrome Complications of Sjogrens syndrome About Sjogrens syndrome Sjgrens (pronounced Show-grins) syndrome is an autoimmune disorder. The bodys immune system attacks glands that secrete fluid, such as the tear and saliva glands. The effects ofSjgrens syndrome can be widespread. Certain glands become inflamed, which reduces the production of tears and saliva, causing the main symptoms of Sjgrens syndrome, which aredry eyes and dry mouth . In women (who are most commonly affected), the glands that keep the vagina moist can also be affected, leading to vaginal dryness. Readmore about the symptoms of Sjgrens syndrome What causes Sjgrens syndrome? Sjgrens syndrome is an autoimmune condition, which means that instead of protecting the body from infection or illness, the immune system reacts abnormally and starts attacking healthy cells and tissue. In Sjgrens syndrome, the immune system attacks the tear and saliva glands,and other secretory glands throughout the body. The reasons for this remains unknown, but research suggests that its triggered by a combination of genetic, environmental and, possibly, hormonal factors. Some people are thought to be more vulnerable to the syndrome when theyre born and that certain events, such an infection, can trigger the problems with the immune system. Read more about the causes of Sjgrens syndrome Healthcare professionals classify Sjgrens syndrome as being either: primary  when the syndrome develops by itself and not as the result of another condition secondary  when the syndrome develops in combination with another autoimmune disorder, such as lupus or rheumatoid arthritis DiagnosingSjgrens syndrome Sjgrens syndrome can be difficult to diagnose, becauseit has similar symptoms to other conditions and there is no single test for it. Your doctor will ask about your symptoms and carry out a test to see how dry your mouth and eyes are. Read more about diagnosing Sjgrens syndrome Treating Sjgrens syndrome There is no cure for Sjgrens syndrome, but treatments can help control symptoms. Dry eyes and mouth can usually behelped with artificial tears and saliva. Its important to maintain good eye and mouth hygiene, because your risk of developing an infection is greater. Taking care of your eyes and mouth can help prevent problems such ascorneal ulcers and tooth decay . In severe cases, medication or surgery may be recommended. Read more about treating Sjgrens syndrome Complications ofSjgrens syndrome Sjgrens syndrome can sometimes lead to complications. For example, your eyesight could be permanently damaged if the reduced tear production isnt treated. Sjgrens syndrome also increases your risk of developing non-Hodgkin lymphoma , which isa cancer of the lymph glands. However, the chancesare still low, at around 5%. Women with Sjgrens syndrome have an increased risk of having children with a temporary lupus rashor heart abnormalities. Any pregnancy will be closely monitored for potential problems. Read more about the complications of Sjgrens syndrome Whos affected bySjgrens syndrome? Sjgrens syndrome most commonly affects people aged 40-60, with women accounting for about 90% of cases. Its difficult to know exactly how many people are affected by the syndrome because many dont see their GP about their symptoms. Further information on Sjgrens syndrome Information about you If you have Sjgrens syndrome, your clinical team will pass information about you on to the National Congenital Anomaly and Rare Diseases Registration Service (NCARDRS). This helps scientists look for better ways to prevent and treat this condition. You can opt out of the register at any time. Find out more about the register Symptoms of Sjogrens syndrome The most commonly reported symptoms of Sjgrens syndrome are a dry mouth and eyes, which can lead to other associated symptoms. However, these symptoms can be common in old age, and most people withdry eyes or a dry mouth do not have Sjgrens syndrome. Many women also experience vaginal dryness, which can make sex painful. Associated symptoms of dry mouth A dry mouth can lead to: tooth decay and gum disease dry cough difficulty swallowing and chewing hoarse voice difficulty speaking swollen salivary glands (located between your jaw and ears) repeated fungal infections in the mouth ( oral thrush )  symptoms of which can include a coated or white tongue Associated symptoms of dry eyes Dry eyes can lead to: burning or stinging eyes itchy eyes a feeling that theres grit in your eyes irritated and swollen eyelids sensitivity to light (photophobia) tired eyes mucusdischarge from your eyes These symptoms can get worse when youre: in a windy or smoky environment in an air-conditioned building travelling on aeroplane Other symptoms of Sjgrens syndrome In more serious cases of Sjgrens syndrome, the immune system can attack other parts of the body, causing symptoms and conditions such as: dry skin tiredness and fatigue  which are common and can lead to total exhaustion muscle pain joint pain, stiffness and swelling vasculitis(inflammation of blood vessels) difficulty concentrating, remembering and reasoning Causes of Sjogrens syndrome Its not known exactly what causes Sjgrens syndrome, but its thought to be linked to a problem with the immune system. The immune system Your immune system usually helps protect the body from infection and illness by making antibodies. Antibodies attack bacteria and viruses, which help stop you from becoming ill. An autoimmune condition causes your immune system to react abnormally. Instead of attacking foreign cells, such as bacteria, the antibodies start attacking your bodys healthy cells and tissue. In Sjgrens syndrome, the parts of the body usually affected are the tear, saliva and vaginal glands, which are collectively known as the exocrine glands. The antibodies damage the exocrine glands so they can no longer function normally. Theres some evidence that the immune system also damages the nerves that control these glands, which further reduces their effectiveness. The immune system can go on to damage other parts of the body, such as muscles, joints, blood vessels, nerves and, less commonly, organs. Possible triggers for Sjgrens syndrome Primary Sjgrens syndrome Most researchers believe that primary Sjgrens syndrome is triggered by a combination of genetic and environmental factors. Certain people are born with specific genes that make them more vulnerable to a faulty immune system. Then, many years later, an environmental factor, possibly a common virus, triggers the immune system to stop working properly. The female hormone oestrogen also seems to playa role. Sjgrens syndrome mostly occurs in women, and symptoms usually start around the time of the menopause , when oestrogen levels begin to fall. Falling oestrogen levels can contribute to dryness, and this drynesscould make thecondition more noticeable. Secondary Sjgrens syndrome Sjgrens syndrome can be associated with other autoimmune conditions, such as rheumatoid arthritis or lupus . This is known as secondary Sjgrens syndrome. The exocrine glands Your saliva and tear glands play a vital role in protecting your mouth and eyes, which is why the symptoms ofSjgrens syndrome can be widespread and troublesome. The importance of tears We usually only notice our tears when we cry, but our eyes are always covered by a thin layer of tears, known as a tear film. Tears are made up of a mix of water, proteins, fats, mucus and infection-fighting cells. Tears serve several important functions. They: lubricate the eye keep the eye clean and free of dust protect the eye against infection help stabilise your vision The importance of saliva Saliva also serves several important functions, including: keeping the mouth and throat naturally lubricated aiding digestion by moistening food and containing enzymes that can break down certain starches acting as a natural disinfectant (saliva contains antibodies, enzymes and proteins that protect against some common bacterial and fungal infections) Diagnosing Sjogrens syndrome Sjgrens syndrome can be difficult to diagnose because the symptoms are similar to those of other health conditions. You may see different health professionalsfor yourdifferent symptoms, such as a dentist for a dry mouth , an optician fordry eyes and a gynaecologist foradry vagina, which can sometimes make it difficult to reach a firm diagnosis. Seeyour GP if you experience any symptoms of dryness, particularly of your eyes and mouth. Screening questions Experts in the field have come up with a series of screening questions, which may be useful if youre worried you may have Sjgrens syndrome. If you answer yes to most of the questions below, you may have Sjgrens syndrome and will probably be advised to have further tests. Have you had daily, persistent, troublesome dry eyes for more than three months? Do you keep having a sensation of grit in your eye? Do you need to use eye drops containing tear substitutes more than three times a day? Have you had a daily feeling of dry mouth for more than three months? Do you keep getting swollen salivary glands (located between your jaw and your ears)? Do you frequently drink liquids to help you swallow food? Further testing Tests used to diagnoseSjgrens syndrome include: tear break-up time and Schirmer tests a lip biopsy blood tests salivary flow rate These are explained below. Tear break-up time and Schirmer tests Tear break-up time and Schirmer tests are usually carried out by an ophthalmologist (a doctor who specialises in treating eye conditions). The tear break-up time test measures how effective your tear glands are.A non-toxic dye is dropped onto the surface of your eye and thecolour of the dye allows the ophthalmologist to see how well your tear film is functioning and how long it takes for your tears to evaporate. This test is also carried outusing a slit lamp. A slit lamp is a low-power microscope with a high-intensity light source that can be focused to shine in anarrow beam. The specialist will use the slit lamp to examine your tear glands more closely. In the Schirmer test, small strips of blotting paper are placed into your lower eyelid. After five minutes, the strips are removed to see how much of the paper is soaked with tears. Lip biopsy During a lip biopsy , a small tissuesampleis removed from your inner lip and examined under a microscope. A local anaesthetic isinjected intothe inner surface of your lower lip to numb the area, before a small cut is made to remove a few of your minor salivary glands. Clusters of lymphocytes (a type of white blood cell) in the tissue can indicate Sjgrens syndrome. Blood tests Blood tests are carried out to look for antibodies known as anti-Ro and anti-La (or SS-A and SS-B), which are produced when the immune system has been affected by Sjgrens syndrome. These antibodies are only present in about 60% of people with Sjgrens syndrome, so its possible to have a negative blood test result and still have the condition. Salivary flow rate A salivary flow rate test measures how much saliva your glands produce. Youll usually be asked to spit as much saliva as you can into a cupover a five-minute period. The amount of saliva is then weighed or measured. An unusually low flow rate can indicate Sjgrens syndrome. Treating Sjogrens syndrome Theres no cure for Sjgrens syndrome, but treatments help relieve symptoms such as eye and mouth dryness. Sjgrens syndrome affects everyone in different ways, so your treatment plan will betailored to suit you. Eye care Artificial tears Mild to moderate cases of dry eye can usually be successfully treated with eye drops containing artificial tears  a liquid that mimics tears. These eye drops are available from a pharmacist, without a prescription. There are many different types of eye drops, so you can try different brands to find the one that works best for you. If youre using eye drops regularly (more than three times a day), you should use one that doesnt containpreservatives. This is because theres evidence that over-exposure to preservatives can damage the surface of the eye. A short-term dose of eye drops containing corticosteroids may be recommended if your eyes become irritated. However,long-term corticosteroid use isnt recommended because they can cause serious side effects. To minimise the chance of experiencing side effects from corticosteroids, youll be prescribed the lowest effective dose for the shortest possible time. Moisture chamber spectacles Wearing glasses reduces tear evaporation by up to 30%, and this effect can be maximised by wearing specially-made glasses called moisture chamber spectacles. These wrap around your eyes like goggles and help retain moisture and protect the eyes from irritants. Some people used to be embarrassed towear them, but modern designs look like sports glasses. Punctal plugs Punctual occlusion is a widely-used technique that seals the tear ducts (into which the tears drain) with small plugs. This should help keepthe eye better protected by tears. Temporary plugs made of silicone are usually used first to see if they help. If it does, more permanent plugs can be used. Mouth care Looking after your mouth Anumber of techniques can be used to keep your mouth lubricated, including: maintaining good oral hygiene to prevent tooth decay and gum disease increasing your fluid intake using sugar-free chewing gum to stimulate saliva production sucking ice cubes to help lubricate your mouth and reduce dryness regularly using mouth rinses to sootheyour mouth and protect it against infection If you smoke, you should try to quit. Smoking irritates the mouth and increases the rate at which saliva evaporates. Read more about how to stop smoking Saliva substitutes There are a number of saliva substitute products that can help lubricate your mouth. However, they dont replicate the role ofsaliva in preventing infection, so youll still need to maintain excellent oral hygiene. Saliva substitutes are available as a spray, lozenge (medicated sweet), gel, or gum. Your GP or pharmacist can tell you which product is most suitable for you. Medication for Sjgrens syndrome Pilocarpine The medicine pilocarpine is often used to treat the symptoms of dry eyes and dry mouth . Pilocarpine stimulates the glands to produce more saliva and tears. Side effects of pilocarpine include: hyperhidrosis (excessive sweating) nausea diarrhoea heartburn abdominal (stomach) pain an increased need to go to the toilet For some people, the side effects of pilocarpine are mild. Others find that the side effects outweigh the benefits. Dont take pilocarpine if you have asthma or chronic obstructive pulmonary disease (COPD) , or if youre pregnant or breastfeeding. Hydroxychloroquine Hydroxychloroquine has been shown to slow down the immune systems attack on the tear and saliva glands. It can also help reduce any associated symptoms of muscle pain, joint pain and stiffness. Youll need to take hydroxychloroquine for several weeks before you notice any improvements, and it could be six months before you experience the full benefit of the treatment. Side effects are uncommon and usually mild. They include: nausea skin rash loss of appetite stomach cramps vomiting In very rare cases, hydroxychloroquine can damage the retina, affecting vision. Youll probably be asked to attend an eye examination so that your retina can be checked before you start treatment. Regular eye examinations (usually at least once a year) are also recommended after you begin treatment. Hydroxychloroquine shouldnt be used by breastfeeding women. Treating other symptoms of Sjgrens syndrome Dry skin Several soaps and creams are specifically designed for people with dry skin. Your pharmacist or GP can advise you. Vaginal dryness Vaginal dryness can be treated using a lubricant. Some women also use oestrogen creams or hormone replacement therapy (HRT) . Muscle and joint pains Muscle and joint pains can be treated with an over-the-counter non-steroidal anti-inflammatory drug (NSAID) , such as ibuprofen . If this doesnt work, see your GP, as stronger NSAIDs are available on prescription. NSAIDs can increase your risk of developing stomach ulcers and internal bleeding, particularly if theyre taken on a long-term basis. If you find swallowing NSAIDs difficult because of your dry mouth, you can try an NSAID cream thats rubbed into affected joints. NSAIDs arent recommended for pregnant or breastfeeding women, or for people with pre-existing risk factors for cardiovascular or kidney conditions. General advice Thesesimple tips can help prevent many of the problems associated with Sjgrens syndrome: have a dental check-up every six months practise good dental hygiene  brushing, flossing and using mouthwash regularly avoid eating too many sweet foods avoid strong and perfumed soaps  use special creams and soaps from your pharmacist avoid dry environments, such as air-conditioned offices, whenever possible avoid drinking too much alcohol Complications of Sjogrens syndrome Sjgrens syndrome isnt usually life-threatening, but it is linked to more seriousproblems. Non-Hodgkin lymphoma Its estimated that people with Sjgrens syndrome are 44 times more likely to develop non-Hodgkin lymphoma than people without the condition. Non-Hodgkin lymphoma is a cancer of the lymphatic system. The lymphatic system is a series of vessels and glands (lymph nodes) that are spread throughout your body, much like your blood vessels. While this increased risk may sound alarming, the chance of a person with Sjgrens syndrome developing non-Hodgkin lymphoma is still small, as it only affects around 5% of people with the syndrome. However, if you have Sjgrens syndrome, you should be aware of the main early symptom of non-Hodgkin lymphoma, which is a painless swelling in a lymph node (gland)  usually in the neck, armpit or groin. Report any swollen lymph nodes to your GP. Eye damage If dry eyes arent treated, they canbecome inflamed and you can develop ulcers on the surface of youreyes (corneal ulcers). If left untreated, corneal ulcers can lead to loss of vision and permanent sight damage. Pregnancy If youre planning to become pregnant and have Sjgrens syndrome, ask your GP to test for certain antibodies that may be present in Sjgrens syndrome and are known to cause a temporary lupus rash in newborn babies. In very rare cases, the antibodies can also cause heart defects in babies. If these antibodies are found, there should be no reason why you cant continue with the pregnancy, but your child may need additional specialist care during pregnancy and after the birth. Read more about antenatal appointments Other conditions A number of other conditions have been linked to Sjgrens syndrome, including: peripheral neuropathy  a condition that often involves loss of sensation in the hands and feet Raynauds phenomenon restricted blood flow to the hands, which can cause them to feel cold, numb and painful kidney problems  such as inflammation or kidney stones an underactive thyroid gland (hypothyroidism)  which can lead to tiredness and weight gain irritable bowel syndrome (IBS)  which can cause abdominal pain and irregular bowel movements teeth cavities Source: NHS 24 - Opens in new browser window Last updated: 23 February 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Lupus Rheumatoid arthritis NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Skin cancer (melanoma),"Skin cancer (melanoma) - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Skin cancer (melanoma) Skin cancer (melanoma) About melanoma Symptoms of melanoma Causes of melanoma Diagnosing melanoma Treating melanoma About melanoma Melanoma is a type of skin cancer that can spread to other organs in the body. The most common sign of melanoma is the appearance of a newmole or a change in an existing mole. This can happen anywhere on the body, but the back, legs, arms and face are most commonly affected. In most cases, melanomas have an irregular shape and more than 1 colour. They may also be larger than normal moles and can sometimes be itchy or bleed. An ABCDE checklist has been developed for people to tell the difference between a normal mole and a melanoma. Read more about the symptoms of melanoma . These pages mainly cover a type of melanoma known as superficial spreading melanoma, which accounts for around 70% of all melanomas in the UK. Nodular melanoma Nodular melanoma is a fast-developing type of melanoma, most common in middle-aged people. It may not develop from an existing mole and can appear in areas of skin that arent regularly exposed to the sun. Lentigo maligna melanoma Lentigo maligna melanoma is most common in elderly people and those who have spent a lot of time outdoors. It is common on the face and tends to grow slowly over a number of years. Acral lentiginous melanoma Acral lentiginous melanomaisa rare type of melanoma that usually appears on the palms of the hands and the soles or big toenails of the feet. This is the most common type of melanoma in people with dark skin. Cancer Research UK has more information about the different types of melanoma . Why does melanoma happen? Melanoma happens when some cells in the skin begin to develop abnormally. Its thought that exposure to ultraviolet (UV) light from natural or artificial sources may be partly responsible. Certain things can increase your chances of developing melanoma, such as having: lots of moles or freckles pale skin that burns easily red or blonde hair a family member who has had melanoma Read more about the causes of melanoma . Diagnosing melanoma Speak to your GP if you notice any change to your moles. Your GP will refer you to a specialist clinic or hospital if they think you have melanoma. In most cases, a suspicious mole will be surgically removed and studied to see if it is cancerous. This is known as a biopsy . You may also have a test to check if the melanoma has spread elsewhere in your body. This is known as asentinel node biopsy. Read more about diagnosing melanoma . How is melanoma treated? The main treatment for melanoma is surgery, although your treatment will depend on your circumstances. If melanoma is diagnosed and treated at anearly stage, surgery is usually successful. If melanoma isnt diagnosed until an advanced stage, treatment is mainly used to slow the spread of the cancer and reduce symptoms. This usually involves medicines, such as chemotherapy . Read more about treating melanoma . Onceyouhave had melanoma, there is a chance it may return. This risk is increased if your cancer was widespread and severe. If your cancer team feels there is a significant risk of your melanoma returning, you will probably need regular check-ups to monitor your health. You will also be taught how to examine your skin and lymph nodes to help detect melanoma if it returns. Who is affected Melanoma is the 5th most common cancer in the UK. More than a quarter of cases are diagnosed in people under 50, which is unusual compared to most other types of cancer. Its also becoming more common in the UK over time, thought to be caused by increased exposure to UV light from the sun and sunbeds. Can melanoma be prevented? Melanoma is not always preventable, but you can reduce your chances of developing it by limiting your exposure to UV light. You can help protect yourself from sun damage by using sunscreen and dressing sensibly in the sun. Sunbeds and sunlamps should also be avoided. Regularly checking yourmoles and frecklescan help lead to early diagnosis and increase your chances of successful treatment. Symptoms of melanoma The first sign of a melanoma is often a new mole or a change in the appearance of an existing mole. Normalmoles are usually round or oval, with a smooth edge, andnobigger than 6mm (1/4 inch) in diameter. Speak to your GP as soon as possible if you notice changes in a mole, freckle or patch of skin, especially if the changes happen over a few weeks or months. Signs to look out for include a mole that is: getting bigger changing shape changing colour bleeding or becoming crusty itchy or painful Ahelpfulway to tell the difference between a normal mole and a melanoma is the ABCDE checklist: Asymmetrical  melanomas have 2 very different halves and are an irregular shape Border  melanomas have a notched or ragged border Colours  melanomas will be a mix of 2 or more colours Diameter  melanomas are larger than 6mm (1/4 inch) in diameter. Enlargement or elevation  a mole that changes size over timeis more likely to be a melanoma Melanomas can appear anywhere on your body, but they most commonlyappear on theback, legs, arms and face. They may sometimes develop underneath a nail. In rare cases, melanoma can develop inthe eye. Noticing a dark spot or changes in vision can be signs, although it is more likely to bediagnosed during a routine eye examination. Read further information: Cancer Research UK: Melanoma symptoms Causes of melanoma Most skin cancer is caused by ultraviolet (UV) light damaging the DNA in skin cells. The main source of UV light is sunlight. Sunlight contains 3 types of UV light: ultraviolet A (UVA) ultraviolet B (UVB) ultraviolet C (UVC) UVC is filtered out by the Earths atmosphere, but UVA and UVB damage skin over time, making it more likely for skin cancers to develop. UVB is thought to be the main cause of skin cancer. Artificial sources of light, such as sunlamps and tanning beds, also increase your risk of developing skin cancer. Repeated sunburn , either by the sun or artificial sources of light, increases the risk of melanoma in people of all ages. Moles Youare at an increasedrisk of melanoma if you havelots ofmoleson your body, especially if they are large(over 5mm) or unusually shaped. Having just 1 unusually shaped or very large mole increases your risk of melanoma by 60%. For this reason, its important to monitor moles for changes and avoid exposing them to the sun. Family history Research suggests that if you have 2 or more close relatives who have had non-melanoma skin cancer, your chances of developing the condition may be increased. Increased risk Certainthingsare believed to increase your chances of developing all types of skin cancer, including: pale skin that does not tan easily red or blonde hair blue eyes older age a large number of freckles an area of skin previously damaged by burning or radiotherapy treatment a condition that suppresses your immune system  such as HIV medicines that suppress your immune system (immunosuppressants)  commonly used after organ transplants exposure to certain chemicals  such as creosote and arsenic a previous diagnosis of skin cancer Read further information: Cancer Research UK: Melanoma risks and causes. Diagnosing melanoma A diagnosis of melanoma will usually begin with an examination of your skin. Your GP will refer you to a specialist if they suspect melanoma. Some GPs take digital photographs of suspected tumours so they can email them to a specialist for assessment. As melanoma is a relatively rare condition, many GPs will only see a case every few years. Its importantto monitor your moles and return to your GP if you notice any changes. Taking photos to document any changes will help with diagnosis. Seeing a specialist In 2015, the National Institute for Health and Care Excellence ( NICE ) published guidelines to help GPs recognise the signs and symptoms of malignant melanoma and refer people for the right tests faster. To find out if you should be referred for further tests for suspectedmalignant melanoma, read the NICE 2015 guidelines on Suspected Cancer: Recognition and Referral . You will be referred to a dermatology clinic or hospitalfor further testing if melanoma is suspected. You should see a specialist within 2 weeks of seeing your GP. Thedermatologistor plastic surgeon will examine the mole and the rest of your skin. They mayalso remove the mole and send it for testing ( biopsy ) tocheck whether the mole is cancerous. A biopsy is usually carried out under local anaesthetic ,meaning the area around the mole will be numbed and you wont feel any pain. If cancer is confirmed, you will usually need a further operation, most often carried out by a plastic surgeon, to remove a wider areaof skin. Further tests Further tests will be carried out if there is a concern the cancer has spread into other organs, bones or your bloodstream. Sentinel lymph node biopsy If melanoma spreads, it will usually begin spreading through channels in the skin (called lymphatics) to the nearest group of glands (called lymph nodes).Lymph nodesare part of the bodys immune system, helping to remove unwanted bacteria and particles from the body. Sentinel lymph node biopsy is a test to determine whether microscopic amounts of melanoma (less than would show up on any X-ray or scan) might have spread to the lymph nodes. It is usually carried out by a specialist plastic surgeon, while you are under general anaesthetic . A combination of blue dye and a weak radioactive chemical is injected around your scar. This is usually done just before the widerareaof skin is removed. The solution follows the same channels in the skin as any melanoma. The first lymph node this reachesis known asthe sentinel lymph node. The surgeon canlocate and remove the sentinel node, leaving the others intact. The node is then examined for microscopic specks of melanoma(this process can take several weeks). If the sentinel lymph node is clear of melanoma, its extremely unlikely that any other lymph nodes are affected. This can be reassuringbecause if melanoma spreads to the lymph nodes, its more likely to spread elsewhere. If the sentinel lymph node contains melanoma, there is a risk that other lymph nodes in the same group will contain melanoma. Your surgeon should discuss the pros and cons of having a sentinel lymph node biopsy before you agree to the procedure. Sentinel lymph node biopsy does not cure melanoma, butis used to investigate the outlook of your condition. An operation to remove the remaining lymph nodes in the groupmay be recommended. This is known as a completion lymph node dissection or completion lymphadenectomy. Other tests you may have include: a computerised tomography (CT) scan a magnetic resonance imaging(MRI) scan a positron emission tomography (PET) scan blood tests Read further information: Cancer Research UK: Melanoma tests Cancer Research UK: Further tests for melanoma Treating melanoma Melanoma stages Health professionals use a staging system to describe how far melanoma has grown into the skin (the thickness) and whether it has spread. The type of treatment you receive will depend on what stage the melanoma has reached. The melanoma stages can be described as: stage 0  the melanoma is on the surface of the skin stage 1A  the melanoma is less than 1mm thick stage 1B  the melanoma is 1 to 2mm thick, or the melanoma is less than 1mm thick and the surface of the skin is broken (ulcerated) or its cells are dividing faster than usual (mitotic activity) stage 2A  the melanoma is 2 to 4mm thick, or the melanoma is 1 to 2mm thick and is ulcerated stage 2B  the melanoma is thicker than 4mm, or the melanoma is 2 to 4mm thick and ulcerated stage 2C  the melanoma is thicker than 4mm and ulcerated stage 3A  the melanoma has spread into 1 to 3 nearby lymph nodes, but they are not enlarged; the melanoma is not ulcerated and has not spread further stage 3B  the melanoma is ulcerated and has spread into 1to 3 nearby lymph nodes but they are not enlarged, or the melanoma is not ulcerated and has spread into 1 to 3 nearby lymph nodes and they are enlarged, or the melanoma has spread to small areas of skin or lymphatic channels, but not to nearby lymph nodes stage 3C  the melanoma is ulcerated and has spread into 1 to 3 nearby lymph nodes and they are enlarged, orthe melanoma has spread into 4 or more lymph nodes nearby stage 4  the melanoma cells have spread to other areas of the body, such as the lungs, brain or other parts of the skin Read further information: Cancer Research UK: Treating melanoma Cancer Research UK: Stages of melanoma Macmillan: Melanoma Stage 1 melanoma Treating stage 1 melanoma will involve surgically removing the melanoma and a small area of skin around it  this is known as surgical excision. Surgical excisionis usuallycarried outunder local anaesthetic . This means you will be awake but the area around the melanoma will be numbed, so you wont feel pain. In some cases, general anaesthetic is used, which means you will be asleep during the procedure. If a surgical excision is likely to leave a significant scar, it may be done in combination with a skin graft. A skin graft involves removing a patch of healthy skin, usuallytaken from a part of your body where scarring cannot be seen, such as your back. It is then connected, or grafted, to the affected area. Skin grafts or flaps are used when the area of skin being removed is too big to close using a direct method. Once the melanoma has been removed, there is little possibility it will return and no further treatment should be required. You will probably be asked to come for follow-up appointments before being discharged. Stage 2 and 3 melanoma As with stage1 melanomas, any affected areas of skin will be removed.The remaining skin iseither closed directly, or a skin graft or flap may becarried outif necessary. Sentinel node biopsy Sentinel node biopsy, which is not a mandatory procedure, will be discussed with you. If you decide to go aheadwith the procedureand the results show no spread to nearby lymph nodes, it is unlikely you will have further problems with this melanoma. If the test confirms melanoma has spread to nearby nodes, your specialist will discuss with you whether further surgery is required. Additional surgery involves removing the remaining nodes, known as a completion lymph nodedissection or completion lymphadenectomy. Lymph nodes If the melanoma has spread to nearby lymph nodes, you may need further surgery to remove them. Your doctor willhave felt a lump in your lymph nodes andthe diagnosis of melanoma is usually confirmed using a needle biopsy (fine needle aspiration).Removing the affected nodes requires a procedure called a block dissection, performed under general anaesthetic. While the surgeon will try to ensurethe rest of your lymphatic system can function normally, there is a risk that the removal of lymph nodes will disrupt the lymphatic system, leading to a build-up of fluids in your limbs. This is known as lymphoedema . Follow-up Once the melanoma has been removed, you will need follow-up appointments to see how you are recovering and to watch for any sign of the melanoma returning. You may be offered treatment to try to prevent the melanomareturning. This is called adjuvant treatment. There is not much evidence that adjuvant treatment helps prevent melanoma from coming back, so this is only offered as part of a clinical trial. Stage 4 melanoma It may not be possible to cure melanoma if it has: beendiagnosed at its most advanced stage spread to another part of your body (metastasis) come back in another part of your body after treatment (recurrent cancer) Treatment is available and given in the hope that it can slow the cancers growth, reduce any symptoms you may have and possibly extend your life expectancy. You may be able to have surgery to remove other melanomas that have occurred away from the original site. You may also be able to have other treatments to help with symptoms. These include: radiotherapy drug treatments Radiotherapy Radiotherapy may be used after an operation to remove your lymph nodes, and can also be used to help relieve the symptoms of advanced melanoma. Radiotherapy uses controlled doses of radiation to kill cancer cells. It is given at the hospital as a series of 10 to 15 minute daily sessions, with a rest period over the weekend. The side effects of radiotherapy include: tiredness nausea loss of appetite hair loss sore skin Many side effects can be prevented or controlled with medicines your doctor can prescribe, so let them know about any that you experience. After treatment has finished, the side effects of radiotherapy should gradually reduce. Read further information: Cancer Research UK: Radiotherapy for melanoma . Drug treatment In recent years there have been major advancements in treating melanoma. The medications used to treat melanoma are changing as new formulations are being introduced into clinics. The medications currently being used include: vemurafenib ipilimumab nivolumab However, not everyone is suitable for these drugs. Your specialist will discuss an appropriate treatment with you, and many people are entered into clinical trials. Chemotherapy Chemotherapy involves using anti-cancer (cytotoxic) drugs to kill the cancer.It is normally used to treat melanoma that has spread to parts of the body and is mainly given to help relieve symptoms of advanced melanoma. Several different chemotherapy drugs are used to treat melanoma and are occasionally given in combination. The drugs most commonly used for melanoma are dacarbazine and temozolomide. However, many different types of drugs can be used. Your specialist can discuss with you which drugs are the most suitable. Chemotherapy is usually given as an outpatient treatment, which means you will not have to stay in hospital overnight. Dacarbazine is given through a drip and temozolomide is given in tablet form. Chemotherapy sessions are usually given once every 3 to 4 weeks, with gaps between treatment intended to give your body and blood time to recover. The main side effects of chemotherapy are caused by their influence on the rest of the body. Side effects include infection, nausea and vomiting, tiredness and sore mouth. Many side effects can be prevented or controlled with medicines that your doctor can prescribe. Electrochemotherapy Electrochemotherapy is a possible treatment for melanoma. It may be considered if: surgery isnt suitable or hasnt worked radiotherapy and chemotherapy havent worked The procedure involves giving chemotherapy intravenously (directly into a vein).Short, powerful pulses of electricity are then directed to the tumour using electrodes. These electrical pulses allow the medicine to enter the tumour cells more effectively and cause more damage to the tumour.The procedureis usuallycarried out using general anaesthetic (where youre asleep) but some people maybe able to havelocal anaesthetic(where youre awake but the area is numbed). Depending on how many tumours need to be treated, the procedure can take up to an hour to complete. The main side effect is some pain where the electrode was used, which can last for a few days and may require painkillers. It usually takes around 6 weeks for results to appear and the procedure usually needs to be repeated. Your specialist can give you more detailed information about this treatment option. Read the NICE (2013) guidelines on Electrochemotherapy for metastases in the skin . Immunotherapy Immunotherapy uses drugs (often derived from substances that occur naturally in the body) that encourage your bodys immune system to work against the melanoma. Two such treatments in regular use for melanoma areinterferon-alpha and interleukin-2. Both are given as an injection (into the blood, under the skin, or into lumps of melanoma). Side effects include flu-like symptoms, such as chills, a high temperature, joint pain and fatigue. Vaccines There is ongoing researchinto producing a vaccine for melanoma, either to treat advanced melanoma or to be usedafter surgery in patients who have a high risk of the melanoma coming back. Vaccines are designed to focus the bodys immune system so it recognises the melanoma and can work against it. Vaccines are usually given as an injection under the skin every few weeks, often over a period of months. As more research is needed into vaccines, they are only given as part of a clinical trial. Monoclonal antibodies Our immune systems make antibodies all the time, usually as a way of controlling infections. They are substances that recognise something which doesnt belong in the body and help to destroy it. Antibodies can be produced in the laboratory and can be made to recognise and lock onto specific targets, either in the cancer or in specific parts of the body. Antibodies produced in the laboratory are usually called monoclonal antibodies. Ipilimumab Ipilimumab is a monoclonal antibody that has been licensed for use in the UK since 2011. It works like an accelerator for the immune system, allowing the body to work against all sorts of conditions, including cancer. In December 2012, NICE recommended ipilimumab as a possible treatment for people with previously treated advanced melanoma that has spread or cannot be surgically removed. Signalling inhibitors Signalling inhibitors are drugs that work by disrupting the messages (signals) a cancer uses to co-ordinate its growth. There are hundreds of these signals, and it is difficult to know which ones need to be blocked. Most of the signals have short, technical names. Two that are of current interest in relation to melanoma are BRAF and MEK. There are drugs available that can interfere with these signals, but most are currently only widely available as part of clinical trials. NICE recommends a signalling inhibitor called vemurafenib as a possible treatment for melanoma that has spread or cannot be surgically removed. Read further information: Cancer Research UK: Biological therapy for melanoma . Cancer Research UK: Chemotherapy for melanoma . Clinical trials All new treatment for cancer (and other diseases) is first given to patients in a clinical trial. A clinical trial or study is an extremely rigorous way of testing a drug on people. Patients are monitored for any effects of the drug on the cancer, as well as side effects. Many people with melanoma are offered entry into clinical trials, but some people are suspicious of the process. There are a few key things to know about clinical trials: overall, patients in clinical trials do better than those on routine treatment, even when receiving a drug that would be given routinely all clinical trials are highly regulated all new treatments will first become available through clinical trials even where a new drug fails to offer any benefits over existing treatment, the knowledge that we gain from the trial is valuable for future patients If you are asked to take part in a trial, you will be given an information sheet and, if you want to take part, you will be asked to sign a consent form. You can refuse or withdraw from a clinical trial without it affecting your care. Read further information: Cancer Research UK: Melanoma research . Deciding against treatment for stage 4 melanoma Many of the treatments described have unpleasant side effects that can affect your quality of life. You may decide against having treatment if it is unlikely to significantly extend your life expectancy, or if you do not have symptoms causing you pain or discomfort. This is entirely your decision and your healthcare team will respect it. If you decide not to receive treatment, pain relief and nursing care will be made available when you need it. This is called palliative care . Read further information: Accessing palliative care Cancer Research UK: Advanced melanoma (stage 4) Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites BAD: skin cancer Cancer Research UK: Melanoma Macmillan Cancer Support: Melanoma Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Skin cancer (non-melanoma),"""Skin cancer (non-melanoma) - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Skin cancer (non-melanoma) Skin cancer (non-melanoma) About non-melanoma skin cancer Symptoms of non-melanoma skin cancer Causes of non-melanoma skin cancer Diagnosing non-melanoma skin cancer Treating non-melanoma skin cancer About non-melanoma skin cancer Skin cancer is one of the most common cancers in the world. Non-melanoma skin cancer refers to a group of cancers that slowly develop in the upper layers of the skin. The term non-melanoma distinguishes these more common kinds of skin cancer from the less common skin cancer known as melanoma , which spreads faster in the body. The first sign of non-melanoma skin cancer is usually the appearance of a lump or patch on the skin that doesnt heal after a few weeks. In most cases, cancerous lumps are red and firm, while cancerous patches are often flat and scaly. Speak to your GP if you have any skin abnormality that hasnt healed after 4 weeks. Although it is unlikely to be skin cancer, it is best to be sure. Read more about the symptoms of non-melanoma skin cancer Types of non-melanoma skin cancer Non-melanoma skin cancers usually develop in the outermost layer of skin (epidermis) and are often named after the type of skin cell from which they develop. The 2 most common types of non-melanoma skin cancer are: basal cell carcinoma  starts in the cells lining the bottom of the epidermis and accounts for about 75% of skin cancers squamous cell carcinoma  starts in the cells lining the top of the epidermis and accounts for about 20% of skin cancers Although not classed as non-melanoma skin cancers, actinic keratosesand Bowens disease may sometimes develop into squamous cell carcinoma if left untreated. Why does it happen? Non-melanoma skin cancer is mainly caused by overexposure to ultraviolet (UV) light. UV light comes from the sun, as well as artificial sunbeds and sunlamps. In addition to UV light overexposure, there are certain things that can increase your chances of developing non-melanoma skin cancer, such as: a family history of the condition pale skin that burns easily a large number of moles or freckles Read more about the causes of non-melanoma skin cancer Who is affected? Non-melanoma skin cancer is one of the most common types of cancer in the world. It affects slightly more men than women. Diagnosis Your GP can examine your skin for signs of skin cancer. They may refer you to a skin specialist (dermatologist) or a specialist plastic surgeon if they are unsure or suspect skin cancer. Your GP may refer you urgently, within 2 weeks, for squamous cell skin cancer. Basal cell skin cancers usually dont need an urgent referral but you should still see a specialist within 18 weeks. The specialist will examine your skin again and will perform a biopsy to confirm a diagnosis of skin cancer. A biopsy is an operation that removes some affected skin so it can be studied under a microscope. Read more about diagnosing non-melanoma skin cancer Treating non-melanoma skin cancer Surgery is the main treatment for non-melanoma skin cancer. This involves removing the cancerous tumour and some of the surrounding skin. Other treatments for non-melanoma skin cancer include cryotherapy, creams, radiotherapy, chemotherapy and a treatment known as photodynamic therapy (PDT). Treatment for non-melanoma skin cancer is generally successful as, unlike most other types of cancer, there is a considerably lower risk that the cancer will spread to other parts of the body. It is estimated that basal cell carcinoma will spread to other parts of the body in less than 0.5% of cases. The risk is slightly higher in cases of squamous cell carcinoma, which spreads to other parts of the body in around 2 to 5% of cases. Treatment fornon-melanoma skin canceris completely successful in approximately 90% of cases. Read more about treating non-melanoma skin cancer Complications If you have had non-melanoma skin cancer in the past, there is a chance the condition may return. The chance of non-melanoma skin cancer returning is increased if your previous cancer was widespread and severe. If your cancer team feels there is a significant risk of your non-melanoma skin cancer returning, you will probably require regular check-ups to monitor your health. You will also be shown how to examine your skin to check for tumours. Prevention Non-melanoma skin cancer is not always preventable, but you can reduce your chances of developing the condition by avoiding overexposure to UV light. You can help protect yourself from sunburn by using sunscreen, dressing sensibly in the sun and limiting the time you spend in the sun during the hottest part of the day. Sunbeds and sunlamps should also be avoided. Regularly checking your skin for signs of skin cancer can help lead to an early diagnosis and increase your chances of successful treatment. Read more about sunscreen and sun safety Symptoms of non-melanoma skin cancer The main symptom of non-melanoma skin cancer is the appearance of a lump or discoloured patch on the skin that doesnt heal. The lump or discoloured patch is the cancer, sometimes referred to as a tumour. Non-melanoma skin cancer most often appears on areas of skin which are regularly exposed to the sun, such as the face, ears, hands andshoulders. Basal cell carcinoma Basal cell carcinoma (BCC) usuallyappears as a small red or pink lump, although it can be pearly-white or waxy looking.It can also look like a red, scaly patch. The lump slowly grows and may become crusty, bleed or develop into a painless ulcer. Squamous cell carcinoma Squamous cell carcinoma (SCC) appears as a firm pink lumpand may havea flat, scaly and crusted surface. The lump is often tender to touch, bleeds easily and may develop into an ulcer. Bowens disease Bowens disease is a very early form of skin cancer, sometimes referred to as squamous cell carcinoma in situ. It develops slowly and is easilytreated. The main sign is a red, scaly patch on the skin which may itch. It most commonly affects elderly women and is often found on the lower leg. However, it can appear on any area of the skin. When toseek medical advice If you develop a lump, lesion or skin discolouration that hasnt healed after 4 weeks, speak to your GP. While it is unlikely to be cancer, it is best to be sure. Read further information: Cancer Research UK: Skin cancer symptoms Macmillan: Symptoms of skin cancer Causes of non-melanoma skin cancer Most skin cancer is caused by ultraviolet (UV) light damaging the DNA in skin cells. The main source of UV light is sunlight. Sunlight contains 3 types of UV light: ultraviolet A (UVA) ultraviolet B (UVB) ultraviolet C (UVC) UVC is filtered out by the Earths atmosphere but UVA and UVB damage skin over time, making it more likely for skin cancers to develop. UVB is thought to be the main cause of non-melanoma skin cancer. Artificial sources of light, such as sunlamps and tanning beds, also increase your risk of developing skin cancer. Repeated sunburn , either by the sun or artificial sources of light, will make your skin more vulnerable to non-melanoma skin cancer. Family history Research suggests that if you have 2 or more close relatives who have had non-melanoma skin cancer, your chances of developing the condition may be increased. Increased risk Certain factors are believed to increase your chances of developing all types of skin cancer, including: pale skin that does not tan easily red or blonde hair blue eyes older age a large number of moles a large number of freckles an area of skin previously damaged by burning or radiotherapy treatment a condition that suppresses your immune system, such as HIV medicines that suppress your immune system (immunosuppressants), commonly used after organ transplants exposure to certain chemicals, such as creosote and arsenic a previous diagnosis of skin cancer Read further information: Cancer Research UK: Skin cancer risks and causes . Macmillan: Risk factors and causes of skin cancer . Diagnosing non-melanoma skin cancer A diagnosis of non-melanoma skin cancer will usually begin with a visit to your GP who will examine your skin and decide whether you need further assessment by a specialist. Some GPs take digital photographs of suspected tumours so they can email them to a specialist for assessment. In 2015, the National Institute for Health and Care Excellence ( NICE ) published guidelines to help GPs recognise the signs and symptoms ofskin cancerand refer people for the right tests faster. To find out if you should be referred for further tests for suspected skin cancer, read the NICE 2015 guidelines on Suspected Cancer: Recognition and Referral . Biopsy If skin cancer is suspected, you may be referred to a skin specialist (dermatologist) or specialist plastic surgeon. The specialist should be able to confirm the diagnosis by carrying out a physical examination. However, they will probably alsoperform a biopsy  a surgical procedure where either a part or all of the tumour is removed and studied under a microscope. This is usually carried out under a local anaesthetic , meaning you will be awake, but the affected area will be numbed so you wont feel pain. This allows the dermatologist or plastic surgeon to determine what type of skin cancer you have and whether there is any chance the cancer could spread to other parts of your body. Sometimes, skin cancer can be diagnosed and treated at the same time. In other words, the tumour can be removed and tested and you may not need further treatment because the cancer is unlikely to spread. It may be several weeks before you receive the results of a biopsy. Further tests If you have basal cell carcinoma (BCC), then you usually wont require further tests, as the cancer is unlikely to spread. However, in rare cases of squamous cell carcinoma, further tests may be needed to make sure the cancer has not spread to another part of your body. These tests may include a physical examination of your lymph nodes (glands found throughout your body). If cancer has spread, it may cause your glands to swell. If the dermatologist or plastic surgeon thinks there is a high risk of the cancer spreading, it may be necessary to perform a biopsy on a lymph node. This is called a fine needle aspiration (FNA). During FNA, cells are removed using a needle and syringe so they can be examined. Finding cancerous cells in a nearby lymph node would suggest the squamous cell carcinoma has started to spread to other parts of your body. Treating non-melanoma skin cancer Surgery is the main treatment for non-melanoma skin cancer, although it may depend on your individual circumstances. Overall, treatment is successful for more than 90% of people with non-melanoma skin cancer. People with cancer should be cared for by a team of specialists that often includes a dermatologist, a plastic surgeon, an oncologist (a radiotherapy and chemotherapy specialist), a pathologist and a specialist nurse. If you have non-melanoma skin cancer, you may see several (or all) of these professionals as part of your treatment. When deciding what treatment is best for you, your doctors will consider: the type of cancer you have the stage of your cancer (how big it is and how far it has spread) your general health Your cancer team will recommend what they think is the best treatment option, but the final decision will be yours. Before visiting hospital to discuss your treatment options, you may find it useful to write a list of questions you would like to ask the specialist. For example, you may want to find out what the advantages and disadvantages of particular treatments are. The National Institute for Health and Care Excellence (NICE) has produced healthcare guidelines about NHS skin cancer services. These outline NICEs main recommendations on how, over the coming years, people with skin cancer or melanoma should be treated. Read further information: NICE: improving outcomes for people with skin tumours including melanoma Surgical excision Surgical excision is anoperation tocut out the cancer along with surrounding healthy tissue to ensure the cancer is completely removed. It may be done in combination with a skin graft, ifits likely to leave significant scarring. A skin graft involves removing a patch of healthy skin, usually from a part of your body where any scarring cannot be seen, such as your back. It is then connected, or grafted, to the affected area. In many cases, this operation is enough to cure skin cancer. Curettage and electrocautery Curettage and electrocautery is a similar technique to surgical excision, but is only suitable for cases where the cancer is quite small. The surgeon will use a small, spoon-shaped blade to remove the cancer and an electric needle to remove the skin surrounding the wound. The procedure may need to be repeated two or three times to ensure the cancer is completely removed. Cryotherapy Cryotherapy uses cold treatment to destroy the cancer. It is sometimes used for non-melanoma skin cancers in their early stages. Liquid nitrogen is used to freeze the cancer, and this causes the area to scab over. After about a month, the scab containing the cancer will fall off your skin. Cryotherapy may leave a small white scar on your skin. Mohs micrographic surgery Mohs micrographic surgery (MMS) is used to treat non-melanoma skin cancers when: its felt there is a high risk of the cancer spreading or returning the cancer is in an area where it would be important to remove as little skin as possible, such as the nose or eyes It involves removing the tumour bit by bit, as well as a small area of skin surrounding it. This minimises the removal of healthy tissue and reduces scarring. Each time a piece of tissue is removed, it is checked for cancer. The procedure may need to be repeated 2 or 3 times to ensurethe cancer is completely removed. Chemotherapy Chemotherapy involves using medicines to kill cancerous cells. In the case of non-melanoma skin cancer, chemotherapy is only recommended when the tumour is contained within the top layer of the skin. This type of chemotherapy involves applying a cream containing cancer-killing medicines to the affected area. As only the surface of the skin is affected, you will not experience the side effects associated with other forms of chemotherapy, such as vomiting or hair loss. However, your skin may feel sore for several weeks afterwards. Photodynamic therapy (PDT) Photodynamic therapy (PDT) is used to treat basal cell carcinoma,Bowens disease and actinic keratoses. It involves using a cream which makes the skin highly sensitive to light. After the cream has been applied, a strong light source is shone onto the affected area of your skin, which kills the cancer. PDT may cause a burning sensation and around 2% of people who have this treatment will be left with some superficial scarring. Imiquimod cream Imiquimod cream is a treatment for basal cell carcinoma with a diameter of less than 2cm (0.8 inches). Its also used to treat actinic keratoses. Imiquimod encourages your immune system to attack the cancer in the skin. Common side effects of imiquimod include redness, flaking or peeling skinand itchiness. Less common and more serious side effects of imiquimod include blistering or ulceration of your skin. Wash the cream off and contact your GP if your skin blisters or you develop ulcers after using it. Radiotherapy Radiotherapy involves using low doses of radiation to destroy the cancer. The level of radiation involved is perfectly safe. However, your skin may feel sore for a few weeks after radiotherapy. Radiotherapy is sometimes used to treat basal cell and squamous cell carcinomas if: surgery would be unsuitable the cancer covers a large area the area is difficult to operate on Radiotherapy is sometimes used after surgical excision to try to prevent the cancer coming back. This is called adjuvant radiotherapy. Electrochemotherapy Electrochemotherapy is a possible treatment for non-melanoma skin cancer. It may be considered if: surgery isnt suitable or hasnt worked radiotherapy and chemotherapy havent worked The procedure involves giving chemotherapy intravenously (directly into a vein).Short, powerful pulses of electricity are then directed to the tumour using electrodes. These electrical pulses allow the medicine to enter the tumour cells more effectively and cause more damage to the tumour. The procedureis usuallycarried out using general anaesthetic (where youre asleep) but some people maybe able to havelocal anaesthetic(where youre awake but the area is numbed). Depending on how many tumours need to be treated, the procedure can take up to an hour to complete. The main side effect is some pain where the electrode was used, which can last for a few days and may require painkillers. It usually takes around 6 weeks for results to appearand the procedure usually needs to be repeated. Your specialist can give you more detailed information about this treatment option. Read the NICE (2013) guidelines on Electrochemotherapy for metastases in the skin . Read further information: Cancer Research UK: Treating skin cancer . Macmillan: Treatment for skin cancer . Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Kaposi's sarcoma Skin cancer (melanoma) Other health sites Royal Marsden British Association of Dermatologists Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Skin rashes in children,"Skin rashes in children | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Skin, hair and nails Skin rashes in children Skin rashes in children Skin rashes in children are common and are often nothing to worry about. Learn about some common skin rashes in children, what their symptoms are and how to treat them. What to do if a child has a rash Phone 999 or go to A&E now if: Your child is unwell with a rash and: has a stiff neck is bothered by light seems confused has a high temperature has difficulty breathing (you may notice grunting noises or their tummy sucking under their ribs), breathlessness, or theyre breathing very fast has a rash that looks like small bruises or bleeding under the skin and does not fade when you press a glass against it their skin, lips or tongue look pale, blue, grey or blotchy On brown and black skin, it may be easier to see the rash or colour changes on the soles of the feet, palms, lips, tongue and inside the eyelids. Ask for an urgent GP appointment or phone 111 if: youre worried about your childs rash and youre not sure what to do Cellulitis Image source: dermnetnz.org Cellulitis is an infection of the deeper layers of skin and underlying tissue. Moreabout cellulitis Symptoms and treatments Symptoms The affected area will be: red painful swollen hot It often affects the legs, but can occur anywhere on the body. Your child will probably also have a fever. See your GP immediately if an area of your childs skin suddenly turns red, hot and tender. If you cant see your GP on the same day, go to a walk-in centre or minor injuries unit. Treatment Cellulitis can usually be diagnosed by assessing the symptoms and examining the skin. It usually responds well to treatment with antibiotics. Chickenpox Image source: dermnetnz.org Chickenpox is a viral illness that most children catch. Its most likely to affect children under 10. Moreabout chickenpox Symptoms and treatment Symptoms An itchy, spotty rash is the main symptom of chickenpox. It can be anywhere on the body. Some children only have a few spots. Others have them all over their body. The spots turn into fluid-filled blisters. This can be very itchy and some may burst. These spots crust over to form scabs, which after a while drop off. Chickenpox on back Treatment Theres no treatment for chickenpox. But, you can get remedies from your pharmacy that can help symptoms. These include: paracetamol to help bring down a fever calamine lotion and cooling gels to ease itching Eczema Image source: dermnetnz.org The most common type of eczema is atopic eczema. This mostly affects children but can continue into adulthood. More about eczema Symptoms and treatments Symptoms Eczema is a long-term condition that causes the skin to become: itchy red dry cracked Atopic eczema often develops on the: backs of the knees elbows neck eyes ears Eczema isnt a serious condition. But, if your child becomes infected with the herpes simplex virus, it can cause the eczema to flare up into an outbreak of tiny blisters. This is called eczema herpeticum and will cause a fever. Treatment Creams and ointments can help eczema symptoms like itching and redness. You should speak to your GP if you think your child has eczema. Theyll be able to tell you whats the most suitable treatment. Erythema multiforme Image source: dermnetnz.org Erythema multiforme is a skin rash. Its caused by an allergic reaction to the herpes simplex virus and is usually mild. Symptoms and treatment Erythema multiforme causes spots. These look like targets with a dark red centre and paler ring around the outside. The hands or feet are usually affected first, followed by the limbs, upper body and face. Your child will probably feel unwell and may have a fever. In rare cases, erythema multiforme can be triggered by a reaction to certain medications. This can include antibiotics or anticonvulsants. This more severe form is called Stevens-Johnson syndrome and it can be life-threatening. Treatment You should speak to your GP if your child has a rash and seems unwell. Hand, foot and mouth disease Image source: dermnetnz.org Hand, foot and mouth disease is a common, contagious infection. Its most common in young children (particularly those under 10). But, it can also affect older children and adults. More about hand, foot and mouth disease Symptoms and treatments Symptoms Hand, foot and mouth disease causes: mouth ulcers spots and blisters on the palms of the hands and soles of the feet Treatment Theres no cure for hand, foot and mouth disease. Your childs immune system will fight the virus and it should clear up after about 7 to 10 days. Hand, foot and mouth disease spreads easily. This means you should keep your child away from school or nursery until theyre better. Make sure your child drinks plenty of fluid. If eating and swallowing is uncomfortable, give them soft foods like mashed potatoes, yoghurt and soup. Impetigo Image source: dermnetnz.org Impetigo is a common and highly contagious skin infection. More about impetigo Symptoms and treatment Symptoms Impetigo causes sores and blisters. There are 2 types of impetigo called: non-bullous bullous Non-bullous impetigo usually affects the skin around the nose and mouth. It causes sores that burst quickly to leave a yellow-brown crust. Bullous impetigo typically affects the trunk (the area of the body between the waist and neck). It causes fluid-filled blisters that burst after a few days to leave a yellow crust. Treatment Speak to your GP or pharmacist if you think your child has impetigo. An antibiotic cream or tablets will be prescribed. This should reduce the length of the illness to around 7 to 10 days. Impetigo isnt usually serious and often improves within a week of treatment. Hives (urticaria) Image source: dermnetnz.org Hives is a common skin reaction that often affects children. It can be known as: hives urticaria weals welts nettle rash More about hives Symptoms and treatments Symptoms Hives is a raised, itchy rash. It can affect one part of the body or be spread across large areas. It occurs when a trigger causes high levels of histamine and other chemicals to be released in the skin. These substances cause the blood vessels in the skin to open up, resulting in: redness or pinkness swelling itchiness There are many possible triggers of hives, including: allergens, like food or latex irritants, like nettles or medicines physical factors, like heat or exercise Sometimes a cause of hives cant be identified. Treatment A hives rash is usually short-lived and mild. It can often be controlled with antihistamines. Keratosis pilaris (chicken skin) Image source: dermnetnz.org Keratosis pilaris is a common and harmless skin condition. It usually begins in childhood and gets worse during puberty. Some people find it improves after this and may even disappear in adulthood. Symptoms and treatment Symptoms The skin on the back of the upper arms becomes rough and bumpy, as if its covered in permanent goose pimples. Sometimes other areas of the body can be affected like the: buttocks thighs forearms upper back Treatment Theres no cure for keratosis pilaris. It often gets better on its own without treatment. But, there are some things you can do that may improve your childs rash. You could use: non-soap cleansers rather than soap an emollient to moisturise their skin Your GP or pharmacist will be able to recommend a suitable cream. Measles Image source: dermnetnz.org Measles is a highly infectious illness that most often affects young children. Its now rare in the UK because of the effectiveness of the measles, mumps and rubella (MMR) vaccine . More about measles Symptoms and treatments Symptoms The measles rash is red-brown blotches. It usually starts on the head or upper neck and then spreads outwards to the rest of the body. Your child may also have a fever and cold-like symptoms. Treatment Phone your GP practice immediately if you think your child has measles. Its best to phone before visiting your GP practice as they may need to make special arrangements. Thisll help to reduce the risk of spreading the infection to others. Measles usually passes in about 7 to 10 days without causing further problems. Paracetamol or ibuprofen can be used to relieve fever, aches and pains. You should also make sure that your child drinks plenty of water to avoid dehydration . Molluscum contagiosum Image source: dermnetnz.org Molluscum contagiosum is a viral skin infection. It often affects young children aged between 1 to 5. They usually catch it after close physical contact with another infected child. Most adults are resistant to the virus. This means theyre unlikely to catch it if they come into contact with it. Symptoms and treatment Symptoms Molluscum contagiosum causes clusters of small, firm, raised spots on the skin. The condition is usually painless, although some children may experience some itchiness. Treatment Molluscum contagiosum usually goes away within 18 months without the need for treatment. Pityriasis rosea Image source: dermnetnz.org Pityriasis rosea is a relatively common skin condition. Most cases occur in older children and young adults (aged between 10 and 35). Symptoms and treatments Symptoms It causes a temporary rash of raised, red scaly patches. The rash can be very itchy. Treatment In most cases, pityriasis rosea clears up without treatment. It usually takes 2 to 12 weeks to clear. But, in rare cases it can last up to 5 months. Emollients, steroid creams and antihistamines can be used to help relieve the itchiness. The rash doesnt usually leave scars. But, the skin can sometimes be discoloured afterwards. Prickly heat (heat rash) Image source: dermnetnz.org Prickly heat (heat rash) is also known as miliaria. It occurs when the sweat ducts in the outer layer of skin (epidermis) are obstructed. Symptoms and treatment Symptoms Heat rash is an itchy rash of small, raised red spots. It causes a stinging or prickly sensation on the skin. You can get a heat rash anywhere on your body but it often affects the: face neck back chest thighs Infants can sometimes get a prickly heat rash if they sweat more than usual. For example, when its hot and humid or if theyre overdressed. Treatment Heat rash isnt a serious condition and rarely requires any specific treatment. Psoriasis Image source: dermnetnz.org Psoriasis is a long-lasting (chronic) skin condition. More about psoriasis Symptoms and treatments Symptoms Psoriasis causes red, flaky, crusty patches of skin covered with silvery scales. The severity of psoriasis varies from person to person. Treatment Theres no cure for psoriasis. But, there are treatments to help improve the symptoms and appearance of skin patches. This includes topical corticosteroids like creams and ointments. Ringworm Image source: dermnetnz.org Ringworm is a highly infectious fungal skin infection. More about ringworm Symptoms and treatment Symptoms Ringworm causes a ring-like red or silvery patch on the skin that can be scaly, inflamed or itchy. Ringworm often affects the arms and legs, but it can appear almost anywhere on the body. Other similar fungal infections can affect the scalp, feet, groin and nails. Treatment Ringworm can usually be easily treated with antifungal medicines. These are available from a pharmacy. Ringworm of the scalp can cause scaling and patches of hair loss. Its treated with antifungal tablets, often combined with antifungal shampoo. Scabies Image source: dermnetnz.org Scabies is a contagious skin condition. Its caused by tiny mites that burrow into the skin. In children, scabies is usually spread through long periods of skin-to-skin contact with an infected adult or child. For example, during play fighting or hugging. More about scabies Symptoms and treatments Symptoms Scabies mites leave small, red blotches. These are often found on the palms of the hands or the soles of the feet. In infants, blisters are often found on the soles of the feet. A scabies rash can be very itchy. Treatment Speak to your GP if you think your child has scabies. Its not usually a serious condition, but it does need to be treated. Your GP will prescribe a lotion or cream. Scarlet fever Image source: dermnetnz.org Scarlet fever is a highly contagious bacterial infection. It usually affects children between 2 and 8. More about scarlet fever Symptoms and treatment Symptoms Scarlet fever causes a distinctive pink-red rash. This feels like sandpaper to touch and may be itchy. Scarlet fever often starts with a sore throat, fever and headache . The rash then develops 2 to 5 days after infection. The rash usually occurs on the chest and stomach. It then spreads to other areas of the body, like the ears and neck. Treatment Speak to your GP if you think your child has scarlet fever. Antibiotics are used to treat scarlet fever. It usually clears up after about a week. Slapped cheek syndrome Image source: dermnetnz.org Slapped cheek syndrome is a viral infection thats common in children aged 6 to 10. Its also known as fifth disease or parvovirus B19. More about slapped cheek syndrome Symptoms and treatments Symptoms Slapped cheek syndrome causes a distinctive bright red rash on both cheeks. This can look alarming, but it usually clears up by itself in 1 to 3 weeks. Treatment Unless your child is feeling unwell, they dont need to stay away from school. Once the rash appears, the infection is no longer contagious. But, its a good idea to notify your childs school about the infection. NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Slapped cheek syndrome,"Slapped cheek syndrome | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Slapped cheek syndrome Slapped cheek syndrome Slapped cheek syndrome (also called fifth disease or parvovirus B19) is a viral infection. Its most common in children but it can affect people of any age. It usually causes a bright red rash on the cheeks. Slapped cheek syndrome is normally a mild infection that clears up by itself in 1 to 3 weeks. Once youve had the infection, youre usually immune to it for life. However, slapped cheek syndrome can be more serious for some people. If youre pregnant, have a blood disorder or a weakened immune system and have been exposed to the virus, you should get medical advice. Symptoms of slapped cheek syndrome Symptoms of slapped cheek syndrome usually develop 4 to 14 days after becoming infected. Sometimes, symptoms may not appear for up to 21 days. First symptoms Some people with slapped cheek syndrome wont notice any early symptoms, but most people will have the following symptoms for a few days: a slightly high temperature (fever) of around 38C (100.4F) a runny nose a sore throat a headache an upset stomach feeling generally unwell The infection is most contagious during this initial period. Adults may also feel joint pain and stiffness. This may continue for several weeks or even months after the other symptoms have passed. Slapped cheek rash Image source: dermnetnz.org After a few days, a distinctive bright red rash on both cheeks (slapped cheeks) normally appears. Adults may not get this. By the time this rash develops, the condition is no longer contagious. After another few days, a light pink rash may also appear on the chest, stomach, arms and thighs. This often has a raised, lace-like appearance and may be itchy. The rashes will normally fade within a week or two. Occasionally, the body rash may come and go for a few weeks after the infection has passed. This can be triggered by exercise, heat, anxiety or stress. When to get medical advice You dont usually need to see your GP if you think you or your child has slapped cheek syndrome as it normally gets better on its own. Speak to your GP practice if: Youve been exposed to anyone with slapped cheek syndrome or you have symptoms of the infection and: youre pregnant  theres a very small risk of miscarriage or other complications you have a blood disorder, such as sickle cell anaemia or thalassaemia you have a weakened immune system ask for an urgent appointment if you have symptoms of severe anaemia, such as very pale skin, shortness of breath , extreme tiredness or fainting If your GP is closed, phone 111 . In these cases, a blood test may be carried out to see if youre immune to the infection. If youre not immune, youll be monitored carefully to check for any problems. If you develop severe anaemia, its likely that youll be sent to hospital for a blood transfusion . What to do if you or your child has slapped cheek syndrome Slapped cheek syndrome is usually mild and should clear up without specific treatment. If you or your child is feeling unwell, there are things you can do help ease the symptoms. Do rest drink plenty of fluids  babies should continue their normal feeds take paracetamol or ibuprofen for a high temperature, headaches or joint pain  children under 16 shouldnt take aspirin use an emollient (moisturising lotion) on itchy skin speak to a pharmacist about itchy skin  they can recommend the best antihistamine for children Unless you or your child is feeling unwell, you do not have to stay away from work or school once the rash has developed. The infection is no longer contagious by this point. Let your childs school know if your child has slapped cheek syndrome. How do you get slapped cheek syndrome? Slapped cheek syndrome is caused by a virus called parvovirus B19. This is found in the droplets in the coughs and sneezes of someone with the infection. The virus is spread in a similar way to colds and flu . You can become infected by: inhaling droplets that are sneezed or coughed out by someone with the infection touching a contaminated surface or object and then touching your mouth or nose Someone with slapped cheek syndrome is infectious during the period before the rash develops. Once the rash appears, the condition can no longer be passed on. Preventing slapped cheek syndrome Its very difficult to prevent slapped cheek syndrome. This is because people who have the infection are most contagious before they develop any obvious symptoms. Make sure that everyone you live with washes their hands often to help stop the infection from spreading. Theres currently no vaccine available to protect you against the condition. Source: NHS 24 - Opens in new browser window Last updated: 04 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Self-help guide: Rash Skin rashes in children NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Soft tissue sarcomas,"""Soft tissue sarcomas - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Soft tissue sarcomas Soft tissue sarcomas Soft tissue sarcomas are a group of rare cancers affecting the tissues that connect, support and surround other body structures and organs. Tissues that can be affected by soft tissue sarcomas include fat, muscle, blood vessels, deep skin tissues, tendons and ligaments. Soft tissue sarcomas can develop in almost any part of the body, including the legs, armsand the trunk (torso). There are many different types of soft tissue sarcoma, depending on where in the body they are located. For example: leiomyosarcomas  which develop in muscle tissue liposarcomas  which develop in fat tissue angiosarcomas  which develop in the cells of the blood or lymph vessels gastrointestinal stromal tumours (GISTs)  which can develop inthe connective tissues that support the organs of the digestive system Soft tissue sarcomas account for around 1 in every 100 cancers diagnosed in the UK. What causes soft tissue sarcomas? Cancer develops when cells multiply uncontrollably, forming tumours. In the vast majority of soft tissue sarcomas its unclear what causes this to happen but there are a number of factors known to increase the risk, including: age  soft tissue sarcomas can occur at any age, including in children, but they are more common in middle-aged or elderly people and your risk increases as you get older certain genetic conditions  some genetic conditions, such as neurofibromatosis type 1 and retinoblastoma, are associated with an increased risk of soft tissue sarcomas previous radiotherapy  some people who have previously had radiotherapy for another type of cancer develop a soft tissue sarcoma, often many years after their previous treatment exposure to certain chemicals  exposure to some chemicals, including vinyl chloride, dioxins and phenoxyacetic herbicides, has been associated with increased rates of soft tissue sarcomas One particular type of soft tissue sarcoma called Kaposis sarcoma  which develops in skin cells  is caused by a virus known as the human herpesvirus type 8 (HHV-8) infecting someone with a weakened immune system (such as people with HIV ). Signs and symptoms As soft tissue sarcomas can develop in most parts of the body, they can cause a wide range of symptoms. For example, a tumour near the stomach may cause abdominal (tummy) pain , a feeling of fullness and constipation , whereas a tumour near the lungs may cause a cough or breathlessness . There are often no obvious symptoms in the early stages of soft tissue sarcomas, although you may notice a soft, painless lump under your skin or deeper, that cant easily be moved around and gets bigger over time. You should speak to your GP if you have a worrying lump or any other troublesome symptoms. A lump the size of a golf ball or larger should be regarded as suspicious and needs to be investigated urgently. Although it is much more likely you have a benign (non-cancerous) condition, it is important to get your symptoms checked out. Diagnosing soft tissue sarcomas If your GP feels there is a possibility you do have cancer, they will refer you for a number of hospital tests to confirm whether you have a soft tissue sarcoma. In 2015, the National Institute for Health and Care Excellence ( NICE ) published guidelines to help GPs recognise the signs and symptoms ofsoft tissue sarcomaand refer people for the right tests faster. To find out if you should be referred for further tests for suspected soft tissue sarcoma, read the NICE 2015 guidelines on Suspected Cancer: Recognition and Referral . A diagnosis of a soft tissue sarcoma will usually be made by a hospital specialist and will be based on your symptoms, a physical examination, and the results of: a biopsy  where a sample of suspected cancerous tissue is removed using a needle or during an operation so it can be tested and analysed in a laboratory imaging tests  a magnetic resonance imaging (MRI) scan is the main type of scan carried out to assess soft tissue sarcomas, although other scans may also be carried out If a diagnosis of a soft tissue sarcoma is confirmed, these tests will also help determine how far the cancer has spread (known as the stage) and how aggressive the cancer is (known as the grade). Treating soft tissue sarcomas If youre diagnosed with a soft tissue sarcoma your care team of specialist doctors and nurses will help you decide on the most appropriate treatment. Treatment depends on factors such as the stage and grade of the cancer, the location of any tumours, and your age and general health. The main treatments used are: surgery  to remove any tumours radiotherapy  where high-energy radiation is used to kill cancer cells chemotherapy  where medication is used to kill cancer cells Surgery Surgery is the main treatment for soft tissue sarcomas that are detected at an early stage. It involves removing the cancerous tumour along with a section of surrounding healthy tissue. This will help ensure no cancer cells are left behind. Every effort will be made to reduce the impact of surgery on the appearance and functionality of the affected body part. But there is a possibility youll have some difficulty using the part of the body that is operated on after surgery and sometimes reconstructive plastic surgery may be needed to repair significant damage. In a small number of cases, there may be no option but to amputate the part of the body where the cancer is located, such as part of the leg. Radiotherapy Radiotherapy is often used after surgery to destroy any remaining cancer cells. This is carried out using an external machine that directs beams of radiation at a defined treatment area. Radiotherapy may also sometimes be used before surgery to make a tumour easier to remove, or as part of your treatment to reduce your symptoms if surgery is not possible. Common side effects of radiotherapy include sore skin, tiredness andhair lossin the treatment area. These tend to get better within a few days or weeks of treatment finishing. Read more about the side effects of radiotherapy Chemotherapy Like radiotherapy, chemotherapy is sometimes used before surgery to shrink a tumour and make it easier to remove. This involves being given anti-cancer medication directly into a vein (intravenously). Chemotherapy may also be used alone or alongside radiotherapy for soft tissue sarcomas that cannot be surgically removed. Chemotherapy medications have a poisonous effect on the bodys cells, and can cause a number of temporary but unpleasant side effects, such as feeling tired and weak all the time, feeling and being sick, and hair loss from several parts of the body. Read more about the side effects of chemotherapy Outlook As with most types of cancer, the outlook for a soft tissues sarcoma depends largely on how far the cancer has advanced when it is diagnosed. If the cancer is detected at an early stage and can be removed during surgery, there is a possibility it can be cured. But youll need regular check-ups following treatment to check for any signs the cancer has come back. You may also need long-term physiotherapy and occupational therapy to help you manage any physical difficulties resulting from surgery. Acure is not usually possible if a soft tissue sarcoma is only detected at a late stage when it has already spread to other parts of the body, although treatment can help slow the spread of the cancer and control your symptoms. Read further information: Macmillan Cancer Support: soft tissue sarcomas Sarcoma UK: what is sarcoma? Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Kaposi's sarcoma Radiotherapy Other health sites Sarcoma UK Cancer Research UK: Soft tissue sarcomas Macmillan Cancer Support: Soft tissue sarcomas GIST Support UK Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Soft tissue sarcomas: Teenagers and young adults,"Soft tissue sarcomas | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in teenagers and young adults Soft tissue sarcomas: Teenagers and young adults Soft tissue sarcomas: Teenagers and young adults Introduction The soft tissue Tests for soft tissue sarcomas Treating soft tissue sarcomas Living with a soft tissue sarcoma Introduction This section is for teenagers and young adults. Its about a type of cancer called soft tissue sarcoma. There are several different types of soft tissue sarcoma. The information in this section covers rhabdomyosarcomas, synovial sarcomas, soft tissue Ewings sarcoma and fibrosarcomas. These are the most common types in teenagers. If you have a different type and want to know more,contact Macmillan . If youre looking for information about soft tissue sarcomas in people of all ages, read our general soft tissue sarcoma section. Soft tissue sarcomas are cancers that develop from cells in the soft, supporting tissues of the body. There are many different types, but the ones that tend to affect teenagers are: rhabdomyosarcomas synovial sarcomas soft tissue Ewings sarcoma fibrosarcomas Sarcomas can also develop in the bones. This is called osteosarcoma. Signs and symptoms of soft tissue sarcomas The symptoms of a sarcoma will depend on where it is: if its in an arm or leg, symptoms include a lump or swelling in the limb  this is usually painless, but not always if its in the tummy (abdomen), symptoms include a painful, swollen tummy, and problems going to the toilet to poo (called constipation) if its in your bladder, symptoms include pain in the lower tummy, finding it difficult to pee (pass urine), and having blood in your pee if its in the chest, symptoms can include breathlessness, a cough and pain in your chest if its in the head or neck, symptoms include a lump, a blockage and discharge from the nose or throat;occasionally an eye may become swollen and stick out a bit You may also have other symptoms, such as tiredness, loss of appetite or weight loss. Remember  most people with these symptoms wont have a sarcoma. But if you have any of these symptoms, or are worried that you may have a sarcoma, the first thing to do is to speak to your GP. Theyll examine you and refer you to a hospital if they think you need to see a specialist doctor. Causes Its unknown what causes sarcomas in teenagers and young adults. People often think a knock or injury might have caused a sarcoma, but theres no evidence for this. Remember that nothing youve done has caused the cancer. Types of soft tissue sarcoma Rhabdomyosarcoma This type of sarcoma grows in the active muscles of the body. These are muscles that we have control over, like the muscles we use to move our arms or legs. Rhabdomyosarcomas are most likely to happen in the head, neck, bladder, vagina, arms, legs and trunk. There are different types or rhabdomyosarcoma. The most likely one to happen in teenagers and young adults is called an alveolar rhabdomyosarcoma and affects an arm or a leg. To find out more look atMacmillans rhabdomyosarcoma information that is written for all ages. Synovial Sarcoma This type of sarcoma is most likely to happen in the tissue around the joints, like your elbow, knee and ankle. It can also happen in other parts of your body, but that is less common. This type of sarcoma might not be obvious straight away because the lump grows slowly and is usually not sore. Soft tissue Ewings sarcoma If you have a type of soft tissue sarcoma called a soft tissue Ewings sarcoma, its treated in the same way as a Ewings sarcoma in a bone. You can read more about this in Macmillans bone cancer section. Fibrosarcoma This type of sarcoma happens in the fibrous tissue in your body. Fibrous tissue joins the structures inside your body together  like your muscles to bones. Youre most likely to find a fibrosarcoma on your arms, legs or trunk, but they can happen deeper in your body. If youre looking for information about soft tissue sarcomas in people of all ages, read our general soft tissue sarcoma information. The soft tissue The soft tissues of the body connect, surround and support other body tissue and organs. Soft tissue includes muscle, cartilage, fat, fibrous tissue, nerves and blood vessels. Types of soft tissue sarcoma Soft tissue sarcomas are cancers that develop from cells in the soft, supporting tissues of the body. There are many different types, but the ones that tend to affect teenagers are: rhabdomyosarcomas synovial sarcomas fibrosarcomas There are also bone sarcomas. Doctors can tell the type of soft tissue sarcoma by closely examining the sample of tissue thats been removed (called a biopsy) under a microscope. Rhabdomyosarcomas These develop from muscle and the surrounding tissue. There are 2 main types that affect younger people: alveolar rhabdomyosarcomas these are more common in teenagers and young adults and are usually found in an arm or leg (limb), or in the muscles of the chest or tummy (abdomen) embryonal rhabdomyosarcomas  these are more common in children and can start in a number of areas, for example, around the eye, where the throat joins with the nose, the bladder, the womb, or the vagina Synovial sarcomas These usually develop near to but not inside joints, such as the knee or elbow. But they can develop anywhere in the body. They usually appear as hard lumps. Fibrosarcomas These start in cells called fibrocytes, which form the tissue that helps join parts of our body together, such as joining the muscles to the bones. Fibrosarcomas are usually found in the arms, legs or torso, but can also start in areas deeper in the body. The information in this section covers the common types of soft tissue sarcoma, but if you have a different one and want to know more, please contact Macmillan . Causes Its unknownwhat causes sarcomas in teenagers and young adults. Remember that nothing youve done has caused the cancer. Some rare conditions that run in families (known as genetic conditions) can increase the chance (risk) of getting a soft tissue sarcoma. You would usually know if anyone in your family had one of these conditions. People who had radiotherapy for another type of cancer when they were a child may have an increased risk of developing a sarcoma in later life  this would be from their teens onwards. People often think a knock or injury might have caused a sarcoma, but theres no evidence for this. If youre looking for information about soft tissue sarcomas in people of all ages, read our general soft tissue sarcoma information. Tests for soft tissue sarcomas There are some tests you might have at your GP surgery or at the hospital. These tests will help the doctors see whether you have a soft tissue sarcoma. Visiting your GP If you think you might have some of the symptoms of a soft tissue sarcoma, you should go to your GP. Theyll be able to talk to you about your symptoms, and they can arrange tests to find out more. Theyll examine you and usually arrange for some tests, such as X-rays. There may be a number of reasons why youre feeling unwell, so it can be difficult to diagnose the problem straight away. If your GP cant find the cause, youll be referred to a specialist at the hospital. At the hospital To begin with, you may see a specialist at a general hospital for more tests. If your GP suspects you have a soft tissue sarcoma, they may refer you directly to a sarcoma specialist. If youre diagnosed with a sarcoma and youre not already seeing a specialist, youll be referred to one. Youll probably see a lot of doctors, nurses and other staff. Your hospital doctor will examine you and arrange for some of thefollowing tests, which Macmillan have information on: X-rays bone scans ultrasound scans MRI , CT or PET scans biopsies bone marrow tests You wont necessarily need all of these tests. Further tests If the tests show that you have a sarcoma, you might need a few more tests to check how your body is working in general. Macmillan have information on these, including: blood tests tests to check your heart is healthy, including an echocardiogram or electrocardiogram (ECG), or a nuclear medicine scan (MUGA scan) tests to check your kidneys are healthy, which can involve blood tests or having your wee (urine) collected for a period of time or a nuclear medicine blood test (GFR) This may seem like a lot of tests, but theyll help the doctors plan the best treatment for you. Having tests and waiting for the results can be a scary time. Talking about how you feel and getting support from family, friends and your specialist nurse and doctor can make it a bit easier. If youre looking for information about soft tissue sarcomas in people of all ages, read our general soft tissue sarcoma information. Treating soft tissue sarcomas This section is for teenagers and young adults. Its about treatment for a type of cancer called a soft tissue sarcoma. There are different types of soft tissue sarcoma, and the information in this section covers rhabdomyosarcomas, synovial sarcomas and fibrosarcomas, which are the most common types in teenagers. If you have a different type and want to know more, please contact Macmillan . The 3 main types of treatment for soft tissue sarcomas are surgery, chemotherapy and radiotherapy. Most people have a combination of treatments. Your doctors will plan your treatment based on: thetype of sarcoma you have the stage of the cancer (how big it is and whether it has spread from where it started) the grade of the cancer (how fast-growing the cancer cells are). If you have any questions about your treatment, ask your doctor or nurse. Theyll be happy to help you understand whats involved. If you have a type of soft tissue sarcoma called a soft tissue Ewings sarcoma, its treated in the same way as a Ewings sarcoma in a bone. Chemotherapy This is when youre given anti-cancer drugs to destroy the cancer cells. For soft tissue sarcomas, chemotherapy can be given in a number of situations: before surgery  to shrink the tumour after surgery  to reduce the risk of the cancer coming back, and to treat cancer cells that have spread when it isnt possible to remove the sarcoma with an operation For soft tissue sarcomas, chemotherapyis given into a vein, usually through a central line, a port or a PICC line. You can find out more about chemotherapy and how its given. Youll have chemotherapyover a few days, then youll have a few weeks off so that your body can recover from any side effects. The days you have the chemotherapyand the rest period afterwards are called a cycle. Most people have several cycles of chemotherapy. Youll probably need to stay in hospital for some of the time during chemotherapy, but its often possible to have part of your treatment as an outpatient. Different chemotherapy drugs are used for soft tissue sarcomas, and youll usually have 2 or 3 drugs in combination. This is sometimes called a regimen or treatment plan. Your doctor will decide which regimen or treatment plan is best for you depending on the grade and stage of your sarcoma. You may have chemotherapy treatment as part of a clinical research trial. It will be your decision whether or not you take part in a trial. Your doctor will explain it fully before you make the choice if there is a trial that is right for you. Some of the main chemotherapy drugs for soft tissue sarcomas are: ifosfamide vincristine actinomycin D doxorubicin cyclophosphamide cisplatin If you have a rhabdomyosarcoma, you may be given ifosfamide, vincristine and actinomycin. Giving these drugs together is called IVA. You might also be given ifosfamide, vincristine actinomycin and doxorubicin. Giving these drugs together is called IVADO. Macmillan have more information about chemotherapy , including information about individual drugs and combinations of drugs , IVA and IVADO chemotherapy. This is written for anyone whos looking for information about chemotherapy, not just for young adults. Other types of soft tissue sarcoma can be treated with different combinations of drugs, such as ifosfamide and doxorubicin, or vinorelbine and cyclophosphamide. Your cancer doctor and specialist nurse will explain more about the type of chemotherapy youre going to have and how many cycles youll need. Side effects Different chemotherapydrugs cause different side effects. Some people have just a few side effects and others have more. Its hard to know how its going to be for you, as everyone is different. The most common are hair loss, tiredness, sickness and being more at risk of getting an infection. Side effects can often be controlled, so always let your doctor or nurse know about the side effects youre having. They can usually do something to improve them. Most side effects are short-term (temporary) and gradually disappear once treatment stops. If you want to know more about the type of chemotherapyyoure having and its side effects, theres lots more information inMacmillans chemotherapy section . Surgery Surgery to remove the cancer is one of the main treatments for soft tissue sarcomas. Your surgeon will aim to remove all of the cancer, and at the same time reduce any long-term effects as much as possible. The operation you have will depend on the size of the sarcoma and where it is in your body. You might meet other people with the same type of sarcoma who have had a different operation. Everyone is different. Your cancer doctor and specialist nurse will talk to you about your operation and make sure you understand why you need to have it and whats involved. Below are some of the different types of operation you might have for a soft tissue sarcoma. We also have more information about what will happen before and after the operation in our surgery section. Wide local excision You may have an operation called a wide local excision to remove the cancer and an area of tissue surrounding it (called the margin). This tissue is checked to make sure it doesnt contain any cancer cells. Sometimes the surgeon also removes some of the lymph nodes (glands) near the cancer to find out if there are any cancer cells there. If there are cancer cells in the margin or lymph nodes, some people may need to have more surgery. Skin graft or soft tissue graft If you need to have a large area of tissue removed, you may need to have a skin graft or soft tissue graft. This is when skin and sometimes muscle is taken from a different part of the body to place over the area where the sarcoma was removed from. This is called plastic surgery or reconstructive surgery. Its done to give you as natural an appearance as possible and to make sure you can still do the things you did before your operation. Both operation sites will gradually heal over a few weeks after the operation. Limb-sparing surgery If the sarcoma is in an arm or leg you may have limb-sparing surgery. This means the surgeon takes away the cancer without removing the arm or leg. Youll have all of the tumour taken away from your limb, as well as any bone and muscle affected by the tumour. The surgeon then replaces what theyve taken away. This may involve using plastic surgery or reconstructive surgery (see skin graft or soft tissue graft) to replace the tissue thats been removed, or it may involve surgery to replace any bone thats been removed. If you need to have bone removed, the surgeon replaces it with a specially designed metal implant called an endoprosthesis. If the cancer affects a bone in or near a joint, your joint can be replaced with an artificial one. Before the operation Your physiotherapist might give you exercises before your operation to strengthen your muscles. If youve had chemotherapy, youll need 2 or 3 weeks to recover from the treatment before you can have your operation. Doctors will check that your blood count has returned to normal. Theyll also make sure that youre well enough to have the operation. If youve lost weight or been off your food, you might need to build yourself up a bit. The hospital dietitian can help you do this. Youll probably also see a physiotherapist, wholl give you exercises to do to strengthen your muscles. If you want to have a look at the endoprosthesis that will be put in during your surgery, your nurse or surgeon can usually arrange this. After the operation Youll have a bandage or splint on your limb to keep it still and let it heal. Youll probably have a tube, called a drain, coming out of your wound. This stops fluid building up in your wound. A nurse will take it out after about 3 to 4 days or when there isnt very much fluid coming out of the wound. You wont feel like eating or drinking much for a few hours after your operation, so youll be given fluids into a vein. Youll probably feel a bit sore to begin with, but youll be given strong painkillers to help. Its important to tell the nurses if you need extra pain relief. The pain usually starts to get better within 2to 3 days. As time goes on youll need fewer painkillers and will start to feel a lot more comfortable. Be honest about how you are feeling to your doctors and nurses and they can make sure that you are comfortable and as pain-free as possible. Once youre home youll probably feel a bit better and stronger every day. But if you do have any problems its important to get them treated right away, as a delay could mean they get much more serious. If your new joint starts to stiffen up you may need some more physiotherapy, so tell your doctor so they can arrange this for you. If you notice any new redness, soreness or swelling in the limb thats been operated on, its really important to get in touch with your doctor right away. You might have an infection that needs treatment, so youll need to see the surgeon who did your operation without delay. Theres more information about the long-term effects of limb-sparing surgery in our section on living with and after a soft tissue sarcoma . Amputation Very occasionally the only way to get rid of the cancer is to remove the limb where the sarcoma is growing. This is called an amputation and its only ever done if there is no alternative. Before the operation Your doctor will talk things through with you so that you fully understand whats involved. Losing a limb can feel very scary and you might want to talk to a specialist nurse or a counsellor about your feelings. It might also help to talk to someone who has had an amputation  your nurse or doctor can arrange this. Its really important to get support. After the operation Youll have bandages or a plaster cast on the area thats been operated on. Therell be a drain coming from the wound to remove any excess fluid that builds up. The drain is usually taken out by a nurse on the ward after 3 to 4 days or when there is no fluid coming from the wound. Youll also be given fluid into a vein in your arm until you feel like eating and drinking again. Youll probably feel a bit sore after your operation, especially for the first 2 to 4 days, but youll be given strong painkillers to help with this. Its important to tell the doctors and nurses if you need extra pain relief. You may have pain that feels as if its coming from the part of the limb thats been removed. This is known as phantom pain. Let your doctor or nurse know if you have this. There are medicines that can help ease it or take it away. It usually gets better and goes away in time. A physiotherapist will visit you a day or so after your operation. Theyll show you exercises to keep your muscles strong and flexible. If youve had an arm removed, youll be able to get up and move around once youve recovered from the anaesthetic and dont feel too sore. If youve had a leg removed, the physiotherapist will show you how to move around in bed and get from your bed to a chair. Youll probably be moving around with crutches or in a wheelchair within a few days. Once youre up and around youll go to the hospital gym for physiotherapy. This is a big part of your recovery. Your physiotherapist will give you more exercises to do as your wound heals and you get stronger. Itll take a few months for your limb to heal to its final shape after the operation, so you wont be fitted with your permanent prosthesis (artificial limb) until this happens. In the meantime, youll be given a temporary prosthesis and youll start learning how to use it in physiotherapy. A specialist team will help you recover from the operation and get you used to the artificial limb that youre fitted with. Youll be able to go home about two weeks after your operation. You can read more about recovering after the operation in our information about living with and after a soft tissue sarcoma . Remember that it may be possible to talk to someone who has been through the same as you. Your doctor or nurse can arrange this. Radiotherapy Radiotherapy treats cancer by using high-energy X-rays to destroy cancer cells while doing as little harm as possible to normal cells. Theres more information about it in the radiotherapy section. For soft tissue sarcomas radiotherapy can be given in a number of situations: after surgery  to reduce the risk of the cancer coming back in the same area, or to get rid of any cancer cells that may be left behind; youll usually have it about 4 to 6 weeks after the operation, when your wound has healed before surgery  to shrink the tumour and make it easier to remove with an operation when it isnt possible to remove the sarcoma with an operation Radiotherapy is generally given every weekday (Monday to Friday). Each treatment takes a few minutes. Side effects Radiotherapy isnt painful, but it can cause some side effects. After a few treatments you may begin to feel tired, and your skin may go red or get darker and feel sore or itchy around the area thats being treated. This gets better once your radiotherapy treatment is over. Other side effects depend on which part of your body is being treated. Having radiotherapy around a joint can make it feel stiff, but physiotherapy can help. If youre looking for information about soft tissue sarcomas in people of all ages, read our general soft tissue sarcoma information. Living with a soft tissue sarcoma This information is about life after having surgery for a soft tissue sarcoma. You may find it useful to read the information about surgery first. Life after limb-sparing surgery The long-term effects of limb-sparing surgery depend on which part of your body is affected and what kind of operation you have. The best person to ask about your operation is your surgeon. After limb-sparing surgery the limb might not work as well as it used to. Physiotherapy is an important part of your recovery. Youll be given exercises to do to help you get your limb working as well as possible. These can be hard work, but its important to keep going with them. Joint replacements If youve had a joint replacement, youll be able to walk and swim and do most of the things you could do before, but your doctor might advise you not to play high-impact sports like hockey, football, tennis or rugby. These activities could damage or loosen the new joint. Check with your surgeon about any special instructions they may have for what activities you can do. If youve had a shoulder replacement you might find it harder to lift your arm above your shoulder. After any kind of joint replacement, you will be given physiotherapy. Its very important to do the exercises your physiotherapist shows you so that you get as much movement back as possible. Life after amputation After amputation most people have an artificial limb, called a prosthesis. There are artificial limbs designed to let you do all types of physical activities, including walking, swimming, running, cycling and playing sports. Different types of prosthesis let you do different things. Some people have one for wearing day-to-day, and an extra one specially designed for something like swimming or doing athletics. How will I feel? You might feel lots of different emotions. You might be tearful, angry, fed up or depressed at times. You might think youve lost all your confidence and that youll never be able to live a normal life or be in a relationship. These feelings are normal, and its important that you get support to help you cope with them. You could talk to: family or friends a counsellor  this can be arranged by your doctor or nurse other young people in a similar situation Things will be tough as you get used to living with an amputation, but help is available. Other peoples reactions can be hard to cope with, too. You might be worried about what your friends think or how theyre going to treat you. The thought of going back to school, college or work can be scary. Even people in your family who you are close to might not know what to say or do. Others might say things that sound stupid or seem hurtful. Try to choose a couple of really close relatives or friends you can call on when things get you down. You might also find it useful to talk to someone outside your close circle, like a counsellor. Most people find it helps to talk about how theyre feeling or whats on their mind. If youre looking for information about soft tissue sarcomas in people of all ages, read our general soft tissue sarcoma information. Source: Macmillan - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Sore throat,"Sore throat | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Ears, nose and throat Sore throat Sore throat Return to Symptoms Enter age Last Updated: Next Review Date: Review my answers Find your local services Search for a service near you by entering your postcode below. Please input your postcode in the following format: A12 1BC GP Practices Dental Services Pharmacies Opticians Postcode Search NHS inform has more information on this condition. Read more Previous Start guide Review my answers  You told us your credentials were: : You said: Based on the information you gave us, we made the following recommendation: Close Keep a copy View PDF Sore throats are very common and usually nothing to worry about. They normally get better within a week. Most are caused by minor illnesses such as cold or flu and can be treated at home. Treatments for a sore throat There are things you can do to help soothe a sore throat. Do take ibuprofen or paracetamol  paracetamol is better for children and for people who cant take ibuprofen (children under 16 should never take aspirin) drink plenty of cool or warm fluids, and avoid very hot drinks eat cool, soft foods avoid smoking and smoky places suck lozenges, hard sweets, ice cubes or ice lollies  but dont give young children anything small and hard to suck because of the risk of choking gargle with a homemade mouthwash of warm, salty water (children should not try this) How to gargle with salt water Dissolve half a teaspoon of salt in a glass of warm water (warm water helps salt dissolve). Gargle with the solution, then spit it out (do not swallow it). Repeat as often as you like. There are also products such as medicated lozenges and sprays sold in pharmacies that you may want to try. There isnt much scientific evidence to suggest they help, although some people find them worth using. Antibiotics arent usually prescribed for a sore throat, even if its caused by a bacterial infection. Theyre unlikely to make you feel better any quicker and they have unpleasant side effects . Sore throat self-help guide Complete our self-help guide to check your symptoms and find out what to do next. When to get professional advice Go to A&E or phone 999 if: You or your child have: symptoms that are severe or getting worse quickly difficulty breathing or swallowing severe pain started drooling a muffled voice a high-pitched sound as you breathe (stridor) If you have a sore throat, you can get advice and treatment directly from a pharmacy. Find your nearest pharmacy You dont usually need to get medical advice if you have a sore throat. Your pharmacist may advise you to see your GP if: your symptoms are severe  for example with a high temperature or you feel shivery you have persistent symptoms that havent started to improve after a week you experience severe sore throats frequently you have a weak immune system  for example, you have HIV , are having chemotherapy , or are taking medication that suppresses your immune system If your GP practice is closed, phone 111 . If you have a persistent sore throat (one that lasts 3 to 4 weeks), you should see your GP who may refer you for further tests. This is because your sore throat may be a symptom of a more serious condition. Causes of a sore throat The cause of a sore throat isnt always obvious. But in most cases its a symptom of a viral or bacterial infection. Common causes A sore throat is often a symptom of: colds or flu  you may also have a blocked or runny nose, a cough , a high temperature (fever), a headache and general aches laryngitis (inflammation of the voice box)  you may also have a hoarse voice, a dry cough and a constant need to clear your throat tonsillitis (inflammation of the tonsils)  you may also have red or spotty tonsils, discomfort when swallowing and a fever strep throat (a bacterial throat infection)  you may also have swollen glands in your neck, discomfort when swallowing and tonsillitis glandular fever  you may also feel very tired, have a fever and swollen glands in your neck It may also be caused by something irritating your throat. For example, smoke, gastro-oesophagealreflux disease (where acid leaks up from the stomach) and allergies . Less common causes Less often, a sore throat can be a sign of: a painful collection of pus at the back of the throat (quinsy)  the pain may be severe and you may also have difficulty opening your mouth or difficulty swallowing inflammation of the flap of tissue at the back of the throat (epiglottitis)  the pain may be severe and you may have difficulty breathing and difficulty swallowing These conditions are more serious and should be seen by a doctor as soon as possible. Source: NHS 24 - Opens in new browser window Last updated: 26 May 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Common cold Tonsillitis Glandular fever Find your nearest pharmacy Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Spleen problems and spleen removal,"Spleen problems and spleen removal | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Spleen problems and spleen removal Spleen problems and spleen removal Some people are born without a spleen or need to have it removed because of disease or injury. The spleen is a fist-sized organ foundin the upper left side of your abdomen, next to your stomach and behind your left ribs. Its animportant part of your immune system but you can survive without it. This is because the liver can take over many of the spleens functions. What does the spleen do? The spleen has a few important functions. It fights any invading germs in the blood (the spleen contains infection-fighting white blood cells). It controls the level of blood cells. The spleen controls the level of white blood cells, red blood cells and platelets (small cells that form blood clots). It screens the blood and removes any old or damaged red blood cells. If the spleen doesnt work properly, it may start to remove healthy blood cells. Thiscan lead to: anaemia , from a reduced number of red blood cells an increased risk of infection, from a reduced number of white blood cells bleeding or bruising, from a reduced number of platelets Spleen problems Spleen pain Spleen pain is usually felt as a pain behind your left ribs. It may be tender when you touch the area.This can be a sign of a damaged, ruptured or enlarged spleen. A damaged or ruptured spleen The spleen can become damaged or may rupture (burst) after a forceful blow to the abdomen,car accident, sporting accident or fractureto the ribs. Rupture can happen straight away or it may happen weeks after the injury. Signs of a ruptured spleen are: pain behind your left ribs and tenderness when you touch this area dizziness and a rapid heart rate (a sign of low blood pressure caused by blood loss) Sometimes, if you lie down and raise your legs, the pain can be felt at the tip of your left shoulder. A ruptured spleen is a medical emergency, as it can cause life-threatening bleeding. Go straight to A&E if: you think youve ruptured or damaged your spleen Enlarged spleen The spleen can become swollen after an infection or injury. It can also become enlarged as a result of a disease such as cirrhosis , leukaemia or rheumatoid arthritis . An enlarged spleen doesnt always cause symptoms. Otherwise, look out for: feeling full very quickly after eating (an enlarged spleen can press on the stomach) feeling discomfort or pain behind your left ribs anaemia and/or fatigue frequent infections easy bleeding Doctors can often tell if you have an enlarged spleen by feeling your abdomen. A blood test, CT scan or MRI scan would confirm the diagnosis. The spleen is not usually removed if its just enlarged. Instead, youll receive treatment for any underlying condition and your spleen will be monitored. Antibiotics may be prescribed if theres an infection. Youll need to avoid contact sports for a while, as youll be at greater risk of rupturing the spleen while it is enlarged. Surgery is only necessary if the enlarged spleen is causing serious complications or if the cause cant be found. Splenectomy (having the spleen removed) An operation to remove the spleen, known as a splenectomy, may be needed if the spleen is damaged, diseased or enlarged. It may sometimes be more appropriate to have just part of your spleen removed a partial splenectomy. If theres time, youll be advised to have a series of immunisations before the operation. Laparoscopy Most splenectomies are carried out using laparoscopy (keyhole surgery). A laparoscope is long, thin, flexible instrument withits own light source. It is attached to a camera andwill relay high definition, magnified pictures back to a TV screen to guide the surgeons instruments. Laparoscopic splenectomy allows a surgeon to access the inside of your abdomen without having to make large incisions (cuts) in your skin. However, you will still need a general anaesthetic. The procedure involves: making several incisions in your abdomen (tummy area) guiding a laparoscope into your body through one of the incisions, so doctors can see what theyre doing passing thin instruments into your abdomen through the other incisions, to remove your spleen  gas will be pumped into your abdomento make this easier The incisions will then be stitched up or sometimes glued together.You may be able to go home the same day, or may need to stay in hospital overnight. If you go home the same day, someone will need to stay with you for the first 24 hours. Open surgery Open surgery, where one large incision is made, may be needed if the spleen is too large or too damaged to be removed via keyhole surgery.Often, in emergencies, this will be the preferred method to rapidly control bleeding. Youll need a general anaesthetic and may need to stay in hospital for a few days to recover. Afterwards Its normal to feel sore and be bruised after a splenectomy, but youll be given pain relief medication. You should be able to eat and drink as normal soon after the operation. Like any operation, a splenectomy carries a small risk of complications, including bleeding and infection. Your doctor will run through these risks with you. You should be given breathing and leg movement exercises to doat home, to reduce your risk of getting a blood clot or a chest infection. Another risk is the surgical wound becoming infected. If you spot any signs of infection, contact your GP or hospital immediately, as youmay need antibiotics. Recovery usually takes a few weeks. Your doctor or nurse will advise when you can go back to your usual activities, such as driving. Living without a spleen If your spleen needs to be removed, other organs such as the liver can take over many of the spleens functions. This meansyou will still be able to cope with most infections. However, there is a small risk that a serious infection may develop quickly.This risk will be present for the rest of your life. Risk of infection Young children have a higher risk of serious infection than adults, but the risk is still small. The risk is also increased if you have a medical condition such as sickle cell anaemia , coeliac disease or a condition that affects your immune system, such as HIV . This risk can be minimised by following simple precautions to prevent infection. Vaccinations Read about vaccinations for children and adults without a fully working spleen. Antibiotics Its recommended that you take low-dose antibiotics for the rest of your life to prevent bacterial infections. Antibiotics are particularly important: for children under the age of 16 for the first 2 years after your spleen is removed if your immune system doesnt work properly Be alert for signs of infection Watch out for signs of infection, such as: high temperature (fever) sore throat cough severe headache headache with drowsiness or a rash abdominal pain redness and swelling around the surgical wound Your GP can prescribe a course of antibiotics for you to use if you get an infection. You should start taking them at the first sign of an infection, so see your GP as soon as possible. If your infection becomes serious, you will be admitted to hospital. Animal and tick bites Bites from animals and ticks (small blood-sucking parasites) can cause infections. If you get bitten by an animal, particularly a dog, start your course of antibiotics and seek medical advice urgently. If you go trekking or camping regularly, you may be at risk of babesiosis, which is a rare disease transmitted by ticks. Try to avoid tick bites by wearing clothes that cover your skin, particularly long trousers. If you become ill, get medical advice straight away. Telling medical staff about your condition Healthcare professionals will mark your health records to show that you dont have a working spleen. However, always remember to tell any medical professionals that you see, including your dentist. Carry medical ID Its a good idea to carry or wear some medical ID. For example: if your spleen is removed, the hospital may give you a splenectomy card to take home with you you may want to buy your own medical ID, such as a MedicAlert or Medi-Tag bracelet or pendant If you need help or emergency treatment, your medical ID will alert the staff to your condition. Travel abroad Read advice about travelling abroad without a fully working spleen. Scars The scars from your operation will gradually fade. Source: NHS 24 - Opens in new browser window Last updated: 29 May 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Children and adults without a fully working spleen (Asplenia) NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Stillbirth,"Stillbirth | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Pregnancy and childbirth Stillbirth Stillbirth A stillbirth is when a baby dies after the 24th week of a pregnancy or during birth. Its a devastating experience for parents and can affect you and your family in ways you dont expect. How you might be feeling Your emotions will likely be in turmoil and you might feel angry, guilty, sad and lonely but also love and pride. Theres no right or wrong way to feel. If you already have children, think about how they might be feeling too and what support theyll need. This is a very difficult time for you and everyone close to you so its important to support each other and ask for help if you need it. Causes of stillbirth The stillbirth or death of a newborn baby can happen for lots of reasons and doctors dont yet know all the causes. Some are linked to problems with the placenta or mums health and others to the babys health or development but in some cases the reason cant be explained. Although there are many reasons that a stillbirth can happen, you can decrease the risk by maintaining a health lifestyle before and during pregnancy. Read more about living a healthy lifestyle during pregnancy Death during pregnancy If your baby dies before birth, labour is usually induced. Going through labour and giving birth is the safest option for most women, even though it can be very distressing. Its natural to want to know why this happened. Its not always possible to know why your baby died and that can be hard to come to terms with. Your midwife and obstetrician will be there to support you through it. They will tell you what to expect and give you whatever help you need. Should I hold my baby? Your midwife or doctor will ask if youd like to see or hold your baby. You might want to involve other members of your family too. If youre worried about what your baby looks like, your midwife or doctor can describe them to help you decide. Many parents find it comforting to see, touch and hold their baby and, if you want to, you can bath and dress them. Cuddle cot Your midwife can talk to you about a Cuddle Cot, a special cooling mattress inside a cot which can let you spend more time with your baby in the hospital or at home. This gives you more time to say goodbye, with the support of family and friends. If the hospital doesnt have a Cuddle Cot then there are other organisations that can organise one for bereaved parents. Ask your midwife. After a stillbirth What you choose to do is very personal and individual, as is the way you grieve. Specialist help and support is available for parents and families who have lost a baby and your midwife, family nurse and health visitor can help you to find the right support locally. Registering a stillbirth Your babys stillbirth must be registered. Your midwife and the hospital staff can advise you how to do this. You cant officially register a baby lost before 24 weeks of pregnancy, but some hospitals will give you a certificate in memory of your baby if you ask. More about registering the death of a baby Funeral arrangements Youll need time to think what youd like for your babys funeral. This could be a burial or cremation with a service in the style of your choice. Take as much time as you need to decide on the right way to say goodbye. All hospitals in Scotland will offer a funeral service for your baby free of charge or you may choose to make your own private arrangements, which can give you more choice and control. More about funeral arrangements Coping with the loss of a baby Everyone reacts differently to the loss of a baby. Your emotions might be overwhelming and you might feel physically drained too. Take time to rest and look after yourself. Its important to know you are not alone and have done nothing wrong. More about coping with the loss of a baby Post-mortem If you lost your baby after 13 weeks, youll be offered a post-mortem (autopsy). This is a medical investigation to try to understand what happened and find out if there are issues that could affect a future pregnancy Whether or not to have a post-mortem can be a difficult decision and youll be given support and time to think it over. If you have questions or worries, ask the person who discusses the post-mortem with you. Recovering from a stillbirth You will need care from your midwife and doctor to make sure your body is recovering. Your midwife will assist you through all the decisions you need to make and help you to find the right support. You dont have to manage alone and it can sometimes help to talk with others who have been through baby loss. You, your babys father or your partner and your family are likely to need time to grieve. Remembering your baby Some parents find it helps to do something to remember their baby, like: creating a space in their garden saying a prayer writing a poem Others keep photographs, handprints or footprints, or locks of their babys hair in a memory box. No matter what stage of pregnancy your loss is, you can make a memory box  ask your midwife about this. Some hospitals give special boxes to parents just for this. Some parents dont want to do any of these things, and thats okay too. Theres no right or wrong way. To request a different language or format please email: nhs.healthscotland-alternativeformats@nhs.net Source: Public Health Scotland - Opens in new browser window Last updated: 06 December 2022 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Stomach ache and abdominal pain,"Stomach ache and abdominal pain | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Stomach ache and abdominal pain Stomach ache and abdominal pain Return to Symptoms Enter age Last Updated: Next Review Date: Review my answers Find your local services Search for a service near you by entering your postcode below. Please input your postcode in the following format: A12 1BC GP Practices Dental Services Pharmacies Opticians Postcode Search NHS inform has more information on this condition. Read more Previous Start guide Review my answers  You told us your credentials were: : You said: Based on the information you gave us, we made the following recommendation: Close Keep a copy View PDF A stomach ache is cramps or a dull ache in the tummy (abdomen). It usuallydoes not last longand is often not serious.Severe abdominal pain is a greater cause for concern. Abdominal pain self-help guide Complete our self-help guide to check your symptoms and find out what to do next. Stomach crampswith bloating Stomach crampswith bloating areoftencaused bytrapped wind. Your pharmacist can recommend treatments to help, such as: buscopan mebeverine Find your local pharmacy Sudden stomach cramps with diarrhoea If your stomach cramps have started recently and you also have diarrhoea , the cause may be a tummy bug (gastroenteritis) . This means you have a viral or bacterial infection of the stomach and bowel. It should get better without treatment after a few days. Gastroenteritis may be caused by: coming into close contact with someone whos infected eating contaminated food ( food poisoning ) If you have repeated bouts of stomach cramps and diarrhoea, you may have a long-term condition, such as irritable bowel syndrome (IBS) . Sudden severe abdominal pain Sudden agonising pain in a particular area of your abdomen may be a sign of a serious problem. Itcould rapidly get worse without treatment. If there is any possibility that you could be pregnant, take a pregnancy test. Go to A&E or phone 999 for an ambulance if: youre less than 16 weeks pregnant and have severe abdominal pain a stomach ache came on very suddenly or is severe it hurts when you touch your stomach youre vomiting blood or your vomit looks like ground coffee your poo is bloody or black and sticky and extremely smelly you cannot pee you cannot poo or fart you cannot breathe you have chest pain you have diabetes and youre vomiting someone has collapsed Speak to your GP if: a stomach ache gets much worse quickly stomach pain or bloating will not go away or keeps coming back you have stomach pain and problems with swallowing food youre losing weight without trying to you suddenly pee more often or less often peeing is suddenly painful you bleed from your bottom or vagina, or have abnormal discharge from your vagina you have diarrhoea that does not go away after a few days If your GP is closed, phone 111. Serious causes of sudden severe abdominal pain include: appendicitis  the swelling of the appendix means your appendix will need to be removed a bleeding or perforated stomach ulcer acute cholecystitis  inflammation of the gallbladder, which may need to be removed kidney stones  small stones may be passed out in your urine, but larger stones may block the kidney tubes, and youll need to go to hospital to have them broken up diverticulitis  inflammation of the small pouchesin the bowel that sometimes requires treatment with antibiotics in hospital ectopic pregnancy  when a fertilised egg develops outside the womb  ectopic pregnancy can be very serious if it isnt treated If your GP suspects you have one of these conditions, they may refer you to hospitalimmediately. Sudden and severe pain in your abdomen can also sometimes be caused by an infection of the stomach and bowel (gastroenteritis). It may also be caused by a pulled musclein your abdomen or by an injury. Long-term or recurring abdominal pain See your GP if you or your child havepersistent or repeated abdominal pain. The cause is often not serious and can be managed. Possible causes in adults include: irritable bowel syndrome (IBS)  the pain is often relieved when you go to the toilet inflammatory bowel disease (IBD)for example Crohns disease , ulcerative colitis and endometriosis a urinary tract infection (UTI) that keeps returning youll usually alsohavea burning sensation when you urinate constipation period pain painful muscle cramps in women that are linked to the menstrual cycle stomach ulcer heartburn and acid reflux gastritis (inflammation of the stomach lining) Possiblecauses in children include: constipation aUTIthat keeps returning heartburn and acid reflux abdominal migraines recurrent episodes of abdominal pain with no identifiable cause Source: NHS 24 - Opens in new browser window Last updated: 29 May 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Self-help guide: Diarrhoea Chest pain NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Stomach cancer,"Stomach cancer | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Stomach cancer Stomach cancer About stomach cancer Symptoms of stomach cancer Causes of stomach cancer Diagnosing stomach cancer Treating stomach cancer Living with stomach cancer About stomach cancer Stomach cancer, or gastric cancer, is a fairly uncommon type of cancer. The initial symptoms of stomach cancer are vague and easy to mistake for other less seriousconditions.They include: persistent indigestion and heartburn trapped wind and frequent burping feeling very full or bloated after meals persistent stomach pain Symptoms of advanced stomach cancer can include: blood in your stools, or black stools loss of appetite weight loss As the earlysymptoms of stomach cancer are similar to those of many otherconditions, the cancer is often advanced by the time its diagnosed. Its therefore important to get any possible symptoms of stomach cancer checked by your GP as soon as possible. Read more about diagnosing stomach cancer Whos affected The exact cause of stomach cancer is still unclear, although youre more likely to develop it if you: are male are 55 years of age or older smoke have a diet low in fibre and high in processed food or red meat have a diet that contains a lot of salted and pickled foods have a stomach infection caused by Helicobacter pylori (H. pylori) bacteria Read more about the causes of stomach cancer . Types of stomach cancer There are several different types of stomach cancer. More than 95% of stomach cancers develop in the cells of the stomach lining and are known as adenocarcinomas. Less common types of stomach cancer include lymphoma of the stomach, which develops in the lymphatic tissue (tissue that drains away fluid and helps fight infection), and gastrointestinal stromal tumours (GISTs), which develop in the muscle or connective tissue of the stomach wall. How stomach cancer is treated Many cases of stomach cancer cant be completely cured, but its still possible to relieve symptoms and improve quality of life using chemotherapy and in some cases radiotherapy and surgery. If operable, surgery can cure stomach cancer as long as all of the cancerous tissuecan be removed. Surgery to remove some or all of the stomach is known as agastrectomy. It will still be possible to eat normally after a gastrectomy, but youll probably have to adjust the size of your portions. Chemotherapy can also be used before surgery to help shrink the tumour and sometimes after surgery to help prevent the cancer returning. Read more about treating stomach cancer Living with stomach cancer Living with stomach cancer and the effects of surgery can be tough, but there are a range of services that can provide social, psychological and financial support. Read more about living with stomach cancer Symptoms of stomach cancer Many symptoms of stomach cancer are similar to less serious conditions, so it can be difficult to recognise in the early stages. Early stage symptoms include: persistent indigestion trapped wind and frequent burping heartburn feeling full very quickly when eating feeling bloated after eating feeling sick pain in your stomach or breastbone difficulty swallowing ( dysphagia ) vomiting (the vomit may be streaked with blood), although this is uncommon in the early stages Advanced stomach cancer Symptoms of more advanced stomach cancer include: blood in your stools, or black stools loss of appetite weight loss tiredness lumpiness and swelling in your stomach (caused by a build-up of fluid) anaemia (a reduced number of red blood cells that can cause you to feel tired and breathless) yellowing of the skin and whites of the eyes (jaundice) When to seek medical help Stomach cancer is usually easier to treat if its diagnosed early. Its thereforeimportant for your GP to refer you to a specialist as soon as possible if stomach cancer is suspected. Stomach cancer is much more common in older people, with 90 out of 100 cases occurring in people who are over 55 years of age. Indigestion is a very common symptom in the general population. However, its unlikely that someone with indigestion whos under the age of 55 will have stomach cancer. However,see your GP if you have indigestion and weight loss, anaemia or persistent vomiting. Theyshould refer you to a specialist for further testing. Also see your GP if you have difficulty swallowing. Thisisnt a common symptom among the general population and the cause should always be investigated. Read more about diagnosing stomach cancer Causes of stomach cancer Stomach cancer is caused by changes in the cells of the stomach, although its unclear exactly why these changes occur. Cancer begins with a change (mutation) in the structure of the DNA in cells, which can affect how they grow. This means cells grow and reproduceuncontrollably, producing a lump of tissue called a tumour. Left untreated, cancer can spread to other parts of the body, usually through the lymphatic system (a network of vessels and glands called lymph nodes located throughout the body). Once the cancer reaches your lymphatic system, its capable of spreading to other parts of your body, including your blood, bones and organs. Its not known what triggers thechanges in DNAthat lead to stomach cancer and why only a small number of people develop the condition. Increased risk However, evidence suggests that a number of different factors can affect yourchances of developing stomach cancer. Age and gender Your risk of developing stomach cancer increases with age. Most cases occur in people aged 55 or over. For reasons that are unclear, men are twice as likely as women to develop stomach cancer. Smoking People who smoke are about twice as likely to develop stomach cancer compared with non-smokers. This is because you swallow some cigarette smoke when you inhale and it ends up in your stomach. Cigarettes containharmful chemicals which can damage the cells in your stomach. The more you smoke and the longer youve been smoking, the bigger the risk.In the UK, around 1in every 5 cases of stomach cancer (20%) is thought to be caused by smoking. H. pylori infection Helicobacter pylori (H. pylori)is a common type of bacteria. In most people, these bacteria are harmless, butin some people an H. pylori infection can cause problems such as stomach ulcers , recurring bouts of indigestion orlong-term inflammation of the stomach lining (chronic atrophic gastritis). Research has foundpeople with severe chronicatrophic gastritis havean increasedrisk of developing stomach cancer, although this risk is still small. Diet A diet rich in pickled vegetables, such as pickled onions or piccalilli, salted fish, salt in general and smoked meats, such as pastrami or smoked beef, increases your risk of stomach cancer. Countries where this type of diet is popular, such as Japan, tend to have much higher rates of stomach cancer than the UK. A high fibre diet with 5 portions of fruit and vegetables a daywill help protect against stomach cancer, and a diet high in fats and processed food and red meat will increase your risk of getting stomach cancer. Family history Youre more likely to develop stomach cancer if you have a close relative with the condition, such as one of your parents or a sibling (brother or sister). In such cases, it may be appropriate for your doctor to arrange genetic counselling. Its not fully understood why stomach cancer seems to run in families. It may be because of shared risk factors, such as having similar diets or having an H. pylori infection, or because of certain genes you inherit from your parents. In around 1 in 50 cases of stomach cancer, testing has found that people share a mutation in a gene known as E-cadherin. You may be more at risk of getting the condition if you have the blood type A. Yourblood type is passed on from your parents, so this could be another way in which family history may increase your risk of developing stomach cancer. Theres also a condition that runs in families called familial adenomatous polyposis (FAP), which may increase your risk of developing stomach cancer. FAP causes small growths, called polyps, to form in your digestive system, and is known to increase your risk of developing bowel cancer . Having another type of cancer Your risk of developing stomach cancer is increased if youve had another type of cancer, such as cancer of the oesophagus or non-Hodgkin lymphoma (cancer that develops in your white blood cells). For men, the risk of getting stomach cancer is increased after having prostate cancer , bladder cancer , breast cancer or testicular cancer . For women, the risk of developing stomach cancer increases after having ovarian cancer , breast cancer or cervical cancer . Certain medical conditions Having certain medical conditions can also increase your risk of developing stomach cancer, such as pernicious anaemia (a vitamin B12 deficiency, which occurs when your body cant absorb it properly), and peptic stomach ulcers (an ulcer in your stomach lining, often caused by H. pylori infection). Stomach surgery If youve had stomach surgery, or surgery to a part of your body that affects your stomach, you may be more likely to develop stomach cancer. This can include surgery to remove part of your stomach (known as a partial gastrectomy), surgery to remove part of your vagus nerve (the nerve that carries information from your brain to organs such as your heart, lungs and digestive system), or surgery to repair a stomach ulcer. How stomach cancer spreads There are 3 ways stomach cancer can spread: directly the cancer can spread from the stomach into nearby tissues and organs, such as the pancreas, colon, small intestine and peritoneum (the lining of the inside of the abdominal cavity) throughthe lymphatic system  the lymphatic system is a series of glands (nodes) located throughout your body, similar to the blood circulatory system; the glands produce specialised cells needed by your immune system to fight infection throughthe blood which can cause the cancer to spread from the stomach to other parts of the body, most commonly the liver Stomach cancer that spreads to another part of the body is known as metastatic stomach cancer. Diagnosing stomach cancer Speak to your GP as soon as possible if you have stomach cancer symptoms such as indigestion, unexpected weight loss, anaemia and persistent vomiting. Your GP will ask about your symptoms and examine your stomach for any lumpiness or tenderness. If they think that stomach cancer may be a possibility theyll refer you to a specialist for further investigation. In 2015, the National Institute for Health and Care Excellence (NICE) published guidelines to help GPs recognise the signs and symptoms of stomach cancer and refer people for the right tests faster.Find out who should be referred for further tests for suspected stomach cancer . Hospital tests If your GP thinks you may have stomach cancer, theyll refer you to a specialist for tests. These may include a blood test and chest X-ray , which will assess your overall health. A sample of your stools may also be tested for blood. Because ofthe potentially serious nature of stomach cancer, you should be referred to the specialist within 2 weeks. Read more about waiting times . Endoscopy and endoscopic ultrasound An endoscopy is a procedure where the inside of your body is examined using a piece of equipment called an endoscope (a long, thin flexible tube with a light and a video camera at the end). If you need to have an endoscopy, you wont be able to eat or drink for four to eight hours before the procedure. This is to ensure your stomach and duodenum (top of the small intestine) are empty. Youll be awake during the endoscopy, but may be given a sedative by injection to make you feel drowsy and relaxed. A local anaesthetic may also be sprayed onto the back of your throat, so the area is numbed. The endoscope will be passed down your gullet (food pipe) and into your stomach so the specialist can look for any stomach ulcers or signs of cancer. If tissue is found that may be cancerous, a sample will be taken for testing. This procedure is known as a biopsy . The sample will be examined under a microscope in a laboratory. The results will show whether the cells are cancerous (malignant) or non-cancerous (benign) and will usually take 7 to 10 days to come back. The endoscopy itself usually takes about 15 minutes, although you should allow about 2 hours in total for your visit. If your specialist thinks you may have cancer in the top part of your stomach, you may have an ultrasound scan at the same time as an endoscopy. This is known as an endoscopic ultrasound and uses high-frequency sound waves to produce an image of your stomach (this method is commonly used to view an unborn baby in the womb). If you have an endoscopic ultrasound, an ultrasound probe will be attached to the end of the endoscope before its passed down your throat. The scan will help determine the stage of any cancer in the top part of your stomach. After an endoscopy, or an endoscopic ultrasound, you wont be able to drive for several hours because of the sedative. You may also have a sore throat , although this should pass within a few days. Barium meal X-ray A barium meal X-ray or barium swallow involves drinking a chalky liquid containing a substance called barium, which makes your stomach show up on an X-ray. Nowadays, however, its less commonly used to diagnose stomach cancers. Organs such as your stomach dont usually show up on an X-ray because theyre made of soft tissue that isnt dense enough to stop the X-rays passing through. However, when these organs are filled with barium, it blocks the X-rays and shows up white on an X-ray screen. You wont able to eat or drink for at least 6 hours before the procedure because your stomach and duodenum need to be empty. You may be given an injection to relax the muscles in your digestive system. A barium swallow usually takes about 15 minutes. Afterwards, youll be able to eat and drink as normal, although you may need to drink more water to help flush the barium out of your system. You may feel slightly sick, and the barium may cause constipation . Your stools may be white for a few days afterwards as the barium passes through your system. Further testing If youre diagnosed with stomach cancer, further tests may be needed to help determine how far its spread and how quickly its likely to spread (known as the stage and grade). Your cancer specialist (oncologist) will discuss this with you. However, it may not always be possible to identify the exact stage of your condition until your treatment starts. Laparoscopy Your specialist may need to examine your stomach in more detail to see if the cancer has spread, particularly to the lining of the abdominal cavity (peritoneum). If it has, you may need to have a small operation called a laparoscopy. This procedure is carried out under a general anaesthetic , so youll be unconscious during it. During the procedure, a thin viewing tube with a camera at the end (a laparoscope) will be inserted into your stomach through a small incision in the lower part of your tummy. In some cases, your specialist may need to examine more than one area of your stomach and make more than one incision. Computerised tomography or positron emission tomography scans During CT scans or PET scans , a series of X-ray images of your body are taken. A computer is then used to put the images together and create a detailed picture of the inside of your body. These scans will help your doctor assess how advanced your cancer is. It allows them to see whether the cancerous cells have formed tumours anywhere else in the body. The scans can alsohelp your doctors work out which type of treatment will be most effective and appropriate for you. Liver ultrasound scan If your specialist thinks your stomach cancer may have spread to your liver, you may need to have a liver ultrasound . This type of scan uses high-frequency sound waves to produce an image of your liver. Staging and grading After all of the tests have been completed and your test results are known, it should be possible to tell what stage and grade of stomach cancer you have. Staging is a measurement of how far cancer has spread. There are a number of different ways stomach cancer can be staged.One method uses a numbering system from 1 to 4. The higher the number, the further the cancer has spread. The majority of stomach cancers are at stage 3 or 4 when diagnosed, which means a cure isntusually possible. Grading describes how quickly the cancer is likely to spread in the future. There are 3 grades of stomach cancer: low-grade  the cancer tends to grow slowly medium-grade  the cancer grows a bitfaster high-grade  the cancer is aggressive and likely to grow quickly Cancer Research UK has more information about the staging and grading of stomach cancer. Treating stomach cancer The treatments recommended for stomach cancer will depend on your general health and how far the cancer has spread. Most hospitals use multidisciplinary teams made up of a number of different specialists (see below) who work together to plan and carry outthe best treatment, tailored to your circumstances. Feel free to discuss treatment with your care team at any time and ask questions. Your treatment plan The main treatments for stomach cancer are surgery, chemotherapy and radiotherapy . You may have 1 of these treatments or a combination. If surgery is recommended, you may have chemotherapy beforehand. If the tumour is in the upper part of your stomach, including the junction between the oesophagus and stomach, you may also have radiotherapy prior to surgery. Surgery is mainly used if stomach cancer is diagnosed at an early stage, whereas chemotherapy and radiotherapy tend to be used when the condition is diagnosed at a later stage. Where possible, the primary aim of treatment is to completelyremove the tumour and any other cancerous cells in your body.Its estimated that a cure is possible in 20 to 30% of stomach cancer cases. If its not possible to remove the tumour, your doctors will focus on trying to prevent it from getting any bigger and causing further harm to your body. This may be done using surgery or chemotherapy. In some cases, its not possible to eliminate the cancer or slow it down. In this case, your treatment will aim to relieve your symptoms and make you as comfortable as possible, usually with surgery or radiotherapy. A relatively new medication calledtrastuzumab (see below) can also be used to treat some types of advanced stomach cancer. Your healthcare team will talk to you about which treatments are most suitable. Surgery If youre diagnosed with stomach cancer at an early stage,it may be possible for the cancer to be completely removed during surgery. In some cases, it may be possible to pass a thin, flexible tube (endoscope) down your oesophagus (gullet),rather than making incisions in your tummy. This is known as endoscopic surgery, and can be used toremove a sample of the tumour for testing ( biopsy ). It can also be used to remove the tumour completely if stomach cancer is diagnosed at an early stage. However, if your cancer has spread beyond your stomach, it may not be possible to remove it completely. If this is the case, you may still have surgery to remove any cancer blocking your stomach, to ease your symptoms. This will depend on whether your symptoms can be controlled and the risks and side effects of undertaking major surgery. Any type of surgery for stomach cancer will involve a large operation and a long recovery time. If you have stomach cancer surgery, youll usually need to stay in hospital for around 2 weeks. Youll also need several weeks at home to recover. Surgery to remove your stomach You mayneed to have part or all of your stomach removed. Surgery to remove part of your stomach is known as a partial or sub-total gastrectomy, and surgery to remove all of your stomach is known as a total gastrectomy. In some cases, your surgeon may remove part of your oesophagus as well as all ofyour stomach, usinga procedure known as an oesophagogastrectomy. These operations may be carried outusing either a large incision in your tummy (open surgery), or a number of smaller incisions through which surgical tools can be passed (laparoscopic or keyhole surgery). Both of these techniques are carried out under general anaesthetic , which means youll be unconscious throughout the procedure. During these operations, your surgeon will also remove the lymph nodes (small glands that help fight infection) nearest to the cancer. Its possible that your stomach cancer may have spread to these lymph nodes, and removing them helps prevent the cancer returning. Partial gastrectomy If your cancer is in the lower part of your stomach, you may have a partial gastrectomytoremove it. After surgery, your stomach will be smaller than it was before the operation. However, the top part of your stomach, where your oesophagus feeds into it, wont be affected. Total gastrectomy or oesophagogastrectomy If your cancer is in the middle or at the top of your stomach, you may need to have a total gastrectomy. If the cancer is close to the end of your oesophagus, where it meets your stomach, you mayneed to have an oesophagogastrectomy. If you have a total gastrectomy, the end of your gullet will be joined to the top of your jejunum (the top part of your small intestine). If you have an oesophagogastrectomy, the remaining part of your gullet will be joined to your jejunum. Surgery to ease your symptoms If your stomach cancer has spread beyond your stomach, it may not be possible to remove it using surgery. However, if your stomach has been significantly affected by cancer it can cause a blockage, which prevents food from being properly digested. A blocked stomach can cause symptoms such as stomach pain, vomiting and feeling very full after eating. If your stomach is blocked, there are a few options: stenting  a stent is a plastic or wire mesh tube inserted through the oesophagus using an endoscope under local anaesthetic ; after being inserted, the stent will be expanded and open up the stomach partial or total gastrectomy  to remove the blockage and improve your symptoms bypass surgery  an operation where part of your stomach above the blockage is joined to yoursmall intestine, leaving the blocked part of your stomach out of your digestive system Chemotherapy Chemotherapy is a specialist treatment for cancer that uses medicines, called cytotoxic medicines,to stop cancer cells dividing and multiplying. As it circulates through your body, the medicine can target cancer cells in your stomach and any that may have spread to other parts of your body. You may have chemotherapy for stomach cancer before surgery to reduce the amount of cancer that has to be removed during the operation. Chemotherapy can also be used after surgery to destroy any remaining cancer cells and prevent the cancer from coming back. Chemotherapy can also help to slow the progression of cancer and ease the symptoms of more advanced stomach cancer, which may not be suitable for surgery. If may be given orally (as tablets) or intravenously (by injection or a drip through a vein directly into your bloodstream), or a combination of both. Intravenous chemotherapy is usually given in hospital, while oral chemotherapy is taken at home. Chemotherapy is often given in cycles, each usually lasting about three weeks. Alternatively, chemotherapy may be administered through a small pump, which gives you a constant low dose over a few weeks or months. The pumps are portable and can be worn at home, which means fewer trips to hospital. Side effects of chemotherapy Chemotherapy works by preventing cancerous cells from growing rapidly. However, it also destroys non-cancerous cells such ashair follicles and red and white blood cells. Side effects may include: tiredness nausea and vomiting nerve damage ( peripheral neuropathy ) hair loss diarrhoea anaemia (a lack of red blood cells) weight loss skin changes  such as redness, swelling and a tingling sensation in the palms of the hands and/or soles of the feet The side effects you experience after having chemotherapy will depend on the type of chemotherapy and the number of treatment sessions you need. Youll be told who to contact if youre experiencing serious side effects from chemotherapy, and its very important that this contact information is recorded carefully. If you experience nausea and vomiting as a result of chemotherapy, you may be able to take anti-sickness medication to counter it. This may be given intravenously (by injection directly into your bloodstream) at the same time as your chemotherapy. The side effects of chemotherapy will only last for as long as your course of treatment lasts. Once your treatment is over, thehair folliclesand blood cellswill repair themselves. This means your hair will grow back, although it might look or feel different from how it did before chemotherapy (for example, it may be a slightly different colour, or be softer or curlier than before). Radiotherapy Radiotherapy uses beams of high energy radiation to destroy cancer cells. Its not often used to treat stomach cancer because theres a risk that other organs close to your stomach might be damaged by the treatment. However, if you have advanced stomach cancer thats causing pain or bleeding,you may need to have radiotherapy. In some cases, following surgery, you may have chemotherapy and/or radiotherapy to help prevent the stomach cancer from recurring. If a cancer is bleeding slowly and causing anaemia , a single fraction of radiotherapy can be used to try to prevent further bleeding. If you need radiotherapy, your treatment will usually begin 2 or 3 months after surgery or chemotherapy, to give your body a chance to recover. This is a painless procedure where you lie under a radiotherapy machine while it directs radiation at your stomach. Youll be positioned by a radiographer (a specialist in radiotherapy) so that the machine targets the cancer cells and avoids as much healthy tissue as possible. Radiotherapy often involves having treatment sessions 5 days a week. Each session will only last a few minutes. The radiation doesnt stay in your system afterwards, and its perfectly safe to be around others between your treatments. How long youll need to have radiotherapy for will depend on how its used. Radiotherapy used after surgery to help prevent stomach cancer coming back usually lasts 5 weeks. If its being used to control symptoms of advanced stomach cancer, it may only last 1 or 2 weeks. Side effects of radiotherapy You may experience the following side effects after having radiotherapy: tiredness nausea diarrhoea irritation and darkening of your skin where the treatment takes place These side effects will usually improve within a few weeks of treatment finishing. Trastuzumab Trastuzumab(sold under the brand name Herceptin) is a medicationused to treat breast cancer and some cases of advanced stomach cancer. Some stomach cancers are stimulated by a type of protein called human epidermal growth factor receptor 2 (HER2). Trastuzumab works by blocking the effects of this protein. This doesnt cure stomach cancer, butit can slow its growth and increase survival time. If youre diagnosed with advanced stomach cancer and tests show high levels of the HER2 protein in the cancerous cells, your doctors may recommend treatment with a combination of chemotherapy and trastuzumab. Trastuzumab is given intravenously, through a drip, and youll have the treatment in hospital. Each treatment session takes up to 1 hour and youll usually need a session once every 3 weeks. Trastuzumab can cause side effects, including heart problems. Therefore, it may not be suitable if you have a heart problem such as angina , uncontrolled high blood pressure ( hypertension ) or heart valve disease. If you need to take trastuzumab, youll also need regular tests on your heart to check for any problems. Other side effects of trastuzumab may include: an initial allergic reaction to the medication, which can cause nausea, wheezing, chills and fever diarrhoea tiredness aches and pains Living with stomach cancer Being diagnosed with cancer is a tough challenge for most people, but support is available to help you cope. You may find the followingadvice helpful: keep talking to your friends and family they can be a powerful support system talk to others in the same situation research your condition set reasonable goals take time out for yourself Cancer charities, such as Macmillan Cancer Support , are a good source of information and support. Recovery Getting back to normal after surgery can take time. Its important to take things slowly and give yourself time to recover. During your recovery,avoid lifting heavy things such as children or shopping bags, and strenuous tasks such as housework. You may also be advised not to drive. Some other treatments, particularly chemotherapy and radiotherapy , can make you very tired. You may need to take a break from some of your normal activities for a while. Dont be afraid to ask for practical help from family and friends. Follow-up After your treatment has finished, youll be invited for regular check-ups, usually every three months for the first year. During the check-up, your doctor will examine you and may arrange blood tests or scans to see how youre responding to treatment. Diet after surgery If youve had an operation to remove part of your stomach (partial gastrectomy), youll only be able to eat small amounts of food for a while after your operation. This is because your stomach wont be able to hold as much food as it could before the surgery, and your body will need to adjust to its new stomach capacity. You should gradually be able to increase the amount you eat as your stomach begins to expand. If youve had surgery to remove all of your stomach (total gastrectomy), it may be some time before you can eat normally again. As with a partial gastrectomy, youll only be able to eat small amounts of food until your body adjusts. You may have to eat little and often, and make changes to the types of food you eat. Your care team will be able to advise you about what and when you should eat. Having surgery to remove your stomach also means youll need to have regular injections of vitamin B12. Vitamin B12 is usually absorbed through your stomach from the food you eat and is needed to help preventa condition called anaemia and nerve problems. Looking after yourself Eat regularly and healthily. You may not have time to sit down for every meal, but you should make time to do so at least once a day. Its understandable if there are times when you feel resentful, and then guilty for feeling so. You may also feel exhausted, isolated and worry about the person you care for.Remember: youre human, and those feelings are natural. Dealing with dying If your stomach cancer cant be cured, your GP will give you support and any necessary pain relief (often alongside chemotherapy or radiotherapy, which can be used to reduce your symptoms).This is called palliative care .Support is also available for your family and friends. Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites Cancer Research UK: Stomach cancer Macmillan Cancer Support: Stomach cancer Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Stomach ulcer,"Stomach ulcer (gastric ulcer) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Stomach ulcer Stomach ulcer About stomach ulcers Stomach ulcer symptoms Stomach ulcer causes Stomach ulcer diagnosis Stomach ulcer treatment Stomach ulcer complications About stomach ulcers Stomach ulcers (gastric ulcers)are open sores that develop on the lining of the stomach. Ulcers can also occur in part of the intestine just beyond the stomach. These are called duodenal ulcers. Stomach and duodenal ulcers are sometimes called peptic ulcers. This information applies to both. Symptoms of stomach ulcers Although the most common symptom of a stomach ulcer is a burning or gnawing pain in the centre of the abdomen (tummy). Not all stomach ulcers are painful. Some people experience: indigestion heartburn nausea (feeling sick) You should speak to your GP if you think you have a stomach ulcer. More about the symptoms of a stomach ulcer Get urgent medical advice Speak to your GP immediately (or phone 111) if: your symptoms persist youre vomiting blood  the blood can appear bright red or have a dark brown, grainy appearance like coffee grounds youre passing dark, sticky, tar-like stools you feel a sudden, sharp pain in your tummy that gets steadily worse These could be a sign of a serious complication. What causes stomach ulcers? Stomach ulcers occur when the layer protecting the stomach lining from stomach acid breaks down. This allows the stomach lining to become damaged. This is usually caused by: an infection with Helicobacter pylori (H. pylori) bacteria taking non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin  particularly if theyre taken for a long time or at high doses Theres little evidence that stress or certain foods causes stomach ulcers. More about the causes of stomach ulcers Treating stomach ulcers Youll be treated using antibiotics if your ulcer was caused by a H. pylori infection. This kills the bacteria and should prevent the ulcer coming back. Youll be treated using a proton pump inhibitor (PPI) if your ulcer was caused by NSAIDs. Your doctor will prescribe these and discuss whether you should keep using NSAIDs. Alternative medication to NSAIDs, such as paracetamol , may be recommended. Most stomach ulcers take a few months to heal after treatment. However, stomach ulcers can come back after treatment, although this is less likely to happen if the underlying cause is addressed. More about treating stomach ulcers Complications Complications are rare but can be very serious and potentially life-threatening. The main complications include: bleeding at the site of the ulcer the stomach lining at the site of the ulcer splits open  known as perforation the ulcer blocks the movement of food through the digestive system  known as gastric obstruction More about the complications of stomach ulcers Stomach ulcer symptoms The most common symptom of a stomach ulcer is a burning or gnawing pain that develops in your abdomen (tummy). However, some stomach ulcers arent painful and are only noticed when a complication develops, such as bleeding from the ulcer. Tummy pain The pain caused by a stomach ulcer can either travel: out from the middle of your tummy up to your neck down to your belly button through to your back And: can last from a few minutes to a few hours often starts within a few hours of eating can cause you to wake up during the night Taking antacids (indigestion medication) may temporarily relieve the pain, but it will keep coming back if the ulcer isnt treated. Less common symptoms Less common symptoms of a stomach ulcer include: indigestion heartburn loss of appetite feeling and being sick weight loss Some people also find they burp or become bloated after eating fatty foods. Stomach ulcer causes Stomach ulcers are usually caused by Helicobacter pylori (H. pylori) bacteria or non-steroidal anti-inflammatory drugs (NSAIDs). These can break down the stomachs defence against the acid it produces to digest food. The stomach lining then becomes damaged causing an ulcer to form. H. pylori bacteria H. pylori bacteria live in the stomach lining. The bacteria can irritate the stomach lining and make it more vulnerable to damage from stomach acid. Infections are common. Its possible to be infected without realising it because the infection doesnt usually cause symptoms. People of all ages can be infected. Its not clear exactly why some people are more vulnerable to the effects of H. pylori bacteria than others. Non-steroidal anti-inflammatory drugs ( NSAIDs) NSAIDs are medicines widely used to treat pain, a high temperature (fever) and inflammation (swelling). Commonly used NSAIDs include: ibuprofen aspirin naproxen diclofenac Many people take NSAIDs without having any side effects. But theres always a risk the medication could cause problems, such as stomach ulcers, particularly if taken for a long time or at high doses. You may be advised not to use NSAIDs if you currently have a stomach ulcer or if youve had one in the past. Paracetamol is a safer painkiller to use. More about NSAIDs Lifestyle factors Theres little evidence that stomach ulcers are caused by: spicy foods stress alcohol But these can make the symptoms worse. However, smoking can: increase your risk of developing stomach ulcers make treatment less effective Stomach ulcer diagnosis If your GP thinks you have an ulcer, they will want to know if youre taking non-steroidal anti-inflammatory drugs (NSAIDs) might test you for an Helicobacter pylori (H. pylori) infection In some cases, you may be referred for a gastroscopy to look for an ulcer inside your stomach. Testing for H. pylori infection If your GP thinks your symptoms might be caused by an H. pylori infection, youll be offered a: urea breath test stool antigen test  a small stool sample is tested for the bacteria blood test Urea breath test Youll be given a special drink containing a chemical thats broken down by H. pylori. Your breath is then analysed to see whether or not you have an H. pylori infection. Blood test A sample of your bloods tested for antibodies to the H. pylori bacteria. Antibodies are proteins produced naturally in your blood to help fight infection. This tests now largely been replaced by the stool antigen test More about blood tests Gastroscopy A gastroscopy is a procedure that involves passing a thin, flexible tube (an endoscope) with a camera at one end into your mouth and down into your stomach and first section of the small intestine (duodenum). You may: be given a mild sedative injection before the procedure have your throat sprayed with a local anaesthetic to make it more comfortable to pass the endoscope The images taken by the camera will usually confirm or rule out an ulcer. A small tissue sample may also be taken from your stomach or duodenum to test for the H. pylori bacteria. Youll have this procedure as an outpatient in hospital. This means you wont have to spend the night. You may have a repeat gastroscopy after 4 to 6 weeks to check that the ulcers healed. Stomach ulcer treatment If you have a stomach ulcer, your treatment will depend on what caused it. With treatment, most ulcers heal in a month or two. Treating Helicobacter pylori (H. pylori) infection If your stomach ulcers caused by a Helicobacter pylori (H. pylori) bacterial infection, youll be given: a course of antibiotics a medication called a proton pump inhibitor (PPI) This is also recommended if its thought your stomach ulcers caused by a combination of an H. pylori infection and non-steroidal anti-inflammatory drugs (NSAIDs). Antibiotics If you have an H. pylori infection, youll usually be prescribed a course of 2 or 3 antibiotics. The most commonly used antibiotics are: amoxicillin clarithromycin metronidazole You should take these twice a day for a week. Side effects The side effects of these are usually mild, but can include: feeling and being sick diarrhoea a metallic taste in your mouth Further testing Youll be re-tested at least 4 weeks after finishing your antibiotic course to see if there are any H. pylori bacteria left in your stomach. If there are, a further course of eradication therapy using different antibiotics may be given. Ulcers caused by NSAIDs If your stomach ulcers caused by taking NSAIDs: youll be given a course of PPI medication your use of NSAIDs will be reviewed, and you may be advised to use an alternative painkiller Alternative painkillers You may be advised to use an alternative painkiller not associated with stomach ulcers, such as paracetamol . COX-2 inhibitorsare sometimes recommended. These are an alternative type of NSAID thats less likely to cause stomach ulcers. Low-dose aspirin If youre taking low-dose aspirin to reduce your risk of blood clots, your GP will tell you whether you need to keep taking it. If you do, you may also be prescribed long-term treatment with a PPI or H2-receptor antagonist to prevent further ulcers. Complications Its important to understand the potential risks associated with continued NSAID use. Youre more likely to develop another stomach ulcer and could experience a serious complication, such as internal bleeding. Read more about the complications of stomach ulcers Proton pump inhibitors (PPIs) PPIs work by reducing the amount of acid your stomach produces. This prevents further damage to the ulcer as it heals naturally. The most commonly used PPIs are: omeprazole pantoprazole lansoprazole Theyre usually prescribed for 4 to 8 weeks. Side effects Side effects of these are usually mild, but can include: headaches diarrhoea or constipation feeling sick abdominal (tummy) pain dizziness rashes These should pass once treatment has been completed. H2-receptor antagonists Sometimes a type of medication called H2-receptor antagonists are used instead of PPIs. These also reduce the amount of acid your stomach produces. Ranitidine is the most widely used H2-receptor antagonist for treating stomach ulcers. Side effects Side effects are uncommon, but can include: diarrhoea headaches dizziness rashes tiredness Antacids and alginates As these treatments can take several hours before they start to work, your GP may recommend taking additional antacid medication. Antacids: neutralise your stomach acid provide immediate, but short-term, symptom relief should be taken when you experience symptoms or when you expect them, such as after meals or at bedtime Some antacids also contain a medicine called an alginate, which produces a protective coating on the lining of your stomach. Antacids containing alginates are best taken after meals. You can buy these medications at pharmacies. Your pharmacist can tell you which is most suitable for you. Side effects Side effects of both medications are usually mild, but can include: diarrhoea or constipation farting stomach cramps feeling and being sick Lifestyle changes There arent any special lifestyle measures you need to take during treatment. However, avoiding stress, alcohol, spicy foods and smoking may reduce your symptoms while your ulcer heals. Stomach ulcer complications Complications of stomach ulcers are rare, but can be very serious. The main complications are: internal bleeding perforation  the lining of the stomach splits open gastric outlet obstruction  the stomach ulcer obstructs the normal passage of food through your digestive system Internal bleeding Internal bleedings the most common complication of stomach ulcers. It can occur when an ulcer develops at the site of a blood vessel. The bleeding can either be slow and long-term, or rapid and severe. Slow, long-term bleeding Slow, long-term bleeding can lead to anaemia. Symptoms of anaemia include: fatigue breathlessness pale skin heart palpitations (noticeable heartbeats) You should visit your GP if you have persistent symptoms of anaemia. If they think you have a stomach ulcer, they may refer you to a gastroenterologist for an examination and treatment. More about anaemia Severe bleeding Contact your GP or the NHS 24 111 service immediately if you have symptoms of more severe bleeding, including: youre vomiting blood  the blood can appear bright red or have a dark brown, grainy appearance like coffee grounds youre passing dark, sticky, tar-like stools Stopping severe bleeding An endoscopy will be used to identify the cause of the bleeding. Treatment can be given during the endoscopy to stop the bleeding. Sometimes: specialised procedures carried out under X-ray guidance are used to stop bleeding ulcers surgery is needed to repair the affected blood vessel Blood transfusions may also be needed to replace the blood youve lost. Perforation Perforations are a rarer complication of stomach ulcers. This is when the lining of the stomach splits open. This can be very serious because it lets the bacteria that live in your stomach escape and infect the lining of your abdomen (peritoneum). This is known as peritonitis. Peritonitis In peritonitis, an infection can rapidly spread into the blood ( sepsis ) before spreading to other organs. This carries the risk of multiple organ failureand can be fatal if left untreated. The most common symptom of peritonitis is sudden abdominal pain, which gets steadily worse. If you have this type of pain, contact your GP or the NHS 24 111 service immediately. Peritonitis is a medical emergency that requires hospital admission. In some cases, surgery may be needed. Gastric outlet obstruction In some cases, an inflamed (swollen) or scarred stomach ulcer can obstruct the normal passage of food through your digestive system. This is called a gastric outlet obstruction. Symptoms include: vomiting large amounts of undigested food a constant feeling of bloating or fullness feeling more full than usual after eating less food unexplained weight loss Treating a gastric outlet obstruction An endoscopy can be used to confirm the obstruction. If the obstructions caused by inflammation, proton pump inhibitors (PPIs) or H2-receptor antagonists can be used to reduce stomach acid levels until the swelling goes down. If the obstructions caused by scar tissue, surgery may be needed. This can involve passing a small balloon through an endoscope and inflating it to widen the site of the obstruction. Source: NHS 24 - Opens in new browser window Last updated: 13 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform NSAIDs Stomach ache and abdominal pain Other health sites Lab Tests Online UK: H. pylori test NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Streptococcus A (strep A),"Streptococcus A (Strep A) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Streptococcus A (strep A) Streptococcus A (strep A) Group A Streptococcus (GAS), also known as Strep A, are bacteria commonly found on the skin or in the throat. Under some circumstances these bacteria can cause disease. GAS infection commonly presents as a mild sore throat (strep throat) and skin/soft tissue infections such as impetigo and cellulitis. Phone 999 or go to A&E if: you or your child is having difficulty breathing (you may notice grunting noises or their tummy sucking under their ribs) there are pauses when you or your child breathes you or your childs skin, tongue or lips are blue you or your child is floppy and will not wake up or stay awake Contact your GP if you or your child: is getting worse is feeding or eating much less than normal is showing signs of dehydration, like sunken eyes, drowsiness has not passed urine for 12 hours is under 3 months and has a temperature of 38C is older than 3 months and has a temperature of 39C or higher feels hotter than usual when you touch their back or chest, or feels sweaty is very tired or irritable If your GP is closed, phone the 111 service. If you feel that you or your child is seriously unwell, trust your own judgement and seek medical assistance. Strep A tests are not available through the NHS in Scotland for self-testing at home. Should you or your child need to be tested for Strep A, your GP or other healthcare professional will advise you. GAS infections GAS bacteria can cause a wide variety of skin, soft tissue and respiratory tract infections ranging in severity from mild to life-threatening. These include: tonsillitis sore throat scarlet fever impetigo erysipelas (a type of cellulitis) cellulitis pneumonia In rare cases, patients may go on to develop post-streptococcal complications, such as: rheumatic fever glomerulonephritis (heart and kidney diseases caused by an immune reaction to the bacteria)\u200b iGAS infections GAS can very rarely cause more serious conditions, known as invasive group A Streptococcus (iGAS) infections. These can include: bacteraemia (an infection of the bloodstream) septic arthritis meningitis necrotising fasciitis (a severe infection involving death of areas of soft tissue below the skin) Streptococcal toxic shock syndrome (rapidly progressive symptoms with low blood pressure and multi-organ failure) iGAS infections tend to happen in the elderly, the very young, or people with an underlying risk factor such as injecting drug use, alcoholism, immunosuppression or cancer. Treating GAS infections Most GAS infections are relatively mild illnesses that clear up on their own without the need for antibiotics. Often symptoms that look like GAS infections, like sore throats , are more commonly caused by viruses than GAS bacteria. If you or your child has a runny nose with their sore throat, its likely to be a virus infection. Sore throats caused by viruses do not need to be treated with antibiotics unless there are concerns about complications. More about sore throat symptoms, self-care at home, and what to do if your condition worsens Your healthcare professional will consider antibiotics if they think: you or your child need medication to get better or to ease symptoms you or your child are at risk of serious complications from a GAS infection you or your child has scarlet fever If you or your child is prescribed antibiotics, they could be in liquid or pill form. Its not uncommon for someone to have GAS bacteria on their skin or in their throat without being unwell. These people often dont know they have the bacteria and wont need antibiotics. Preventing GAS infection GAS are spread by close contact between individuals, through respiratory droplets (moisture in your breath) and direct skin contact. To help reduce the risk of picking up or spreading infections: Do wash your hands properly with soap for 20 seconds use a disposable tissue to catch coughs and sneezes and wash your hands afterwards keep away from others if you feel unwell Dont do not share contaminated food, utensils, cups and glasses, baths, bed linen or towels GAS can be a secondary infection, developing in people who are already unwell with illnesses like the flu. You can help protect your child from this risk by making sure they get their free flu vaccine this winter. New evidence also shows that the nasal spray flu vaccine offered to children may also protect them from GAS infection. Source: NHS 24 - Opens in new browser window Last updated: 04 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Self-help guide: Sore throat Self-help guide: Fever in adults Self-help guide: Fever in babies Fever in adults Fever in children Other health sites Group A strep in Scotland NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
"Stress, anxiety and low mood","""Mental wellbeing | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Healthy living Mental wellbeing Mental wellbeing Advice on dealing with low mood, anxiety, phobias, stress and where you can get help. Five steps to mental wellbeing Steps you can take to help you feel happier and more positive. Mind to Mind Other people share the small changes that have made a big difference to their mental wellbeing Get help with your mental health Use our tool to find the right SilverCloud, Daylight or Sleepio course to help improve your mental health and wellbeing Anger management How to control your anger Anger can become a problem if you find it difficult to keep it under control. Find out how to recognise signs of anger and how to manage it. Why am I so angry? Reasons why anger problems occur and where to get help for anger issues Fears and phobias 10 ways to fight your fears Whatever it is that makes you feel afraid, here are 10 ways to help you cope with your day-to-day fears and anxieties. Coping with fears and phobias Find out more about how to cope with phobias Coping with a fear of the dentist Tips on coping with your fear of the dentist, including advances in dentistry and sedation clinics Help for phobias Many people with phobias resign themselves to living in fear, but this doesn't have to be the case as help is available Anxiety and panic How to deal with panic and anxiety Find out ways to manage anxiety or panic. Low mood and depression Do you have the winter blues? Lots of people get depressed in winter, the medical term is seasonal affective disorder (SAD). Exercise for depression Regular exercise can boost your mood if you have depression How to feel happier Try these 6 tips to help you be happier, more in control, and able to cope better with life's ups and downs. Low mood and depression Learn what you can do if you are experiencing low mood, depression or anxiety Tips for coping with depression If you're feeling depressed, try these coping strategies What to do if youre worried someone is depressed Often it's a partner, family member or friend who first realises that someone needs help Stress 10 stress busters Try these 10 tips to help you deal with stress Beat stress at work Some pressure at work can be motivating, but when it becomes excessive it can lead to work-related stress Breathing and relaxation exercises for stress \u200bThese exercises are designed to help you relieve stress and relax. Coping with exam stress Tests and exams can be a challenging part of school life for both children and parents. Find tips and advice to help relieve exam stress. Coping with money worries Find sources of advice and support to help you cope with money worries. Easy time-management tips Tips and advice to help you manage your time and achieve the lifestyle balance you want. What to do if you are struggling with stress Learn what to do if you are struggling to deal with stress Dealing with traumatic events Support for people who have experienced a traumatic event There are many organisations that can provide advice and support after traumatic events Therapy and counselling Benefits of talking therapy Talking therapies can help all sorts of people in lots of different situations Depression support groups Information on the support groups available if you have depression Find the right therapist What to look out for when finding the right therapist for you Self-help therapies Learn more about self-help therapies and what they can be used for Talking therapies explained Information on common types of talking therapies and how they can help certain conditions Pregnancy Your mental health and wellbeing after birth How to look after your mental wellbeing after the birth and when to get help Your mental health and wellbeing in pregnancy How to look after your mental wellbeing during pregnancy and when to get help Mental health self-help guides Anxiety self-help guide Work through a self-help guide for anxiety that uses cognitive behavioural therapy (CBT). Bereavement and grief self-help guide Work through a self-help guide for coping with bereavement and grief that uses cognitive behavioural therapy (CBT). Chronic pain self-help guide Work through a self-help guide that uses cognitive behavioural therapy (CBT) to help you live with chronic pain. Depression self-help guide Work through a self-help guide for depression that uses cognitive behavioural therapy (CBT). Panic self-help guide Work through a self-help guide for panic that uses cognitive behavioural therapy (CBT). Phobias self-help guide Work through a self-help guide for phobias that uses cognitive behavioural therapy (CBT). Problems with anger self-help guide Work through a self-help guide for managing problems with anger based on Cognitive Behavioural Therapy (CBT). Problem solving self-help guide Work through a self-help guide for problem solving based on Cognitive Behavioural Therapy (CBT). PTSD and CPTSD self-help guide Work through a self-help guide for PTSD and CPTSD based on Trauma-Focused Cognitive Therapy (TF-CT). Self-esteem self-help guide Work through a self-help guide that uses cognitive behavioural therapy (CBT) to improve self-esteem. Sleep problems and insomnia self-help guide Work through a self-help guide that uses cognitive behavioural therapy (CBT) and expert advice to manage sleep problems. Social anxiety self-help guide Work through a self-help guide for social anxiety that uses cognitive behavioural therapy (CBT). Obsessive compulsive disorder (OCD) self-help guide Work through a self-help guide for mild-to-moderate obsessive compulsive disorder (OCD) that uses cognitive behavioural therapy (CBT). Addictions Problem gambling Learn about the signs of problem gambling and how to get help and support. Women's health Self-help tool: Menopause and mental wellbeing Self-help tool: Periods and mental wellbeing NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Sudden infant death syndrome (SIDS),"Sleeping safely | Ready Steady Baby! 0 Ready Steady Baby Pregnancy Health problems in pregnancy Looking after yourself and your baby Preparing for parenthood Relationships and wellbeing in pregnancy Your antenatal care Your babys development Labour and birth After the birth Assisted birth Getting ready for the birth Giving birth Labour Meeting your new baby Early parenthood Caring for your new baby Getting to know your baby Going home If your babys ill Your growing family Your wellbeing after the birth Other languages and formats Back Ready Steady Baby! Home Ready Steady Baby Early parenthood Going home Sleeping safely For the first 6 months of your babys life the safest place for them to sleep is in a cot in the same room as the person looking after them, for all sleeps. Sadly, every year a small number of babies die suddenly and unexpectedly in their sleep. Sometimes a cause is found, such as an underlying health condition, but often theres no obvious reason. You may hear the term sudden infant death syndrome (SIDS) which used to be called cot death. Sudden infant death syndrome SIDS happens most often during sleep at any time, day or night. Doctors dont yet know what causes it but its most likely to happen in the first 6 months. Babies born early and underweight, and twins or multiple babies are more at risk. What increases the risk of SIDS? SIDS is at increased risk of happening if you: sleep with your baby in an armchair or on the sofa share a bed with your baby and you or your partner smoke share a bed with your baby and you or your partner have been drinking alcohol or have been taking drugs smoke or smoked when you were pregnant or lived with someone who did SIDS is at increased risk of happening if your baby: is put on their tummy or side gets too warm sleeps on a soft mattress sleeps in another room during the day or night, where you cant see them sleeps sitting up or not completely flat, such as in a car seat, as their head can roll forwards and affect how theyre breathing was born before 37 weeks and/or born weighing less than 2.5 kg Breastfeeding your baby reduces the risks of SIDS Helping your baby sleep safely Always tuck your baby in with blankets across their chest and under their arms Public Health Scotland Since the Back to Sleep campaign began in 1991, the rate of SIDS has dropped by 80%. For the first 6 months the safest place for your baby to sleep is in a cot, crib or moses basket in your room beside your bed and in the same room as you, for all sleeps. Youll also be close by if they need a feed or cuddle. You can help your baby get a good sleep and stay as safe as possible by: always putting them to sleep flat on their back on a firm flat mattress, and putting them on their back again if they roll over tucking them in with blankets across their chest and under their arms always putting them feet first at the bottom of the cot so they cant wriggle down and get caught under the blankets removing any bumpers, pillows or soft toys from the cot as these can cause your baby to overheat or affect your babys breathing if theyre too close to their face making sure they dont get too hot or cold  check their temperature by feeling their stomach or the back of their neck, and dont go by hands and feet as theyll often feel cold keeping their head uncovered when theyre sleeping and taking off any swaddling or sleeping bag if theyre in bed with you taking your baby out of their car seat when theyre not travelling, and out from a bouncy seat, swing or nest if theyre asleep as their head can roll forward if theyre not sleeping flat, which can affect their breathing making your home smoke-free, and keeping your baby away from cigarette smoke If your baby uses a dummy, use it for every sleep. If youre breastfeeding, wait at least 4 weeks before giving your baby a dummy. Make sure that any other family or friends who may look after your baby know how to put your baby down for a sleep safely. Do not sleep on a sofa or chair Never put yourself in a position that you can fall asleep with your baby in an armchair or on the sofa as this increases the risk of SIDS by 50% (Source: Baby Sleep Info Source and the Lullaby Trust). Sharing a bed with your baby Adult beds arent designed for babies. Before you bed-share, consider whether you think its a safe place for your baby to sleep. Check that: your baby cannot fall out of the bed your baby cannot get trapped between the mattress and the wall your adult bedding can be kept away from your baby other children and pets will not be in the bed at the same time as your baby Mothers do sometimes bed-share when breastfeeding, however, without some planning and thought it can be very dangerous. If you are breastfeeding while lying down, make sure your baby cannot roll onto their front. Try and keep your baby on their back, or move them onto their back once they have been fed. If youre thinking about bed-sharing, talk to your midwife, health visitor or family nurse about how to reduce the risks for your baby. Baby Sleep Info Source has more information about bed-sharing When your baby should always sleep separately Its never safe to share a bed with your baby if: you or your partner have had alcohol or taken drugs (legal or illegal) you smoked when you were pregnant you or your partner is a smoker your babys small or was born early you or your partner are overly tired  less than 4 hours sleep in previous 24 hours Your baby should sleep separately in their cot in these situations. How much sleeps normal? Theres no normal amount of sleep and some babies sleep more than others. New babies sleep a lot  sometimes as much as 18 hours a day for the first month or so. But your baby probably wont sleep for more than a few hours at a time to begin with. Unusually sleepy baby If your baby seems unusually sleepy they might be unwell. Always trust your instincts and get medical advice if youre worried. Dont expect your baby to sleep several times a day and wake only for feeds and to smile, there will be some crying and grumbling. Crying When your baby cries and you go to them and comfort them, youre teaching them the worlds a safe place. This helps them to develop the skills to sleep through the night. How to soothe a crying baby Plagiocephaly Sometimes babies develop a flatter area either at the back of or on one side of their head. This is called plagiocephaly. Plagiocephaly usually gets better on its own if your babys spending less time lying down. More about plagiocephaly Translations and alternative formats of this information are available from Public Health Scotland . If you need a different language or format, please contact phs.otherformats@phs.scot. Ready Steady Baby leaflet in Arabic, Polish, Simplified Chinese (Mandarin) and Ukrainian Ready Steady Baby leaflet in English (Easy Read) Source: Public Health Scotland - Opens in new browser window Last updated: 19 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites Lullaby Trust: How to reduce the risk of SIDS Scottish Cot Death Trust Twins Trust: Sleeping advice for twins and more NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Suicide,"Getting help with your suicidal thoughts | Suicide | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Surviving suicidal thoughts Getting Help with your Suicidal Thoughts Suicide If youre experiencing suicidal thoughts or thinking about killing yourself, its important to know that youre not alone. There is practical support and advice available. Suicidal thoughts can happen to any of us, at any time. Often people start noticing thesethoughts after a traumatic or stressful event in their life but sometimes theres no obvious trigger. Who you are, what you feel and what has happened or is happening in your life does not change the fact that theres help available. Whether youve just started to notice or have had similarthoughts for a long time you canchange things for the better,today. Call 999 or go to your nearest A&E now if: someones life is at immediate risk, for example by serious injury or overdose. Find your nearest A&E Coping right now focus on getting through today get yourself to a safe place, like a friends house be around other people stay away from drugs and alcohol If youre feeling overwhelmed or out of control you can try these practical tools from Mind. Find out what you can do to help yourself cope and how you can distract yourself . You can also read advice on how to cope with suicidalthoughts from Rethink Mental Illness . Phone a helpline NHS 24 For everyone  open 24 hours. Phone: 111 and choose the mental health option Samaritans For everyone  open 24 hours. Phone: 116 123 Childline For children and young people under 19 open24 hours. Phone: 0800 1111 Breathing Space For everyone  openMonday to Thursday 6pm to 2am andFriday 6pm to Monday 6am at weekends. Phone: 0800 83 85 87 Campaign Against Living Miserably (CALM) For men open 5pm to midnight every day Phone: 0800 58 58 58 Switchboard LGBT+ For anyone who identifies as LGBT+  open 10am to 10pm every day Phone: 0300 330 0630 Message a webchat Samaritans For everyone  open 24 hours Webchat: samaritans.org/how-we-can-help/contact-samaritan/chat-online/ Childline For children and young people under 19  open 24 hours Webchat: childline.org.uk/get-support/1-2-1-counsellor-chat/ Campaign Against Living Miserably (CALM) For men open 5pm to midnight every day Webchat: href=https://www.thecalmzone.net/help/webchat/>thecalmzone.net/help/webchat/ Switchboard LGBT+ For anyone who identifies as LGBT+ open 10am to 10pm every day Webchat: switchboard.lgbt Coping with suicidal thoughts Making a safety plan If you struggle with suicidal thoughts or are supporting someone else, it may help to make a safety plan to use if you need it. The Staying Safe website provides information on how to make a safety plan, including video tutorials and online templates to guide you through the process. You can also get information on planning for a mental health crisis from Mind Other languages and accessible formats Easy Read Get help with your suicidal thoughts  Easy Read British Sign Language (BSL) Get help with your suicidal thoughts  BSL Bengali Get help with your suicidal thoughts  Bengali Chinese (simplified) Get help with your suicidal thoughts  Chinese (simplified) Polish Get help with your suicidal thoughts  Polish NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Sunburn,"Sunburn | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Injuries Skin injuries Sunburn Sunburn Sunburn is skin damage caused by ultraviolet (UV) rays. It usually causes the skin to become red, sore, warm, tender and occasionally itchy for about a week. The skin will normally start to flake and peel after a few days and will usually fully heal within 7 days. While sunburn is often short-lived and mild, its important totryto avoid it, because it can increase your chances of developing serious health problems, such as skin cancer, in later life. Its easy to underestimate your exposure to the sun when outside, as the redness doesnt usually develop for several hours. Breezes and getting wet (such as going in and out of the sea) may cool your skin, so you dont realise youre getting burnt. You should always be aware of the risk of sunburn if youre outside in strong sun, and look out for your skin getting hot. What to do if youre sunburnt If you or your child has sunburn, you should get out of the sun as soon as possible  head indoors or into a shady area. You can usually treat mild sunburn at home, although there are some circumstances where you should seek medical advice. The following advice may help to relieve your symptoms until your skin heals. Do cool the skin by sponging it with cold water or by having a cold bath or shower  applying a cold compress such as a cold flannel to the affected area may also help drink plenty of fluids to cool you down and prevent dehydration take pain relief such as ibuprofen or paracetamol to relieve any pain  aspirin should not be given to children under 16 try to avoid all sunlight, including through windows, by covering up the affected areas of skin until your skin has fully healed Get treatment advice from your local pharmacy Your nearest pharmacist can advise you on the best treatment if you have sunburn. Find your nearest pharmacy When to seek medical advice Contact your GP practice if: You have sunburn and feel unwell or have any concerns about your sunburn, particularly if youre burnt over a large area or have any of the more severe symptomssuch as: blistering or swelling of the skin (oedema) chills a high temperature (fever) of 38C (100.4F) or above,or 37.5C (99.5F) or above in children under five dizziness, headaches and feeling sick (symptoms of heat exhaustion) You should also see your GP if a young child or baby has sunburn, as their skin is particularly fragile. If your GP practice is closed, phone 111. Your GP may recommend using hydrocortisone cream for a few days (this is also available over the counter at pharmacies) to reduce the inflammation of your skin. Severe sunburn may require special burn cream and burn dressings from your GP or a nurse at your GP practice. Very occasionally, hospital treatment may be needed. Whos at risk of sunburn? Everyone who is exposed to UV light is at risk of getting sunburn, although some people are more vulnerable than others. You should take extra care when out in the sun if you: have pale, white or light brown skin have freckles or red or fair hair tend to burn rather than tan have many moles have skin problems relating to a medical condition are only exposed to intense sun occasionally  for example, while on holiday are in a hot country where the sun is particularly intense have a family history of skin cancer People who spend a lot of time in the sun, whether its for work or play, are at increased risk of skin cancer if they dont take the right precautions. Snow, sand, concrete and water can reflect the suns rays onto your skin, and the sun is more intense at high altitudes. Dangers of UV rays The short-term risks of sun exposure are sunburn and sun allergy . The longer-term risks (over decades) include: actinic (solar) keratoses rough and scaly pre-cancerous spots on the skin skin cancer  including both melanoma and non-melanoma skin cancer eye problems  such as photokeratitis (snow blindness) andcataracts premature ageing of the skin and wrinkling Preventing sunburn Skin should be protected from strong sunlight by covering up with suitable clothing, seeking shade and applying sunscreen. In the UK, the risk of getting sunburnt is highest from March to October, particularly from 11am to 3pm, when the suns rays are strongest. There is also a risk of getting sunburn in other weather conditions. For example, light reflecting off snow can also cause sunburn. You can also burn in cloudy and cool conditions. Suitable clothing Suitable clothing includes: a wide-brimmed hat that shades the face, neck and ears a long-sleeved top trousers or long skirts in close-weave fabrics that do not allow sunlight through sunglasses with wraparound lenses or wide arms with the CE Mark and European Standard EN 1836:2005. Sunscreen When buying sunscreen, make sure its suitable for your skinand blocks both ultraviolet A (UVA) and ultraviolet B (UVB) radiation. The sunscreen label should have: the letters UVA in a circle logo and at least 4-star UVA protection at least SPF30 sunscreen to protect against UVB Most people do not apply enough sunscreen. The amount of sunscreen needed for the body of an average adult to achieve the stated sun protection factor (SPF) is around 35ml or 6 to 8 teaspoons of lotion. If sunscreen is applied too thinly, it provides less protection. If youre worried you might not be applying enough SPF30, you could use a stronger SPF50 sunscreen. If you plan to be out in the sun long enough to risk burning, sunscreen needs to be applied twice: 30 minutes before going out just before you go out Sunscreen should be applied to all exposed skin, including the face, neck and ears (and head if you have thinning or no hair), but a wide-brimmed hat is better. How long it takes for your skin to go red or burn varies from person to person. The Cancer Research UK website has a handy tool where you can find out your skin type , to see when you might be at risk of burning. Water-resistant sunscreen is needed if sweating or contact with water is likely. Sunscreen needs to be reapplied liberally, frequently and according to the manufacturers instructions. This includes straight after youve been in water (even if it is water-resistant) and after towel drying, sweating or when it may have rubbed off. Advice for babies and children Children aged under 6 months should be kept out of direct strong sunlight. From March to October in the UK, children should: cover up with suitable clothing spend time in the shade (particularly from 11am to 3pm) wear at least SPF30 sunscreen To ensure they get enough vitamin D, children aged under 5 are advised to take vitamin D supplements even if they do get out in the sun. Source: NHS 24 - Opens in new browser window Last updated: 14 June 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Supraventricular tachycardia,"Supraventricular tachycardia - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Heart and blood vessels Conditions Supraventricular tachycardia Supraventricular tachycardia Supraventricular tachycardia is a condition where the heartbeat is abnormally fast. It can happen to anyone at any age and often occurs for the first time in children or young adults. In most cases, supraventricular tachycardia is harmless. It doesnt usually last long and can settle without treatment. Why it happens Some people are born with an abnormality of the hearts natural wiring or conduction system. This allows a short circuit to develop. Under certain circumstances, this allows the heart to race very fast. One example of this is Wolff-Parkinson-White syndrome . This is where theres an abnormal electrical connection between the: atria (upper heart chambers), and the ventricles (lower heart chambers) Some people with this condition can develop supraventricular tachycardias. This is because of this short circuit. Symptoms of supraventricular tachycardia If you have supraventricular tachycardia, youll usually feel your heart racing in your chest or throat. The heart rate is usually between 140 to 180 beats per minute but can be as high as 250. A normal heartbeat should be 60 to 100 beats per minute at rest. During a supraventricular tachycardia, the heart muscle contracts very fast. This means that it cannot relax properly between contractions to fill with blood. This reduces the amount of blood being pumped around the body. Therefore, you may also feel: chest pain dizziness light-headedness fatigue (tiredness) breathlessness On rare occasions, you may faint because of a drop in blood pressure. These symptoms vary in length and frequency. Diagnosing supraventricular tachycardia If your doctor thinks that you might have supraventricular tachycardia, youll be referred for tests. These can include an: electrocardiogram (ECG) ambulatory heart monitor echocardiogram Causes of supraventricular tachycardia Common causes of supraventricular tachycardia in people at risk of the condition include: stress anxiety a change in posture some medications alcohol caffeine smoking recreational drugs Treating supraventricular tachycardia The treatment for supraventricular tachycardia varies from person to person. It depends on: the type of supraventricular tachycardia you have your symptoms treatment of any underlying cause your age your overall health Types of treatment Supraventricular tachycardia treatments focus on controlling the rate and rhythm of the heart. They include: medication, like beta blockers and other anti-arrhythmic drugs electric shock treatment (DC cardioversion) in an urgent case radiofrequency ablation Source: Scottish Government - Opens in new browser window Last updated: 21 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Swollen glands,"Swollen glands | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Glands Swollen glands Swollen glands Swollen lymph glands are usually a sign of infection. Swollen lymph glands that are caused by an infection usually get better by themselves in 1 to 2 weeks. Sometimes swollen lymph glands can have a more serious cause and may need to be seen by a doctor. Phone 111 or ask for an urgent GP appointment if: You have swollen glands and you: are finding it very difficult to swallow have difficulty breathing Speak to your GP practice if: You have swollen glands and: theyre getting bigger theyve not gone down within 1 week they feel hard or do not move when you press them youre having night sweats or have a very high temperature (you feel hot and shivery) you have no other signs of illness or infection you have swollen lymph glands just above or below your collar bone (the bone that runs from your breastbone to each of your shoulders) What are the lymph glands? The lymph glands (or lymph nodes) are small lumps of tissue that contain white blood cells. These help to fight bacteria, viruses and anything else that causes infection. Theyre an important part of the immune system and are found throughout the body. What swollen lymph glands feel like The lymph glands can swell to more than a few centimetres in response to infection or disease. Swollen glands feel like tender, painful lumps. You may feel them: on each side of the neck under the chin in the armpits around the groin Common causes of swollen glands Swollen glands are usually caused by a viral or bacterial infection like: a cold tonsillitis glandular fever a throat infection an ear infection a dental abscess cellulitis (a skin infection) The glands in the affected area will often become suddenly tender or painful. You may also have other symptoms like a sore throat, cough, or fever. These infections usually clear up on their own and the swollen glands will soon go down. Swollen lymph glands are rarely caused by anything more serious. Managing swollen glands at home When an infection causes swollen glands you can help to ease symptoms at home. Do drink plenty of fluids rest use over-the-counter medicines like paracetamol or ibuprofen Source: NHS 24 - Opens in new browser window Last updated: 12 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Syphilis,"Syphilis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Sexual and reproductive Syphilis Syphilis British Sign Language (BSL) |  | Polski | Romn | slovenina Syphilis is a bacterial infection. Its hard to detect and is one of the most easily caught sexually transmitted infections (STIs). Symptoms of syphilis Most people with syphilis dont notice any symptoms and dont know they have it. Symptoms change over time and may come and go. Syphilis usually has 3 stages. The first stage (primary syphilis) Ten days to 3 months after infection, you may notice a small, painless sore or ulcer. This is typically on either the: penis vagina anus rectum tongue lips You might only have 1 sore, but can have more. Swelling in your lymph glands (such as in the neck, groin or armpit) often happens with the ulcers. The sore will then disappear within 2 to 6 weeks. If left untreated, syphilis will move into its second stage. The second stage (secondary syphilis) Symptoms of secondary syphilis begin a few weeks after the original sore disappears. Common symptoms of secondary syphilis include: a non-itchy skin rash appearing anywhere on the body, but commonly on the palms of the hands or soles of the feet tiredness headaches swollen lymph glands Less common symptoms include: fever weight loss patchy hair loss joint pains These symptoms may disappear within a few weeks, or come and go for a few months. Syphilis will then move into a stage where you will experience no symptoms. Youre still infected during this stage. This is called latent syphilis. You can still pass it on during the first year of this stage. After a couple of years, you cant pass the infection to others, even though you remain infected. However, during this stage, the infection can be passed on from a mother to an unborn child during pregnancy. The latent stage can continue for many years (even decades) after you first become infected. Without treatment, there is a risk that latent syphilis will move on to the more serious stage tertiary syphilis. The third stage (tertiary syphilis) The symptoms of tertiary syphilis can begin years or even decades after the initial infection. 1 in 3 people who are not treated for syphilis develop serious symptoms eventually. The symptoms of tertiary syphilis will depend on what part of the body the infection spreads to. For example, it may affect the brain, nerves, eyes, heart, bones, skin or blood vessels, potentially causing any of the following symptoms: stroke dementia loss of co-ordination numbness paralysis blindness deafness heart disease skin rashes At this stage, syphilis can be dangerous enough to cause death. Testing for syphilis If you think you might have syphilis, get tested for free by: booking an appointment at your local sexual health service contacting your GP practice for an appointment What does a syphilis test involve? The only reliable way to tell if you have syphilis or not is to have a blood test. This is usually sent to the lab for analysis. However, in some sexual health services, a same day test can be done if you have symptoms. Treatment for syphilis Antibiotics will treat the syphilis infection, even during pregnancy. These are given by injection, tablets or capsules. Treatment may be started before your test result is known. You may be given one or more doses, depending on the stage of infection. Youll need to go back to your GP practice or sexual health clinic 6 and 12 weeks after starting treatment to be retested. You should avoid having sex until you and your partner (s) have finished treatment and your tests have shown treatment has worked. This includes oral sex and sex using a condom. Your partner should also get tested for syphilis. It can be hard to spot in its early stages and they might not realise they have it. They will generally be offered treatment regardless. Syphilis and pregnancy In Scotland, pregnant women are tested for syphilis as part of their antenatal checks . If youre pregnant and have syphilis, you can pass it on to your baby before theyre born. This is known as congenital syphilis. Having syphilis during pregnancy can increase the risk of: miscarriage premature birth stillbirth How syphilis is passed on You can get syphilis by having unprotected vaginal, anal or oral sex (sex without a condom). Around one third of all people who get syphilis do so through having unprotected oral sex with no other vaginal or anal sex involved. It can also be passed by coming into contact with an ulcer on your partners penis, vagina, anus or inside their mouth. Syphilis can be passed on: to an unborn baby during pregnancy (congenital syphilis) by injecting drugs with a needle thats been used by someone who has syphilis during a blood or organ transplant (this is extremely rare as all blood and organ donations in the UK are checked for syphilis) Syphilis also makes HIV easier to pass on and catch. The number of people getting syphilis in Scotland has greatly increased over the last 5 years. You could be at higher risk if you: are a man who has sex with men have had sex overseas have had multiple sexual partners How to prevent syphilis The best way to reduce your risk of STIs is to practice safer sex . This means using a condom for vaginal, anal and oral sex. Other STIs If you have been diagnosed with syphilis you should get tested for all STIs including: HIV chlamydia gonorrhoea Find your local sexual health clinic Source: Scottish Government - Opens in new browser window Last updated: 26 February 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Other languages and formats British Sign Language (BSL) |  | Polski | Romn | slovenina British Sign Language (BSL) |  | Polski | Romn | slovenina Add this page to\n            Info For Me Also on NHS inform Book a sexual health appointment online Syphilis (BSL) Syphilis (Chinese) Syphilis (Polish) Syphilis (Romanian) Syphilis (Slovak) Other health sites BASHH: sexual health NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Testicular cancer,"Testicular cancer | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Testicular cancer Testicular cancer About testicular cancer Symptoms of testicular cancer Diagnosing testicular cancer Treating testicular cancer Causes of testicular cancer About testicular cancer Cancer of the testicle is one of the less common cancers. It tends to mostly affect men and anyone with testicles between 15 and 49 years of age. The most common symptom is a painless lump or swelling in one of the testicles . It can be the size of a pea or it may be much larger. Other symptoms can include: a dull ache in the scrotum a feeling of heaviness in the scrotum Its important to be aware of what feelsnormal for you. Get to know your body and speak to your GP if you notice any changes. Read more aboutthe symptoms of testicular cancer and diagnosing testicular cancer . The testicles The testicles are the 2 oval-shaped male sex organs that sit inside the scrotum on either side of the penis. The testicles are an important part of the male reproductive system because they produce sperm and the hormone testosterone, which plays a major role in male sexual development. Types of testicular cancer The different types of testicular cancer are classified by the type of cells the cancer begins in. The most common type of testicular cancer is germ cell testicular cancer, which accounts for around 95% of all cases. Germ cells are a type of cell that the body uses to create sperm. There are 2 main subtypes of germ cell testicular cancer. They are: seminomas which have become more common in the last 20 years and now account for 50 to 55% of testicular cancers non-seminomaswhich account for most of the rest and include teratomas, embryonal carcinomas, choriocarcinomas and yolk sac tumours Both typestend to respond well to chemotherapy . Less common types of testicular cancer include: Leydig cell tumours which account for around 1 to 3% of cases Sertoli cell tumours which account for around 1% of cases lymphoma which accounts for around 4% of cases This topic focuses on germ cell testicular cancer. You can contact the cancer support specialists at Macmillan for more information about Leydig cell tumour and Sertoli cell tumours. Their helpline number is 0808 808 00 00 and its open Monday to Friday, 9am to 8pm. Read more about Hodgkin lymphoma and non-Hodgkin lymphoma . How common is testicular cancer? Testicular cancer is a relatively rare type of cancer. Testicular cancer is unusual compared to other cancers because it tends to affect younger men and anyone with testicles. Although its relatively uncommon overall, testicular cancer is the most common type of cancer to affect men and anyone with testicles between the ages of 15 and 49. For reasons that are unclear,white men and anyone with testicles have a higher risk of developing testicular cancer compared with other ethnic groups. The number of cases of testicular cancer that are diagnosed each year in the UK has roughly doubled since the mid-1970s. Again, the reasons for this are unclear. Causes of testicular cancer The exact cause or causes of testicular cancer are unknown, but a number of factors have been identified that increase a mans risk of developing it. The 3 main risk factors are described below. Undescended testicles Undescended testicles(cryptorchidism) is the most significant risk factor for testicular cancer. About 3to 5% of boys are born with their testicles inside their abdomen. They usually descend into the scrotum during the first year of life, but in some boys the testicles dont descend. In most cases, testiclesthat dont descend by the time a boy is 1 year old descendat a later stage. If the testicles dont descend naturally,an operation known as anorchidopexy can be carried out to move the testicles into the correct position inside the scrotum. Its important that undescended testicles move down into the scrotum during early childhood because boys with undescended testicles have a higher risk of developing testicular cancer than boyswhose testicles descend normally. Its also much easier to observe the testicles when theyre in the scrotum. People with undescended testicles are about 3 times more likely to develop testicular cancer than those whose testicles descend at birth or shortly after. Family history Having a close relative with a history of testicular cancer or an undescended testicle increases your risk of also developing it. For example, if your father had testicular cancer, youre around 4 times more likely to developit than someone with no family history of the condition. If your brother had testicular cancer, youre about 8 times more likely to develop it. A number of genes may be involvedin the development of testicular cancerin families where more than 1 person has had the condition. This is an ongoing area of researchin which patients and their families may be asked to take part. Previous testicular cancer People whove previously been diagnosed with testicular cancer are between 4 to 12 times more likely to develop it in the other testicle. For this reason,if youve previously been diagnosed with testicular cancer, its very important that you keep a close eye on the other testicle. If youve been diagnosed with testicular cancer, you also need to be observed for signs of recurrence for between 5 and 10 years, so its very important that you attend your follow-up appointments. Cancer Research UK has more information about testicular cancer risks and causes . Outlook Testicular cancer is one of the most treatable types of cancer, and the outlook is one of the best for cancers. Almost all men and anyone with testicles who are treated for testicular germ cell tumours are cured, and its rare for the condition to return more than 5 years later. Treatment almost always includes the surgical removal of the affected testicle  called orchidectomy or orchiectomy  which doesnt usually affect fertility or the ability to have sex. In some cases, chemotherapy or, less commonly, radiotherapy may be used for seminomas (but not non-seminomas). Read more about treating testicular cancer . Symptoms of testicular cancer The most common symptom of testicular cancer is a lump or swelling in 1 of your testicles. The lump or swelling can be about the size of a pea, but may be larger. Most lumps or swellings in the scrotum arent in the testicle and arent a sign of cancer. But they should never be ignored. Visit your GP as soon as you notice a lump or swelling in your scrotum. Associated symptoms Testicular cancer can also cause other symptoms, including a: dull ache or sharp pain in your testicles or scrotum, which may come and go feeling of heaviness in your scrotum change in the texture or increase in firmness of a testicle difference between one testicle and the other When to speak to your GP Speak to your GP as soon as you notice any lump or swelling on your testicle. Theyll examine your testicles to help determine whether or not the lump is cancerous. Lumps within the scrotum can have many different causes and testicular cancer is rare. If your GP thinks the lump is in your testicle they may consider cancer as a possible cause. Research has shown that less than 4% of scrotal lumps or swellings are cancerous. For example,varicoceles (swollen blood vessels) and epididymal cysts (cysts in the tubes around the testicle) are common causes of testicular lumps. If you do have testicular cancer, the sooner treatment begins, the greater the likelihood that youll be completely cured. If you dont feel comfortable visiting your GP, you can go to your local sexual health clinic , where a healthcare professional will be able to examine you. Metastatic cancer If testicular cancer has spread to other parts of your body, you may also experience other symptoms. Cancer that has spread to other parts of the body is known as metastatic cancer. Around 5% of people with testicular cancer will experience symptoms of metastatic cancer. The most common place for testicular cancer to spread to is nearby lymph nodes in your abdomen or lungs. Lymph nodes are glands that make up your immune system. Less commonly, the cancer can spread to your liver, brain or bones. Symptoms of metastatic testicular cancer can include: a persistent cough coughing or spitting up blood shortness of breath swelling and enlargement of male breasts alump or swelling in your neck lowerback pain Diagnosing testicular cancer Speak to your GP as soon as possible if you notice a lump or other abnormality in your scrotum that you think may be on one of your testicles. Most scrotal lumps arent cancerous, but if you have a lump that you think may be in one of your testicles its important you have it checked as soon as possible. Treatment for testicular cancer is much more effective when startedearly. Physical examination As well as asking you about your symptoms and looking at your medical history, your GP will usually need to examine your testicles. They may hold a small light or torch against your scrotum to see whether light passes through it. Testicular lumps tend to be solid, which means light is unable to pass through them. A collection of fluid in the scrotum will allow light to pass through it. Tests for testicular cancer If you have a non-painful lump, or a change in shape or texture of oneof your testicles, and yourGP thinks it may be cancerous, youll be referred for further testing within 2 weeks. Scrotal ultrasound A scrotal ultrasound s can is a painless procedure that uses high-frequency sound waves to produce an image of the inside of your testicle. Its one of the main ways of finding out whether or not a lump is cancerous (malignant) or non-cancerous (benign). During a scrotal ultrasound, your specialist will be able to determine the position and size of the abnormality in your testicle. It will also give a clear indication of whether the lump is in the testicle or separate within the scrotum, and whether its solid or filled with fluid. A fluid-filled lump or collection around the testisis usually harmless. A more solid lump may be a sign the swelling is cancerous. Blood tests To help confirm a diagnosis, you may need a series of blood tests to detect certain hormones in your blood, known as markers. Testicular cancer often produces these markers, so if theyre in your blood itmay indicate you have the condition. Markers in your blood that will be tested for include: AFP (alpha feta protein) HCG (human chorionic gonadotrophin) A third blood test is also often carried out as it may indicate how active a cancer is. Its calledLDH (lactate dehydrogenate), but it isnt a specific marker fortesticular cancer. Not all people with testicular cancer produce markers. There may still be a chance you have testicular cancer even if your blood test results come back normal. Histology The only way to definitively confirm testicular cancer is to examine part of the lump under a microscope. These tests and reports are called histology. Unlike many cancers where a small piece of the cancer can be removed (a biopsy ), in most cases the only way to examine a testicular lump is by removing theaffected testicle completely. This is because the combination of the ultrasound and blood marker tests is usually sufficient to makea firm diagnosis. Also, a biopsy may injure the testicle and spread cancer into the scrotum which isnt usually affected. Your specialist will only recommend removing your testicle if theyre relatively certain the lump is cancerous. Losing a testicle wont affect your sex life or ability to have children. The removal of a testicle is called an orchidectomy. Its the main type of treatment for testicular cancer, so if you have testicular cancer its likely youll need to have an orchidectomy. Other tests In almost all cases, youll need further tests to check whether testicular cancer has spread. When cancer of the testicle spreads, it most commonly affects the lymph nodes in the back of the abdomen or the lungs. Therefore, you may require a chest X-ray to check forsigns of a tumour. Youll also need a scan of your entire body. This is usually a CT scan (computerised X-ray) to check for signs of the cancer spreading. In some cases, a different type of scan, known as a magnetic resonance imaging (MRI) scan may be used. Stages of testicular cancer After all tests have been completed, its usually possible to determine the stage ofyour cancer. There are 2 ways that testicular cancer can be staged. The first is known as the TNM staging system: T  indicates the size of the tumour N  indicates whether the cancer has spread to nearby lymph nodes M  indicates whether the cancer has spread to other parts of the body (metastasis) Testicular cancer is also staged numerically. The 4 main stages are: stage 1  the cancer is contained within your testicle and epididymis (the tube at the back of the testicle) stage 2  the cancer has spread from the testicles into the lymph nodes (small glands that help fight infection) at the back of the abdomen stage 3  the cancer has spread to the lymph nodes in the middle of the chest or in the neck stage 4  the cancer has spread to the lungs or, rarely, to other tissues ororgans, such as the liver, bones or brain Cancer Research UK has more information about testicular cancer stages . Treating testicular cancer Chemotherapy, radiotherapy and surgery are the 3 main treatments for testicular cancer. Your recommended treatment plan will depend on: the type of testicular canceryou have  whether its aseminoma or a non-seminoma the stageof your testicular cancer The first treatment option for all cases of testicular cancer, whatever the stage, is to surgically remove the affected testicle (an orchidectomy). For stage 1 seminomas, after the testicle has been removed, a single dose of chemotherapy may be given to help prevent the cancer returning. A short course of radiotherapy is also sometimes recommended. However, in many cases, the chance of recurrence is low and your doctors may recommend that youre very carefully monitored over the next few years. Further treatment is usually only needed for the small number of people who have a recurrence. Forstage 1 non-seminomas, close follow-up (called surveillance) may also be recommended, or a short course of chemotherapy using a combination of different medications. For stage 2, 3 and 4 testicular cancers, 3 to 4 cycles of chemotherapy are given using a combination of different medications. Further surgery is sometimes needed after chemotherapy to remove any affected lymph nodes or deposits in the lungs or, rarely, in the liver. Some people with stage 2 seminomas may be suitable for less intense treatment with radiotherapy, sometimes with the addition of a simpler form ofchemotherapy. In non-seminoma germ cell tumours, additional surgery may also be required after chemotherapy to remove tumours from other parts of the body, depending on the extent of the spread of the tumour. Deciding what treatment is best for you can be difficult. Your cancer team will make recommendations, but the final decision will be yours. Before discussing your treatment options with yourspecialist,you may find it useful to write a list of questions to ask them. For example, you may want to find out the advantages and disadvantages of particular treatments. Orchidectomy An orchidectomy is a surgical procedure to remove a testicle. If you have testicular cancer, the whole of the affected testicle will need to be removed because only removing the tumour may lead to the cancer spreading. By removing the entire testicle, your chances of making a full recovery are greatly improved.Your sex life andability to father children wont be affected. About1 in 50 people will get a second new testicular cancer in their remaining testicle. In such circumstances, itssometimes possible to only remove the part of the testicle containing the tumour. You should ask your surgeon about this if youre in this position. If testicular cancer is detected in its very early stages, an orchidectomy may be the only treatment you require. An orchidectomy isnt carried out through the scrotum. Its done by making an incision in your groin through which the testicle isremoved with all of the tubes and blood vessels attached to the testicle that pass through the groin into the abdomen. The operation is carried out under general anaesthetic . You can have an artificial (prosthetic) testicle inserted into your scrotum so that the appearance of your testicles isnt greatly affected. The artificial testicle is usually made of silicone (a soft type of plastic).It probably wont be exactly like your old testicle or the one you still have. It may be slightly different in size or texture. Afteran orchidectomy, its often possible to be discharged quickly, although you may need to stay in hospital for a few days. If only 1 testicle is removed, there shouldnt be any lasting side effects. If both testicles are removed (a bi-lateral orchidectomy), youll be infertile. However, removing both testicles at the same time is very rarely required, and only 1 in every 50 cases require the other testicle to be removed at a later date. You may be able to bank your sperm before having a bi-lateral orchidectomy to allow you to father children if you decide to. Sperm banking Most people are still fertile after having 1 testicle removed. However, some treatments for testicular cancer can cause infertility. Some people with testicular cancer may have low sperm counts because of changes that occur in the testicles before the cancer develops. For some treatments, such as chemotherapy, infertility may occur, but standard chemotherapies have a less than 50% chance of causing infertility if the remaining testicle is normal. In people who need to have post-chemotherapy removal of lumps at the back of the abdomen, known as retroperitoneal lymph node dissection (RPLND), the ability to ejaculate (eject sperm from the penis) may be affected, even though the remaining testicle can still produce sperm. Before your treatment begins, you may want to consider sperm banking. This is where a sample of your sperm is frozen so that it can be used at a later date to impregnate your partner during artificial insemination. Before sperm banking, you may be asked to have tests for HIV , hepatitis B and hepatitis C . If youre having complex chemotherapy for stage 2 to 4 testicular cancer, you should always be offered sperm banking. Ask if youre concerned about your fertility. Not all men are suitable for sperm banking. For the technique to work, the sperm has to be of a reasonably high quality. There may also be situations where its considered too dangerous to delay treatment for sperm banking to take place. MostNHS cancer treatment centres offer a free sperm banking service. However, its up to each area of the country to decide whether they store sperm for free or whether you have to pay. Cancer Research UK has more information about sperm banking , including the cost of sperm storage. Testosterone replacement therapy If you still have a remaining testicle, in most cases (90%)your body will make enough testosterone so you wont notice any difference. If there are any problems with your remaining testicle, you may experience symptoms due to a lack of testosterone. These symptoms can be caused for other reasons but can include: tiredness weight gain loss of libido (sex drive) reduced beard growth reduced ability to achieve or maintain an erection ( erectile dysfunction ) Having both testicles removed will definitely stop you producing testosterone and youll develop the above symptoms. Testosterone replacement therapy is where youre given testosterone in the form of an injection, skin patch or gel to rub into your skin. If you have injections, youll usually need to have them every 2 to 3 months. After having testosterone replacement therapy, youll be able to maintain an erection and your sex drive will improve. Side effects associated with this type of treatment are uncommon, and any side effects that you do experience will usually be mild. They may include: oily skin, which can sometimes trigger the onset of acne breast enlargement and swelling a change innormal urinary patterns, such as needing to urinate more frequently or having problems passing urine (caused by an enlarged prostate gland that puts pressure on your bladder) There are also concerns that testosterone replacement may increase the risk of prostate cancer and you should discuss this with your doctor. However, the risks from having testosterone replacement are usually much lower than the benefits of receiving it. Lymph node and lung surgery More advanced cases of testicular cancer may spread to your lymph nodes. Lymph nodes are part of your bodys immune system, which helps protect against illness and infection. Lymph node surgery is carried out under general anaesthetic. The lymph nodes in your abdomen are the nodes most likely to need removing. In some cases, the nerves near the lymph nodes can become damaged, which means that rather than ejaculating semen out of your penis during sex or masturbation, the semen instead travels back into your bladder. This is known as retrograde ejaculation. If you have retrograde ejaculation, youll still experience the sensation of having an orgasm during ejaculation, but you wont be able to father a child. There are a number of ways of treating retrograde ejaculation, including the use of medicines that strengthen the muscles around the neck of the bladder to prevent the flow of semen into the bladder. Men and anyone with testicles who wants to have children can have sperm taken from their urine for use inartificial insemination or in-vitro fertilisation (IVF). There are also a number ofnewer surgical techniques that carry a lower risk of retrograde ejaculation and infertility. Some people with testicular cancer have deposits of cancer in their lungs and these may also need to be removed after chemotherapy if they havent disappeared or reduced sufficiently in size. This type of surgery is also carried out under general anaesthetic and doesnt usually significantly affect breathing in the long-term. Nerve-sparing retroperitoneal lymph node dissection A newer type of lymph node surgery, called nerve sparing retroperitoneal lymph node dissection (RPLND), is increasingly being used because it carries a lower risk of causing retrograde ejaculation and infertility. In nerve-sparing RPLND, the site of the operation is limited to a much smaller area. This means theres less chance of nerve damage occurring. The disadvantage is that the surgery is more technically demanding. Therefore, nerve-sparing RPLND is currently only available at specialist centres that employ surgeons with the required training. Laparoscopic retroperitoneal lymph node dissection Laparoscopic retroperitoneal lymph node dissection (LRPLND) is a type of keyhole surgery that can be used to remove the lymph nodes. During LRPLND, the surgeon will make a number of small incisions in your abdomen. An instrument called an endoscope is inserted into one of the incisions. An endoscope is a thin, long, flexible tube with a light and a camera at one end, enabling images of the inside of your body to be relayed to an external television monitor. Small, surgical instruments are passed down the endoscope and can be used to remove the affected lymph nodes. The advantage of LRPLND is that theres less post-operative pain and a quicker recovery time. Also, as with nerve-sparing RPLND, in LRPLND theres a smaller chance that nerve damage will lead to retrograde ejaculation. However, as LRPLND is a new technique, theres little available evidence regarding the procedures long-term safety and effectiveness. If youre consideringLRPLND, you should understand there are still uncertainties about the safety and effectiveness ofthe procedure. Radiotherapy Radiotherapy uses high-energy beams of radiation to help destroy cancer cells. Sometimes, seminomas may require radiotherapy after surgery to help prevent the cancer returning. It may also be needed in advanced cases where someone is unable to tolerate the complex chemotherapies that are usually used to treat stage 2, 3 and 4 testicular cancer. If testicular cancer has spread to your lymph nodes, you may require radiotherapy after a course of chemotherapy. Side effects of radiotherapy can include: reddening and soreness of the skin, which is similar to sunburn nausea diarrhoea fatigue These side effects are usually only temporary and should improve when your treatment is completed. Chemotherapy Chemotherapy uses powerful medicines to kill the malignant (cancerous) cells in your body or stop them multiplying. You may require chemotherapy ifyou have advanced testicular cancer or its spread within your body. Its also used to help prevent the cancer returning. Chemotherapy is commonly used to treat seminomas and non-seminoma tumours. Chemotherapy medicines for testicular cancer are usually injected into a vein. In some cases, a special tube called a central line is used, which stays in a vein throughout your treatment so that you dont have to keep having blood tests or needles placed in a new vein. Sometimes, chemotherapy medicines can attack your bodys normal, healthy cells. This is why chemotherapy can have many different side effects. The most commoninclude: vomiting hair loss nausea sore mouth and mouth ulcers loss of appetite fatigue breathlessness and lung damage infertility ringing in your ears ( tinnitus ) skin that bleeds or bruises easily low blood counts increased vulnerability to infection numbness and tingling (pins and needles) in your hands and feet kidney damage These side effects are usually only temporary and should improve after youve completed your treatment. Side effects, such as infections that occur when you have a low blood count, can be life-threatening, and its essential that you always call your cancer care team if youre worried between chemotherapy treatments. Bleomycin One of the medicines commonly used, called bleomycin, can cause long-term lung damage and you should discuss this with your doctors if damage to your lungs would have specific issues for your career or lifestyle. However, the advice may still be that you should receive it for the best chance of a cure. Having children You shouldnt father children while having chemotherapy and for a year after your treatment has finished. This is because chemotherapy medications can temporarily damage your sperm, increasing your risk of fathering a baby with serious birth defects. Therefore, youll need to use a reliable method of contraception , such as a condom , during this time. Condoms should also be used during the first 48 hours after having a course of chemotherapy. This is to protect your partner from any potentially harmful effects of the chemotherapy medication in your sperm. Read more about the side effects of chemotherapy . Follow-up Even if your cancer has been completely cured, theres a risk it will return.The risk of your cancer returning will depend on what stage it was atwhen you were diagnosed and what treatment youve had since. Most recurrences of non-seminoma testicular cancer occur within 2 years of surgery or completion of chemotherapy. In seminomas, recurrences still occur until 3 years. Recurrences after 3 years are rare, occurring in less than 5% of people. Because of the risk of recurrence, youll need regular tests to check if the cancer has returned. These include: a physical examination blood tests to check for tumour markers a chest X-ray a computerised tomography (CT) scan Follow-up and testing is usually recommended dependingon the extent of the cancer and the treatment offered. This is usually more frequent in the first year or two but follow-up appointments may last for up to 5 years. In certain cases, it may be necessary to continue follow-up appointments for 10 years or longer. If the cancer returns following treatment for stage 1 testicular cancer, and its diagnosed at an early stage, it will usually be possible to cure it using chemotherapy and possibly also radiotherapy. Some types of recurring testicular cancer have a cure rate of over 95%. Recurrences that occur after previous combination chemotherapy can also be cured, but the chances of this will vary between individuals and youll need to ask your doctors to discuss this with you. Cancer Research UK hasmore information about follow-up for testicular cancer. Causes of testicular cancer The causes of testicular cancer are not fully understood. However, several things that increase yourrisk of developing the condition. Undescended testicles Undescended testicles is the most significant risk factor. When male babies grow in the womb, their testicles develop inside their abdomen. The testicles then normally move down into the scrotum when the baby is born or during their first year of life. However, for some children, the testicles fail to descend. The medical name forundescended testicles is cryptorchidism. Surgery is usually required to move the testicles down. If you have had surgery to move your testicles down into your scrotum, your risk of developing testicular cancer may be increased. Of surgery is performed before the child is 13 years of age, their risk of later developing testicular cancer is approximately double that of the rest of the population. However, if the operation is carried out after the boy is 13 years of age, the risk of developing testicular cancer is 5 times greaterthan that ofthe rest of the population. Previous testicular cancer Men and anyone with testicles who has previously been diagnosed with testicular cancer are 12 times more likely to develop testicular cancer in the other testicle. For this reason, its important to attend follow-up appointments if you have previously been diagnosed with testicular cancer. Age and race Unlike most other types of cancer, testicular cancer is more common in young and middle-aged men and anyone with testicles. Men and anyone with testicles aged 30to 34 are most likely to be diagnosed with testicular cancer. Testicular cancer is more common in white men and anyone with testicles than other ethnic groups. Its also more common in Northern and Western Europe compared with other parts of the world. Family history Having a close relative with a history of testicular cancer increases your risk of developing it. If your father had testicular cancer, you are 4 to 6 times more likely to developit thana person with no family history of the condition. If your brother had testicular cancer, you are 8 to 10 times more likely to develop it (having an identical twin with testicular cancer means that you are 75 times more likely to develop it). The fact that testicular cancer appears to run in families has led researchers to speculate that there may be one or more genetic mutations (abnormal changes to the instructions that control cell activity) that make a person more likely to develop testicular cancer. Mutations in 2 genes (known as the KITLG and SPRY4 genes) mayincrease the risk of a person developing testicular cancer. Endocrine disruptors Examples of endocrine disruptors include: some types of pesticide polychlorinated biphenyls (PCBs), chemical compounds used as a coolant dibutyl phthalate, a chemical used to manufacture cosmetics, such as nail polish In most countries, including the UK, many endocrine disruptors, such as PCBs, have been withdrawn as a result of their link to health problems. However, there is a concern that exposure to endocrine disruptors may still occur due to contamination of the food chain. However, there is not yet enough evidence to prove a definite link between indirect exposure to low levels of endocrine disruptors and health problems. Indirect exposure is the type of exposure that would occur if the food chain was contaminated. Infertility Men and anyone with testicles who are infertileare 3 times more likely to develop testicular cancer. The reasons for this are not clear. Smoking Research has found that long-term smokers (people who have been smoking a pack of 20 cigarettes a day for 12 years or 10 cigarettes a day for 24 years) are twice as likely to develop testicular cancerthan non-smokers. HIV and AIDS Studies show that men and anyone with testicles with HIV or AIDS have an increased risk of testicular cancer. Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS in",,,,,,,,,,,,,
