General Health Tuesday February 24, 2015

Dr Hilary Answers Your Questions: Part V

Welcome to the next installment of Dr Hilary answers your questions. As Medical Advisor to HealthExpress, Dr Hilary Jones is always happy to address the health queries of our patients.

This month he has looked at a wide variety of topics including headaches, back pain, diet and sexual health. Check out his answers below to find out if your question was included! Don't forget, if you'd like to ask Dr Hilary a question, just leave a comment below or email and we'll include your query in the March edition :)

1. I think i am suffering from chronic tension-type headaches, as i’ve been getting a headache every day in the afternoon for a few weeks. I am trying not to take painkillers as i’ve read that can make it worse. Assuming they are caused by stress and i can’t make any changes to my situation at the moment, what advice would you give me on how to treat them?

Whilst your headaches might very well be due to stress, I don't think you should just assume that if they have been going on for a few weeks. Since they occur in the afternoons there might be an element of dehydration, of low blood sugar if you skip lunch, neck strain if you work at a desk all day or of eyestrain if you use a keyboard and computer. I certainly think you should see your optician to check your vision and to get your doctor to look at the back of your eyes (for signs of raised intracranial pressure) and to check your blood pressure. If neck strain is the problem an osteopath or chiropractor could manipulate your neck possibly with immediate results. Your doctor can advise you about a safe non-steroidal anti-inflammatory medication and investigate further if they feel it is necessary.

2. You discussed Salmon Flips as a back exercise in a previous Q&A. I have been trying them for about a week and this morning my back seemed worse. Years ago I tried a similar exercise from yoga, in which the legs were raised at the same time as the chest and I swear this made things worse also. Could it be that such exercises don't suit certain back conditions or should one persevere?

Both of these exercises are designed to strengthen the extensor muscles of the back. These enable you to arch the back and have to be strong for lifting and straightening up. If the muscles are particularly weak these exercises can exacerbate the problem to begin with and it is worth persevering, albeit with very minimal movement and relatively few repetitions. It is important, however, to exercise all of the core muscles including the muscles at the side and the abdominals. Try doing five of each at a time. There is also the possibility that you have inflammation of the facet joints, which are the joints above and below each vertebral body which enable the spine to move in any direction. Arching the back often irritates the joints and increases pain. A full examination from your doctor, together with an MRI scan if the problem has persisted for more than six weeks, would be appropriate. Facet joint inflammation can be resolved with a combination of physiotherapy and judiciously placed injections of long-acting local anaesthetic and cortisone.

3. Recently i developed a circular, red patch on my nose (the bridge). I thought it could be a burn from cooking oil, but it’s been over a week and it doesn’t seem to be healing. My GP thinks it could be an infection and has given me some cream. Would you agree with this diagnosis?

Circumscribed red patches of skin often indicate a fungal or bacterial infection. A combination cream containing an antifungal and an antibiotic may well solve the problem if this is the case. Another possibility however is that this is the first sign of rosacea, a skin condition affecting the bridge of the nose and the cheeks on either side, characterised by visible blood vessels and small acne like spots. There are creams that are suitable for this condition which are different from those for infection, so a proper diagnosis is required. If it does not settle, referral to a dermatologist would be a good idea.

4. A while ago i got pretty drunk (i don’t drink often) and spent the evening and the next few days being sick and unable to keep anything down. I’ve never had such an extreme reaction to alcohol. Why did this happen?

After binge drinking there is often inflammation of the gullet (oesophagitis) or lining of the stomach (gastritis) which can lead to prolonged sickness and retching. Sometimes the lining of the gullet can actually be torn leading to some blood in the vomit and considerable pain. Things have obviously settled down now but in future, if you know you are going to drink heavily, line your stomach with milk or better still have a meal before you go out. This will reduce the speed of absorption of alcohol and neutralise the acid which your stomach produces in response to the booze. Aim to have at least a half pint of water between each unit of alcohol you consume to dilate its effect.

5. I’m not overweight but i do eat a lot of sugar. An i at risk of type 2 diabetes?

Although most people who develop Type II diabetes are overweight it is not a prerequisite, and many people with the condition are of normal weight. A positive family history of Type II diabetes is another risk factor, as is lack of regular exercise. Too much sugar and carbohydrate in the diet leads to insulin resistance in the body, which may predate Type II diabetes by many years. Globally, the countries where Type II diabetes is most common tend to have the highest consumption of carbohydrates and sugar. It is a good idea therefore to reduce one's intake of sugar and energy dense carbohydrates, in order to protect the liver, heart and muscles from excess fat deposition, which is what the sugar is metabolised into. Cravings for sugary food will decrease, as will mood swings and energy dips, when you reduce your sugar intake.

