DR. JONES ANSWERS YOUR HEALTH QUESTIONS...

Issue 56:

Q.

I have had fillers in my lips and I am very happy with the results and now I am addicted and want more, but I am worried that it may be too much, how many times do you recommend I have this done from a doctors point of view?

Ryan - City Dweller Resident

A.

Modern dermal fillers are non permanent. They are made from Hyaluronic Acid and are designed to break down slowly over several months. This is typically 4 - 6 months but depends on the size of the molecule and how it has been crosslinked within the filler itself. I think 2-3 times per year would be a safe amount as long as the procedure is being done at a reputable establishment.

Q.

I have hay fever and blocked sinuses and have used all the regular antihistamine available but find that I have become immune to them are there any permanent solution's?

Dave - City Centre Worker

A.

If you have not yet done so you can add in over the counter steroid nasal drops to try and unblock your sinuses and help calm your hayfever ( or if present all year round - chronic rhinitis ) down. The next step would be to see your GP as he should be able to prescribe you with a stronger anti-histamine. These are usually newer tablets that GP's are generally discouraged from prescribing because they are more expensive than the usual ones. They may be reluctant but willing to give it a go if you explain your situation. Failing that you can be referred to the Immunology department for desensitisation therapy which involves exposure to increasing concentrations of the allergen until your body is no longer sensitive to them. This should be available on the NHS but if you are struggling come and see me at the Nuffield and I can refer you on to our specialist here.

Q.

I get eczema on my face only, it comes out when I get nervous or stressed about things and can be very embarrassing and uncomfortable. I have steroid creams but I know they thin your skin so am reluctant to use then too often. What do you recommend? I would be grateful of your advice.

Kind regards, Sam

A .
When your eczema breaks out don't be afraid to use your steroid cream twice a day for a few weeks or more.
This is perfectly safe and should cause no long term problems. You also need a good emollient cream to use daily to keep you skin well nourished. You can see your GP for a prescription for these. You should then take a look at what makes you stressed and embarrassed and see what you can do to reduce this. Your GP may also be able to help you with this too.

Q.

I am 48 years old female and recently when I move my neck in certain ways it feels weak and as if the bones are grinding together and I can feel it throughout my skull. I have no pain with this it is just the sensation and weak feeling. I can move my neck with ease from left to right and up and down. Also on a morning when I wake up the bones on the top of my feet are stiff and I find it difficult to walk. Should I be worried, is there any supplements I could take or should I seek medical advice?

June from Leeds.

A.
Stiff joints in the morning can be a symptom of a mechanical problem such as Osteoarthritis ( we often call this wear and tear arthritis ). It is always worth seeing your GP for a general check up if you've not been for a while. They can also do blood tests for other forms of arthritis particularly if there is a family history of joint trouble. They should be able to suggest strengthening exercises or refer you to the local physiotherapy team if appropriate.

Issue 53:

Today we’ll tackle the subject of knee pain. A common presentation at the doctors particularly when people start to get more active! The knee joint has three compartments – medial, lateral, and patellofemoral. The joint is surrounded by ligaments strapping the inside and outside of the joint (collateral ligaments) as well as two crossing within the joint (cruciate ligaments).

There are also two cartilage pads between the main knee joint called menisci. These act to absorb the weight of the body when standing and help with motion when walking. The knee joint is surrounded by fluid-filled sacs called bursae, which help to reduce friction when we walk.

The causes of knee pain include:

Injury - A ligament injury is often associated with tenderness over the area involved, although cruciate ligament injuries can be felt deep within the joint. There can be a ‘popping’ sensation with the initial trauma and some swelling and heat too. The pain is usually worse with bending the knee, weight bearing or walking. Ligament injuries are initially treated with rest, ice and elevation. Some patients are placed in splints or braces to immobilise the joint to decrease pain and promote healing. Surgery may be necessary to repair severe injuries.
The menisci can be torn with shearing forces of rotation that are applied to the knee during sharp or rapid motion.
This is common in sports requiring quick reactive body movements. There is a higher incidence with ageing and degeneration of the underlying cartilage. It is often associated with locking or instability of the joint.
Tendonitis is inflammation of the tendon, which is often produced by a strain of the knee. It can occur in the front of the knee below the kneecap or in the back of the knee. It is treated with a combination of ice, rest and anti-inflammatory medications followed by gradual mobilisation. With severe knee trauma, such as motor accidents and sports traumas, fractures of any of three bones of the knee can occur. Bone fractures within the knee joint can be serious and may require surgical repair. Investigations of knee pain include X-rays, arthroscopy (a video camera is inserted into the knee for examining and repairing internal problems) and MRI scans.

