Reviewed by Dr Stephen Collins, GP
What are burns?Burns are skin damage caused by contact with fire, heat, electricity, radiation, or caustic chemicals. Burns are classified according to the depth and extent of the skin damage, in the following way:
In second and third degree burns a skin graft can be necessary.
first-degree burns - the skin is red, painful and very sensitive to touch. The damaged skin may be slightly moist from leakage of the fluid in the deeper layers of the skin.
second-degree burns - the damage is deeper and blisters usually appear on the skin. The skin is still painful and sensitive.
third-degree burns - the tissues in all layers of the skin are dead. Usually there are no blisters. The burned surface can have several types of appearance, from white to black (charred) or bright red from blood in the bottom of the wound. Because the skin nerves are damaged the burn can be quite painless. On touch the burned skin lacks sensation. It is important not to confuse a pale third-degree burn for normal skin – the lack of sensation or blanching of the skin blood vessels on pressure indicates damaged skin. . A skin graft is usually necessary for significant areas.
First aid for burnsThe first thing to do is to limit the extent of the damage, and prevent the burn from becoming worse.
The burnt area must be cooled by being placed under cold running water. The water must not be unpleasantly cold.
The damaged area must stay under running water for at least one hour, or longer if the pain has not stopped. Up to four hours of this treatment can be beneficial.
First-degree burns, eg mild sunburn, do not require this treatment.
Which burns need treatment by health professionals?
Burns that are bigger than the palm of the hand.
Burns on the face, neck, hands, and in the groin.
All third-degree burns.
Most second-degree burns. Remember that it can be difficult to distinguish between second- and third-degree burns, so always have a nurse or doctor check all but the most minor burns.
If possible, keep pouring water over the burn on the way to the doctor, or use clean, soaking wet towels.
Do not lance the blisters yourself.
Never apply an ointment to burns or try other folk remedies - water is the only thing that should be used.
Do not forget to have a tetanus injection if you have not had a booster within the last 10 years.
What complications can occur?
When skin is burned, it loses its ability to protect, which increases the risk of infection. So it is important that the damaged area be thoroughly cleansed within the first six hours, and that the area is kept clean while it is healing. If, after a few days, there are signs of an infection - ie the skin is becoming increasingly red, hot, and swollen, and the victim experiences a throbbing pain - contact a doctor or your practice nurse.
Severe burns can cause scarring.
In cases of extensive severe burns, the body may lose large quantities of fluid. This can disturb the blood circulation and cause problems with the body's salt balance. Such injuries should be assessed at your local Accident and Emergency department.
What can be done to prevent burns? The kitchen is the most dangerous room in the house, and the most likely place for burns and scalds to occur. When cooking, keep small children away from hot drinks, pans and kettles, barbecues and other open flames. Remember that barbecues can suddenly 'spit' flames when inflammable liquids are poured over them. Barbecues are a major cause of serious burns. When there are small children in the house, fill baths by running the cold tap first. Never throw water over oil fires, such as in a chip pan, because this will cause a fire explosion that can have severe consequences. Instead the fire should be smothered by covering the pan with a damp cloth.Buy a proper fire-smothering blanket and keep it somewhere in the kitchen where it is easily accessible.Based on a text by Eric Olesen, plastic surgeon
Sunday, August 17, 2008
Burns
"In the initial years of our life we forget our health while going after wealth, in the later years of our life we spend our wealth to take care of our health... It's today reality. Health is not everything, BUT without health everything is nothing."
Sprains and bruises
Reviewed by Dr Dan Rutherford, GP
What are sprains and bruises? A sprain causes pain, swelling and discolouration (blue colouring). This happens because the small blood vessels and fibres in the flesh burst, causing blood to enter the surrounding tissue. This results in swelling and the blue colouring. It is the same principle with a bruise: the skin is exposed to such a hard blow that the blood vessels break.
What should I do about a sprain? If you have a sprain, you will also suffer pain. The injured area must be kept still or the bleeding in the tissue will continue more intensely. The most important treatment for a sprain is: rest, ice, compression, elevation (RICE).
RestRest is important to ensure that healing occurs as quickly as possible. You should rest the injured area for at least one or two days, because the bleeding can continue for up to 24 hours. If possible, the sprained area should be kept straight - an arm, for example, can be supported in a sling. Try to keep the injured area in the same position while you are sleeping, perhaps by placing a couple of pillows under your sprain.
IceSince blood enters the tissues when you have a sprain, the main thing is to limit the bleeding. This can be done by cooling. Try the following techniques.
Put ice cubes in a plastic bag, then place over the sprained area.
In an emergency, use frozen vegetables in a bag.
Use custom-made cooling-packets, which are bags containing a special jelly that can be chilled in your freezer. In each case, wrap the cold bag in a towel before placing it on the sprain. Always put a piece of fabric between your skin and the coolant, otherwise your skin may get frostbite. Stop the cooling long before your skin turns white or hard. Contact a doctor if your skin does not regain its usual colour after the process has stopped. It is a good idea to cool the skin for 15 minutes, stop for 15 minutes, then cool again, and so on. Usually, the cooling is felt in different ways. This can range from cold to painful, burning and finally numbing. Be careful if you are diabetic. To prevent damage to your blood circulation, do not cool an area without consulting your doctor.
CompressionYou can also wrap bandages around the damaged area to prevent movement. Most people use a pressure bandage at first, followed by tape when the swelling has disappeared. If you are wearing bandages, it is important to monitor the area surrounding them. If this becomes blue-coloured and the surrounding tissue seems cold, you should remove the bandages and contact a doctor.
ElevationThe injured area shouldn't point downwards, otherwise fluid build-up may occur. This prolongs the healing process and causes more pain.
How can I relieve the pain?The most important treatment for a sprain is rest, ice, compression and elevation, as described above. However, the pain experienced following a sprain can also be relieved with over-the-counter anti-inflammatory painkillers, such as aspirin and ibuprofen. These reduce swelling and combat pain.
Good advice
Ask a pharmacist for advice on which products are suitable for you.
Paracetamol can also be useful. Aspirin and ibuprofen should not be used by people with asthma or stomach problems, and aspirin should not be given to children under 16 years of age, unless on the advice of a doctor. Topical painkillers containing non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen gels or creams, can also relieve pain effectively. These should also not be used by people with asthma or stomach problems.
When to consult a doctor
If the sprain is accompanied by severe pain and severe swelling.
If one of your joints gives way and is unable to carry your weight.
If the pain is still present after two days.
If the sprain has not improved after four days of self-treatment.
What should I do to prevent sprains? Ask yourself what caused your accident and focus on the cause. Note that the following information is a very rough guide: if in doubt, consult a doctor.
Running too quickly?
Exercising without any warm-up or stretching exercises?
Running, working out or playing sport without the proper shoes?
Running on hard or uneven surfaces?
Are any of your muscles overcompensating for weakness in another - for instance, due to a bad knee?
Recovering from sprains When the pain and the swelling have gone, start exercising the injured part of the body gently. After one or two days' rest, it is important to start moving again to reduce the amount of scarring formed in the damaged tissue. As with any activity, warm up slowly and use stretching exercises to begin with. If it's possible to stay physically active without further injuring the sprained area, do so. Keep your other muscles functioning and maintain physical fitness.
How to treat bruises Bruises and swellings are caused by bleeding under the skin. Again, bruises are best treated with cooling. To do this, follow the instructions given above for cooling treatment of sprains.If several bruises surround a large one, and you have not had any other accidents, consult your doctor to find out whether your blood is clotting as it should. Based on a text by Dr Hans Gad Johansen, specialist and Dr Ejnar Kuur, consultant
What are sprains and bruises? A sprain causes pain, swelling and discolouration (blue colouring). This happens because the small blood vessels and fibres in the flesh burst, causing blood to enter the surrounding tissue. This results in swelling and the blue colouring. It is the same principle with a bruise: the skin is exposed to such a hard blow that the blood vessels break.
What should I do about a sprain? If you have a sprain, you will also suffer pain. The injured area must be kept still or the bleeding in the tissue will continue more intensely. The most important treatment for a sprain is: rest, ice, compression, elevation (RICE).
RestRest is important to ensure that healing occurs as quickly as possible. You should rest the injured area for at least one or two days, because the bleeding can continue for up to 24 hours. If possible, the sprained area should be kept straight - an arm, for example, can be supported in a sling. Try to keep the injured area in the same position while you are sleeping, perhaps by placing a couple of pillows under your sprain.
IceSince blood enters the tissues when you have a sprain, the main thing is to limit the bleeding. This can be done by cooling. Try the following techniques.
Put ice cubes in a plastic bag, then place over the sprained area.
In an emergency, use frozen vegetables in a bag.
Use custom-made cooling-packets, which are bags containing a special jelly that can be chilled in your freezer. In each case, wrap the cold bag in a towel before placing it on the sprain. Always put a piece of fabric between your skin and the coolant, otherwise your skin may get frostbite. Stop the cooling long before your skin turns white or hard. Contact a doctor if your skin does not regain its usual colour after the process has stopped. It is a good idea to cool the skin for 15 minutes, stop for 15 minutes, then cool again, and so on. Usually, the cooling is felt in different ways. This can range from cold to painful, burning and finally numbing. Be careful if you are diabetic. To prevent damage to your blood circulation, do not cool an area without consulting your doctor.
CompressionYou can also wrap bandages around the damaged area to prevent movement. Most people use a pressure bandage at first, followed by tape when the swelling has disappeared. If you are wearing bandages, it is important to monitor the area surrounding them. If this becomes blue-coloured and the surrounding tissue seems cold, you should remove the bandages and contact a doctor.
ElevationThe injured area shouldn't point downwards, otherwise fluid build-up may occur. This prolongs the healing process and causes more pain.
How can I relieve the pain?The most important treatment for a sprain is rest, ice, compression and elevation, as described above. However, the pain experienced following a sprain can also be relieved with over-the-counter anti-inflammatory painkillers, such as aspirin and ibuprofen. These reduce swelling and combat pain.
Good advice
Ask a pharmacist for advice on which products are suitable for you.
Paracetamol can also be useful. Aspirin and ibuprofen should not be used by people with asthma or stomach problems, and aspirin should not be given to children under 16 years of age, unless on the advice of a doctor. Topical painkillers containing non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen gels or creams, can also relieve pain effectively. These should also not be used by people with asthma or stomach problems.
When to consult a doctor
If the sprain is accompanied by severe pain and severe swelling.
If one of your joints gives way and is unable to carry your weight.
If the pain is still present after two days.
If the sprain has not improved after four days of self-treatment.
What should I do to prevent sprains? Ask yourself what caused your accident and focus on the cause. Note that the following information is a very rough guide: if in doubt, consult a doctor.
Running too quickly?
Exercising without any warm-up or stretching exercises?
Running, working out or playing sport without the proper shoes?
Running on hard or uneven surfaces?
Are any of your muscles overcompensating for weakness in another - for instance, due to a bad knee?
Recovering from sprains When the pain and the swelling have gone, start exercising the injured part of the body gently. After one or two days' rest, it is important to start moving again to reduce the amount of scarring formed in the damaged tissue. As with any activity, warm up slowly and use stretching exercises to begin with. If it's possible to stay physically active without further injuring the sprained area, do so. Keep your other muscles functioning and maintain physical fitness.
How to treat bruises Bruises and swellings are caused by bleeding under the skin. Again, bruises are best treated with cooling. To do this, follow the instructions given above for cooling treatment of sprains.If several bruises surround a large one, and you have not had any other accidents, consult your doctor to find out whether your blood is clotting as it should. Based on a text by Dr Hans Gad Johansen, specialist and Dr Ejnar Kuur, consultant
"In the initial years of our life we forget our health while going after wealth, in the later years of our life we spend our wealth to take care of our health... It's today reality. Health is not everything, BUT without health everything is nothing."
Salmonella and food poisoning
Reviewed by Dr Dan Rutherford, GP
What is salmonella?Salmonella is a type of bacteria. It is usually found in poultry, eggs, unprocessed milk and in meat and water. It may also be carried by pets like turtles and birds.
What kind of infection does salmonella cause?The salmonella bacteria attacks the stomach and intestines. In more serious cases, the bacteria may enter the lymph tracts, which carry water and protein to the blood, and the blood itself. The bacteria attack all age groups and both sexes. Children, the elderly and people who are already ill are much more likely to get a serious infection.
What are the symptoms of salmonella poisoning?
Diarrhoea or constipation.
Headaches.
Stomach cramps.
Nausea and vomiting.
Fever.
Possibly, blood in the faeces. In the case of less serious infections there are fewer symptoms - usually only diarrhoea two or three times a day for a couple of days. Most mild types of salmonella infection clear up in four to seven days without requiring any treatment other than rest and plenty of liquid. A more severe infection may cause excessive diarrhoea, stomach cramps and general health problems. In such cases, treatment with antibiotics may be necessary and a doctor should be consulted.
When is it necessary to contact a doctor?
If diarrhoea continues for more than 24 hours.
If the diarrhoea is frequent and intense.
If the patient has severe stomach cramps.
If there is blood in the faeces.
If the patient has fever of 38oC or higher.
If there are signs of jaundice - a yellowish discolouration of the skin or eyes. This may indicate problems with the liver or the bile ducts that take the bile from the liver to the stomach.
Dehydration.
What is the danger of dehydration?Frequent diarrhoea and vomiting may drain the body of fluids, salts and minerals. Dehydration occurs when the patient loses more liquid than they can take in. Cases of dehydration should always be checked by a doctor and can be very dangerous in babies and the elderly.Signs of dehydration are:
the tongue or the mucous membranes in the mouth are dry
dry, chapped skin
increased thirst
dark urine
lack of, or decreased, urine output
weakness.
How can salmonella infections be prevented?
Pay attention to cleanliness.
Make sure that all food is thoroughly cooked.
What are the basic rules for preparing food hygienically?
Always wash your hands with soap after going to the toilet and before preparing food. Dry them on a dry towel.
Wash your hands when you switch from preparing one type of food to another, eg vegetables to meat. This helps prevent the exchange of bacteria between different ingredients.
Kitchen utensils must be properly washed with soap and water before use with another type of food. Again, this stops bacteria being exchanged.
Use different cutting boards and knives for preparing different foods.
Change the dishcloth every day. Wash dishcloths in water that is at least 60oC.
Store food in the refrigerator. Meat, poultry and fish must not be left out of the fridge for long periods.
How should food be cooked to avoid salmonella poisoning?The only effective way to kill salmonella bacteria is with heat. For this reason it is essential to cook food thoroughly.
Poultry must always be thoroughly cooked or boiled.
Minced meat must always be thoroughly cooked or boiled.
Never crack a raw egg on a bowl containing other foods - use a knife to crack the shell.
In most eggs, the salmonella bacteria exist only on the shell. Eggs should be scalded in boiling water for five seconds before use.
Based on a text by Christel Bech, nurse
What is salmonella?Salmonella is a type of bacteria. It is usually found in poultry, eggs, unprocessed milk and in meat and water. It may also be carried by pets like turtles and birds.
What kind of infection does salmonella cause?The salmonella bacteria attacks the stomach and intestines. In more serious cases, the bacteria may enter the lymph tracts, which carry water and protein to the blood, and the blood itself. The bacteria attack all age groups and both sexes. Children, the elderly and people who are already ill are much more likely to get a serious infection.
What are the symptoms of salmonella poisoning?
Diarrhoea or constipation.
Headaches.
Stomach cramps.
Nausea and vomiting.
Fever.
Possibly, blood in the faeces. In the case of less serious infections there are fewer symptoms - usually only diarrhoea two or three times a day for a couple of days. Most mild types of salmonella infection clear up in four to seven days without requiring any treatment other than rest and plenty of liquid. A more severe infection may cause excessive diarrhoea, stomach cramps and general health problems. In such cases, treatment with antibiotics may be necessary and a doctor should be consulted.
When is it necessary to contact a doctor?
If diarrhoea continues for more than 24 hours.
If the diarrhoea is frequent and intense.
If the patient has severe stomach cramps.
If there is blood in the faeces.
If the patient has fever of 38oC or higher.
If there are signs of jaundice - a yellowish discolouration of the skin or eyes. This may indicate problems with the liver or the bile ducts that take the bile from the liver to the stomach.
Dehydration.
What is the danger of dehydration?Frequent diarrhoea and vomiting may drain the body of fluids, salts and minerals. Dehydration occurs when the patient loses more liquid than they can take in. Cases of dehydration should always be checked by a doctor and can be very dangerous in babies and the elderly.Signs of dehydration are:
the tongue or the mucous membranes in the mouth are dry
dry, chapped skin
increased thirst
dark urine
lack of, or decreased, urine output
weakness.
How can salmonella infections be prevented?
Pay attention to cleanliness.
Make sure that all food is thoroughly cooked.
What are the basic rules for preparing food hygienically?
Always wash your hands with soap after going to the toilet and before preparing food. Dry them on a dry towel.
Wash your hands when you switch from preparing one type of food to another, eg vegetables to meat. This helps prevent the exchange of bacteria between different ingredients.
Kitchen utensils must be properly washed with soap and water before use with another type of food. Again, this stops bacteria being exchanged.
Use different cutting boards and knives for preparing different foods.
Change the dishcloth every day. Wash dishcloths in water that is at least 60oC.
Store food in the refrigerator. Meat, poultry and fish must not be left out of the fridge for long periods.
How should food be cooked to avoid salmonella poisoning?The only effective way to kill salmonella bacteria is with heat. For this reason it is essential to cook food thoroughly.
Poultry must always be thoroughly cooked or boiled.
Minced meat must always be thoroughly cooked or boiled.
Never crack a raw egg on a bowl containing other foods - use a knife to crack the shell.
In most eggs, the salmonella bacteria exist only on the shell. Eggs should be scalded in boiling water for five seconds before use.
Based on a text by Christel Bech, nurse
"In the initial years of our life we forget our health while going after wealth, in the later years of our life we spend our wealth to take care of our health... It's today reality. Health is not everything, BUT without health everything is nothing."
Poisoning in children
Reviewed by Dr Stephen Greene, consultant paediatrician
Poisoning accidentsAccidents in the home are much too common, especially since many can be avoided by taking a few simple precautions. Some of the more serious accidents are poisoning incidents involving children. When young children explore the world, they use all their senses including taste. They typically put everything in their mouth to find out what it is. For this reason, adults must make sure that children do not have access to anything poisonous. It is surprising just how many ordinary household articles are dangerous in this respect. To make your home safe from poisoning, examine it carefully one room at a time. Identify any potentially harmful substances and either lock them away or store them somewhere out of your children's reach.
What is poisonous in the kitchen? Cleaning materials are usually kept in the kitchen, often in a low cupboard under the sink where they are easily accessible to curious children. Potentially dangerous products include:
all kinds of detergents and cleaning products, which often contain chemicals that are poisonous to children.
plant fertilizer. This is extremely dangerous.
detergents used in automatic dishwashers. These are highly caustic and, therefore, very dangerous if consumed. Move these products to a locked cabinet where children cannot see or reach them. It's not enough to simply store them on a worktop since children are excellent climbers. Buy products with childproof lids wherever possible - but lock them away nonetheless. Think about the appearance of the containers. Chemicals and detergents often come in colourful containers which appeal to small children, while the scent of some detergents also tends to be attractive. As strange as it may seem, nasty tastes don't seem to put children off experimenting further. Never pour chemicals or detergents into empty soft drink or water bottles. Children may think the bottles still contain the original liquid.
What is poisonous in the bathroom? Medicines, cosmetics, creams and lotions contain harmful substances (such as alcohol) that may poison a child. Many tablets, medicines, herbal remedies and even vitamins are dangerous for children. Remember that children are less tolerant than adults and even a small quantity may be poisonous. Always keep such items in a locked cabinet that the children do not have access to. Put any medicines back in the cabinet immediately after use.
What is poisonous in the living room? Alcohol is very dangerous for children. Always lock cabinets containing wine and spirits - screwing down the lids tightly is not enough. Children are very good at opening things and even a small amount of alcohol can be harmful to a young child. Remote controls for electronic equipment may contain small mercury batteries, which can cause poisoning if swallowed. Cigarettes and tobacco are often left lying around. Tobacco, in all forms, is an extremely dangerous poison and just one cigarette stub may poison a child. All kinds of tobacco should be kept out of the reach of children.
Are plants poisonous?Many houseplants and garden plants are poisonous if eaten. A pharmacist can provide advice about poisonous plants. If you have small children, do not keep any poisonous houseplants - even if you place them out of reach, leaves may fall to the floor. Plant poison often causes blisters and/or ulcers in your child's mouth or their tongue may start swelling.
What is poisonous in the garden? Check which of the plants growing in your garden may have leaves, berries, flowers or fruit that could poison a child.A garden shed is likely to contain decorating materials, paint, methylated spirits, turpentine, plant fertilizer, weedkiller, barbecue fire lighters and many more substances that are all extremely poisonous. Garden sheds should be locked at all times.