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Testicular cancer: Teenagers and young adults,"Testicular cancer | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in teenagers and young adults Testicular cancer: Teenagers and young adults Testicular cancer: Teenagers and young adults The testicles Having tests for testicular cancer Treating testicular cancer Life after treatment for testicular cancer The testicles It can be embarrassing to talk about your testicles and any changes to them that youve noticed. Understanding more about what they do might help. Facts about testicles Testicles are small and oval-shaped. They hang below your penis in a sac called the scrotum. From puberty, your testicles produce a hormone called testosterone. This gives you a lower voice, hair on your face and body, and makes your muscles get bigger. You also need it for your sex drive and for getting an erection. The testicles make sperm from puberty (around 13to 14 years old) onwards. When sperm meets with a female egg during sex, this can cause pregnancy. The testicles make millions of sperm a day, but if sperm are not ejaculated they are reabsorbed back into your body. Sperm wait in the epididymis next to the testicle until they are ejaculated. At ejaculation, they travel up through the spermatic cord and mix with fluid from the prostate to make semen. They go out of the body through the urethra (this is the same tube you pass urine (pee) through). Lymph nodes (glands) Lymph nodes are small and round, and connect to each other by tiny tubes that carry fluid called lymph. We have lymph nodes throughout our bodies. They are part of the lymphatic system, which protects us from infections. Sometimes cancer cells from the testicle can spread to lymph nodes at the back of the abdomen (tummy). Youll have a scan to check your lymph nodes. If youre looking for information for all ages about testicular cancer,readour general testicular cancer section . Having tests for testicular cancer You may have tests done by your GP or at the hospital. They will help your doctors see whether you have testicular cancer. Visiting your GP If you think you might have some of the symptoms of testicular cancer, you should go to your GP. Theyll be able to talk to you about your symptoms. If they think the symptoms could be because of cancer they can do tests to find out more. If your doctor thinks there is a chance you might have cancer, theyll examine your testicles. They might also arrange for you to have an ultrasound test. This uses sound waves to take a picture of the testicles. At the hospital If you need more tests youll be referred to a hospital. This could be a general hospital or a specialist cancer hospital. Youll be seen by a specialist doctor (urologist), who will examine you and do the following tests: blood tests to check for chemicals in the blood called tumour markers  some testicular cancers (but not all) produce high levels of these an ultrasound scan of the scrotum and testicles (if you havent already had one)  this can usually tell the difference between a cancer and a cyst (a harmless lump filled with fluid) Removing a testicle If your ultrasound shows the lump is almost certainly cancer, an operation to remove a testicle (orchidectomy) is done. Youll only have this operation if its necessary. Your specialist will explain this to you. After the operation a doctor will use a microscope to look for cancer cells in the removed testicle. This may be the only operation you need. It will not stop you having sex or becoming a dad in the future. Further tests If testicular cancer is diagnosed you will need some other tests: more blood tests to check how well your liver and kidneys are working, and to check your tumour markers again chest X-rays to check your lungs are healthy  this is sometimes done before the operation CT , MRI , or PET scans to find out if the cancer has spread to the lymph nodes at the back of your abdomen (tummy), or to anywhere else in your body Youll be seen by a cancer specialist and usually a specialist nurse at a cancer treatment centre to get your test results. The results will help your specialist plan the best treatment for you. Having tests and waiting for the results can be a scary time. Talking about how you feel and getting support from your family, friends, specialist nurse and doctor can make it a bit easier. If you need any further treatment you will have it at the cancer treatment centre. If youre looking for information for all ages about testicular cancer, read our general testicular cancer section . Treating testicular cancer Treatment for testicular cancer can be very successful. Surgery and chemotherapy are the 2 main types of treatment. Often people have both treatments. To make sure you have the right treatment, your specialist needs to know what stage the cancer is. The stage of a cancer describes the tumour and whether it has spread outside the testicle. You may need some more tests to confirm what stage you are at. Waiting to hear about the stage of the cancer can be worrying. But this information is important because it helps your doctors plan the right treatment. Treatment for testicular cancer can be really successful. Most young men with testicular cancer are cured, even if the cancer has spread. If you have any questions about your treatment, dont be afraid to ask your doctor or nurse. Surgery Surgery to remove the testicle is one of the main treatments for testicular cancer. The operation is called an orchidectomy. It can be done as a day patient or during a short stay in hospital. You may feel shocked and scared at the thought of having this done. Your doctor and nurse will tell you more about it so that you know what to expect. The surgeon makes a small cut (incision) through your lower abdomen (tummy) in the groin on the affected side. The testicle is pushed up from the scrotum and removed through the cut. During the operation the surgeon can put a false testicle into your scrotum so that youll look the same as before. Your surgeon will explain this to you before the operation, or you can ask them about it. If this wasnt done at the time of the operation, but now you think you would like this, talk to your doctor or nurse. It is a small operation to put this in later on. After the operation Youll have a small dressing where the cut was made. This can usually be removed a day or so after the operation. The stitches in the wound will dissolve by themselves over the next few months. Youll probably feel a bit sore and youll be given painkillers to take regularly. Let your nurse or doctor know if theyre not controlling the pain. Wearing fitted briefs or shorts that support you and loose trousers like jogging bottoms can feel more comfortable after your operation. Youll probably feel tired and need to take things easy for about a week. You can expect to make a quick recovery after this operation. If one of your testicles is removed, you will still be able to have sex and make someone pregnant. Your other testicle should produce enough of the hormone testosterone and sperm. It isnt common to have both testicles removed. If youve had this done then youll be prescribed testosterone so youll still be able to have sex. But you wont be making sperm now, so you wont be able to make someone pregnant through sex. Your doctor will talk to you about sperm banking before your surgery. Storing your sperm before the operation can help you to become a dad in the future. Our sections on sex and relationships and fertility have more information as well as ways of coping. Surveillance If after surgery the chance of the cancer coming back is very low, your doctor might suggest you have surveillance. This means having regular checks to look for signs of the cancer coming back. If it does come back and its picked up very early, then its easy to cure. If the cancer doesnt come back then youve avoided having unnecessary treatment. At each clinic appointment, your doctor will examine you and you may have blood tests and chest X-rays. Going to all your surveillance appointments is really important. You could put a reminder in your phone. Chemotherapy Chemotherapy is when youre given anti-cancer drugs to destroy the cancer cells. You might be given chemotherapy: after the operation to remove your testicle, to reduce the chance of the cancer coming back to destroy cancer cells that have already spread outside the testicle if the cancer comes back occasionally before surgery, if the cancer has spread Chemotherapy can affect your fertility. Before your chemotherapy starts, your doctor will talk to you about storing some of your sperm. This is called sperm banking. We have more information about fertility issues. Chemotherapy is given into a vein as injections or drips. You have your chemotherapy through one of the following: a fine tube called a cannula a line into a vein in the chest (called a central line) a line into the arm (PICC line) that leads into a vein in the chest Find out more about how chemotherapy is given . The amount of chemotherapy you have depends on the stage of the cancer. If the stage is low then you will have 1to 2 cycles (sessions) of chemotherapy. If the stage is higher, or if the cancer comes back during surveillance, youll usually have 3to 4 cycles of chemotherapy. The drugs most often used to treat testicular cancer are cisplatin, etoposide and bleomycin. Giving these drugs together is called BEP. Chemotherapy is given in cycles of treatment. A cycle usually takes 3 weeks. If you have BEP, youll usually spend 3 to 5 days of the first week having your chemotherapy as a day patient, or you might need to stay in hospital overnight. After this youll come back to the clinic for another injection of chemotherapy a week later, and again the following week. If the cancer has spread to other parts of the body, or if it isnt going away completely with BEP, then different chemotherapy drugs can be given. Side effects Different chemotherapy drugs cause different side effects. You will probably have a few side effects, but its hard to know exactly how its going to be you. Your doctor will do everything they can to treat any side effects you have. Most side effects are short-term and gradually disappear once treatment stops. The most common temporary side effects are: hair loss tiredness feeling sick or being sick (which can be controlled with medicines) being more at risk of getting an infection Theres more information in the chemotherapy section . Sometimes side effects can be long-term. For example, although chemotherapy usually only affects fertility for a year or so, sometimes its permanent. Read Macmillans fertility section for more information. There may be other late effects of treatment and your specialist can talk to you about this. Further surgery If the lymph nodes at the back of your tummy area are still swollen after chemotherapy, theyre usually removed with an operation.Lymph nodes are part of the bodys immune system and help fight infection. The lymph nodes in the tummy are called the retroperitoneal lymph nodes, so the operation is called a retroperitoneal lymph node dissection. The operation will be done by experienced surgeons in specialist centres. The lymph nodes might contain cells that could become cancerous in the future, so having them removed is the only certain way to find this out. You might be in hospital for up to 10 days. The surgeon usually makes a cut from the top of your tummy (near your breastbone) to below your belly button. This leaves you with a scar but itll gradually fade until it ends up looking like a fine line. Sometimes you have surgery to remove any abnormal cells in areas like the lung or the lymph nodes in the chest. After the operation Youll have a drip in your arm to give you fluids until youre able to eat and drink normally. Youll also have drainage tubes from the wound to stop any extra fluid collecting. The nurses will keep a check on the dressing over your wound and change it when needed. Youll be given painkillers to take regularly. Your staples (like metal stitches) are removed 7 to 10 days after the operation. It might take a few months to get back to the level of fitness you had before. This operation can affect your fertility, because the nerves that control the release of sperm (ejaculation) may be damaged by surgery. Surgeons use nerve-sparing techniques to try to stop this happening. The operation doesnt usually stop you getting an erection or having an orgasm. If youre looking for information for all ages about testicular cancer, read our general testicular cancer section . Life after treatment for testicular cancer Being diagnosed with cancer can have a big impact on your life, even after youve finished treatment . After treatment Once you finish your treatment, youll have regular follow-up appointments at the hospital. Youll have blood tests for tumour markers and sometimes other scans or X-rays. If the tumour markers go up, this can be a sign that the cancer has come back. This means you need more treatment, which can still cure the cancer. How will I feel? You might find it embarrassing to talk about your private parts and how the cancer or cancer treatment has affected them. It can feel awkward talking to doctors or your family about this. Try not to let this put you off talking about things. It can be really helpful to let someone know how youre feeling, so that you dont bottle things up. Sex and fertility Fertility is the ability to have children. Some cancers and cancer treatments can affect a young mans fertility, but your doctors will always think about this when planning your treatment. Your doctor will talk to you about sperm banking prior to treatment if this might happen. If only1of your testicles has been removed, the one left should continue to make sperm and produce enough testosterone so that your fertility is not affected. You can still have sex. If you have chemotherapy, your ability to produce sperm might be affected. After chemotherapy you can have a sample checked to see if this has happened. You can still have sex, but when you are on chemotherapy (and for a few months afterwards) you should always wear a condom to protect your partner from the chemotherapy. If you had an operation to remove both of your testicles or the lymph nodes at the back of your tummy (abdomen), your fertility and your ability to have sex may be affected. This is a really tough thing to cope with on top of everything else that youre going through. Your specialist nurse will provide support and help you find more advice and support if you feel you need it. There are things which can be done to help so that you can still have sex. If youre looking for information for all ages about testicular cancer, read our general testicular cancer section . Source: Macmillan - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Testicular lumps and swellings,"Testicular lumps and swellings | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Sexual and reproductive Testicular lumps and swellings Testicular lumps and swellings Lumps and swellings in the testicles (balls) are relatively common in boys, men and anyone with testicles. Its important to know whats normal for you so you can notice any changes in your testicles. When to get medical advice Speak to your GP practice if you have: a lump in your testicles swollen testicles a change in the shape of your testicles a change in the way your testicles feel 1 testicle that has become bigger than the other aching or discomfort in your testicles that does not go away Diagnosing testicular lumps and swellings There is not a singular test for testicular lumps and swellings. The doctor will discuss your situation and carry out a physical examination. Your doctor may: look at and feel your testicles shine a torch through the bag of skin containing your testicles (scrotum) to check for a build-up of fluid refer you for an ultrasound scan take a urine (pee) sample if they suspect your lump or swelling may be caused by an infection If the lump or swelling is painful or very big, your doctor may refer you to a specialist for an operation to drain, shrink or remove it. What causes testicular lumps and swellings? Lumps and swellings in the testicles can have lots of different causes. The vast majority of testicular lumps and swellings are caused by non-cancerous (benign) conditions. Most of these may not need treatment. If you experience testicular lumps and swellings, they may be caused by: varicoceles  soft lumps that develop gradually above the testicle and on the left side of the scrotum hydroceles  swellings in the scrotum caused by a build-up of fluid epididymal cysts  a small, smooth fluid-filled swelling that slowly develops in the epididymis (a coil-like structure behind the testicles that helps to store and transport sperm) epididymo-orchitis  inflammation in the epididymis and the testicle caused by bacterial infections such as urinary tract infections (UTIs) , sexually transmitted infections (STIs) and mumps inguinal hernias  when fatty tissue or part of the bowel pokes through into the groin at the top of the inner thigh testicular torsion a benign but serious condition caused by the spermatic cord (the cord that supplies blood to the testicles) becoming severely twisted testicular cancer  a more serious health condition Treatment for testicular lumps and swellings Treatment for testicular lumps and swellings will vary depending on whats causing it. Painkillers such as paracetamol can be taken to ease discomfort or pain. In some cases, surgery may be used to treat some testicular lumps and swellings. The surgery is carried out under either local anaesthetic or general anaesthetic depending on the procedure. Antibiotics may be prescribed if the cause is a bacterial infection. If you have been diagnosed with testicular cancer , you will be cared for by a team of clinicians who will help decide the best treatment for you. Surgery to remove the affected testicle will be recommended in most cases and this may sometimes be followed by a course of chemotherapy or radiotherapy . Source: Scottish Government - Opens in new browser window Last updated: 26 February 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites Cancer Research UK: Testicular cancer British Association of Urological Surgeons: Testicular lumps NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Thirst,"Thirst - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Nutritional Thirst Thirst About thirst About thirst Feeling thirsty all the time and for no good reason isnt normal and should be investigated by your GP. Thirst is normally justthe brains way of warning that youre dehydrated because youre not drinking enough fluid. Butexcessive and persistent thirst (known aspolydipsia) could be a sign ofan underlying problem such as diabetes . Common causes of thirst Dehydration You will usually feel thirsty because youre notdrinking the amount of fluid your body needs. This may be because youve been sweating heavily or youve lost fluid because you have diarrhoea and are vomiting . You can soon quench your thirst and restore the fluid balance in your body by having a drink and ensuring you remain well hydrated. Itsparticularly important to stay well hydratedduring hot weather, while exercising and while youre unwell with vomiting and diarrhoea. Food In some cases, thirst may be caused by something as simple as a recent meal or snack. Eatingsalty or spicy foods can cause you to suddenly feel thirsty. Diabetes If you feel thirsty all the time, it could be a sign of diabetes particularly if you also have other symptoms such as needing to urinate frequently, extreme tiredness (fatigue) andunexplained weight loss. Diabetes is a lifelong condition that makes it difficult to control the level of sugar (glucose) in your blood. The high levels of glucose can mean your kidneys need to produce more urine to help pass the glucose out of your body. This can make you feel thirsty because your brain is telling you to drink more to make up for the fluids youve lost. If you feel thirsty all the time and have other symptoms, your GP will probably carry out a blood glucose test to see whether you have diabetes. Pregnancy Feeling thirsty, as well as urinating more often than usual, is a common symptom in pregnancy and usually nothing to worry about. Very occasionally, these problems can be a sign of gestational diabetes (a type of diabetes that affects women during pregnancy). You should be screened for this as part of your antenatal care if youre at risk. Medication Excessive thirst cansometimes be a side effect of certain types of medication, including lithium, certain antipsychotics and diuretics (water tablets). If you think a particular medicine is causing your thirst, it may be possible to change to a different medicine or reduce your dose. Speak to your GP about this. Other causes of thirst There are also many other potential causes of severe thirst. These include: diabetes insipidus  a condition caused by problems with a hormone that regulates the amount of fluid in the body diabetic ketoacidosis  a dangerous complication of diabetes caused by a lack of the hormone insulin in the body sickle cell aneamia  an inherited blood disorder psychogenic polydipsia  where a person with a mental health condition, such as schizophrenia , drinks excessive amounts of water that cant be excreted (got rid of) by the kidneys excessive bleeding Source: NHS 24 - Opens in new browser window Last updated: 10 March 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Dehydration Other health sites Diabetes UK Diabetes.co.uk: excessive thirst NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Threadworms,"Threadworms | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Threadworms Threadworms About threadworms Symptoms of threadworms Causes of threadworms Treating threadworms About threadworms Threadworms, also known as pinworms, are tiny parasitic worms that infect the large intestine of humans. Threadwormsare a common type ofworminfection in the UK, particularly in children under the age of10. The wormsare white and look like small pieces of thread. You may notice them around your childsbottom or intheir poo. They dont always cause symptoms, but peopleoften experience itchiness around their bottomor vagina. It can beworse at night and disturb sleep. Read more about the symptoms of threadworms . When to seek professional advice Pharmacy First Scotland: Threadworm treatment from your pharmacy If you have threadworms you can get advice and treatment directly from a pharmacy. Find your local pharmacy on Scotlands Service Directory. Search for a pharmacy near you If you think you or your child may have threadworms, you can usually treat the infection yourself with medication available at pharmacies without a prescription. You only need to see your GP if youthink you have threadworms and youre pregnant or breastfeeding, or if you think your child has threadworms and theyre under 2years old. In these circumstances, the recommendedtreatment isusually different. Severe or persistent threadworm infections can cause: loss of appetite weight loss skin infection around the anus if bacteria enterany scratches caused by itching  wearing cotton gloves while sleeping may help prevent this difficulty getting to sleep or staying asleep (insomnia) bedwetting In such cases, you should seek further advice from your GP. In very rare cases, threadworms can spread outside the intestinetothe urinary tract orliver, or the vagina or womb in girls or women. How threadworms are spread Threadworms lay their eggs around an infected persons anus (bottom), usually at night. Along with the eggs, the worm also secretes a mucus that causes itching. If the eggs get stuck on the persons fingertips when they scratch, they can be transferred to their mouth or on to surfaces and clothes. If other people touch an infected surface, they can thentransfer the eggs to their mouth. Threadworm eggs can survive for up to 2weeks before hatching. If the eggs hatch around the anus, the newborn worms can re-enter the bowel. Eggs that have been swallowed will hatch inside the intestine. After 2weeks, the worms reach adult size and begin to reproduce, starting the cycle again. Read more about what causes threadworms . Treating threadworms If you or your child has threadworms, everyone in your household will need to be treatedas theres a highrisk of the infection spreading. This includes those who dont have any symptoms of an infection. For most people, treatment will involve taking a single dose of a medication calledmebendazole to kill the worms. If necessary, another dose can be taken after 2weeks. During treatment and for a few weeks afterwards, its also important to follow strict hygiene measures to avoid spreading the threadworm eggs. This includes regularly vacuuming your house and thoroughly washing your bathroom and kitchen. If youre pregnant or breastfeeding, hygiene measures are usually recommended without medication. This is alsooften the case for young children. Read more about treating threadworm infections . Preventing threadworms Its not always possible to prevent a threadworm infection, but you can significantly reduce your riskby always maintaining good hygiene and encouraging children to do the same. Children should wash their hands regularly, particularly after going to the toilet and before mealtimes. Kitchen and bathroom surfaces should be kept clean. If your child is infected, encouraging them not to scratch the affected area around their anus or vagina will help prevent reinfection and reduce the risk of the infection spreading to others. Symptoms of threadworms Threadworms often go unnoticed by people who have them. However, they can cause intense itching around the anus (and the vagina in girls), particularly at night when the female worms are laying eggs. This can disturb sleep. In some cases, you may spot threadworms on your bed clothes or sheets at night, or you may notice them in your stools. The worms look like threads of white cotton and are about 1cm long. Causes of threadworms A threadworm infection is passed from person to person by swallowing threadworm eggs. A female threadworm can lay thousands of tiny eggs around the anus or vagina.The female threadworm also releases mucus, whichcan cause an itchy bottom . Scratching the anus or vagina, or wiping them after going to the toilet, can cause the eggs to stick to your fingertips or under your fingernails. If you dont wash your hands, the eggs can be transferred to your mouth or on to food or objects, such as toys and kitchen utensils. If someone else touches a contaminated object, or eats contaminated food and thentouches their mouth, theyll become infected. After the eggs have been swallowed they pass into a persons intestine, where they hatch. After about 2 weeks the threadworms will have grown into adults, at which point theyll reproduce and the cycle of infection will start again. Transferring eggs Threadworm eggs can be transferred from your anus (or vagina) to anything you touch, including: bedsheets andbed clothes flannels and towels childrens toys kitchen utensils toothbrushes furniture kitchen or bathroom surfaces Threadworm eggs can survive on surfaces for up to two weeks. As well as being swallowed by a person who touches a contaminated object or surface, threadworm eggs can also be swallowed after being breathed in. This can happen if the eggs become airborne for example, after shaking a contaminated towel or bed sheet. Animals and pets Threadworms only infect humans and arent spread in animal faeces. However, theres a small risk that threadworms can be caught from pets if the animals fur becomes contaminated with eggs after an infected person strokes it. If another person then touches the animals fur, the eggs could be passed on to them. Whos at risk? Threadworm infections most commonly affect young children because they often forget to wash their hands and they share toys with other children. People who are in close contact with someone with a threadworm infection also have a high risk of infection. This is why all members of a householdneed tobe treated when someone has a threadworm infection. Read more about treating threadworms . Treating threadworms To treat threadworms successfully, all household members must be treated, even if they dont have any symptoms. This is because the risk of the infection spreading is very high. The aim of treatment is to get rid of the threadworms and prevent reinfection. This will usually involve a combination of medication to kill the worms and strict hygiene measures to stop the spread of the eggs. The main medication used to treat threadworms is available from your local pharmacy without a prescription. However, its important to follow the manufacturers instructionsas it isnt suitable for everyone. Medication Mebendazoleis the main medication used to treat threadworm infections. It can be bought over the counter from your local pharmacy orprescribed by your GP. Its available as a chewable tablet or a liquid. Mebendazole works by preventing the threadworms absorbing sugar, which means they should die within a few days. This medication is 90 to 100% effective at killing the threadworms, but it doesnt kill the eggs. This is why the hygiene measures outlined below should also be followed for 6weeks. Visit your pharmacist if the infection continues two weeks after treatment. They may recommend a second dose of medication. In rare cases, mebendazole can cause abdominal pain or diarrhoea , particularly if the threadworm infection is severe. Hygiene measures Strict hygiene measures can help clear up a threadworm infection and reduce the likelihood of reinfection. The lifespan of threadworms is approximately 6weeks, so its important that hygiene measures are followed for at least this length of time. Everyone in the household must follow the advice outlined below. wash all night clothes, bed linen, towels and soft toys when youre first diagnosed  this can be done at normal temperatures, but make sure the washing is well rinsed thoroughly vacuum and dust the whole house, paying particular attention to the bedrooms  this should be repeated regularly carefully clean the bathroom and kitchen by damp-dusting surfaces and washing the cloth frequently in hot water  this should be repeated regularly avoid shaking any material that may be contaminated with eggs, such as clothing or bed sheets  this will prevent eggs being transferred to other surfaces dont eat food in the bedroom  you may end up swallowing eggs that have been shaken off the bedclothes keep your fingernails short encourage other members of your household to do the same discourage nail-biting and sucking fingers in particular, make sure children dont suck their thumb wash your hands frequently and scrub under your fingernails its particularly important to do this before eating, after going to the toilet, and before and after changing your babys nappy wear close-fitting underwear at night and change your underwear every morning bathe or shower regularly  its particularly important to bathe or shower first thing in the morning: make sure you clean around your anus and vagina to remove any eggs ensure everyone in your household has their own face flannel and towel  dont share towels keep toothbrushes in a closed cupboard and rinse them thoroughly before use Children can easily pick up another threadworm infection from friends or at school, so maintaining good hygiene may help prevent reinfection. Pregnant or breastfeeding women Medication isnt usually recommended for pregnant or breastfeeding women. Instead, you should follow the hygiene measures above. See your GP if youre more than 3months pregnant, or if youre breastfeeding and you continue to experience problemsafter only taking hygiene measures. In certain circumstances, your GP may consider prescribing medication. Children under 2years old Make sure you wash your babys bottom gently but thoroughly every time you change their nappy. Also wash your hands thoroughly before and after changing their nappy. Mebendazole isnt licensed for use in children under 2years of age, but GPs may decide to prescribe itoff-label for children over 6months. If medication isnt used, the hygiene measures outlined above are recommended instead. Source: NHS 24 - Opens in new browser window Last updated: 13 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Impetigo Search for your nearest pharmacy Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Thrush,"Thrush | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Sexual and reproductive Thrush Thrush British Sign Language (BSL) |  | Polski | Romn | slovenina Thrush is a very common yeast infection. Its not a sexually transmitted infection (STI). Its usually harmless but it can be uncomfortable and keep coming back. Symptoms of thrush Some people wont have any signs or symptoms of thrush at all. Sometimes there can be too much yeast and it can cause symptoms. Thrush symptoms in women Symptoms of thrush in women include: white vaginal discharge (often like cottage cheese), which does not usually smell itching and irritation around the vagina soreness and stinging during sex or when you pee Thrush symptoms in men Symptoms of thrush in men include: irritation, burning and redness around the head of the penis and under the foreskin a white discharge (like cottage cheese) an unpleasant smell difficulty pulling back the foreskin Thrush in other areas Thrush can affect other areas of skin, including the armpits, groin and between your fingers. Symptoms of thrush in other areas include: a red itchy or painful rash (the rash might not be easy to see on darker skin) white or yellow discharge When to get medical advice Speak to your GP practice or local sexual health clinic if: you have symptoms of thrush for the first time you have thrush and are under 16 or over 60 thrush keeps coming back (more than 4 times in 12 months) treatment for thrush has not worked you have thrush and are pregnant or breastfeeding you have thrush and a weakened immune system  for example, because of diabetes , HIV or chemotherapy Testing for thrush If you think you might have thrush, get tested for free by: contacting your GP practice for an appointment booking an appointment at your local sexual health service Testing is also available in some pharmacies . What does a thrush test involve? The test for thrush only takes a few seconds and isnt usually painful, though it may be uncomfortable for a moment. Its not always necessary to have a test for thrush. If you do have a test, a doctor or nurse may: look at the genital area use a swab (cotton bud) to collect a sample from the parts of the body that could be affected such as the vagina Thrush may have similar symptoms to some STIs, so its important you seek advice if you think you may be at risk of an STI. Treatment for thrush Treatment is simple and only necessary if you have signs and symptoms of thrush. You may be given: antifungal cream to apply to the genital area vaginal pessaries (tablets that you put into your vagina) oral pills a combination of treatments Your doctor or nurse will tell you how to use the treatment. Its very important to take the treatment as instructed and finish any course of treatment even if the symptoms go away earlier. You can buy antifungal treatments from most pharmacies if youve been diagnosed with thrush in the past and you know the symptoms. Some antifungal products can weaken latex condoms , diaphragms and caps . You should avoid sex while undergoing treatment if this is your method of contraception. You should tell your doctor, nurse or pharmacist if youre pregnant, might be pregnant, or if youre breastfeeding. This may affect the type of treatment youre given. If thrush isnt treated it eventually goes away on its own. Theres no need for your partner(s) to have treatment unless they have signs and symptoms of thrush. What causes thrush? Your chances of developing thrush increase if: your skin is irritated or damaged youre taking antibiotics you have poorly controlled diabetes you have a weakened immune system  for example youre having chemotherapy or living with HIV youre having hormone replacement therapy (HRT) youre pregnant you use products that irritate the skin such as perfumed products, bubble baths or vaginal washing products How to prevent thrush Some people find that different triggers cause thrush. If you notice a pattern, you may be able to help control it. There are things you can do to relieve symptoms and stop thrush from coming back. Do use a soap substitute (emollient) to add moisture instead of soap  these are available in some pharmacies use non-soap bath additives such as unfragranced bath oil instead of bubble bath dry properly after washing wear cotton underwear avoid sex until thrush has cleared up if sex is uncomfortable if you do have sex, make sure your vagina is well-lubricated Dont do not use soaps on or near your genital area, it can be drying do not let products like shampoo or conditioner run onto your genital area do not use bubble baths, essential oils or soap or shower gels in the bath as theyll run onto the genital skin and cause irritation do not use wet wipes on the genital skin do not use feminine washing products  even if they say they are pH balanced as they disrupt healthy bacteria in the vagina do not douche (wash out the vagina with water or other products) as it damages the healthy vaginal organisms and changes their natural balance do not wear tight underwear, tights, tight trousers or jeans do not use fabric softeners If youre prescribed an antibiotic for another condition, remind your doctor that you tend to get thrush and ask for some preventive treatment for thrush at the same time. Regular thrush Some people may only get thrush once. Others may get it multiple times. You may need to take treatment for longer if you keep getting thrush (you get it more than 4 times in 12 months). If you get recurrent thrush the doctor or nurse will want to check that other conditions, such as diabetes, arent the cause of the thrush. Theyll recommend how often you should use treatment. Find your local sexual health clinic Source: Scottish Government - Opens in new browser window Last updated: 26 February 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Other languages and formats British Sign Language (BSL) |  | Polski | Romn | slovenina British Sign Language (BSL) |  | Polski | Romn | slovenina Add this page to\n            Info For Me Also on NHS inform Thrush (BSL) Thrush (Chinese) Thrush (Polish) Thrush (Romanian) Thrush (Slovak) NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Thyroid cancer,"Thyroid cancer | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Thyroid cancer Thyroid cancer About thyroid cancer Symptoms of thyroid cancer Causes of thyroid cancer Diagnosing thyroid cancer Treating thyroid cancer Complications of thyroid cancer About thyroid cancer Thyroid cancer is a rare type of cancer that affects the thyroid gland, a small gland at the base of the neck. The most common symptom ofcancer of the thyroid is a painless lump or swelling that develops in the neck. Other symptoms only tend to occur afterthe condition has reached an advanced stage, and may include: unexplained hoarseness that lasts for more than a few weeks a sore throat or difficulty swallowing that doesnt get better a lump elsewherein yourneck If you have a lump in your thyroid gland, it doesnt necessarily mean you have thyroid cancer.About 1 in 20 thyroid lumps are cancerous. Read more about the symptoms of thyroid cancer The thyroid gland The thyroid gland consists of 2lobes located oneither side of the windpipe. Its main purpose is to release hormones (chemicals that have powerful effects on many different functions of the body). The thyroid gland releases 3separate hormones: triiodothyronine known as T3 thyroxine known as T4 calcitonin The T3 and T4 hormones help regulate the bodys metabolic rate (the rate at which the various processes in the body work, such as how quickly calories are burnt). An excess ofT3 and T4 will make you feel overactive and youmay lose weight. If you dont have enough of these hormones, youll feel sluggish and youmay gain weight. Calcitonin helps control blood calcium levels. Calcium is a mineral that performs a number of important functions, such as building strong bones. Calcitonin isnt essential for maintaining good health because your body also has other ways of controlling calcium. Types of thyroid cancer There are 4main types of thyroid cancer. They are: papillary carcinoma  this is the most common type, accounting for about 6 out of 10(60%) cases; it usually affects people under the age of 40, particularly women follicular carcinoma  accounts for around3 out of 20 (15%) cases of thyroid cancer and tends to affect older adults medullary thyroid carcinoma  accounts for between 5 and 8 out of every 100 diagnosed cases (5% to 8%); unlike the other types of thyroid cancer, medullary thyroid carcinomacan run in families anaplastic thyroid carcinoma  this is the rarest and most aggressive type of thyroid cancer, accounting for less than 1in 20 thyroid cancers; it usually affects older people over the age of 60 Papillary and follicular carcinomas are sometimes known as differentiated thyroid cancers, and theyre often treated in the same way. How common is thyroid cancer? Thyroid cancer is a rare form of cancer, accounting for less than 1% of all cancer cases in the UK. Its most common in people aged 35 to 39 years and in those aged 70 years or over. Women are 2to 3times more likely to develop thyroid cancer than men. Its unclear why this is, but it may bea result ofthe hormonal changes associated with the female reproductive system. What causes thyroid cancer? In most cases, the cause of thyroid cancer is unknown. However, certain things can increase your chances of developing the condition. Risk factors for thyroid cancer include: having a benign (non-cancerous) thyroid condition having a family history of thyroid cancer (in the case of medullary thyroid cancer) having a bowel condition known as familial adenomatous polyposis acromegaly a rare condition where the body produces too much growth hormone having a previous benign (non-cancerous) breast condition weight and height radiation exposure Read more about the causes of thyroid cancer Diagnosing thyroid cancer Atype of blood test known as a thyroid function testwill measure the hormone levels in your blood and rule out or confirm other thyroid problems. If nothing else seems to be causing the lump in your thyroid, fine-needle aspiration cytology (FNAC) is used. Further testing may be required if the FNAC results are inconclusive, or if more information is needed to make your treatment more effective. Read more about how thyroid cancer is diagnosed . Treating thyroid cancer Yourrecommended treatment plan will depend on the type and grade of your cancer, and whether a complete cure is realistically achievable. Differentiated thyroid cancers (DTCs)are treated using a combination of surgery to remove the thyroid gland (thyroidectomy) and a type of radiotherapy that destroys any remaining cancer cells and prevents the thyroid cancer returning. Medullary thyroid carcinomas tend to spread faster than DTCs, so it may be necessary to remove any nearby lymph nodes, as well as your thyroid gland. Read more about treating thyroid cancer Recurrence Cancerous cells will returnin an estimated 5% to 20% of people with a history of thyroid cancer. In approximately 10% to 15% of people, the cancerous cells will come back in other parts of their body, such as their bones. Cancerous cells can sometimesreturn many years after surgery and radioactive iodine treatment has been completed. Youll be asked to attend regular check-ups so any cancerous cells that return can be treated quickly. Read more about the complications of thyroid cancer Preventing thyroid cancer From the available evidence, eating a healthy, balanced diet is the best way to avoid getting thyroid cancer and all other types of cancer. A low-fat, high-fibre diet is recommended that includes plenty of fresh fruit and vegetables (at least 5 portions a day) and whole grains. Symptoms of thyroid cancer In its early stages, thyroid cancer tends to cause no or very few symptoms. The main symptom of thyroid cancer is a lump or swelling at the front of the neckjust below your Adams apple, which is usually painless. Women also have Adams apples, but theyremuch smaller and less prominentthan a mans. The lymph nodes in your neck can also be affected and become swollen. Lymph nodes are small glands that are part of the lymphatic system, which helps fight infection. Other symptoms of thyroid cancer only tend to occur after the condition has reached an advanced stage, and may include: unexplained hoarseness that doesnt get better after a few weeks a sore throat or difficulty swallowing that doesnt get better pain in your neck When to seek medical advice You should always speak to your GP if you develop a swelling or lumpat the front of your neck. Although its unlikely to be thyroid cancer, its important thatit isinvestigated. About 1 in 20 swellings or lumps in the neck are caused by thyroid cancer. Most cases are caused by non-cancerous swellings calledgoitres. Goitres Agoitre is an enlarged thyroid gland. Non-cancerous goitresare usually caused by other less serious problems with your thyroid gland, such as: too much triiodothyronine (T3) and thyroxine (T4) hormones this is known as having an overactive thyroid gland , or hyperthyroidism not enough T3 and T4 hormones this is known as having an underactive thyroid gland , or hypothyroidism Thyroid cancer support The Butterfly Thyroid Cancer Trust provides information, advice and support for people with thyroid cancer. As well as the website, they also have a helpline number that can be contacted on01207 545469, Monday to Friday, 10am to 4pm. Causes of thyroid cancer In most cases, the exact cause of thyroid cancer is unknown. However, there are certain things that can increase your chances of developing the condition, including having another thyroid condition and being exposed toradiation. What is cancer? Cancer begins with a change (mutation) in the structure of the DNA in cells, which can affect how they grow. This means cells grow andreproduce uncontrollably, producing a lump of tissue called a tumour. Left untreated, cancer can spread to other parts of the body, usually through the lymphatic system. The lymphatic system is made up of a network of vessels and glands (lymph nodes) located throughout the body. Lymph nodesproduce many of the cells needed by your immune system (the bodys natural defence system against infection and illness). Once the cancer reaches your lymphatic system, its capable of spreading to other parts of your body, including your blood, bones and organs. The most common types of thyroid cancer are papillary carcinomas and follicular carcinomas, which are known as differentiated thyroid cancers (DTCs). They spread much more slowly than other types of cancer. When DTCs are diagnosed, theyre usually limited to the thyroid gland itself or nearby lymph nodes. The rarer types of thyroid cancer are more aggressive and spread faster. By the time medullary thyroid carcinoma is diagnosed, it may have spread to the lymph nodes. In advanced cases, it may have also spread to the bones and lungs. Anaplastic thyroid cancer often spreads to the windpipe and, in some cases, the lungs. Risk factors for thyroid cancer The main risk factors for developing thyroid cancer are: having a thyroid condition having a family history of thyroid cancer (in the case of medullary thyroid cancer) having a bowel condition known as familial adenomatous polyposis (FAP) acromegaly (a rare condition where the body produces too much growth hormone) having previous benign (non-cancerous) breast conditions weight and height radiation exposure Thyroid conditions Your risk of developingthyroid cancer isslightly increased if you have certain non-cancerous (benign) thyroid conditions, such as an inflamed thyroid gland(thyroiditis) or anenlarged thyroid gland (goitre). Having an overactive thyroid gland (hyperthyroidism) or an underactive thyroid gland (hypothyroidism) doesnt increase your chances of developing thyroid cancer. Around 1in 5cases ofthyroid cancer occur in people whove had a previous benign thyroid condition. Family history Inherited genetic mutations are responsible for a small number of medullary thyroid carcinomas. If the instructions carried in genes are altered, some of the bodys processes wont work normally. This inherited mutation occurs in: familial medullary thyroid cancer multiple endocrine neoplasia (MEN) syndrome, types 2A and 2B In cases of MEN2A or MEN2B thyroid cancer, the mutations usually develop during childhood or the teenage years. In familial medullary thyroid cancer, the mutations usually develop in adulthood. If one of your parents has a history of medullary thyroid carcinoma or MEN syndrome, you should consider having a blood test to find out whether you have the mutated genes. If your test results are positive, its recommended you have surgery to remove your thyroid gland as a precaution. Familial adenomatous polyposis If you have a bowel condition calledfamilial adenomatous polyposis (FAP), your risk of developing thyroid cancer is increased. FAP runs in families and is caused by inheriting a faulty gene. Macmillan Cancer Support have more information about familial adenomatous polyposis . Acromegaly Thyroid cancer risk is increased in people who have acromegaly.Thisis a rare condition where the body produces too much growth hormone. Previous breast conditions If youve hada benign (non-cancerous) breast condition in the past, such as abreast cyst or fibroadenoma (non-cancerous tumour), yourrisk of developing thyroid cancerincreases by around half (50%) comparedwith women who havent had this type of condition. Weight and height If youre overweight, youre more at risk of developing thyroid cancer than someone who isnt overweight. Research hasalso shown thattaller adultshavean increased risk. However, the reasons for this are unclear. Radiation exposure Exposure to radiation during childhood is another risk factor for thyroid cancer. Radiation from nuclear fallout and radiation used for medical treatments have bothbeen associated with thyroid cancer. Many recently reported cases of thyroid cancer are thought to have been caused by radiation exposure during medical procedures carried out between 1910 and 1960. During this time, not much was known about the risks of radiation treatment. Today there are much stricter regulations regarding the use of radiation for medical procedures. Other risk factors Diet If your diet contains low levels of the trace element iodine, youre at anincreased risk of developing thyroid cancer. Peopleexposed to radiation, or those witha history of benign thyroid conditions,are more likely to have low levels of iodine. Eating a lot of butter, cheese and meat may also increase your risk of developing thyroid cancer. To help reduce your risk, you should include plenty of fresh fruit and vegetables in your diet. People with a high body mass index (BMI) also have an increased risk of developing thyroid cancer. Gender Women are about 2to 3times more likely to develop thyroid cancer than men. Its thought this may bebecause of thehormones released during a womans monthly period or during pregnancy. However, theres little scientific evidence to support this theory. Diagnosing thyroid cancer For many people, the first stage of diagnosing thyroid cancer is a consultation with a GP. Your GP will examine your neck and ask about any associated symptoms you may be experiencing, such as unexplained hoarseness. Thyroid function test A blood test known as a thyroid function test is used to check whether the swelling in your neck is caused by other problems with your thyroid gland. It will rule out conditions such as an overactive thyroid gland (hyperthyroidism) or an underactive thyroid gland (hypothyroidism), which are the most common thyroid problems. A thyroid function test measures the amount of certain types of hormones in your blood. Further tests will be needed if the thyroid function test reveals your thyroid gland is working normally. Fine-needle aspiration cytology Fine-needle aspiration cytology (FNAC)is the next stage in diagnosing thyroid cancer. Its an outpatient procedure, which means you wont have to spend the night in hospital. Asmall needleis inserted into the lump in your neck to allow a tiny sample of cells to be removed. The sampleis thenstudied under a microscope. This testcan usually reveal whether cancerous cells are present in your thyroid gland and, if they are, what type of thyroid cancer you have. Further testing Further testing may be recommended if the FNAC results are inconclusive or if further information is needed to make your treatment more effective. These tests may include: repeat FNAC combined with an ultrasound scan other types of scan, such as a computerised tomography (CT) scan or magnetic resonance imaging (MRI) scan In most cases, surgery will be recommended to remove the part of the thyroid gland that contains the lump or swellingwhen it hasnt been possible to rule out thyroid cancer. Treating thyroid cancer If youre diagnosed with thyroid cancer, youll be assigned a care team, who will devise a treatment plan for you. Your recommendedtreatment plan will depend on the type and grade of your cancer, and whether your care team thinks that a complete cure is realistically achievable. Cancer treatment team All NHS hospitals have multidisciplinary teams (MDTs)that treat thyroid cancer. An MDT is made up of a number of different specialists, and may include: a surgeon an endocrinologist (a specialist in treating hormonal conditions) an oncologist (a cancer treatment specialist) a pathologist (a specialist in diseased tissue) a radiotherapist or clinical oncologist (a specialist in non-surgical methods of treating cancer, such aschemotherapy and radiotherapy) a specialist cancer nurse, who will usually be yourfirst point of contact with the rest of the team Deciding on the best course of treatment can be difficult. Your cancer team will make recommendations after reviewing your case, but the final decision will be yours. Before you go to hospital to discuss your treatment options, you may want to write a list ofquestions to askthe specialist. For example, you may want to find out what the advantages and disadvantages of particular treatments are. Your treatment plan Your recommended treatment will depend on a number of things, including: the type of thyroid cancer you have the grade of your cancer whether your care team thinksa complete cure is realistically achievable Most differentiated thyroid cancers papillary carcinomas and follicular carcinomas and some medullary thyroid carcinomas have a good prospect of achieving a cure. Differentiated thyroid cancersare treated using a combination of: surgery to remove your thyroid gland (thyroidectomy) a type of radiotherapy calledradioactive iodine treatment, which isdesigned to destroy any remaining cancer cells and prevent the thyroid cancer returning Medullary thyroid carcinomas tend to spread faster than differentiated thyroid cancers, so it may be necessary to removeyour thyroid gland and any nearby lymph nodes. Radiotherapy iodine treatment is not effectiveat treating this type of thyroid cancer. Stage 4 medullary thyroid carcinomas arent usually curable, but it should be possible to slow their progression and control any associated symptoms. In most cases of anaplastic thyroid carcinoma, a cure isnt usually achievable. This is because its usually spread to other parts of thebody by the time its been diagnosed. Radiotherapyandchemotherapy can be used to slow the progression of anaplastic thyroid carcinoma and help control any symptoms. Some cases of differentiated thyroid cancer, medullary thyroid carcinoma and anaplastic thyroid carcinoma may benefit from a new type of treatment known as targeted therapies. This is where medication is used to directly target the cancerous cells. However, thesetypes of treatments are currently undergoingclinical trials and arent offered routinely on the NHS. Thyroidectomy In almost all cases of thyroid cancer its necessary to either remove some of your thyroid gland in a procedure called a hemithyroidectomy, or all of your thyroid gland(total thyroidectomy). This decisionwill be influenced by: the type of thyroid cancer you have the size of the tumour whether or not the cancer has spread beyond your thyroid gland Your surgeon should discuss with you the type of surgery required and why soyou can make an informed decision. A thyroidectomyis carried out under a general anaesthetic and usually takes around 2hours. The operation will leave a small scar on your neck, whichshouldnt be very noticeable. In a small number of cases, it may cause permanent hoarseness. Most people are well enough to leave hospital 3to 5days after having thyroid surgery. However, youll need to rest at home for 2to 3weeks and avoid any activities that could put a strain on your neck, such as heavy lifting. A member of your care team will be able to advise you about when youll be fit enough to resume normal activities and return to work. Replacement hormone therapy If some or all of your thyroid gland is removed, it will no longer be able to produce the hormones that regulate your metabolic system. This means youll experience symptoms of an underactive thyroid (hypothyroidism), such as fatigue (extreme tiredness), weight gain and dry skin. To compensate, youll need to take replacement hormone tablets for the rest of your life. If your surgery is to be followed by radioactive iodine treatment, its likely youll be given a hormone tablet called triiodothyronine. After radioactive iodine treatment is completed, youll be prescribed an alternative hormone tablet called thyroxine, which most people only need to take once a day. Youll need to have regular blood tests to check youre receiving the right amount of hormones and to determine whether your dose needs to be adjusted. It may take some time to achieve the optimum dose. Until this time, you may experience symptoms of tiredness or weight gain if your hormone levels are too low. Alternatively, if your hormone levels are too high, you may experience symptoms such as weight loss, hyperactivity or diarrhoea. You shouldnt experience any more side effects once theright dose has been achieved. Calcium levels Occasionally, the parathyroid glands can be affected during surgery. The parathyroid glands are located close to the thyroid gland and help regulate the levels of calcium in your blood. If your parathyroid glands are affected, your calcium levels may decrease, which can cause a tingling sensation in your hands, fingers, lips and around your nose. These symptoms should be reported to your MDT or GP as you may need to take calcium supplements. Most people only need to take a short course of calcium tabletsas the parathyroid glands will soon start to function normally again. Radioactive iodine treatment After having thyroid surgery, a course of radioactive iodine treatment may be recommended. This willhelp destroy any remaining cancer cells in your body and prevent the cancer returning. If youre taking thyroid hormone replacement tablets, youll need to stop taking them for 2 to 4 weeks before having radioactive iodine treatment. This is because they can interfere with the effectiveness of the iodine treatment. If withdrawing your hormone replacement treatment is problematic, you may be given a medicine called recombinant human thyroid stimulating hormone (rhTSH). This is given as an injection on 2 consecutive days. Your MDT will be able to advise you about whether or not rhTSH is suitable for you. The procedure Radioactive iodine treatment involves swallowing radioactive iodine in either liquid or capsule form. Theradiation in the iodine travels up into your neck through your blood supply and destroys any cancerous cells. Side effects of radioactive iodine treatment are uncommon, but a small number of people may experience tightness, pain or swelling in their neck and may feel flushed (warm). These side effects usually pass within 24 hours. After treatment, you may have a dry mouth and notice a change in your taste. These symptoms usually disappear after a few weeks or months, although they can be permanent in some people. Youll need to stay in hospital for3 to 5 days after the procedure because the iodine will make your body slightly radioactive. As a precaution, youll need to stay in a single room protected by lead sheets so that hospital staff arent exposed to radiation. You wont be able to have visitors during this time and hospital staff will keep their contact with you to a minimum. Your bodily fluids, such as urine, will alsobe slightly radioactive for3 to 5 days after your treatment, so its important that you flush the toilet every time you use it. Your sweat willbe radioactive, too, so you shouldbathe or shower every day. Youll be allowed home after the radioactive levels in your body have subsided. Dietary recommendations While having radioactive iodine treatment, youll need to eat a dietlow in iodine. An iodine-richdiet may reduce the effectiveness of your treatment. Its recommended that you: avoid all seafood limit the amount of dairy products you eat dont take cough medicines or use sea saltas they both contain iodine You should eat plenty of fresh meat, fresh fruit and vegetables ,and pasta and rice. These areall low in iodine. Pregnancy and breastfeeding You shouldnt have radioactive iodine treatment if youre pregnant or if theres a good chance that you may be. The treatment could damage your baby. Tell a member of your care team if youre unsure whether youre pregnant. Any treatment will need to be delayed until after your pregnancy. You must stop breastfeeding before you can be treated with radioactive iodine. If possible, you should stop breastfeeding6 weeks prior to treatment. You should not resume breastfeeding after treatment for your current child, but you may safely breastfeed any babies you may have in the future. Breastfeeding also isnt recommended while receiving iodine treatment. If youre breastfeeding, you should stop at least 4 weeks (but preferably 8) before starting iodine treatment. You should also notresume breastfeeding your baby. However, its safe for you to breastfeed if you have another child in the future. You shoulduse a reliable method of contraception for at least 6 months after having iodine treatment. This is because theres a small risk that any child conceived during this time could develop birth defects. This applies to both men and women. Fertility Radioactive iodine treatment doesnt affect fertility in women. However,theres a small risk that it could affect fertility in men who need to have multiple treatment sessions. Yourcare team will be able to advise you about the level of risk in your individual circumstances. If theres asignificant risk youll become infertile after having radioactive iodine treatment, you may wish to consider having your sperm or eggs harvested and frozen so they can be used for fertility treatment at a later date. External radiotherapy External radiotherapy , where radioactive waves are targeted at affected parts of the body, is usually only used to treat advanced or anaplastic thyroid carcinomas. The length of time youll need to have radiotherapy for will depend on the particular type of thyroid cancer you have and its progression. Side effects of radiotherapy include: nausea vomiting tiredness pain when swallowing dry mouth These side effects should pass 2 to 3 weeks after your course of radiotherapy has finished. Chemotherapy Chemotherapy is usually only used to treat anaplastic thyroid carcinomas that have spread to other parts of your body. Itinvolves taking powerful medicines that kill cancerous cells. Its rarely successfulin curing anaplastic cancer, but can slow its progression and help relieve symptoms. Possible side effects of chemotherapy include: nausea vomiting tiredness loss of appetite hair loss mouth ulcers If youre receiving chemotherapy, youll also be more vulnerable to infection. See your GP if you suddenly feel ill or your temperature rises above 38C (100.4F). Targeted therapies A number of targeted therapies are being tested inclinical trials to treat advanced cases of: medullary thyroid cancers differentiated thyroid cancers that dont respond to radioactive iodine anaplastic thyroid carcinomas In targeted therapies, medication specifically targets the biological functions that cancers need to grow and spread. As research is ongoing, some medications used in this type of treatment are unlicensed. In exceptional circumstances, your specialist may suggest using an unlicensed medication. Theyll do this if: they think its likely to be effective there are no better alternatives the benefits of treatment outweigh any associated risks If your specialist is considering prescribing an unlicensed medication, theyll tell you that its unlicensed and will discuss the possible risks and benefits with you. The decision about whether to fund treatment with medications used in targeted therapies is often made by individualclinical commissioning groups (CCGs). Complications of thyroid cancer Cancerous cells can return many years after surgery and radioactive iodine treatment has been completed. Itsestimated that 5% to 20% of people with a history of thyroid cancer will experience a return of cancerous cells in their neck. An estimated 10% to 15% of people willsee a return of cancerous cells in other parts of their body, such as their bones. Because ofthe risk of cancer cells returning, youll be asked to attend regular check-ups so any cancerous cells that do return can be treated quickly. Thyroglobulin testing Thyroglobulin testing is a special type of blood test thats used to monitor some types of thyroid cancer and to check for the return of cancerous cells. Thyroglobulin is a protein released by a healthy thyroid gland, but it can also be released by cancerous cells. If youve had your thyroid gland removed, there should be no thyroglobulin present in your blood, unless cancerous cells have returned. Regularly testing your blood for thyroglobulin can be an effective way of checking whether or not any cancerous cells have returned. For the first few years after having surgery youll probably need to have thyroglobulin testing every 6 months. After this period, youll need to be tested once a year. Ultrasound scan An ultrasound scanner uses high-frequency sound waves to create an image of part of the inside of the body. An ultrasound scan can detect changes inside your neck that could indicate the recurrence of cancer. Radioactive iodine scan Aftersurgery to remove part or all of your thyroid gland, you may be asked to attend a radioactive iodine scanning test. You swallow a small amount of radioactive iodine before undergoing a scan. The radioactive iodine will highlight any cancerous thyroid cells in the body. Before the scan, youll need to go on a low-iodine diet and stop taking your thyroid hormone medication. Asonly a smalldose of radioactive iodineis used, its not necessary tokeep your distance from others. However, if you think you may be pregnant or youre breastfeeding, let the doctors know before your test. A radioactive iodine scan willusually be carried out6 to 8 months after surgery. Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Overactive thyroid Underactive thyroid Other health sites British Thyroid Foundation Butterfly Thyroid Cancer Trust Cancer Research UK: Thyroid cancer Lab Tests Online UK: thyroglobulin test Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Thyroid cancer: Teenagers and young adults,"Thyroid cancer | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in teenagers and young adults Thyroid cancer: Teenagers and young adults Thyroid cancer: Teenagers and young adults Introduction The thyroid and types of thyroid cancer Having tests for thyroid cancer Treating thyroid cancer Introduction This section is for teens and young adults. Its about a type of cancer called thyroid cancer. If youre looking for information about thyroid cancer in people of all ages, read our thyroid cancer section. Papillary and follicular thyroid cancers are the most common types of thyroid cancer in young adults. If youd like to find out about a different type of thyroid cancer you could talk to MacmillanCancer Support . Its important to remember that thyroid cancer in young people can be successfully treated. Most young people are completely cured. Symptoms The first sign of thyroid cancer is usually a painless lump or swelling in the front of the neck that gradually gets bigger. Less common symptoms are: a hoarse voice that doesnt get better difficulty swallowing or breathing If you have any of these symptoms, its important to speak to a doctor. Remember  these symptoms can happen for lots of reasons other than cancer. What are the causes of thyroid cancer? Its unknown exactly what causes thyroid cancer. But research into possible causes is going on all the time. Some things called risk factors increase your chance of developing cancer. But having these doesnt mean youll get cancer. Genes Genes are the biological information in each cell that we inherit from our parents. Genes affect the way we look (for example, our eye colour) and how our bodies grow and work. Some rare genetic conditions that run in families can increase the risk of thyroid cancer. But fewer than 1 in 10 cases of cancer are caused by an inherited faulty gene. Radiotherapy If you were exposed to radiation or had radiotherapy treatment to the neck area when you were younger, you may be at a higher risk of developing thyroid cancer many years later. If youre worried about thyroid cancer If you think you might have some of these symptoms you should go straight to your GP. Theyll be able to talk to you about your symptoms. If they think the symptoms could be because of cancer, they can do tests to find out more. The thyroid and types of thyroid cancer The thyroid is a small gland in the front of the neck just below the voice box (larynx). It is made up of 2 parts, or lobes, 1 on each side of the neck. Its part of a network of glands throughout the body that make up the endocrine system. This system is responsible for producing the bodys hormones that help to control and influence various body functions. The thyroid produces 2 hormones: thyroid hormone that controls your metabolism calcitonin that helps to control the calcium levels in your body Types of thyroid cancer There are 4 main types of thyroid cancer: papillary is the most common type of thyroid cancer its usually slow-growing follicular is the second most common type  its also usually slow-growing medullary is a rare type of thyroid cancer which sometimes runs in families anaplastic is another rare type of thyroid cancer, which is more common in older people Young people are mostly affected by the papillary and follicular types. Rarely other types of cancer occur in the thyroid gland such as lymphoma, or other cancers that have spread from another part of the body. This section is for teens and young adults. Its about a type of cancer called thyroid cancer. If youre looking for information about thyroid cancer in people of all ages, read our thyroid cancer section. Having tests for thyroid cancer This information is for teenagers and young adults who may be having tests to find out if they have thyroid cancer. If you think you might have some of the symptoms of thyroid cancer , you should talk to your GP. If they think the symptoms could be because of cancer, they can do tests to find out more. Visiting your GP When you go to your GP they will usually examine you and arrange some blood tests. There may be a number of reasons why you have these symptoms. If your GP is concerned that you may have thyroid cancer they will make an appointment for you with a specialist at the hospital. At the hospital Youll probably be seen by lots of people at the hospital during and after the tests they do to find out what is happening to you. They work as a team and all have an important part in your care, even though you may only meet some of them. They may include: a doctor who specialises in thyroid problems (endocrinologist) a surgeon who specialises in thyroid surgery a pathologist who looks at blood and tissue samples to diagnose diseases a cancer specialist (oncologist) an X-ray specialist (radiologist) a clinical nurse specialist Your doctor will examine you and arrange for more detailed tests, which may include an ultrasound, a fine needle aspiration (FNA) or a biopsy. An FNA involves having a very small needle placed into your thyroid gland to remove a few cells for the pathologist to look at under the microscope. A biopsy involves removing a small piece of the thyroid to be analysed. You might have a general anaesthetic and so will be asleep when it is done. You may only need a local anaesthetic, which numbs the area. There is more information about having an anaesthetic in the surgery section. If the biopsy shows that it is thyroid cancer you will have some other tests to check the size of the tumour and whether it has spread. Macmillan Cancer Support has information on these tests. These tests may include: a chest X-ray to check your lungs a CT , MRI or PET scan a radioisotope scan You wont necessarily need all of these tests. It will depend on the results of the first ones. Having tests and waiting for the results can be an anxious time. Talking about how you feel and getting support from your family, friends, specialist nurse or doctor can help. If youre looking for information about thyroid cancer in people of all ages, read our general thyroid cancer information. Treating thyroid cancer Its important to remember that thyroid cancer in young people can be successfully treated. Most young people are completely cured. If thetestsyouve had show you have thyroid cancer, your team of specialists will discuss treatment with you. Surgery Surgery to remove the thyroid gland is the main treatment for thyroid cancer. You might hear the doctors talk about a thyroidectomy, which is the medical name for the operation. Sometimes the surgeon will only need to remove part of your thyroid. Lymph nodes In the neck, close to the thyroid,there are lymph nodes. These are part of the bodys immune system and help fight infection. Sometimes cancer cells settle in these lymph nodes, so the surgeon might remove some or all of the nodes as well. They may also remove some tissue from the area around the thyroid if they suspect that there are any cancer cells there. After the operation You will probably need to spend a few days in hospital after the operation. There will be a scar on your neck  usually just above the collarbone. Sometimes you can have a low calcium level in your blood or a hoarse voice after the operation. You may need to take tablets to replace the thyroid hormone. The tissue removed will be carefully looked at under the microscope. Sometimes another operation is needed after this. The results will help your doctors decide if you need radioactive iodine treatment and other treatments. Your team will talk through the results of the operation with you. You may feel really shocked and scared by the thought of having this operation. But it does give a really good chance of a cure. Your specialist will talk things over with you in detail and make sure that you fully understand whats involved. If you want to know more about what happens when you go in for an operation, theres lots more information in the generalsurgery section. Radioactive iodine If youve been told that you need to have treatment with radioactive iodine, you may be worried about whats going to happen. Knowing what to expect can help. Your doctors and nurses will also explain things to you and give you support. How does it work? Theresa mineral called iodine in the bloodstream. Normal thyroid tissue takes iodine from the bloodstream and uses it to make thyroid hormones. Some thyroid cancers can take iodine from the bloodstream too. Radioactive iodine is often used after surgery when the whole thyroid gland has been removed. Any thyroid cancer cells left behind soak up the iodine which contains high doses of radiation. This helps to destroy them. Radioactive iodine doesnt usually affect other parts of the body because other cells dont take up iodine the way thyroid cells do. How is it given? You may have radioactive iodine as a capsule, as a drink or as an injection into a vein in your arm through a cannula. Preparing for treatment There are 2 ways to prepare your body for the radioiodine treatment, either youll: be given an injection of a drug called thyrotropin alfa (Thyrogen  ) need to stop taking your thyroid hormone tablets 2 to 4 weeks before the treatment Some people wont be started on thyroid hormones until after surgery and radioactive iodine treatment. Youll probably feel very tired during this time. But, if you are not having the injections, its important that you stop taking thyroid hormones or the radioactive iodine treatment wont work. For 2 weeks before treatment, youll be asked to eat a low-iodine diet and avoid certain foods. This encourages the body to use up its stores of iodine. Then when the radioactive iodine is given, the cancer cells will soak it up because the amount of iodine in the body is so low. Youll be given information about what foods you should eat and what to avoid. You cant have this treatment if you are pregnant. If there is any chance of this tell your team and they can test you. What happens during treatment? This treatment makes you slightly radioactive for several weeks. Your body will gradually get rid of the radioactivity through your wee, sweat and saliva. You will be kept in hospital when the radioactivity is highest, which is usually between 1to 5 days. You will be looked after in a side room on the ward, either on your own or with someone else having the same treatment. During this treatment, the amount of contact you can have with your friends, family and the nurses will be limited, to protect them from exposure to the radiation. Anyone pregnant or younger than 18 usually isnt allowed to visit. This can make you feel lonely. You will be able to keep in touch with your friends and family by phone and internet. There should be plenty of books, magazines, DVDs, computer games and a TV in the room. You can take in a few of your own things in to help pass the time. Ask your team whether you can take a computer or an MP3 player into the room with you. Anything that comes back out of your room will be checked for radiation levels. Sometimes your things may have to be kept on the ward for a while if the radiation levels are high. But theyll be returned to you when theyre safe again. What happens after treatment? Once your radiation levels are safe, youll be allowed home. Youll also be able to start eating your usual foods again. Check with the staff about what you can and cant do when you get home. There are likely to be some precautions to take for up to a few weeks. You might need a scan shortly after your treatment. This shows if you need more radioiodine treatment. If you need more treatment it is usually given every 3to 6 months. Your fertility wont be affected by the treatment. But its safer not to become pregnant or get someone else pregnant during treatment, and for a year after. You should avoid all sex and open-mouthed kissing for a few days after treatment. Travelling on public transport can be restricted just after treatment, so you may not be able to go on holiday just after treatment. For a few months after treatment you might set off the alarms at the security gates. If you are planning a holiday, discuss it with your team. External beam radiotherapy You may also have external beam radiotherapy. For this treatment you come to hospital and lie on a bed in the radiotherapy department for about 10 to 20 minutes every day. You will have treatment every weekday for several weeks. It is like having an X-ray, so it doesnt hurt and you cannot feel it. Hormone therapy after treatment for thyroid cancer If youve had all your thyroid gland removed, your body cant produce thyroid hormones anymore. Without these hormones, your metabolism slows down. This can cause dry skin and hair, tiredness, poor concentration and lack of energy. What can help? These hormones can be replaced by taking tablets. Youll need to take them for the rest of your life. The usual long-term hormone treatment is thyroxine (levothyroxine) and you normally start taking it once your radioactive iodine treatment is finished. As well as replacing the hormones youre missing, thyroxine can also help stop papillary or follicular thyroid cancer coming back. So if you have only had part of your thyroid gland removed you may still need to take thyroid hormone tablets. Blood tests Youll need to have your blood checked regularly to monitor the hormone levels. It can sometimes take months to find the right dose of thyroxine for you. But once the right dose is found, there shouldnt be any side effects, because they are simply replacing normal thyroid hormones. Its important to remember to take your tablets every day. It can help to take them at the same time every day so you get into a routine. Macmillan Cancer Supporthas more general information about radiotherapy , surgery and radioactive iodine treatment . This information is written for people of all ages, not just young adults with thyroid cancer. This information is for teenagers and young adults and is about having treatment for thyroid cancer. If youre looking for information about thyroid cancer in people of all ages,read our thyroid cancer information. Source: Macmillan - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites Butterfly Thyroid Cancer Trust British Thyroid Foundation Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Tinnitus,"Tinnitus | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Ears, nose and throat Tinnitus Tinnitus Tinnitus is the name for hearing sounds that come from inside your body rather than an outside source. Its not usually a sign of anything serious and may get better by itself. Symptoms of tinnitus Tinnitus is often called ringing in the ears but its not just ringing. You might hear: buzzing humming grinding hissing whistling music or singing noises that beat in time with your pulse You may also notice hearing loss or that youre more sensitive to everyday sounds. For some people, tinnitus may come and go. But sometimes it can impact your daily life and be very distressing. It can affect concentration and cause difficulty sleeping (insomnia) and depression . Tinnitus will sometimes get better over time, either by disappearing or by the body getting used to it. When to get medical advice Speak to your GP practice if: you continually or regularly hear sounds such as buzzing, ringing or humming in your ears your tinnitus is getting worse your tinnitus is bothering you  for example, its affecting your sleep or concentration, or is making you feel anxious and depressed you have tinnitus that beats in time with your pulse Diagnosing tinnitus Your doctor can examine your ears to see if the problem might be caused by a condition they could easily treat, such as an ear infection or earwax build-up . They can also check if you have any hearing loss . If needed, your GP can refer you to a specialist for further tests and treatment. What causes tinnitus? Tinnitus can develop slowly over time or happen suddenly. Its not known exactly why it happens but its often linked to: hearing loss inner ear damage caused by repeated exposure to loud noises or some medicines an earwax build-up a middle ear infection Mnires disease  a condition that also causes hearing loss and vertigo (a spinning sensation) otosclerosis  an inherited condition where an abnormal bone growth in the middle ear causes hearing loss Who is affected? Most people have tinnitus for a short time after being exposed to loud noises, such as after a music concert. Around 1 in 10 people have persistent tinnitus. Around 1 in 100 having severe tinnitus that affects their daily life. Tinnitus can affect people of all ages, including children. Its more common in people aged over 65. How is tinnitus treated Theres currently no treatment for tinnitus that works for everyone. If your tinnitus is caused by an underlying condition, then treating that condition may help your tinnitus. If a cause cant be found, treatment will focus on helping you manage the condition on a daily basis. This may involve: sound therapy  listening to neutral sounds to distract you from the sound of tinnitus counselling  to teach you about tinnitus and help you learn to cope with it better cognitive behavioural therapy (CBT)  to help change the way you think about your tinnitus so it becomes less noticeable tinnitus retraining therapy (TRT)  to help you start to tune tinnitus out and become less aware of it Things you can do to help your symptoms Do try to relax  deep breathing or yoga may help try to find ways to improve your sleep, such as sticking to a bedtime routine or cutting down on caffeine try to avoid things that can make tinnitus worse, such as stress or loud background noises join a support group  talking to other people with tinnitus may help you cope Dont do not have total silence  listening to soft music or sounds (sound therapy) may distract you from the tinnitus do not focus on it, as this can make it worse  hobbies and activities may take your mind off it Source: ENT Scotland - Opens in new browser window Last updated: 05 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Hearing loss Other health sites British Tinnitus Association NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Tonsillitis,"Tonsillitis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Ears, nose and throat Tonsillitis Tonsillitis Return to Symptoms Enter age Last Updated: Next Review Date: Review my answers Find your local services Search for a service near you by entering your postcode below. Please input your postcode in the following format: A12 1BC GP Practices Dental Services Pharmacies Opticians Postcode Search NHS inform has more information on this condition. Read more Previous Start guide Review my answers  You told us your credentials were: : You said: Based on the information you gave us, we made the following recommendation: Close Keep a copy View PDF Tonsillitis is an infection that causes inflammation (redness and swelling) of the tonsils. Tonsillitis is a common condition in children, teenagers and young adults. What are the tonsils? The tonsils are 2 small glands that sit on either side of the throat. In young children, they help to fight germs and act as a barrier against infection. When the tonsils become infected, they stop it spreading further into the body. As a childs immune system gets stronger, the tonsils become less important and usually get smaller. In most people, the body is able to fight infection without the tonsils. Sore throat self-help guide Complete our self-help guide to check your symptoms and find out what to do next. Symptoms of tonsillitis The symptoms of tonsillitis include: a sore throat pain when swallowing earache high temperature (fever) over 38C (100.4F) coughing headache feeling sick feeling tired swollen, painful lymph glands in your neck white pus-filled spots on the tonsils bad breath loss of voice or changes to your voice Symptoms usually get better within 3 to 4 days. When to get medical advice Speak to your GP practice if: symptoms last longer than 4 days and dont show any signs of getting better symptoms are severe  for example, if youre unable to eat or drink due to the pain, or you have difficulty breathing you keep getting throat infections If your GP practice is closed, phone 111. Diagnosing tonsillitis If needed, your GP will examine your throat and ask you some questions about your symptoms. They may take a swab of your throat to check if its caused by a viral or bacterial infection. Itll usually take a few days to get your results. If you develop severe tonsillitis as a teenager or adult, your GP may recommend a blood test for glandular fever. Treating tonsillitis Theres no specific treatment for tonsillitis. It usually gets better on its own within a week. Things you can do to help your symptoms Do take paracetamol or ibuprofen to help relieve pain drink plenty of fluids get plenty of rest Always read the leaflet that comes with your medicine before taking it. Follow the recommended dosage instructions. If youre not sure which treatments are suitable for you or your child, speak to a pharmacist for advice. Treatments from your doctor If test results show that your tonsillitis is caused by a bacterial infection, a short course of oral antibiotics may be prescribed. If oral antibiotics do