Degeneration/ arthritis - The knee joint is the most commonly involved joint in arthritis. Arthritis is inflammation within a joint. The causes of arthritis ranges from non-inflammatory such as osteoarthritis (commonly known as wear and tear arthritis) to inflammatory types of arthritis (such as rheumatoid arthritis or gout). Treatment of the arthritis is directed according to the type of arthritis. Many people suffer from arthritis in which the pain and discomfort can be so limiting that they may require a knee joint replacement. Knee replacement surgery often allows the patient to regain much of their mobility.

Chondromalacia - refers to a softening of the cartilage under the kneecap. It is a common cause of deep knee pain and stiffness in younger women and can be associated with pain and stiffness after prolonged sitting and climbing stairs. While treatment with anti-inflammatory medications, ice and rest can help, long-term relief is best achieved by strengthening exercises for the quadriceps muscles of the front of the thigh.

Bursitis - (inflammation of the fluid filled sacs) commonly affects the kneecap area. Bursitis is generally treated with anti-inflammatory medications but may require local injections of cortisone.

Infections - Infections of the bone or joint can rarely be a serious cause of knee pain. These will have associated signs of infection including fever, a hot and tender joint and possibly a puncture wound in the area around the knee. Treatment is with antibiotics.

Tumours - Tumours involving the joint are extremely rare. Treatment depends on the tumour type and position and often involves surgery, sometimes even requiring amputation of the lower leg!

Issue 52:

Hi all, some common problems have been raised by a few folk but these questions caught my eye.

Q: Dear Dr Jones, I am thinking of having my eyebrow's tattooed, is permanent make-up safe?

A: Hi There, As the link in your question suggests ( although this is an American site ) you do have to be careful with any form of 'permanent' product. You should always make sure the person is fully qualified and has been through a comprehensive training programme with a reputable company such as nouveau contour. Ask to see examples of their work before you commit.

Q: Dear Dr Jones, I am an overweight woman age thirty. I am single and have tried every diet known to mankind. I'm really at my wits end. I go to the Gym regularly and feel healthy but just fat. I am really scared if the only option is to have a gastric band. What advice can you give me please?

A: Hi There, Firstly, if you haven't already done this you should see your GP for a full check up including blood tests to rule out an underactive thyroid and other hormonal disorders such as polycystic ovaries syndrome which can affect your weight. They can check you over physically to see if there are any other obvious signs of any medical problems. You will also be able to discuss with them your diet and exercise regime. Gastric banding is usually only recommended as a last resort for people who are morbidly obese (those with a BMI of over 40), or those with a BMI of between 30-40 who also have a condition that poses a serious health risk, such as diabetes, high blood pressure (hypertension), or heart disease.

Q: Dear Dr Jones, Would you advise having laser hair removal, are there any side effects or can it cause any long term problems? I am a woman aged forty, have very dark hair on my upper lip which I have removed by waxing. I would love to get rid of it permanently?

A: Laser hair reduction is normally performed in the NHS for patients who: have a proven underlying hormonal disturbance (eg. polycystic ovary syndrome) resulting in hirsutism (excessive hair growth in women on an abnormal place like the chin), have hirsutism leading to significant psychological problems, have a birthmark that has hair or have undergone reconstructive surgery leading to skin in abnormal places growing hair.Availability of this treatment varies depending on funding arrangements with your local primary care trust. Side effects can include pigmentation, reddening, crusting, scarring and wound infections. A cream is also available from some NHS centres for women with hirsuitism called Vaniqa. This would be a viable alternative to laser treatment in some. Again I would see your GP first to look for any underlying causes.

If you have any questions for Dr Jones please email him at: drjones@city-dweller.co.uk
For further information please visit: www.nuffieldhealth.com

Issue 51:

Hi all, some common problems have been raised by a few folk but these questions caught my eye.