Guests When you have guests politely ask them not to leave cigarettes or medicines where your children can get their hands on them. Be vigilant when taking your child to visit friends - particularly those who don't have small children themselves and may not be aware of the potential hazards around their home. Find a diplomatic way to suggest that your hosts move any toxic substances to a safe place - tell them, if you like, that you're child is particularly curious and has a tendency to open interesting-looking bottles. Keep an eye on your child at all times.
What if my child is poisoned? Try to stay calm and call a doctor immediately. The doctor will need as much of the following information as possible.
What did the child eat/drink? Write it down.
How much? Find out whether it is one tablet or half a bottle.
The doctor will ask you what the child weighs.
If you are going to Accident & Emergency, take some of the substance that your child has eaten/drunk.
Which medicines are used? Inactivated charcoal is often used in hospital emergency departments as an antidote in cases of poisoning. Large doses are used to prevent the poison being absorbed from the stomach. Inactivated charcoal tablets are available to buy from pharmacies, but these are for the treatment of indigestion and flatulence only and should not be used at home to treat poisoning, as the dose they contain is far too small. For this reason you shouldn't keep charcoal tablets as poisoning treatment in your first-aid kit. You should always consult a doctor or hospital emergency department in cases of poisoning.In some cases of poisoning your doctor will recommend that you give your child milk. But only do this if the doctor has advised it.Induced vomiting - or forcing your child to throw up - is necessary only in some cases of poisoning. Do it only if you know exactly what has poisoned the child and the doctor has told you to go ahead. If your child has swallowed a caustic substance it could be extremely dangerous for them to vomit, so always get medical advice first.
How can I protect my child Although it is important to keep an eye on your children as much as you possibly can, it is simply not possible to know what they're up to 100 per cent of the time. For this reason, when it comes to preventing poisoning, the most important and practical measure is to ensure toxic substances are completely out of reach in the first place. Make a thorough check of your house and garden, removing any harmful products and placing them in a securely locked cabinet. Based on a text by Dr Per Grinsted, GP
Poisoning accidentsAccidents in the home are much too common, especially since many can be avoided by taking a few simple precautions. Some of the more serious accidents are poisoning incidents involving children. When young children explore the world, they use all their senses including taste. They typically put everything in their mouth to find out what it is. For this reason, adults must make sure that children do not have access to anything poisonous. It is surprising just how many ordinary household articles are dangerous in this respect. To make your home safe from poisoning, examine it carefully one room at a time. Identify any potentially harmful substances and either lock them away or store them somewhere out of your children's reach.
What is poisonous in the kitchen? Cleaning materials are usually kept in the kitchen, often in a low cupboard under the sink where they are easily accessible to curious children. Potentially dangerous products include:
all kinds of detergents and cleaning products, which often contain chemicals that are poisonous to children.
plant fertilizer. This is extremely dangerous.
detergents used in automatic dishwashers. These are highly caustic and, therefore, very dangerous if consumed. Move these products to a locked cabinet where children cannot see or reach them. It's not enough to simply store them on a worktop since children are excellent climbers. Buy products with childproof lids wherever possible - but lock them away nonetheless. Think about the appearance of the containers. Chemicals and detergents often come in colourful containers which appeal to small children, while the scent of some detergents also tends to be attractive. As strange as it may seem, nasty tastes don't seem to put children off experimenting further. Never pour chemicals or detergents into empty soft drink or water bottles. Children may think the bottles still contain the original liquid.
What is poisonous in the bathroom? Medicines, cosmetics, creams and lotions contain harmful substances (such as alcohol) that may poison a child. Many tablets, medicines, herbal remedies and even vitamins are dangerous for children. Remember that children are less tolerant than adults and even a small quantity may be poisonous. Always keep such items in a locked cabinet that the children do not have access to. Put any medicines back in the cabinet immediately after use.
What is poisonous in the living room? Alcohol is very dangerous for children. Always lock cabinets containing wine and spirits - screwing down the lids tightly is not enough. Children are very good at opening things and even a small amount of alcohol can be harmful to a young child. Remote controls for electronic equipment may contain small mercury batteries, which can cause poisoning if swallowed. Cigarettes and tobacco are often left lying around. Tobacco, in all forms, is an extremely dangerous poison and just one cigarette stub may poison a child. All kinds of tobacco should be kept out of the reach of children.
Are plants poisonous?Many houseplants and garden plants are poisonous if eaten. A pharmacist can provide advice about poisonous plants. If you have small children, do not keep any poisonous houseplants - even if you place them out of reach, leaves may fall to the floor. Plant poison often causes blisters and/or ulcers in your child's mouth or their tongue may start swelling.
What is poisonous in the garden? Check which of the plants growing in your garden may have leaves, berries, flowers or fruit that could poison a child.A garden shed is likely to contain decorating materials, paint, methylated spirits, turpentine, plant fertilizer, weedkiller, barbecue fire lighters and many more substances that are all extremely poisonous. Garden sheds should be locked at all times.
Guests When you have guests politely ask them not to leave cigarettes or medicines where your children can get their hands on them. Be vigilant when taking your child to visit friends - particularly those who don't have small children themselves and may not be aware of the potential hazards around their home. Find a diplomatic way to suggest that your hosts move any toxic substances to a safe place - tell them, if you like, that you're child is particularly curious and has a tendency to open interesting-looking bottles. Keep an eye on your child at all times.
What if my child is poisoned? Try to stay calm and call a doctor immediately. The doctor will need as much of the following information as possible.
What did the child eat/drink? Write it down.
How much? Find out whether it is one tablet or half a bottle.
The doctor will ask you what the child weighs.
If you are going to Accident & Emergency, take some of the substance that your child has eaten/drunk.
Which medicines are used? Inactivated charcoal is often used in hospital emergency departments as an antidote in cases of poisoning. Large doses are used to prevent the poison being absorbed from the stomach. Inactivated charcoal tablets are available to buy from pharmacies, but these are for the treatment of indigestion and flatulence only and should not be used at home to treat poisoning, as the dose they contain is far too small. For this reason you shouldn't keep charcoal tablets as poisoning treatment in your first-aid kit. You should always consult a doctor or hospital emergency department in cases of poisoning.In some cases of poisoning your doctor will recommend that you give your child milk. But only do this if the doctor has advised it.Induced vomiting - or forcing your child to throw up - is necessary only in some cases of poisoning. Do it only if you know exactly what has poisoned the child and the doctor has told you to go ahead. If your child has swallowed a caustic substance it could be extremely dangerous for them to vomit, so always get medical advice first.
How can I protect my child Although it is important to keep an eye on your children as much as you possibly can, it is simply not possible to know what they're up to 100 per cent of the time. For this reason, when it comes to preventing poisoning, the most important and practical measure is to ensure toxic substances are completely out of reach in the first place. Make a thorough check of your house and garden, removing any harmful products and placing them in a securely locked cabinet. Based on a text by Dr Per Grinsted, GP
"In the initial years of our life we forget our health while going after wealth, in the later years of our life we spend our wealth to take care of our health... It's today reality. Health is not everything, BUT without health everything is nothing."
Is it dangerous to take several different medicines at the same time?
Reviewed by Dr Christine Clark, pharmacist
What is drug interaction? This can occur when people take two or more different drugs at the same time.
Make sure you always know what medicines you are taking and why.
The drugs might be taken for the same illness, such as quinsy (an abscess in the throat), for which a person needs antibiotics and painkillers. Or it may be because they suffer from two different diseases at the same time, such as gastric ulcers and arthritis, for which they need acid neutralisers and medicines for arthritis.If the drugs influence each other producing an increased effect, extra side effects, or decreased effectiveness of one or more drugs, it is called a drug interaction.
How can two different drugs influence each other's effect?Nearly all medicines are broken down by specific enzymes in the liver, and then excreted as smaller molecules through the kidneys.If medicine A impedes the enzyme responsible for breaking down medicine B, the result can be an excessive amount of medicine B in the bloodstream. This can increase the chance of serious side effects. If a doctor thinks that both medicines are necessary at the same time, they will ensure that the dose of medicine B is reduced, to avoid any adverse effects.If, on the other hand, medicine A increases the amount of the enzyme responsible for breaking down medicine B, the breakdown will occur much faster and the effect of medicine B will be lost or decreased. In that case, a doctor will increase the dose of medicine B.Medicines can also influence each other in other ways; for instance, they can affect absorption from the intestines or secretion from the kidneys. In both instances, this can result in effects similar to those described above - too much or too little medicine in the bloodstream, which may lead to serious side effects or little or no effect at all.
Do I have to tell my doctor about the medicines I am using?As long as a doctor has taken into account the effect of taking two or more medicines at the same time it should be perfectly safe. However, always tell a doctor about all the medicines you are using, including herbal remedies and those bought from a pharmacist.When buying over-the-counter medicines from a chemist you should also remember to tell the pharmacist all the medicines you are using.Based on a text by Unni Elmer Jeppesen
What is drug interaction? This can occur when people take two or more different drugs at the same time.
Make sure you always know what medicines you are taking and why.
The drugs might be taken for the same illness, such as quinsy (an abscess in the throat), for which a person needs antibiotics and painkillers. Or it may be because they suffer from two different diseases at the same time, such as gastric ulcers and arthritis, for which they need acid neutralisers and medicines for arthritis.If the drugs influence each other producing an increased effect, extra side effects, or decreased effectiveness of one or more drugs, it is called a drug interaction.
How can two different drugs influence each other's effect?Nearly all medicines are broken down by specific enzymes in the liver, and then excreted as smaller molecules through the kidneys.If medicine A impedes the enzyme responsible for breaking down medicine B, the result can be an excessive amount of medicine B in the bloodstream. This can increase the chance of serious side effects. If a doctor thinks that both medicines are necessary at the same time, they will ensure that the dose of medicine B is reduced, to avoid any adverse effects.If, on the other hand, medicine A increases the amount of the enzyme responsible for breaking down medicine B, the breakdown will occur much faster and the effect of medicine B will be lost or decreased. In that case, a doctor will increase the dose of medicine B.Medicines can also influence each other in other ways; for instance, they can affect absorption from the intestines or secretion from the kidneys. In both instances, this can result in effects similar to those described above - too much or too little medicine in the bloodstream, which may lead to serious side effects or little or no effect at all.
Do I have to tell my doctor about the medicines I am using?As long as a doctor has taken into account the effect of taking two or more medicines at the same time it should be perfectly safe. However, always tell a doctor about all the medicines you are using, including herbal remedies and those bought from a pharmacist.When buying over-the-counter medicines from a chemist you should also remember to tell the pharmacist all the medicines you are using.Based on a text by Unni Elmer Jeppesen
"In the initial years of our life we forget our health while going after wealth, in the later years of our life we spend our wealth to take care of our health... It's today reality. Health is not everything, BUT without health everything is nothing."
Heart attack - emergency first aid
Reviewed by Dr Neal Uren, consultant cardiologist and Dr Reginald Odbert, GP
Important: this is a brief guide to the emergency help that can be given in the event of a heart attack or cardiac arrest before the arrival of emergency services. It is not intended as a replacement for a first aid or resuscitation course.
What should you do if someone has a heart attack? If someone has a cardiac arrest or heart attack, there are only a few minutes to act before it is too late. It is vital to know what to do beforehand. To perform CPR (cardiopulmonary resuscitation) and artificial respiration (mouth to mouth resuscitation) effectively, training and frequent practice on resuscitation dummies are essential.First aid courses are offered all over the country at night schools or by voluntary organisations such as St John Ambulance or The Red Cross.
How can you tell if someone is having a heart attack? If the person is unconscious:
are they breathing? Look at the patient's chest to see if it is rising and falling.
do they have a pulse? Place two fingers on one or other side of the person's voice box in their throat to feel if they have a carotid pulse. If the patient has a pulse but is not breathing:
could it be because of suffocation? Feel inside the mouth with a finger to see if there is anything blocking it or the windpipe and remove any food or other objects. Provided that dentures are not broken, it is better not to remove them.
call for help immediately, stating that the casualty is not breathing, and provide resuscitation (see below) until the patient begins to breathe or the ambulance arrives. If there is no breathing or pulse, the patient has had a cardiac arrest.
What help is needed?
If possible, raise the legs up 12 to 18 inches to allow more blood to flow towards the heart
Immediately place the palm of your hand flat on the patient's chest just over the lower part of the sternum (breast bone) and press your hand in a pumping motion once or twice by using the other hand. This may make the heart beat again. If these actions do not restore a pulse or if the subject doesn't begin to breathe again:
call for help, stating that the casualty is having a cardiac arrest but stay with the patient.
find out if any one else present knows CPR.
provide artificial respiration immediately (see below).
begin CPR immediately (see below).
How to give artificial respiration
Tilt the head back and lift up the chin.
Pinch the nostrils shut with two fingers to prevent leakage of air.
Take a deep breath and seal your own mouth over the person's mouth.
Breathe slowly into the person's mouth - it should take about two seconds to adequately inflate the chest.
Do this twice.
Check to see if the chest rises as you breathe into the patient.
If it does, enough air is being blown in.
If there is resistance, try to hold the head back further and lift the chin again.
Repeat this procedure until help arrives or the person starts breathing again.
How do I perform CPR (cardiopulmonary resuscitation)? See if there is breathing. If not, start artificial respiration as described above. Checking for a pulse in the neck (carotid artery) may waste valuable time if the rescuer is inexperienced in this check. The procedure is:
place your fingers in the groove between the windpipe and the muscles of the side of the neck. Press backwards here to check for a pulse. If there is no pulse, or if you are unsure, then proceed without delay thus:
look at the person's chest and find the 'upside-down V' shaped notch that is made by the lower edge of the ribcage. Place your middle finger in this notch and then place your index finger beside it, resting on the breastbone. Take the heel of your other hand and slide it down the breastbone until it is touching this index finger. The heel of your hand should now be positioned on the middle of the lower half of the breastbone.
now place the heel of your other hand on top of the first. Keep your fingers off the chest, by locking them together. Your pressure should be applied through the heels of the hands only.
keep your elbows straight, and bring your body weight over your hands to make it easier to press down.
press down firmly and quickly to achieve a downwards movement of 4 to 5cm, then relax and repeat the compression.
do this 15 times, then give artificial respiration twice, and continue this 15:2 procedure until help arrives.
aim for a rate of compression of about 100 per minute. You can help your timing and counting by saying out loud 'one and two and three and four ...' etc.
Artificial respiration and CPR should both be performed at the same time
If possible, get someone else to help - one person to perform artificial respiration and the other to perform CPR. (This is not easily done without prior practice and it is well worth attending sessions on CPR training to become familiar with the technique.)
The ratio of chest compressions to breaths is 15:2 for both one-person and two-person CPR.
Continue until the ambulance arrives or the patient gets a pulse and starts to breathe again.
If the pulse returns and breathing begins but the person remains unconscious, roll them gently onto their side into the recovery position. This way mucus or vomit can get out of the mouth and will not obstruct the patient's breathing. It also prevents the tongue from falling back and blocking the air passage.
Make sure the patient continues breathing and has a pulse until the ambulance arrives
If you succeed in resuscitating the person who has been taken ill, he or she may be confused and alarmed by all the commotion. Keep the patient warm and calm by quietly, but clearly, telling them what has happened. Again, it needs to be emphasised that the only way to provide proper first aid and resuscitation is through learning the technique, then regular practice and guidance.
Based on a text by Dr Henrik Omark Petersen
Important: this is a brief guide to the emergency help that can be given in the event of a heart attack or cardiac arrest before the arrival of emergency services. It is not intended as a replacement for a first aid or resuscitation course.
What should you do if someone has a heart attack? If someone has a cardiac arrest or heart attack, there are only a few minutes to act before it is too late. It is vital to know what to do beforehand. To perform CPR (cardiopulmonary resuscitation) and artificial respiration (mouth to mouth resuscitation) effectively, training and frequent practice on resuscitation dummies are essential.First aid courses are offered all over the country at night schools or by voluntary organisations such as St John Ambulance or The Red Cross.
How can you tell if someone is having a heart attack? If the person is unconscious:
are they breathing? Look at the patient's chest to see if it is rising and falling.
do they have a pulse? Place two fingers on one or other side of the person's voice box in their throat to feel if they have a carotid pulse. If the patient has a pulse but is not breathing:
could it be because of suffocation? Feel inside the mouth with a finger to see if there is anything blocking it or the windpipe and remove any food or other objects. Provided that dentures are not broken, it is better not to remove them.
call for help immediately, stating that the casualty is not breathing, and provide resuscitation (see below) until the patient begins to breathe or the ambulance arrives. If there is no breathing or pulse, the patient has had a cardiac arrest.
What help is needed?
If possible, raise the legs up 12 to 18 inches to allow more blood to flow towards the heart
Immediately place the palm of your hand flat on the patient's chest just over the lower part of the sternum (breast bone) and press your hand in a pumping motion once or twice by using the other hand. This may make the heart beat again. If these actions do not restore a pulse or if the subject doesn't begin to breathe again:
call for help, stating that the casualty is having a cardiac arrest but stay with the patient.
find out if any one else present knows CPR.
provide artificial respiration immediately (see below).
begin CPR immediately (see below).
How to give artificial respiration
Tilt the head back and lift up the chin.
Pinch the nostrils shut with two fingers to prevent leakage of air.
Take a deep breath and seal your own mouth over the person's mouth.
Breathe slowly into the person's mouth - it should take about two seconds to adequately inflate the chest.
Do this twice.
Check to see if the chest rises as you breathe into the patient.
If it does, enough air is being blown in.
If there is resistance, try to hold the head back further and lift the chin again.
Repeat this procedure until help arrives or the person starts breathing again.
How do I perform CPR (cardiopulmonary resuscitation)? See if there is breathing. If not, start artificial respiration as described above. Checking for a pulse in the neck (carotid artery) may waste valuable time if the rescuer is inexperienced in this check. The procedure is:
place your fingers in the groove between the windpipe and the muscles of the side of the neck. Press backwards here to check for a pulse. If there is no pulse, or if you are unsure, then proceed without delay thus:
look at the person's chest and find the 'upside-down V' shaped notch that is made by the lower edge of the ribcage. Place your middle finger in this notch and then place your index finger beside it, resting on the breastbone. Take the heel of your other hand and slide it down the breastbone until it is touching this index finger. The heel of your hand should now be positioned on the middle of the lower half of the breastbone.
now place the heel of your other hand on top of the first. Keep your fingers off the chest, by locking them together. Your pressure should be applied through the heels of the hands only.
keep your elbows straight, and bring your body weight over your hands to make it easier to press down.
press down firmly and quickly to achieve a downwards movement of 4 to 5cm, then relax and repeat the compression.
do this 15 times, then give artificial respiration twice, and continue this 15:2 procedure until help arrives.
aim for a rate of compression of about 100 per minute. You can help your timing and counting by saying out loud 'one and two and three and four ...' etc.
Artificial respiration and CPR should both be performed at the same time
If possible, get someone else to help - one person to perform artificial respiration and the other to perform CPR. (This is not easily done without prior practice and it is well worth attending sessions on CPR training to become familiar with the technique.)
The ratio of chest compressions to breaths is 15:2 for both one-person and two-person CPR.
Continue until the ambulance arrives or the patient gets a pulse and starts to breathe again.
If the pulse returns and breathing begins but the person remains unconscious, roll them gently onto their side into the recovery position. This way mucus or vomit can get out of the mouth and will not obstruct the patient's breathing. It also prevents the tongue from falling back and blocking the air passage.
Make sure the patient continues breathing and has a pulse until the ambulance arrives
If you succeed in resuscitating the person who has been taken ill, he or she may be confused and alarmed by all the commotion. Keep the patient warm and calm by quietly, but clearly, telling them what has happened. Again, it needs to be emphasised that the only way to provide proper first aid and resuscitation is through learning the technique, then regular practice and guidance.
Based on a text by Dr Henrik Omark Petersen
"In the initial years of our life we forget our health while going after wealth, in the later years of our life we spend our wealth to take care of our health... It's today reality. Health is not everything, BUT without health everything is nothing."
Foreign body in the eye
Reviewed by Dr Caroline MacEwan, consultant ophthamologist
Any material such as dust, sand or paint that gets into the eye is called a foreign body. Foreign bodies fall into two categories.
Superficial foreign bodies: these stick to the front of the eye or get trapped under one of the eyelids, but do not enter the eye.
Penetrating foreign bodies: these penetrate the outer layer of the eye (cornea or sclera) and enter the eye. These objects are usually travelling at high speed and are commonly made of metal.