6. Is sugar really worse for you than fat? What about carbs?

There is no simple answer to this question, except that both too much sugar and too much fat in the diet can have far-reaching consequences for heart health and increased risks of diabetes. Sugar in itself has no nutritional value and merely provides empty calories, which the body turns into fat. Too much saturated fat from full-fat dairy products, fatty meats and processed food also lead to obesity and to unhealthy levels of cholesterol in the blood. In reality, much of the processed food in our diet contains both sugar and fat at the same time and this is the real problem in today's society. Fat at least helps people feel full quicker and may in fact reduce overall calorie intake. Healthy fats from nuts and vegetables have a cardioprotective action as well as containing healthy vitamins and minerals. Not all fats are the same. Carbohydrates are just complex forms of sugar which are broken down into smaller sugar molecules by the body, although they may also contain other components such as fibre, vitamins and minerals. Most of us should reduce our intake of both sugar and unhealthy fats but particularly those energy-dense foods which are rich in fructose and all other sugars ending in the letters ‘OSE’.

7. I get really nervous in new situations, for example at job interviews. What should i do to help me stay calm?

Many people become nervous in challenging situations and some have quite incapacitating panic attacks. The good news is that you have several options. Good preparation and rehearsal will always help in these situations. You could also have some cognitive behavioural therapy to deal with your anxiety in a more positive way and to channel it into something constructive. Relaxation exercises, including deep muscular relaxation and breathing exercises can really help also. Hypnosis is yet another option. If you need a quicker solution, however, asking your doctor for a prescription for a beta-blocker medication will help to reduce all the physical symptoms of anxiety without affecting your mental abilities and performance. The more you practice job interviews, the easier you will find them and your anxiety will wane.

8. I’ve heard that some STIs can make you infertile. Is this true, and if so how likely is it to happen?

The commonest sexually transmitted infection in women is chlamydia. This often causes no symptoms but can spread to the uterus, ovaries or fallopian tubes. This is known as pelvic inflammatory disease, which can lead to complications including chronic pelvic pain, infertility, ectopic pregnancy and miscarriage. If PID is treated early with antibiotics, the risk of infertility is greatly reduced. Other sexually transmitted infections, such as gonorrhoea, can also cause infertility but these infections are less common.

If you have concerns you can either attend a genitourinary medicine (GUM) clinic locally or you could carry out a do-it-yourself home test with results available from the laboratory within a few days. The key, however, is prevention. Ensure as far as possible that your partner is clear of infection, consider both of you having a screening check-up and use condoms as a contraceptive, which are the best form of protection overall.

9. Is coffee good or bad for you? I’ve read a lot of conflicting research.

Which coffee are we talking about and how much? Are we talking about cafetiere, filter, espresso, instant, percolated, Turkish cappuccino or decaffeinated? Not all coffee is the same, with different amounts of caffeine among other ingredients and chemicals. You probably already know that too much caffeine can lead to irritability, muscle twitching and insomnia. People drinking four or more cups a day can also suffer withdrawal symptoms, including fatigue, headaches, poor concentration and depression when they go without coffee. The bottom line is that most research has shown very little significant evidence that a moderate intake of coffee presents any serious risk to health. There are far worse elements in our diet than coffee, and as a tasty stimulant enjoyed by millions, there is no reason why it should not be savoured in moderation.

10. There’s been a lot in the news recently about how sitting down all day is bad for you. As i work in an office there’s no way i can avoid sitting down for 8 hours a day. Is there anything i can do to counteract the bad effects of sitting?

There is plenty. Since you have no alternative about sitting when you work in an office, the first thing to do is to address the office ergonomics. By that I mean making sure that your office chair is at the right height for your desk so that your back is straight and your shoulders back not slumped forward and rounded. For work at a computer the machine should be at a height where your chin should be slightly elevated and your eyes looking slightly upwards to make sure that your neck is in the correct alignment. If it makes your back more comfortable put a lumbar support in the small of your back and do this in your car also. Get up every half hour or so to straighten your back and walk around a little. Normalise your weight and enjoy the occasional back massage with heat treatment. Don't underestimate the importance of keeping the back muscles strong with core muscle activities, which include the abdominals the spinal and side muscles. By exercising your spinal muscles as much as possible when you are not at work you reduce the risk of back problems in the future as a result of your occupation.

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