Q: Dear Dr Jones, Can I ask you about some small skin overgrowths which I get around my collar line. I think this is the correct name. I never used to have these until about 3 years ago (I'm now 45). I have about 3 of them and I am very tempted to use something like TCA (Trichloroacetic acid) to get rid of them but not sure if this is safe. Could you recommend what to do?

A: Hi There, What you are describing are 'skin tags'. You are right they are overgrowths of skin, usually found in places of friction and areas subject to sweat. So, they are commonly found in the armpit and groin regions and around the collar area. There are several effective ways of treating them. They can be frozen off by cryotherapy ( using liquid nitrogen ) or cauterised ( burnt off ) with a hot wire. Both of these treatments should be available at your surgery. My preferred choice is cautery as this has an immediate effect. Sometime people cut them off themselves but they have a tendency to bleed a lot. TCA would probably not help much. This is used for peels and probably will not be specific enough for this.

Q: Dear Dr Jones, I wonder if you can help me. I have a problem with man boobs. I am 26 years old male and not happy with the way I look at all. I have tried the gym and dieting. What would be a solution?

Q: Hi There, Firstly it's important to determine the cause of your 'man boobs'. This could be a condition called gynaecomastia which is where actual breast tissue is present and is thought to be the result from a change in the balance of the body's sex hormones, testosterone and oestrogen.. Gynaecomastia is common condition, effecting between 40 and 60 % of men at some point in their lifetimes. For the majority of men the symptoms tend to clear up after a few weeks or months but for others the problem can persist over a period of years. It is extremely common in boys who are going through puberty because of all the intense hormonal changes taking place in their bodies. Older men are also relatively susceptible to gynaecomastia because the levels of testosterone in their bodies begin to drop off naturally with age. Medical causes include genetic conditions, liver and kidney problems and side effects of medication. Lifestyle causes can include excessive alcohol or marijuana consumption, anabolic steroids and obesity. The other cause is likely to be pseudogynaecomastia or male chest fat. In some men there is a tendency for excess fat to be stored around the chest wall / pectoral muscle area just as in some women excess fat appears to be stored around the hips. Unfortunately in some people no matter how much they diet and exercise they seem unable to shift this fat completely. But, diet and exercise are important. Keeping a diet low in carbohydrates should help as sugar tends to cause the release of insulin which amongst other things encourages the body to store fat. Exercise of the high intensity, interval type can also help. Encouragingly there has been some recent work showing that 'mesotherapy' - the practice of injecting vitamins and other substances into the fat layer below the skin can help shrink some of the tissue there. This may well be available in your local area. As a last resort fatty tissue can be removed by surgery but may well come back.

If you have any questions for Dr Jones please email him at: drjones@city-dweller.co.uk

For further information please visit: www.nuffieldhealth.com

Issue 50:

Hi all, another common problem has been raised by a few folk but this question caught my eye.

Q I am a forty year old fairly fit guy and I have started to get varicose veins. Am I just being vain or is there something I can do about them? Or even worse could it be something more serious to worry about? Darren.

A Hi Darren. This is a very common problem affecting about 1 in 3 adults. They occur more in women and develop when valves inside veins that are there to stop blood flowing backwards stop working properly. Blood then collects in the vein causing it to become varicose - meaning ‘abnormally swollen and knotty’. They commonly appear on the back of the calf and on the inside of the thigh. This is because standing and walking puts extra pressure on the veins in the lower body. They can also occur in other parts of the body too, including the oesophagus, scrotum and rectum. There are a number of risk factors that can increase the likelihood of developing varicose veins. Gender - Women are more likely to be affected. Family History - Risk is increased if a close family member has the condition. Age - As we age our veins start to lose their elasticity and the valves inside them stop working as well. Weight - Being overweight puts extra pressure on the veins. Occupation - Jobs that require long periods of standing increase risk. Pregnancy – During pregnancy the amount of blood in the body increases to help support the developing baby and increased hormone levels causes the muscular walls of the blood vessels to relax, increasing the risk of developing varicose veins.