How do you get foreign bodies in the eye? Non-perforating superficial foreign bodies are generally either blown or fall into the eye. This may occur, for instance, when working under a car or when outside on a windy day. Penetrating eye injuries tend to occur when people are hammering or grinding. Under these circumstances small pieces of metal travelling at high speed hit the eye and enter it through the outer coat of the eye.
Is it a serious condition? Superficial foreign bodies are not usually serious. A penetrating eye injury can be extremely serious - it may lead to blindness if not detected and treated promptly. Even if treated appropriately, it may cause loss of vision.
What does it feel like? Superficial foreign bodies tend to be very uncomfortable. The foreign body may be stuck on to the cornea or the conjunctiva, causing a red, watery and gritty eye. The foreign material may have become stuck under the upper lid, whereby every time the eye opens and closes the pain increases. Penetrating eye injuries, although they are much more serious injuries, paradoxically are often much less painful. The vision may be reduced, but this is not always the case.
How can I get rid of a foreign body?If you get a superficial foreign body in your eye, first-aid treatment in the form of gentle rinsing with warm water is appropriate. An 'eye bath' can make this easier to do on your own, or you can get someone to help rinse the eye from the side, with you lying down.Do not try to remove a foreign body with cotton buds, matchsticks or any other type of solid object. You could do more harm than good - go to the nearest casualty doctor or contact your GP's surgery.It is also advisable to consult a doctor if you think you've had a foreign body in your eye and it's continuing to cause irritation. If you think something has gone into your eye while you have been grinding or hammering, even if you have little in the way of pain or loss of vision, it is essential that you consult a doctor immediately and tell them about the circumstances of your injury.
How does the doctor make a diagnosis?
Superficial foreign bodies If you tell your doctor you have felt something going into your eye, he or she will examine the eye using a fluorescein stain, which helps to detect any foreign material on the surface of the eye. The eyelid also needs to be turned outwards so that the underside of the lid can be examined and any foreign material removed from that surface. The material can be removed using a cotton bud, although occasionally a small needle may be required to lift any embedded particles from the eye. This is carried out with local anaesthetic drops and does not hurt.
Penetrating foreign material
Good advice
Wear protective glasses or goggles to prevent foreign bodies entering your eyes.
For example, when:
welding
using a grinder
using a sander
using a Strimmer
doing DIY.
If you tell your doctor that you have suffered a possible eye injury while carrying out a high-risk activity such as hammering, the eye will be examined in full detail. Your vision will be assessed, and it is possible that this may be reduced. There may be evidence that the pupil is distorted and there may be blood inside the eye. If the lens of the eye has been hit by the foreign material, there may be evidence of an early cataract. X-rays or scans may be required if there is any suspicion there is foreign material inside the eye.
What happens if the foreign body is not removed from my eye?
Superficial foreign materialThis will tend to cause persistent irritation and may lead to conjunctivitis. Sometimes the foreign material becomes buried and stops causing problems, although there may be some scarring.
Penetrating foreign bodies The damage caused by an intraocular foreign body depends on:
the type of material that makes up the foreign body
the amount of damage it causes as it passes into the eye.Metal foreign bodies that have iron in them can cause a condition called 'siderosis', which gradually leads to poor vision over the following months and years. Some other metals and vegetable materials may cause rapid destruction of the eye or infection inside the eye. It is possible for a small foreign body to enter the eye and cause no apparent damage, but it may lead to bleeding within the eye, early cataract formation or damage to the retina. Surgery may be required to correct this damage.
How is a penetrating foreign body removed? An operation is needed to remove foreign bodies that have penetrated inside the eye. This usually takes the form of a vitrectomy, which involves going into the eye to remove the foreign material. At the same time, any damage to the eye caused by the entry of the foreign material can be repaired. This may involve removal of haemorrhage, removal of the lens or repair of retinal damage.
Will there be any long-term effects? Superficial foreign bodies are not sight-threatening injuries and the eye tends to make a full recovery. Penetrating foreign bodies are potentially very serious and may lead to blindness or loss of the eye, even if treated appropriately. Based on a text by Dr Per Grinsted
Any material such as dust, sand or paint that gets into the eye is called a foreign body. Foreign bodies fall into two categories.
Superficial foreign bodies: these stick to the front of the eye or get trapped under one of the eyelids, but do not enter the eye.
Penetrating foreign bodies: these penetrate the outer layer of the eye (cornea or sclera) and enter the eye. These objects are usually travelling at high speed and are commonly made of metal.
How do you get foreign bodies in the eye? Non-perforating superficial foreign bodies are generally either blown or fall into the eye. This may occur, for instance, when working under a car or when outside on a windy day. Penetrating eye injuries tend to occur when people are hammering or grinding. Under these circumstances small pieces of metal travelling at high speed hit the eye and enter it through the outer coat of the eye.
Is it a serious condition? Superficial foreign bodies are not usually serious. A penetrating eye injury can be extremely serious - it may lead to blindness if not detected and treated promptly. Even if treated appropriately, it may cause loss of vision.
What does it feel like? Superficial foreign bodies tend to be very uncomfortable. The foreign body may be stuck on to the cornea or the conjunctiva, causing a red, watery and gritty eye. The foreign material may have become stuck under the upper lid, whereby every time the eye opens and closes the pain increases. Penetrating eye injuries, although they are much more serious injuries, paradoxically are often much less painful. The vision may be reduced, but this is not always the case.
How can I get rid of a foreign body?If you get a superficial foreign body in your eye, first-aid treatment in the form of gentle rinsing with warm water is appropriate. An 'eye bath' can make this easier to do on your own, or you can get someone to help rinse the eye from the side, with you lying down.Do not try to remove a foreign body with cotton buds, matchsticks or any other type of solid object. You could do more harm than good - go to the nearest casualty doctor or contact your GP's surgery.It is also advisable to consult a doctor if you think you've had a foreign body in your eye and it's continuing to cause irritation. If you think something has gone into your eye while you have been grinding or hammering, even if you have little in the way of pain or loss of vision, it is essential that you consult a doctor immediately and tell them about the circumstances of your injury.
How does the doctor make a diagnosis?
Superficial foreign bodies If you tell your doctor you have felt something going into your eye, he or she will examine the eye using a fluorescein stain, which helps to detect any foreign material on the surface of the eye. The eyelid also needs to be turned outwards so that the underside of the lid can be examined and any foreign material removed from that surface. The material can be removed using a cotton bud, although occasionally a small needle may be required to lift any embedded particles from the eye. This is carried out with local anaesthetic drops and does not hurt.
Penetrating foreign material
Good advice
Wear protective glasses or goggles to prevent foreign bodies entering your eyes.
For example, when:
welding
using a grinder
using a sander
using a Strimmer
doing DIY.
If you tell your doctor that you have suffered a possible eye injury while carrying out a high-risk activity such as hammering, the eye will be examined in full detail. Your vision will be assessed, and it is possible that this may be reduced. There may be evidence that the pupil is distorted and there may be blood inside the eye. If the lens of the eye has been hit by the foreign material, there may be evidence of an early cataract. X-rays or scans may be required if there is any suspicion there is foreign material inside the eye.
What happens if the foreign body is not removed from my eye?
Superficial foreign materialThis will tend to cause persistent irritation and may lead to conjunctivitis. Sometimes the foreign material becomes buried and stops causing problems, although there may be some scarring.
Penetrating foreign bodies The damage caused by an intraocular foreign body depends on:
the type of material that makes up the foreign body
the amount of damage it causes as it passes into the eye.Metal foreign bodies that have iron in them can cause a condition called 'siderosis', which gradually leads to poor vision over the following months and years. Some other metals and vegetable materials may cause rapid destruction of the eye or infection inside the eye. It is possible for a small foreign body to enter the eye and cause no apparent damage, but it may lead to bleeding within the eye, early cataract formation or damage to the retina. Surgery may be required to correct this damage.
How is a penetrating foreign body removed? An operation is needed to remove foreign bodies that have penetrated inside the eye. This usually takes the form of a vitrectomy, which involves going into the eye to remove the foreign material. At the same time, any damage to the eye caused by the entry of the foreign material can be repaired. This may involve removal of haemorrhage, removal of the lens or repair of retinal damage.
Will there be any long-term effects? Superficial foreign bodies are not sight-threatening injuries and the eye tends to make a full recovery. Penetrating foreign bodies are potentially very serious and may lead to blindness or loss of the eye, even if treated appropriately. Based on a text by Dr Per Grinsted
"In the initial years of our life we forget our health while going after wealth, in the later years of our life we spend our wealth to take care of our health... It's today reality. Health is not everything, BUT without health everything is nothing."
First-aid kit
Reviewed by Christine Clark, pharmacist and Dr John Pillinger, GP
First-aid kit basicsA first-aid kit contains emergency supplies and medication for unexpected minor illnesses or accidents. While it is vital for people who suffer from a chronic disease or condition to take their medication with them at all times, it is also a good idea for everyone to keep a first-aid kit in the home or car, or take one with them on holiday in case of emergencies. If going abroad, talk to your doctor before leaving about arrangements for vaccinations or special medication such as malaria tablets. Although it is possible to buy additional items for your first aid kit when you are abroad, it is a good safeguard to purchase extra supplies and medication before your departure. Emergency situations occur unexpectedly and you may find yourself unable to obtain essential items just when you need them most.Remember that medicines suitable for adults are not always suitable for children as well. Always read the label to check who can take the medicines in your first-aid kit, and at what dose.
Motion sickness Medication to prevent motion sickness caused by car, air or sea travel can be bought over the counter without prescription. If necessary, this should be taken before starting a journey.
Diarrhoea, irregular bowel movements or indigestion It is a good idea to be prepared for diarrhoea. Tablets or capsules are available both on prescription or over the counter at your local pharmacy.If diarrhoea or vomiting occur despite these precautions you will need to make sure the patient gets enough liquid. This is especially important where children are concerned. Cola drinks are particularly helpful since they replace essential salt and sugar as well as provide a source of liquid, but a first-aid kit should also contain a saline antidiarrhoea preparation (a powder or large tablet that is dissolved in clean water) to prevent dehydration. Many people get constipation when travelling. A mild laxative, available from a pharmacy, usually relieves most symptoms. For people who suffer from acid burn or heartburn when eating spicy food, it is a good idea to keep a supply of antacid preparation in the first-aid kit.
Pain relievers Aspirin or paracetamol can be bought over the counter. They come in different forms including soluble tablets, ordinary tablets or suppositories, and can relieve headache, muscle pain, toothache and period pain. Aspirin should not be given to children under 16 years of age, unless on the advice of a doctor.
FeverFever is most commonly caused by viruses that cannot be treated with antibiotics. Even though antibiotics can be bought in some countries without a prescription, they should be avoided. If antibiotics are necessary, a GP should be consulted. A doctor will be able to prescribe the appropriate antibiotics or other medication.
Sunburn A sunblock to be applied prior to exposure to the sun should always be included in a first-aid kit, along with cream and lotion for use after sunbathing. The pharmacist should be consulted as to the appropriate screening (SPF-sun protection factor) level.
Insect bitesAntipruritic lotions such as calamine are effective against insect bites or stings.
Cuts and grazes The following items are all useful for treating minor cuts and grazes:
sticking plasters
cotton wool
safety pins
a gauze bandage and supportive bandages
antiseptic lotion or saline to clean wounds.
Do I need to take everything wherever I go? There is no need to take everything with you. Indeed, a longer trip might require more supplies than a shorter one. Buy products in small sizes that fit easily into your luggage. Remember that all drugs have a 'use by' date and should be thrown away after they have expired. Based on a text by Dr Per Grinsted, GP and Dr Erik Fangel Poulsen, specialist
First-aid kit basicsA first-aid kit contains emergency supplies and medication for unexpected minor illnesses or accidents. While it is vital for people who suffer from a chronic disease or condition to take their medication with them at all times, it is also a good idea for everyone to keep a first-aid kit in the home or car, or take one with them on holiday in case of emergencies. If going abroad, talk to your doctor before leaving about arrangements for vaccinations or special medication such as malaria tablets. Although it is possible to buy additional items for your first aid kit when you are abroad, it is a good safeguard to purchase extra supplies and medication before your departure. Emergency situations occur unexpectedly and you may find yourself unable to obtain essential items just when you need them most.Remember that medicines suitable for adults are not always suitable for children as well. Always read the label to check who can take the medicines in your first-aid kit, and at what dose.
Motion sickness Medication to prevent motion sickness caused by car, air or sea travel can be bought over the counter without prescription. If necessary, this should be taken before starting a journey.
Diarrhoea, irregular bowel movements or indigestion It is a good idea to be prepared for diarrhoea. Tablets or capsules are available both on prescription or over the counter at your local pharmacy.If diarrhoea or vomiting occur despite these precautions you will need to make sure the patient gets enough liquid. This is especially important where children are concerned. Cola drinks are particularly helpful since they replace essential salt and sugar as well as provide a source of liquid, but a first-aid kit should also contain a saline antidiarrhoea preparation (a powder or large tablet that is dissolved in clean water) to prevent dehydration. Many people get constipation when travelling. A mild laxative, available from a pharmacy, usually relieves most symptoms. For people who suffer from acid burn or heartburn when eating spicy food, it is a good idea to keep a supply of antacid preparation in the first-aid kit.
Pain relievers Aspirin or paracetamol can be bought over the counter. They come in different forms including soluble tablets, ordinary tablets or suppositories, and can relieve headache, muscle pain, toothache and period pain. Aspirin should not be given to children under 16 years of age, unless on the advice of a doctor.
FeverFever is most commonly caused by viruses that cannot be treated with antibiotics. Even though antibiotics can be bought in some countries without a prescription, they should be avoided. If antibiotics are necessary, a GP should be consulted. A doctor will be able to prescribe the appropriate antibiotics or other medication.
Sunburn A sunblock to be applied prior to exposure to the sun should always be included in a first-aid kit, along with cream and lotion for use after sunbathing. The pharmacist should be consulted as to the appropriate screening (SPF-sun protection factor) level.
Insect bitesAntipruritic lotions such as calamine are effective against insect bites or stings.
Cuts and grazes The following items are all useful for treating minor cuts and grazes:
sticking plasters
cotton wool
safety pins
a gauze bandage and supportive bandages
antiseptic lotion or saline to clean wounds.
Do I need to take everything wherever I go? There is no need to take everything with you. Indeed, a longer trip might require more supplies than a shorter one. Buy products in small sizes that fit easily into your luggage. Remember that all drugs have a 'use by' date and should be thrown away after they have expired. Based on a text by Dr Per Grinsted, GP and Dr Erik Fangel Poulsen, specialist
"In the initial years of our life we forget our health while going after wealth, in the later years of our life we spend our wealth to take care of our health... It's today reality. Health is not everything, BUT without health everything is nothing."
First aid - what everybody should know
Reviewed by Dr Stuart Crisp, specialist registrar
Why learn first aid?
WARNING!
This advice is a general guideline for use in an emergency.
It is not intended to replace professional classes in first aid and resuscitation.
First aid is an important skill. By performing simple procedures and following certain guidelines, it may be possible to save lives by giving basic treatment until professional medical help arrives. Remember, too, that practice makes perfect. In an emergency there is no time to read instructions. If you've memorised some of the basic procedures, it will help you react quickly and efficiently.
Breathing difficultiesIf someone stops breathing, see if the person replies if talked to or touched on the shoulder. If not, call an ambulance and then begin first aid.
Place the person on his or her back on the floor.
Tilt the head so that the chin is pointing upwards. Do this by placing the fingertips under the jawbone, then lift gently while pressing down softly on the person's forehead. This is done to make sure the tongue is not blocking the throat.
Keep holding the head in this way while checking for breathing: see if the chest is rising and falling, or place your ear next to their mouth to listen for breathing.
If there is breathing, hold the head as described above until help arrives. If not, start artificial respiration.
How to give artificial respiration
Tilt the head back and lift up the chin.
Pinch the nostrils shut with two fingers to prevent leakage of air.
Take a deep breath and seal your own mouth over the person's mouth.
Breathe slowly into the person's mouth - it should take about two seconds to adequately inflate the chest.
Do this twice.
Check to see if the chest rises as you breathe into the patient's mouth.
If it does, enough air is being blown in.
If there is resistance, try to hold the head back further and lift the chin again.
Repeat this procedure until help arrives or the person starts breathing again.
If an adult is unconscious and has no pulseIf an adult is unconscious, see if there is breathing. If not, start artificial respiration as described above.
Checking for a pulse
If you are inexperienced, you may waste valuable time checking for a pulse.
How to take a pulse
Place your fingers in the groove between the windpipe and the muscles of the side of the neck.
Press backwards here to check for a pulse.
If there is no pulse, or if you are unsure, then proceed without delay as follows.
Look at the person's chest and find the 'upside-down V' shaped notch that is made by the lower edge of the ribcage. Place your middle finger in this notch and then place your index finger beside it, resting on the breastbone.
Take the heel of your other hand and slide it down the breastbone until it is touching this index finger. The heel of your hand should now be positioned on the middle of the lower half of the breastbone.
Now place the heel of your other hand on top of the first. Keep your fingers off the chest, by locking them together. Your pressure should be applied through the heels of the hands only.
Keep your elbows straight, and bring your body weight over your hands to make it easier to press down.
Press down firmly and quickly to achieve a downwards movement of 4-5cm, then relax and repeat the compression.
Do this 15 times, then give artificial respiration twice. Continue this 15:2 procedure until help arrives.
Aim for a rate of compression of about 100 per minute. You can help your timing and counting by saying out loud 'one and two and three and four ...' etc.
If a baby (up to 1 year) is unconscious and has no pulse
Find the place between the nipples where the ribs meet in the breastbone. Move your fingers about 2cm to the right from this point - just above their heart.
Press firmly, but not forcefully, with your index and middle fingers.
If you can't see the baby's chest rise, the pressure is not correct. But with babies, it is especially important to prevent further injury by taking care not to press too hard.
BleedingWith all types of bleeding, it's important to stop the flow of blood as quickly as possible.
Small cutsSmall cuts in the veins stop bleeding and clot within a few minutes. The area should then be washed, and a plaster placed gently on top.
Deeper cutsDeeper cuts in the veins produce dark blood that seeps out slowly and steadily. It can be stopped by gentle pressure on the wound with a sterile or clean cloth, followed by the application of a clean or sterile bandage. Often, these wounds need sewing or glueing, and therefore medical treatment will be necessary after first aid.
Arterial bleeding
WARNING!
Arterial bleeding must always be treated by a doctor.
Bleeding from an artery can cause death within a few minutes, so urgent first aid is essential. This type of bleeding pulsates and squirts blood as the pulse beats. The blood is often a light red colour. To stop bleeding from an artery:
apply hard pressure on the wound and keep this up until the patient receives medical treatment.
press with a sterile cloth or just use your hand if nothing else is available.
put a bandage on the wound if possible. If the blood soaks through the bandages, press harder until the bleeding stops.
do not remove the soaked bandages, but place another on top if necessary.
do not attempt to clean the wound. The person must be made to lie down, preferably with their head lower than the rest of their body. This will ensure that enough oxygen gets to the brain. If possible, position the wounded area higher than the rest of their body so that the pressure, and therefore the bleeding, will be reduced.
NosebleedsNosebleeds occur when one of the small blood vessels in the mucous membranes of the nose bursts. Do not bend the head backwards or lie down, because this increases blood pressure in the head and so increases the bleeding. Blood may also run into the stomach. To limit the bleeding:
pinch the nostrils shut with the index and middle finger for 10 minutes. This way, the vein is pressed together, which is often enough to stem the flow.
while the nostrils are shut, the person must breathe through their mouth.
if the bleeding continues, it is important to contact a doctor.If the person frequently suffers sudden, intense nosebleeds, they should also consult a doctor.
ChokingChoking happens when the passage through the windpipe is blocked. This usually occurs when food that has not been thoroughly chewed gets stuck. If someone looks like they are choking, ask them if they are able to talk. A person who is genuinely choking can usually only communicate with hand movements, and may place their hand against their throat. In such a case they will definitely need help, so summon assistance for them. Provided the person is conscious and breathing, you should not interfere. However, be prepared to do so if the obstruction appears to become complete or markedly worse. The best way to relieve choking is by using the Heimlich manoeuvre.
The Heimlich manoeuvre
Stand behind the person who is choking.
Place your arms around their waist and bend them well forward.
Clench your fist and place it right above the person's navel (belly button).
Place your other hand on top, then thrust both hands backwards into the stomach with a hard, upward movement.
Repeat this until the object stuck in the throat is expelled through their mouth. If you need to carry out this manoeuvre on yourself, place a clenched hand above your navel (belly button) and your other hand on top. Then thrust your fist hard into your stomach. Repeat this until the object stuck in the throat is expelled through the mouth.