not help and your symptoms are getting worse, your GP may refer you to hospital for antibiotics to be given into a vein (IV antibiotics). Surgery to remove the tonsils (tonsillectomy) A small number of children and adults have tonsillitis for longer, or it keeps returning. This is called chronic tonsillitis and surgery may be needed. Surgery to remove the tonsils (a tonsillectomy) is usually only recommended if: youve had several severe episodes of tonsillitis over a long period of time repeated episodes are disrupting normal activities What causes tonsillitis? Most cases of tonsillitis are caused by a viral infection, such as cold or flu . Some cases can also be caused by a bacterial infection, typically a strain of bacteria called group A streptococcus bacteria. Tonsillitis itself isnt contagious, but the infections that cause it are. How to prevent infections spreading Do wash your hands often, especially after touching your nose or mouth and before handling food always sneeze and cough into tissues throw used tissues away and wash your hands Complications of tonsillitis Complications of tonsillitis are rare and usually only occur if its caused by a bacterial infection. Theyre usually the result of the infection spreading to another part of the body. Possible complications of tonsillitis include: quinsy (peritonsillar abscess)  an abscess (collection of pus) that develops between one of the tonsils and the wall of the throat obstructive sleep apnoea (OSA)  where the walls of the throat relax during sleep, which causes breathing difficulties and poor sleep Other complications of tonsillitis are very rare. They usually only occur if an underlying bacterial infection is left untreated. Source: ENT Scotland - Opens in new browser window Last updated: 05 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Earache Glandular fever Middle ear infection (otitis media) Other health sites GOSH: what happens when your childs tonsils are removed NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Tooth decay,"Tooth decay | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Mouth Tooth decay Tooth decay If you have a dental problem you should, in the first instance always phone the dental practice that you normally attend . If you are not registered with any dental practice thenyou should read our advice on dental emergencies . Tooth decay can occur when acid is produced from plaque, which builds up on your teeth. If plaque is allowed to build up, it can lead to further problems, such as dental caries(holes in the teeth), gum disease or dental abscesses , which are collections of pus at the end of the teeth or in the gums. Symptoms of tooth decay Tooth decay may not cause any pain. However, if you have dental caries you might have: toothache  either continuous pain keeping you awake or occasional sharp pain without an obvious cause tooth sensitivity you may feel tenderness or pain when eating or drinking something hot, cold or sweet grey, brown or black spotsappearing on your teeth bad breath an unpleasant taste in your mouth Seeing a dentist Visit your dentist regularly, so early tooth decay can be treated as soon as possible and the prevention of decay can begin.Tooth decay is much easier and cheaperto treat in its early stages.Dentists can usually identify tooth decay andfurther problems with a simple examinationor X-ray . Find your nearest dentist Itsalso important to have regular dental check-ups . Adults should have a check-up at least once every 2 years andchildren under the age of 18 should have a check-up at least once a year. Read more on getting over a fear of the dentist Treatments for tooth decay Treatmentof tooth decay depends on how advanced it is. For early stage tooth decay  your dentist will talk to you about the amount of sugar in your diet and the times you eat. They may apply a fluoride gel, varnish or pasteto the area. Fluoridehelps to protect teeth by strengthening the enamel, making teeth more resistant to the acids from plaque that can cause tooth decay. Your dentist may discussa filling or crown with you. This involves removing the dental decay, offering local anaesthetic to numb the tooth and filling the hole. If tooth decay has spread to the pulp (in the centre of the tooth, containing blood and nerves)  this may be removed in a process known asroot canal treatment. If the tooth is so badly damaged that it cant be restored  it may need to be removed. Your dentist maybe able toreplace the tooth with a partial denture , bridge or implant. Cost of NHS treatment NHS charges are set by the government and are standard for all NHS patients. Charges are assessed each year and usually change every April. Some people dont have to pay for dental treatment, including children, pregnant womenand new mothers.Financial help may also be available to those on a low income. The cost of private dental treatment varies between practices, as there is no set charge. If you choose to see a private dentist, make sure to agree the cost before having treatment. Preventing tooth decay Although tooth decay is acommon problem, its often entirely preventable. The best way to avoid tooth decay is to keep your teeth and gums as healthy as possible. For example, you should: visit your dentist regularly  your dentist will decide how often they need to see you based on the condition of your mouth, teeth and gums cut down on sugary and starchy food and drinks, particularly between meals or within an hour of going to bed  some medications can also contain sugar, so its best to look for sugar-free alternatives where possible look after your teeth and gums  brushing your teeth properly with a fluoride toothpaste twice a day, using floss and an interdental brush at least once a day avoid smoking or drinking alcohol excessively  tobacco can interfere with saliva production, which helps to keep your teeth clean,and alcohol can contribute to the erosion of tooth enamel see your dentist or GPif you have a persistently dry mouth  this may be caused by certain medicines, treatment or medical conditions Read: how to keep your teeth clean reading food labels Protecting your childs teeth Establishing good eating habits by limiting sugary snacks and drinkscan help your child avoid tooth decay. Regular visits to the dentist at an early age should also be encouraged. Its important to teach your child how to clean their teeth properly and regularly. Your dentistcanshowyou how to do this. Younger children should use a childrens toothpaste, but make sure to read the label about how to use it. Children should still brush their teeth twice a day, especially before bedtime. How plaque causes tooth decay Your mouth is full of bacteria that form a film over the teeth called dental plaque. When you consume food and drink high in carbohydrates  particularly sugary foods and drinks  the bacteria in plaque turn the carbohydrates into energy they need, producing acid at the same time. If the plaque is allowed to build up, the acid can begin to break down (dissolve) the surface of your tooth, causing holes known as cavities. Once cavities have formed in the enamel, the plaque and bacteria can reach the dentine (the softer, bone-like material underneath the enamel). As the dentine is softer than the enamel, the process of tooth decay speeds up. Without treatment, bacteria will enter the pulp (the soft centre of the tooth that contains nerves and blood vessels). At this stage, your nerves will be exposed to bacteria, usually making your tooth painful. The bacteria can cause a dental abscess in the pulp and the infection could spread into the bone, causing another type of abscess . Source: NHS 24 - Opens in new browser window Last updated: 05 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Toothache,"Toothache | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Mouth Toothache Toothache If you have a dental problem you should, in the first instance always phone the dental practice that you normally attend . If you are not registered with any dental practice then your nearest dental practice will still be able to help. Toothache refers to pain in and around the teeth and jaws thats usually caused by tooth decay. You may feel toothache in many ways. It can come and go or be constant. Eating or drinking can make the pain worse, particularly if the food or drink is hot or cold. The pain can also be mild or severe. It may feel sharp and start suddenly. It can be worse at night, particularly when youre lying down. A lost filling or broken tooth can sometimes start the pain. It can also sometimes be difficult to decide whether the pain is in your upper or lower teeth. When a lower molar tooth is affected, the pain can often feel like its coming from the ear. Toothache in other upper teeth may feel like its coming from the sinuses, the small, air-filled cavities behind your cheekbones and forehead. The area of your jaw close to the infected tooth may also be sore and tender to touch. Its also possible for periodontal disease to give rise to a dull pain. Periodontal disease is a bacterial infection that affects the soft and hard structures that support the teeth. When to see your dentist If you have toothache for more than one or two days, visit your dentist as soon as possible to have it treated. The longer you leave it, the worse it will get. If your toothache isnt treated, the pulp inside your tooth will eventually become infected. This can usually lead to a dental abscess , with severe and continuous throbbing pain. Painkillers, such as paracetamol and ibuprofen , may reduce the pain and discomfort while youre waiting for an appointment.Children under 16 years of age shouldnt be given aspirin. Find a dentist near you What causes toothache? Toothache occurs when the innermost layer of the tooth (dental pulp) becomes inflamed. The pulp is made up ofsensitive nerves and blood vessels. Dental pulp can become inflamed as a result of: tooth decay this leads to holes (cavities) forming in the hard surface of the tooth a cracked tooth the crackis often so small that it cant be seen with the naked eye loose or broken fillings receding gums where the gums shrink(contract) to expose softer, more sensitive parts of the tooth root periapical abscessa collection of pus at the end of the tooth caused by a bacterial infection There are a number of other conditions that can cause pain similar to toothache, even though the pulp isnt affected. These include: periodontal abscessa collection of pus in the gums caused by a bacterial infection ulcers on your gums sore or swollen gums around a tooth thats breaking through  for example, when yourwisdom teeth start to come through sinusitis which sometimes causes pain around the upper jaw an injury to the joint that attaches the jaw to the skull (temporomandibular joint) Babies can also experience discomfort when their teeth start to develop. This is known as teething. Treating toothache The type of treatment you have for toothache will depend on the cause of the pain, so your dentist will examine your mouth and may carry out an X-ray to try to identify the problem. If your toothache is caused by tooth decay, your dentist will remove the decayed area and replace it with a filling. If your toothache is caused by a loose or broken filling, the filling will be taken out, any decay will be removed, and a new filling put in place. Ifthe pulp inside your tooth is infected, you may need root canal treatment. This procedure involves removing the infected pulp and then inserting a special type of filling to seal the tooth and prevent reinfection. Your tooth may need to be removed if the toothache cant be treated using these methods orthe tooth is wedged between another tooth and your jaw (impacted). Preventing toothache The best way toavoid getting toothache and other dental problems is to keep your teeth and gums as healthy as possible. To do this, you should: limit your intake of sugary foods and drinksyou should have theseas an occasional treat and only at mealtimes; read more about cutting down on sugar brush your teeth twice a day using a toothpaste that contains fluoride  gently brush your gums and tongue as well clean between your teeth using dental floss and, if necessary, use a mouthwash stop smokingsmoking can make some dental problems worse Make sure you have regular dental check-ups ,preferably with the same dentist. The time between check-ups can vary, depending on how healthy your teeth and gums are and your risk of developing future problems. Your dentist will suggest when you should have your next check-up based on your overall oral health. Children should have a dental check-up every six months so tooth decay can be spotted and treated early. Read more about taking care of your teeth and keeping your teeth clean . Source: NHS 24 - Opens in new browser window Last updated: 05 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Dental abscess Gum disease Tooth decay NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Transient ischaemic attack (TIA),"Transient ischaemic attack (TIA) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Transient ischaemic attack (TIA) Transient ischaemic attack (TIA) A transient ischaemic attack (TIA), or mini stroke, happens when there is a temporary disruption in the blood supply to part of the brain. The disruption in blood supply results in a lack of oxygen to the brain. This can cause sudden symptoms like those of a stroke . However, a TIA does not last as long as a stroke. The effects only last for a few minutes or hours and fully resolve within 24 hours. Phone 999 immediately if: you suspect you or someone else is having a TIA or stroke Do not drive if you suspect you have had a stroke or TIA (transient ischaemic attack). Symptoms of a TIA Like a stroke, the signs and symptoms of a TIA usually begin suddenly. The main symptoms of stroke can be remembered with the word FAST. FAST stands for: Face  the face might drop on one side, the person may not be able to smile or their mouth may have dropped, and their eyelid may droop Arms  the person may not be able to lift both arms and keep them there because of arm weakness or numbness in one arm Speech  they might slur their speech or it might be garbled, or the person may not be able to talk at all despite appearing to be awake Time  its time tophone 999 immediately if you see any of these signs or symptoms Its important to be aware of the symptoms of a stroke or TIA, especially if you live with or care for somebody in a high-risk group, such as an elderly person or someone with diabetes or high blood pressure . Symptoms in the FAST test identify most strokes and TIAs. TIAs sometimes cause different symptoms that appear suddenly (usually over a few seconds). Other signs and symptoms may include: complete paralysis of one side of the body sudden loss or blurring of vision dizziness confusion difficulty understanding what others are saying problems with balance and co-ordination However, there may be other causes for these symptoms. During a TIA, its not possible to tell whether youre having a TIA or a full stroke, so its important to phone 999 immediately. Even if the symptoms disappear, you should still have an assessment at hospital. A TIA is a warning that youre at risk of having a full stroke. An assessment can help doctors decide the best way to reduce the chances of this happening. Causes of a TIA TIAs happen when there is a temporary disruption in the blood supply to part of the brain. In TIAs, the blockage resolves before any significant damage. A full stroke disrupts the blood flow to your brain for much longer. This leads to more severe damage to the brain and longer-term problems. The blockage responsible for most TIAs is usually caused by a blood clot that has travelled to the blood vessels supplying the brain. A type of irregular heartbeat called atrial fibrillation can also cause TIAs. It can create blood clots that escape from the heart and become stuck in the blood vessels that supply the brain. There are some things that can make you more likely to have a stroke or TIA: poor diet lack of exercise obesity smoking an excessive alcohol intake high cholesterol high blood pressure (hypertension) diabetes atrial fibrillation Lifestyle changes can help control some of these risk factors. You may also need to take regular medication. Taking anticoagulant medication if you have an irregular heartbeat due to atrial fibrillation will help reduce the risk of stroke. If youve had a stroke or TIA, these measures are particularly important because youre more likely to have another stroke in future. There are some risk factors you cant change like: age  people over 65 are most at risk of having strokes, although they can happen at any age  including in children family history  if a close relative (parent, grandparent, brother or sister) has had a stroke, your risk is likely to be higher ethnicity  if youre south Asian, African or Caribbean, your risk of stroke is higher, partly because rates of diabetes and high blood pressure are higher in these groups your medical history  if youve had a stroke , transient ischaemic attack (TIA) or heart attack , your risk of stroke is higher Diagnosing TIAs You should have an assessment in hospital as soon as possible if you think youve had a TIA. Initial assessment TIAs are often over very quickly, so you may not have any symptoms by the time you see a doctor. You should tell the person assessing you about the symptoms you experienced and how long they lasted. This will help to rule out other conditions that may have caused your symptoms. Even if you no longer have symptoms, you might still need a neurological examination. This involves simple tasks designed to check your strength, sensation and co-ordination skills. Referral to a specialist If a TIA is suspected, youll see a specialist for further tests as soon as possible. Youll normally take aspirin while youre waiting for specialist assessment. This can help to reduce your risk of having a stroke or another TIA in the meantime. Its likely youll see a doctor who specialises in strokes. Tests You might have some tests to rule out other causes of your symptoms and to help identify the underlying cause of your TIA. Blood tests You might need blood tests to determine whether you have high cholesterol , and to check if you have diabetes . Electrocardiogram (ECG) An electrocardiogram (ECG) measures your hearts electrical activity using electrodes (small, sticky patches) on your skin. An ECG can detect abnormal heart rhythms, which may be a sign of conditions like atrial fibrillation (where your heart beats irregularly) . Carotid ultrasound A carotid ultrasound scan can show if theres narrowing or blockages in the neck arteries leading to your brain. A small probe (transducer) sends high-frequency sound waves into your body. When these sound waves bounce back, they create an image of the inside of your body. Brain scans Brain scans are not always necessary if youve had a TIA. You might have a magnetic resonance imaging (MRI) scan . This scan uses a strong magnetic field and radio waves to create an image of your brain. You might have a computerised tomography (CT) scan if an MRI scan is not suitable for you. This type of scan uses a series of X-rays to produce an image of the inside of brain. Treating TIAs Although the symptoms of a TIA stop on their own, youll need treatment to help reduce the risk of another TIA or a full stroke . Appropriate treatment following a TIA can help to reduce your risk of having one. Your doctor will tell you about lifestyle changes you can make to reduce your stroke risk. Your doctor will prescribe medication to treat the underlying cause of your TIA. You might need surgery as part of your treatment. Lifestyle changes There are lifestyle changes you can make that may help reduce your chances of having a stroke after a TIA like: eating a healthy diet a low-fat, low-salt, high-fibre diet is usually recommended, with plenty of fresh fruit, vegetables and whole grains exercising regularly  this can help lower your cholesterol level and keep your blood pressure at a healthy level stopping smoking if you smoke cutting down on the amount of alcohol you drink Medication Most people whove had a TIA will take medication to reduce their chances of having a stroke or another TIA. After a TIA, the aim is to reduce the risk of a stroke especially in the first few days. To do this a combination of treatments is usually recommended. Some of the treatments might include: antiplatelets like aspirin and clopidogrel anticoagulants like apixaban, edoxaban, rivaroxaban, dabigatran or warfarin medication to lower your blood pressure (antihypertensives) statins to lower your cholesterol The antiplatelet medications need to be taken immediately. Others may only be started later and usually need to be taken long term. Carotid endarterectomy A carotid endarterectomy is an operation to remove part of the lining of the carotid artery and any blockage in the artery. By unblocking the carotid arteries, a carotid endarterectomy can reduce the risk of having a stroke or another TIA. Source: Scottish Government - Opens in new browser window Last updated: 16 June 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Stroke Low-risk drinking guidelines Quit Your Way Scotland Keeping active Eatwell Guide: How to eat a healthy balanced diet How to lose weight safely Other health sites The Stroke Association Chest Heart & Stroke Scotland BIRT: Brain rehabilitation Headway: stroke Different Strokes NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Trigeminal neuralgia,"Trigeminal neuralgia - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Trigeminal neuralgia Trigeminal neuralgia About trigeminal neuralgia Symptoms of trigeminal neuralgia Causes of trigeminal neuralgia Diagnosing trigeminal neuralgia Treating trigeminal neuralgia About trigeminal neuralgia Trigeminal neuralgia is a sudden, severe facial pain, described as sharp, shooting or like an electric shock. It usually occurs in sudden short attacks lasting from a few seconds to about two minutes, which stop just as abruptly. In the vast majority of cases it affects part or all of one side of the face,with the pain most commonly felt in the lower part of the face. Very occasionally it affects both sides of the face, but not normally at the same time. People with the condition may experience attacks of pain regularly for days, weeks or months at a time. In severe cases, attacks may occur hundreds of times a day. Its possible for the pain to improve or even disappear altogether for several months or years at a time (known as a period of remission), although these periods of remission tend to get shorter with time. Some people may then go on to develop a more continuous aching, throbbing and burning sensation, sometimes accompanied by the sharp attacks. Typically, the attacks of pain are brought on by activities that involve lightly touching the face, such as washing, eating and brushing the teeth, but they can also be triggered by wind (even a slight breeze or air conditioning) or movement of the face or head. Sometimes, the pain can occur without any trigger whatsoever. Living with trigeminal neuralgia can be very difficult and it can have a significant impact on a persons quality of life, resulting in problems such as weight loss, isolation and depression. Read more about the symptoms of trigeminal neuralgia When to seek medical advice You should see your GP if you experience frequent or persistent facial pain, particularly if standard painkillers such as paracetamol and ibuprofen do not help and a dentist has ruled out any dental causes. Your GP will try to identify the problem by asking about your symptoms and ruling out conditions that could be responsible for your pain. However, diagnosing trigeminal neuralgia can be difficult, and it can take a few years for a diagnosis to be confirmed. Read more about diagnosing trigeminal neuralgia What causes trigeminal neuralgia? In the vast majority of cases, trigeminal neuralgia is caused by compression of the trigeminal nerve. This is the largest nerve inside the skull, which transmits sensations of pain and touch from your face, teeth and mouth to your brain. This compression is usually caused by a nearby blood vessel pressing on part of the nerve inside the skull. In rare cases, trigeminal neuralgia can occur as a result of damage to the trigeminal nerve, caused by an underlying condition such as multiple sclerosis (MS) or a tumour. Read more about the causes of trigeminal neuralgia Who is affected Its not clear exactly how many people are affected by trigeminal neuralgia, but the condition is thought to be rare. Some studies have suggested that around 27 in every 100,000 people are diagnosed with the condition in the UK each year, although this figure is probably too high as the condition tends to be over-diagnosed by doctors. Other estimates have suggested that there are about 6,500 new cases diagnosed each year in the UK. The condition affects women more often than men and is rare in people under the age of 40, although it can occur in younger people. Most cases are first seen in people between the ages of 50 and 60. How trigeminal neuralgia is treated Trigeminal neuralgia is usually a long-term condition, and the periods of remission often get shorter over time. However, most cases can be controlled to at least some degree with treatment. The first treatment offered will usually be with an anticonvulsant medication (usually used to treat epilepsy ) called carbamazepine. To be effective, this medication needs to be taken several times a day, with the dose gradually increased over the course of a few days or weeks so that high enough levels of the medication can build up in your bloodstream. Unless your pain starts to diminish or disappears altogether, the medication is usually continued for as long as is necessary, sometimes for many years. If you are entering a period of remission and your pain goes away, stopping the medication should always be done slowly over days or weeks, unless you are advised otherwise by a doctor. Carbamazepine was not originally designed to treat pain, but it can help relieve nerve pain by slowing down electrical impulses in the nerves and reducing their ability to transmit pain messages. If this medication is ineffective, unsuitable or causes too many side effects, you may be referred to a specialist to discuss alternative medications or surgical procedures that may help. There are a number of minor surgical procedures that can be used to treat trigeminal neuralgia  usually by damaging the nerve to stop it sending pain signals  but these are generally only effective for a few years. Alternatively, your specialist may recommend having surgery to open up your skull and move away any blood vessels compressing the trigeminal nerve. Research suggests this operation offers the best results in terms of long-term pain relief, but it is a major operation and carries a risk of potentially serious complications, such as hearing loss ,facial numbness or, very rarely, a stroke . Read more about treating trigeminal neuralgia Symptoms of trigeminal neuralgia The main symptom of trigeminal neuralgia is sudden attacks of severe, sharp and shooting facial pain that last from a few seconds to about two minutes. The pain is often described as an excruciating sensation, similar to an electric shock. The attacks can be so severe that you are unable to do anything during them, and the pain can sometimes bring you to your knees. Trigeminal neuralgia usually only affects one side of your face. In rare cases it can affect both sides, although not at the same time. The pain can be in the teeth, the lower jaw, upper jaw, cheek and, less commonly, in the forehead or the eye. You may feel aware of an impending attack of pain, though these usually come unexpectedly. After the main, severe pain has subsided, you may experience a slight ache or burning feeling. There may also be a constant throbbing, aching or burning sensation between attacks. You may have episodes of pain lasting regularly for days, weeks or months at a time. It is possible for the pain to then disappear completely and not recur for several months or years (a period known as remission). However, in severe cases, attacks may occur hundreds of times a day, and there may be no periods of remission. Symptom triggers Attacks of trigeminal neuralgia can be triggered by certain actions or movements, such as: talking smiling chewing brushing your teeth washing your face a light touch shaving or putting on make-up swallowing kissing a cool breeze or air conditioning head movements vibrations, such as walking or a car journey However, pain can occur spontaneously with no triggers whatsoever. Further problems Living with trigeminal neuralgia can be extremely difficult, and your quality of life can be significantly affected. You may feel like avoiding activities such as washing, shaving or eating to avoid triggering pain, and the fear of pain may mean you avoid social activities. However, its important to try to live a normal life, and be aware that becoming undernourished or dehydrated can make the pain far worse. The emotional strain of living with repeated episodes of pain can lead to psychological problems, such as depression . During periods of extreme pain, some people may even consider suicide . Even when pain-free, you may live in fear of the pain returning. When to see your GP You should see your GP if you experience frequent or persistent facial pain, particularly if standard painkillers such as paracetamol and ibuprofen do not help and a dentist has ruled out any dental causes. Your GP will try to identify the problem by asking about your symptoms and ruling out conditions that could be responsible for your pain. Trigeminal neuralgia can be a difficult condition to diagnose, so its important to try to describe your symptoms as accurately and in as much detail as possible. Read more about diagnosing trigeminal neuralgia Causes of trigeminal neuralgia Although the exact cause is not known, trigeminal neuralgia is often thought to be caused by compression of the trigeminal nerve or an underlying condition affecting this nerve. The trigeminal nerve The trigeminal nerve (also called the fifth cranial nerve) is the largest nerve inside the skull. You have two trigeminal nerves, one in each side of your face. Small branches from different parts of the face join into three major nerve branches. These are: the upper branch (ophthalmic)  which carries sensory information from the skin above the eye, forehead and front of the head the middle branch (maxillary)  which carries sensory information from the skin through the cheek, side of the nose, upper jaw, teeth and gums the lower branch (mandibular)  which carries sensory information from the skin through the lower jaw, teeth and gums These branches enter the skull through three different routes and then join together in what is called the Gasserian ganglion, before connecting to the brainstem in the part of the skull called the posterior fossa. Trigeminal neuralgia can involve one or more branches of the trigeminal nerve. The maxillary and mandibular branches are affected most often, and the ophthalmic branch is the least commonly affected. Pressure on the trigeminal nerve Evidence suggests that in up to 95% of cases, the cause of trigeminal neuralgia is pressure on the trigeminal nerve close to where it enters the brain stem (the lowest part of the brain that merges with the spinal cord), past the Gasserian ganglion. In most cases, this pressure seems to be caused by an artery or vein compressing the trigeminal nerve, although its not known why this happens. Its also not clear exactly why this pressure can cause painful attacks, as not everyone with a compressed trigeminal nerve will experience pain. It may be that, in some people, the pressure on the nerve wears away its protective outer layer called the myelin sheath, which may cause uncontrollable pain signals to travel along the nerve. However, this does not fully explain why periods of remission (periods without symptoms) can occur and why pain relief is immediate after a successful operation to move the blood vessels away from the nerve. Other underlying causes Other reasons why the trigeminal nerve can become compressed or damaged include: a tumour (a growth or lump) a cyst (fluid-filled sac) arteriovenous malformation (an abnormal tangle of arteries and veins) multiple sclerosis (MS)  a long-term condition that affects the central nervous system (the brain and spinal cord) Diagnosing trigeminal neuralgia As the pain caused by trigeminal neuralgia is often felt in the jaw, teeth or gums, it is common for people to visit their dentist initially, rather than their GP. If you visit your dentist, they will ask you questions about your symptoms and investigate your facial pain using a dental X-ray and other means to look for other more common causes, such as a dental infection or cracked tooth. If the dentist cannot find a cause, it is important not to undergo unnecessary treatment such as a root canal filling or an extraction, even though you may be convinced that it is a tooth problem. If your dentist cant find anything wrong, do not try to persuade them to remove a particular tooth, as this will not solve the problem. Often, the diagnosis of trigeminal neuralgia is made by a dentist, but if you have already seen your dentist and they have not been able to find an obvious cause of your pain, visit your GP. Seeing your GP There is no specific test for trigeminal neuralgia, so a diagnosis is largely based on your symptoms and your description of the pain. If you have experienced facial pain, your GP will ask you questions about your symptoms, such as how often they occur, how long the pain attacks last and which areas of your face are affected. The more details about your pain you can provide, the better. Your GP will consider other possible causes of your pain and may also examine your head and jaw to identify which parts are painful. Ruling out other conditions An important part of the process of diagnosing trigeminal neuralgia involves ruling out other conditions that can also cause facial pain. By asking about your symptoms and carrying out an examination, your GP may be able to rule out other conditions, such as: migraine joint pain in the lower jaw giant cell arteritis (temporal arteritis)  a condition in which medium and large arteries in the head and neck become inflamed and cause pain in the jaw and temples a possible injury to one of the facial nerves Your medical, personal and family history will also need to be taken into consideration when determining possible causes of your pain. For example, trigeminal neuralgia is less likely if you are under 40 years old, and multiple sclerosis (MS) may be more likely if you have a family history of the condition or if you have some other form of this condition. However, trigeminal neuralgia is very unlikely to be the first symptom of MS. MRI scans If your GP is not sure about your diagnosis, or if you have unusual symptoms, they may refer you for a magnetic resonance imaging (MRI) scan of your head. An MRI scan uses strong magnetic fields and radio waves to create detailed images of the inside of your head. It can help identify potential causes of your facial pain, such as sinusitis (inflammation of the lining of the sinuses), tumours on one of the facial nerves, or nerve damage caused by MS. An MRI can also sometimes detect whether a blood vessel in your head is compressing one of the trigeminal nerves, which is one of the main causes of trigeminal neuralgia . However, highly sophisticated MRI scans may be needed to show this accurately, although this may not necessarily be helpful, because not everyone with a compressed trigeminal nerve has trigeminal neuralgia. Treating trigeminal neuralgia There are a number of treatments available that can offer some relief from the pain caused by trigeminal neuralgia. Identifying triggers and avoiding them can also help. Most people with trigeminal neuralgia will be prescribed medication to help control their pain, although surgery may be considered for the longer term in those cases where medication is ineffective or causes too many side effects. Avoid triggers The painful attacks associated with trigeminal neuralgia can sometimes be triggered or made worse by a number of different things. Therefore, in addition to your medical treatment, it may help to try to avoid these triggers, if possible. For example, if your pain is triggered by wind or even a draught in a room, it may help to avoid sitting near open windows or the source of air conditioning, and wearing a scarf wrapped around your face in windy weather. A transparent dome-shaped umbrella can also protect your face from the weather. Hot, spicy or cold food or drink may also trigger your pain, so avoiding these can help. Using a straw to drink warm or cold drinks may also help prevent the liquid coming into contact with the painful areas of your mouth. It is important to eat nourishing meals, however, so if you are having difficulty chewing, consider eating mushy foods or liquidising your meals. Certain foods seem to trigger attacks in some people, so you may want to consider avoiding things such as caffeine, citrus fruits and bananas. Medication As normal painkillers such as paracetamol are not effective in treating trigeminal neuralgia, you will normally be prescribed an alternative medication, such as an anticonvulsant medication (usually used to treat epilepsy ) to help control your pain. These medications were not originally designed to treat pain, but they can help relieve nerve pain by slowing down electrical impulses in the nerves and reducing their ability to transmit pain. They need to be taken regularly, not just when the pain attacks occur, but can be stopped when the episodes of pain cease and you are in remission. Unless otherwise instructed by your GP or specialist, it is important to build up the dosage slowly and reduce it again gradually over a few weeks. Taking too much too soon and stopping the medication too quickly can cause serious problems. Initially, your GP will probably prescribe a type of anticonvulsant called carbamazepine, although a number of alternatives are available if this is ineffective or unsuitable. Carbamazepine The anticonvulsantcarbamazepine is currently the only medication licensed for the treatment of trigeminal neuralgia in the UK. It can be very effective initially, but may become less effective over time. You will usually need to take this medicine at a low dose once or twice a day, with the dose slowly increasing up to four times a day until it provides satisfactory pain relief. Carbamazepine often causes side effects, which may make it difficult for some people to take. These include: tiredness and sleepiness dizziness (lightheadedness) difficulty concentrating and memory problems confusion feeling unsteady on your feet feeling sick and vomiting double vision a reduced number of infection-fighting white blood cells (leukopenia) allergic skin reactions, such asurticaria (hives) You should speak to your GP if you experience any persistent or troublesome side effects while you are taking carbamazepine, especially allergic skin reactions, as these could be dangerous. Carbamazepine has also been linked to a number of less common but more serious side effects, including thoughts of self-harm or suicide . You should immediately report any suicidal feelings to your GP. If this is not possible, call the NHS 24 111 service. Other medications Carbamazepine may stop working over time. If this occurs, or if you experience significant side effects while taking it, you should be referred to a specialist to consider alternative medications or procedures. There are a number of specialists you may be referred to for further treatment, including neurologists specialising in headaches, neurosurgeons and pain medicine specialists (for example, at a pain clinic). In addition to carbamazepine, there are a number of other medications that have been used to treat trigeminal neuralgia, including: oxcarbazepine lamotrigine gabapentin pregabalin baclofen None of these medications are specifically licensed for the treatment of trigeminal neuralgia, which means they have not undergone rigorousclinical trials to determine whether they are effective and safe to treat the condition. However, this is largely only because trigeminal neuralgia is a rare condition, and clinical trials are difficult to carry out on such a painful condition because giving some people an inactive, dummy medication (placebo) to compare these medications to would be unethical and impractical. However, many specialists will prescribe an unlicensed medication if they think it is likely to be effective and the benefits of treatment outweigh any associated risks. If your specialist is considering prescribing an unlicensed medication to treat trigeminal neuralgia, they should inform you that it is unlicensed and discuss possible risks and benefits with you. With most of these medications, the side effects can be quite difficult to cope with initially. Not everyone experiences side effects, but if you do, try to persevere because they do tend to diminish with time or at least until the next dosage increase, when you may find a further period of adjustment is necessary. Talk to your GP if you are finding the side effects unbearable. Surgery and procedures If medication does not adequately control your symptoms or is causing persistently troublesome side effects, you may be referred to a specialist to discuss the different surgical and non-surgical options available to relieve your pain. There a number of procedures that have been used to treat trigeminal neuralgia, so you will need to discuss the potential benefits and risks of each treatment with your specialist before making a decision. It is wise to be as informed as possible and to make the choice that it right for you as an individual. There is no guarantee that one or any of these procedures will work for you but, once you have had a successful procedure, you wont need to take your pain medications unless the pain returns. If one procedure does not work, you can always try another or remain on your medication temporarily or permanently. Some of the procedures that can be used to treat people with trigeminal neuralgia are outlined below. Percutaneous procedures There are a number of procedures that can offer some relief from trigeminal neuralgia pain, at least temporarily, by inserting a needle or thin tube through the cheek and into the trigeminal nerve inside the skull. These are known can percutaneous (through the skin) procedures, and they are carried out using X-rays to guide the needle or tube into the correct place while you are heavily sedated with medication or under a general anaesthetic (where you are asleep). Percutaneous procedures that can be carried out to treat people with trigeminal neuralgia include: glycerol injections  where a medication called glycerol in injected around the Gasserian ganglion (where the three main branches of the trigeminal nerve join together) radiofrequency lesioning  where a needle is used to apply heat directly to the the Gasserian ganglion balloon compression  where a tiny balloon is passed along a thin tube inserted through the cheek and is inflated around the Gasserian ganglion to squeeze it; the balloon is then removed These procedures work by deliberately injuring or damaging the trigeminal nerve, which is thought to disrupt the pain signals travelling along it. You are usually able to go home the same day, following your treatment. Overall, all of these procedures are similarly effective in relieving trigeminal neuralgia pain, although there can be complications with each, and these vary with the procedure and the individual. The pain relief will usually only last a few years, and sometimes only a few months. Sometimes these procedures do not work at all. The major side effect of these procedures is numbness of part or all the side of the face, and this can vary in severity from being very numb or just pins and needles. The sensation, which can be permanent, is often similar to that following an injection at the dentist. Very rarely, you can get a combination of numbness and continuous pain called anesthesia dolorosa, which is virtually untreatable. The procedures also carry a risk of other short- and long-term side effects and complications, including bleeding, facial bruising, eye problems and problems moving the facial muscles. Stereotactic radiosurgery An alternative way to relieve pain by damaging the trigeminal nerve that doesnt involve inserting anything through the skin is stereotactic radiosurgery. This is a fairly new treatment that uses a concentrated beam of radiation to deliberately damage the trigeminal nerve where it enters the brainstem. Stereotactic radiosurgery does not require ageneral anaesthetic and no cuts (incisions) are made in your cheek. A metal frame is attached to your head with four pins inserted around your scalp (a local anaesthetic is used to numb the areas where these are inserted) and your head, complete with the frame attached, is held in a large machine for an hour or two (which may make you feel claustrophobic) while the radiation is given. The frame and pins are then removed, and you are able to go home after a short rest. It can take a few weeks  or sometimes many months  for this procedure to take effect, but it can offer pain relief for some people for several months or years. Studies into this treatment have shown similar results to the other procedures mentioned above. The most common complications associated with stereotactic radiosurgery include facial numbness andpins and needles (paraesthesia) in the face. This can be permanent and, in some cases, very troublesome. Microvascular decompression Microvascular decompression (MVD) is an operation that can help relieve trigeminal neuralgia pain without intentionally damaging the trigeminal nerve. Instead, the procedure involves relieving the pressure placed on the nerve by blood vessels that are touching the nerve or wrapped around it. This is a major procedure that involves opening up the skull, and is carried out under general anaesthetic by a neurosurgeon. During MVD, the surgeon will make an incision in your scalp, behind your ear, and remove a small circular piece of skull bone. They will then either remove or relocate the blood vessel(s), separating them from the trigeminal nerve using an artificial pad or a sling constructed from adjoining tissue. For many people, this type of surgery is effective in easing or completely stopping the pain of trigeminal neuralgia. It provides the longest lasting relief, with some studies suggesting that pain only recurs in about 30% of cases within 10-20 years of surgery. Currently, this is the closest possible cure for trigeminal neuralgia. However, its an invasive procedure and carries a risk of potentially serious complications, such as facial numbness, hearing loss, stroke and even death (in around 1 in every 200 cases). More information and support Living with a long-term and painful condition such as trigeminal neuralgia can be very difficult. You may find it useful to contact local or national support groups, such as the Trigeminal Neuralgia Association UK , for more information and advice about living with the condition, and to get in touch with other people who have the condition to talk to them about their experiences. Research has shown that groups that have support from health care professionals provide high-quality help, which can significantly improve your ability to manage this rare condition. Learning from others how to cope can help remove the fear of more pain and reduce the risk of depression. However, you need to be wary of potentially unreliable information you may find elsewhere, especially if offering cures for the condition. There is a great deal of misinformation on the internet, so do your research only on reliable websites, not on open forums or on social media. There are a number of research projects running both in the UK and abroad to determine the cause of this condition and to find new treatments, including new medications, so there is always hope on the horizon. Source: NHS 24 - Opens in new browser window Last updated: 16 June 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites Trigeminal Neuralgia Assocation UK Brain and Spine Foundation: Trigeminal neuralgia NICE: Trigeminal neuralgia Community content from Health Unlocked - This will open in a new window. NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Tuberculosis (TB),"Tuberculosis (TB) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Tuberculosis (TB) Tuberculosis (TB) Audio | British Sign Language (BSL) About tuberculosis Symptoms of tuberculosis Causes of tuberculosis Diagnosing tuberculosis Treating tuberculosis About tuberculosis Tuberculosis (TB) is a bacterial infection spread through inhaling tiny droplets from the coughs or sneezes of an infected person. It is a seriouscondition, but can be cured with proper treatment. TB mainly affects the lungs. However, it can affect any part of the body, including the glands, bones and nervous system. Symptoms of TB Typical symptoms of TB include: a persistent cough that lasts more than three weeks and usually brings up phlegm, which may be bloody weight loss night sweats high temperature (fever) tiredness and fatigue loss of appetite new swellings that havent gone away after a few weeks You should see a GP if you have a cough that lastsmore than three weeks or if you cough up blood. Read more about the symptoms of TB and diagnosing TB What causes TB? TB is caused by a bacterium called Mycobacterium tuberculosis. TB that affects the lungs is the most contagious type, but itusually only spreads afterprolonged exposure to someone with the illness. For example,it often spreads within a family who live in the same house. In most healthy people, the immune system (the bodys natural defence against infection and illness) kills the bacteria, and you have no symptoms. Sometimesthe immune system cannot kill the bacteria, but manages to prevent it spreading in the body. This means you will not have any symptoms, but the bacteria will remain in your body. This is known as latent TB. Ifthe immune system fails to kill or contain the infection, it can spread within the lungs or other parts of the body and symptoms will develop within a few weeks or months. This is known as active TB. Latent TB could develop into an active TB infection at a later date, particularly if your immune system becomes weakened. Read more about the causes of TB Who is affected? Before antibiotics were introduced, TB was a major health problem in the UK. Nowadays, the condition is much less common. However, in the last 20 years, TB cases have gradually increased, particularly among ethnic minority communities who are originally from countries where TB is more common. Its estimated that around one-third of the worlds population is infected with latent TB. Of these, up to 10% will become active at some point. How TB is treated With treatment, TB can usually be cured. Most people will need a course of antibiotics, usually for 6 months. Several different antibiotics are used. This is because some forms of TB are resistant to certain antibiotics. If you are infected with a drug-resistant form of TB, treatment with 6 or more different medications may be needed. If you are in close contact with someone who has TB, tests may be carried out to see if you are also infected. These can include a chest X-ray , blood tests , and a skin test called the Mantoux test. Read more about treating TB Tuberculosis vaccination The BCGvaccine canprovide effective protection against TB in up to8 out of 10peoplewho are given it. Currently, BCG vaccinations are only recommended for groups of people who are at a higher risk of developing TB. This includes children living in areas with high rates of TB, or those who have close family members from countries with high TB rates, andpeople under the age of 16who are going to live and work with local people in an area with high rates of TBfor more than three months. Its also recommended that some people, such as healthcare workers, are vaccinatedbecause ofthe increased risk of contracting TB while working. Symptoms of tuberculosis The symptoms of tuberculosis (TB) depend on where the infection occurs. TB usually develops slowly. Your symptoms might not begin until months or even years after you were initially infected. In some cases the infection doesnt cause any symptoms, which is known as latent TB. Its called active TB if you have symptoms.You should contact your GP if you or your child have symptoms of TB. Read about the causes of tuberculosis for more information about latent and active TB. Main symptoms General symptoms of TB include: lack of appetite and weight loss a high temperature (fever) night sweats extreme tiredness or fatigue These symptoms can have many different causes, however, and are not always a sign of TB. Additional symptoms TB can also cause additional symptoms depending on which part of the body is infected. Pulmonary TB Most infections affect the lungs, which can cause: a persistent cough that lasts more than 3 weeks and usually brings up phlegm, which may be bloody breathlessness that gradually gets worse This is known as pulmonary TB. Extrapulmonary TB Less commonly, TB infections develop in areas outside the lungs, such as the lymph nodes (small glands that form part of the immune system), the bones and joints, the digestive system, the bladder and reproductive system, and thenervous system (brain and nerves). This is known as extrapulmonary TB. Symptoms of extrapulmonary TB vary, but can include: persistently swollen glands abdominal (tummy) pain pain and loss of movement in an affected bone or joint confusion a persistent headache seizures (fits) Extrapulmonary TB is more common in people with a weakened immune system, such as those with HIV . Causes of tuberculosis Tuberculosis (TB) is caused by a type of bacterium called Mycobacterium tuberculosis. The condition is spread when a person with an active TB infection in their lungs coughs or sneezes and someone else inhales the expelled droplets, whichcontain TB bacteria. Although it is spread in a similar way to a cold or the flu , TB is not as contagious. You would usually have to spend prolonged periods in close contact with an infected person to catch the infection yourself. For example, TB infections usually spread between family members who live in the same house. It would be highly unlikely to become infected by sitting next to an infected person on a bus or train. Not everyone with TB is infectious. Generally, children with TB or people with TB that occurs outside the lungs (extrapulmonary TB) do not spread the infection. Latent or active TB In most healthy people the immune system is able to destroy the bacteria that cause TB. However, in some cases the bacteria infect the body but dont cause any symptoms (latent TB), or the infection begins to cause symptoms within weeks or months (active TB). Up to 10% of people with latent TB eventually develop active TB years after the initial infection. This usually happens when the immune system is weakenedfor example, during chemotherapy . Whos most at risk? Anyone can catch TB, but people particularly at risk include those: who live in, come from, or have spent time in a country or area with high levels of TB  around 3 in every 4 TB cases in the UK affect people born outside the UK in prolonged close contact with someone who is infected living in crowded conditions with a condition that weakens their immune system, such as HIV having treatments that weaken the immune system, such as corticosteroids , chemotherapy or tumour necrosis factor (TNF) inhibitors (used to treat some types of arthritis and certain gut conditions) who are very young or very old  the immune systems of people who are young or elderly tend to be weaker than those of healthy adults in poor health or with a poor diet because of lifestyle and other problems, such as drug misuse, alcohol misuse , or homelessness Diagnosing tuberculosis Several tests are used to diagnose tuberculosis (TB), depending on the type of TB suspected. Your GP may refer you to a TB specialist for testing and treatment if they think you have TB. Pulmonary TB A diagnosis of pulmonary TB (TB that affects the lungs) can be difficult and several tests are usually needed. This will include a chest X-ray to look for changes in the appearance of your lungs that are suggestive of TB. Samples of phlegm will also often be taken and checked for the presence of TB bacteria. These tests are important in helping todecide onthe most effective treatment for you. Extrapulmonary TB If you have suspected extrapulmonary TB (TB that occurs outside the lungs), several tests can be used to confirm a diagnosis. These may include: a computerised tomography (CT) scan , magnetic resonance imaging (MRI) scan , or ultrasound scan of the affected part of the body examining the inside of your body with along, thin, flexible tube that contains a light and camera, which is inserted either through an opening such as your mouth (endoscopy) or a small cut made in your skin (laparoscopy) urine and blood tests a biopsy  a small sample of tissue or fluid is taken from the affected area and tested for TB bacteria You may also have a lumbar puncture. This involves taking a small sample of cerebrospinal fluid (CSF) from the base of your spine. CSF isfluid that surrounds the brain. It can be checked to see whether TB has infected your central nervous system (brain and spinal cord). Screening for latent TB In some circumstances, you may need to be tested to check for latent TB (when you have been infected with TB bacteria, but do not have any symptoms). For example, you may need to be screened if you have been in close contact with someone known to have an active TB infection (an infection that causes symptoms), or if you have recently spent time in a country where TB levels are high. If you have just moved to the UK from a country where TB is common, you may be screened when you arrive or your GP may suggest screening when you register as a patient. Mantoux test The Mantoux test is a widely used test for latent TB. It involves injecting a substance called PPD tuberculin into the skin of your forearm. Its also called the tuberculin skin test (TST). If you have a latent TB infection, your skin will be sensitive to PPD tuberculin and a hard red bump will develop at the site of the injection, usually within 48 to 72 hours of having the test. If you have a very strong skin reaction, you may need a chest X-ray to confirm whether you have an active TB infection. If you do not have a latent infection, your skin will not react to the Mantoux test. However, as TB can take a long time to develop, you may need to be screened again at a later stage. If you have had the BCG vaccination, you may have a mild skin reaction to the Mantoux test. This does not necessarily mean you have latent TB. Interferon gamma release assay (IGRA) The IGRA is a newer type of blood test for TB that is becoming more widely available. The IGRA may be used to help diagnose latent TB: if you have a positive Mantoux test if you previously had the BCG vaccination (as the Mantoux test may not be reliable in these cases) as part of your TB screening if you have just moved to the UK from a country where TB is common as part of a health check when you register with a GP if you are about to have treatment that will suppress your immune system if you are a healthcare worker Treating tuberculosis Treatment for tuberculosis (TB) will usually involve a long course of antibiotics lasting several months. While TB is a serious condition that can be fatal if left untreated, deaths are rare if treatment is completed. For most people, a hospital admission during treatment is not necessary. Pulmonary TB If youre diagnosed with active pulmonary TB (TB that affects your lungs and causes symptoms), you will be given a 6-month course of a combination of antibiotics. The usual course of treatment is: 2 antibiotics (isoniazid and rifampicin) for 6 months 2 additional antibiotics (pyrazinamide and ethambutol) for the first 2 months It may be several weeks or months before you start to feel better. The exact length of time will depend on your overall health and the severity of your TB. After taking the medicine for 2 weeks, most people are no longer infectious and feel better. However, it isimportant to continue taking your medicine exactly as prescribed and to complete the whole course of antibiotics. Taking medication for 6 months is the most effective method of ensuring the TB bacteria are killed. If you stop taking your antibiotics before you complete the course, oryou skip a dose, the TB infection may become resistant to the antibiotics. This is potentially serious, as it can be difficult to treat and will require a longer course of treatment. If you find it difficult to take your medication every day, your treatment team can work with you to find a solution. This may include having regular contact with your treatment team at home, the treatment clinic, or somewhere else that is more convenient. Iftreatment is completed correctly, you should not need any further checks by a TB specialist afterwards. However, you may be given advice about spotting signs that the illness has returned, although this is rare. Inrare cases TB can be fatal, even with treatment. Death can occur if the lungs become too damaged to work properly. Extrapulmonary TB Extrapulmonary TB (TB that occurs outside the lungs) can be treated using the same combination of antibiotics as those used to treat pulmonary TB. However, you may need to take them for 12 months. If you have TB in areas such as your brain or the sac surrounding your heart (pericardium), you may initially be prescribed a corticosteroid such as prednisolone for several weeks to take at the same time as your antibiotics. This will help to reduce any swelling in the affected areas. As with pulmonary TB, its important to take your medicines exactly as prescribed and to finish the whole course. Latent TB Latent TB is when you have been infected with the TB bacteria, but do not have any symptoms of active disease. Treatment for latent TB is usually recommended for anyone aged 65 or under. However, the antibiotics used to treat TB can cause liver damage in older adults, so treatment for people with latent TB aged 35 to 65 isnt recommended if this is a concern. Latent TB is also not always treated if its thought to be drug-resistant. If this is the case, you may be regularly monitored to check the infection does not become active. In some cases, testing and treatment for latent TB may be recommended for people who require treatment that will weaken their immune system, such as long-term corticosteroids, chemotherapy or TNF inhibitors. This is because there is a risk of the infection becoming active. Treatment for latent TB generally involves either taking a combination of rifampicin and isoniazid for 3 months, or isoniazid on its own for 6 months. Side effects of treatment Isoniazid can cause nerve damage ( peripheral neuropathy ), but youll be given supplements ofvitamin B6 (pyridoxine) to take alongside it to reduce this risk. Your liver function may be tested before you start treatment. In rare cases, the antibiotics used to treat TB can cause eye damage, which can be serious. If you are going to be treated with ethambutol, your vision should also be tested at the beginning of the course of treatment. Contact your TB treatment team if you develop any worrying symptoms during treatment, such as: being sick yellowing of your skin and whites of your eyes (jaundice) an unexplained high temperature (fever) tingling or numbness in your hands or feet a rash or itchy skin changes to your vision, such as blurred vision Rifampicin can reduce the effectiveness ofsome types of contraception, such as the combinedcontraceptive pill . Use an alternative method of contraception, such as condoms , while taking rifampicin. Preventing the spread of infection If you are diagnosed with pulmonary TB,you will be contagious up to about 2 to 3 weeks into your course of treatment. You will not normally need to be isolated during this time, but its important to take some basic precautions to stop TB spreading to your family and friends. You should: stay away from work, school or college until your TB treatment team advises you it is safe to return always cover your mouthpreferably with a disposable tissue when coughing, sneezing or laughing carefully dispose of any used tissues in a sealed plastic bag open windows when possible to ensure a good supply of fresh air in the areas where you spend time do not sleep in the same room as other people, as you could cough or sneeze in your sleep without realising it Source: NHS 24 - Opens in new browser window Last updated: 04 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. 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Type 1 diabetes,"Type 1 diabetes | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Diabetes Type 1 diabetes Type 1 diabetes About type 1 diabetes Symptoms of type 1 diabetes Causes of type 1 diabetes Diagnosing type 1 diabetes Treating type 1 diabetes Complications of type 1 diabetes Living with type 1 diabetes About type 1 diabetes Diabetes is a lifelong condition that causes a persons blood glucose (sugar) level to become too high. The hormone insulin  produced by the pancreas  is responsible for controlling the amount of glucose in the blood. There are two main types of diabetes: Type 1  where the pancreas doesnt produce any insulin Type 2  where the pancreas doesnt produce enough insulin or the bodys cells dont react to insulin This topic is about type 1 diabetes. Read more about type 2 diabetes Another type of diabetes, known as gestational diabetes, occurs in some pregnant women and tends to disappear following birth. Its very important for diabetes to be diagnosed as soon as possible, because it will get progressively worse if left untreated. You should therefore visit your GP if you have symptoms, which include feeling thirsty, passing urine more often than usual and losing weight unexpectedly (see the list below for more diabetes symptoms). Type 1 diabetes Type 1 diabetes can develop at any age, but usually appears before the age of 40, particularly in childhood. Around 10% of all diabetes is type 1. In type 1 diabetes, the pancreas (a small gland behind the stomach) progressively reduces the amount of insulin (the hormone that regulates blood glucose levels) it produces until it stops producing any at all. If the amount of glucose in the blood is too high, it can, over time, seriously damage the bodys organs. Diabetes symptoms The symptoms of diabetes occur because the lack of insulin means that glucose is high but isnt used by your muscles as fuel for energy. When blood glucose is high, glucose is lost in your urine and you may become dehydrated. Typical symptoms include: feeling very thirsty passing urine more often than usual, particularly at night feeling very tired all the time weight loss and loss of muscle bulk persistent infections such as thrush The symptoms of type 1 diabetes usually develop very quickly in young people (over a few hours or days). In adults, the symptoms often take longer to develop (a few days or weeks). Read more about the symptoms of type 1 diabetes Causes of type 1 diabetes Type 1 diabetes is an autoimmune condition, where the immune system (the bodys natural defence against infection and illness) mistakes the cells in your pancreas as harmful and attacks them. Without insulin, your body will break down its own fat and muscle, resulting in weight loss. This can lead to a serious short-term condition called diabetic ketoacidosis. This is when the bloodstream becomes acidic, you develop dangerous levels of ketones in your blood stream and become severely dehydrated . This results in the body being unable to produce insulin, which is required to move glucose out of the blood and into your cells to be used for energy. This is called Type 1 diabetes. Read more about the causes of type 1 diabetes Treating type 1 diabetes Its important that diabetes is diagnosed as early as possible.If left untreated, type-1 diabetes is a life-threatening condition. Its essential that treatment is started early. Diabetes cant be cured, but treatment aims to keep your blood glucose levels as normal as possible and control your symptoms, to prevent health problems developing later in life. If youre diagnosed with diabetes, youll be referred to a diabetes care team for specialist treatment and monitoring. As your body cant produce insulin, youll need regular insulin injections to keep your glucose levels normal. Youll be taught how to do this and how to match the insulin you inject to the food (carbohydrate) you eat, taking into account your blood glucose level and how much exercise you do. Insulin injections come in several different forms, with each working slightly differently. Youll most likely need a combination of different insulin preparations. Insulin is given to some patients by a continuous infusion of fast (rapid)acting insulin (pump therapy). This is where a small device constantly pumps insulin (at a rate you control) into your bloodstream through a plastic tube (cannula) thats inserted under the skin with a needle. There are alternatives to insulin injections and pumps, but theyre only suitable for a small number of patients. They are: islet cell transplantation  where healthy insulin-producing cells from the pancreas of a deceased donor are implanted into the pancreas of someone with type 1 diabetes a complete pancreas transplant  this is still relatively rare and only a few centres of excellence offer this. Read more about diagnosing diabetes and treating type 1 diabetes Complications If diabetes is left untreated, it can cause a number of different health problems. Large amounts of glucose can damage blood vessels, nerves and organs. Having a consistentlyraised glucose level that doesnt cause any symptoms can have damaging effects in the long term. There is also complications that can arise if your insulin is not balanced with your food intake and exercise. Your diabetes team will work with you to manage your insulin correctly. Read more about the complications of type 1 diabetes Living with diabetes If you have type 1 diabetes, youll need to look after your health very carefully. Caring for your health will also make treating your diabetes easier and minimise your risk of developing complications. For example, eating a healthy, balanced diet and exercising regularly will lower your blood glucose level. Stopping smoking (if you smoke) will also reduce your risk of developing cardiovascular disease . Your healthcare team will discuss this with you, and you can see your own results through My Diabetes My Way . Its important that you learn the skills to self manage your diabetes and there are people to help and support you to do this. If you have diabetes, your eyes are at risk from diabetic retinopathy, a condition that can lead to sight loss if its not treated. Everyone with diabetes aged 12 or over should be invited to have their eyes screenedonce a year. Read more about living with type 1 diabetes Symptoms of type 1 diabetes The symptoms of type 1 diabetes should disappear when you start taking insulin and you get the condition under control. The main symptoms of diabetesare: feeling very thirsty urinating more frequently than usual, particularly at night feeling very tired weight loss and loss of muscle bulk itchiness around the genital area, or regular bouts of thrush(a yeast infection) blurred vision caused by the lens of your eye changing shape Vomiting or heavy, deep breathing can also occur at a later stage. This is a dangerous sign and requires immediate admission to hospital for treatment. When to seek urgent medical attention You should seek urgent medical attention if you have diabetes and develop: a loss of appetite nausea or vomiting a high temperature stomach pain fruity smelling breath  which may smell like pear drops or nail varnish (some people can smell this themselves) Hypoglycaemia (low blood glucose) If you have diabetes, your blood glucose levels can become very low. This is known as hypoglycaemia (or a hypo). In most cases, hypoglycaemia occurs as a result of taking too much insulin, although it can also develop if you skip a meal, exercise very vigorously or drink alcoholon an empty stomach. Symptoms of a hypo include: feeling shaky and irritable sweating tingling lips feeling weak feeling confused hunger nausea (feeling sick) A hypo can be brought under control simply by eating or drinking something sugary. If it isnt brought under control, a hypo can cause confusion, slurred speech and, eventually, unconsciousness. In this case, an emergency injection of a hormone called glucagon will be needed. Glucagon increases the glucose in your blood.Your diabetes team will advise you in more detail about avoiding, recognising and treating a hypo. Hyperglycaemia (high blood glucose) As diabetes occurs as a result of your body being unable to produce any, or enough, insulin to regulate your blood glucose, your blood glucose levels may become very high. This happens because theres insufficient insulin to move glucose out of your bloodstream and into your cells to produce energy. If your blood glucose levels become too high, you may experience hyperglycaemia. The symptoms of hyperglycaemia are similar to the main symptoms of diabetes, but they may come on suddenly and be more severe. They include: extreme thirst a dry mouth blurred vision drowsiness a need to pass urine frequently Left untreated or if you already have an infection, hyperglycaemia can lead to diabetic ketoacidosis. This is a life-threateningcondition, where the body breaks down fat and muscle as an alternative source of energy. This leads to a build-up of acids in your blood, which can cause vomiting, dehydration, unconsciousness and even death. Your healthcare team will teach you about looking out for these symptoms and how to manage your Sick Day rules . The Diabetes UK website has more information about type 1diabetes symptoms . Causes of type 1 diabetes Type 1 diabetes occurs when the body is unable to produce insulin. Insulin is a hormone thats needed to control the amount of glucose (sugar) in your blood. When you eat, your digestive system breaks down food and passes its nutrients  including glucose  into your bloodstream. The pancreas (a small gland behind your stomach) usually produces insulin, which transfers any glucose out of your blood and into your cells, where its converted to energy. However, if you have type 1 diabetes, your pancreas is unable to produce any insulin (see below). This means that glucose cant be moved out of your bloodstream and into your cells. Autoimmune condition Type 1 diabetes is an autoimmune condition. Your immune system (the bodys natural defence against infection and illness) mistakes the cells in your pancreas as harmful and attacks them, destroying them completely or damaging them enough to stop them producing insulin. Its not known exactly what triggers the immune system to do this, but some researchers have suggested that it may be due to a viral infection. Type 1 diabetes is often inherited (runs in families), so the autoimmune reaction may also be genetic. If you have a close relative  such as a parent, brother or sister  with type 1 diabetes, you have about a 6% chance of also developing the condition. The risk for people who dont have a close relative with type 1 diabetes is just under 0.5%. Readabout diagnosing type 1 diabetes Diagnosing type 1 diabetes If you experience the symptoms of diabetes , you should visit your GP as soon as possible. Theyll ask about your symptoms and may request a urine and blood test. Urine and blood tests Your urine sample will be tested to see whether it contains glucose. Urine doesnt usually contain glucose, but if you have diabetes, some glucose can overflow through the kidneys and into the urine. Your urine may also be tested for ketones (chemicals) that indicate type 1 diabetes. The GP may do a finger prick blood test for glucose and ketones. A sample will be sent to the laboratory to confirm the diagnosis. These results will be discussed with the specialist diabetes service if there is concern you have Type 1 Diabetes. Glycated haemoglobin (HbA1c) The glycated haemoglobin (HbA1c) test is another blood test that can be used to diagnose diabetes.nd to monitor our long-term diabetes control. In people whove already been diagnosed with diabetes, the HbA1c test is often used to show how well their diabetes is being controlled. The HbA1c test gives your average blood glucose level over the previous two to three months. The results can indicate whether the measures youre taking to control your diabetes are working. If youve been diagnosed with diabetes, its recommended that you have your HbA1c measured at least twice a year. However, you may need to have your HbA1c measured more frequently if: youve recently been diagnosed with diabetes your blood glucose remains too high your treatment plan has been changed youre planning a pregnancy Unlike other tests, the HbA1c test can be carried out at any time of day and doesnt require any special preparation, such as fasting. However, its less reliable in certain situations, such as during pregnancy. The advantages associated with the HbA1c test make it the preferred method of assessing how well blood glucose levels are being controlled in a person with diabetes. Read about treating type 1 diabetes Treating type 1 diabetes Monitoring blood glucose An important part of your treatment is to make sure that your blood glucose level is as normal and stable as possible. Youll be able to manage this using insulin treatment and by eating a healthy, balanced diet , but you will also have to regularly check your blood glucose levels to make sure theyre not too high or too low. Exercise, illness, stress, drinking alcohol, taking other medicines and, for women, changes to your hormone levels during your monthly period can all affect your blood glucose levels. In most cases, youll need to check your blood glucose levels during the day, both at home and at work or school, using a simple finger prick blood test. You may need to do this up to four or more times a day, depending on the type of insulin treatment youre taking. There are different methods of checking your blood glucose that doesnt involve pricking your finger. Discuss your options with your diabetes care team. The normal blood glucose level is 4-7 mmol/l before meals and less than 8.5 mmol/l two hours after meals. Mmol/l means millimoles per litre, and its a way of defining the concentration of glucose in your blood. There is another method to check glucose levels without pricking your finger. This is called a flash glucose monitor (Freestyle Libre). The Diabetes UK website has more information on testing your glucose levels . Having your blood glucose levels checked Youll be measuring your blood glucose yourself every day, to check your levels. Your GP or diabetes care team will also carry out a different blood test every two to six months, called the HbA1c test. This gives a clearer idea of how well your treatment plan is working, by measuring how stable your glucose levels have been over the past 6-12 weeks. It measures the amount of haemoglobin, which is the oxygen-carrying substance in red blood cells that has glucose attached to it. A high HbA1c level may indicate that your blood glucose level is consistently high and that your diabetes treatment plan needs to be altered. The ideal HbA1c target for people with diabetes is below 53 mmol/mol. Treating hypoglycaemia (low blood glucose) Hypoglycaemia can occur when your blood glucose level becomes very low. Its likely that youll develop hypoglycaemia from time to time. Mild hypoglycaemia (or a hypo) can make you feel shaky, weak and hungry, and can be controlled by eating or drinking something sugary, such as: 200ml pure fruit juice 5 to 7 Dextrose tablets 4 to 5 Glucotabs 60ml Glucojuice 5 jelly babies You may also be able to take pure glucose, in the form of a tablet or fluid, if you need to control the symptoms of a hypo quickly. If you develop severe hypoglycaemia, you can become drowsy and confused, and you may even lose consciousness. If this occurs, youll need assistance from another person who may be able to give you a glucose gel rubbed into your cheeks or an injection of glucagon into your muscle. Glucagon is a hormone that quickly increases your blood glucose levels. Your diabetes care team may show several of your family members and close friends how to inject glucagon or give you glucose gel, should you need it. Once you begin to come round, youll need to eat something sugary when youre alert enough to do so. If you lose consciousness as a result of hypoglycaemia, theres a risk that it could happen again within a few hours. Youll need to rest afterwards and have someone with you to ensure that you eat some food to replace the glucose stores in your body. If the glucagon injection into your muscle doesnt work, and youre still drowsy or unconscious 10 minutes after the injection, youll need urgent medical attention. Youll need to have an injection of dextrose straight into a vein, which must be given by a trained healthcare professional. If you have type 1 diabetes, its recommended that you carry identification with you so that people are aware of the problem if you become hypoglycaemic. If significant hypoglycaemia is a regular problem or you have lost your awareness of hypoglycaemia your health care team may consider using a continuous glucose monitor (CGM) . Islet cell transplantation Some people with type 1 diabetes may benefit from a fairly new procedure known as islet cell transplantation. It involves implanting healthy islet cells from the pancreas of a deceased donor into the pancreas of someone with type 1 diabetes. In 2008, a government-funded islet cell transplant programme was introduced, and the procedure is now available through the NHS for people who satisfy certain criteria (see below). You may be suitable for an islet cell transplant if youve had: two or more severe hypos within the last two years and you have a poor awareness of hypoglycaemia a working kidney transplant, severe hypos and poor hypoglycaemia awareness, or poor blood glucose control even after receiving the best medical treatment You may not be suitable for an islet cell transplant if you: weigh over 85kg (13st 5.4lb) have poor kidney function need a lot of insulin  for example, over 50 units a day for a 70kg (11st) person An islet cell transplant is a minor, low-risk procedure thats carried out under local anaesthetic. The procedure has been shown to be effective at reducing the risk of severe hypos. So far, the results of islet cell transplants carried out in the UK have shown a significant reduction in the number of hypos, from 23 per person per year before transplantation to less than one per person per year afterwards. Pancreas transplant People with type 1 diabetes who are having a kidney transplant from a donor may also be offered a pancreas transplant at the same time. Others may be offered a pancreas transplant after theyve had a kidney transplant because theyre already on anti-rejection tablets. If youre having repeated, severe and life-threatening hypoglycaemic attacks, a pancreas transplant may also be recommended. During the procedure, your faulty pancreas will be replaced with a healthy pancreas from a donor. This will allow you to get a new source of insulin. Pancreas transplants are complicated operations and, like other types of major surgery, theres a risk of complications. In the UK, about 200 pancreas transplants are carried out each year, with more than 300 people on the waiting list. The waiting time for a pancreas transplant is one to two years, because theres a shortage of suitable donor organs. Treating high blood glucose (hyperglycaemia) Hyperglycaemia can occur when your blood glucose levels become too high. It can happen for several reasons, such as eating too much, being unwell or not taking enough insulin. If you develop hyperglycaemia, you may need to adjust your diet or your insulin dose to keep your glucose levels normal. Your diabetes care team can advise you about the best way to do this. If hyperglycaemia isnt treated, it can lead to a condition called diabetic ketoacidosis, where the body begins to break down fats for energy instead of glucose, resulting in a build-up of ketones (acids) in your blood. Diabetic ketoacidosis is very serious and, if not addressed quickly, it can lead to unconsciousness and, eventually, death. The signs of diabetic ketoacidosis include: frequently passing urine thirst tiredness and lethargy (lack of energy) blurry vision abdominal (stomach) pain nausea and vomiting deep breathing smell of ketones on breath (described as smelling like pear drops) collapse and unconsciousness Read more about the symptoms of diabetic ketoacidosis Your healthcare team will educate you on how to decrease your risk of ketoacidosis by testing your own blood for ketones using blood ketone sticks if youre unwell. If you develop diabetic ketoacidosis, youll need urgent hospital treatment. Youll be given insulin directly into a vein (intravenously). You may also need other fluids given by a drip if youre dehydrated, including salt solution and potassium. Other treatments Type 1 diabetes can lead to long-term complications. If you have the condition, you have an increased risk of developing heart disease , stroke , eyeand kidney disease . To reduce the chance of this, you may be advised to take: anti-hypertensive medicines to control high blood pressure a statin  such as simvastatin  to reduce high cholesterol levels low-dose aspirin to prevent stroke angiotensin-converting enzyme (ACE) inhibitor  such as enalapril, lisinopril or ramipril if you have the early signs of diabetic kidney disease Diabetic kidney disease is identified by the presence of small amounts of a protein called albumin in your urine. Its often reversible if treated early enough. Care standards for diabetes The aim of treating diabetes is to help people with the condition control their blood glucose levels and minimise the risk of developing future complications. In Scotland there is a National Diabetes Improvement Plan produced by the Scottish Diabetes Group, patients and health care professionals. The Diabetes National Service Framework has also been developed by diabetes clinical experts and patients with diabetes. Good diabetes care includes: access to information and appropriate support for people with type 1 diabetes, including access to a structured education programme an agreed care plan, helping all people with diabetes to manage their care and lead a healthy lifestyle  including a named contact for their care information, care and support to enable all people with diabetes to control their blood glucose, maintain an acceptable blood pressure and minimise other risk factors for developing complications access to services to identify and treat possible complications  such as screening for diabetic retinopathy (where high blood glucose levels damage the retina at the back of the eye) and specialised foot care effective care for all people with diabetes admitted to hospital, for whatever reason Complications of type 1 diabetes If diabetes isnt treated, it can lead to a number of different health problems. High glucose levels can damage blood vessels, nerves and organs. A consistently raised glucose level that doesnt cause any symptoms can have damaging effects in the long term. Heart disease and stroke If you have diabetes, youre up to five times more likely to develop heart disease or have a stroke . Prolonged, poorly controlled blood glucose levels increase the likelihood of developing atherosclerosis (furring and narrowing of your blood vessels). This may result in a poor blood supply to your heart or to your lower limbs, causing angina (a dull, heavy or tight pain in the chest) or claudication (pain in the back of your calves when walking). It also increases the chance that a blood vessel in your heart or brain will become completely blocked, leading to a heart attack or stroke. Nerve damage High blood glucose levels can damage the tiny blood vessels of your nerves. This can cause a tingling or burning pain that spreads from your fingers and toes up through your limbs. If the nerves in your digestive system are affected, you may experience nausea, vomiting, diarrhoea or constipation . Retinopathy Retinopathyis where the retina (the light-sensitive layer of tissue) at the back of the eye is damaged. Blood vessels in the retina can become blocked or leaky, or can grow haphazardly. This prevents the light from fully passing through to your retina. If it isnt treated, it can damage your vision. The better you control your blood glucose levels, the lower your risk of developing serious eye problems. Having an annual eye check with a specialist (an ophthalmologist or optometrist) can help pick up signs of a potentially serious eye problem early so that it can be treated. Treatment for diabetic retinopathy is only necessary if screening detects significant problems that mean your vision is at risk. If the condition hasnt reached this stage, the advice on managing your diabetes, BP and cholesterol level is recommended. The main treatments for more advanced diabetic retinopathy are: laser treatment injections of medication into your eyes an operation to remove blood or scar tissue from your eyes Read about diabetic eye screening Kidney disease If the small blood vessels in your kidney become blocked and leaky, your kidneys will work less efficiently. In rare, severe cases, this can lead to kidney failureand the need for dialysis (treatment to replicate the functions of the kidneys). In some cases, a kidney transplant may be necessary. Foot problems Damage to the nerves of the foot can mean that small nicks and cuts arent noticed, which can lead to a foot ulcer developing. About 1 in 10 people with diabetes get a foot ulcer, which can cause serious infection. If you develop nerve damage, you should check your feet every day and report any changes to your doctor, nurse or podiatrist. Look out for sores and cuts that dont heal, puffiness or swelling, and skin that feels hot to the touch. You should also have a foot examination at least once a year. Sexual dysfunction In men with diabetes, particularly those who smoke, nerve and blood vessel damage can lead to erection problems. This can usually be treated with medication. Women with diabetes may experience: a reduced sex drive (loss of libido) reduced pleasure from sex vaginal dryness a reduced ability to orgasm pain during sex If you experience a lack of vaginal lubrication, or you find sex painful, you can use a vaginal lubricant or a water-based gel. Miscarriage and stillbirth Pregnant women with diabetes have an increased risk of miscarriage and stillbirth. If your blood glucose level isnt carefully controlled immediately before and during early pregnancy, theres also an increased risk of the baby developing a serious birth defect. Pregnant women with diabetes will usually have their antenatal check-ups in hospital or a diabetes clinic. This allows doctors to keep a close eye on their blood glucose levels and control their insulin dosage more easily. Read more about diabetes and pregnancy: Diabetes UK My Diabetes My Way Living with type 1 diabetes Look after your feet Having diabetes means that youre more likely to develop problems with your feet, including foot ulcers and infections from minor cuts and grazes. This is because blood glucose can damage the nerves in your feet. To prevent problems with your feet, keep your nails short and wash your feet daily using warm water. Wear shoes that fit properly and see a podiatrist or chiropodist (a foot care specialist) regularly so that any problems are detected early. Regularly check your feet for cuts, blistersor grazes because you may not be able to feel them if the nerves in your feet are damaged. See your GP if you have a minor foot injury that doesnt start to heal within a few days. The Diabetes UK website has more information and advice about taking care of your feet . Regular eye tests If you have type 1 diabetes, you should be invited to have your your eyes screened at once a year to check for diabetic retinopathy. Retinopathy is an eye condition where the small blood vessels in your eye become damaged. It can occur if your blood glucose level is too high for a long time (hyperglycaemia). If it isnt treated, retinopathy can eventually cause sight loss. Read more about diabetic eye screening Diabetes sick day rules If you need to take insulin to control your diabetes, you should have received instructions about looking after yourself when youre ill  known as your sick day rules. Contact your diabetes care team or GP for advice if you havent received these. The advice youre given will be specific to you, but some general measures that your sick day rules may include could be to: keep taking your insulin  its very important not to stop treatment when youre ill; your treatment plan may state whether you need to temporarily increase your dose test your blood glucose level more often than usual  most people are advised to check the level at least four times a day keep yourself well hydrated  make sure you drink plenty of sugar-free drinks keep eating  eat solid food if you feel well enough to, or liquid carbohydrates such as milk, soup and yoghurt if this is easier check your ketone levels if your blood glucose level is high Seek advice from your diabetes care team or GP if your blood glucose or ketone level remains high after taking insulin, if: youre not sure whether to make any changes to your treatment you develop symptoms of diabetic ketoacidosis you have any other concerns Pregnancy If you have diabetes and youre thinking about having a baby, its a good idea to discuss this with your diabetes care team. A planned pregnancy enables you to make sure your blood glucose levels are as well controlled as possible before you get pregnant.Most women with diabetes have a healthy baby. Youll need to keep your blood glucose under tight control, particularly before becoming pregnant and during the first eight weeks of pregnancy, to reduce the risk of the baby developing serious birth defects. You should also take a higher dose of folic acidtablets. Folic acid helps prevent your baby developing spinal cord problems. Doctors now recommend that all women planning to have a baby take folic acid. Women with diabetes are advised to take 5mg a day until theyre 12 weeks pregnant (only available on prescription). Folic acid should be taken alongside pregnancy multivitamins that include vitamin D . Insulin and metformin are safe to take during pregnancy. Its important to review any other medications you take to ensure these are safe to take during pregnancy. You should also have your eyes checked. Retinopathy (see above) affects the blood vessels in the eyes and is a risk for all people with diabetes. Pregnancy can place extra pressure on the small vessels in your eyes, so its important to treat retinopathy before you become pregnant. Your GP or diabetes care team can give you further advice. Diabetes UK and JDRF also provide more useful information about pregnancy and diabetes to help you get your pregnancy off to a healthy start. Education Youll be best equipped to manage your diabetes if youre given information and education when youre diagnosed, and then on an ongoing basis. The National Institute for Health and Care Excellence (NICE) strongly recommends that all people who have diabetes should be offered a structured patient education programme, providing information and education to help them care for themselves. This gives people the best chance of developing the skills they need to effectively treat their condition, maintain their glucose levels at a normal level and help prevent long-term complications. It also reduces the risk of developing hypoglycaemia (low blood glucose levels). Structured patient education Structured patient education means theres a planned course that: covers all aspects of diabetes is flexible in content is relevant to a persons clinical and psychological needs is adaptable to a persons educational and cultural background There are also several local adult education programmes, many of which are working towards the criteria for structured education. Ask your diabetes care team about the adult education programmes they provide. Diabetes and your child For a parent whose child is diagnosed with a life-long condition, the job of parenting becomes even tougher. Although being diagnosed with type 1 diabetes will involve coming to terms with the diagnosis, getting used to treatment and makingchanges toeveryday life, your child can still lead a normal and healthy life. The Diabetes UK website has information and advice about your child and diabetes . Help and support Many people find it helpful to talk to others in a similar position, and you may find support from a group for people with diabetes. Patient organisations have local groups where you can meet others whove been",,,,,,,,,,,,,