Some people with varicose veins do not experience any pain or discomfort, while others are more severely affected. In these people symptoms can include: aching, heavy legs, swollen feet and ankles, muscle cramps and dry, itchy skin over the affected vein. Symptoms can be worse during warm weather or after standing up for long periods of time.

For most people, varicose veins do not present a serious health problem. They may have an unpleasant appearance, but they should not affect the circulation or cause any long-term health problems. Most varicose veins do not require any treatment.

Varicose veins are more likely to require treatment if they are causing significant discomfort or if complications develop. These can include thrombophlebitis (inflammation), varicose eczema, a condition that causes the skin to become red, scaly and flaky. Blisters and crusting of the skin called Lipodermatosclerosis may develop and ultimately an ulcer may form.

There are now a number of different surgical procedures to remove varicose veins, although the first treatment is usually compression stockings. Compression stockings are specially designed to steadily squeeze the legs to improve your circulation. They are tightest at the ankle and get gradually looser as they go further up the leg.The most common surgical technique is ligation and stripping, which involves tying off the vein in the affected leg and then removing it. Other treatments include sclerotherapy which involves injecting a chemical into the vein. The chemical scars the veins, which seals them closed. Newer treatments include radiofrequency ablation and endovenous laser treatment. Both techniques also seal the veins.

I hope that helps. We have vascular specialists at the Nuffield that can help if you are worried.

Issue 49:

Your questions, answered.

Hi All. It's back to questions this week. As before, I have tried to group the questions together so as to answer a few if they are on a similar subject. Keep 'em coming!

Q: I have a constant ache in my elbow. I have taken pain killers and they only work short term on the pain.

A: It is likely that you have some inflammation in the soft tissues of your elbow around the joint. An example of this would be tennis elbow ( playing tennis is not required to get this! ).Rather than pain killers such as paracetamol
and codeine an anti-inflammatory such as ibuprofen would be more helpful. Note, do not take ibuprofen if you have asthma, high blood pressure or if you have stomach problems before consulting your GP. You can also see a physio for exercises and massage in this area or visit your doctor for stronger medication or sometimes a steroid injection.

Q: I keep getting really angry over the slightest thing. I can feel my heart racing and I snap at people a lot. I don't want to be like this as my job is dealing with people and I am very worried I will eventually lose my job.

A: It sounds as though you may be suffering from stress. We often lose our temper quickly and out of proportion when we are under pressure and our emotions are high. I would suggest you sit down and think what may be underlying this. Can you get any help at work? Do your colleagues or friends know? Are they supportive?
Often the best type of help for this is what we call 'Talking therapies' rather than medication. See your GP to
discuss the possibility of being referred to a counsellor. There are also some self help Cognitive Behavioural Therapy ( CBT ) resources available on the internet. Your doctor may be able to temporarily give you some medication to help slow your heart rate and keep you calm. These are called beta blockers and it would be worth discussing this with him or her too.

Q: Can you tell me does Actimel work?

A: Actimel was first launched in Europe in 1994 as a 'probiotic' yoghurt-type drink. Each bottle is claimed to contain billions of the bacteria Lactobacillus casei plus traditional yoghurt cultures. The main benefit is thought to be an increase in the body's defence system and is supported by several scientific studies. It is also claimed that it helps diarrhoea and allergy reduction and a reduction of duration of winter infections. A study published by the British Medical Journal in 2007 suggested that the product could help to avoid antibiotic associated diarrhea and helps to limit the super bug Clostridium difficile infections in elderly patients. But, saying all that it still seems very individual. Many people take it and feel it helps their bowels and general health, some feel bloated and pass a lot of wind which usually leads to stopping!

Q: I am a 25 year old girl and enjoy an active lifestyle. My feet are embarrassing because I have bunions. I have been told this is hereditary. Is there anything I can do?