Shock and faintingShock and fainting occur when only a small amount of blood circulates to the brain. This means that the brain is not receiving enough oxygen, which leads to a feeling of faintness, disorientation and dizziness. Shock may also occur:
after an accident involving loss of blood
after a serious infection with loss of fluids
after a serious burn
after other accidents that cause loss of fluids or blood. When the flow of blood in the body is too slow, the blood pressure drops and too little oxygen is circulated through the body. When this occurs a person will:
go pale
turn sweaty, clammy and cold
become dizzy
have a weak, fast pulse
have low blood pressure
have slow, weak breathing
lose consciousness
become anxious or restless.
What to do if someone is in shock or fainting
The person must lie on their back - preferably with their feet raised - to ensure enough blood gets to the brain.
Make sure the person is warm, comfortable and covered by a blanket if possible.
Do not give them anything to drink because they could run a risk of choking.
If the person vomits or bleeds from the mouth, he or she must be placed on their side to prevent choking.
Call for an ambulance. A person in shock must always be treated by a doctor.
References Resuscitation council (UK) guidelines 2000. http://www.resus.org.uk/pages/guide.htmBased on a text by Dr Henrik Omark Petersen
Why learn first aid?
WARNING!
This advice is a general guideline for use in an emergency.
It is not intended to replace professional classes in first aid and resuscitation.
First aid is an important skill. By performing simple procedures and following certain guidelines, it may be possible to save lives by giving basic treatment until professional medical help arrives. Remember, too, that practice makes perfect. In an emergency there is no time to read instructions. If you've memorised some of the basic procedures, it will help you react quickly and efficiently.
Breathing difficultiesIf someone stops breathing, see if the person replies if talked to or touched on the shoulder. If not, call an ambulance and then begin first aid.
Place the person on his or her back on the floor.
Tilt the head so that the chin is pointing upwards. Do this by placing the fingertips under the jawbone, then lift gently while pressing down softly on the person's forehead. This is done to make sure the tongue is not blocking the throat.
Keep holding the head in this way while checking for breathing: see if the chest is rising and falling, or place your ear next to their mouth to listen for breathing.
If there is breathing, hold the head as described above until help arrives. If not, start artificial respiration.
How to give artificial respiration
Tilt the head back and lift up the chin.
Pinch the nostrils shut with two fingers to prevent leakage of air.
Take a deep breath and seal your own mouth over the person's mouth.
Breathe slowly into the person's mouth - it should take about two seconds to adequately inflate the chest.
Do this twice.
Check to see if the chest rises as you breathe into the patient's mouth.
If it does, enough air is being blown in.
If there is resistance, try to hold the head back further and lift the chin again.
Repeat this procedure until help arrives or the person starts breathing again.
If an adult is unconscious and has no pulseIf an adult is unconscious, see if there is breathing. If not, start artificial respiration as described above.
Checking for a pulse
If you are inexperienced, you may waste valuable time checking for a pulse.
How to take a pulse
Place your fingers in the groove between the windpipe and the muscles of the side of the neck.
Press backwards here to check for a pulse.
If there is no pulse, or if you are unsure, then proceed without delay as follows.
Look at the person's chest and find the 'upside-down V' shaped notch that is made by the lower edge of the ribcage. Place your middle finger in this notch and then place your index finger beside it, resting on the breastbone.
Take the heel of your other hand and slide it down the breastbone until it is touching this index finger. The heel of your hand should now be positioned on the middle of the lower half of the breastbone.
Now place the heel of your other hand on top of the first. Keep your fingers off the chest, by locking them together. Your pressure should be applied through the heels of the hands only.
Keep your elbows straight, and bring your body weight over your hands to make it easier to press down.
Press down firmly and quickly to achieve a downwards movement of 4-5cm, then relax and repeat the compression.
Do this 15 times, then give artificial respiration twice. Continue this 15:2 procedure until help arrives.
Aim for a rate of compression of about 100 per minute. You can help your timing and counting by saying out loud 'one and two and three and four ...' etc.
If a baby (up to 1 year) is unconscious and has no pulse
Find the place between the nipples where the ribs meet in the breastbone. Move your fingers about 2cm to the right from this point - just above their heart.
Press firmly, but not forcefully, with your index and middle fingers.
If you can't see the baby's chest rise, the pressure is not correct. But with babies, it is especially important to prevent further injury by taking care not to press too hard.
BleedingWith all types of bleeding, it's important to stop the flow of blood as quickly as possible.
Small cutsSmall cuts in the veins stop bleeding and clot within a few minutes. The area should then be washed, and a plaster placed gently on top.
Deeper cutsDeeper cuts in the veins produce dark blood that seeps out slowly and steadily. It can be stopped by gentle pressure on the wound with a sterile or clean cloth, followed by the application of a clean or sterile bandage. Often, these wounds need sewing or glueing, and therefore medical treatment will be necessary after first aid.
Arterial bleeding
WARNING!
Arterial bleeding must always be treated by a doctor.
Bleeding from an artery can cause death within a few minutes, so urgent first aid is essential. This type of bleeding pulsates and squirts blood as the pulse beats. The blood is often a light red colour. To stop bleeding from an artery:
apply hard pressure on the wound and keep this up until the patient receives medical treatment.
press with a sterile cloth or just use your hand if nothing else is available.
put a bandage on the wound if possible. If the blood soaks through the bandages, press harder until the bleeding stops.
do not remove the soaked bandages, but place another on top if necessary.
do not attempt to clean the wound. The person must be made to lie down, preferably with their head lower than the rest of their body. This will ensure that enough oxygen gets to the brain. If possible, position the wounded area higher than the rest of their body so that the pressure, and therefore the bleeding, will be reduced.
NosebleedsNosebleeds occur when one of the small blood vessels in the mucous membranes of the nose bursts. Do not bend the head backwards or lie down, because this increases blood pressure in the head and so increases the bleeding. Blood may also run into the stomach. To limit the bleeding:
pinch the nostrils shut with the index and middle finger for 10 minutes. This way, the vein is pressed together, which is often enough to stem the flow.
while the nostrils are shut, the person must breathe through their mouth.
if the bleeding continues, it is important to contact a doctor.If the person frequently suffers sudden, intense nosebleeds, they should also consult a doctor.
ChokingChoking happens when the passage through the windpipe is blocked. This usually occurs when food that has not been thoroughly chewed gets stuck. If someone looks like they are choking, ask them if they are able to talk. A person who is genuinely choking can usually only communicate with hand movements, and may place their hand against their throat. In such a case they will definitely need help, so summon assistance for them. Provided the person is conscious and breathing, you should not interfere. However, be prepared to do so if the obstruction appears to become complete or markedly worse. The best way to relieve choking is by using the Heimlich manoeuvre.
The Heimlich manoeuvre
Stand behind the person who is choking.
Place your arms around their waist and bend them well forward.
Clench your fist and place it right above the person's navel (belly button).
Place your other hand on top, then thrust both hands backwards into the stomach with a hard, upward movement.
Repeat this until the object stuck in the throat is expelled through their mouth. If you need to carry out this manoeuvre on yourself, place a clenched hand above your navel (belly button) and your other hand on top. Then thrust your fist hard into your stomach. Repeat this until the object stuck in the throat is expelled through the mouth.
Shock and faintingShock and fainting occur when only a small amount of blood circulates to the brain. This means that the brain is not receiving enough oxygen, which leads to a feeling of faintness, disorientation and dizziness. Shock may also occur:
after an accident involving loss of blood
after a serious infection with loss of fluids
after a serious burn
after other accidents that cause loss of fluids or blood. When the flow of blood in the body is too slow, the blood pressure drops and too little oxygen is circulated through the body. When this occurs a person will:
go pale
turn sweaty, clammy and cold
become dizzy
have a weak, fast pulse
have low blood pressure
have slow, weak breathing
lose consciousness
become anxious or restless.
What to do if someone is in shock or fainting
The person must lie on their back - preferably with their feet raised - to ensure enough blood gets to the brain.
Make sure the person is warm, comfortable and covered by a blanket if possible.
Do not give them anything to drink because they could run a risk of choking.
If the person vomits or bleeds from the mouth, he or she must be placed on their side to prevent choking.
Call for an ambulance. A person in shock must always be treated by a doctor.
References Resuscitation council (UK) guidelines 2000. http://www.resus.org.uk/pages/guide.htmBased on a text by Dr Henrik Omark Petersen
"In the initial years of our life we forget our health while going after wealth, in the later years of our life we spend our wealth to take care of our health... It's today reality. Health is not everything, BUT without health everything is nothing."
Carbon monoxide poisoning
Written by Dr Dan Rutherford, GP
Carbon monoxide (CO) is an odourless, colourless, non-irritant gas. It is the most common cause of fatal poisoning in Britain today. It causes the accidental deaths of up to 50 people each year in the UK and a much larger number of sub-lethal poisonings.These figures could be just the tip of the iceberg as poisoning by carbon monoxide is almost certainly underdetected. There are two main reasons for this. Firstly, there is generally little awareness of carbon monoxide poisoning among the general public and the medical profession. Secondly, the signs and symptoms associated with carbon monoxide poisoning are not easy to diagnose as they often mimic many other conditions.To overcome this deadly killer requires improved awareness among the public of the risks and dangers of carbon monoxide poisoning and increased vigilance on the part of healthcare professionals in its detection. Children, pregnant women, babies, and individuals with a heart condition are those at most risk but CO poisoning can affect anyone.
Where does carbon monoxide come from?Carbon monoxide is produced by the incomplete combustion of carbon-containing fuels, such as gas (domestic or bottled), coal, oil, coke and wood1,3. Gas stoves, fires, heating boilers, gas-powered water heaters, paraffin heaters, and solid fuel-powered water heaters are all potential sources of carbon monoxide. The problem arises when such appliances are poorly maintained, not serviced and housed in poorly ventilated areas.When the waste products of combustion are not effectively removed, for example because of blocked flues and chimneys, then poisonous gas mixtures may re-enter the room. This problem is not just associated with older or poorer homes; it can also affect the occupants of newer homes with gas central heating. Exhaust fumes from cars is another obvious source.Domestic sources of carbon monoxide include:
domestic heating systems
blocked flues/chimneys
inadequate ventilation in living areas
inadequate ventilation in adjoining car garages
leakage from faulty appliances and chimneys/flues.
How is carbon monoxide formed?When any fire burns, in an enclosed room, the amount of oxygen available gradually decreases. At the same time the amount of carbon dioxide increases. As the amounts of these two gases change, this increasingly causes the combustion process to alter from one of complete combustion to one of incomplete combustion. This results in the release of increasing amounts of CO.This highlights an important issue. Even with perfectly designed and maintained heating appliances (or any kind of combustion device), they too will eventually begin producing dangerous amounts of CO if used in confined and poorly ventilated areas. Having poorly operating appliances, only makes the problem worse more quickly. Maintaining appliances and ensuring sufficient fresh air is available are two easy ways of avoiding potentially lethal scenarios.
How does carbon monoxide cause poisoning?To explain this aspect, we need to explain how the body uses oxygen from the air. Oxygen is transported around the body via the red blood cells. Specifically, oxygen binds to a substance within the red blood cells called haemoglobin, which is also responsible for their red colour.Haemoglobin takes up oxygen as blood passes through the lungs, and at the same time carbon dioxide, produced by the body's metabolism, is released from the blood into the exhaled breath. The combination of oxygen with haemoglobin is called oxyhaemoglobin and this 'oxygenated' blood is carried away from the lungs through the bloodstream to all the tissues of the body.Carbon monoxide can also bind to haemoglobin but does so about 240 times more tightly than oxygen, forming a compound called carboxyhaemoglobin. This means that if both carbon monoxide and oxygen are inhaled, carbon monoxide will preferentially bind to haemoglobin. This reduces the amount of haemoglobin available to bind to oxygen, so the body and tissues become starved of oxygen.Carboxyhaemoglobin also has direct effects on the blood vessels of the body - causing them to become 'leaky'. This is seen especially in the brain, causing the brain to swell, leading to unconsciousness and neurological damage.
What are the symptoms of carbon monoxide poisoning?One of the difficulties with diagnosing carbon monoxide poisoning is that many of its symptoms are similar to those of other conditions. Often the onset of symptoms is gradual, occurring without the individual or doctor being fully aware of what is happening. Coupled with this is the fact that the severity of the poisoning depends on:
how much carbon monoxide is actually present in the environment.
the duration you are exposed to carbon monoxide.
the age of the individual concerned - elderly, children and the foetus are all at greater risk.
the general state of health.
the extent of physical activity - effects are increased with higher activity levels. The commonest symptoms (with frequency of occurrence in brackets) include:
headache (90 per cent)
nausea and vomiting (50 per cent)
vertigo (50 per cent)
altering states of consciousness (30 per cent)
weakness (20 per cent). The likely symptoms in adults, children and infants are shown in Table 1.Table 1: Likely symptoms of CO poisoning
Symptoms
Adult
Child
Infant
General
Dizziness, fatigue, weakness
.
Not feeling well
Neurological
Headache, drowsiness, disorientation, fits
Headache, drowsiness, fits, uncoordinated movement
.
Stomach/intestine
Nausea, vomiting, stomach pains
Vomiting, stomach pains, anorexia, diarrhoea
Loss of appetite
Heart
Chest pain, wheeziness, palpitations, hyperventilation
Hyperventilation
.
How is carbon monoxide poisoning diagnosed?Individuals can either be exposed to high levels of carbon monoxide over a relatively short period of time (acute exposure) or to lower levels of exposure over a longer period of time (chronic exposure).Acute exposure is easier to diagnose as the symptoms are more pronounced, but it is the more common chronic exposure symptoms that are more subtle and difficult to tell apart from other conditions. Where whole families are affected by suspected 'food poisoning' this has been known to be due to carbon monoxide exposure.Where such symptoms are reported repeatedly, domestic carbon monoxide poisoning should be suspected. Clues that point towards a problem within the home include:
more than one family member being affected
symptoms appear or get worse when gas appliances are in use
symptoms are worse in the winter when gas boilers/heaters are in use
symptoms improve when family members are not at home, but recur on their return. Important information can also be obtained by inspecting gas-operated heating appliances within the home. Relevant points include:
black soot marks on gas fire burners or on walls near cookers, boilers, gas fires
a yellow gas flame colour, rather than the blue colour it should be.
How is carbon monoxide poisoning treated?The first step is to move the affected individual(s) away from further exposure to the carbon monoxide source. Their signs and symptoms will then determine what happens next. If the individual is only mildly affected they should seek medical attention, but may not need to be admitted to hospital. All other exposed individuals will require hospital treatment.Administering 100 per cent oxygen, via a tightly fitting mask with an inflated face-seal, is the first treatment. A high concentration of oxygen in the air being breathed will speed up the formation of oxyhaemoglobin to replace carboxyhaemoglobin. The severity of the CO exposure can be checked by measuring the amount of carbon monoxide in the air breathed out by the individual or by taking a blood sample and measuring the carboxyhaemoglobin levels, and taking these laboratory tests along with the clinical signs and symptoms present in the affected person.If exposure is deemed to be significant and signs indicate nerve damage, then 'hyperbaric' oxygen therapy should be considered. This involves placing the individual in a sealed pressure chamber, similar to those used in treating decompression sickness in divers, and exposing the person to oxygen at high pressure. Using this technique there is greater penetration of oxygen at tissue level, and oxygen displaces carboxyhaemoglobin from the red cells more quickly.As a guide to who should be offered hyperbaric oxygen therapy the following indications have been recommended:
loss of consciousness
neurological signs (other than a headache)
abnormal heart rhythm or lack of blood to the heart
women who are pregnant. It should be noted that this treatment is still considered controversial. Although it speeds the reduction of carboxyhaemoglobin in the blood back to normal levels, symptom reduction may not be seen at the same time.
Prevention is always better than cureThe best course of action is to take steps that prevent carbon monoxide becoming a problem in the first place.
Raise the general awareness of the risks associated with carbon monoxide by communicating the relevant information to friends, family and work colleagues.
Be aware of the sources of carbon monoxide especially in domestic properties where a number of appliances could be responsible.
Get appliances professionally installed and regularly serviced to ensure they work efficiently and safely.
Ensure adequate ventilation for all fuel burning appliances.
Install monitoring devices for the early detection of excess carbon monoxide.
Recognise the early signs and symptoms of carbon monoxide poisoning, particularly when more than one family or work member is affected, and seek medical advice promptly.
How do you measure carbon monoxide levels?Carbon monoxide levels can be measured either in the environment or in the blood. The latter is usually performed in a hospital setting to check how much carbon monoxide (in the form of carboxyhaemoglobin) there is present in the blood. There are also ways by which carbon monoxide levels can be monitored in the home or office.
Carbon monoxide monitorsCarbon monoxide detectors are available from most local hardware and DIY stores. They can provide an audible high-pitched alarm when high levels of carbon monoxide are detected or provide an alarm plus a digital display of the concentration of carbon monoxide detected in units of 'parts per million' (ppm).Three types of carbon monoxide detectors are available.
Chem-optical (gel cell) technologyChem-optical technology (or gel cell or biomimetic technology) alarms use a type of sensor that simulates haemoglobin in the blood.
Electrochemical alarmElectrochemical alarms work by converting the carbon monoxide electrochemically to carbon dioxide, which generates an electrical current that is taken as a measure of the gas concentration. Electrochemical alarms are usually powered by a battery lasting about five years.
Semiconductor technologyThese alarms use semiconductors or tin dioxide technology to detect carbon monoxide levels. Unlike the alarms above, semiconductor detector alarms do not require any replacement sensors. The British Standards Institute (BSI) is a national standards body, responsible for ensuring products meet certain agreed standards of safety. BSI standard BS7860 is the one for monitors that detect carbon monoxide at levels well before they become dangerous for humans.
What to do if the alarm soundsIt is essential to read the instruction manual accompanying the detector as it provides important information on where to place it, how to use it and what to do if the alarm goes off. It will also contain important information about the levels of carbon monoxide detected and the risks associated with varying levels. The manual should be placed somewhere (ideally near the detector) so it can be accessed quickly in the event of an emergency. The following are some general points to bear in mind.
If your alarm goes off and you have a detector that displays the amount of carbon monoxide detected, make a mental note of what the reading states. Pick up the instruction manual but take it outside the house to read it.
Check whether you or any other family member is affected by any of the signs and symptoms of carbon monoxide poisoning (headache, dizziness, nausea, fatigue). If carbon monoxide poisoning symptoms are suspected, everyone should vacate the house and call for medical assistance. Dial 999 for an ambulance if necessary.
If no one has any symptoms of poisoning, promptly turn off all gas or other fuel burning appliances. Ventilate the whole house by opening all windows and doors.
Contact a professional appliance specialist, eg British Gas or other CORGI (Council of Registered Gas Installers) registered gas specialists, to check your appliances.
References 1. Department of Health, From the Chief Medical Officer and Chief Nursing Officer - Carbon monoxide: The Forgotten Killer. September 1998.2. Henry JA. Carbon monoxide. Journal of Accident and Emergency Medicine 1999; 16: 91-92.3. Spedding R et al. Carbon monoxide poisoning. Update 1999: 568-571.4 Walker E and Hay A. Carbon monoxide poisoning. BMJ 1999; 319: 1082-1083.5 Tibbles PM et al. Hyperbaric oxygen therapy. New England Journal of Medicine. 1996; 334: 1642-1648.6 Weaver L K. Hyperbaric oxygen in carbon monoxide poisoning. BMJ 1999;319; 1083-1084.
Carbon monoxide (CO) is an odourless, colourless, non-irritant gas. It is the most common cause of fatal poisoning in Britain today. It causes the accidental deaths of up to 50 people each year in the UK and a much larger number of sub-lethal poisonings.These figures could be just the tip of the iceberg as poisoning by carbon monoxide is almost certainly underdetected. There are two main reasons for this. Firstly, there is generally little awareness of carbon monoxide poisoning among the general public and the medical profession. Secondly, the signs and symptoms associated with carbon monoxide poisoning are not easy to diagnose as they often mimic many other conditions.To overcome this deadly killer requires improved awareness among the public of the risks and dangers of carbon monoxide poisoning and increased vigilance on the part of healthcare professionals in its detection. Children, pregnant women, babies, and individuals with a heart condition are those at most risk but CO poisoning can affect anyone.
Where does carbon monoxide come from?Carbon monoxide is produced by the incomplete combustion of carbon-containing fuels, such as gas (domestic or bottled), coal, oil, coke and wood1,3. Gas stoves, fires, heating boilers, gas-powered water heaters, paraffin heaters, and solid fuel-powered water heaters are all potential sources of carbon monoxide. The problem arises when such appliances are poorly maintained, not serviced and housed in poorly ventilated areas.When the waste products of combustion are not effectively removed, for example because of blocked flues and chimneys, then poisonous gas mixtures may re-enter the room. This problem is not just associated with older or poorer homes; it can also affect the occupants of newer homes with gas central heating. Exhaust fumes from cars is another obvious source.Domestic sources of carbon monoxide include:
domestic heating systems
blocked flues/chimneys
inadequate ventilation in living areas
inadequate ventilation in adjoining car garages
leakage from faulty appliances and chimneys/flues.