Type 1 diabetes,"diagnosed with the condition. The Diabetes UK website enables you to find your local diabetes support group . If you want to contact a trained counsellor directly	 you can phone Diabetes UKs care line on 0345 123 2399	 or email helpline.scotland@diabetes.org.uk Further information on Helpline Scotland Financial support and benefits Some people with diabetes may be eligible to receive disability benefits and incapacity benefits	 depending on the impact the condition has on their life. The main groups likely to qualify for welfare benefits are children	 elderly people	 people with learning disabilities or mental health problems	 and those with complications of diabetes . People over 65 who are severely disabled	 may qualify for a type of disability benefit called Attendance Allowance. Carers may also be entitled to some benefit too	 depending on their involvement in caring for the person with diabetes. Staff at your local Citizens Advice Scotland can check whether youre getting all of the benefits youre entitled to. Both they and your diabetes specialist nurse should also be able to give you advice about filling in the forms. Driving with diabetes Its a common myth that people with diabetes arent allowed to drive anymore. Although there are some restrictions on drivers with diabetes its not as severe as you may think. You should always tell your insurer that you are diabetic as this may affect your insurance claim. Only individuals who use insulin have to tell the DVLA that they have diabetes. A high majority of individuals who use insulin can carry on driving on a restricted licence. This usually has to be renewed every 3 years. Additional restictions may apply for different licences (e.g Group 2 HGV) so always refer to the DVLA guidelines . Unfortunately some individuals do lose their driving license most commonly due to experiencing severe hypos or being unable to recognise symptoms of a hypo (hypo unawareness). To prevent hypos whilst driving you should check your blood glucose levels before driving keep medication close by in the car take regular breaks on long journeys over 2 hours avoid missing meals ",,,,,,,,,,,,,
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Type 2 diabetes,"Type 2 diabetes - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Diabetes Type 2 diabetes Type 2 diabetes About type 2 diabetes Symptoms of type 2 diabetes Causes of type 2 diabetes Treating type 2 diabetes Complications of type 2 diabetes Living with type 2 diabetes About type 2 diabetes Diabetes is usually a lifelong condition that causes a persons blood glucose (sugar) level to become too high. The hormone insulin  produced by the pancreas  is responsible for controlling the amount of glucose in the blood There are two main types of diabetes: type 1  where the pancreas doesnt produce any insulin type 2  where the pancreas doesnt produce enough insulin or the bodys cells dont react to insulin This topic is about type 2 diabetes. Read more about type 1 diabetes Another type of diabetes, known as gestational diabetes, occurs in some pregnant women and tends to disappear after birth. Symptoms of diabetes The symptoms of diabetes occur because the lack of insulin means glucose stays in the blood and isnt used as fuel for energy. Your body tries to reduce blood glucose levels by getting rid of the excess glucose in your urine. Typical symptoms include: feeling very thirsty passing urine more often than usual, particularly at night feeling very tired weight loss and loss of muscle bulk slow to heal cuts or ulcers frequent vaginal or penile thrush blurred vision Read more about the symptoms of type 2 diabetes Its very important for diabetes to be diagnosed as soon as possible as it will get progressively worse if left untreated. Causes of type 2 diabetes Type 2 diabetes occurs when the body doesnt produce enough insulin to function properly, or the bodys cells dont react to insulin. This means glucose stays in the blood and isnt used as fuel for energy. Type 2 diabetes is often associated with obesity and tends to be diagnosed in older people. Due to increased obesity, type 2 diabetes is now being seen in young people and all ages. Its far more common than type 1 diabetes. Read about the causes and risk factors for type 2 diabetes Treating type 2 diabetes Type 2 diabetes is treated with changes in your diet and depending on the response of your blood glucose levels, sometimes tablets and insulin. Early in the course of type 2 diabetes, planned weight loss can even reverse the disease. Read more about the treatment of type 2 diabetes Complications of type 2 diabetes Diabetes can cause serious long-term health problems. Its the most common cause of vision loss and blindness in people of working age. Everyone with diabetes aged 12 or over should be invited to have their eyes screened once a year for diabetic retinopathy. Diabetes is also responsible for most cases of kidney failureand lower limb amputation, other than accidents. Read more about the complications of type 2 diabetes Preventing type 2 diabetes If youre at risk of type 2 diabetes, you may be able to prevent it developing by making lifestyle changes. These include: losing weight if youre overweight, and maintaining a healthy weight eating a healthy, balanced diet stopping smoking if you smoke drinking alcohol in moderation taking plenty of regular exercise Living with type 2 diabetes If you already have type 2 diabetes, it may be possible to control your symptoms by making the above changes. This also minimises your risk of developing complications. Read more about living with type 2 diabetes Symptoms of type 2 diabetes The symptoms of diabetes include feeling very thirsty, passing more urine than usual, and feeling tired all the time. The symptoms occur because some or all of the glucose stays in your blood and isnt used as fuel for energy. Your body tries to get rid of the excess glucose in your urine. The main symptoms oftype 2 diabetes are: urinating more often than usual, particularly at night feeling very thirsty feeling very tired unexplained weight loss itchiness around the genital area, or regular bouts of thrush(a yeast infection) cuts or wounds that heal slowly blurred vision  caused by the lens of the eye becoming dry The signs and symptoms of type 1 diabetes are usually obvious and develop very quickly, often over a few weeks. These signs and symptoms arent always as obvious, however, and its often diagnosed during a routine check-up. This is because they are often mild and develop gradually over a number of years. This means you may have type 2 diabetes for many years without realising it. Early diagnosis and treatment for type 2 diabetes is very important as it may reduce your risk of developing complications later on. Hyperglycaemia Type 2 diabetes occurs when the pancreas, a large gland behind the stomach, cant produce enough insulin to control your blood glucose level, or when the cells in your body dont respond properly to the insulin that is produced. This means your blood glucose levels may become very high, and is known as hyperglycaemia. Hyperglycaemia can occur for several reasons, including: eating too much being unwell ineffective diabetes medication not taking enough medication Hyperglycaemia causes the main symptoms of diabetes, which include extreme thirst and frequent urination. Causes of type 2 diabetes Type 2 diabetes occurs when the pancreas doesnt produce enough insulin to maintain a normal blood glucose level, or the body is unable to use the insulin that is produced (insulin resistance). The pancreas is a large gland behind the stomach that produces the hormone insulin. Insulin moves glucose from your blood into your cells, where its converted into energy. In type 2 diabetes, there are several reasons why the pancreas doesnt produce enough insulin. Risk factors for type 2 diabetes Four of the main risk factors for developing type 2 diabetes are: age  being over the age of 40 (over 25 for south Asian people) genetics  having a close relative with the condition, such as a parent, brother or sister weight  being overweight or obese ethnicity  being of south Asian, Chinese, African-Caribbean or black African origin, even if you were born in the UK Age Your risk of developing type 2 diabetes increases with age. This may be because people tend to gain weight and exercise less as they get older. Maintaining a healthy weight by eating a healthy, balanced diet and exercising regularly are ways of preventing and managing diabetes. White people over the age of 40 have an increased risk of developing the condition. People of south Asian, Chinese, African-Caribbean and black African descent have an increased risk of developing type 2 diabetes at a much earlier age. However, despite increasing age being a risk factor for type 2 diabetes, over recent years younger people from all ethnic groups have been developing the condition. Its also becoming more common for children  as young as seven in some cases  to develop type 2 diabetes, mainly due to rising obesity levels. Genetics Genetics is one of the main risk factors for type 2 diabetes. Your risk of developing the condition is increased if you have a close relative such as a parent, brother or sister who has the condition. The closer the relative, the greater the risk. A child who has a parent with type 2 diabetes has about a one in three chance of also developing the condition. Being overweight or obese Youre more likely to develop type 2 diabetes if youre overweight or obese with a body mass index (BMI) of 30 or more. Fat around your tummy (abdomen) particularly increases your risk. This is because it releases chemicals that can upset the bodys cardiovascular and metabolic systems. This increases your risk of developing a number of serious conditions, including coronary heart disease , stroke and some types of cancer. Measuring your waist is a quick way of assessing your diabetes risk. This is a measure of abdominal obesity , which is a particularly high-risk form of obesity. Women have a higher risk of developing type 2 diabetes if their waist measures 80cm (31.5 inches) or more. Asian men with a waist size of 89cm (35 inches) or more have a higher risk, as do white or black men with a waist size of 94cm (37 inches) or more. Exercising regularly and reducing your body weight by about 5% could reduce your risk of getting diabetes by more than 50%. Read about measuring your waist size Ethnicity People of south Asian, Chinese, African-Caribbean and black African origin are more likely to develop type 2 diabetes. Type 2 diabetes is up to six times more common in south Asian communities than in the general UK population, and its three times more common among people of African and African-Caribbean origin. People of south Asian and African-Caribbean origin also have an increased risk of developing complications of type 2 diabetes , such as heart disease, at a younger age than the rest of the population. Other risks Your risk of developing type 2 diabetes is also increased if your blood glucose level is higher than normal, but not yet high enough to be diagnosed with diabetes. This is sometimes called pre-diabetes, and doctors sometimes call it impaired fasting glycaemia (IFG) or impaired glucose tolerance (IGT). Pre-diabetes is reversible if you lose weight. Discuss your options with your GP. Pre-diabetes can progress to type 2 diabetes if you dont take preventative steps, such as making lifestyle changes. These include eating healthily , losing weight if youre overweight, and taking plenty of regular exercise . Women who have had gestational diabetes during pregnancy also have a greater risk of developing diabetes in later life. Treating type 2 diabetes Medicines for type 2 diabetes Type 2 diabetes is a progressive condition andusually gets worse over time. Making lifestyle changes, such as adjusting your diet and taking more exercise, may help you control your blood glucose levels at first, but may not be enough in the long term. You may eventually need to take medication to help control your blood glucose levels. Initially, this will usually be in the form of tablets and can sometimes be a combination of more than one type of tablet. It may also include insulin or another medication that you inject. Metformin Metformin is usually the first medicine used to treat type 2 diabetes. It works by reducing the amount of glucose your liver releases into your bloodstream. It also makes your bodys cells more responsive to insulin. If youre overweight, its also likely youll be prescribed metformin. Unlike some other medicines used to treat type 2 diabetes, metformin shouldnt cause additional weight gain. However, it can sometimes cause mild side effects, such as nausea and diarrhoea , and you may not be able to take it if you have kidney damage. SGLT2 inhibitors SGLT2 inhibitors work by increasing the amount of glucose excreted in urine. Theyre particularly useful in people with type 2 diabetes and who have cardiac disease. The three SGLT2 inhibitors that may be prescribed include: dapagliflozin canagliflozin empagliflozin Each medication is taken as a tablet once a day. The main side effect is a higher risk of genital and urinary tract infections. If youre unwell and have a dehydrating illness (e.g. fever, vomiting or diarrhoea), its important you stop these medications. Get your glucose and ketone level checked by your healthcare professional to prevent diabetic ketoacidosis developing. GLP-1 agonists GLP-1 agonists acts in a similar way to the natural hormone GLP-1 (see the section on gliptins, below). Theyre given by injection and boost your owninsulin production when there are high blood glucose levels, reducing blood glucose without the risk of hypoglycaemia episodes (hypos). Theyre also particularly useful for people with type 2 diabetes and cardiac disease. Sulphonylureas Sulphonylureas increase the amount of insulin thats produced by your pancreas. Examples include: glibenclamide gliclazide glimepiride glipizide gliquidone You may be prescribed one of these medicines if you cant take metformin. Alternatively, you may be prescribed sulphonylurea and metformin if metformin doesnt control blood glucose on its own. Sulphonylureas can increase the risk of hypoglycaemia (low blood glucose) because they increase the amount of insulin in your body. They can sometimes cause side effects, including weight gain, nausea and diarrhoea. Pioglitazone Pioglitazone is a type of thiazolidinedione medicine (TZD), which make your bodys cells more sensitive to insulin so more glucose is taken from your blood. Its usually used in combination with other oral diabetes medication. It may cause weight gain and ankle swelling (oedema). You shouldnt take pioglitazone if you have heart failure or a high risk of bone fracture. Gliptins (DPP-4 inhibitors) Gliptins work by preventing the breakdown of a naturally occurring hormone called GLP-1. GLP-1 helps the body produce insulin in response to high blood glucose levels, but is rapidly broken down. By preventing this breakdown, the gliptins (linagliptin, saxagliptin, sitagliptin and vildagliptin) prevent high blood glucose levels, but dont result in episodes of hypoglycaemia. You may be prescribed a gliptin if youre unable to take sulphonylureas or glitazones, or in combination with them. Theyre not associated with weight gainand are often used with other oral diabetes medication for those who are obese. Insulin treatment If glucose-lowering tablets arent effective in controlling your blood glucose levels, you may need to have insulin treatment. This can be taken instead of or alongside your tablets, depending on the dose and the way you take it. Insulin comes in several different preparations, and each works slightly differently.Your treatment may include a combination of these different insulin preparations. Insulin injections Insulin must be injected because it would be broken down in your stomach like food and unable to enter your bloodstream if it were taken as a tablet. If you need to inject insulin, your diabetes care team will advise you about when you need to do it. They will show you how to inject it yourself, and will also give you advice about storing your insulin and disposing of your needles properly. Insulin injections are given using either a syringe or an injection pen, also called an insulin pen (auto-injector). Most people need between two and four injections of insulin a day. Your GP practiceor diabetes nurse will also teach a relative or a close friend how to inject the insulin properly. You can read more about insulin and how to inject it on the Diabetes UK website. Treatment for low blood glucose (hypoglycaemia) If you have type 2 diabetes thats controlled using insulin or certain types of tablets (e.g. sulfonylurea), you may experience episodes of hypoglycaemia . Hypoglycaemia is where your blood glucose levels become very low. Mild hypoglycaemia (a hypo) can make you feel shaky, weak and hungry, but it can usually be controlled by eating or drinking something sugary. If you have a hypo, you should initially have a form of carbohydrate that will act quickly, such as a sugary drink or glucose tablets. This should be followed by a longer-acting carbohydrate, such as a cereal bar, sandwich or piece of fruit. In most cases, these measures will be enough to raise your blood glucose level to normal. You should aim for a hypo to be treated and to recheck your blood glucose level within 15 minutes. If blood glucose still less than 4mmol/l then repeat the treatment using a fast acting carbohydrate. When your blood glucose returns to normal then have your longer acting carbohydrate. If you develop severe hypoglycaemia, you may become drowsy and confused, and you may even lose consciousness. If this occurs, you may need to have an injection of glucagon into your muscle or glucose into a vein. Glucagon is a hormone that quickly increases your blood glucose levels. You may require input from a health care professional. If the glucagon is not successful, you may require an injection of dextrose into your vein. Your diabetes care team can advise you on how to avoid a hypo and what to do if you have one. Other treatments If you have type 2 diabetes, your risk of developing heart disease , stroke , foot problems, eyeand kidney disease is increased. To reduce your risk of developing other serious health conditions, you may be advised to take other medicines, including: anti-hypertensive medicines to control high blood pressure a statin , such as simvastatin or atorvastatin, to reduce high cholesterol low-dose aspirin to prevent a stroke an angiotensin-converting enzyme (ACE) inhibitor, such as enalapril, lisinopril or ramipril, if you have the early signs of diabetic kidney disease Diabetic kidney disease is identified by the presence of small amounts of albumin (a protein) in your urine. If treated early enough, it may be reversible. Monitoring blood glucose levels If you have type 2 diabetes, your GP or diabetes care team will need to take a reading of your blood glucose level about every two to six months. This will show how stable your glucose levels have been in the recent past and how well your treatment plan is working. The HbA1c test is used to measure blood glucose levels over the previous two to three months. HbA1c is a form of haemoglobin, the chemical that carries oxygen in red blood cells, which also has glucose attached to it. A high HbA1c level means that your blood glucose level has been consistently high over recent weeks, and your diabetes treatment plan may need to be changed. Your diabetes care team can help you set a target HbA1c level to aim for. This will usually be less than 53 mmol/mol (7%) or individualised as agreed with your diabetes team. Read more about the HbA1c test Monitoring your own blood glucose If you have type 2 diabetes, as well as having your blood glucose level checked by a healthcare professional every two to six months, you may be advised to monitor your own blood glucose levels at home. Even if you have a healthy diet and are taking tablets or using insulin therapy, exercise, illness and stress can affect your blood glucose levels. Other factors that may affect your blood glucose levels include drinking alcohol, taking other medicines and, for women, hormonal changes during the menstrual cycle. A blood glucose meter is a small device that measures the concentration of glucose in your blood. It can be useful for detecting high blood glucose (hyperglycaemia) or low blood glucose (hypoglycaemia). If blood glucose monitoring is recommended, you should be trained in how to use a blood glucose meter and what you should do if the reading is too high or too low. Blood glucose meters arent currently available for free on the NHS but, in some cases, blood monitoring strips may be. Ask a member of your diabetes care team if youre unsure. Regularly monitoring your blood glucose levels will ensure your blood glucose is as normal and stable as possible. As your blood glucose level is likely to vary throughout the day, you may need to check it several times a day, depending on the treatment youre taking. In home testing, blood glucose levels are usually measured by how many millimoles of glucose are in a litre of blood. A millimole is a measurement used to define the concentration of glucose in your blood. The measurement is expressed as millimoles per litre, or mmol/l for short. A normal blood glucose level is 4-7 mmol/l before meals (preprandial) and less than 8.5 mmol/l two hours after meals (postprandial), although this can vary from person to person. Your diabetes care team can discuss your blood glucose level with you in more detail. Its important to know your individual targets. Complications of type 2 diabetes If diabetes isnt treated, it can lead to a number of other health problems. High glucose levels can damage blood vessels, nerves and organs. Even a mildly raised glucose level that doesnt cause any symptoms can have long-term damaging effects. Heart disease and stroke If you have diabetes, youre up to five times more likely to develop heart disease or have a stroke . Prolonged, poorly controlled blood glucose levels increase the likelihood of atherosclerosis, where the blood vessels become clogged up and narrowed by fatty substances. This may result in a poor blood supply to your heart or to your lower limbs, causing angina (a dull, heavy or tight pain in the chest) or claudication (pain in the back of your calves when walking). It also increases the chance that a blood vessel in your heart or brain will become blocked, leading to a heart attack or stroke. Nerve damage High blood glucose levels can damage the tiny blood vessels in your nerves. This can cause a tingling or burning pain that spreads from your fingers and toes up through your limbs. It can also cause numbness, which can lead to ulceration of the feet. Damage to the peripheral nervous system, which includes all parts of the nervous system that lie outside the central nervous system, is known as peripheral neuropathy . If the nerves in your digestive system are affected, you may experience nausea, vomiting, diarrhoea or constipation . Diabetic retinopathy Diabetic retinopathyis when the retina, the light-sensitive layer of tissue at the back of the eye, becomes damaged. Blood vessels in the retina can become blocked or leaky, or can grow haphazardly. This prevents light fully passing through to your retina. If it isnt treated, it can damage your vision. Annual eye checks are usually organised by a regional photographic unit. If significant damage is detected, you may be referred to a doctor who specialises in treating eye conditions (ophthalmologist) such as cataract and glaucoma. The better you control your blood glucose levels, the lower your risk of developing serious eye problems. Treatment for diabetic retinopathy is only necessary if screening detects significant problems that mean your vision is at risk. If the condition hasnt reached this stage, the advice on managing your diabetes, BP and cholesterol level is recommended. The main treatments for more advanced diabetic retinopathy are: laser treatment injections of medication into your eyes an operation to remove blood or scar tissue from your eyes Read about diabetic eye screening. Kidney disease If the small blood vessels of your kidney become blocked and leaky, your kidneys will work less efficiently. Its usually associated with high blood pressure, and treating this is a key part of management. In rare, severe cases, kidney disease can lead to kidney failure . This can mean a kidney replacement, treatment with dialysis or sometimes kidney transplantation becomes necessary. Foot problems Damage to the nerves of the foot can mean small nicks and cuts arent noticed and this, in combination with poor circulation, can lead to a foot ulcer. About 1 in 10 people with diabetes get a foot ulcer, which can cause a serious infection. If you have diabetes, look out for sores and cuts that dont heal, puffiness or swelling, and skin that feels hot to the touch. You should also have your feet examined at least once a year. If poor circulation or nerve damage is detected, check your feet every day and report any changes to your doctor, nurse or podiatrist. Sexual dysfunction In men with diabetes, particularly those who smoke, nerve and blood vessel damage can lead to erection problems. This can usually be treated with medication. Women with diabetes may experience: reduced sex drive (loss of libido) less pleasure from sex vaginal dryness less ability to orgasm pain during sex If you experience a lack of vaginal lubrication or find sex painful, you can use a vaginal lubricant or a water-based gel. Miscarriage and stillbirth Pregnant women with diabetes have an increased risk of miscarriage and stillbirth. If your blood glucose level isnt carefully controlled during the early stages of pregnancy, theres also an increased risk of the baby developing a birth defect. Pregnant women with diabetes will usually have their antenatal check-ups in hospital or a diabetic clinic, ideally with a doctor who specialises in pregnancy care (an obstetrician). This will allow your care team to keep a close eye on your blood glucose levels and control your insulin dosage more easily, as well as monitoring the growth and development of your baby. The Diabetes UK website has more information about diabetes complications . Looking after your eyes The NHS diabetic eye screening programme will arrange for you to have your eyes checked every year. Everyone who is on a diabetes register will be given the opportunity to have a digital picture taken of the back of their eye. Speak to your GP to register. Living with type 2 diabetes Look after your feet If you have diabetes, youre at greater risk of developing problems with your feet, including foot ulcers and infections from minor cuts and grazes. This is because diabetes is associated with poor blood circulation in the feet, and blood glucose can damage the nerves. To prevent problems with your feet, keep your nails short and wash your feet daily using warm water. Wear shoes that fit properly, and see foot care specialists (a podiatrist or chiropodist) regularly so any problems can be detected early. Regularly check your feet for cuts, blisters or grazes as you may not be able to feel them if the nerves in your feet are damaged. See your GP if you have a minor foot injury that doesnt start to heal within a few days. Regular eye tests If you have type 2 diabetes, you should be invited to have your eyes screened once a year to check for diabetic retinopathy. Diabetic retinopathy is an eye condition where the small blood vessels in your eye become damaged. It can occur if your blood glucose level is too high for a long period of time (hyperglycaemia). Left untreated, retinopathy can eventually lead to sight loss. Read more about diabetic eye screening People with diabetes should also see their optician every two years for a regular eye test. Diabetic eye screening is specifically for diabetic retinopathy and cant be relied upon for other conditions. Pregnancy If you have diabetes and youre thinking about having a baby, its a good idea to discuss this with your diabetes care team. If youre taking oral medications to manage your diabetes, this may need to change before you are pregnant. Its important that you plan your pregnancy and discuss it with your diabetes team. Planning your pregnancy means you can ensure your blood glucose levels are as well controlled as they can be before you get pregnant. Youll need to tightly control your blood glucose level  particularly before becoming pregnant and during the first eight weeks of your babys development  to reduce the risk of birth defects. You should also: check your medications  some tablets used to treat type 2 diabetes may harm your baby, so you may have to switch to insulin injections, stop statin medication or some blood pressure medications take a higher dose of folic acid tablets  folic acid helps prevent your baby developing spinal cord problems, and its recommended all women planning to have a baby take folic acid; women with diabetes are advised to take 5mg each day (only available on prescription) along with pregnancy multivitamins that include vitamin D have your eyes checked  retinopathy, which affects the blood vessels in the eyes, is a risk for all people with diabetes; as pregnancy can place extra pressure on the small vessels in your eyes, its important to treat retinopathy before you become pregnant Your GP or diabetes care team can give you further advice. Diabetes education Youll be best equipped to manage your diabetes day-to-day if youre given information and education when youre diagnosed and on an ongoing basis. The National Institute for Health and Care Excellence (NICE) recommends that all people who have diabetes should be offered a structured patient education programme, providing information and education to help them care for themselves. Structured patient education Structured patient education means theres a planned course that: covers all aspects of diabetes is flexible in content is relevant to a persons clinical and psychological needs is adaptable to a persons educational and cultural background For type 2 diabetes, there are several local adult education programmes, many of which are working towards the criteria for structured education. Ask your diabetes care team about the adult education programmes they provide. Talk to others Many people find it helpful to talk to others in a similar position, and you may find support from a group for people with diabetes. Patient organisations have local groups where you can meet others diagnosed with the condition. To find your local diabetes support group , visit Diabetes UK . If you want to get in touch with a trained counsellor directly, you can call the Diabetes UK Helpline on 0345 123 2399 (Monday to Friday, 9am to 7pm) or email helpline@diabetes.org.uk Financial support and benefits Some people with diabetes may be eligible for disability and incapacity benefits, depending on the impact the condition has on their lives. The main groups likely to qualify for welfare benefits are children, the elderly, and those with learning disabilities, mental health difficulties or diabetes complications. People over the age of 65 who are severely disabled may qualify for a type of disability benefit called Attendance Allowance. Carers may also be entitled to some benefits, depending on their involvement in caring for the person with diabetes. Citizens Advice Scotland can check whether youre getting all the benefits youre entitled to. Your diabetes specialist nurse and Citizens Advice can also provide advice about filling in the forms. Driving with diabetes Its a common myth that people with diabetes arent allowed to drive anymore. Although there are some restrictions on drivers with diabetes, its not as severe as you may think. You should always tell your insurer that you have diabetes as this may affect your insurance claim. Only individuals who use insulin have to tell the DVLA that they have diabetes. A high majority of individuals who use insulin can carry on driving on a restricted licence. This usually has to be renewed every 3 years. Additional restictions may apply for different licences (e.g Group 2 HGV) so always refer to the DVLA guidelines . Unfortunately, some individuals do lose their driving license, most commonly due to experiencing severe hypos. If you start to have a hypo whilst driving you should: Pull over safely Switch off your car engine Take fast-acting carbs, like glucose tablets or sweets, and some longer-acting carbohydrates too, like plain biscuits or crackers Dont drive until 45 minutes after your blood sugar level has gone back to 5mmol/l or above For more information about driving with diabetes, visit Diabetes UK. Diabetes sick day rules If you need to take insulin to control your diabetes, you should have received instructions about looking after yourself when youre ill  known as your sick day rules. Contact your diabetes care team or GP for advice if you havent received these. The advice youre given will be specific to you, but some general measures that your sick day rules may include could be to: keep taking your insulin  its very important not to stop treatment when youre ill; your treatment plan may state whether you need to temporarily increase your dose test your blood glucose level more often than usual  most people are advised to check the level at least four times a day keep yourself well hydrated  make sure you drink plenty of sugar-free drinks keep eating  eat solid food if you feel well enough to, or liquid carbohydrates such as milk, soup and yoghurt if this is easier check your ketone levels if your blood glucose level is high Seek advice from your diabetes care team or GP if your blood glucose or ketone level remains high after taking insulin, if: youre not sure whether to make any changes to your treatment you develop symptoms of diabetic ketoacidosis you have any other concerns Telecare Self-Check online tool Visit the Telecare Self-Check online tool to find the right support for you in your area. This easy to use online tool allows you to find helpful information on telecare services that could help you live independently at home for longer. Source: NHS Grampian - Opens in new browser window Last updated: 17 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any perso",,,,,,,,,,,,,
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Trichomonas infection,"Trichomonas infection | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Sexual and reproductive Trichomonas infection Trichomonas infection British Sign Language (BSL) |  | Polski | Romn | slovenina Trichomonas is a sexually transmitted infection (STI) caused by a small parasite. It infects the genitals and may lead to an infection in the urethra (the tube that carries urine out of the body) and the prostate. Symptoms of trichomonas Most people with trichomonas infection will have no symptoms but they can still pass the infection on. If you do develop symptoms you may get: a yellow or green discharge from the vagina or penis, which can sometimes have an unpleasant smell genital itching and soreness pain or a burning sensation when peeing Some women may get some pain or discomfort during sex. Testing for trichomonas If you think you might have trichomonas, get tested for free by: booking an appointment at your local sexual health service contacting your GP practice for an appointment What does a trichomonas test involve? Testing is quick and straightforward. There are 2 main ways the sample can be collected: using a swab  a small cotton bud is gently wiped over the area that might be infected, such as inside the vagina or penis urine sample  this should ideally be done at least 1 or 2 hours after you last peed Most sexual health clinics can look at the sample straightaway under the microscope and see the parasite. In some clinics and at your GP, the swab needs to be sent away to a lab to make the diagnosis. The test is more accurate from vagina samples. Its less accurate from penis and urine samples. Treating trichomonas Trichomonas infection is treated with antibiotics. Its advised that both you and your partner(s) are treated if you have the infection. You and your partner(s) may be asked to return to your GP practice or sexual health clinic for another test to check the infection has gone. You should avoid having sex until 1 week after you and your partner(s) treatment has finished. If your infection is untreated you may pass it on to other sexual partners. How trichomonas is passed on Trichomonas infection is spread through unprotected sex and sharing sex toys. Its not passed on through oral or anal sex. You cant pass on trichomonas through: kissing or hugging sharing cups, plates or cutlery toilet seats How to prevent trichomonas The best way to reduce your risk of STIs is to practice safer sex . This means using a condom for vaginal, anal and oral sex. Other STIs If you have been diagnosed with trichomonas, you should get tested for all STIs including: chlamydia gonorrhoea syphilis Find your local sexual health clinic Source: Scottish Government - Opens in new browser window Last updated: 26 February 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Other languages and formats British Sign Language (BSL) |  | Polski | Romn | slovenina British Sign Language (BSL) |  | Polski | Romn | slovenina Add this page to\n            Info For Me Also on NHS inform Book a sexual health appointment online Trichomonas (BSL) Trichomonas (Chinese) Trichomonas (Polish) Trichomonas (Romanian) Trichomonas (Slovak) Other health sites BASHH: sexual health NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Transverse myelitis,"Transverse myelitis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Transverse myelitis Transverse myelitis Transverse myelitis is a rare neurological condition. Its caused by inflammation (swelling) of the spinal cord. The swelling damages the nerves and can leave permanent scars or lesions. The scars or lesions interrupt the communication between the nerves in the spinal cord and the rest of the body. Transverse refers to the swelling being across the width of the spinal cord. Its also sometimes used to describe swelling that only affects part of the width of the spinal cord. Symptoms of transverse myelitis The symptoms of transverse myelitis can include: muscle weakness in the legs, and sometimes the arms mobility problems unusual sensations and numbness bladder problems bowel problems sexual problems pain Transverse myelitis can happen to anyone at any time in their life. In most cases there might only be one episode of symptoms, but sometimes it can happen repeatedly. Transverse myelitis can be the first sign of MS or another condition. Causes of transverse myelitis There are several different causes of transverse myelitis. Sometimes a cause isnt found, and this is called idiopathic transverse myelitis. Autoimmune disease Sometimes transverse myelitis is caused by an autoimmune reaction. In autoimmune diseases, the immune system mistakes the bodys own tissue as dangerous and attacks it. This causes swelling that results in damage to the myelin sheath. This includes: MS-like swelling neuromyelitis optica (NMO) myelin oligodendrocyte antibody (MOG) associated myelitis sarcoidosis Sjgrens syndrome lupus Viral infection Sometimes transverse myelitis is caused indirectly by a viral infection, although often the virus responsible isnt identified. Transverse myelitis often develops after a viral infection like: echovirus enterovirus Epstien-Barr hepatitis A herpes simplex HIV rubella influenza (flu) varicella zoster (the virus that causes chicken pox and shingles) Bacterial infection Bacterial infections such as syphilis might also lead to transverse myelitis. Cancer Some cancers might trigger an unusual immune response that can lead to transverse myelitis. Diagnosing transverse myelitis If your GP thinks you could have transverse myelitis, you should see a neurologist (a specialist in conditions of the nervous system) for a specialist assessment. Some of the tests you may need to confirm transverse myelitis are: neurological examination magnetic resonance imaging (MRI) scan lumbar puncture blood test s Sometimes your neurologist will do other tests to look for conditions thatcausetransverse myelitis. This might include CT scans . Treating transverse myelitis Sometimes transverse myelitis requires no treatment as it will improve on its own. Sometimes patients may require treatment for their symptoms, the swelling, or the underlying cause. Treatment for transverse myelitis symptoms There are different treatments available for transverse myelitis symptoms. Muscle weakness Physiotherapy can help improve strength, and the muscle spasms and stiffness that may sometimes develop. Techniquessuch as stretching exercises can help if your movement is restricted. If your muscle spasms are more severe, you may be prescribed a medicine that can relax your muscles. This will usually be either baclofen, gabapentin or tizanidine. These medicines all have side effects. You might experience dizziness, weakness, nausea and diarrhoea. Discuss which of these would be best for you with yourhealthcare professional. Mobility problems Mobility problems are often the result of muscle spasms and spasticity. Muscle weakness, or problems with balance can also cause mobility problems. If you have problems with mobility, your healthcare professional might suggest: an exercise programmesupervised by a physiotherapist mobility aids, such as a walking stick, or a wheelchair home adaptations such as stair lifts or railings An occupational therapist can carry out an assessment of your home and suggest adaptations. Treatment of the inflammation (swelling) Sometimes your neurologist might offer treatment with steroids. This can help with some types of transverse myelitis. Steroids are only given for a short period of time to avoid possible steroid side effects . The side effects could include reflux and stomach irritation, worsening infection, mood swings, and difficulty sleeping. Bladder problems Medication might help if you have an overactive bladder or need to pee frequently during the night. If you find it difficult to empty your bladder, advice from a continence nurse or physiotherapist can help. Hand-held external stimulators can help some people to start peeing or to empty the bladder. Sometimes a catheter can empty the bladder when needed. You might be taught how to do intermittent self catheterisation (ISC). In rare cases, people with transverse myelitis may need a long-term catheter to keep the bladder emptying safely. You might be referred to a continence adviser or urologist, for specialist treatment and advice. Read more about treating urinary incontinence . Bowel problems It might be possible to treat mild to moderate constipation by changing your diet or taking laxatives . More severe constipation may need to be treated with suppositories, which are inserted into your bottom, or an enema. During an enema, liquid medication is rinsed through your bottom and large bowel, which softens and flushes out your stools. Anti diarrhoea medication or pelvic floor exercises might help bowel incontinence. Sexual problems If you experience problems with less interest in sex or difficulty reaching orgasm, relationship counselling or seeing a sex therapist might help. If you have transverse myelitis and find it hard to get or maintain an erection ( erectile dysfunction ) you may be prescribedmedication toincrease the blood flow to the penis. Musculoskeletal pain A physiotherapist might be able to help withthis pain by suggesting exercises or better seating positions. If your pain is more severe, you may be prescribed painkillers. Or, you might have a transcutaneous electrical nerve stimulation (TENS) machine that stimulates your nerves. Neuropathic pain Neuropathic pain is caused by damage to your nerves and is usually sharp and stabbing. It can also occur in the form of extreme skin sensitivity, or a burning sensation. This type of pain can be treated using neuropathic painkillers. Other treatments for transverse myelitis You may be offered other treatments depending on the cause of your transverse myelitis. Your neurologist will discuss your options with you. Source: Scottish Government - Opens in new browser window Last updated: 27 February 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites Neurological Alliance of Scotland Siegel Rare Neuroimmune Association Scotland Support Group NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Ulcerative colitis,"""Ulcerative colitis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Inflammatory bowel disease (IBD) Ulcerative colitis Ulcerative colitis Ulcerative colitis is a long-term condition where your large bowel (colon and rectum) gets swollen and inflamed. Your colon is your large intestine (bowel). Your rectum is the end of your bowel, where poo is stored. If you have ulcerative colitis, you get swelling, inflammation and ulcers in the lining of your large bowel. They can bleed and produce pus. Ulcerative colitis can affect people of all ages, but its usually diagnosed between the age of 15 and 40. Symptoms The main symptoms of ulcerative colitis are: recurring diarrhoea , which may contain blood, mucus or pus abdominal pain needing to poo often You may also experience: extreme tiredness (fatigue) loss of appetite weight loss Some people also get symptoms in other parts of their body. For example, some people develop: painful and swollen joints ( arthritis ) mouth ulcers areas of painful, red and swollen skin irritated and red eyes Speak to your GP practice if: you have symptoms of ulcerative colitis and you havent been diagnosed with the condition Symptoms of a flare-up Some people may go for weeks or months with very mild symptoms, or none at all. This is known as remission. This may be followed by periods where the symptoms are particularly troublesome. These are known as flare-ups or relapses. Symptoms of flare-ups vary from person-to-person. They may include: diarrhoea 6 or more times a day blood or mucus in your poo severe abdominal pain symptoms in other parts of your body Severe ulcerative colitis can also cause symptoms like: shortness of breath a fast or irregular heartbeat a high temperature (fever) blood in your poo becoming more obvious Speak to your inflammatory bowel disease (IBD) team if: you have ulcerative colitis and think youre having a flare-up Causes The exact cause of ulcerative colitis is unknown. A combination of factors may be responsible, including: problems with your immune system  where the immune system mistakenly attacks the lining of your large bowel, making it inflamed genetics  genes you inherit from your family environmental factors  like air pollution, medication and viruses or bacteria in your gut Diagnosis To help diagnose ulcerative colitis, your GP will ask about your: your pattern of symptoms your diet any recent travel  for example, you may have developed travellers diarrhoea whether youre taking any medication, including any over-the-counter medicines whether anyone else in your family has a bowel condition any health problems youve had in the past Your GP may also: examine your abdomen (tummy) ask for a stool (poo) sample and use a qFIT test to check for blood and mucus, infection or inflammation via a faecal calprotectin test arrange blood tests to check for inflammation or anaemia Additional tests for ulcerative colitis If your GP thinks that you have ulcerative colitis you may be referred to hospital for more tests. These could include: colonoscopy  a thin, flexible tube with a camera is put into your bottom to look at the whole of your large bowel sigmoidoscopy  a thin, flexible tube with a camera is put into your bottom to look at the end of your large bowel X-ray MRI scan or computerised tomography (CT) You will be told what tests you need and what you need to do to prepare for them. Treatment Treatment for ulcerative colitis aims to relieve and prevent symptoms. Your treatment will depend on how severe your symptoms are and how often they flare up. Mild flare-ups can be usually be treated at home. But severe flare-ups usually need treatment in hospital to reduce the risk of complications. Treatment will usually be provided by a range of healthcare professionals. Medication Most people will get medication to treat symptoms of ulcerative colitis. This includes medications like: aminosalicylates (ASAs)  often the first treatment option, used to get and keep inflammation under control and can be given rectally as well as orally corticosteroids  used to get inflammation under control quickly, but not suitable for long-term use If you have lots of flare-ups or aminosalicylates do not keep your inflammation under control, you may need other treatments, such as: immunosuppressants like azathioprine or mercaptopurine  used to reduce the activity of the immune system biologic medicines, like adalimumab, infliximab, golimumab, ustekinumab or vedolizumab other advanced medicines like filgotinib, ozanimod, tofacitinib and upadacitinib Surgery Surgery to treat ulcerative colitis may be an option if: you choose to have surgery instead of taking medications that may cause side effects medications dont control your symptoms your quality of life is severely affected by your condition you have serious complications of ulcerative colitis Surgery for ulcerative colitis involves removing part or all of your large bowel (known as a colectomy). This means the small intestine must be used to pass waste products out of your body instead. During the surgery, your small intestine will either be: joined to the surface of your tummy (known as an ileostomy or a colostomy)  after this type of surgery, poo comes out of the opening on your tummy and is collected in special bags that you wear joined directly to your rectum (the end of your large bowel), so your poo comes out of your bottom as usual used to create an internal pouch thats connected to your bottom (known as an ileo-anal pouch or J-pouch)  this means your poo can pass through your bottom as usual Diet Theres no evidence that a particular diet causes ulcerative colitis. But alongside medications, some changes to your diet may help control symptoms for some people. You could: eat 5 to 6 small meals rather than 3 main meals try to eat a healthy, varied diet that includes a wide variety of fruit, vegetables, nuts, seeds, proteins and wholegrains drink plenty of water You could also speak to your IBD team about: keeping a food diary to find out if any particular foods affect your symptoms removing trigger foods from your diet  but do not make major changes to your diet without talking to your IBD team and make sure you are still getting all the nutrients you need taking a food supplement if you are struggling to get enough nutrients from your diet being referred to a dietitian Managing stress Stress doesnt cause ulcerative colitis. But, managing stress may reduce how often you get symptoms. To help manage stress, you could: exercise  speak to your IBD team about a suitable exercise plan try relaxation techniques like yoga, medication and breathing exercises talk to others  Crohns & Colitis UK has details of local support groups speak to your GP if you think you may have depression Fertility and pregnancy A womans chance of becoming pregnant isnt usually affected by ulcerative colitis. However, surgery for ulcerative colitis might affect your fertility, especially pouch surgery. Most women with ulcerative colitis will have a normal pregnancy and a healthy baby. But if youre pregnant or planning a pregnancy you should discuss it with your IBD team. This is because they may need to change your medication. If youre having a flare-up of ulcerative colitis you may also be advised to avoid getting pregnant until its under control. Complications If you have ulcerative colitis, you may be at an increased risk of developing other problems. This can include: osteoporosis poor growth and development in children and young people More serious and rare complications can include: primary sclerosing cholangitis (PSC)  inflammation in the bile ducts, which can lead to liver damage narrowings in the bowel (strictures) that may become blocked or make it difficult for poo to pass through toxic megacolon  severe inflammation in the colon may lead to trapped gas so the colon becomes very enlarged and can rupture a higher risk of getting bowel cancer a higher risk of getting blood clots in your legs or lungs Source: Scottish Government - Opens in new browser window Last updated: 25 January 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Crohn's disease Inflammatory bowel disease (IBD) Other health sites Crohn's & Colitis UK: Ulcerative colitis Crohn's & Colitis UK: Symptoms Crohn's & Colitis UK: Tests and investigations Crohn's & Colitis UK: Treatments Crohn's & Colitis UK: Surgery Crohn's & Colitis UK: Stoma Chron's & Colitis UK: Getting a diagnosis Crohn's & Colitis UK: Food Crohn's & Colitis UK: Wellbeing support Crohn's & Colitis UK: Reproductive health Crohn's & Colitis UK: Joints Crohn's & Colitis UK: Bones Crohn's & Colitis UK: Pregnancy and breastfeeding NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Underactive thyroid,"Underactive thyroid - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Glands Underactive thyroid Underactive thyroid About underactive thyroids Symptoms of an underactive thyroid Causes of an underactive thyroid Diagnosing an underactive thyroid Treating an underactive thyroid Complications of an underactive thyroid About underactive thyroids An underactive thyroid gland (hypothyroidism) is where your thyroid gland doesnt produce enough hormones. Common signs of an underactive thyroid are tiredness, weight gain and feeling depressed. An underactive thyroid can often be successfullytreated by taking daily hormone tablets to replace the hormonesyour thyroid isnt making. Theres no way of preventing an underactive thyroid. Most cases are caused either by the immune system attacking the thyroid gland and damaging it,orby damage to the thyroid that occurs during some treatments for an overactive thyroidor thyroid cancer . Read more about the causesof an underactive thyroid When to see your GP Symptoms of an underactive thyroid are often similar to those of other conditions,and theyusually develop slowly, so you may not notice them for years. You should see your GP and ask to be tested for an underactive thyroid if you havesymptoms including: tiredness weight gain depression being sensitive tothe cold dry skin and hair muscle aches The only accurate way of finding out whether you have a thyroid problem is to haveathyroid function test, where a sample of blood is tested to measure yourhormone levels. Readmore about testing for an underactive thyroid Whos affected Both men and women can have an underactive thyroid, althoughits more commonin women. In the UK, it affects 15 in every 1,000 women and1 in 1,000 men. Children can also develop an underactive thyroid. Around 1 in 3,500 to 4,000 babiesare born with anunderactive thyroid (congenital hypothyroidism).All babies born in the UK are screened for congenital hypothyroidismusing a blood spot test when the baby is about 5 days old. Treating an underactive thyroid Treatment for an underactive thyroid involves taking dailyhormone replacement tablets, called levothyroxine,to raise yourthyroxine levels. Youll usually need treatment for the rest of your life. However, with proper treatment, you should be able to lead a normal, healthy life. If an underactive thyroid isnt treated, it can lead to complications, including heart disease ,goitre, pregnancy problems and a life-threatening condition called myxoedema coma (although this is very rare). Read more about treating an underactive thyroid and the complications of an underactive thyroid Symptoms of an underactive thyroid Many symptoms of an underactive thyroid (hypothyroidism) are the same as those of other conditions, so it can easily be confused for something else. Symptomsusually develop slowly and you may not realise you have a medical problem for several years. Common symptoms include: tiredness being sensitive to cold weight gain constipation depression slow movements and thoughts muscle aches and weakness muscle cramps dry and scaly skin brittle hair and nails loss of libido (sex drive) pain, numbness and a tingling sensation in the hand and fingers (carpal tunnel syndrome) irregular periodsor heavy periods Elderly people with an underactive thyroid may develop memory problems and depression. Children may experience slower growth and development. Teenagers may startpuberty earlier than normal. If you have any of these symptoms, see your GP and ask to be tested for an underactive thyroid. Read more about getting tested for an underactive thyroid If an underactive thyroid isnt treated Its unlikely that youd have many of the later symptoms of an underactive thyroid, because the condition is often identified before more serious symptoms appear. Later symptoms of an underactive thyroidinclude: a low-pitched and hoarse voice a puffy-looking face thinned or partly missing eyebrows a slow heart rate hearing loss anaemia Causes of an underactive thyroid An underactive thyroid (hypothyroidism) is when your thyroid gland doesnt produce enough of the hormone thyroxine (also called T4). Most cases of an underactive thyroid are caused by the immune system attacking the thyroid gland and damaging it, or by damage that occurs as a result oftreatments for thyroid cancer or an overactive thyroid . Immune system An underactive thyroid often occurs when the immune system, which usually fights infection, attacks the thyroid gland. This damages the thyroid, which means its not able to make enough of the hormone thyroxine,leading to the symptoms of an underactive thyroid . A condition called Hashimotos disease is the most common type of autoimmune reactionthatcauses an underactive thyroid. Its not clear what causes Hashimotos disease, but it runs in families. Its also common in people with another immune system disorder, such as type 1 diabetes and vitiligo. Previous thyroid treatment An underactive thyroid can also occur as a side effect or complication of previous treatment to the thyroid gland, such as surgery or a treatment called radioactive iodine therapy. These treatments are sometimes used for an overactive thyroid(where the thyroid glandproduces too much hormone) or thyroid cancer. Less common causes Worldwide,alack of dietaryiodine is a common cause of an underactive thyroid, because the body needs iodine to make thyroxine. However, iodine deficiency isuncommon in the UK. Babies are sometimes born with an underactive thyroid because the thyroid gland doesnt develop properly in the womb. This is called congenital hypothyroidism and isuncommon, affecting around 1 in 3,000 babies. Itsusually picked up during routine screening soon after birth. A problem with the pituitary gland could lead to an underactive thyroid.The pituitary gland sits at the base of the brain andregulates the thyroid. Therefore, damage to the pituitary gland may lead to an underactive thyroid. An underactive thyroid has also been linked tosome viral infections or somemedications used to treat other conditions, such as: lithium  a medication sometimes used to treat certain mental health conditions, including depression and bipolar disorder amiodarone  a medication sometimes used to treat irregular heartbeats (arrhythmias) interferons  a class of medication sometimes used to treat certain types of cancer and hepatitis C Speak to your GP or specialist if youre concerned that a medication youre taking may be affecting your thyroid hormone levels. Diagnosing an underactive thyroid Its very important that an underactive thyroid (hypothyroidism) is diagnosed as soon as possible. Low levels of thyroid-producing hormones, such astriiodothyronine (T3) and thyroxine (T4), can change the way the body processes fat. This can cause high cholesterol and atherosclerosis (clogging of the arteries) , which can potentially lead to serious heart-related problems, such as angina and heart attack . Therefore, you should see your GP and ask for a blood test if you repeatedly have symptoms of an underactive thyroid . Thyroid function test Ablood test measuring your hormone levels is the only accurate way to find out whethertheres a problem. The test, called a thyroid function test, looks at levels of thyroid-stimulating hormone (TSH) and thyroxine (T4) in the blood. Ahigh level of TSH and a low level ofT4 in the bloodcould mean you havean underactive thyroid. If your test results show raised TSH but normalT4, you may be at risk of developing an underactive thyroid in the future. Your GP may recommend that you have a repeat blood test every so often to see whether you eventually develop an underactive thyroid. Blood tests are also sometimes used for other measurements, such as checking the level of a hormone calledtriiodothyronine (T3). However, this isnt routine, because T3 levels can often remain normal, even if you have a significantly underactive thyroid. The Lab Tests Online UK website has more information about the different types of thyroid function tests . Referral Your GP may refer you to an endocrinologist (a specialist in hormone disorders) if you: are younger than 16 are pregnant or trying to get pregnant have just given birth have another health condition, such as heart disease , which may complicate your medication are taking a medication known to cause a reduction in thyroid hormones, such as amiodarone or lithium Treating an underactive thyroid An underactive thyroid (hypothyroidism) is usually treated by taking daily hormone replacement tablets called levothyroxine. Levothyroxinereplaces the thyroxine hormone, which your thyroid doesnt make enough of. Youll initially have regular blood tests until the correct doseof levothyroxine is reached. Thiscan take a little while to get right. You may start on a low dose of levothyroxine, which may be increased gradually, depending on how your body responds.Some people start to feel bettersoon after beginning treatment,while othersdont notice an improvement in their symptoms for several months Once youre taking the correct dose, youll usually have a blood test once a year to monitor your hormone levels. Ifblood tests suggest you may have an underactive thyroid, but you dont have any symptoms or theyre very mild, you may not need any treatment. In these cases, your GP will usually monitor your hormone levels every few months and prescribe levothyroxine if you develop symptoms. Taking levothyroxine If youre prescribed levothyroxine, you should take 1 tablet at the same time every day.Its usually recommended that you take the tablets in the morning, although some people prefer to take them at night. The effectiveness of thetablets can be altered by other medications, supplements or foods, so they should be swallowed with water on an empty stomach, and you should avoid eating for 30 minutes afterwards. If you forget to take a dose, take it as soon as you remember, if this is within a few hours of your usual time. If you dont remember until later than this, skip the dose and take the next dose at the usual time, unlessadvised otherwise by your doctor. An underactive thyroid is a lifelong condition, so youll usually need to take levothyroxine for the rest of your life. Side effects Levothyroxine doesnt usually have any side effects, because the tablets simply replace a missing hormone. Side effects usually only occur if youre taking too much levothyroxine. This can cause problems includingsweating, chest pain , headaches , diarrhoea and vomiting. Tell your doctor if you develop new symptoms while taking levothyroxine. You should also let them know if your symptoms get worse or dont improve. Combination therapy In the UK, combination therapy  using levothyroxine and triiodothyronine (T3) together  isnt routinely used because theres insufficient evidence to show its better than using levothyroxine alone (monotherapy). In most cases,suppressing thyroid-stimulating hormone (TSH) using high dose thyroid replacement therapy should be avoided because it carries a risk of causing adverse side effects, such as atrial fibrillation (an irregular and abnormally fast heart rate), strokes , osteoporosis and fracture. However, this type of treatment may sometimes be recommended in cases where a person has a history of thyroid cancer and theres a significant risk of it reoccurring. Complications of an underactive thyroid Several complications can occur if you have an underactive thyroid that isnt treated. Heart problems If you have an untreated underactive thyroid, your risk of developing cardiovascular disease is increased. This is because having low levels of the hormone thyroxine can lead to increased levels of cholesterol in your blood. High cholesterol can cause fatty deposits to build up in your arteries, restrictingthe flow of blood. Contact your doctor if youre being treated for an underactive thyroid and you develop chest pain , so that any problems can bedetected and treated, if necessary. Goitre Agoitreis an abnormal swelling of the thyroid gland that causes a lump to form in the throat. Goitres can develop in people with an underactive thyroidwhen the body tries tostimulate the thyroid to produce more thyroid hormones. Pregnancy complications If an underactive thyroid isnt treated during pregnancy, theres a risk of problems occurring. Theseinclude: pre-eclampsia  which can cause high blood pressure and fluid retentionin the mother and growth problems in the baby anaemia in the mother an underactive thyroid in the baby birth defects bleeding after birth problems with the babys physical and mental development premature birth or a low birthweight stillbirth or miscarriage These problems can usually be avoided with treatment under the guidance of a specialist in hormone disorders (an endocrinologist). Therefore, tell your GP if you have an underactive thyroid and youre pregnant or trying to get pregnant. Myxoedema coma In very rare cases, a severe underactive thyroid may lead to a life-threatening condition called myxoedema coma. This is where the thyroid hormone levels become very low, causing symptoms such as confusion, hypothermia and drowsiness. Myxoedema coma requires emergency treatment in hospital. Its usually treated with thyroid hormone replacement medication given directly into a vein. In some cases, other treatments such as breathing support, antibiotics and steroid medication ( corticosteroids ) are also required. Source: NHS 24 - Opens in new browser window Last updated: 01 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Overactive thyroid Other health sites Lab Tests Online: TSH Lab Tests Online UK: T4 test British Thyroid Foundation NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Urinary incontinence,"""Urinary incontinence | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Kidneys, bladder and prostate Urinary incontinence Urinary incontinence Urinary incontinence is when you pee by accident. It can happen when doing exercise like running, lifting weights at the gym or jumping on a trampoline. Urinary incontinence can affect anyone. It tends to be more common in women. Further information about urinary incontinence in women Although its common, it shouldnt be thought of as normal. There are things you can do to reduce the chance of this happening and improve your symptoms. How to prevent urinary incontinence There are things you can do that may help reduce the chance of urinary incontinence in the future. Do strengthen you pelvic floor muscles with simple pelvic floor exercises stay active maintain a healthy weight avoid or cut down on alcohol and caffeinated drinks, such as coffee, tea and some fizzy drinks Types of urinary incontinence The 2 most common types of urinary incontinence are: stress incontinence  pee leaking out when your bladder is under pressure (life when you laugh, cough, sneeze, exercise or lift something heavy) urge incontinence  feeling a sudden and very intense need to pee and being unable to stop it Less common types of incontinence are: mixed incontinence  having both stress and urge incontinence overflow incontinence (also called chronic urinary retention)  the bladder cannot completely empty total incontinence  severe and continuous urinary incontinence When to get medical advice Speak to your GP practice if: You have any symptoms of urinary incontinence, such as: peeing by accident feeling a sudden need to pee and are unable to stop it What causes urinary incontinence? The causes of urinary incontinence depend on the type. Certain things can increase the chances of urinary incontinence developing, including: being overweight a family history of incontinence getting older  but incontinence doesnt happen just because youve aged if youre a woman, pregnancy and vaginal birth if youre a man, having surgery to remove the prostate gland Diagnosing urinary incontinence Your GP will ask you some questions to understand what may be causing the incontinence and how bad it is. They may also: try to rule out other things that could be causing your symptoms, such as a urinary tract infection suggest you keep a diary of how much fluid you drink and how often you have to pee carry out a pelvic examination (in women) or rectal examination (in men)  as this is an intimate examination, there may be another person (chaperone) present refer you to a specialist, usually a physiotherapist Treatment for urinary incontinence Treatments which do not involve taking medication or having surgery are usually tried first. These include: treating the underlying cause, if urinary incontinence is caused by another condition lifestyle changes  such as reducing your caffeine intake, changing how much you drink, and maintaining a healthy weight pelvic floor muscle training  your healthcare professional will explain how to do these exercises bladder training  techniques to increase the length of time between feeling the need to go to the toilet and peeing Incontinence products (like pads or pants) arent a treatment for urinary incontinence. But you might find them helpful while you are waiting for assessment or for a treatment to start working. If these treatments dont work for you, your doctor may suggest trying other treatments, like medication or surgery. This will depend on the cause and type of incontinence you are experiencing. Its ok to ask any questions about your care to help you get the information you might need. Source: Scottish Government - Opens in new browser window Last updated: 11 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Urinary incontinence in women Pelvic floor muscles Menopause It's OK To Ask Urinary tract infection (UTI) Bowel incontinence Urinary catheterisation Other health sites Pelvic, Obstetric and Gynaecological Physiotherapy: Bladder & Bowel Incontinence Pelvic, Obstetric and Gynaecological Physiotherapy: Promoting continence with physiotherapy (PDF, 609 KB) Pelvic, Obstetric and Gynaecological Physiotherapy: Mens pelvic health The Chartered Society of Physiotherapy: Training for pelvic floor muscles Age UK: Urinary incontinence NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Urinary tract infection (UTI),"Urinary tract infection (UTI) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Kidneys, bladder and prostate Urinary tract infection (UTI) Urinary tract infection (UTI) Return to Symptoms Enter age Last Updated: Next Review Date: Review my answers Find your local services Search for a service near you by entering your postcode below. Please input your postcode in the following format: A12 1BC GP Practices Dental Services Pharmacies Opticians Postcode Search NHS inform has more information on this condition. Read more Previous Start guide Review my answers  You told us your credentials were: : You said: Based on the information you gave us, we made the following recommendation: Close Keep a copy View PDF Urinary tract infections (UTIs) are common infections that affect the bladder, the kidneys and the tubes connected to them. Anyone can get them, but theyre particularly common in women. Some women experience them regularly (called recurrent UTIs). UTIs can be painful and uncomfortable, but usually pass within a few days and can be treated with antibiotics . This page is about UTIs in adults. There is a separate page about UTIs in children . Urinary infection self-help guide Complete our self-help guide to check your symptoms and find out what to do next. Symptoms of UTIs Lower UTIs Infections of the bladder (cystitis) or urethra (tube that carries urine out of the body) are known as lower UTIs. These can cause: a need to pee more often than usual pain or discomfort when peeing sudden urges to pee feeling as though youre unable to empty your bladder fully pain low down in your tummy urine thats cloudy, foul-smelling or contains blood feeling generally unwell, achy and tired You can speak to your pharmacist for advice and treatment on lower UTIs. Lower UTIs are common and arent usually a cause for major concern. Find your nearest pharmacy Upper UTIs Infections of the kidneys or ureters (tubes connecting the kidneys to the bladder) are known as upper UTIs. These can cause the same symptoms as lower UTIs and also: a high temperature (fever) of 38C (100.4F) or above pain in your sides or back shivering and chills feeling and being sick confusion agitation or restlessness Upper UTIs can be serious if left untreated, as they could damage the kidneys or spread to the bloodstream. Speak to your GP urgently if: You think you, your child or someone you care for may have a urinary tract infection (UTI) and: have a very high temperature, or feel hot and shivery have a low temperature below 36C are confused or drowsy have pain in the lower tummy or in the back, just under the ribs can see blood in your pee If your GP is closed, phone 111. These symptoms could mean you have a kidney infection , which can be serious if its not treated as it could cause sepsis . Speak to your GP if: you have symptoms of an upper UTI your child has symptoms of a UTI the symptoms are severe or getting worse the symptoms havent started to improve after a few days you get UTIs frequently your symptoms come back after treatment Your GP team can: rule out other possible causes of your symptoms by testing a sample of your urine prescribe antibiotics if you have an infection Treatment for UTIs UTIs are normally treated with a short term course of antibiotics. Most women are given a 3-day course of antibiotic capsules or tablets. Men, pregnant women and people with more serious symptoms may need a slightly longer course. Your symptoms will normally pass within 3 to 5 days of starting treatment. Make sure you complete the whole course of antibiotics that youve been prescribed, even if youre feeling better. Over-the-counter pain relief such as paracetamol can help with any pain. Drinking plenty of fluids may also help you feel better. Return to your GP if your symptoms dont improve, get worse, or come back after treatment. Causes of UTIs UTIs occur when the urinary tract becomes infected, usually by bacteria. In most cases, bacteria from the gut enter the urinary tract through the urethra. This may happen when wiping your bottom or having sex. But often its not clear why it happens. The following may increase your risk of getting a UTI: conditions that obstruct your urinary tract, such as kidney stones difficulty emptying your bladder fully using a contraceptive diaphragm or condoms coated in spermicide diabetes a weak immune system  for example from chemotherapy or HIV a urinary catheter (a tube in your bladder used to drain urine) an enlarged prostate gland in men Women may be more likely to get UTIs because their urethra is shorter than a mans and is closer to their anus (back passage). Preventing UTIs There are some things you can do to try to prevent UTIs. Do go to the toilet as soon as you need to pee always empty your bladder fully stay well hydrated wipe your bottom from front to back when you go to the toilet pee as soon as possible after having sex have a shower rather than a bath wear underwear made from cotton, rather than synthetic material such as nylon avoid tight jeans and trousers Dont do not use perfumed bubble bath, soap or talcum powder around your genitals  use plain, unperfumed ones instead do not use a diaphragm or condoms with spermicidal lubricant on them  try another type of contraception Speak to your GP if these measures dont work. Drinking cranberry juice or using probiotics arent proven to reduce your chances of getting UTIs. Source: NHS 24 - Opens in new browser window Last updated: 13 February 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Find your nearest pharmacy Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Urinary tract infection (UTI) in children,"Urinary tract infection (UTI) in children | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Kidneys, bladder and prostate Urinary tract infection (UTI) in children Urinary tract infection (UTI) in children Urinary tract infections (UTIs) are common infections. They can affect the urinary tract, including the: bladder urethra (the tube where urine leaves the body) kidneys UTIs arent usually serious and can be treated with antibiotics if needed. Speak to your GP if your child has symptoms of a UTI like: vomiting tiredness and lack of energy (lethargy) irritability not eating properly not gaining weight yellowing of the skin and whites of the eyes (jaundice) in very young children pain or a burning sensation when peeing needing to pee frequently deliberately holding in their pee a change in their normal toilet habits, like wetting themselves or wetting the bed unpleasant-smelling pee cloudy pee Phone 111 or speak to a GP urgently if: You think a child has a urinary tract infection (UTI) and they: are under 3 have a very high temperature, or feel hot and shivery have a very low temperature below 36C are confused or drowsy have pain in the lower tummy or in the back, just under the ribs have blood in their pee Types of UTI A UTI may be either: upper lower An upper UTI means an infection of the kidneys or ureters. Ureters are the tubes connecting the kidneys to the bladder. A lower UTI means an infection of the bladder (cystitis) or urethra. This is the tube that carries urine out of the body. Causes of UTIs in children UTIs occur when the urinary tract becomes infected, usually by bacteria. Bacteria from the gut can enter the urinary tract through the tube that carries pee out of the body (urethra). This may happen when a child: wipes their bottom soils their nappy Some children may be more likely to get UTIs due to problems emptying their bladder. This can be due to: constipation dysfunctional elimination syndrome  a child holds on to their pee, even though they have the urge to pee vesicoureteral reflux  urine leaks back up from the bladder into the ureters and kidney Treating UTIs in children UTIs in children will often improve within 24 to 48 hours of treatment. A UTI wont usually cause any long term problems. Antibiotics UTIs can usually be treated at home with antibiotics as long as the child is: over 3 months not at risk of serious illness The most suitable antibiotic depends on what type of UTI the child has. Sometimes children can experience side effects whilst taking antibiotics. This can include feeling sick or having an upset stomach. These symptoms are usually mild and should stop once the antibiotics have finished. Its very important to finish the prescribed course of antibiotics. Thisll prevent the infection from coming back. Other treatments If necessary, children can also take liquid paracetamol to help ease the symptoms of a UTI. As a precaution, some children with a UTI may have to be treated in hospital. Your GP may advise you if this is necessary. Dont use non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen to treat a UTI. These can harm the kidneys. Aspirin should never be given to children under the age of 16. Preventing UTIs in children It isnt possible to prevent all childhood UTIs. But, there are some things you can do to reduce the risk of your child getting one. Do encourage girls to wipe their bottom from front to back make sure children are well hydrated and go to the toilet regularly avoid nylon and other synthetic underwear  pick loose, cotton underwear avoid scented soaps or bubble baths  these can increase the risk of developing a UTI Recurrent UTIs in children A small number of children have recurring UTIs. If your child has had a UTI before, its important to watch out for any symptoms. If any symptoms do come back, tell your GP as soon as possible. Source: NHS 24 - Opens in new browser window Last updated: 23 October 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Urticaria (hives),"Hives | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Skin, hair and nails Hives Hives Return to Symptoms Enter age Last Updated: Next Review Date: Review my answers Find your local services Search for a service near you by entering your postcode below. Please input your postcode in the following format: A12 1BC GP Practices Dental Services Pharmacies Opticians Postcode Search NHS inform has more information on this condition. Read more Previous Start guide Review my answers  You told us your credentials were: : You said: Based on the information you gave us, we made the following recommendation: Close Keep a copy View PDF The main symptom of hives (urticaria) is a rash. The rash may: be raised be very itchy be on one part of the body spread over large areas range is size from a few millimetres to the size of a hand change in appearance within 24 hours The image shows a hives rash on the side of the stomach. The rash is small, circular patches of pink on pale skin. https://dermnetnz.org/ More images of hives Image 1 Image 2 Image 3 Diagnosing hives Hives can usually be diagnosed by examining the distinctive red rash. The pharmacist or GP may also ask you questions to find out what triggered your symptoms. If your symptoms last a while (chronic urticaria), a doctor may arrange for tests to help work out the cause. Theyll also ask about anything that makes your symptoms worse. Treating hives Most hives rashes dont need treatment. The symptoms are usually mild and often get better within a few days. If necessary, a pharmacist can give you advice about antihistamines to help treat hives. Antihistamines may not be suitable for young children or if youve got a long term condition. You should discuss this with the pharmacist. Find your nearest pharmacy Treating severe hives If hives are more severe, your doctor may prescribe: steroid tablets ( oral corticosteroids ) antihistamines menthol cream to relieve itchiness If hives dont go away with treatment, a doctor may also refer you to a skin specialist (dermatologist). Phone 999 or go to A&E if you: have swelling in your mouth, eyes, face, lips, tongue, throat, feet or hands are wheezing feel lightheaded or faint get tightness in your chest or throat have trouble breathing or talking have abdominal pain, nausea and vomiting You could be having a serious allergic reaction (anaphylaxis) and may need immediate treatment in hospital. Speak to a GP if: the symptoms dont improve after 2 days youre worried about your childs hives the rash is spreading the symptoms are severe hives keeps coming back (you may be allergic to something) you also have a high temperature and feel unwell you also have swelling under your skin (this might be angioedema) the symptoms cause distress the symptoms disrupt daily activities Causes of hives Hives occur when histamine and other chemicals are released from under the skins surface. This causes the tissues to swell. Histamine can be released for many reasons, including: eating certain foods an insect bite or sting cold  including exposure to cold water or wind heat  including from exercise or eating spicy food emotional stress an infecti o n like a cold having drinks like alcohol or caffeine taking medicines like non-steroidal anti-inflammatory drugs (NSAIDs) or antibiotics a reaction to environmental factors like pollen, dust mites or chemicals an allergic reaction to latex scratching or pressing on your skin  like wearing itchy or tight clothing a problem with your immune system water or sunlight (though this is rare) If you can, try to work out whats causing your hives. This can help to avoid them in the future. Rash self-help guide Complete our self-help guide to check your symptoms and find out what to do next. Complications of hives Complications of hives can include: angioedema  a deeper swelling of tissues psychological and emotional problems like stress and anxiety anaphylaxis  a severe allergic reaction that should be treated as a serious medical emergency Source: NHS 24 - Opens in new browser window Last updated: 29 May 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Self-help guide: Rash NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Vaginal cancer,"Vaginal cancer - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Vaginal cancer Vaginal cancer About vaginal cancer Causes of vaginal cancer Diagnosing vaginal cancer Treating vaginal cancer About vaginal cancer Vaginal cancer is a rare type of cancer that begins in the vagina. Cancer that begins in the vagina is called primary vaginal cancer. Cancer that begins in another part of the body  such as the cervix, womb or ovaries  and spreads to the vagina is known as secondary vaginal cancer. This topic is about primary vaginal cancer. There are separate topics on cervical cancer , ovarian cancer and womb cancer . Signs and symptoms The most common symptom of vaginal cancer is abnormal vaginal bleeding. This includes: bleeding between your normalperiods, or after sex bleeding after the menopause (post-menopausal bleeding) Other symptoms can include: smelly or bloody vaginal discharge pain during sex pain when urinating needing to urinate more frequently than usual blood in your urine pelvic pain an itch or lump in your vagina Speak to your GP if you experience any abnormal vaginal bleeding, changes in your usual pattern of periods (such as irregular periods or heavier periods than usual), or problems urinating. While its highly unlikely that these symptoms are caused by vaginal cancer, they should still be investigated by your GP. Read more about diagnosing vaginal cancer. What causes vaginal cancer? The exact causes of vaginal cancer are unknown, but things that may increase your risk of developing it include: being infected with a particularly persistent type of the human papilloma virus (HPV), which can be spread during sex your age  7out of every 10 cases of vaginal cancer affect women and anyone with a vagina over 60 a previous history of vaginal intraepithelial neoplasia (VAIN) or cervical intraepithelial neoplasia (CIN)  abnormal cells in the vagina or cervix that can sometimes become cancerous As there is a possible link with HPV, it may be possible to reduce your risk of vaginal cancer by practising safe sex. The HPV vaccination ,which is routinely offered to girls who are 12 to 13 years old, provides protection against 2strains of HPV thought to be responsible for most cases of vaginal and cervical cancer. Read more about the causes of vaginal cancer . How vaginal cancer is treated Treatment for vaginal cancer depends on which part of your vagina is affected and how far the cancer has spread (known as the stage). The main treatments for vaginal cancer are: radiotherapy  radiation is used to destroy the cancerous cells surgery to remove the cancerous cells chemotherapy  medication is used to kill the cancerous cells; this is often used in combination with radiotherapy These treatments can cause both short- and long-term side effects that should be discussed with your care team before treatment begins. Read more about treating vaginal cancer Causes of vaginal cancer Cancer occurs when the cells in a certain area of your body divide and multiply too rapidly. This produces a lump of tissue known as a tumour. The exactreason why this happens in casesof vaginal cancer is unknown, but certain things canincrease your chances of developing the condition. Human papilloma virus (HPV) Human papilloma virus (HPV) is the name given to agroup of viruses that affect the skin and the moist membranes that line the body, such as those in the cervix, anus, mouth and throat. HPV is spread during sex, including anal and oral sex. There are many different types of HPV and up to 8out of every 10 people are infected withthevirusat some time during their lives. In most cases, the virus goes away without causing any harm and doesnt lead to vaginal cancer. However, HPV is present inmore thantwo-thirds of people with vaginal cancer, which suggests that it may increase your risk of developing the condition. HPV is known to cause changes in the cells of the cervix, which can lead to cervical cancer . Its thought that the virus could have a similar effect on the cells of the vagina. Abnormal cells in the cervix or vagina Youre more likely to develop vaginal cancer if youve previously been found to have abnormal cells in your: cervix known as cervical intraepithelial neoplasia (CIN) vagina known asvaginal intraepithelial neoplasia (VAIN) CIN and VAIN are terms used to describe cells that are abnormal, but not different enough to be considered cancerous. Both are thought to be closely linked to having a persistent HPV infection. Theabnormal cellsdontusually cause any problems themselves andmay only be detected during cervical screening , but left untreated there is a small chance they could eventually become cancerous. If youre found to have CIN or VAIN, a procedure to remove or destroy the abnormal cells may be recommended. Diethylstilbestrol A medicine called diethylstilbestrol is known to increase your risk of vaginal cancer. The medicationwas widely prescribed during pregnancy between 1938and 1971, because it was thought itcould help reduce the risk of miscarriage . However, in 1971, researchers discovered a link between diethylstilbestrol and cancer in the children of women given the medicine.The use of diethylstilbestrol during pregnant was then banned. The risk of vaginal cancer associated withdiethylstilbestrol is small and as its nowover 40 years since it was lastused during pregnancies, cases of vaginal cancer linked to the medication are very rare. Other possible factors Other things that may increase your risk of vaginal cancer include: your age  7out of every 10 cases of vaginal cancer occur in women and anyone with a vagina over 60 having a history of reproductive cancers, such as cervical cancer or vulval cancer  particularly if you were treatedwith radiotherapy smoking having HIV Read further information: Cancer Research UK: risks and causes of vaginal cancer Diagnosing vaginal cancer To help diagnose vaginal cancer, your GP will ask you about your symptoms and may carry out a physical examination. They may also refer you for blood tests to rule out other causes of your symptoms, such as infection. If your GP cannot find an obvious cause of your symptoms, they will probably refer you to a gynaecologist for further testing. A gynaecologist is a specialist in treating conditions of the female reproductive system. If your GP refers you urgently because they think you have cancer, you have the right to be seen by a specialist within 2weeks. The National Institute for Health and Care Excellence ( NICE ) recommends that GPs consider referring a woman who has an unexplained mass in or at the entrance to their vagina. Seeing a gynaecologist If you are referred to a gynaecologist, you may have: external and internal vaginal examinations to look for any unusual lumps or swellings a colposcopy an examination where a special instrument (colposcope) that acts like a magnifying glass is used to study your vagina in greater detail If yourgynaecologist thinks there may be abnormal tissue inside your vagina, a small sample of the tissue will be removed and checked under a microscope for cancerous cells. This is known as a biopsy . If the results of the biopsy suggest you have cancer, youmay have further tests to see if the cancer has spread. These tests may include a moredetailed internal vaginal examination carried out under general anaesthetic , X-rays , computerised tomography (CT) scans and magnetic resonance imaging (MRI) scans . Staging Healthcare professionals use a staging system to describe how far vaginal cancer has advanced. stage 1 the cancer has started to grow into the wall of the vagina stage 2 the cancer has begun to spread outside the vagina into the surrounding tissues stage 3 the cancer has spread into your pelvis and may have spread to nearby lymph nodes stage 4a the cancer has spread beyond your vagina and into organs such as your bladder or back passage (rectum) stage 4b the cancer has spread into organs further away, such as the lungs The stage of your cancer is important in determining which treatment is most appropriate and whether a cure is possible. Generally, the lower the stage when cancer is diagnosed, the better the chance of a cure. If a cure is not possible, treatment can still helprelieveany symptoms and slow down the spread of the cancer. Read more about how vaginal cancer is treated . Read further information: Cancer Research UK: tests for vaginal cancer Cancer Research UK: stages of vaginal cancer Treating vaginal cancer Treatment for vaginal cancer will depend on where the cancer is in your vagina and how far it has spread. Possible treatments include radiotherapy, surgery and chemotherapy. When you are diagnosed with cancer, you will be cared for by a group of different healthcare professionals, known as a multidisciplinary team (MDT). Your MDT will include a range of specialists, including surgeons, clinical oncologists (specialists in the non-surgical treatment of cancer), andspecialist cancer nurses. Your MDT will recommend a treatment plan they feel is most suitable for you, but the final decision will be yours. Before going to hospital to discuss your treatment options, you may find it useful to write a list of questions to ask the specialist. For example, you may want to find out the advantages and disadvantages of particular treatments. Radiotherapy Radiotherapy is the main treatment for vaginal cancer. It can be used: as an initial treatment to cure the cancer in combination with chemotherapy (chemoradiation) after surgery to prevent the cancer from returning to control symptoms when a cure is not possible (palliative radiotherapy) How its carried out There are 2main ways that radiotherapy for vaginal cancer can be given: external radiotherapy a machine beams high-energy rays at your vagina and pelvis internal radiotherapy  a small radioactive device, which looks like a tampon, is inserted into your vagina The type of radiotherapy you receive depends on where the cancer is in your body. For example, internal radiotherapy may be used if the cancer is in the lining of your vagina, and external radiotherapy may be used if the cancer is deeper in the tissues of the vagina. You canreceive a combination of internal and external radiotherapy. External radiotherapy is usually given for around 4to 6weeks in short daily sessions, from Monday to Friday. You return home between treatments and have a breakat the weekends. Internal radiotherapy may involve either a long treatment session where you need to stay in hospital for 24 hours, or several short day-case treatments. Read more about how radiotherapy is performed . Side effects Following radiotherapy, its likely you will have some side effects. These occur because radiotherapy temporarily damages some healthy cells as well as destroying cancerous ones. Possible side effects of radiotherapy for vaginal cancer include: sore, red skin similar to sunburn vaginal discharge pain while passing urine diarrhoea tiredness feeling sick narrowing of the vagina (see below) early menopause and infertility (see below) Read more about the side effects of radiotherapy . Effects on sex Radiotherapy may cause you to lose interest in sex, particularly if you have side effects such as tiredness or nausea, or you are anxious about your condition or treatment. Radiotherapy can also cause scar tissue to form in your vagina, which can make it narrower and means having sex is difficult or uncomfortable. If you feel up to it, your care team may suggest having sex regularly during treatment to help stop this happening. Devices called dilators, which are inserted into the vagina, can also be used after treatment stops to helpstop your vagina getting narrower. You may also experience somevaginal dryness or pain when having sex. If this happens, you can try using lubricants or asking yourcare team aboutpossible treatments. Menopause and fertility If you have external radiotherapy to your pelvis, you may experience an early menopause (if you have not had the menopause already). This means you will no longer be able to have children (infertility). Before your treatment, yourcare team will explain whether this is a risk and discuss the options and supportavailable. Surgery There are 4main types of surgery used to treat vaginal cancer: partial vaginectomy  removing the upper section of your vagina radical vaginectomy removing all of your vagina and pelvic lymph nodes radical vaginectomy and radical hysterectomy removing all of your vagina, womb, ovaries, fallopian tubes and pelvic lymph nodes pelvic exenteration  removing all of your vagina and surrounding tissue, including the bladder and/or rectum (back passage) Partial vaginectomy A partial vaginectomy can be used to treatstage 1vaginal cancer, when radiotherapy has failed to remove the cancer or where a woman prefers to have surgery rather than radiotherapy because she still wants to have children. Your surgeon will remove the cancerous section of the vagina, as well assome surrounding healthy tissue, just in case a small number of cancerous cells have spread. Your surgeon will repair the defect in the vaginal wall, which means you will be able to have sex after you have recovered from the operation. Radical vaginectomy A radical vaginectomymay beused to treat cases of advanced stage 1 and stage 2 vaginal cancer. The surgeon will remove most, or all, of your vagina. A plastic surgeon may be able to make a new vagina using skin, muscle and tissue taken from another part of your body  usually one of your thighs or buttocks. You will still be able to have sex after a vaginal reconstruction, although you will need to use lubricant, becausethe lining of the new vagina cannot make the mucus it would naturally make. Radical hysterectomy A radical hysterectomy is oftenperformed at the same time as a radical vaginectomy. During a radical hysterectomy, all of the reproductive system is removed, including the womb, fallopian tubes, ovaries and nearby lymph nodes. Pelvic exenteration Pelvic exenteration is used in a few cases to treat recurrent or advanced cases of vaginal cancer. Ifyou no longer have a bladder, you will need another way to pass urine. One solution is for your surgeon to make a hole (stoma) in your tummy. A bag is then attached to the stoma so that urine can be passed into it. The bag is known as a urostomy bag. Similarly, as youmay no longer have a rectum, you will need a way to pass stools (faeces) out of your digestive system. Another stoma can be made and attached to a collection bag, known as a colostomy bag. Read more about colostomies . A vaginal reconstruction can be carried out aftera pelvic exenteration. Itmay also be possible to reconstruct your rectum and attach it to the remaining section of your bowel once this has healed. In this case, you will only need a temporary colostomy. As pelvic exenteration is major surgery, it may take you several months to fully recover from the operation. Chemotherapy Chemotherapy is usually used in combination with radiotherapy or to control symptoms when a cure is not possible (palliative chemotherapy). Its usually given by injection (intravenous chemotherapy). Like radiotherapy, the powerful cancer-killing medicines used in chemotherapy can also damage healthy tissue and cause a range of side effects. Side effects of chemotherapy for vaginal cancer can include: tiredness feeling sick increased risk of infections diarrhoea hair loss Read more about the side effects of chemotherapy . Coping with treatment Treatment for vaginal cancer can have a significant emotional impact, particularly for young women who experience an early menopause as a result of treatment. The removal of some or all of the vagina can be traumatic for pre- and post-menopausal women alike, andsome women feel less womanly than they did before. Its not uncommon to feel a sense of loss and bereavement after treatment. In some women, this may lead to depression . You may find it helpful to talk to other women who have had similar treatment. Your GP or hospital staff may be able to recommend a suitable local support group. Charities can also help: Macmillan Cancer Support has informationon groups you can join and a support line that you can call for free on 0808 808 00 00 (Monday to Friday, 9am to 8pm) Cancer Research UK provides a free phone number that you can call on 0808 800 40 40 (Monday to Friday, 9am to 5pm) If feelings of depression persist,speak to yourGP about the treatment and support available. Clinical trials As vaginal cancer is rare, you may be asked to take part in aclinical trial. Clinical trials are an important way for healthcare professionals to learn more about the best way to treat specific conditions. Most clinical trials involve comparing a new treatment with an existing treatment to determine whether the new treatment is more or less effective. If you do receive a new treatment, there is no guarantee it will be more effective than an existing one. You can find out whether there are currently anyclinical trials for vaginal cancer, or ask your care team if there are clinical trials in your area. Your care team can explain the advantages and disadvantages of taking part. Read further information: Cancer Research UK: Treatment for vaginal cancer Macmillan Cancer Support: Vaginal cancer Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Cervical cancer Radiotherapy Other health sites Cancer Research UK: Vaginal cancer The Eve Appeal: vaginal cancer Macmillan Cancer Support: Vaginal cancer Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Vaginal discharge,"Vaginal discharge | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Sexual and reproductive Vaginal discharge Vaginal discharge You can experience vaginal discharge for many reasons. It doesnt always mean you have an STI. Vaginal discharge is nothing to worry about if its: odourless (no unpleasant smell) clear or white thick and sticky slippery and wet The amount of discharge you might experience can vary. You might experience heavier or more frequent discharge if youre: pregnant sexually active using contraception , such as the contraceptive pill During ovulation, youll notice more slippery and wet discharge, which is normal. Contact your GP or sexual health service if: You have vaginal discharge and: you experience pelvic pain youre bleeding between periods or after sex you experience pain when peeing you feel itchy, sore or have blisters your vaginal discharge changes in colour, smell or texture You should look out for anything that doesnt seem normal for you. This can include discharge which is: foul-smelling thick and white (like cottage cheese) green or yellow and frothy accompanied by pain or bleeding accompanied by itchiness, blister or sores STIs that can cause vaginal discharge include: chlamydia gonorrhoea genital herpes trichomonas If youre sexually active and you experience any abnormal discharge, contact your local sexual health clinic to get tested for STIs. Vaginal discharge can also be caused by thrush or bacterial vaginosis . You might be asked to visit your local sexual health clinic for a vaginal examination to ensure you get the correct treatment. Free treatment If youre experiencing discharge that you dont think has been caused by an STI, you can visit your local pharmacy for advice. If you experience discharge and think theres a chance it could be caused by an STI, you should contact your local sexual health clinic . If they think you need treatment or aftercare for anything thats caused vaginal discharge, youll be given this for free. Free treatment is available for: vaginal infections such as bacterial vaginosis (BV) and thrush all STIs Genital hygiene You cant always prevent vaginal discharge. But its important to keep your vagina clean and healthy. Your vagina cleans itself internally. So you dont need to clean inside with things like a vaginal douche. You can use panty liners if you experience heavy discharge. But dont use them all the time as they can cause irritation. Read genital washing advice Source: Scottish Government - Opens in new browser window Last updated: 27 February 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Book a sexual health appointment online Find your nearest sexual health service Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Varicose eczema,"Varicose eczema - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Skin, hair and nails Varicose eczema Varicose eczema About varicose eczema Causes of varicose eczema Diagnosing varicose eczema Treating varicose eczema About varicose eczema Varicose eczema is a long-term skin condition that affects the lower legs and is common in people with varicose veins . Itisalso known as venous eczema, gravitational eczema andstasis eczema. Signs and symptoms Like all types of eczema,the affected skin becomes: itchy red andswollen dry andflaky scaly or crusty There may be periodswhen these symptomsimprove and periods when they become more severe. Your legs may become swollen, especially towards the end of the day or after long periods of standing. Varicose veins (swollen and enlarged veins) are often visible on the legs. Some people also have other symptoms, such as: brown discolouration of the skin red, tender and tight skin that can eventually become hardened (lipodermatosclerosis) small, white scars (atrophie blanche) pain eczema affecting other parts of the body Left untreated, leg ulcers can develop. These arelong-lasting wounds that form where the skin has become damaged. When to seek medical advice See your GP if you have symptoms of varicose eczema. They willoften be able to make a diagnosis simply by looking at the skin. Read more about diagnosing varicose eczema . What causes varicose eczema? Varicose eczema is caused by increased pressure in the leg veins. When the small valves in the veins stop working properly, its difficult for blood to be pushed against gravity and itcan leakbackwards. This increases thepressure in the veins, which can cause fluid to leak into the surrounding tissue. It is thought that varicose eczema may develop as a result of the immune system reacting to this fluid. Varicose eczema is more common in people with varicose veins, as these are also often a sign that the leg veins arent working properly. Read more about the causes of varicose eczema . How varicose eczema is treated Varicose eczema tends to be a long-termproblem. However, treatments are available to help keepit under control. For most people, treatment involves a combination of: self-help measures  including ways to improve your circulation, such as keeping active and frequently raising your legs emollients  moisturisers applied to the skin to stop it becoming dry) topical corticosteroids  ointments and creams applied to the skin to help treat the eczema and relieve symptoms compression stockings  specially designed stockings, usually worn every day, that steadily squeeze your legs and help to improve your circulation If these treatments dont help, your GP may refer you to a dermatologist (skin specialist) in case there is another cause for your symptoms or if they are concerned you may also have a type of eczema called contact dermatitis. If you also have varicose veins, you may be referred to a vascular specialist (a doctor or surgeon specialising in conditions affecting the blood vessels) who can talk to you about the treatment options for varicose veins . Readmore about treating varicose eczema . Causes of varicose eczema Varicose eczema is usually caused by increased pressure in your leg veins. Inside your veins there arevalves that let the blood through in one direction and prevent it flowing backwards. Sometimes, the walls of the veins can become stretched and lose their elasticity, causing the valves to become weakened. If the valves do not function properly,blood may leak backwards. Thisincreases the pressure in your veins, which may cause fluid to leak into surrounding tissues. It is thought that varicose eczema may develop as a result of your immune system reacting to these fluids in the tissues under your skin. This increase in pressure can also cause blood to collect in your veins, which become swollen and enlarged ( varicose veins ). Whosmost at risk? It is not fully understood why the walls of the veins stretch and the valves weaken.Somepeople develop the conditionfor no obvious reason, although there are certainfactors that increase the chances of this happening, including: gender  varicose eczema is more common in women obesity  this can increase the pressure in your leg veins pregnancy this can alsoincrease the pressure in yourleg veins not being able to move for a long period of time  this can affect the circulation inyour leg veins having previously had deep vein thrombosis (DVT) blood clots that develop inleg veins, which can damage thevalves in your veins increasing age  people generally find it harder to move about as they get older, which can affect their circulation Diagnosing varicose eczema See your GP if you have symptoms of varicose eczema. They can usually make a diagnosis by simply looking at the affected areas. Your GP will also ask you questions to determine whether you have a problem with the flow of blood in your leg veins, as this is the main cause of varicose eczema. To help make a diagnosis, your GP may want to know if you have a history of: varicose veins  swollen and enlarged veins deep vein thrombosis (DVT) a blood clot in one of the deep veins of your legs leg ulcers areas of damaged skin that take several weeks to heal cellulitis  an infection of the deeper layers of the skin and underlying tissue surgery or injury to your legs Your GP may also check the pulse in your feet and they may carry out an ankle brachial pressure index (ABPI) test to see if compression stockings are suitable for you. See the section on treating varicose eczema for more information about these. The ABPI test involves comparing blood pressure readings taken from your ankles and upper arms. A significant difference in the readings suggests a problem with the flow of blood in your arteries in which case, compression stockings may not be safe to use. Referral to a specialist You may be referred to a specialist in a local hospital for further tests. This might bea vascular specialist (a doctor or surgeonspecialising in conditions affecting the blood vessels) or a dermatologist (a specialist in skin conditions) if: you have varicose veins and changes to your skin, such as varicose eczema, lipodermatosclerosis (hard, tightened skin) or a history ofleg ulcers you have very poor blood flow in the blood vessels in your legs your symptoms dont get better, despite treatment it is possible that you may havecontact dermatitis Treating varicose eczema Treatment for varicose eczema aims to improve the condition of your skin, treat your symptoms and help improve your circulation (blood flow). For many people, this will involve long-term treatment with a combination of: emollients (moisturisers) topical corticosteroids compression stockings There are also some self-help techniques that you can try. These treatment options are described in more detail below. Lipodermatosclerosis (hardened,tight skin) is treated in a similar way to varicose eczema. If you have a venous leg ulcer , you can alsoread about treating venous leg ulcers . Self-help There are some steps you can take to reduce the symptoms of varicose eczema and help prevent further problems, such as: try to avoid injuring your skin injuries to your skin could lead to an ulcerdeveloping raise your legs when you are resting for example, by propping up your feet on some pillows(ideally so that they are above the level of your heart), as this can help reduce swelling keep physically active this will improve your circulation andhelp you maintain a healthy weight Fluidcan build upin the lower legs if you sit or stand for too long, so it is important to keep moving. Walking will get your muscles working and help to push the blood through the veins to your heart. The National Eczema Society also recommends regularly flexing your feet and rising up onto your toes or bending down at the knees. Emollients Emollients aremoisturising treatments applied directly to the skin to reduce water loss and cover it with a protective film.They are often used to help manage dry or scaly skin conditions such as eczema. Choice of emollient Anumber of different emollients are available. Some can be bought over the counter without a prescription, but if you have varicose eczema it may be helpful to ask your GPto recommend a suitable product. You may need to try several different emollients to find one that works for you. You may also be prescribed a mixture of emollients, for example: an ointment for very dry skin a cream or lotion for less dry skin an emollient to use instead of soap an emollient to add to bath water or use in the shower The difference between lotions, creams and ointments is the amount of oil thatthey contain. Ointments contain the most oil, so they can be quite greasy, butare the most effective at keeping moisture in the skin. Lotions contain the least amount ofoil, so are not greasy, but can be less effective. Creams are somewhere in between. How to use emollients If you have varicose eczema, you should usean emollient at least twice a day, even if you do not have any symptoms. To apply the emollient: use a large amount you should aim to cover all of the skin on your lower leg, not just the obviously affected areas dont rub it ininstead, smooth it into the skin in the same direction that the hair grows applyevery 2to 3hours for very dry skin after a bath or shower, gently dry the skin, then immediately apply the emollient while the skin is still moist do not share emollients with other people It is very important to keep using emollients during a flare-up of varicose eczema, because this is when the skin needs the most moisture.Apply emollients frequently and in generous amounts during a flare-up. Side effects Its unusual for emollients to cause side effects, but they can occasionally cause a rash, and greasy emollients may sometimes cause folliculitis (inflammation of the hair follicles). If you experience any side effects from your emollient, speak to your GP, who can prescribe an alternative product. Emollients added to bath water can make your bath very slippery, so take care getting in and out of the bath. Topical corticosteroids If your skin is inflamed from a flare-up of varicose eczema, your GP may prescribe a topical corticosteroid (corticosteroid medication that is applied directly to your skin in the form of a cream or ointment) to quickly reduce the inflammation. They are also commonly known as topical steroids. Different strength topical corticosteroids can be prescribed, depending on the severity of your varicose eczema. If you have flare-ups of lipodermatosclerosis, you may need a very strong topical corticosteroid. How to use topical corticosteroids When using corticosteroids, only apply the treatment to the affected areas. Your doctor can advise youon how much to apply and how often. You can also check the advice in the patient information leaflet that comes with your medication. Most people only have to apply a topical corticosteroid once a day. When applying the medication, you should: apply your emollient first and wait around 30 minutes before applying the topical corticosteroid (until the emollient has soaked into your skin) apply it only to the affected area use the topical corticosteroid for7 to 14 days and continue to apply the treatment for 48 hours after the flare-up has cleared If your varicose eczema is moderate to severe, you may need to apply topical corticosteroids both between flare-ups and during them. If you need to use topical corticosteroids on a long-term basis, you should apply them less frequently. Your GP will advise youon how often you should be applying them. You should also speak to your GP if you have been using a topical corticosteroid and your symptoms have not improved. Side effects Topical corticosteroids may cause a mild and short-lived burning or stinging sensation as you apply them, particularly if using a cream. Generally, using a strong topical corticosteroid for prolonged periods will increase your risk of getting more serious side effects, such as thinning of the skin. Your doctor will advise you as to the strength of the medication you require and when you should use it. Compression stockings Medical compression stockings are specially designed to steadily squeeze your legs to help improve your circulation. They are tightest at the ankle and get gradually looser as they go further up your leg. This encourages blood to flow upwards towards your heart. Medical compression stockings are used to treat varicose eczema and lipodermatosclerosis by improving the flow of blood through your leg veins and reducing the pressure in the veins. Choice of compression stockings Compression stockings are available in a variety of different sizes and pressures. They are also available in: different colours different lengths  some come up to the knee and others also cover the thigh (you should only need knee-high stockings for varicose eczema) different foot styles  some cover the whole foot and some stop before the toes Support stockings or tights that lightly compress the legs can be bought from pharmacies. Compression stockings that compress the legs more are available on prescription and will require you to be measured by a nurse first. In some cases, if you find it difficult to put on your stockings, you may be advised to use a tubular bandage instead. Wearing compression stockings You will usually need to put your compression stockings on as soon as you get up in the morning and take them off when you go to bed. Wearing compression stockings can be uncomfortable, particularly during hot weather, but it is important to wear them correctly to get the most benefit from them. Pull them all the way up so that the correct level of compression is applied to each part of your leg. Do not let the stocking roll down, or it may dig into your skin in a tight band around your leg. Speak to your GP if the stockings are uncomfortable, they do not seem to fit, or you have difficulty putting them on. It may be possible to get custom-made stockings that will fit you exactly. Take care whenputting compression stockings on and taking them off,as thiscan damage fragile skin. If you have a leg ulcer, it ideally needs to heal before you start wearing compression stockings. Caring for compression stockings Compression stockings usually have to be replaced every 3to 6months. Speak to your GP if your stockings become damaged, as they may no longer be effective. You should be prescribed 2stockings (or 2sets of stockings if you are wearing 1on each leg) so that 1stocking can be worn while the other is being washed and dried. Compression stockings should be hand-washed in warm water and dried away from direct heat. Treating varicose veins If you have varicose veins ,as well asvaricose eczema, treating these may sometimes be helpful. If your GP thinks treatment may be beneficial, they can refer you to a vascular surgeon, who can arrange for an ultrasound scan of your leg to find the faulty blood vessels. Treatment of your varicose veins can then be planned. There are a number of treatments available that can improve the symptoms and appearance of varicose veins, including: endothermal ablation where energy from either high-frequency radio waves or lasers is usedto seal the affected veins sclerotherapy  where aspecial foam is injectedinto your veins to seal them ligation and stripping  where affected veins are tied off and surgically removed These procedures are usually performed in the day surgery department of a hospital. Read more about treating varicose veins . Source: NHS 24 - Opens in new browser window Last updated: 07 December 2022 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Atopic eczema Venous leg ulcer Other health sites BAD: venous eczema Circulation Foundation NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Venous leg ulcer,"Venous leg ulcer - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Skin, hair and nails Venous leg ulcer Venous leg ulcer About venous leg ulcers Symptoms of venous leg ulcers Causes of venous leg ulcers Diagnosing venous leg ulcers Treating venous leg ulcers Preventing venous leg ulcers About venous leg ulcers A leg ulcer is a long-lasting (chronic) sore that takes more than 4to 6weeks to heal. They usually develop on the inside of the leg, just above the ankle. The symptoms of a venous leg ulcer include pain, itching and swelling in the affected leg. There may also be discoloured or hardened skin around the ulcer, and the sore may produce a foul-smelling discharge. See your GP if you think you have a leg ulcer, as it will need specialist treatment to help it heal. Your GP will examine your leg and may carry out additional tests to rule out other conditions. Read more about how a venous leg ulcer is diagnosed . What causes venous leg ulcers? A venous leg ulcer is the most common type of leg ulcer, accounting for over 90% of all cases. Venous leg ulcers can develop after a minor injury, where persistently high pressure in the veins of the legs has damaged the skin. Read more about the causes of venous leg ulcers . Whos affected? Venous leg ulcers are estimated to affect around 1 in 500 people in the UK, although they become much more common with age. Its estimated that around 1 in 50 people over the age of 80 has one. Youre more at risk of developing one if youve previously had deep vein thrombosis (DVT) orfind it difficult towalk because of a problem such as: osteoarthritis a leg injury obesity paralysis Youre also more at risk ifyouve recently had an operation on your leg, such as a hip replacement or knee replacement . People with varicose veins (swollen and enlarged veins) also have a higher risk of developing venous leg ulcers. How venous leg ulcers are treated Most venous leg ulcers heal within 3to 4months if theyre treated by a healthcare professional trained in compression therapy for leg ulcers. However, some ulcers may take longer to heal, and a very small number never heal. Treatment usually involves: cleaning and dressing the wound using compression, such as bandages or stockings, to improve the flow of blood in the legs Antibiotics may also be used if the ulcer becomes infected, but they dont help ulcers to heal. However, unless the underlying cause of the ulcer is addressed, theres a high risk of a venous leg ulcer recurring after treatment. Underlying causes could include immobility, obesity, previous DVT, or varicose veins. Read more about treating venous leg ulcers . Can venous leg ulcers be prevented? There are several ways to help prevent a venous leg ulcer in people at risk, such as: wearing compression stockings losing weight if youre overweight exercising regularly elevating your leg when possible This is particularly important if youve previously had a leg ulcer  once a leg has suffered a venous ulcer, youre at risk of further ulcers developing within months or years. Read more about preventing venous leg ulcers . Symptoms of venous leg ulcers Venous leg ulcers are open, often painful, sores in the skin that take more than a month to heal. They usually develop on the inside of the leg, just above the ankle. If you have a venous leg ulcer, you may also have: swollen ankles (oedema) discolouration and darkening of the skin around the ulcer hardened skin around the ulcer, which may make your leg feel hard or evenresemble the shape of an upside-down champagne bottle a heavy feeling in your legs aching or swelling in your legs red, flaky, scaly and itchy skin on your legs ( varicose eczema ) swollen and enlarged veins on your legs ( varicose veins ) an unpleasant and foul-smelling discharge from the ulcer Signs of an infection A venous leg ulcer can be susceptible to bacterial infection. Symptoms of an infected leg ulcer can include: worsening pain a green or unpleasant discharge coming from the ulcer redness and swelling of the skin around the ulcer a high temperature (fever) When to seek medical advice Contact your GP if you think youve developed a venous leg ulcer. Theyre unlikely to get better on their own, as they usually require specialist medical treatment. You should also contact your GP or leg ulcer specialist if youve been diagnosed with a venous leg ulcer and have symptoms that suggest it could be infected. Read more about how venous leg ulcers are treated . Causes of venous leg ulcers A venous leg ulcer can develop after a minor injury if theres a problem with the circulation of blood in your leg veins. If this happens, pressure inside the veins increases. This constant high pressure can gradually damage the tiny blood vessels in your skin and make it fragile. As a result, your skin can easily break and form an ulcer after a knock or scratch. Unless you have treatment to improve the circulation in your legs, the ulcermay notheal. Read more about treating venous leg ulcers . Whos most at risk? Anumber of factors can increase your risk of developing a venous leg ulcer, including: obesity or being overweight this increases the pressure in the leg veins if you have difficulty walking this can weaken the calf muscles, which can affect circulation in the leg veins previous deep vein thrombosis (DVT) blood clots that develop in the leg can damage valves inthe veins varicose veins swollen and enlarged veins caused by malfunctioning valves previous injury to the leg, such as a broken or fractured bone, which may cause DVT or impair walking previous surgery to the leg, such as a hip replacement or knee replacement , which can prevent you from moving about increasing age  people find it harder to move around as they get older, particularly if they suffer from arthritis Diagnosing venous leg ulcers See your GP if you think you have a venous leg ulcer. The ulcer is unlikely to heal without specialist treatment. Diagnosis is largely based on your symptoms and examination of your affected leg, although additional tests may be required. Medical history and examination Your GP or practice nurse will ask whether you have any other symptoms associated with venous leg ulcers, such as: swelling in your ankles discoloured or hard skin Theyll try to determine the cause of the ulcer by asking about underlying conditions or previous injuries, such as: diabetes deep vein thrombosis (DVT) injury or surgery in the affected leg a previous leg ulcer Theyll also examine your leg, both when youre standing up and lying down. Varicose veins will be more obvious when youre standing up, and it will be easier to look at the ulcer when youre lying down. Theyll also feel your pulse at your ankles to make sure the arteries in your leg are working properly. Doppler study To rule outperipheral arterial disease(acondition affecting the arteries) as apossible cause of your symptoms, your GP or nurse will carry out a test known as a Doppler study. This involves measuring the blood pressure in the arteries at your ankles and comparing itto the pressure in your arms.If you have peripheral arterial disease, the blood pressure in your ankles will be lower than your arms. Its important to carry out this check as the main treatment for venous ulcers is compression bandages or stockings to improve thevein circulation in your legs. Its not safe to apply compression if the ankle artery pressures are low. Read more about how venous leg ulcers are treated . Referral to a specialist In some cases, your GP or nurse may decide to refer you toa specialist in conditions affecting the blood vessels (vascular specialist). For example, you may be referred to a vascular specialist if your GP or nurse is unsure about your diagnosis, or if they suspect your ulcer may be caused by artery diseases, diabetesor rheumatoid arthritis . After taking your medical history and examining you, the vascular specialist may need to arrange further investigations to plan your treatment. Treating venous leg ulcers With appropriate treatment, most venous leg ulcers heal within 3to 4months. Treatment should always be carried out by a healthcare professional trained in compression therapy for leg ulcers. Usually, this will be a practice or district nurse. Cleaning and dressing the ulcer The first step is to remove any debris or dead tissue from the ulcer and apply an appropriate dressing. This provides the best conditions for the ulcer to heal. A simple, non-sticky dressing will be used to dress your ulcer. This usually needs to be changed once a week. Many people find they can manage cleaning and dressing their own ulcer under the supervision of a nurse. Compression To improve vein circulation in your legs and treat swelling, your nurse will apply a firm compression bandage over the affected leg. These bandages are designed to squeeze your legs and encourage blood to flow upwards, towards your heart. There are many different types of bandageor elastic stockings used to treat venous leg ulcers, whichmay be madein 2, 3or 4different layers. The application of a compression bandage is a skilled procedure and they should only be applied by trained healthcare staff. The bandage is changed once a week, when the dressing is changed. When compression bandages are first applied to an unhealthy ulcer, its usually painful.Ideally, you should have paracetamol or an alternative painkiller prescribed by your GP.The pain will lessen once the ulcer starts to heal, but this can take up to 10-12 days. Its important to wear your compression bandage exactly as instructed. If you have any problems, its usually best to contact your nurse, instead of trying to remove it yourself. If the compression bandage feels a little too tight and is uncomfortable in bed at night, getting up for a short walk will usually help. However,youll need to cut the bandage off if: you get severe pain at the front of your ankle you get severe pain on the top of your foot your toes become blue and swollen Once you remove the bandage,make sure you keep your leg highly elevated and contact your doctor or nurse as soon as possible. In some clinics, specialist teams are using new alternatives to compression bandages, such as special stockings or other compressive devices. These may not be available in every clinic butcould change the way ulcers are treated in future. Your specialist will be able to advise you whether a different approach may help you. Treating associated symptoms Swelling in the legs and ankles Venous leg ulcers are often accompanied by swelling of your feet and ankles (oedema), which is caused by fluid. This can be controlled by compression bandages. Keeping your leg elevated whenever possible, ideally with your toes at the same level as your eyes, will also help ease swelling. You should put a suitcase, sofa cushion or foam wedge under the bottom of your mattress, to help keep your legs raised while you sleep. You should also keep as active as possible and aim to continue with your normal activities. Regular exercise, such as a daily walk, will help reduce leg swelling. However, you should avoid standing or sitting still with your feet down. You should elevate your feet at least every hour. Itchy skin Some people with venous leg ulcers develop rashes with scaly and itchy skin. This isoften due to varicose eczema , which can be treated with a moisturiser (emollient) and occasionally a mild corticosteroid cream or ointment. Inrare cases,you may need to be referred to a dermatologist (skin specialist) for treatment. Itchy skin can also sometimes be caused by an allergic reaction to the dressings or creams applied by your nurse. If this happens, you may need to be tested for allergies. Its important to avoid scratching your legs if they feel itchy, because this damages the skin and may lead to further ulcers. Looking after yourself duringtreatment To help your ulcer heal more quickly, follow the advice below: Try to keep active by walking regularly. Sitting and standing still without elevating your legs can make venous leg ulcers and swelling worse Whenever youre sitting or lying down, keep your affected leg elevated  withyourtoes level with your eyes Regularly exercise your legs by moving your feet up and down, and rotating them at the ankles. This can help encourage better circulation If youre overweight, try to reduce your weight witha healthy diet and regular exercise Stop smoking Moderate your alcohol consumption Be careful not to injure your affected leg, and wear comfortable, well-fitting footwear You may also find it helpful to attend a local healthy leg club, such as those provided by the Lindsay Leg Club Foundation , for support and advice. Treating an infected ulcer An ulcer sometimes produces a large amount of discharge and becomes more painful. There may also be redness around the ulcer. These symptomsand feeling unwell are signs of infection. If your ulcer becomes infected, it should be cleaned and dressed as usual. You should also elevate your leg most of the time and youll be prescribed a 7-day course of antibiotics . The aim of antibiotic treatment is toclear the infection. However, antibiotics dont heal ulcers and should only be used in short courses to treatinfected ulcers. Follow-up You should visit your nurse once a week to have your dressings and compression bandages changed. Theyll also monitor the ulcer to see how well its healing. Once your ulcer is healing well, your nurse will see you less often. After the ulcer has healed Once youve had a venous leg ulcer, another ulcer could develop within months or years. The most effective method of preventing this is to wear compression stockings at all times when youre out of bed. Your nurse will help you find a stocking that fits correctly and that you can manage yourself. Various accessories are available to help you put them on and take them off. Read more about preventing venous leg ulcers . Preventing venous leg ulcers You can help reduce your risk of developing a venous leg ulcer in several ways, such as wearing a compression stocking, losing weight and taking care of your skin. People most at risk of developing a venous leg ulcer are those who have previously had a leg ulcer. Compression stockings If youve previously had a venous leg ulcer, or youre at risk of developing one,treatment withcompression stockings may be recommended by your GP. These stockingsare specially designed to squeeze your legs, improving your circulation. Theyreusually tightest at the ankle and less tight further up your leg  this encourages blood to flow upwards, towards your heart. To be most effective, these stockings should be put on as soon as you get up and only taken off at night. Compression stockings are available in a variety of sizes, colours, styles and pressures. A nurse can help you find a stocking that fits correctly and that you can manage yourself. There are various accessories you can buy to help get the stockings on and off. Losing weight If youre obese or overweight, losing weight can help treat and prevent venous leg ulcers. Excess weight leads to high pressure in the veins in your legs, which can damage your skin. Venous ulcers are much more common among people who are overweight. To help you lose weight, regular exercise and a healthy, balanced diet are recommended. You should also avoid sitting or standing for long periods.Elevating your legs whenever possible can also help. Read moreabout: losing weight health and fitness healthy eating Treating underlying problems Treating severe varicose veins may help prevent leg swelling or ulcers. This may involve a procedure where a catheter (a thin, flexible tube) is inserted into the affected veins withhigh-frequency radio waves or lasers used to seal them. Alternatively, you may need surgery to repair the damage to your leg veins, or to remove the affected veins altogether. Read more about treating varicose veins . Source: NHS 24 - Opens in new browser window Last updated: 22 February 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Deep vein thrombosis High blood pressure (hypertension) Varicose veins Varicose eczema Other health sites British Association of Dermatologists The Lindsay Leg Club Foundation Circulation Foundation: Leg ulcers NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Vertigo,"Vertigo | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Ears, nose and throat Vertigo Vertigo Vertigo is a symptom, rather than a condition itself. Its the feeling that you, or the environment around you, is moving or spinning. This feeling may be barely noticeable, or it may be so severe that you find it difficult to keep your balance and do everyday tasks. Vertigo can develop suddenly and last for a few seconds or much longer. If you have severe vertigo, your symptoms may be constant and last for several days, making daily life very difficult. Symptoms of vertigo may include: loss of balance  which can make it difficult to stand or walk feeling sick or being sick dizziness When to get medical advice Speak to your GP practice if: your vertigo comes on suddenly you have vertigo that will not go away you have vertigo that keeps coming back vertigo is affecting your daily life Diagnosing vertigo Your GP will ask about your symptoms and can carry out an examination to help determine some types of vertigo. They may also refer you for further tests. What causes vertigo? Inner ear problems, which affect balance, are the most common causes of vertigo. It can also be caused by problems in certain parts of the brain. Causes of vertigo may include: benign paroxysmal positional vertigo (BPPV)  where certain head movements trigger vertigo migraine labyrinthitis or vestibular neuronitis  an inner ear infection Mnires disease Depending on the condition causing vertigo, you may have other symptoms, such as: a high temperature ringing in your ears ( tinnitus ) hearing loss Treatment for vertigo Most people with vertigo get better without treatment. Treatment will depend on the cause. Medicines, such as prochlorperazine and some antihistamines, can help in most cases of vertigo. Your GP may refer you to an ear nose and throat (ENT) specialist or a balance physiotherapist if needed. Things you can do to help your symptoms There may be things you can do yourself to help your symptoms, and reduce how often you have vertigo. Do lie still in a quiet, dark room to reduce the spinning feeling move your head carefully and slowly during daily activities sit down straight away when you feel dizzy turn on the lights if you get up at night use a walking stick if youre at risk of falling sleep with your head slightly raised on 2 or more pillows get up slowly when getting out of bed and sit on the edge of the bed for a minute or so before standing try to relax and avoid stress  anxiety can make vertigo worse Dont do not bend over to pick things up  squat to lower yourself instead do not stretch your neck  for example, while reaching up to a high shelf Safety If you have vertigo, there are some safety issues to consider. For example: you should tell your employer if your job involves operating machinery or climbing ladders you may have a higher chance of falling  read about preventing falls for advice on reducing your risk Driving and vertigo If you drive, you must tell the DVLA about your vertigo. Further information on driving with vertigo on GOV.UK Fear of heights The term vertigo is often incorrectly used to describe a fear of heights. The medical term for a fear of heights and the dizzy feeling associated with looking down from a high place is acrophobia. Further information and advice about phobias Source: ENT Scotland - Opens in new browser window Last updated: 05 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Labyrinthitis Tinnitus Other health sites Brain and Spine Foundation: Dizziness and balance problems Action on Hearing Loss: protect your hearing NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Vitamin B12 or folate deficiency anaemia,"Vitamin B12 & folate anaemia - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Nutritional Vitamin B12 or folate deficiency anaemia Vitamin B12 or folate deficiency anaemia About vitamin B12 or folate deficiency anaemia Symptoms of vitamin B12 or folate deficiency anaemia Causes of vitamin B12 or folate deficiency anaemia Diagnosing vitamin B12 or folate deficiency anaemia Treating vitamin B12 or folate deficiency anaemia Complications of vitamin B12 or folate deficiency anaemia About vitamin B12 or folate deficiency anaemia Vitamin B12 or B9 (commonly called folate) deficiency anaemia occurs when a lack of vitamin B12 or folate causes the body to produce abnormally large red blood cells that cant function properly. Red blood cells carry oxygen around the body using a substance called haemoglobin. Anaemia is the general termfor having either fewer red blood cells than normal or having an abnormally low amount of haemoglobin in each red blood cell. There are several different types of anaemia, and each one has a different cause. For example, iron deficiency anaemia , which occurswhen the body doesnt contain enough iron. Symptoms of vitamin B12or folate deficiency Vitamin B12 and folate perform several important functions in the body, including keeping the nervous system healthy. A deficiency in either of these vitamins can cause a wide range of problems, including: extreme tiredness a lack of energy pins and needles (paraesthesia) a sore and red tongue mouth ulcers muscle weakness disturbed vision psychological problems, which may include depression andconfusion problems withmemory, understanding and judgement Some of these problems can also occur if you have a deficiency in vitamin B12 or folate, but dont have anaemia. Read about the symptoms of vitamin B12 or folate deficiency anaemia When to see your GP See your GP if you think you may have a vitamin B12 or folate deficiency. These conditions can often be diagnosed based on your symptoms and the results of a blood test . Its important for vitamin B12 or folate deficiency anaemia to be diagnosed and treated as soon as possible because, although many of the symptoms improve with treatment, some problems caused by the condition can be irreversible. Read about diagnosing vitamin B12 or folate deficiency anaemia Causes of a vitamin B12 or folate deficiency There are a number of problems that can lead to a vitamin B12 or folate deficiency, including: pernicious anaemia  where your immune system attacks healthy cells in your stomach, preventing your body from absorbing vitamin B12 from the food you eat; thisis the most common cause of vitamin B12 deficiency in the UK a lack of these vitamins in your diet  this is uncommon, but can occur if you have a vegan diet, follow a fad diet or have a generally poor diet for a long time medication  certain medications, including anticonvulsants and proton pump inhibitors (PPIs), can affect how much of these vitamins your body absorbs Both vitamin B12 deficiency and folate deficiency are more common in older people, affecting around 1 in 10 people aged 75 or over, and 1 in 20 people aged 65 to 74. Read about the causes of vitamin B12 or folate deficiency anaemia Treating vitamin B12 or folatedeficiency anaemia Most cases of vitamin B12 and folate deficiency can beeasily treated with injections or tablets to replace themissing vitamins. Vitamin B12 supplements are usually given by injection at first. Then, depending on whether your B12 deficiency is related to your diet, youll either require B12 tablets between mealsor regular injections. These treatments may be needed for the rest of your life. Folic acid tablets are used to restore folate levels. These usually need to be taken for four months. In some cases, improving your diet can help treat the condition and prevent it recurring. Vitamin B12 is found in meat, fish, eggs,dairy products, yeast extract (such as Marmite) and specially fortified foods. The best sources of folate include green vegetables such as broccoli, Brussels sprouts and peas. Read about treating vitamin B12 or folate deficiency Complications of vitamin B12 or folate deficiency anaemia Although its uncommon, vitamin B12 or folate deficiency (with or without anaemia) can lead to complications, particularly if youve been deficient in vitamin B12 or folate for some time. Potential complications can include: problems with the nervous system temporary infertility heart conditions pregnancy complications and birth defects Adults with severe anaemia are also at risk of developing heart failure. Somecomplications improve with appropriate treatment, but others  such as problems with the nervous system  can be permanent. Read about the complications of vitamin B12 or folate deficiency anaemia Symptoms of vitamin B12 or folate deficiency anaemia Vitamin B12 or folate deficiency anaemia can cause a wide range of symptoms. These usually develop gradually but can worsen if the condition goes untreated. Anaemia is whereyou have fewer red blood cells than normal oryou havean abnormally low amountof a substance called haemoglobin in each red blood cell. General symptoms of anaemia may include: extreme tiredness (fatigue) lack of energy (lethargy) breathlessness feeling faint headaches pale skin noticeable heartbeats (palpitations) hearing soundscoming from inside the body, rather than from an outside source ( tinnitus ) loss of appetite and weight loss Symptoms of vitamin B12deficiency If you have anaemia caused by a vitamin B12 deficiency, you may have othersymptoms in addition to those listed above, such as: a pale yellow tinge to your skin a sore and red tongue (glossitis) mouth ulcers pins and needles (paraesthesia) changes in the way that you walk and move around disturbed vision irritability depression changes in theway you think, feel and behave a decline in your mental abilities, such asmemory, understanding and judgement ( dementia ) Some of these symptoms can also occur in people who have a vitamin B12 deficiency, but have not developed anaemia. Symptoms of folate deficiency Additional symptoms in people withanaemia caused by a folate deficiency can include: symptoms related to anaemia reduced sense of taste diarrhoea numbness and tingling in the feet and hands muscle weakness depression When to see your GP See your GP if youre experiencing symptoms of vitamin B12 or folate deficiency anaemia.These conditions can often be diagnosed based on your symptoms and the results of a blood test. Read more about diagnosingvitamin B12 or folate deficiency anaemia Its important forvitamin B12 or folate deficiency anaemia to be diagnosed and treated as soon as possible. Although many of the symptoms improve with treatment, some problems caused by the condition can be irreversible if left untreated. The longer the condition goes untreated, the higher the chance of permanent damage. Causes of vitamin B12 or folate deficiency anaemia Vitamin B12 or folate deficiency anaemia occurs when a lack of either of these vitamins affects the bodys ability to produce fully functioning red blood cells. Red blood cells carry oxygen around the body. Most people withvitamin B12 or folate deficiency anaemia have underdeveloped red blood cells that arelarger than normal. The medical term for this is megaloblastic anaemia. A vitamin B12 or folate deficiency can be the result of a variety of problems, some of which are described below. Causes of vitamin B12 deficiency Pernicious anaemia Pernicious anaemia is the most common cause of vitamin B12 deficiency in the UK. Pernicious anaemia is an autoimmune condition that affects your stomach. An autoimmune condition meansyourimmune system (the bodys natural defence system that protects against illness and infection) attacks your bodys healthy cells. In your stomach, vitamin B12is combined withaprotein called intrinsic factor. This mix of vitamin B12 and intrinsic factor is then absorbed into the body in part of the gut called the distal ileum. Pernicious anaemia causes your immune system to attack the cells in your stomach that produce the intrinsic factor, which meansyour body is unable to absorb vitamin B12. The exact causeof pernicious anaemia is unknown, but the condition is more common inwomen around 60 years of age, people with a family history of the condition and those with another autoimmune condition, such as Addisons disease orvitiligo. Diet Some people can develop a vitamin B12 deficiency as a result of not getting enough vitamin B12 from their diet. A diet that includes meat, fish and dairy products usually provides enough vitamin B12, but people who dont regularly eat these foods  such as those following avegan diet or who havea generallyvery poor diet  can become deficient. Stores of vitamin B12 in the body canlastaround two to four years without being replenished, so it can take a long time forany problems to develop after a dietary change. Conditions affecting the stomach Some stomach conditions or stomach operations can prevent the absorption ofenough vitamin B12. For example, agastrectomy (a surgical procedure where part of your stomach is removed) increases your risk of developing a vitamin B12 deficiency. Conditions affecting the intestines Some conditions that affect your intestinescan alsostop you from absorbing the necessary amount of vitamin B12. For example, Crohns disease (a long-term condition that causes inflammation of the lining of the digestive system) can sometimes mean your body doesntget enough vitamin B12. Medication Some types of medicine can lead to a reduction inthe amount of vitamin B12 in your body. For example, proton pump inhibitors (PPIs)  a medication sometimes used totreat indigestion  can make a vitamin B12 deficiency worse. PPIs inhibit the production of stomach acid, which is needed to release vitamin B12 from the food you eat. Your GP will be aware of medicines that can affect your vitamin B12 levels and will monitor you if necessary. Functional vitamin B12 deficiency Some people can experience problems related to a vitamin B12 deficiency, despite appearing to have normal levels of vitamin B12 in their blood. This can occur due to a problem known as functional vitamin B12 deficiency  where theres a problem with the proteins that help transport vitamin B12 between cells. This results inneurological complications involving the spinal cord. Causes of folate deficiency Folate dissolves in water, which means your body is unable to store it for long periods of time. Your bodys store of folate is usually enough to last four months. This means you need folate in your daily diet to ensure your body has sufficient stores of the vitamin. Like vitamin B12 deficiency anaemia, folate deficiency anaemia can develop for a number of reasons. Some are described below. Diet Goodsources of folate includebroccoli, Brussels sprouts, asparagus, peas, chickpeas and brown rice. If you dont regularly eat these types of foods, you may develop a folate deficiency. Folate deficiency caused by a lack of dietary folate is more common in people who have a generally unbalanced and unhealthy diet, people who regularly misuse alcohol and people following a fad diet that doesnt involve eating good sources of folate. Malabsorption Sometimes your body may be unable to absorb folate as effectively as it should. This is usually due to an underlying condition affecting your digestive system, such as coeliac disease . Excessive urination You may lose folate from your body if you urinate frequently. This can be caused by an underlying condition that affects one of your organs, such as: congestive heart failure  where the heart is unable to pump enough blood around the body acute liver damage  often caused by drinking excessive amounts of alcohol long-term dialysis  where a machine that replicates the kidney function is used to filter waste products from the blood Medication Some types of medicine reduce the amount of folate in your body, or make the folate harder to absorb. These include someanticonvulsants (medication used to treat epilepsy), colestyramine, sulfasalazine and methotrexate. Your GP will be aware of medicines that can affect your folate levels and will monitor you if necessary. Other causes Your body sometimes requires more folate than normal. This can cause folate deficiencyif you cant meet your bodys demands for the vitamin. Your body may need more folate than usual if you: are pregnant (see below) have cancer have a blood disorder  such as sickle cell anaemia (an inherited blood disorder which causes red blood cells to develop abnormally) are fighting an infection or health condition that causes inflammation (redness and swelling) Premature babies (born before the 37th weekof pregnancy) are also morelikely to develop a folate deficiency, because their developing bodies require higher amounts of folate than normal. Pregnancy If youre pregnant or trying to get pregnant, its recommended that you take a 400 microgram folic acid tablet every day until youre 12 weeks pregnant. This will ensure that both you and your baby have enough folate and help your baby grow and develop. Folic acid tablets are available with a prescription from your GP, or you can buy them over the counter from pharmacies, large supermarkets and health food stores. If youre pregnant and have another condition that may increase your bodys need for folate, such as those mentioned above, your GP will monitor you closely to prevent you from becoming anaemic. In some cases, you may need a higher dose of folic acid. For example, if you have diabetes, you should take a 5 milligrams (5mg or 5,000 micrograms) supplement of folic acid instead of the standard 0.4 milligrams (0.4mg or 400 micrograms). Read more about vitamins and minerals in pregnancy Diagnosing vitamin B12 or folate deficiency anaemia A diagnosis of vitamin B12 or folate deficiency anaemia can often be made by your GP based on your symptoms and the results of blood tests. Blood tests Different types of blood tests can be carried out tohelp identify people with a possiblevitamin B12 or folate deficiency. These tests check: whether you have a lower level of haemoglobin (a substance that transports oxygen)than normal whether your red blood cells are larger than normal the level of vitamin B12 in your blood the leveloffolate in your blood However, some people can have problems with their normal levels of these vitaminsor mayhave low levels despite having no symptoms.This is why its important for your symptoms to be taken into account when a diagnosis is made. A particular drawback of testing vitamin B12 levels is that the current widely-used blood test only measures the total amount of vitamin B12 in your blood. This meansit measuresforms of vitamin B12 that are active and can be used by your body, as well as the inactive forms, which cant. If a significant amount of the vitamin B12 in your blood is inactive, a blood test may show that you have normal B12 levels,even though your body cant use much of it. There are some types of blood test thatmay help determine if the vitamin B12 in your blood can be used by your body, but these arent yet widely available. Identifying the cause If your symptoms and blood test results suggest a vitamin B12 or folate deficiency, your GP may arrange further tests. If the cause can be identified,it willhelpto determine the most appropriate treatment. For example,you may have additional blood tests to check for a condition called pernicious anaemia. This is an autoimmune condition (where your immune system produces antibodies to attack healthy cells), which means youre unable to absorb vitamin B12 from the food you eat. Tests for pernicious anaemia arent always conclusive, but they can oftengive your GP a good idea of whether you have the condition. Referral to a specialist You may be referred to a specialist for further tests or treatment. This may include: ahaematologist (specialist in treating blood conditions) if you have vitamin B12 or folate deficiency anaemia and your GP is uncertain of the cause, youre pregnant or symptoms suggest your nervous system has been affected agastroenterologist (specialist in conditions that affect the digestive system) if your GP suspects you dont have enough vitamin B12 or folate because your digestive system isnt absorbing it properly adietitian (specialist in nutrition)  if your GP suspects youhave a vitamin B12 or folate deficiency caused by a poor diet Adietitian can devise a personalised eating plan for you to increase the amount of vitamin B12 or folate in your diet. Treating vitamin B12 or folate deficiency anaemia The treatment for vitamin B12 or folate deficiency anaemia depends on whats causing the condition. Most people can be easily treated with injections or tablets to replace the missing vitamins. Treating vitamin B12 deficiency anaemia Vitamin B12 deficiency anaemia is usually treated with injections of vitamin B12, in a form called hydroxocobalamin. At first, youll have these injections every other day for two weeks, or until your symptoms have stopped improving. Your GP or nurse will give the injections. After this initialperiod, yourtreatment will depend on whether the cause of your vitamin B12 deficiency is related to your diet. The most common cause of vitamin B12 deficiency in the UK is pernicious anaemia, which isnt related to your diet. Read more about the causes of vitamin B12 or folate deficiency Diet-related If your vitamin B12 deficiency is caused by a lack of the vitamin in your diet, you may be prescribed vitamin B12 tablets to take every day between meals. Alternatively, you may need to have an injection of hydroxocobalamin twice a year. People who find it difficult to get enough vitamin B12 in their diets, such asthose following a vegan diet, may need vitamin B12 tablets for life. Although its less common, peoplewith vitamin B12 deficiency caused by a prolonged poor diet may be advisedto stop taking