How is carbon monoxide formed?When any fire burns, in an enclosed room, the amount of oxygen available gradually decreases. At the same time the amount of carbon dioxide increases. As the amounts of these two gases change, this increasingly causes the combustion process to alter from one of complete combustion to one of incomplete combustion. This results in the release of increasing amounts of CO.This highlights an important issue. Even with perfectly designed and maintained heating appliances (or any kind of combustion device), they too will eventually begin producing dangerous amounts of CO if used in confined and poorly ventilated areas. Having poorly operating appliances, only makes the problem worse more quickly. Maintaining appliances and ensuring sufficient fresh air is available are two easy ways of avoiding potentially lethal scenarios.
How does carbon monoxide cause poisoning?To explain this aspect, we need to explain how the body uses oxygen from the air. Oxygen is transported around the body via the red blood cells. Specifically, oxygen binds to a substance within the red blood cells called haemoglobin, which is also responsible for their red colour.Haemoglobin takes up oxygen as blood passes through the lungs, and at the same time carbon dioxide, produced by the body's metabolism, is released from the blood into the exhaled breath. The combination of oxygen with haemoglobin is called oxyhaemoglobin and this 'oxygenated' blood is carried away from the lungs through the bloodstream to all the tissues of the body.Carbon monoxide can also bind to haemoglobin but does so about 240 times more tightly than oxygen, forming a compound called carboxyhaemoglobin. This means that if both carbon monoxide and oxygen are inhaled, carbon monoxide will preferentially bind to haemoglobin. This reduces the amount of haemoglobin available to bind to oxygen, so the body and tissues become starved of oxygen.Carboxyhaemoglobin also has direct effects on the blood vessels of the body - causing them to become 'leaky'. This is seen especially in the brain, causing the brain to swell, leading to unconsciousness and neurological damage.
What are the symptoms of carbon monoxide poisoning?One of the difficulties with diagnosing carbon monoxide poisoning is that many of its symptoms are similar to those of other conditions. Often the onset of symptoms is gradual, occurring without the individual or doctor being fully aware of what is happening. Coupled with this is the fact that the severity of the poisoning depends on:
how much carbon monoxide is actually present in the environment.
the duration you are exposed to carbon monoxide.
the age of the individual concerned - elderly, children and the foetus are all at greater risk.
the general state of health.
the extent of physical activity - effects are increased with higher activity levels. The commonest symptoms (with frequency of occurrence in brackets) include:
headache (90 per cent)
nausea and vomiting (50 per cent)
vertigo (50 per cent)
altering states of consciousness (30 per cent)
weakness (20 per cent). The likely symptoms in adults, children and infants are shown in Table 1.Table 1: Likely symptoms of CO poisoning
Symptoms
Adult
Child
Infant
General
Dizziness, fatigue, weakness
.
Not feeling well
Neurological
Headache, drowsiness, disorientation, fits
Headache, drowsiness, fits, uncoordinated movement
.
Stomach/intestine
Nausea, vomiting, stomach pains
Vomiting, stomach pains, anorexia, diarrhoea
Loss of appetite
Heart
Chest pain, wheeziness, palpitations, hyperventilation
Hyperventilation
.
How is carbon monoxide poisoning diagnosed?Individuals can either be exposed to high levels of carbon monoxide over a relatively short period of time (acute exposure) or to lower levels of exposure over a longer period of time (chronic exposure).Acute exposure is easier to diagnose as the symptoms are more pronounced, but it is the more common chronic exposure symptoms that are more subtle and difficult to tell apart from other conditions. Where whole families are affected by suspected 'food poisoning' this has been known to be due to carbon monoxide exposure.Where such symptoms are reported repeatedly, domestic carbon monoxide poisoning should be suspected. Clues that point towards a problem within the home include:
more than one family member being affected
symptoms appear or get worse when gas appliances are in use
symptoms are worse in the winter when gas boilers/heaters are in use
symptoms improve when family members are not at home, but recur on their return. Important information can also be obtained by inspecting gas-operated heating appliances within the home. Relevant points include:
black soot marks on gas fire burners or on walls near cookers, boilers, gas fires
a yellow gas flame colour, rather than the blue colour it should be.
How is carbon monoxide poisoning treated?The first step is to move the affected individual(s) away from further exposure to the carbon monoxide source. Their signs and symptoms will then determine what happens next. If the individual is only mildly affected they should seek medical attention, but may not need to be admitted to hospital. All other exposed individuals will require hospital treatment.Administering 100 per cent oxygen, via a tightly fitting mask with an inflated face-seal, is the first treatment. A high concentration of oxygen in the air being breathed will speed up the formation of oxyhaemoglobin to replace carboxyhaemoglobin. The severity of the CO exposure can be checked by measuring the amount of carbon monoxide in the air breathed out by the individual or by taking a blood sample and measuring the carboxyhaemoglobin levels, and taking these laboratory tests along with the clinical signs and symptoms present in the affected person.If exposure is deemed to be significant and signs indicate nerve damage, then 'hyperbaric' oxygen therapy should be considered. This involves placing the individual in a sealed pressure chamber, similar to those used in treating decompression sickness in divers, and exposing the person to oxygen at high pressure. Using this technique there is greater penetration of oxygen at tissue level, and oxygen displaces carboxyhaemoglobin from the red cells more quickly.As a guide to who should be offered hyperbaric oxygen therapy the following indications have been recommended:
loss of consciousness
neurological signs (other than a headache)
abnormal heart rhythm or lack of blood to the heart
women who are pregnant. It should be noted that this treatment is still considered controversial. Although it speeds the reduction of carboxyhaemoglobin in the blood back to normal levels, symptom reduction may not be seen at the same time.
Prevention is always better than cureThe best course of action is to take steps that prevent carbon monoxide becoming a problem in the first place.
Raise the general awareness of the risks associated with carbon monoxide by communicating the relevant information to friends, family and work colleagues.
Be aware of the sources of carbon monoxide especially in domestic properties where a number of appliances could be responsible.
Get appliances professionally installed and regularly serviced to ensure they work efficiently and safely.
Ensure adequate ventilation for all fuel burning appliances.
Install monitoring devices for the early detection of excess carbon monoxide.
Recognise the early signs and symptoms of carbon monoxide poisoning, particularly when more than one family or work member is affected, and seek medical advice promptly.
How do you measure carbon monoxide levels?Carbon monoxide levels can be measured either in the environment or in the blood. The latter is usually performed in a hospital setting to check how much carbon monoxide (in the form of carboxyhaemoglobin) there is present in the blood. There are also ways by which carbon monoxide levels can be monitored in the home or office.
Carbon monoxide monitorsCarbon monoxide detectors are available from most local hardware and DIY stores. They can provide an audible high-pitched alarm when high levels of carbon monoxide are detected or provide an alarm plus a digital display of the concentration of carbon monoxide detected in units of 'parts per million' (ppm).Three types of carbon monoxide detectors are available.
Chem-optical (gel cell) technologyChem-optical technology (or gel cell or biomimetic technology) alarms use a type of sensor that simulates haemoglobin in the blood.
Electrochemical alarmElectrochemical alarms work by converting the carbon monoxide electrochemically to carbon dioxide, which generates an electrical current that is taken as a measure of the gas concentration. Electrochemical alarms are usually powered by a battery lasting about five years.
Semiconductor technologyThese alarms use semiconductors or tin dioxide technology to detect carbon monoxide levels. Unlike the alarms above, semiconductor detector alarms do not require any replacement sensors. The British Standards Institute (BSI) is a national standards body, responsible for ensuring products meet certain agreed standards of safety. BSI standard BS7860 is the one for monitors that detect carbon monoxide at levels well before they become dangerous for humans.
What to do if the alarm soundsIt is essential to read the instruction manual accompanying the detector as it provides important information on where to place it, how to use it and what to do if the alarm goes off. It will also contain important information about the levels of carbon monoxide detected and the risks associated with varying levels. The manual should be placed somewhere (ideally near the detector) so it can be accessed quickly in the event of an emergency. The following are some general points to bear in mind.
If your alarm goes off and you have a detector that displays the amount of carbon monoxide detected, make a mental note of what the reading states. Pick up the instruction manual but take it outside the house to read it.
Check whether you or any other family member is affected by any of the signs and symptoms of carbon monoxide poisoning (headache, dizziness, nausea, fatigue). If carbon monoxide poisoning symptoms are suspected, everyone should vacate the house and call for medical assistance. Dial 999 for an ambulance if necessary.
If no one has any symptoms of poisoning, promptly turn off all gas or other fuel burning appliances. Ventilate the whole house by opening all windows and doors.
Contact a professional appliance specialist, eg British Gas or other CORGI (Council of Registered Gas Installers) registered gas specialists, to check your appliances.
References 1. Department of Health, From the Chief Medical Officer and Chief Nursing Officer - Carbon monoxide: The Forgotten Killer. September 1998.2. Henry JA. Carbon monoxide. Journal of Accident and Emergency Medicine 1999; 16: 91-92.3. Spedding R et al. Carbon monoxide poisoning. Update 1999: 568-571.4 Walker E and Hay A. Carbon monoxide poisoning. BMJ 1999; 319: 1082-1083.5 Tibbles PM et al. Hyperbaric oxygen therapy. New England Journal of Medicine. 1996; 334: 1642-1648.6 Weaver L K. Hyperbaric oxygen in carbon monoxide poisoning. BMJ 1999;319; 1083-1084.
"In the initial years of our life we forget our health while going after wealth, in the later years of our life we spend our wealth to take care of our health... It's today reality. Health is not everything, BUT without health everything is nothing."
Abortion
Reviewed by Dr Philip Owen, consultant obstetrician and gynaecologist
What can be done about an unwanted pregnancy?Terminating a pregnancy is a major decision and an extremely difficult one to make. It is advisable that the woman discusses her concerns with someone close who she can trust.Women should always contact their GP if they are pregnant and do not want to continue with the pregnancy. In the UK it is legal for termination to be carried out up to 24 weeks of pregnancy, but most hospitals and clinics will not consider termination beyond 18 to 20 weeks. For this reason alone, if a woman is considering termination, then she should discuss the situation with her GP sooner rather than later. The law states that two doctors need to agree that the abortion can be carried out. They will reach this decision if they believe there is a greater risk to the woman's mental or physical health if she continues with the pregnancy than if she has an abortion. The doctor can also take social circumstances into account when making this decision. The doctor will then usually examine the woman to determine how long she has been pregnant, and also tell her about the options for termination and the risks involved. The doctor will send this request to the nearest hospital or clinic, which will then make an appointment for the termination to be performed. Many hospitals now have early pregnancy clinics for this reason, staffed by nurses and doctors who will deal with the problems sensitively.
What kind of examination will the doctor make? The doctor will make a pelvic examination to determine the length of the pregnancy. During this examination the doctor may also take a sample from the vagina to check for a bug called Chlamydia. If this test is positive, both the woman and her partner should undergo treatment. An ultrasound scan may also be used in the hospital or clinic to be certain of the length of the pregnancy.
What are the different methods for termination of pregnancy? There are two commonly used methods.
A surgical termination can be performed up to 13 weeks. This may be performed under local or a general anaesthetic. A sterile tube is introduced into the uterus through the cervix. Suction is applied through the tube and the pregnancy terminated. Most women leave hospital on the same day.
A medical termination can be performed up to 24 weeks. This involves giving the patient a course of two different types of medicine. The first medicine (mifepristone) is taken by mouth at the hospital or clinic, with the woman returning 48 hours later. She will then be given a medicine called a prostaglandin, either by mouth or as a vaginal pessary. The termination usually occurs within 12 hours of this when the woman passes the pregnancy vaginally. Pain, is often experienced but pain relief will always be available. The type of termination a woman is offered will depend upon the length of her pregnancy, the facilities available and also her personal preference.
What complications may arise from a termination? Fewer complications arise if the pregnancy is terminated within 10 weeks. If a woman suspects that she is pregnant, and does not want to continue with the pregnancy, she should contact her GP as soon as possible. There is no such thing as an operation or procedure that is completely risk-free. Termination of pregnancy, whether medical or surgical, is a safe procedure but complications are possible. The most common complications are described below.
Bleeding After the abortion it is normal to bleed for a couple of days. After that, the bleeding will decrease for a couple of weeks. A period or menstruation will, in most cases, occur after five to six weeks. If the woman bleeds more heavily than she would normally, it could be because her uterus has not been emptied completely. If this is the case she should ask a doctor to examine her. This complication applies to both medical and surgical terminations.
Pelvic inflammatory disease If a woman has an unpleasant vaginal discharge, a temperature and abdominal pains, she should contact her doctor. Inflammation can occur if the uterus has not been emptied properly, or if bacteria have got into the uterus during the operation. The inflammation is treated with antibiotics. If some tissue still remains in the uterus, it may be necessary to remove it with a new evacuation of the womb. Baths, swimming pools and unprotected sexual intercourse should all be avoided until any bleeding has stopped. This complication applies to both medical and surgical terminations.
PainIt is normal to have mild pain across the lower abdomen for the first couple of days after a termination. If the pain is not reduced by normal pain killers the woman should contact her doctor.
Puncture of the uterusDuring a surgical termination, inserting the suction device may risk puncturing a hole in the uterus. If the doctor suspects this, the operation will be stopped and the patient will be kept in hospital for observation. This complication is rare and does not apply to medical terminations.
Can abortion lead to infertility? Inflammation of the Fallopian tubes and ovaries caused by the Chlamydia organism is the most common cause of infertility following an abortion. Examination for Chlamydia is now routine in most hospitals and clinics and, if necessary, the patient will be treated before the abortion is carried out.
How to protect against pregnancy after an abortion It is important that the woman talks to her doctor about contraception to avoid another unwanted pregnancy. A woman will start ovulating (producing eggs) before her periods return, so she can become pregnant again before she has her next period. It is possible to start taking contraceptive pills on the same day as the abortion, which in most cases will give immediate protection. A contraceptive coil can be fitted during the operation. A contraceptive injection can also be given. You should discuss the options with your doctor.Based on a text by Dr Erik Fangel Poulson, specialist
What can be done about an unwanted pregnancy?Terminating a pregnancy is a major decision and an extremely difficult one to make. It is advisable that the woman discusses her concerns with someone close who she can trust.Women should always contact their GP if they are pregnant and do not want to continue with the pregnancy. In the UK it is legal for termination to be carried out up to 24 weeks of pregnancy, but most hospitals and clinics will not consider termination beyond 18 to 20 weeks. For this reason alone, if a woman is considering termination, then she should discuss the situation with her GP sooner rather than later. The law states that two doctors need to agree that the abortion can be carried out. They will reach this decision if they believe there is a greater risk to the woman's mental or physical health if she continues with the pregnancy than if she has an abortion. The doctor can also take social circumstances into account when making this decision. The doctor will then usually examine the woman to determine how long she has been pregnant, and also tell her about the options for termination and the risks involved. The doctor will send this request to the nearest hospital or clinic, which will then make an appointment for the termination to be performed. Many hospitals now have early pregnancy clinics for this reason, staffed by nurses and doctors who will deal with the problems sensitively.
What kind of examination will the doctor make? The doctor will make a pelvic examination to determine the length of the pregnancy. During this examination the doctor may also take a sample from the vagina to check for a bug called Chlamydia. If this test is positive, both the woman and her partner should undergo treatment. An ultrasound scan may also be used in the hospital or clinic to be certain of the length of the pregnancy.
What are the different methods for termination of pregnancy? There are two commonly used methods.
A surgical termination can be performed up to 13 weeks. This may be performed under local or a general anaesthetic. A sterile tube is introduced into the uterus through the cervix. Suction is applied through the tube and the pregnancy terminated. Most women leave hospital on the same day.
A medical termination can be performed up to 24 weeks. This involves giving the patient a course of two different types of medicine. The first medicine (mifepristone) is taken by mouth at the hospital or clinic, with the woman returning 48 hours later. She will then be given a medicine called a prostaglandin, either by mouth or as a vaginal pessary. The termination usually occurs within 12 hours of this when the woman passes the pregnancy vaginally. Pain, is often experienced but pain relief will always be available. The type of termination a woman is offered will depend upon the length of her pregnancy, the facilities available and also her personal preference.
What complications may arise from a termination? Fewer complications arise if the pregnancy is terminated within 10 weeks. If a woman suspects that she is pregnant, and does not want to continue with the pregnancy, she should contact her GP as soon as possible. There is no such thing as an operation or procedure that is completely risk-free. Termination of pregnancy, whether medical or surgical, is a safe procedure but complications are possible. The most common complications are described below.
Bleeding After the abortion it is normal to bleed for a couple of days. After that, the bleeding will decrease for a couple of weeks. A period or menstruation will, in most cases, occur after five to six weeks. If the woman bleeds more heavily than she would normally, it could be because her uterus has not been emptied completely. If this is the case she should ask a doctor to examine her. This complication applies to both medical and surgical terminations.
Pelvic inflammatory disease If a woman has an unpleasant vaginal discharge, a temperature and abdominal pains, she should contact her doctor. Inflammation can occur if the uterus has not been emptied properly, or if bacteria have got into the uterus during the operation. The inflammation is treated with antibiotics. If some tissue still remains in the uterus, it may be necessary to remove it with a new evacuation of the womb. Baths, swimming pools and unprotected sexual intercourse should all be avoided until any bleeding has stopped. This complication applies to both medical and surgical terminations.
PainIt is normal to have mild pain across the lower abdomen for the first couple of days after a termination. If the pain is not reduced by normal pain killers the woman should contact her doctor.
Puncture of the uterusDuring a surgical termination, inserting the suction device may risk puncturing a hole in the uterus. If the doctor suspects this, the operation will be stopped and the patient will be kept in hospital for observation. This complication is rare and does not apply to medical terminations.
Can abortion lead to infertility? Inflammation of the Fallopian tubes and ovaries caused by the Chlamydia organism is the most common cause of infertility following an abortion. Examination for Chlamydia is now routine in most hospitals and clinics and, if necessary, the patient will be treated before the abortion is carried out.
How to protect against pregnancy after an abortion It is important that the woman talks to her doctor about contraception to avoid another unwanted pregnancy. A woman will start ovulating (producing eggs) before her periods return, so she can become pregnant again before she has her next period. It is possible to start taking contraceptive pills on the same day as the abortion, which in most cases will give immediate protection. A contraceptive coil can be fitted during the operation. A contraceptive injection can also be given. You should discuss the options with your doctor.Based on a text by Dr Erik Fangel Poulson, specialist
"In the initial years of our life we forget our health while going after wealth, in the later years of our life we spend our wealth to take care of our health... It's today reality. Health is not everything, BUT without health everything is nothing."
Premenstrual syndrome (PMS or PMT)
Written by Dr Philip Owen, consultant obstetrician and gynaecologist
What is premenstrual syndrome?
PMS or PMT?
The terms premenstrual syndrome (PMS) and premenstrual tension (PMT) are interchangeable.
Around 90 per cent of menstruating women get advance warning of an approaching period because of physical and/or psychological changes in the days before their period begins. For most women the symptoms are mild, but a small proportion finds their symptoms so severe they dread this time of the month. The terms ‘mild’ and ‘severe’ in respect of PMS are arbitrary, but relate to the extent of disruption to your home and work life that's attributable to the monthly cycle. About a third of women say PMS significantly affects their life, with 5 to 10 per cent classifying their PMS as severe.
Symptoms of PMS
For some women, the days before the start of their period can be awful.
There are more than 100 recognised symptoms that may be due to PMS. Fortunately, most women experience only a handful of problems. The most common symptoms are listed below.
Psychological
Irritability.
Mood swings.
Losing your temper easily.
Loss of confidence.
Crying for no particular reason.
Aggression.
Poor concentration.
Tiredness.
Physical
Breast tenderness.
Abdominal swelling or bloating.
Weight gain.
Swollen ankles.
Headaches and possibly migraine. None of these symptoms is exclusive to PMS. They can be caused by other conditions such as depression, stress, thyroid gland problems (under- or over-activity) and anaemia.
How do I know if I have PMS?
PMDD
Premenstrual dysphoric disorder (PMDD) is a mood disorder that occurs during the menstrual cycle.
The symptoms are similar to PMS, but are severe enough to impair or prevent quality of life.
PMDD is a depressive disorder.