the tablets once their vitamin B12 levels have returned to normal andtheir diet has improved. Good sources of vitamin B12 include: meat salmon and cod milk and other dairy products eggs If youre a vegetarian and vegan, orare looking for alternatives to meat and dairy products, there are other foods that contain vitamin B12, such as yeast extract (including Marmite), as well as some fortified breakfast cereals and soy products. Check the nutrition labels while food shopping to see how much vitamin B12different foods contain. Not diet-related If your vitamin B12 deficiency isnt caused by a lack of vitamin B12 in your diet, youll usually need to have an injection of hydroxocobalamin every three months for the rest of your life. If youve had neurological symptoms (symptoms that affect your nervous system, such as numbnessor tingling in your hands and feet) caused by a vitamin B12 deficiency, youll be referred to a haematologist, and you may need to have injections every two months. Your haematologist will adviseonhow long you need to keep taking the injections. Forinjections of vitamin B12 given in the UK, hydroxocobalamin is preferred to an alternative called cyanocobalamin. This is because hydroxocobalamin stays in the body for longer. If you need regular injections of vitamin B12, cyanocobalaminwould need to be given once a month, whereas hydroxocobalamin can be given every three months. Cyanocobalamin injections arent routinely available on the NHS. However, if you need replacement tablets of vitamin B12, these will be cyanocobalamin. Treating folate deficiency anaemia To treat folate deficiency anaemia, your GP will usually prescribe daily folic acidtablets to build up your folate levels. They may also give youdietary advice so you can increase your folate intake. Good sources of folate include: broccoli Brussels sprouts asparagus peas chickpeas brown rice Most people need to take folic acid tablets for about four months. However, if the underlying cause of your folate deficiency anaemia continues, you may have to take folic acid tablets for longer  possibly for life. Before you start taking folic acid, your GP will check your vitamin B12 levels to make sure theyre normal. This is because folic acid treatment can sometimes improve your symptoms so much that it masks an underlying vitamin B12 deficiency. If a vitamin B12 deficiency isnt detected and treated, it could affect your nervous system. Monitoring your condition To ensure your treatment is working, you may need to have further blood tests . Ablood test is often carried out around 10-14 days after starting treatment to assess whether treatment is working. Thisis to check your haemoglobin level and the number of the immature red blood cells (reticulocytes) in your blood. Another blood test may also be carried out after approximately eight weeks to confirm your treatment has been successful. If youve been taking folic acid tablets, you may be tested again once the treatment has finished (usually after four months). Most people who have had a vitamin B12 or folate deficiency wont need further monitoring unless their symptoms return, or their treatment is ineffective. If your GP feelsits necessary, you may have to return for an annual blood test to see whether your condition has returned. Complications of vitamin B12 or folate deficiency anaemia As most cases of vitamin B12 deficiency or folate deficiency can be easily and effectively treated, complications are rare. However, complications can occasionally develop, particularly if youve been deficientin either vitaminfor some time. Anaemia complications All types of anaemia, regardless of the cause, can lead to heart and lung complications as the heart struggles to pump oxygen to the vital organs. Adults with severe anaemia are at risk of developing: an abnormally fast heart beat(tachycardia) heart failure  where the heart fails to pump enough blood around the body at the right pressure Complications of vitamin B12 deficiency A lack of vitamin B12 (with or without anaemia) can cause the following complications: Neurological changes A lack of vitamin B12 can cause neurological problems (issues affecting your nervous system), such as: vision problems memory loss pins and needles (paraesthesia) loss of physical coordination (ataxia), which can affect your whole body and cause difficulty speaking or walking damage to parts of the nervous system ( peripheral neuropathy ), particularly in the legs If neurological problems do develop, they may be irreversible. Infertility Vitamin B12 deficiency can sometimeslead to temporary infertility (an inability to conceive). Thisusually improves with appropriate vitamin B12 treatment. Stomach cancer If you have a vitamin B12 deficiency caused by pernicious anaemia (a condition where your immune system attacks healthy cells in your stomach), your risk of developing stomach cancer is increased. Neural tube defects If youre pregnant, not having enough vitamin B12 can increase the risk of your baby developing a serious birth defect known as aneural tube defect. The neural tube is a narrow channel that eventuallyforms the brain and spinal cord. Examples of neural tube defects include: spina bifida  where the babys spine doesnt develop properly anencephaly  wherea baby is born without parts of the brain and skull encephalocele  where a membrane or skin-covered sac containing part of the brain pushes out of a hole in the skull Complications of folate deficiency A lack of folate (with or without anaemia) can also cause complications, some of which are outlined below. Infertility As with a lack of vitamin B12, a folate deficiency can also affect your fertility. However,this is only temporary and can usually be reversedwith folate supplements. Cardiovascular disease Research has showna lack of folate in your body may increase your risk of cardiovascular disease (CVD) . CVD is a general term that describes a disease of the heart or blood vessels, such as coronary heart disease (CHD) . Cancer Research has shown that folate deficiency can increase your risk of some cancers, such as colon cancer . Problems in childbirth Alack of folate during pregnancy may increase the risk of the baby being born prematurely (before the 37th week of pregnancy) or having a low birthweight. The risk ofplacental abruption may also be increased. Thisis a serious condition where the placenta starts to come away from the inside of the womb wall, causing tummy (abdominal) pain and bleeding from the vagina. Neural tube defects As with a vitamin B12 deficiency, a lack of folate can also affect an unborn babys growth and development in the womb (uterus). This increases the risk of neural tube defects such as spina bifida developing in the unborn baby. Source: NHS 24 - Opens in new browser window Last updated: 21 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Iron deficiency anaemia Blood tests Other health sites Pernicious Anaemia Society British Nutrition Foundation NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Vomiting in adults,"Vomiting in adults | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Vomiting in adults Vomiting in adults Return to Symptoms Enter age Last Updated: Next Review Date: Review my answers Find your local services Search for a service near you by entering your postcode below. Please input your postcode in the following format: A12 1BC GP Practices Dental Services Pharmacies Opticians Postcode Search NHS inform has more information on this condition. Read more Previous Start guide Review my answers  You told us your credentials were: : You said: Based on the information you gave us, we made the following recommendation: Close Keep a copy View PDF Nausea and vomiting in adults isnt usually a sign of anything serious. It tends to only last 1 or 2 days. Vomiting is the bodys way of getting rid of harmful substances from the stomach, or it may be a reaction to something that has irritated the gut. One of the most common causes of vomiting in adults is gastroenteritis . This is an infection of the gut usually caused by bacteria or a virus. Itll normally improve within a few days. Vomiting can occasionally be a sign of something more serious, such as appendicitis . There is a separate page on vomiting in children and babies . Vomiting self-help guide Complete our self-help guide to check your symptoms and find out what to do next. Phone 999 or go to A&E if: Youre vomiting and you also have: sudden, severe abdominal (tummy) pain severe chest pain blood in your vomit or what looks like coffee granules have green or yellow-green vomit a stiff neck and high temperature (fever) a sudden, severe headache thats unlike any headache youve had before swallowed something poisonous, or think you may have have a stiff neck and pain when looking at bright lights Speak to your GP if: youve been vomiting repeatedly for more than a day or two youre unable to keep down any fluids because youre vomiting repeatedly you have signs of severe dehydration , such as confusion, a rapid heartbeat, sunken eyes and passing little or no urine youve lost a lot of weight since you became ill you experience episodes of vomiting frequently youre worried about your vomiting and are feeling very unwell you have diabetes and have been vomiting a lot, particularly if you take insulin as it can affect your blood sugar level Common causes of vomiting in adults Gastroenteritis If you have diarrhoea as well as vomiting, its likely you have gastroenteritis. This is one of the most common causes of vomiting in adults. Its often caused by: a virus, like norovirus food poisoning caused by bacteria in contaminated food Your immune system will usually fight off the infection after a few days. Pregnancy Pregnant women often experience nausea and vomiting, particularly during the early stages of pregnancy. This is often called morning sicknessbut it can happen at any time of the day. Migraines If you have recurrent episodes of vomiting along with intense, throbbing headaches that last for a few hours to days at a time, you may be experiencing migraines . Pain relief, such as paracetamol and ibuprofen , can sometimes help control the pain. Your GP can prescribe anti-sickness medicine to help prevent vomiting. Labyrinthitis If you also feel dizzy, or feel like youre spinning ( vertigo ), you may have an inner ear infection called labyrinthitis . Labyrinthitis will usually improve over a few days. Your GP can prescribe medication to reduce your symptoms if needed. Motion sickness Nausea and vomiting when travelling could be a sign of motion sickness. You can try: looking at the horizon distracting yourself by listening to music Appendicitis As well as vomiting, appendicitis can cause severe pain in your abdomen (tummy). You should phone 999 for an ambulance if you experience pain that suddenly becomes worse and spreads across your abdomen. These are signs that you appendix may have burst. If you have appendicitis, you will often need surgery to remove your appendix. Other causes of vomiting in adults Vomiting in adults can also be caused by a number of other things, including: certain medicines, such as antibiotics and opioid painkillers drinking too much alcohol kidney infections and kidney stones a blockage in your bowel, which may be caused by a hernia or gallstones chemotherapy or radiotherapy acute cholecystitis (inflammation of the gallbladder) Looking after yourself at home Mostly, you can take care of yourself at home until you feel better. Do keep taking small sips of water frequently so you dont become dehydrated drink a sweet drink such as fruit juice to replace lost sugar, unless it make you feel sick eat salty snacks, such as crisps, which can help replace lost salt try ginger (in supplements, biscuits or tea)  but check with your pharmacist or GP before using ginger supplements Source: NHS 24 - Opens in new browser window Last updated: 29 May 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Dehydration NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Vulval cancer,"Vulval cancer - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Vulval cancer Vulval cancer About vulval cancer Causes of vulval cancer Diagnosing vulval cancer Treating vulval cancer About vulval cancer Cancer of the vulva is a rare type of cancer that affects women and anyone with a vulva. The vulva is a womans external genitals. It includesthe lips surrounding the vagina (labia minora and labia majora), the clitoris (sexual organthat helps reach sexual climax), and the Bartholins glands (2small glands each side of the vagina). Most of those affected by vulval cancer are older women and anyone with a vulva over the age of 65. The condition is rare in women and anyone with a vulva under 50 who have not yet gone through the menopause . Symptoms of vulval cancer Symptoms of vulval cancer can include: a persistent itch in the vulva pain, soreness or tendernessinthe vulva raised and thickened patches of skin that canbe red, white or dark a lump or wart-like growth on the vulva bleeding from the vulva orblood-stainedvaginal discharge between periods an open sore in the vulva a burning painwhen passing urine amole on the vulva that changes shape or colour Speak to your GP if you notice any changes in the usual appearance of your vulva. While its highly unlikely to be the result ofcancer, these changes should be investigated. Read more about diagnosing vulval cancer . What causes vulval cancer? The exact cause of vulval cancer is unclear, but your risk of developing the conditionis increased by the following factors: increasing age vulval intraepithelial neoplasia (VIN)  where the cellsin the vulva are abnormal and at risk of turning cancerous persistent infection with certain versionsof thehuman papilloma virus (HPV) skin conditions affecting the vulva,such aslichen sclerosus smoking You may be able to reduce your risk of vulval cancer by stopping smoking and taking steps to reduce the chances of picking up an HPV infection. Read more about the causes of vulval cancer . How vulval cancer is treated The main treatment for vulval cancer is surgery to remove the cancerous tissue from the vulva and any lymph nodes containing cancerous cells. Some people may also have radiotherapy (where radiation is used to destroy cancer cells) or chemotherapy (where medication is used to kill cancer cells), or both. Radiotherapy and chemotherapy may be used without surgery if youre not well enough to have an operation, or ifthe cancer has spread and it isnt possible to remove it all. Read more about treating vulval cancer . Canvulval cancer be prevented? Its not thought to be possible to prevent vulval cancer completely, but you may be able to reduce your risk by: practisingsafer sex using a condom during sex can offer some protection against HPV attending cervical screening appointmentscervical screening can detect HPV and pre-cancerous conditions such as VIN stopping smoking The HPV vaccination may also reduce your chances of developing vulval cancer. This is offered to all girlswho are 12 to 13 years old as part of their routine childhood immunisation programme. Causes of vulval cancer Cancer occurs when the cells in a certain area of your body divide and multiply too rapidly. This produces a lump of tissue known as a tumour. The exact reason why this happens in cases of vulval cancer is unknown, but certain things can increase your chances of developing the condition. These include: increasing age vulval intraepithelial neoplasia (VIN) human papilloma virus (HPV) infection skin conditions that can affect the vulva, such aslichen sclerosus smoking Increasing age The risk of developing vulval cancer increases as you get older. Most cases develop in women and anyone with a vulva aged 65 or over. Very occasionally women and anyone with a vulva under 50 can be affected. Vulval intraepithelial neoplasia (VIN) Vulval intraepithelial neoplasia (VIN) is a pre-cancerous condition. This meansthere are changes to certain cells in the vulva that arent cancerous, butcould potentially turn into cancer at a later date. This is a gradual process thatusually takes well over 10 years. In some cases, the abnormal cells may go away by themselves. However, because of the risk of cancer, treatment to remove the affected cells is often recommended. Symptoms ofVINare similar to those of vulval cancer, and include persistent itchinessof the vulva and raised discoloured patches. Speak to your GP if you have these symptoms. There are 2types ofVIN: usual or undifferentiated VIN  thisusually affectswomen and anyone with a vulva under 50 and is thought to be caused by an HPV infection differentiated VIN (dVIN)  this is a rarer type, usually affecting women and anyone with a vulva over 60, associated with skin conditions that affect the vulva Human papilloma virus (HPV) Human papilloma virus (HPV) is the name given to a group of viruses that affect the skin and the moist membranes that line the body, such as those in the cervix, anus, mouth and throat.Its spread during sex, including anal and oral sex. There are many different types of HPV, and mostpeople are infected with the virus at some time during their lives. In most cases, the virus goes away without causing any harm and doesnt lead to further problems. However, HPV is present in at least 40% of people with vulval cancer, which suggests it may increase your risk of developing the condition. HPV is known to cause changes in the cells of the cervix, which can lead to cervical cancer . Its thought the virus could have a similar effect on the cells of the vulva, which isknown as VIN. Skin conditions Several skin conditions can affect the vulva. In a small number of cases these are associated with an increasedrisk of vulval cancer. Two of the main conditions associated with vulval cancer are lichen sclerosus and lichen planus . Both of these conditions cause the vulva to become itchy, sore and discoloured. Its estimated that less than 5% of those who develop one of these conditions will go on to develop vulval cancer. Its not clear whether treating these conditions reduces this risk. Smoking Smoking increases your risk of developing VIN and vulval cancer. This may be becausesmoking makes the immune system less effective, and less able to clear the HPV virus from your body and more vulnerable to the effects of the virus. Diagnosing vulval cancer Speak to your GP if you notice any changes in the normal appearance of your vulva. Your GP will ask you about your symptoms, look at your medical history, andexamine your vulva to look for any lumps or unusual areas of skin. If you would prefer to be examined by afemale doctor or you would like a nurse present during the examination, it may help to let your GP practice know in advance of your appointment. Referral to a gynaecologist If your GP feels some further tests are necessary, they will refer you to a hospital specialist called a gynaecologist. A gynaecologist is a specialist in treating conditions of the female reproductive system. The National Institute for Health and Care Excellence ( NICE ) recommends that GPs consider referring a woman who has an unexplained vulval lump orulcer, or unexplained bleeding. The gynaecologistwillaskabout your symptoms and examine your vulva again, and they may recommendatest called a biopsy to determine whether you do have cancer. Biopsy A biopsy is wherea small sample oftissue is removed so it can be examined under a microscope to see if the cells are cancerous. This is often doneafter a local anaesthetic has been given to numb the area, whichmeans the procedure shouldnt be painful and you can go home the same day. Occasionally, it may be done under general anaesthetic (where youre asleep), which may require an overnight stay in hospital. Your doctor may put a few stitches in the area where the biopsy was taken from.You may have slight bleeding and soreness for a few days afterwards. Your doctor will usually see you 7to 10 days later to discuss the results with you. Further tests If the results of the biopsy show cancer, you may need further tests to assess how widespread it is. These may include: a colposcopya procedure where a microscope is used to check for abnormal cells in the vagina a cystoscopy an examination of the inside of the bladder using a thin, hollowtubeinserted into the bladder a proctoscopy  an examination of the inside of the rectum biopsies of the lymph nodes near your vulvatocheck whether cancer has spread through your lymphatic system a computerised tomography (CT) scan or magnetic resonance imaging (MRI) scan  scans to check for signs of cancer in your lymph nodes or other organs an X-ray to check that cancer has not spread to your lungs The results of these tests will allow your doctor to stage your cancer. This means using a number system to indicate how far the cancer has spread. Staging Vulval cancers are staged using a number from 1 to 4. The lower the stage, the less the cancer has spread and the greater the chance of treatment being successful. The staging system for vulval cancer is: stage 1  the cancer is confined to the vulva stage 2 the cancer has spread to other nearby parts of the body, such as the lower vagina, anus or lower urethra (the tube urine passes throughout of the body), but the lymph nodes are unaffected stage 3  the cancer has spread into nearby lymph nodes stage 4  the cancer has spreadto other parts of the body, including more distant lymph nodes Stage 1 and 2 vulval cancers are generally regarded as early-stage cancers with a relatively good chance of being treated successfully. Stage 3 and 4 cancers are usually regarded as advanced-stage cancers and a complete cure for these types of cancers may not always be possible. Treating vulval cancer Treatment for vulval cancer depends on factors such as how far the cancer has spread, your general health, and personal wishes. The mainoptions are surgery, radiotherapy and chemotherapy . Many women and anyone with a vulva with vulval cancer have a combination of these treatments. If your cancer is at an early stage, its often possible to get rid of it completely.However, this may not be possible if the cancer has spread. Even after successful treatment, there is up to a 1in 3chance of the cancer returning at some point later on, so youll need regular follow-up appointments to check for this. Your treatment plan Most hospitals use multidisciplinary teams (MDTs) to treat vulval cancer. MDTs are teams of specialists that work together to make decisions about the best way to proceed with your treatment. Members of your MDT will probably include a specialist surgeon, a specialist in the non-surgical treatment of cancer (clinical oncologist) and a specialist cancer nurse. Deciding which treatment is best for you can often be confusing. Your cancer team will recommend what they think is the best treatment option, but the final decision will be yours. Before visiting hospital to discuss your treatment options, you may find it useful to write a list of questions you would like to ask the specialist. For example, you may want to find out the advantages and disadvantages of particular treatments. Surgery to remove vulval cancer In most cases, your treatment plan will involve some form of surgery. The type of surgery will depend on the stage of the cancer. There are 3surgical options to treat vulval cancer: radical wide local excision the cancerous tissue from your vulva is removed, as a well as a margin of healthy tissue, usually at least1cm wide, as a precaution radical partial vulvectomy  a larger sectionofyour vulva is removed, such as 1 or both of the labia and the clitoris radical vulvectomy  thewhole vulva is removed, including the inner and outer labia, and possibly the clitoris The time it will take you to recover from surgery will depend on the type of surgery and how extensive it was. For extensive operations, such as a pelvic exenteration, it may be many weeks or monthsbefore you start tofeel better. Your surgeon will talk to you about the possible risks associated with the type of procedure youre having. Possible risks include infection, bleeding, blood clots, altered sensation in your vulva, and problems having sex. Assessing and removing groin lymph nodes An additional operation may also be required to assess whether the cancerous cells have spread into one or more lymph nodes in your groin, and remove these if theyre found to contain cancer. Sentinel node biopsy If the cancer has spread to nearby lymph nodes, its sometimes possible to only remove certain lymph nodes, known assentinel nodes. Sentinelnodes are identified by injecting a dye at the site of the tumour and studyingits flowto locate the nodes closest to the tumour. These are then removed and checked for cancerous cells. Groin lymphadenectomy In some cases, some or all of the nodes in your groinmay need to be surgically removed. This is called a groin oringuinofemoral lymphadenectomy. Further treatment with radiotherapy may also berecommended. Removing cancerous lymph nodesreduces the risk of the cancer returning, but it can make you more vulnerable to infection and cause swelling in your legs from a build-up of lymphatic fluid (lymphoedema) . Pelvic exenteration In cases of advanced vulval cancer or where the cancer returns after previous treatment, an operation called a pelvic exenteration may be recommended. This involves removing your entire vulva as well as your bladder, womb and part of your bowel. This is a major operation and isnt carried out very often these days. If a section of your bowel is removed, it will be necessary for your surgeon to divert your bowel throughan opening made in your tummy (a stoma). Stools then pass along this piece of bowel and into a bag you wear over the stoma. This is known asa colostomy . If your bladder is removed, urine can be passed out of your body into a pouch via a stoma. This isknown as a urostomy. Alternatively,it may be possible to create a new bladder by removing a section of your bowel and using it to create a pouch to store urine in. Reconstructive surgery If only a small amount of tissue has been removed during surgery, the skin of the vulvacan often be neatly stitched together. Otherwise, it may be necessary to reconstruct the vulva using askin graft,where a piece of skin is taken from your thigh ortummy and moved tothe wound in yourvulva. Another option is to have askin flap, whereanarea of skin near the vulva is used to create a flap andcover the wound. These reconstructive procedures are usually carried out at the same time as the operation to remove the cancer. Radiotherapy Radiotherapy involves using high-energy radiation to destroy cancerous cells. There are several ways itcan be used to treat vulval cancer: before surgery totrytoshrink a large cancer this is tohelp make the operation possible without removing nearby organs after surgeryto destroy any cancerous cells that may be left for example, for cases where cancer cellshave spread to the lymph nodes in the groin as an alternative to surgery, if youre not well enough to have an operation to relieve symptoms in cases where a complete cure is not possible  this is known as palliative radiotherapy In most cases, youll have external radiotherapy, where a machine directs beams of radiationon to the section of the body that contains the cancer. Thisis normally given in daily sessions, 5days a week, with each session lasting a few minutes.The whole course of treatment will usually last a few weeks. Side effects While radiation is effective in killing cancerous cells, it can also damage healthy tissues. This canlead to a number of side effects, such as: sore skin around the vulva area diarrhoea feeling tired all the time loss of pubic hair, which may be permanent swelling of the vulva narrowing of your vagina, which can make sex difficult inflammation of your bladder (cystitis) In younger people, external radiotherapy can sometimes trigger an early menopause .This means theywill no longer be able to have any children. Read more about the side effects of radiotherapy . Chemotherapy Chemotherapy is where medication is used to kill cancer cells. Its usually given by injection. Its usually used if vulval cancer comes back or to control symptoms when a cure is not possible. Sometimes it may be combined with radiotherapy. Side effects The medicines used in chemotherapy can sometimes damage healthy tissue, as well as the cancerous tissue. Side effects are common and include: tiredness feeling and beingsick hair thinning orhairloss sore mouth and mouth ulcers an increased risk of infections  tell your care team if you develop any symptoms of an infection, and try to avoid close contact with people known to have an infection These side effects should pass once treatment has finished. Read more about the side effects of chemotherapy . Emotional support The emotional impact of living with vulval cancer can be significant. Many people report experiencing a kind of rollercoaster effect. You may feel down at receiving a diagnosis, feel up when the cancer has been removed from your body, and then feel down again as you try to come to terms with the after-effects of surgery. Some people experience feelings of depression . If you think you may be depressed, contact your GP or care team for advice. There are a range of treatments that can help. You may also find it useful to contact one of the main cancer charities, such as: Macmillan Cancer Support  the helplineis availableon 0808 808 00 00, Monday to Friday, 9am to 8pm Cancer Research UK  a cancer nurse helpline is availableon 0808 800 4040, Monday to Friday, 9am to 5pm Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Radiotherapy Other health sites Cancer Research UK: Vulval cancer Macmillan Cancer Support: Understanding vulval cancer The Eve Appeal: vulval cancer Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Warts and verrucas,"Warts | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Skin, hair and nails Warts and verrucas Warts and verrucas Warts are small lumps that often develop on the skin of the hands and feet. They vary in appearance and may develop singly or in clusters. Most people will have warts at some point in their life. They tend to affect children and teenagers more than adults. Warts are caused by certain strains of the human papilloma virus (HPV). More images of warts Warts can develop on the hands and feet Source: dermnetnz.org Wart on finger Source: dermnetnz.org Cause of warts and verrucas Warts are caused by certain strains of the human papilloma virus (HPV). There are lots of different strains of HPV and these cause different types of warts. HPV causes too much keratin (a hard protein) to develop in the top skin layer (epidermis). The extra keratin produces the rough, hard texture of a wart. How warts spread HPV is passed on through close skin-to-skin contact. It can also be passed on indirectly by contact with contaminated objects like: towels shoes areas surrounding swimming pools the floors of communal changing areas Youre more likely to get infected if your skin is wet or damaged. Warts can also be spread to other parts of your own body. You can spread the virus if you: scratch, knock or bite a wart bite your nails or suck your fingers (if they have warts on them) shave your face or legs After you become infected, it can take weeks or even months for a wart or verruca to appear. When to get help Warts and verrucas arent usually serious and can be treated by a pharmacist. Your pharmacist will give you advice about the best treatment for you. Find your nearest pharmacy Speak to a GP if you have a: growth on your skin that youre worried about wart or verruca that keeps coming back wart or verruca thats very large or painful wart that bleeds wart that changes in how it looks wart on your face or genitals Types of wart There are several different types of warts. These vary in size and shape. Common warts (verruca vulgaris) Source: dermnetnz.org If you have a common wart, it will: be round or oval-shaped be firm and raised have a rough, irregular surface often develop on the knuckles, fingers and knees vary in size, from less than 1mm to more than 10mm (1cm) in diameter You may develop one common wart or several. Filiform warts (verruca filiformis) Source: dermnetnz.org Filiform warts are long and slender in appearance. They often develop on the neck or face. Mosaic warts Mosaic warts grow in clusters and form a tile-like pattern. They often develop on the palms of the hands and soles of the feet. Periungual warts Source: dermnetnz.org Periungual warts develop under and around the fingernails or toenails. They: have a rough surface can affect the shape of the nail can be painful Plane warts Source: dermnetnz.org Its possible to have between one and several hundred plane warts, which can develop in clusters. They are usually: a yellowish colour smooth, round and flat-topped 2 to 4mm in diameter common in young children  mainly affecting the hands, face and legs Plane warts can sometimes develop on the lower legs of women. This is because the human papilloma virus (HPV) can be spread through shaving. Verrucas (plantar warts) Verrucas usually develop on the soles of the feet. The affected area of skin will be: white, often with a black dot (blood vessel) in the centre flat rather than raised Verrucas can sometimes be painful if theyre on a weight-bearing part of th Treating warts and verrucas Warts usually clear up without treatment. The length of time it takes for a wart to disappear will vary from person to person. It can take up to 2 years for the virus to leave your system and for warts to disappear. Warts tend to last longer in older children and adults. Leaving the wart to go away by itself is one option. But, you may want to consider treatment if your wart is: painful in an awkward position causing you distress or embarrassment A wart will sometimes return following treatment. Types of treatment Common ways to treat warts and verrucas include: salicylic acid  available from pharmacies in creams, gels, paints and medicated plasters cryotherapy  liquid nitrogen is applied to the wart to freeze and destroy affected skin cells chemical treatments  chemicals are applied to warts to kill affected skin cells Surgery is not usually recommended for warts. Preventing warts and verrucas There are steps you can take to lower your chances of getting warts, and prevent them spreading to others. Do keep your feet dry change your socks every day take care when shaving  the virus can be spread easily if you cut yourself wear gloves when using shared gym equipment if you have a wart on your hand wear pool slippers or flip flops in communal changing rooms and showers cover the wart or verruca with a waterproof plaster or a verruca sock when swimming or while doing PE at school Dont do not touch other peoples warts do not share towels, flannels or other personal items with someone who has a wart do not share shoes or socks with someone who has a verruca do not scratch or pick a wart or verruca  itll encourage the HPV to spread to other parts of your body Source: NHS 24 - Opens in new browser window Last updated: 07 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Search for a pharmacy near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Whooping cough,"Whooping cough | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Whooping cough Whooping cough Whooping cough, also called pertussis, is a highly contagious bacterial infection of the lungs and airways. It causes repeatedcoughing bouts that can last for 2 to 3months or more, and can make babies and young children in particular very ill. Whooping cough is spread inthe dropletsof the coughs or sneezes of someone with the infection. Symptoms of whooping cough The first symptomsof whooping cough aresimilar to those of a cold , such asa runny nose,red and watery eyes,a sore throat, anda slightly raised temperature. Intensecoughing bouts start about a week later. The boutsusually last a few minutes at a time and tend to be more common at night. Coughing usually brings up thickmucus and may be followed by vomiting. Between coughs, you or your child may gasp for breath thismay cause a whoop sound,although not everyone has this. The strain of coughing cancause thefaceto become very red, and there may be some slight bleeding under the skin or inthe eyes. Young children can sometimes brieflyturn blue (cyanosis)if they have trouble breathingthis often looks worse than it is and their breathing shouldstart againquickly. In very young babies, the cough may not be particularly noticeable, but there may be brief periods where they stop breathing. The bouts will eventually start to become less severe and less frequent over time,but it may be afewmonths before they stop completely. Whos at risk of whooping cough Whooping cough can affect people of any age, including: babies and young children young babies under 6 months of age are at a particularly increased risk ofcomplications of whooping cough older children and adults  it tends to be less serious in these cases, but can still be unpleasant andfrustrating people whove had whooping cough before  youre not immune to whooping coughif youve had it before, although it tends to be less severe the second time around people vaccinated against whooping cough as a child  protection from thewhooping cough vaccine tends to wear off after a few years You can get whooping cough if you come into close contact with someone with the infection. A person with whooping cough is infectious from about 6 days after they were infected when they just have cold-like symptoms until three weeks after the coughing bouts start. Antibiotic treatment can reduce the length of time someone is infectious. When to get medical advice Phone 999 or go to A&E if: You or your child: have significant breathing difficulties, such as long periods of breathlessness or choking, shallow breathing, periods where breathing stops, or dusky, blue skin develop signs of seriouscomplications of whooping cough, such as fits (seizures) or pneumonia Speak to your GP practice or phone 111 if: You or your child: have symptoms ofwhooping cough have had a cough for more than 3 weeks have a cough that is particularly severe or is getting worse Treatment for whooping cough Treatment for whooping cough depends on your ageand how long youve had the infection. Children under 6 months who are very ill and people with severe symptoms will usually be admitted to hospital for treatment. Peoplediagnosed during the first 3 weeks of infection may be prescribed antibiotics to take at home. These will help stop the infection spreading to others, but may not reducethe symptoms. People whove had whooping cough for more than 3 weeks wont normally need any specific treatment, as theyre no longer contagious and antibiotics are unlikelytohelp. While youre recovering at home, it can help to get plenty of rest, drink lots of fluids, clean away mucus and sick fromyour or your childs mouth, and take painkillers such as paracetamol or ibuprofen for a fever. Avoid using cough medicines, as theyre not suitable for young children and are unlikely to be of much help. Stopping the infection spreading If you or your child are taking antibiotics for whooping cough, you need to be careful not to spread the infection to others. Do stay away from nursery, school or work until 2 days after the start of antibiotic treatment or, if not taking antibiotics 3 weeks from when the coughing bouts started cover your or your childs mouth and nose with a tissue when coughing and sneezing dispose of used tissues immediately wash your and your childs hands regularly with soap and water Other members of your household may also be given antibiotics and adose of the whooping cough vaccine to stop them becoming infected. Vaccinations for whooping cough There are 3 routine vaccinations that can protect babies and children from whooping cough: the whooping cough vaccine in pregnancy this can protect your baby during the first few weeks of life;the best time to have it is soon after the 16th week of your pregnancy the 6-in-1 vaccineoffered to babies at 8,12 and 16 weeks of age the 4-in-1 pre-school booster offered to childrenby3 years and 4 months These vaccines dont offer lifelong protection from whooping cough, but they can help stopchildren getting it when theyre young and more vulnerable to the effects of the infection. Older children and adults arent routinely vaccinated, except during pregnancy or a whooping cough outbreak. Complications of whooping cough Babies and young children under 6 months are usually most severely affected by whooping cough. Theyre at anincreased risk of: dehydration breathing difficulties weight loss pneumonia  an infection of the lungs fits (seizures) kidney problems brain damage caused by a lack of oxygen reachingthe brain death although this is very rare Older children and adults tend to be less severely affected, although they may experience problems caused by repeated coughing, such as nosebleeds , bruised ribs or ahernia. Source: NHS 24 - Opens in new browser window Last updated: 04 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites MHRA study: safety of whooping cough vaccination in 20,000 pregnant women NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Wilms tumour,"""Wilms tumour | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in children Wilms tumour Wilms tumour Wilms tumour is a type of kidney cancer in children. It most often affects children under the age of 5. More children than ever are surviving childhood cancer. There are new and better drugs and treatments, and we can now also work to reduce the after-effects of having had cancer in the past. It is devastating to hear that your child has cancer, and at times it can feel overwhelming. There are many healthcare professionals and support organisations to help you through this difficult time. Understanding more about the cancer your child has and the treatments that may be used can often help parents to cope. Your childs specialist will give you more detailed information. If you have any questions its important to ask the specialist doctor or nurse who knows your childs individual situation. Wilms tumour is a type of kidney cancer that was named after Dr Max Wilms, who first described it. Its thought to come from very specialised cells in the embryo known as metanephric blastema. These cells are involved in the development of the childs kidneys while they are in the womb. The cells usually disappear at birth, but in many children with Wilms tumour, clusters of primitive kidneys cells, called nephrogenic rests can still be found. The kidneys are a pair of organs found at the back of the abdomen. They clean the blood by removing excess fluids and waste products, which are then converted into urine. Causes In most children, the causes of Wilms tumour are unknown. Very rarely, people who develop Wilms tumour have other specific conditions which are present at birth (congenital malformations). These include the lack of an iris in the eye (aniridia), abnormalities of the genitals, and a condition where one side of the body is slightly larger than the other (hemihypertrophy). In 1 in 100 people with Wilms tumour, another family member will also have Wilms tumour. Signs and symptoms The most common symptom is a swollen abdomen, which is usually painless. Sometimes a parent or carer may feel a lump in the abdomen which can be quite large. Occasionally, the tumour may bleed slightly and this can irritate the kidney and may be painful. There may be blood in your childs urine (pee), or their blood pressure may be raised. The child may also have a high temperature (fever), upset stomach, weight loss or a lack of appetite. How Wilms tumour is diagnosed A variety of tests and investigations may be needed to diagnose a Wilms tumour. An abdominal ultrasound scan is usually the first thing that is done. This will be followed by an MRI and/or CT scan of the abdomen and chest. These scans help doctors to identify exactly where the tumour is and whether it has spread beyond the kidney. This is known as staging. Urine and blood samples will also be taken to check your childs kidney function and general health. Most children will go on to have a biopsy , where a sample of tissue is taken from the tumour to confirm the diagnosis. Any tests and investigations that your child needs will be explained to you. Staging The stage of a cancer is a term used to describe its size and whether it has spread beyond its original site. Knowing the particular type and the stage of the cancer helps doctors decide on the most appropriate treatment. In the case of a Wilms tumour, the stage is finalised after surgery to remove the tumour. As most Wilms tumour patients receive chemotherapy before surgery, you may not know the exact stage of your childs tumour straight away. An exception is that babies under 6 months old usually have surgery straight away. Stage 1 The tumour is only affecting the kidney and has not begun to spread. It can be completely removed with surgery. Stage 2 The tumour has begun to spread beyond the kidney to nearby structures, but its still possible to remove it completely with surgery. Stage 3 The tumour has spread beyond the kidney; either because the tumour has burst before (or during) the operation, has spread to lymph glands (nodes), or has not been completely removed by surgery. Stage 4 The tumour has spread to other parts of the body such as the lungs or liver. Tumours in other parts of the body are known as metastases. Stage 5 There are tumours in both kidneys (bilateral Wilms tumour). If the tumour comes back after initial treatment, this is known as recurrent cancer or relapse. Treatment Treatment is planned by specialists in childrens tumours and cancers. This is usually based in a childrens oncology unit within a main hospital, but some treatment may be given closer to home. Treatment will depend on a number of factors including how the cells appear under the microscope (histology) and the stage of the tumour. Treatment may include chemotherapy, radiotherapy or surgery. Surgery All children with Wilms tumour will have surgery. Initially, this may only involve taking a small sample of cells from the tumour to confirm the diagnosis. This is called a biopsy and is usually done under a general anaesthetic using a needle inserted through the skin. Apart from very young children (under 6 months), most patients will receive chemotherapy before having a bigger operation to remove the entire tumour. The operation usually involves removing the whole of the affected kidney (nephrectomy). After examining the whole tumour under the microscope, Wilms tumours can be divided into a number of risk groups based on knowledge about how these different types of tumours are likely to behave. The treatment following surgery will depend on these risk groups. The risk groups are known as LOW, STANDARD (or INTERMEDIATE), and HIGH. The majority of tumours are in the standard risk group. So-called low risk tumours require less treatment than standard risk tumours. Two types of Wilms tumour  anaplastic and blastemal  are considered to be higher risk than other Wilms tumours and require more intensive (stronger) chemotherapy. Anaplastic Wilms tumour About 5% to 10% of Wilms tumours have an appearance called anaplasia, which means the cells look very disorganised under a microscope. Blastemal Wilms tumour This group of high-risk tumours cannot be identified by looking at the biopsy because they occur when a particular type of early kidney cell survives the pre-surgery chemotherapy. These cells are known as blastemal cells. Tumours, where most of these cells survive chemotherapy, are called blastemal tumours. Other kidney tumours Other, less common types of kidney tumours may occur in children. These are usually only recognised after surgery to obtain a tumour sample. Clear cell sarcoma and malignant rhabdoid tumour of the kidney are 2 types of cancerous tumour, with their own treatment recommendations. Congenital mesoblastic nephroma is a non-cancerous (benign) tumour that occurs in very young children. This type of tumour usually only needs surgery and no other treatment. Chemotherapy Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. Its usually given as an injection or drip into a vein (intravenously). Chemotherapy given before surgery is called neoadjuvant chemotherapy. What doctors find out about the tumour after surgery for example, how the cells look under the microscope and how far the cancer has spread  helps them to decide whether additional chemotherapy should be given (adjuvant chemotherapy). This is to help reduce the risk of the cancer coming back (recurring). This chemotherapy may be given as inpatient or outpatient depending on tumour staging and risk group. Radiotherapy Radiotherapy treats cancer by using high-energy rays to destroy the cancer cells, while doing as little harm as possible to normal cells. Not all children with Wilms tumour need radiotherapy. For those that do, the area to be treated depends on the stage of the tumour at diagnosis. Some children receive radiotherapy to the area around the affected kidney or, less commonly, to the whole abdomen. If the tumour has spread to the lungs, then lung radiotherapy may be needed but this depends on how well the cancer responds to initial chemotherapy; its not always needed. Radiotherapy may occasionally be used to shrink tumours that are too large to remove surgically. This will, ideally, allow an operation to be done. Radiotherapy can also be used when tumours have spread elsewhere in the body. Treatment for bilateral Wilms tumour In about 1 in 20 cases, Wilms tumour affects both kidneys. Treatment usually involves surgery to both. The aim of the treatment is to remove as much of the cancer as possible, while leaving as much healthy kidney as possible. Chemotherapy is always given. Sometimes radiotherapy is needed as well. Side effects of treatment Treatment for Wilms tumour often causes side effects. Your childs doctor will discuss this with you before treatment starts. Many side effects are expected and managed effectively. Side effects can include feeling sick (nausea) and being sick (vomiting), hair loss, bruising and bleeding, tiredness, diarrhoea, and an increased risk of infection. Less common effects may include impact on the heart, kidneys, and liver. Late side effects A small number of children may develop late side effects, sometimes many years later. These include a possible reduction in bone growth, a change in the way the heart and lungs work, and a slight increase in their risk of developing another cancer in later life. Infertility is a possible late side effect, although this is rare. Your childs doctor or nurse will talk to you about any possible late side effects. These will depend on the exact treatments given. Clinical trials Many children have their treatment as part of a clinical research trial. Trials aim to improve our understanding of the best way to treat an illness. The trial may include comparing the standard treatment with a new or modified version. It may just involve collecting patient and tumour details including response to treatment to increase specialists knowledge. If appropriate, your childs medical team will talk to you about taking part in a clinical trial, and will answer any questions you have. Written information will be provided to help explain things. Taking part in a research trial is completely voluntary, and you will be given plenty of time to decide if its right for your child. Treatment guidelines Sometimes, clinical trials are not available for your childs tumour. This may be because a recent trial has just finished, or because the tumour is very rare. In these cases, you can expect your doctors and nurses to offer treatment which is agreed to be the most appropriate, using guidelines which have been prepared by experts across the country. The Childrens Cancer and Leukaemia Group (CCLG) is an important organisation which helps to produce these guidelines. Follow-up care Most children with Wilms tumour are cured. If the cancer comes back, its usually within the first 2 years. When one kidney is removed, the other will be able to work normally and can take over the work of the other kidney. Very few children have long-term kidney problems. Your child will have regular check-ups to look for any recurrence or problems following treatment. If you have specific concerns about your childs condition and treatment, its best to discuss them with your childs doctor, who knows the situation in detail. Your feelings As a parent, the fact that your child has cancer is one of the worst situations you can be faced with. You may have many emotions, such as fear, guilt, sadness, anger and uncertainty. These are all normal reactions and are part of the process that many parents go through at such a difficult time. Its not possible to address here all of the feelings you may have. However, the CCLG booklet Children & Young Peoples Cancer; A Parents Guide talks about the emotional impact of caring for a child with cancer and suggests sources of help and support. Your child may have a variety of powerful emotions throughout their experience with cancer. The Parents Guide discusses these further and talks about how you can support your child. Source: Children's Cancer and Leukaemia Group - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852""",,,,,,,,,,,,,
Womb (uterus) cancer,"Womb (uterus) cancer - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Womb (uterus) cancer Womb (uterus) cancer About womb cancer Symptoms of womb cancer Causes of womb cancer Diagnosing womb cancer Treating womb cancer Living with womb cancer About womb cancer Cancer of the womb (uterus) is a common cancer that affects the female reproductive system. Its also called uterine cancer and endometrial cancer. Abnormal vaginal bleeding is the most common symptom of womb cancer. If you have been through the menopause , any vaginal bleeding is considered abnormal. If you have not yet been through the menopause, unusual bleeding may include bleeding between your periods. You should speak to your GP as soon as possible if you experience any unusual vaginal bleeding. While its unlikelyto becaused by womb cancer, its best to be sure. Your GP will examine you and ask about your symptoms. They will refer you to a specialist for further tests if they suspect you may have a serious problem, or if they are unsure about a diagnosis. Read more about the symptoms of womb cancer and diagnosing womb cancer Types of womb cancer The vast majority of womb cancersbegin in the cells that make up the lining of thewomb (called the endometrium), which is why cancer of the wombis often called endometrial cancer. In rare cases, womb cancer can start in the muscles surrounding the womb. This type of cancer is called uterine sarcoma and may be treated in a different way from endometrial cancer. This article uses the term womb cancer, andmostly includes information about endometrial cancer. Read more information about soft tissue sarcomas . Womb cancer is separatefrom other cancers of the female reproductive system, such as ovarian cancer and cervical cancer . Why does womb cancer happen? Its not clear exactly what causes womb cancer, but certain things can increase your risk of developing the condition. A hormone imbalance is one of the most important risks for womb cancer. Specifically, your risk is increased if you have high levels of a hormone called oestrogen in your body. A number ofthings can cause this hormone imbalance, including obesity, diabetes, and hormone replacement therapy (HRT) .There is also a small increase in the risk of womb cancer with long-term use of the breast cancer drug tamoxifen. Its not always possible to prevent womb cancer, but some things are thought to reduce your risk. This includes maintaining a healthy weight and the long-term use of some types of contraception . Read more about the causes of womb cancer How is womb cancer treated? The most common treatment for womb cancer is the surgical removal of the womb (hysterectomy). A hysterectomy can cure womb cancer in its early stages, butyouwill no longer be able to get pregnant.Surgery for womb cancer is also likely to include the removal of the ovaries and fallopian tubes. Radiotherapy or chemotherapy are also sometimes used, often in conjunction with surgery. A type of hormone therapy may be used if you are yet to go through the menopause and would still like to have children. Even if your cancer is advanced and the chances of a cure are small, treatment can still help to relieve symptoms and prolong your life. Read more about treating womb cancer Living with womb cancer Living with cancer is challenging and womb cancer can affect your life in specific ways. For example, your sex life may be affected if you have a hysterectomy. You may find it physically more difficult to have sex and have a reduced sex drive. You may find it beneficial to talk to other people about your condition, including family members, your partner, or other people with womb cancer. Read more about living with womb cancer Who is affected? Womb cancer is the most commonly occurring cancer of the female reproductive system. Its the fourth most common cancer diagnosedin women after breast cancer , lung cancer , and cancer of the colon and rectum . Womb cancer is more common in women and anyone with a womb who has been through the menopause. Most cases are diagnosed in women and anyone with a womb aged 40 to 74. Symptoms of womb cancer The most common symptom of womb cancer is abnormal bleeding from the vagina, although most people with abnormal bleeding dont have cancer. Bleeding may start as light bleeding accompanied by a watery discharge, which may get heavier over time. Most women and anyone with a womb diagnosed with womb cancer have been through the menopause , so any vaginal bleeding will be unusual. In women and anyone with a womb who hasnt been through the menopause, unusual vaginal bleeding may consist of: periods that are heavier than usual vaginal bleeding in between normal periods Less common symptoms include pain in the lower abdomen (tummy) and pain during sex. If womb cancer reaches a more advanced stage, it may cause additional symptoms. These include: pain in the back, legs, or pelvis loss of appetite tiredness nausea When to seek medical advice If you havepostmenopausal vaginal bleeding, or notice a change in the normal pattern of your period, visit your GP. Only1 in 10 cases of unusual vaginal bleeding after the menopause are caused bywomb cancer, so its unlikely your symptomswill be caused by this condition. However, if you have unusual vaginal bleeding, its important to get the cause of your symptoms investigated.The bleeding may be the result of a number of other potentially serious health conditions, such as: endometriosis  where tissue that behaves like the lining of the womb is found on the outside of the womb fibroids  non-cancerous growths that can develop inside the uterus polyps in the womb lining Other types of gynaecological cancer can alsocause unusualvaginal bleeding, particularly cervical cancer . Read further information: Cancer Research UK: womb cancer symptoms Macmillan: symptoms of womb cancer Causes of womb cancer Its not known exactly what causes womb cancer, but certain things can increase your risk of developing it. Cancer begins with a change (mutation) in the structure of the DNA in cells, which can affect how they grow. This means cells grow and reproduce uncontrollably, producing a lump of tissue called a tumour. If left untreated, cancer can grow and spread to other parts of your body, either directly or through the blood and lymphatic system. Increased risk A number of things have been identified thatincrease the risk of developingwomb cancer. Age The risk of developingwomb cancer increases with age. The majority of casesoccur in women and anyone with a womb aged 40 to 74. Oestrogen The risk of developing womb cancer is linked to the bodysexposure to oestrogen. Oestrogen is one of the hormones that regulate the reproductive system. oestrogen stimulates the release of eggs from your ovaries and causes the cells of thewomb lining to divide progesterone gets the lining of your uterus ready to receive the egg from the ovaries The levels of oestrogen and progesterone in your body are usually balanced with each other. If oestrogen isnt kept in balance by progesterone, the level in the body can increase. This is called unopposed oestrogen. After the menopause , the body stops producing progesterone. However, there are still small amounts of oestrogen being produced. This unopposed oestrogen causes the cells of the endometrium to divide, whichcan increase the risk ofwomb cancer. Hormone replacement therapy (HRT) Because of the link between increased levels of unopposed oestrogen andwomb cancer, oestrogen-only hormone replacement therapy (HRT) should only be given to those who have had their womb surgically removed (hysterectomy). In all other cases, both oestrogen and progesterone (combination HRT) must be used in HRT to reduce the risk of womb cancer. Being overweight or obese As oestrogen can be produced in fatty tissue, being overweight or obeseincreases the level of oestrogen in your body. This significantly increases your chances of developing womb cancer. Women and anyone with a womb who is overweight is 3times more likely to develop womb cancer compared with those who are a healthy weight. One way to assess whether your weight is healthy is to understand your healthy body mass index (BMI) . Reproductive history Women and anyone with a womb who has not had children are at a higher risk ofwomb cancer. This may be because the increased levels of progesterone and decreased levels of oestrogen that occur during pregnancyhave a protective effect on the lining of the womb. Tamoxifen Women and anyone with a womb who are treated with tamoxifen (a hormone treatment for breast cancer ) can be at an increased risk of developing womb cancer. However, this risk is outweighed by the benefits that tamoxifen provides in preventing breast cancer. Its important to visit your GP if youre taking tamoxifen and experience any abnormal vaginal bleeding. Diabetes Women and anyone with a womb with diabetes are twice as likely to develop womb cancer as those without the condition. Diabetes causes an increase in the amount of insulin in your body, which in turn can raise your oestrogen levels. Many women and anyone with ovaries with type 2 diabetes are also overweight, which further increases the risk. Polycystic ovarian syndrome (PCOS) Women and anyone with ovaries with polycystic ovarian syndrome (PCOS) are at a higher risk of developing womb cancer, as they have high levels of oestrogen in their bodies. PCOS can cause symptoms such as irregular or light periods, or no periods at all, as well asproblems getting pregnant, weight gain, acne, and excessive hair growth (hirsutism). Endometrial hyperplasia Endometrial hyperplasia is when the lining of the womb becomes thicker. Itmay be increase risk of developingwomb cancer. Read further information: Cancer Research UK: womb cancer risks and causes Macmillan: causes of womb cancer Diagnosing womb cancer You should visit your GP if you have abnormal vaginal bleeding. While its unlikely to be caused by womb cancer, its best to be sure. Your GP will probably carry out a physical examination of your pelvic area, including your vagina, womb, ovaries, and bladder. They will ask about your symptoms, when they happen, and how often. You may be referred to a specialist in conditions of the female reproductive organs (a gynaecologist) for further tests. In 2015, the National Institute for Health and Care Excellence ( NICE ) published guidelines to help GPs recognise the signs and symptoms of gynaecological cancer and refer people for the right tests faster. To find out if you should be referred for further tests for suspected endometrial cancer, read the NICE 2015 guidelines on Suspected Cancer: Recognition and Referral . Transvaginal ultrasound (TVU) Another test you may have is called a transvaginal ultrasound (TVU). TVU is a type of ultrasound scan that uses a small scanner in the form of a probe. This is placed directly into the vagina to obtain a detailed picture of the inside of the uterus. The probe can feel a little uncomfortable, but shouldnt be painful. The TVU checks whether there are any changes to the thickness of the lining of your uterus that could be caused by the presence of cancerous cells. Biopsy If the results of the TVU detect changes in the thickness of the lining of the uterus, you will usually have a biopsy to confirm the diagnosis. Ina biopsy, a small sample of cells is taken from the lining of the womb (the endometrium). The sample is then checked at a laboratory for the presence of cancerous cells. The biopsy can be carried out inseveral ways, including: aspiration biopsy  a small flexible tube is inserted into your vagina and up into your womb, and then sucks up a small sample of cells hysteroscopy  this allows the doctor to look at the inside of the womb using a thin type of telescope called a hysteroscope, which is inserted through your vagina and into your womb, allowing the doctor to look at the lining of the womb and take a sample from it In some cases, a hysteroscopy may be used before dilatation and curettage (D&C). D&C is a minor surgical procedurecarried out under general anaesthetic ,where some tissue from the womb lining is removed. The tissueis then sent off to a laboratory for further testing. Blood test A blood test can sometimes help diagnose womb cancer. This is because some cancerous tumours release certain chemicals into your blood, known as tumour markers, which can be detected during a blood test. However, this type of test isnt very reliable. The presence of these chemicals doesnt mean you definitely have womb cancer. Some people with womb cancer dont have these chemicals in their blood. Read further information: Cancer Research UK: womb cancer tests Macmillan: how womb cancer is diagnosed Tests if you havewomb cancer If youre diagnosed with womb cancer, you may have further teststo help determine the stage of the cancer. Staging the cancer will allow the doctors to work out how large the cancer is, whether or not it has spread, and the best treatment options for you. These tests may include: achest X-ray  where radiation is used to check if the cancer has spread to the lungs magnetic resonance imaging (MRI)  where magnetic fields are used to create adetailed image of the inside of your bodyto check if the cancer has spread a computerised tomography (CT) scan  where a series of X-rays are used to create a detailed image of the inside of your bodyto check if the cancer has spread further blood tests these are usually doneto check your general health and how well some of your organs are functioning Read treating womb cancer for more information about staging. Treating womb cancer Health professionals use a staging system to describe how far womb cancer has advanced. These stages are: stage 1 the cancer is still contained inside the womb (uterus) stage 2  the cancer has spread to the neck of the womb (the cervix) stage 3 the cancer has spread outside the womb into nearby tissues in the pelvis or the lymph nodes stage 4 the cancer has spread to the soft tissues of the abdomen, or into other organs, such as the bladder, bowel, liver, or lungs Your chances of surviving womb cancer depend on the stage at which its diagnosed. Read further information: Cancer Research UK: stages of womb cancer Cancer Research UK: statistics and outlook for womb cancer Treatment overview The main treatment for womb cancer is to remove the womb (hysterectomy), together with the ovaries and fallopian tubes. This is sometimes followed by radiotherapy or chemotherapyto try to kill any possible remaining cancer cells, depending on the stage and grade of the cancer. Treatment if you havent been through the menopause Having a hysterectomy means you willno longer beable to get pregnant. Younger women who havent already reached the menopause may not want to have their womb and ovaries removed if they wish to have children. In this case, under very specific circumstances it may be possible to treat the cancer using hormone therapy. Treating advanced cancer Advanced womb cancerrequires a different course of treatment, usually depending more on chemotherapy. Advanced cancer may not be curable, but the treatment aims to achieve a remission, where the cancer shrinks, making you feel normal and able to enjoy life to the full. Even if theres no chance of a cure, surgery may be carried out to remove as much of the cancer as possible. Radiotherapy, chemotherapy or hormone therapy can reduce symptoms such as pain by shrinking the cancer or slowing its growth. Read further information: Cancer Research UK: controlling symptoms of advanced womb cancer Cancer Research UK: which treatment for womb cancer? Surgery Surgery for stage1womb cancer If you have stage1 cancer, youll probably have a hysterectomy. This involves removing both ovaries and the fallopian tubes in a procedure called a bilateral salpingo-oophorectomy (BSO), as well asthe uterus (hysterectomy). The surgeon may also take samples from the lymph nodes in the pelvis and abdomen and other nearby tissue. These will be sent to the laboratory to see whether the cancer has spread. The most common hysterectomy technique involves using one large cut across your tummy to access the womb and remove it. Its sometimes possible to use a technique called a laparoscopic hysterectomy, also known as akeyhole hysterectomy. This involves using several small cuts so a special type of telescope (laparoscope) and other surgical instrumentscan be used. Thismeans the surgeoncan see inside your body and remove your womb through your vagina with little scarring. Youll probably be ready to go home 3to 5days after your operation, or less if you had keyhole surgery. But it can take many weeks to recover fully. After your operation, youll be encouraged to start moving about as soon as possible. This is very important, and even if you have to stay in bed youll need to keep doing regular leg movements to help your circulation and prevent blood clots. Youll be shown exercises by the nurses or physiotherapist to help prevent complications. When you go home, youll need to exercise gently to build up your strength and fitness. Discuss with your doctor or physiotherapist which types of exercise would be suitable for you. Surgery for stage2 or 3womb cancer If you have stage2 or3 womb cancer and the cancer has spread to the cervix or nearby lymph nodes in the pelvis, you may have a radical or total hysterectomy. This involves the additional removal of the cervix and the top of your vagina, as well as the removal of the pelvic lymph nodes. You may also need radiotherapy or chemotherapy treatment after surgery to reduce the riskof the cancer returning. Surgery for advanced cancer (stage 4) If you have advanced womb cancer, you may have surgery to remove as much of the cancer as possible. This is called debulking surgery. This wont cure the cancer, but it may ease some of the symptoms. Your doctor will discuss whether debulking surgery is suitable for you. Read further information: Cancer Research UK: having your operation for womb cancer National Institute for Health and Care Excellence (NICE): laparoscopic hysterectomy for endometrial cancer Radiotherapy A course of radiotherapy will be recommended if your treatment team thinks theres a significant risk the cancer could return in the pelvis. Radiotherapy may also be used to slow the spread of cancer when a surgical cure is not possible. There are 2types of radiotherapy used to treatwomb cancer: internal radiotherapy (also known as brachytherapy) wherea plastic tube is inserted inside the uterus and radiation treatment is passed down the tube into the womb external radiotherapy wherea machine is used to deliver pulses of radiation to your pelvis A course of external radiotherapy is usually given to you as an outpatient for 5days a week with a break at the weekend. The treatment takes a few minutes. The whole course of radiotherapy may last approximately 4weeks depending on the stage and position of the womb cancer. Some women and anyone with a womb have internal radiotherapy (brachytherapy) as well as external radiotherapy. During brachytherapy, the device that delivers radiation is placed in your vagina. There are different types of brachytherapy, involving either low, medium, or high dose rates. With low dose rate methods the radiation is delivered more slowly, so the device has to stay inside you for longer. Youll have to stay in hospital while you have the treatment. Your doctor will discuss this with you. Radiotherapy has some side effects. Skin in the treated area can become red and sore, and hair loss may occur. Radiotherapy to the pelvic area can affect the bowel and cause sickness and diarrhoea . As your course of treatment progresses, youre likely to get very tired. Most of these side effects will go away when your treatment finishes. Chemotherapy If you have stage3 or4womb cancer, you may be given a course of chemotherapy . Chemotherapy can be used after surgery to try to prevent the return of the cancer. In cases of advanced cancer, it may be used to slow the spread of the cancer and relieve symptoms. Chemotherapy is usually given as an injection into the vein (intravenously). Youll usually be able to go home the same day you have chemotherapy, but sometimes you may need a short stay in hospital. Chemotherapy is usually given in cycles, with a period of treatment being followed by a period of rest to allow the body to recover. Side effects of chemotherapy can include: nausea vomiting hair loss fatigue There is also an increased risk of an infection developing in your bloodstream (sepsis) , as your bodys ability to fight infection is reduced by chemotherapy. The side effects should stop once treatment has finished. Read further information: Cancer Research UK: chemotherapy for womb cancer Macmillan: chemotherapy for womb cancer Hormone therapy Somewomb cancers are affected by the female hormone oestrogen. These cancers may respond to treatment with hormone therapy. Your doctor will discusswhether this is a possible treatment for yourwomb cancer. Hormone therapyusuallyreplacesa hormone called progesterone, which naturally occurs in your body. Artificial progesterone is used and isusually given as tablets. Its mainly used to treat advanced-stagewomb cancers, or cancer that has come back, and can help shrink the tumour and control any symptoms. The treatment may have some side effects, including mild nausea, mild muscle cramps, and weight gain. Your doctor will discuss these with you. Read further information: Cancer Research UK: hormone therapy for womb cancer Macmillan: hormonal treatment for womb cancer Clinical trials A lot of progress has been made in the treatment of womb cancer. More people are living longer with fewer side effects. Some of these advances were discovered through clinical trials,where new treatments and combinations of treatments are compared with standard treatment. All cancer clinical trials in the UK are carefully monitored to make sure the trial is worthwhile and safely conducted. Participants in clinical trials often do better overall than those in routine care. If youre invited to take part in a trial, youll be given an information sheet. If you wish to take part, youll be asked to sign your consent. Youre always free to refuse or withdraw from a clinical trial without it affecting your care. Read further information: Cancer Research UK: trials and research Cancer Research UK: womb cancer research Living with womb cancer Women and anyone with a womb with womb cancer usually have a hysterectomy. This can be a major operation, and recovery may takefrom6 to 12 weeks. During this time you will have to avoid lifting things (for example, children and heavy shopping bags) and doing heavy housework. You wont be able to drive for between 3and 8weeks after the operation. Most people need4 to12 weeks off work after a hysterectomy. The recovery time will depend on the type of surgery you have, whether or notany problems develop, and what type of work you will return to. Some of the treatments for endometrial cancer, particularly radiotherapy, can make you very tired. You may need to take a break from some of your normal activities for a while. Dont be afraid to ask for practical help from family and friends if you need it. Follow-up After your course of treatment has finished, youll probably be invited back for regular check-ups. At the check-up, your doctor will examine you (this is likely to include an internal examination) and possibly carry out blood tests or scans to see how your cancer is responding to treatment. Read further information: Macmillan: follow-up after treatment for womb cancer Relationships and sex Relationships with friends and family Knowing how to talk to your friends and family about your cancer can be difficult, and they may find it hard to talk to you, too. People deal with serious problems in different ways. Its hard to predict how a diagnosis of cancer will affect you. Being open and honest about how you feel and what your family and friends can do to helpmay put them at ease. But dont feel shy about telling people that you want some time to yourself, if thats what you need. Read further information: Talking to your kids about cancer Macmillan: the emotional effects of cancer Macmillan: telling your friends and family Your sex life Wombcancer and its treatment can affect your sex life. This can happen in several ways. If you havent already had the menopause, removing the ovaries means youll go through an early menopause. Symptoms can include vaginal dryness and loss of sexual desire. Radiotherapy for endometrial cancer can make your vagina narrower and less flexible. Sometimes the vagina gets so narrow that having sex becomes difficult. To stop this happening, you should be offered a set of vaginal dilators, which are plastic cones you put into your vagina to stretch it. You can also stretch your vagina by having sex, or by using your fingers or a vibrator. Its common to lose interest in sex after treatment forwomb cancer. Your treatment may leave you feeling very tired. You may feel shocked, confused or depressed about being diagnosed with cancer, and you alsomay be grieving the loss of your fertility. Its understandable that you may not feel like having sex while having to cope with all this. Try to share your feelings with your partner. If you feel you have problems with sex that arent getting better with time, you may want to speak to a counsellor or a sex therapist. Read further information: Macmillan: how treatment for womb cancer may affect your sex life andrelationships Talk to others Being diagnosed with cancer can be hard, both for patients and their families. Youll need to deal with the emotional and practical difficulties. Withwomb cancer, you have to cope physically with recovering from a hysterectomy, as well asthe possible emotional impact of losing your womb. Younger women may have to face the fact they wont be able to have children and all the grief and anger that may cause. Often, it can help to discuss your feelings and other difficulties with a trained counsellor or therapist. You can ask for this kind of help at any stage of your illness. There are various waysto find help and support: your hospital doctor, specialist nurse or GP can refer you to a counsellor if youre struggling with feelings of depression, talk to your GPa course of antidepressant drugs may be helpful, or your GP can arrange for you to get help from a counsellor or psychotherapist it may be helpful to talk to someone whos had the same experience as you many organisations have telephone helplines and forums that may be useful to you, and they can put you in touch with other people who have been through cancer treatment Read further information: Cancer Research UK: coping with cancer Money and financial support If you have to reduce or stop work because of your cancer, you may find it hard to cope financially. If you have cancer or you are caring for someone with cancer, you may be entitled to financial support. if you have a job but cant work because of your illness, youre entitled to Statutory Sick Pay from your employer if you dont have a job and cant work because of your illness, you may be entitled to Employment and Support Allowance if youre caring for someone with cancer, you may be entitled to Carers Allowance you may be eligible for other benefits if you have children living at home, or you have a low household income Find out what help is available to youearly on. You can ask to speak to the social worker at your hospital, who can give you the information you need. Read further information: Find your nearest Citizens Advice Bureau GOV.UK: benefits Macmillan: financial issues Money Advice Service Dealing with dying If youre told nothing more can be done to treat your womb cancer, your care will focus on controlling your symptoms and helping you to be as comfortable as possible. This is called palliative care. Palliative care also includes psychological, social and spiritual support for you and your family or carers. Read further information: Palliative care End of life care Macmillan : support if youre caring for someone with womb cancer (support line: 0808 808 00 00) Marie Curie Cancer Care Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Cervical cancer Ovarian cancer Other health sites Cancer Research UK: Womb cancer The Eve Appeal: womb cancer Macmillan Cancer Support: Womb cancer Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,
Yellow fever,"Yellow fever | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Yellow fever Yellow fever Yellow fever is a serious viral infection that is spread by certain types of mosquito. Its mainly found in sub-Saharan Africa, South America and parts of the Caribbean. The condition can be prevented with a vaccination and is a very rare cause of illness in travellers. Between 1999 and 2018, there were12 cases of yellow fever reported among European travellers. None of these travellers were vaccinated, 5 of these cases occurred in 2018. If youre planning to visit places where yellow fever infection is found, you should seek travel health advice before you travel. A map and list of countries where yellow fever is found is available on the NHS Fit for Travel website. How yellow fever is spread The virus that causes yellow fever is passed to humans through the bites of infected mosquitoes. The mosquitoes that spread the infection are usually active and bite during daylight hours, and are found in both urban and rural areas. Yellow fever cant be passed directly from person to person through close contact. Yellow fever symptoms The symptoms of yellow fever occur in 2 stages. The initial symptoms develop 3 to 6 days after infection, and can include: a high temperature (fever) a headache nausea or vomiting muscle pain, including backache loss of appetite This stage will usually pass after 3 to 4 days and most people will make a full recovery. However, around 15% of people go on to develop more serious problems, including jaundice (yellowing of the skin and whites of the eyes), kidney failure and bleeding from the mouth, nose, eyes or stomach (causing blood in your vomit and stools). Up to half of those who experience these symptoms will die. When to seek medical advice You should see a doctor as soon as possible if you develop symptoms of yellow fever and are currently travelling in an area where the virus is found, or have recently returned from one of these areas. To help determine whether you have yellow fever, the doctor will want to know exactly where you have been travelling and what symptoms you have. A blood test will be needed to confirm the diagnosis. Treating yellow fever There is no specific treatment for yellow fever, but you will be monitored and the symptoms can be treated. You will be admitted to hospital for assessment and supportive care. Yellow fever vaccination The yellow fever vaccine protects you from infection when you travel to a country where yellow fever virus occurs and prevents the disease from spreading between countries. After you have received the vaccine you are given a yellow fever vaccine certificate to prove that you have received the vaccine and are protected from infection. This certificate is designed to fit inside your passport and is valid for life. The countries that require proof of vaccination are those where either the disease occurs, or where it could occur because they have the correct mosquito and monkey species that could harbour the infection. More about the yellow fever vaccine Find your nearest yellow fever vaccination centre Information about you If you have yellow fever, your clinical team will pass information about you on to the National Congenital Anomaly and Rare Diseases Registration Service (NCARDRS). This helps scientists look for better ways to prevent and treat this condition. You can opt out of the register at any time. Find out more about the register . Source: Public Health Scotland - Opens in new browser window Last updated: 04 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites fitfortravel: Yellow fever NaTHNaC: find a yellow fever vaccination centre NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852",,,,,,,,,,,,,