While blood tests and urine tests are helpful in making sure there isn't another cause for PMS symptoms, there is no test that can diagnose PMS.Instead, diagnosis is based upon the type of symptoms and when they occur. The symptoms of PMS have a fairly consistent relationship with the start and finish of a period, which is an essential clue to the diagnosis. However, it is possible to have more than one problem at the same time, so care needs to be taken by doctors not to ‘blame the hormones’ too quickly. Most women with PMS notice a gradual worsening of their symptoms during the week running up to their period, with a rapid or gradual disappearance of symptoms when their period starts. But sometimes symptoms can persist during your period or even for a couple of days after it has finished. To help doctors diagnose PMS, it helps to keep a diary of your symptoms and their severity over a few consecutive months. A cyclical pattern should be apparent, and a diagnosis of PMS is usually only made if there are 10 consecutive symptom-free days each month.
What causes PMS?
Hormone levels
Measuring hormone levels is of no help in understanding PMS because there are no differences between women who get PMS and those who don't.
It is not exactly known what causes PMS. Common sense indicates it must somehow be linked to the fluctuating levels of female hormones experienced after ovulation. But the subtleties of why some women are more affected than others are not understood. Normal fluctuations in hormone levels are responsible for some of the symptoms most commonly associated with the monthly cycle, such as bloating, breast tenderness or headaches. Women who suffer from PMS may possibly have a lower than normal level of a certain chemical in their brain (serotonin), which may explain some of the non-physical symptoms such as irritability, depression and mood swings. PMS is not caused by any underlying abnormality with the pelvic organs.
When should I seek treatment? Recognising your symptoms are due to PMS is an important first step.For the majority of women, the symptoms are a minor inconvenience you can recognise, anticipate and deal with yourself.
Who do I talk to?
A visit to your GP is usually the first step if you are suffering with PMS.
You could ask for a double appointment to give more time for discussion.
Or your GP may prefer to have a quick word at first, then ask you to come back and discuss things in depth.
The Family Planning Clinic and Well-Woman Clinic are other sources of help.
You may seek reassurance from your doctor, but do not necessarily need or want treatment. The value of such a discussion can be high and result in significant improvement in your symptoms.For a minority of women, PMS is serious enough to affect work, daily life and relationships. If this sounds like you, you should see your GP to discuss your problems, possibly with a view to some treatment.Women with severe symptoms who have not responded to simple treatments might wish to see a specialist. This usually means a gynaecologist, but a psychiatrist with a particular interest in treating severe PMS can sometimes be more appropriate.
What treatments are available?
The placebo effect
Part of the reason few PMS treatments provide long-term relief is the so-called 'placebo effect'.
A placebo is a treatment that is ineffective (eg a dummy tablet) but has the psychological effect of making you feel better.
To demonstrate a treatment is better than a placebo requires careful scientific study.
Not all PMS treatments have been subjected to evaluation in this way.
There are many treatments for PMS, most of which have some short-term benefit. However, few provide relief for longer than a few months. Treatment will depend upon the nature of the symptoms and their severity. For many women, simple changes to diet and lifestyle, reducing alcohol and caffeine intake and cutting down on cigarettes will make the monthly symptoms more bearable. Your GP can give you guidance in this. A suitable diet sheet is available via the National Association for Premenstrual Syndrome (NAPS) at www.pms.org.uk.
Non-hormonal treatments
Vitamin B6 This is also known as pyridoxine. It is commonly recommended for mood swings and irritability. There is some scientific support for its use for mild symptoms, but you need to be careful not to take too high a dose. It is advisable to consult your doctor before starting treatment.
Evening primrose oil (EPO) Capsules of EPO can be helpful in alleviating premenstrual breast pain in some women. However, the evidence in favour of its effect is slight and it has been withdrawn from NHS prescription for this reason.
Bromocriptine and cabergolineBromocriptine and cabergoline reduce the output from the brain of a hormone called prolactin. Prolactin is the hormone that stimulates the breasts to produce milk.These drugs may be useful if premenstrual breast pain is a major symptom, but their long-term use should be avoided.
Diuretics (water tablets)Diuretics (water tablets) may give relief from ankle swelling. They will not relieve abdominal bloating, which is not caused by fluid retention but by relaxation and distension of the muscle in the wall of the bowel.Diuretics need to be prescribed by a doctor and should only be taken for a few days each month in the lowest of doses.
Antidepressants There is much enthusiasm for the use of a class of antidepressants called SSRIs (eg Prozac) in the treatment of severe PMS where the symptoms are mostly depression, mood swings, irritability, etc. The results of treatment are often dramatic and are supported by scientific studies. Side effects can sometimes be a problem. Discussion with a GP or specialist is essential before starting treatment.
Hormonal preparations
ProgestogensA group of hormones taken for 10 to 14 days before the beginning of the period. Progestogens are widely prescribed and have relatively few side effects. It was once thought that PMS was due to a lack of progestogen in the bloodstream, but it is now recognised this isn't the case. Some women do gain short-term relief of mild symptoms with progestogens. Most scientific studies do not support their use.
Combined oral contraceptive (COC) pill There is no good evidence that the Pill works in PMS, but it is often prescribed, especially if contraception is required. Some women find the COC gives them PMS because of the hormones contained in the pill. There is some initial evidence to suggest the combined Pill called Yasmin, which contains a novel progestogen, may be of some benefit to women with PMS. However, more data is needed.
Danazol Danazol is a synthetic hormone based on the male hormone testosterone. Its use in PMS is supported by scientific studies. It has a number of side effects, such as encouraging the growth of body hair and other masculinising effects, which means it is only suitable for use in low doses and will not be tolerated by all women. Pregnancy must be avoided while taking this medication.
Oestrogen patches and implantsExtra oestrogen (one of the female hormones) via patches or implants can suppress ovulation and reduce the naturally occurring hormone fluctuations. There is some evidence to support its use in PMS. Usually patches and implants will only be used on the advice of a gynaecologist.
Mirena intra-uterine system (IUS) Mirena is in fact a contraceptive device, which is placed inside the uterus (womb). It releases a small dose of progestogen hormone into the body. Most women experience a reduction in the heaviness and duration of their periods and some say it improves their PMS. It may be combined with an oestrogen patch or implant.
Treatments for severe PMS
MedicinesDrugs known as LHRH analogues or GnRH analogues (such as Zoladex, Prostap and Synarel) are potent medicines used by gynaecologists for a number of conditions. They temporarily ‘switch off’ a woman's ovaries, which usually gives relief from PMS within two months. They are only suitable for short-term use up to six months. LHRH analogues may be used to confirm the diagnosis of PMS and to help guide you and your gynaecologist towards considering surgery. They are used only in severe and difficult-to-treat PMS. One of the potential disadvantages of using these particular drugs is they cause flushings and sweats due to the drop in oestrogen output from the ovaries (like that which occurs in the menopause). They also accelerate the natural rate of bone loss and can therefore increase your chances of developing osteoporosis (fragile bones). To counter this, they are usually combined with a drug called tibolone (Livial) that mimics HRT. Doctors call this ‘add-back’ treatment.
Surgery
Hysterectomy & PMS
Removing the womb only (hysterectomy) may not improve PMS.
This is because you can still get PMS if one or both ovaries are still present and functional.
For a small minority of women, surgical removal of the ovaries is the only measure that will allow them to continue a normal existence, free of PMS. This is a major and still controversial step to be considered carefully by you, your GP and gynaecologist. Once the ovaries are removed, you must be prepared to take hormone replacement therapy (HRT) until at least the age of 50. Because it is such a drastic step, the use of LHRH analogues are usually used first - effectively non-surgical ways of putting the ovaries out of action. If this treatment works well, there is more chance surgery will be effective. Many gynaecologists will not operate for PMS alone, but will do so if there are additional problems, such as uncontrolled heavy menstrual bleeding, for which surgery is going to help.
What is premenstrual syndrome?
PMS or PMT?
The terms premenstrual syndrome (PMS) and premenstrual tension (PMT) are interchangeable.
Around 90 per cent of menstruating women get advance warning of an approaching period because of physical and/or psychological changes in the days before their period begins. For most women the symptoms are mild, but a small proportion finds their symptoms so severe they dread this time of the month. The terms ‘mild’ and ‘severe’ in respect of PMS are arbitrary, but relate to the extent of disruption to your home and work life that's attributable to the monthly cycle. About a third of women say PMS significantly affects their life, with 5 to 10 per cent classifying their PMS as severe.
Symptoms of PMS
For some women, the days before the start of their period can be awful.
There are more than 100 recognised symptoms that may be due to PMS. Fortunately, most women experience only a handful of problems. The most common symptoms are listed below.
Psychological
Irritability.
Mood swings.
Losing your temper easily.
Loss of confidence.
Crying for no particular reason.
Aggression.
Poor concentration.
Tiredness.
Physical
Breast tenderness.
Abdominal swelling or bloating.
Weight gain.
Swollen ankles.
Headaches and possibly migraine. None of these symptoms is exclusive to PMS. They can be caused by other conditions such as depression, stress, thyroid gland problems (under- or over-activity) and anaemia.
How do I know if I have PMS?
PMDD
Premenstrual dysphoric disorder (PMDD) is a mood disorder that occurs during the menstrual cycle.
The symptoms are similar to PMS, but are severe enough to impair or prevent quality of life.
PMDD is a depressive disorder.
While blood tests and urine tests are helpful in making sure there isn't another cause for PMS symptoms, there is no test that can diagnose PMS.Instead, diagnosis is based upon the type of symptoms and when they occur. The symptoms of PMS have a fairly consistent relationship with the start and finish of a period, which is an essential clue to the diagnosis. However, it is possible to have more than one problem at the same time, so care needs to be taken by doctors not to ‘blame the hormones’ too quickly. Most women with PMS notice a gradual worsening of their symptoms during the week running up to their period, with a rapid or gradual disappearance of symptoms when their period starts. But sometimes symptoms can persist during your period or even for a couple of days after it has finished. To help doctors diagnose PMS, it helps to keep a diary of your symptoms and their severity over a few consecutive months. A cyclical pattern should be apparent, and a diagnosis of PMS is usually only made if there are 10 consecutive symptom-free days each month.
What causes PMS?
Hormone levels
Measuring hormone levels is of no help in understanding PMS because there are no differences between women who get PMS and those who don't.
It is not exactly known what causes PMS. Common sense indicates it must somehow be linked to the fluctuating levels of female hormones experienced after ovulation. But the subtleties of why some women are more affected than others are not understood. Normal fluctuations in hormone levels are responsible for some of the symptoms most commonly associated with the monthly cycle, such as bloating, breast tenderness or headaches. Women who suffer from PMS may possibly have a lower than normal level of a certain chemical in their brain (serotonin), which may explain some of the non-physical symptoms such as irritability, depression and mood swings. PMS is not caused by any underlying abnormality with the pelvic organs.
When should I seek treatment? Recognising your symptoms are due to PMS is an important first step.For the majority of women, the symptoms are a minor inconvenience you can recognise, anticipate and deal with yourself.
Who do I talk to?
A visit to your GP is usually the first step if you are suffering with PMS.
You could ask for a double appointment to give more time for discussion.
Or your GP may prefer to have a quick word at first, then ask you to come back and discuss things in depth.
The Family Planning Clinic and Well-Woman Clinic are other sources of help.
You may seek reassurance from your doctor, but do not necessarily need or want treatment. The value of such a discussion can be high and result in significant improvement in your symptoms.For a minority of women, PMS is serious enough to affect work, daily life and relationships. If this sounds like you, you should see your GP to discuss your problems, possibly with a view to some treatment.Women with severe symptoms who have not responded to simple treatments might wish to see a specialist. This usually means a gynaecologist, but a psychiatrist with a particular interest in treating severe PMS can sometimes be more appropriate.
What treatments are available?
The placebo effect
Part of the reason few PMS treatments provide long-term relief is the so-called 'placebo effect'.
A placebo is a treatment that is ineffective (eg a dummy tablet) but has the psychological effect of making you feel better.
To demonstrate a treatment is better than a placebo requires careful scientific study.
Not all PMS treatments have been subjected to evaluation in this way.
There are many treatments for PMS, most of which have some short-term benefit. However, few provide relief for longer than a few months. Treatment will depend upon the nature of the symptoms and their severity. For many women, simple changes to diet and lifestyle, reducing alcohol and caffeine intake and cutting down on cigarettes will make the monthly symptoms more bearable. Your GP can give you guidance in this. A suitable diet sheet is available via the National Association for Premenstrual Syndrome (NAPS) at www.pms.org.uk.
Non-hormonal treatments
Vitamin B6 This is also known as pyridoxine. It is commonly recommended for mood swings and irritability. There is some scientific support for its use for mild symptoms, but you need to be careful not to take too high a dose. It is advisable to consult your doctor before starting treatment.
Evening primrose oil (EPO) Capsules of EPO can be helpful in alleviating premenstrual breast pain in some women. However, the evidence in favour of its effect is slight and it has been withdrawn from NHS prescription for this reason.
Bromocriptine and cabergolineBromocriptine and cabergoline reduce the output from the brain of a hormone called prolactin. Prolactin is the hormone that stimulates the breasts to produce milk.These drugs may be useful if premenstrual breast pain is a major symptom, but their long-term use should be avoided.
Diuretics (water tablets)Diuretics (water tablets) may give relief from ankle swelling. They will not relieve abdominal bloating, which is not caused by fluid retention but by relaxation and distension of the muscle in the wall of the bowel.Diuretics need to be prescribed by a doctor and should only be taken for a few days each month in the lowest of doses.
Antidepressants There is much enthusiasm for the use of a class of antidepressants called SSRIs (eg Prozac) in the treatment of severe PMS where the symptoms are mostly depression, mood swings, irritability, etc. The results of treatment are often dramatic and are supported by scientific studies. Side effects can sometimes be a problem. Discussion with a GP or specialist is essential before starting treatment.
Hormonal preparations
ProgestogensA group of hormones taken for 10 to 14 days before the beginning of the period. Progestogens are widely prescribed and have relatively few side effects. It was once thought that PMS was due to a lack of progestogen in the bloodstream, but it is now recognised this isn't the case. Some women do gain short-term relief of mild symptoms with progestogens. Most scientific studies do not support their use.
Combined oral contraceptive (COC) pill There is no good evidence that the Pill works in PMS, but it is often prescribed, especially if contraception is required. Some women find the COC gives them PMS because of the hormones contained in the pill. There is some initial evidence to suggest the combined Pill called Yasmin, which contains a novel progestogen, may be of some benefit to women with PMS. However, more data is needed.
Danazol Danazol is a synthetic hormone based on the male hormone testosterone. Its use in PMS is supported by scientific studies. It has a number of side effects, such as encouraging the growth of body hair and other masculinising effects, which means it is only suitable for use in low doses and will not be tolerated by all women. Pregnancy must be avoided while taking this medication.
Oestrogen patches and implantsExtra oestrogen (one of the female hormones) via patches or implants can suppress ovulation and reduce the naturally occurring hormone fluctuations. There is some evidence to support its use in PMS. Usually patches and implants will only be used on the advice of a gynaecologist.
Mirena intra-uterine system (IUS) Mirena is in fact a contraceptive device, which is placed inside the uterus (womb). It releases a small dose of progestogen hormone into the body. Most women experience a reduction in the heaviness and duration of their periods and some say it improves their PMS. It may be combined with an oestrogen patch or implant.
Treatments for severe PMS
MedicinesDrugs known as LHRH analogues or GnRH analogues (such as Zoladex, Prostap and Synarel) are potent medicines used by gynaecologists for a number of conditions. They temporarily ‘switch off’ a woman's ovaries, which usually gives relief from PMS within two months. They are only suitable for short-term use up to six months. LHRH analogues may be used to confirm the diagnosis of PMS and to help guide you and your gynaecologist towards considering surgery. They are used only in severe and difficult-to-treat PMS. One of the potential disadvantages of using these particular drugs is they cause flushings and sweats due to the drop in oestrogen output from the ovaries (like that which occurs in the menopause). They also accelerate the natural rate of bone loss and can therefore increase your chances of developing osteoporosis (fragile bones). To counter this, they are usually combined with a drug called tibolone (Livial) that mimics HRT. Doctors call this ‘add-back’ treatment.
Surgery
Hysterectomy & PMS
Removing the womb only (hysterectomy) may not improve PMS.
This is because you can still get PMS if one or both ovaries are still present and functional.
For a small minority of women, surgical removal of the ovaries is the only measure that will allow them to continue a normal existence, free of PMS. This is a major and still controversial step to be considered carefully by you, your GP and gynaecologist. Once the ovaries are removed, you must be prepared to take hormone replacement therapy (HRT) until at least the age of 50. Because it is such a drastic step, the use of LHRH analogues are usually used first - effectively non-surgical ways of putting the ovaries out of action. If this treatment works well, there is more chance surgery will be effective. Many gynaecologists will not operate for PMS alone, but will do so if there are additional problems, such as uncontrolled heavy menstrual bleeding, for which surgery is going to help.
"In the initial years of our life we forget our health while going after wealth, in the later years of our life we spend our wealth to take care of our health... It's today reality. Health is not everything, BUT without health everything is nothing."
Large breasts
Written by Dr Erik Fangel Poulsen, specialist
How do a woman's breasts change throughout her life? Breasts develop differently from woman to woman and their shape and size changes throughout life.Each month, women may feel a tension and swelling in their breasts prior to their period. This sensation disappears as soon as their period begins.When they get pregnant and after giving birth, they clearly feel breast tension and growth as the milk glands develop and milk is produced.Later in life the size of the glands decreases whereas the fat content increases. This causes some women's breasts to grow larger whereas other women experience the opposite effect.
Women and their breastsA great many women dislike the appearance and size of their breasts. This is, of course, connected to our culture. Breasts are seen as a crucial part of any woman's sexual appeal. In newspapers, magazines and on TV and films, we are confronted with images of what is currently regarded as the ideal bosom. Consciously or unconsciously, some women probably wish that their breasts looked like this 'ideal'.
Problems associated with large breasts Even young women who have never been pregnant may feel that their breasts are too large and causing them a significant problem. They may feel self-conscious wearing certain kinds of clothes or be embarrassed about undressing at the gym or in communal changing rooms when shopping. A suitable bra can be a great help, but if their breasts are very heavy, women may find that their bra straps cut deep into their shoulders. Their posture will be affected and they may have aching muscles in their chest and shoulders.
What can be done to help?Women who are unhappy about large breasts should consult their doctor who will be able to assess whether breast-reduction surgery is a suitable option. If so, the doctor will refer them to a hospital or cosmetic surgeon with experience of such operations.
What does the operation consist of?During the operation the surgeon will remove an amount of breast tissue and skin. The nipples stay connected to the remaining gland and fatty tissue, but are moved upwards on the wall of the breast. A circular piece of skin is removed from a suitable area. This method is used for both large or pendulous breasts.The results of these operations are almost always very good, with the surgeon aiming not only to reduce the size of the breast but to make sure the patient is happy with her new appearance.
How do a woman's breasts change throughout her life? Breasts develop differently from woman to woman and their shape and size changes throughout life.Each month, women may feel a tension and swelling in their breasts prior to their period. This sensation disappears as soon as their period begins.When they get pregnant and after giving birth, they clearly feel breast tension and growth as the milk glands develop and milk is produced.Later in life the size of the glands decreases whereas the fat content increases. This causes some women's breasts to grow larger whereas other women experience the opposite effect.
Women and their breastsA great many women dislike the appearance and size of their breasts. This is, of course, connected to our culture. Breasts are seen as a crucial part of any woman's sexual appeal. In newspapers, magazines and on TV and films, we are confronted with images of what is currently regarded as the ideal bosom. Consciously or unconsciously, some women probably wish that their breasts looked like this 'ideal'.
Problems associated with large breasts Even young women who have never been pregnant may feel that their breasts are too large and causing them a significant problem. They may feel self-conscious wearing certain kinds of clothes or be embarrassed about undressing at the gym or in communal changing rooms when shopping. A suitable bra can be a great help, but if their breasts are very heavy, women may find that their bra straps cut deep into their shoulders. Their posture will be affected and they may have aching muscles in their chest and shoulders.
What can be done to help?Women who are unhappy about large breasts should consult their doctor who will be able to assess whether breast-reduction surgery is a suitable option. If so, the doctor will refer them to a hospital or cosmetic surgeon with experience of such operations.
What does the operation consist of?During the operation the surgeon will remove an amount of breast tissue and skin. The nipples stay connected to the remaining gland and fatty tissue, but are moved upwards on the wall of the breast. A circular piece of skin is removed from a suitable area. This method is used for both large or pendulous breasts.The results of these operations are almost always very good, with the surgeon aiming not only to reduce the size of the breast but to make sure the patient is happy with her new appearance.
"In the initial years of our life we forget our health while going after wealth, in the later years of our life we spend our wealth to take care of our health... It's today reality. Health is not everything, BUT without health everything is nothing."
Heavy periods (menorrhagia)
Reviewed by Dr Philip Owen, consultant obstetrician and gynaecologist
What are heavy periods? The correct medical definition of heavy periods is the passage of more than 80ml of blood each period. It is seldom realistic or practical, however, to actually measure the blood loss and so doctors rely on the woman's description of her period. Periods are considered heavy when:
a woman bleeds for more than 8 to 10 days, especially if this is repeated month after month.
a woman bleeds so much that it is difficult for her to attend her job. She may be forced to plan her holidays and leisure time according to the timings of her period.
the bleeding is continuously so heavy that the woman becomes anaemic.
the presence of other than small clots for more than one or two days suggests heavy periods.
'flooding' describes the sudden, unexpected onset of periods, like turning on a tap, and indicates heavy periods.
Why do some women have heavy and long menstrual flows? The causes of prolonged and heavy bleeding are given below.
In younger women heavy periods are most often due to a temporary hormone imbalance, which eventually corrects itself.
In the years close to the menopause, (45 years of age onwards) heavy periods are usually a sign of hormone imbalance. However, the possibility of heavy periods being caused by an underlying disease increases with age.The following conditions are associated with heavy periods:
fibroids.
endometriosis.
pelvic inflammatory disease.
polyps of the lining of the womb.
the commonest cause is a condition called dysfunctional uterine bleeding (DUB). This refers to heavy bleeding with no apparent explanation.
Is it necessary to consult a doctor?If a woman is experiencing heavy or irregular periods that are interfering with her quality of life, then she should consult a GP or gynaecologist.
What will the doctor do?A pelvic examination is usually necessary. If the woman is over 40 years of age, then a pelvic ultrasound scan or a biopsy of the lining of the womb is appropriate. This is to ensure that there is no abnormality with the cells of the lining of the womb. An examination called a hysteroscopy is often suggested. This involves placing a fine telescope through the neck of the womb so that the lining of the womb can be seen. Most hysteroscopies are performed without the need for general anaesthesia.
How are heavy periods treated? If there are no signs of an underlying abnormality, treatment is not absolutely necessary but most women prefer to have something to help them cope more easily each month.
If the problems are severe, bleeding may be regulated by tablet treatment. These may be hormonal or non-hormonal.
Hormonal treatments include the contraceptive pill and danazol.
Progestogens are effective in making a woman's periods more regular but do not reduce the monthly flow.
Non-hormonal treatments include Cyclokapron (tranexamic acid), which reduces the blood loss by up to half.
Non-steroidal anti-inflammatory drugs (NSAIDs) reduce monthly loss by about a third.
Alternative approaches include the use of a hormone containing contraceptive coil (Mirena IUS), which is suitable for most women.
Surgical alternatives include destroying the lining of the womb with a laser or applying heat treatment to the lining of the womb with hot water in a balloon. Hysterectomy - the removal of the uterus - is commonly performed for heavy periods. These two surgical procedures are only appropriate for women who do not wish to have any more children.
If a diagnosis of an underlying condition is made, then the treatment will be tailored towards that condition.
If the woman is anaemic, iron and folic acid supplements are appropriate.
Based on a text by Dr Erik Fangel Poulsen, specialist
What are heavy periods? The correct medical definition of heavy periods is the passage of more than 80ml of blood each period. It is seldom realistic or practical, however, to actually measure the blood loss and so doctors rely on the woman's description of her period. Periods are considered heavy when:
a woman bleeds for more than 8 to 10 days, especially if this is repeated month after month.
a woman bleeds so much that it is difficult for her to attend her job. She may be forced to plan her holidays and leisure time according to the timings of her period.
the bleeding is continuously so heavy that the woman becomes anaemic.
the presence of other than small clots for more than one or two days suggests heavy periods.
'flooding' describes the sudden, unexpected onset of periods, like turning on a tap, and indicates heavy periods.
Why do some women have heavy and long menstrual flows? The causes of prolonged and heavy bleeding are given below.
In younger women heavy periods are most often due to a temporary hormone imbalance, which eventually corrects itself.
In the years close to the menopause, (45 years of age onwards) heavy periods are usually a sign of hormone imbalance. However, the possibility of heavy periods being caused by an underlying disease increases with age.The following conditions are associated with heavy periods:
fibroids.
endometriosis.
pelvic inflammatory disease.
polyps of the lining of the womb.
the commonest cause is a condition called dysfunctional uterine bleeding (DUB). This refers to heavy bleeding with no apparent explanation.
Is it necessary to consult a doctor?If a woman is experiencing heavy or irregular periods that are interfering with her quality of life, then she should consult a GP or gynaecologist.
What will the doctor do?A pelvic examination is usually necessary. If the woman is over 40 years of age, then a pelvic ultrasound scan or a biopsy of the lining of the womb is appropriate. This is to ensure that there is no abnormality with the cells of the lining of the womb. An examination called a hysteroscopy is often suggested. This involves placing a fine telescope through the neck of the womb so that the lining of the womb can be seen. Most hysteroscopies are performed without the need for general anaesthesia.
How are heavy periods treated? If there are no signs of an underlying abnormality, treatment is not absolutely necessary but most women prefer to have something to help them cope more easily each month.
If the problems are severe, bleeding may be regulated by tablet treatment. These may be hormonal or non-hormonal.
Hormonal treatments include the contraceptive pill and danazol.
Progestogens are effective in making a woman's periods more regular but do not reduce the monthly flow.
Non-hormonal treatments include Cyclokapron (tranexamic acid), which reduces the blood loss by up to half.
Non-steroidal anti-inflammatory drugs (NSAIDs) reduce monthly loss by about a third.
Alternative approaches include the use of a hormone containing contraceptive coil (Mirena IUS), which is suitable for most women.
Surgical alternatives include destroying the lining of the womb with a laser or applying heat treatment to the lining of the womb with hot water in a balloon. Hysterectomy - the removal of the uterus - is commonly performed for heavy periods. These two surgical procedures are only appropriate for women who do not wish to have any more children.
If a diagnosis of an underlying condition is made, then the treatment will be tailored towards that condition.
If the woman is anaemic, iron and folic acid supplements are appropriate.
Based on a text by Dr Erik Fangel Poulsen, specialist
"In the initial years of our life we forget our health while going after wealth, in the later years of our life we spend our wealth to take care of our health... It's today reality. Health is not everything, BUT without health everything is nothing."
Heavy periods (menorrhagia)
Reviewed by Dr Philip Owen, consultant obstetrician and gynaecologist
What are heavy periods? The correct medical definition of heavy periods is the passage of more than 80ml of blood each period. It is seldom realistic or practical, however, to actually measure the blood loss and so doctors rely on the woman's description of her period. Periods are considered heavy when:
a woman bleeds for more than 8 to 10 days, especially if this is repeated month after month.
a woman bleeds so much that it is difficult for her to attend her job. She may be forced to plan her holidays and leisure time according to the timings of her period.
the bleeding is continuously so heavy that the woman becomes anaemic.
the presence of other than small clots for more than one or two days suggests heavy periods.
'flooding' describes the sudden, unexpected onset of periods, like turning on a tap, and indicates heavy periods.
Why do some women have heavy and long menstrual flows? The causes of prolonged and heavy bleeding are given below.
In younger women heavy periods are most often due to a temporary hormone imbalance, which eventually corrects itself.
In the years close to the menopause, (45 years of age onwards) heavy periods are usually a sign of hormone imbalance. However, the possibility of heavy periods being caused by an underlying disease increases with age.The following conditions are associated with heavy periods:
fibroids.
endometriosis.
pelvic inflammatory disease.
polyps of the lining of the womb.
the commonest cause is a condition called dysfunctional uterine bleeding (DUB). This refers to heavy bleeding with no apparent explanation.
Is it necessary to consult a doctor?If a woman is experiencing heavy or irregular periods that are interfering with her quality of life, then she should consult a GP or gynaecologist.
What will the doctor do?A pelvic examination is usually necessary. If the woman is over 40 years of age, then a pelvic ultrasound scan or a biopsy of the lining of the womb is appropriate. This is to ensure that there is no abnormality with the cells of the lining of the womb. An examination called a hysteroscopy is often suggested. This involves placing a fine telescope through the neck of the womb so that the lining of the womb can be seen. Most hysteroscopies are performed without the need for general anaesthesia.
How are heavy periods treated? If there are no signs of an underlying abnormality, treatment is not absolutely necessary but most women prefer to have something to help them cope more easily each month.
If the problems are severe, bleeding may be regulated by tablet treatment. These may be hormonal or non-hormonal.
Hormonal treatments include the contraceptive pill and danazol.
Progestogens are effective in making a woman's periods more regular but do not reduce the monthly flow.
Non-hormonal treatments include Cyclokapron (tranexamic acid), which reduces the blood loss by up to half.
Non-steroidal anti-inflammatory drugs (NSAIDs) reduce monthly loss by about a third.
Alternative approaches include the use of a hormone containing contraceptive coil (Mirena IUS), which is suitable for most women.
Surgical alternatives include destroying the lining of the womb with a laser or applying heat treatment to the lining of the womb with hot water in a balloon. Hysterectomy - the removal of the uterus - is commonly performed for heavy periods. These two surgical procedures are only appropriate for women who do not wish to have any more children.
If a diagnosis of an underlying condition is made, then the treatment will be tailored towards that condition.
If the woman is anaemic, iron and folic acid supplements are appropriate.
Based on a text by Dr Erik Fangel Poulsen, specialist
What are heavy periods? The correct medical definition of heavy periods is the passage of more than 80ml of blood each period. It is seldom realistic or practical, however, to actually measure the blood loss and so doctors rely on the woman's description of her period. Periods are considered heavy when:
a woman bleeds for more than 8 to 10 days, especially if this is repeated month after month.
a woman bleeds so much that it is difficult for her to attend her job. She may be forced to plan her holidays and leisure time according to the timings of her period.
the bleeding is continuously so heavy that the woman becomes anaemic.
the presence of other than small clots for more than one or two days suggests heavy periods.
'flooding' describes the sudden, unexpected onset of periods, like turning on a tap, and indicates heavy periods.
Why do some women have heavy and long menstrual flows? The causes of prolonged and heavy bleeding are given below.
In younger women heavy periods are most often due to a temporary hormone imbalance, which eventually corrects itself.
In the years close to the menopause, (45 years of age onwards) heavy periods are usually a sign of hormone imbalance. However, the possibility of heavy periods being caused by an underlying disease increases with age.The following conditions are associated with heavy periods:
fibroids.
endometriosis.
pelvic inflammatory disease.
polyps of the lining of the womb.
the commonest cause is a condition called dysfunctional uterine bleeding (DUB). This refers to heavy bleeding with no apparent explanation.
Is it necessary to consult a doctor?If a woman is experiencing heavy or irregular periods that are interfering with her quality of life, then she should consult a GP or gynaecologist.
What will the doctor do?A pelvic examination is usually necessary. If the woman is over 40 years of age, then a pelvic ultrasound scan or a biopsy of the lining of the womb is appropriate. This is to ensure that there is no abnormality with the cells of the lining of the womb. An examination called a hysteroscopy is often suggested. This involves placing a fine telescope through the neck of the womb so that the lining of the womb can be seen. Most hysteroscopies are performed without the need for general anaesthesia.
How are heavy periods treated? If there are no signs of an underlying abnormality, treatment is not absolutely necessary but most women prefer to have something to help them cope more easily each month.
If the problems are severe, bleeding may be regulated by tablet treatment. These may be hormonal or non-hormonal.
Hormonal treatments include the contraceptive pill and danazol.
Progestogens are effective in making a woman's periods more regular but do not reduce the monthly flow.
Non-hormonal treatments include Cyclokapron (tranexamic acid), which reduces the blood loss by up to half.
Non-steroidal anti-inflammatory drugs (NSAIDs) reduce monthly loss by about a third.
Alternative approaches include the use of a hormone containing contraceptive coil (Mirena IUS), which is suitable for most women.
Surgical alternatives include destroying the lining of the womb with a laser or applying heat treatment to the lining of the womb with hot water in a balloon. Hysterectomy - the removal of the uterus - is commonly performed for heavy periods. These two surgical procedures are only appropriate for women who do not wish to have any more children.
If a diagnosis of an underlying condition is made, then the treatment will be tailored towards that condition.
If the woman is anaemic, iron and folic acid supplements are appropriate.
Based on a text by Dr Erik Fangel Poulsen, specialist
"In the initial years of our life we forget our health while going after wealth, in the later years of our life we spend our wealth to take care of our health... It's today reality. Health is not everything, BUT without health everything is nothing."
The menopause
Reviewed by Dr Dan Rutherford, GP
What is the menopause?The menopause, also called the change of life, is defined as the end of the last menstrual period. In Western women it occurs on average at 51 years, but there is a wide range of normal extending from your 30s to 60s.
What is the menopause like? The menopause occurs when the ovaries no longer respond to the controlling hormones released by the pituitary gland of the brain. As a result, the ovaries fail to release an egg each month and to produce the female sex hormones oestrogen and progesterone. It is the fall in the levels of these hormones in the bloodstream that gives rise to the symptoms of menopause. Research into the menopause is relatively recent. One hundred years ago, when life expectancy was shorter, most women did not live long after the menopause and so little was known about it.
How does the menopause start?Many women experience symptoms of the menopause and irregular periods for several years up to the menopause itself. This is called the climacteric, or 'perimenopause', and represents the gradual decline in the normal function of the ovaries. One of the common problems of the climacteric is that periods become erratic both in spacing and amount. Until the periods peter out altogether, heavy bleeding can cause plenty of problems. Treatments for heavy bleeding are listed below.
NSAIDs Non-steroidal anti-inflammatory drugs (NSAIDs) are medicines such as ibuprofen that are used as painkillers and to lower a raised temperature. They reduce the amount of blood lost in a period and help reduce pain. Mefenamic acid is another painkiller used in the same way.
Tranexamic acid Tranexamic acid is a drug that encourages blood to clot on a bleeding surface, which can reduce heavy menstrual bleeding. It’s only used for the heaviest three or four days of each period. It’s not suitable for women with a previous history of clots in the veins (thrombosis). Nausea, vomiting and diarrhoea are the likeliest side effects from this drug.
Progestogen tabletsOral progestogen tablets will cut menstrual flow when given for long enough (21 days each cycle), as will the progestogen released from the Mirena intra-uterine system. Mirena is currently the most effective non-surgical way of dealing with excessive vaginal bleeding. There are other drug options that can be used by specialists, if necessary, but these can be accompanied by significant side effects.
HysterectomyHeavy menstrual bleeding is the most common reason for having a hysterectomy. One in five women have had a hysterectomy before the age of 60. Complete removal of the uterus is a relatively major operation. This means it is accompanied by risks such as those of an anaesthetic, of bleeding at operation, wound infection, vein clots post-operatively and so on. However, these are risks that apply to any operation. In practice, hysterectomy is a successful and well-tolerated procedure.
Endometrial ablationLesser surgical procedures to treat heavy bleeding are now possible using fibre-optic instruments that can destroy the lining of the uterus (endometrial ablation). This works because it is only the inner lining of the uterus that is hormone-sensitive and responsible for menstruation. The procedure does not completely remove every piece of the uterine lining, and 30-90 per cent of women still get some menstrual bleeding afterwards, but usually it is light. For the same reason, if you later take HRT after an endometrial ablation, you will still need to use a combined HRT preparation and not just oestrogen alone.
What is the menopause like? Every woman experiences the menopause differently. Many hardly notice 'the change', except perhaps their periods become irregular. Others suffer every symptom and find their lives are severely affected. The transition into the menopause is usually gradual and is accompanied by a range of symptoms.
Hot flushes and sweatingThe most common symptoms by far are ‘hot flushes’ and sweating attacks. These episodes can happen at any time, as often as several times an hour.Each hot flush usually lasts for three to six minutes.Exactly why flushes and sweats occur is not fully understood, but mostly it is because the automatic controls of the nervous system become erratic. This triggers the skin blood vessels to open and signals the sweat glands to become active at any time. Usually, this would only happen if you were too hot and needed to lose heat.
Sleep disturbanceSleeping difficulty can be due to problems falling asleep, restlessness or night-time sweats. Some women sweat heavily and have to get up to change the sheets several times a night.
Psychological changes Depression, mood swings, tiredness or headaches are all possible symptoms. Forgetfulness or irritability can be distressing for both you and the rest of the family.
Physical changes
During the menopause your skin becomes thinner.
A lack of oestrogen often means the glands in the vagina don't produce as much lubrication as before and this may cause stinging around the vagina during sex.
Some women don't feel like having sex, whereas others find their orgasms become less intense.
The lack of oestrogen also affects the bladder and you may find you need to pass water more often.
There is a gradual rise in the risk of heart disease and stroke after the menopause.
Falling oestrogen levels result in unfavourable changes in cholesterol and fat levels in the blood, causing a predisposition to these problems.
OsteoporosisIn recent years there has been a lot of interest in osteoporosis (thinning of the bones) in connection with the menopause. Oestrogen normally stimulates the bone-building cells. As a result of the drop in oestrogen, women tend to lose bone mass and strength for several years following the menopause. Ultimately, this can make the bones more likely to collapse or fracture.
What can make the menopause easier?Medical treatment is available for women who are troubled by symptoms of the menopause.
Hormone replacement therapyHormone replacement therapy (HRT) alleviates the symptoms of the menopause by adjusting hormone levels. It involves receiving a small daily dose of oestrogen. Women who have not had a hysterectomy are also given a progesterone-like drug as part of the HRT. This is called combined HRT.Combined HRT can be described as either sequential or continuous. Sequential combined HRT is suitable for women who are perimenopausal, ie still experiencing erratic menstrual bleeding. Most preparations are designed to mimic the menstrual cycle and result in monthly periods. They are based around a 28-day cycle in which oestrogen is taken every day and a progesterone is added for the last 12 to 14 days of the cycle. For women who are borderline postmenopausal and have very infrequent bleeds, there is also a sequential preparation available that results in three-monthly bleeds.Once a woman has not had a natural period for a year and is described as postmenopausal, continuous combined HRT is more suitable. This form of HRT does not produce periods and involves taking a daily dose of oestrogen and progesterone.
How is HRT taken? There are many ways of taking HRT, with the most usual being a daily tablet. Alternatives include skin patches, a small pellet or implant under the skin, a gel applied daily to the skin, a ring inserted into the vagina, or a nasal spray.
What are the side effects of HRT?The majority of women have no side effects, but the following are fairly common:
nausea
breast tenderness
weight gain
fluid retention.These symptoms often settle after the first few months of treatment. If they don't, it's worth consulting your doctor or gynaecologist to adjust the medication.
How effective is HRT? HRT is effective at relieving hot flushes and vaginal dryness and many women report an improvement in their general sense of wellbeing. However, HRT is not a magic fix and if disturbed mood or behaviour is due to underlying problems at home or work, HRT cannot be expected to improve matters. HRT is often taken for a short spell of six months to a year to relieve hot flushes. The long-term benefits of HRT have recently been brought into question. Previously it was thought that HRT prevented heart disease and strokes by slowing the development of hardening of the arteries. Several major research studies reported in 2002 and 2003 have shown this is not so. The possibility that HRT users are less likely to develop Alzheimer's disease is still to be confirmed, but it does seem that HRT offers some protection against developing bowel cancer.The most important result of these research studies has been the confirmation that HRT increases the risk of developing breast cancer and endometrial cancer (cancer of the lining of the womb).
The risks with HRTTo put into perspective the magnitude of these risks, it helps to put together some figures. For purposes of comparison, the risks are stated as the number of people affected per 10,000 women-years of observation. This can mean one thousand women observed over 10 years or five thousand women over two years, etc. The Women’s Health Initiative (WHI) study showed the following risks.
Sequential HRT
Some evidence suggests sequential HRT is associated with a slightly higher risk of endometrial cancer.
Sequential HRT is the sort associated with a monthly or three-monthly bleed.
It is recommended for use in the climacteric phase.
Ideally, all women on long-term HRT should move to a continuous type within a year or two of starting HRT.
Breast cancer: the risk of developing breast cancer in women not taking HRT (on placebo) was 30 per 10,000 women-years. On HRT the risk was 38 per 10,000 women-years.
Heart disease: women not taking HRT had 30 cases of heart disease per 10,000 women-years. Women on HRT had 37 cases per 10,000 women-years.
Stroke: on placebo the risk was 21 per 10,000. On HRT the risk was 29 per 10,000.
Clots in the veins (venous thrombosis): on placebo the risk was 16 per 10,000. On HRT the risk was 34 per 10,000. Researchers included those clots that moved from the leg veins up into the lungs, which are the most dangerous type, as well as those that stayed within the leg veins.
Endometrial cancer: it is difficult to put an exact figure on this, but long-term oestrogen-only HRT does increase the risk of abnormal growth of the lining of the womb (endometrium) and endometrial cancer. Using combined HRT reduces, but does not eliminate, the risk Evidence suggests that sequential combined HRT may still be associated with slightly increased risk of endometrial cancer, however no increased risk has been found with continuous combined HRT.
Breast disease and HRT HRT has been known for years to increase the risk of breast cancer. The risk increases with the length of time HRT is used and becomes detectable after about one to two years of treatment. The risk falls once HRT is stopped, and takes about five years to drop back to the average in the population.The Million Women study showed combined HRT had a higher risk of breast cancer than oestrogen-only HRT. The study found that:
in women aged 50 who do not use HRT, about 32 in every 1000 will be diagnosed with breast cancer by the time they reach the age of 65.
in women who start oestrogen-only HRT at age 50 and use it for five years, about 33 to 34 in every 1000 will be diagnosed with breast cancer by the age of 65.
in women who start combined HRT at age 50 and use it for five years, the figure would be 38 in every 1000.
for those who start oestrogen-only HRT at age 50 and use it for 10 years, breast cancer will be diagnosed in 37 in every 1000 by the age of 65.
in those who start combined HRT at age 50 and use it for 10 years, the figure increases to 51 in every 1000.The best evidence available at present tells us that breast cancers that occur in women taking HRT are smaller, less advanced and of a more treatable type than breast cancers occurring in women not taking HRT. This accounts for the fact that despite the increased numbers of cancers arising due to HRT, the actual mortality of women from breast cancer is the same in the HRT and non-HRT populations. However, experts now feel the balance of risk has swung against HRT given for longer than five years. It is recommended that HRT is only used as a short-term treatment to relieve menopausal symptoms, and that treatment is reviewed at least annually. Any woman considering HRT should discuss the risks and benefits for her individual circumstances with her doctor before making a decision about treatment.
Other breast problems related to HRTWomen in the pre-menopause who take HRT often get breast pain and benign breast lumps, including cysts (fluid-filled lumps). HRT may cause benign breast lumps that are already present to get bigger. In the UK, as well as relying on women to check their breasts and report changes to their GP, there is also a national screening service that offers periodic mammograms to women over 50. HRT is known to increase the density of breast tissue, which makes it harder for the X-rays used in mammography to penetrate the breast. It is therefore of concern that HRT can make it more difficult to detect breast cancer by mammography. However, HRT is not the only type of medicine that can be used to relieve menopausal symptoms.
Other treatments for the menopause
Tibolone Tibolone (Livial) is a synthetic steroid hormone that has some oestrogen plus some progesterone effects (and has some testosterone-like effects, too). In a way it’s a type of combined continuous HRT in a single tablet, which is largely how it’s used. It helps flushings and sweats, vaginal dryness and irritation and also protects against osteoporosis. It possibly improves libido. The benefits of tibolone include much less breast tenderness and little effect on breast tissue density in mammograms density. However, the Million Women study showed that tibolone is associated with a slightly increased risk of breast cancer, of around the same level as that associated with oestrogen-only HRT.
ClonidineClonidine is a drug originally developed for use as a blood pressure lowering treatment, but at smaller doses it can relieve hot flushes.
Oestrogen creams and pessariesVaginal dryness can be relieved by short courses of oestrogen creams or pessaries that are inserted into the vagina. There is also a special vaginal ring containing oestrogen that can be left in the vagina for three months, where it slowly releases oestrogen into the vaginal tissues.
Complementary medicineA range of ‘complementary’ medical treatments are also widely in use to relieve menopausal symptoms. Although the scientific evidence in favour of complementary medicine is not as good as for conventional treatments, they are generally safe to try. Black cohosh is the best known of the complementary treatments. It has its origins among North American Indians, where it has been used as a traditional folk remedy for a range of gynaecological problems for hundreds of years.
A natural processThere has been a tendency to think of the menopause as an illness or a health hazard, which is the wrong way to look at it. It’s a phase of life and we have to live with it. The hand of woman (or man) has little influence on the processes of nature, and the menopause is a changing scene in the world of medicine. There are many unanswered questions - a lot of the problems we thought we had some answers to have turned out not to be so clear cut. The big health issues that face older women in the UK today are mainly to do with cardiovascular diseases, being overweight, developing diabetes and having poor mental health. It’s the same list for men. We know the things that need attention across the population to help these problems:
the low levels of exercise most of us take
our excessive intake of high-calorie foods, salt and alcohol
high blood pressure
cholesterol levels. These are actually bigger threats than cancer to the majority of people, and all of them can be improved by actions we can take ourselves.
Are there steps I can take to make the menopause easier?It’s perhaps taking it a bit far to say that with the right attitude the menopause can be made into a joyous part of your life. However, the same actions that make life better generally will make the menopause better, too.
Regular exercise such as walking for 20-30 minutes three or four times a week can improve your health and add years to your life. Exercise strengthens your bones, increases wellbeing and can help make sleeping easier.
Eating the right food is also important. For healthy bones, the body needs about 1500mg of calcium each day from dairy products such as milk products and cheese.
Eating plenty of fruit and vegetables provides the necessary minerals and vitamins for good general health and also helps to protect against cancer and heart disease.
There is some evidence that soy flour (or other foods rich in so-called ‘plant oestrogen’) can reduce menopausal flushings.
Smoking is never good for your health. Stopping smoking is the biggest single move anyone can make to improve their health, whatever their age.
References Writing group for the WHI study. Risks and benefits of estrogen plus progestin in healthy postmenopausal women. Principal results from the women’s health initiative randomised controlled trial. Journal of the American Medical Association 2002;288:321-333 http://jama.ama-assn.org/cgi/content/abstract/288/3/321.Dixon JM. Hormone replacement therapy and the breast. British Medical Journal 2001; 323: 1381-1382 http://bmj.com/cgi/content/full/323/7326/1381. Beral V, et al. Breast cancer and hormone replacement therapy in the Million Women Study. Lancet 2003; 362: 419-427.HRT: Update on the risk of breast cancer and long term safety; MHRA Current problems in pharmacovigilance, Volume 29 Sept 2003. Tanna N. Hormone replacement therapy: risks and benefits. Pharmaceutical Journal 2003; 271: 646-648.Based on a text by Niels Lund, specialist gynaecology and obstetrics, Charlotte Floridon, MD, PhD, gynaecology and obstetrics and Christel Bech, nurse
What is the menopause?The menopause, also called the change of life, is defined as the end of the last menstrual period. In Western women it occurs on average at 51 years, but there is a wide range of normal extending from your 30s to 60s.
What is the menopause like? The menopause occurs when the ovaries no longer respond to the controlling hormones released by the pituitary gland of the brain. As a result, the ovaries fail to release an egg each month and to produce the female sex hormones oestrogen and progesterone. It is the fall in the levels of these hormones in the bloodstream that gives rise to the symptoms of menopause. Research into the menopause is relatively recent. One hundred years ago, when life expectancy was shorter, most women did not live long after the menopause and so little was known about it.
How does the menopause start?Many women experience symptoms of the menopause and irregular periods for several years up to the menopause itself. This is called the climacteric, or 'perimenopause', and represents the gradual decline in the normal function of the ovaries. One of the common problems of the climacteric is that periods become erratic both in spacing and amount. Until the periods peter out altogether, heavy bleeding can cause plenty of problems. Treatments for heavy bleeding are listed below.
NSAIDs Non-steroidal anti-inflammatory drugs (NSAIDs) are medicines such as ibuprofen that are used as painkillers and to lower a raised temperature. They reduce the amount of blood lost in a period and help reduce pain. Mefenamic acid is another painkiller used in the same way.
Tranexamic acid Tranexamic acid is a drug that encourages blood to clot on a bleeding surface, which can reduce heavy menstrual bleeding. It’s only used for the heaviest three or four days of each period. It’s not suitable for women with a previous history of clots in the veins (thrombosis). Nausea, vomiting and diarrhoea are the likeliest side effects from this drug.
Progestogen tabletsOral progestogen tablets will cut menstrual flow when given for long enough (21 days each cycle), as will the progestogen released from the Mirena intra-uterine system. Mirena is currently the most effective non-surgical way of dealing with excessive vaginal bleeding. There are other drug options that can be used by specialists, if necessary, but these can be accompanied by significant side effects.
HysterectomyHeavy menstrual bleeding is the most common reason for having a hysterectomy. One in five women have had a hysterectomy before the age of 60. Complete removal of the uterus is a relatively major operation. This means it is accompanied by risks such as those of an anaesthetic, of bleeding at operation, wound infection, vein clots post-operatively and so on. However, these are risks that apply to any operation. In practice, hysterectomy is a successful and well-tolerated procedure.
Endometrial ablationLesser surgical procedures to treat heavy bleeding are now possible using fibre-optic instruments that can destroy the lining of the uterus (endometrial ablation). This works because it is only the inner lining of the uterus that is hormone-sensitive and responsible for menstruation. The procedure does not completely remove every piece of the uterine lining, and 30-90 per cent of women still get some menstrual bleeding afterwards, but usually it is light. For the same reason, if you later take HRT after an endometrial ablation, you will still need to use a combined HRT preparation and not just oestrogen alone.
What is the menopause like? Every woman experiences the menopause differently. Many hardly notice 'the change', except perhaps their periods become irregular. Others suffer every symptom and find their lives are severely affected. The transition into the menopause is usually gradual and is accompanied by a range of symptoms.
Hot flushes and sweatingThe most common symptoms by far are ‘hot flushes’ and sweating attacks. These episodes can happen at any time, as often as several times an hour.Each hot flush usually lasts for three to six minutes.Exactly why flushes and sweats occur is not fully understood, but mostly it is because the automatic controls of the nervous system become erratic. This triggers the skin blood vessels to open and signals the sweat glands to become active at any time. Usually, this would only happen if you were too hot and needed to lose heat.
Sleep disturbanceSleeping difficulty can be due to problems falling asleep, restlessness or night-time sweats. Some women sweat heavily and have to get up to change the sheets several times a night.
Psychological changes Depression, mood swings, tiredness or headaches are all possible symptoms. Forgetfulness or irritability can be distressing for both you and the rest of the family.
Physical changes
During the menopause your skin becomes thinner.
A lack of oestrogen often means the glands in the vagina don't produce as much lubrication as before and this may cause stinging around the vagina during sex.
Some women don't feel like having sex, whereas others find their orgasms become less intense.
The lack of oestrogen also affects the bladder and you may find you need to pass water more often.
There is a gradual rise in the risk of heart disease and stroke after the menopause.
Falling oestrogen levels result in unfavourable changes in cholesterol and fat levels in the blood, causing a predisposition to these problems.
OsteoporosisIn recent years there has been a lot of interest in osteoporosis (thinning of the bones) in connection with the menopause. Oestrogen normally stimulates the bone-building cells. As a result of the drop in oestrogen, women tend to lose bone mass and strength for several years following the menopause. Ultimately, this can make the bones more likely to collapse or fracture.
What can make the menopause easier?Medical treatment is available for women who are troubled by symptoms of the menopause.
Hormone replacement therapyHormone replacement therapy (HRT) alleviates the symptoms of the menopause by adjusting hormone levels. It involves receiving a small daily dose of oestrogen. Women who have not had a hysterectomy are also given a progesterone-like drug as part of the HRT. This is called combined HRT.Combined HRT can be described as either sequential or continuous. Sequential combined HRT is suitable for women who are perimenopausal, ie still experiencing erratic menstrual bleeding. Most preparations are designed to mimic the menstrual cycle and result in monthly periods. They are based around a 28-day cycle in which oestrogen is taken every day and a progesterone is added for the last 12 to 14 days of the cycle. For women who are borderline postmenopausal and have very infrequent bleeds, there is also a sequential preparation available that results in three-monthly bleeds.Once a woman has not had a natural period for a year and is described as postmenopausal, continuous combined HRT is more suitable. This form of HRT does not produce periods and involves taking a daily dose of oestrogen and progesterone.
How is HRT taken? There are many ways of taking HRT, with the most usual being a daily tablet. Alternatives include skin patches, a small pellet or implant under the skin, a gel applied daily to the skin, a ring inserted into the vagina, or a nasal spray.
What are the side effects of HRT?The majority of women have no side effects, but the following are fairly common:
nausea
breast tenderness
weight gain
fluid retention.These symptoms often settle after the first few months of treatment. If they don't, it's worth consulting your doctor or gynaecologist to adjust the medication.
How effective is HRT? HRT is effective at relieving hot flushes and vaginal dryness and many women report an improvement in their general sense of wellbeing. However, HRT is not a magic fix and if disturbed mood or behaviour is due to underlying problems at home or work, HRT cannot be expected to improve matters. HRT is often taken for a short spell of six months to a year to relieve hot flushes. The long-term benefits of HRT have recently been brought into question. Previously it was thought that HRT prevented heart disease and strokes by slowing the development of hardening of the arteries. Several major research studies reported in 2002 and 2003 have shown this is not so. The possibility that HRT users are less likely to develop Alzheimer's disease is still to be confirmed, but it does seem that HRT offers some protection against developing bowel cancer.The most important result of these research studies has been the confirmation that HRT increases the risk of developing breast cancer and endometrial cancer (cancer of the lining of the womb).
The risks with HRTTo put into perspective the magnitude of these risks, it helps to put together some figures. For purposes of comparison, the risks are stated as the number of people affected per 10,000 women-years of observation. This can mean one thousand women observed over 10 years or five thousand women over two years, etc. The Women’s Health Initiative (WHI) study showed the following risks.
Sequential HRT
Some evidence suggests sequential HRT is associated with a slightly higher risk of endometrial cancer.
Sequential HRT is the sort associated with a monthly or three-monthly bleed.
It is recommended for use in the climacteric phase.
Ideally, all women on long-term HRT should move to a continuous type within a year or two of starting HRT.
Breast cancer: the risk of developing breast cancer in women not taking HRT (on placebo) was 30 per 10,000 women-years. On HRT the risk was 38 per 10,000 women-years.
Heart disease: women not taking HRT had 30 cases of heart disease per 10,000 women-years. Women on HRT had 37 cases per 10,000 women-years.
Stroke: on placebo the risk was 21 per 10,000. On HRT the risk was 29 per 10,000.
Clots in the veins (venous thrombosis): on placebo the risk was 16 per 10,000. On HRT the risk was 34 per 10,000. Researchers included those clots that moved from the leg veins up into the lungs, which are the most dangerous type, as well as those that stayed within the leg veins.
Endometrial cancer: it is difficult to put an exact figure on this, but long-term oestrogen-only HRT does increase the risk of abnormal growth of the lining of the womb (endometrium) and endometrial cancer. Using combined HRT reduces, but does not eliminate, the risk Evidence suggests that sequential combined HRT may still be associated with slightly increased risk of endometrial cancer, however no increased risk has been found with continuous combined HRT.
Breast disease and HRT HRT has been known for years to increase the risk of breast cancer. The risk increases with the length of time HRT is used and becomes detectable after about one to two years of treatment. The risk falls once HRT is stopped, and takes about five years to drop back to the average in the population.The Million Women study showed combined HRT had a higher risk of breast cancer than oestrogen-only HRT. The study found that:
in women aged 50 who do not use HRT, about 32 in every 1000 will be diagnosed with breast cancer by the time they reach the age of 65.
in women who start oestrogen-only HRT at age 50 and use it for five years, about 33 to 34 in every 1000 will be diagnosed with breast cancer by the age of 65.
in women who start combined HRT at age 50 and use it for five years, the figure would be 38 in every 1000.
for those who start oestrogen-only HRT at age 50 and use it for 10 years, breast cancer will be diagnosed in 37 in every 1000 by the age of 65.
in those who start combined HRT at age 50 and use it for 10 years, the figure increases to 51 in every 1000.The best evidence available at present tells us that breast cancers that occur in women taking HRT are smaller, less advanced and of a more treatable type than breast cancers occurring in women not taking HRT. This accounts for the fact that despite the increased numbers of cancers arising due to HRT, the actual mortality of women from breast cancer is the same in the HRT and non-HRT populations. However, experts now feel the balance of risk has swung against HRT given for longer than five years. It is recommended that HRT is only used as a short-term treatment to relieve menopausal symptoms, and that treatment is reviewed at least annually. Any woman considering HRT should discuss the risks and benefits for her individual circumstances with her doctor before making a decision about treatment.
Other breast problems related to HRTWomen in the pre-menopause who take HRT often get breast pain and benign breast lumps, including cysts (fluid-filled lumps). HRT may cause benign breast lumps that are already present to get bigger. In the UK, as well as relying on women to check their breasts and report changes to their GP, there is also a national screening service that offers periodic mammograms to women over 50. HRT is known to increase the density of breast tissue, which makes it harder for the X-rays used in mammography to penetrate the breast. It is therefore of concern that HRT can make it more difficult to detect breast cancer by mammography. However, HRT is not the only type of medicine that can be used to relieve menopausal symptoms.
Other treatments for the menopause
Tibolone Tibolone (Livial) is a synthetic steroid hormone that has some oestrogen plus some progesterone effects (and has some testosterone-like effects, too). In a way it’s a type of combined continuous HRT in a single tablet, which is largely how it’s used. It helps flushings and sweats, vaginal dryness and irritation and also protects against osteoporosis. It possibly improves libido. The benefits of tibolone include much less breast tenderness and little effect on breast tissue density in mammograms density. However, the Million Women study showed that tibolone is associated with a slightly increased risk of breast cancer, of around the same level as that associated with oestrogen-only HRT.
ClonidineClonidine is a drug originally developed for use as a blood pressure lowering treatment, but at smaller doses it can relieve hot flushes.
Oestrogen creams and pessariesVaginal dryness can be relieved by short courses of oestrogen creams or pessaries that are inserted into the vagina. There is also a special vaginal ring containing oestrogen that can be left in the vagina for three months, where it slowly releases oestrogen into the vaginal tissues.
Complementary medicineA range of ‘complementary’ medical treatments are also widely in use to relieve menopausal symptoms. Although the scientific evidence in favour of complementary medicine is not as good as for conventional treatments, they are generally safe to try. Black cohosh is the best known of the complementary treatments. It has its origins among North American Indians, where it has been used as a traditional folk remedy for a range of gynaecological problems for hundreds of years.
A natural processThere has been a tendency to think of the menopause as an illness or a health hazard, which is the wrong way to look at it. It’s a phase of life and we have to live with it. The hand of woman (or man) has little influence on the processes of nature, and the menopause is a changing scene in the world of medicine. There are many unanswered questions - a lot of the problems we thought we had some answers to have turned out not to be so clear cut. The big health issues that face older women in the UK today are mainly to do with cardiovascular diseases, being overweight, developing diabetes and having poor mental health. It’s the same list for men. We know the things that need attention across the population to help these problems:
the low levels of exercise most of us take
our excessive intake of high-calorie foods, salt and alcohol
high blood pressure
cholesterol levels. These are actually bigger threats than cancer to the majority of people, and all of them can be improved by actions we can take ourselves.
Are there steps I can take to make the menopause easier?It’s perhaps taking it a bit far to say that with the right attitude the menopause can be made into a joyous part of your life. However, the same actions that make life better generally will make the menopause better, too.
Regular exercise such as walking for 20-30 minutes three or four times a week can improve your health and add years to your life. Exercise strengthens your bones, increases wellbeing and can help make sleeping easier.
Eating the right food is also important. For healthy bones, the body needs about 1500mg of calcium each day from dairy products such as milk products and cheese.
Eating plenty of fruit and vegetables provides the necessary minerals and vitamins for good general health and also helps to protect against cancer and heart disease.
There is some evidence that soy flour (or other foods rich in so-called ‘plant oestrogen’) can reduce menopausal flushings.
Smoking is never good for your health. Stopping smoking is the biggest single move anyone can make to improve their health, whatever their age.
References Writing group for the WHI study. Risks and benefits of estrogen plus progestin in healthy postmenopausal women. Principal results from the women’s health initiative randomised controlled trial. Journal of the American Medical Association 2002;288:321-333 http://jama.ama-assn.org/cgi/content/abstract/288/3/321.Dixon JM. Hormone replacement therapy and the breast. British Medical Journal 2001; 323: 1381-1382 http://bmj.com/cgi/content/full/323/7326/1381. Beral V, et al. Breast cancer and hormone replacement therapy in the Million Women Study. Lancet 2003; 362: 419-427.HRT: Update on the risk of breast cancer and long term safety; MHRA Current problems in pharmacovigilance, Volume 29 Sept 2003. Tanna N. Hormone replacement therapy: risks and benefits. Pharmaceutical Journal 2003; 271: 646-648.Based on a text by Niels Lund, specialist gynaecology and obstetrics, Charlotte Floridon, MD, PhD, gynaecology and obstetrics and Christel Bech, nurse
"In the initial years of our life we forget our health while going after wealth, in the later years of our life we spend our wealth to take care of our health... It's today reality. Health is not everything, BUT without health everything is nothing."
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