A: A bunion is a bony swelling at the base of the big toe. The medical name for a bunion is hallux valgus. The big toe can become angled inwards, towards the second toe. This can force the base of the big toe to stick out from the side of the foot. If this happens, a painful, swollen bunion forms.Anyone can develop a bunion, but they affect up to a third more women than men. It is not known exactly why bunions occur but a possible cause is wearing badly fitting shoes. If other members of your family have bunions, you are more likely to develop them yourself. This is because the bend of your big toe that causes bunions tends to run in families. I would advise anyone with a bunion to wear
flat/ low-heeled, wide-fitting shoes. Shoes with laces or straps are preferable as they can be adjusted. There are various treatments that can be used to ease the discomfort. But, they cannot stop a bunion from becoming progressively worse over time. Treatments include painkillers and anti-inflammatories, bunion pads and ice packs. Orthoses may also be tried. These are devices that are used to improve and realign the bones of your foot. Ultimately surgery is the only way to correct a bunion. Surgery is not usually carried out for cosmetic reasons only. As well as improving the alignment of your big toe, bunion surgery is also used to helprelieve pain. Surgery is successful for 85-90% of people who have it. However, there is no guarantee that your foot will be perfectly straight, or pain free, after the operation. At the Nuffield we have both a Podiatry service and Orthopaedic
surgeons who deal with bunions.'

Issue 48:

Hair loss?

OMG Doctor!!! You have to help me!! My hair is coming out in handfuls!

Not an unusual request in the middle of a busy surgery. Hair or more specifically, the lack of it, can be very emotive.

We have on average 100,000 hairs. Each hair grows for about three years, then it drops out and a new one grows. We lose 40-80 hairs a day.

Common Causes of hair loss.
Male or female pattern hair loss is the most common cause of localised hair thinning and loss in adults. It happens to a greater or lesser extent to most people as they age. Male-pattern baldness is hereditary. It generally follows a pattern.

Receding hairline, followed by thinning of the hair on the crown and temples. This leaves a horseshoe shape of hair around the back and sides of the head. It can progress to complete baldness, but this is rare. Women's hair gradually thins with age, but women generally lose hair from the top of the head only. This usually gets more noticeable after the menopause.

There are two medicines that are known to be effective in treating
male-pattern baldness finasteride and minoxidil which are usually prescribed by a specialist. Minoxidil is also licensed for treatment in women.

Alopecia areata causes patches of baldness that are about the size of a
large coin. They usually appear on the scalp but can occur anywhere on the body, including the beard, eyebrows and eyelashes. There are usually no other symptoms. Alopecia areata is linked to an imbalance in the immune
system. Hair often grows back with alopecia areata, but it appears fine and white before it regains its original colour. This hair can be dyed, if
necessary.

There is no completely effective treatment for alopecia areata. In about 8 out of 10 cases, the hair grows back after about a year without any treatment. Steroid injections appear to be the most effective treatment for small patches of alopecia. It can stimulate hair to grow again in those patches after about four weeks. Injections are repeated every few months. Alopecia may return when injections are stopped.

Other causes of hair loss or thinning include anaemia, thyroid dysfunction,
drugs, fungal infections, zinc deficiency, stress, some dermatological skin conditions that also affect the scalp and trichotillomania. This appears to be impulse driven and may be related to obsessive compulsive disorders. Affected individuals feel a sense of tension before pulling their hair, obtaining relief when they do so.

Your doctor may do some routine tests as well as listen to the history and examine your scalp. Here at The Nuffield we are lucky to have a specialist ( Trichologist ), Mr Ian Sallis that has years of experience in this area and can recommend treatments for each individual.

If you have any questions for Dr Jones please email him at: drjones@city-dweller.co.uk

For further information please visit: www.nuffieldhealth.com

Issue 47:

How's Your Head?

Hi All,

I’ve had a few letters recently asking about headaches, their causes and treatments, so I have put it all together in one go.

There are many types of headache, but most commonly they are split between tension headaches and migraines.

Tension headaches are the most common form, accounting for about 70 per cent of headaches. They are thought to result from the contraction of head and neck muscles.

It can occur in either sex, at any age, but it is most common in adults and adolescents.

The possible causes include: stress, fatigue, eye strain, poor posture, tobacco and alcohol use and in women- hormonal changes in and around their period.

They often present as a constant band-like pain or pressure around the forehead or the back of the head and neck.

Treatment includes simple painkillers such as paracetamol and codeine and anti-inflammatory meds such as ibuprofen. Often exercises for neck and back posture will help along with the reduction of exacerbating factors such as stress and fatigue.

Migraines are headaches that last from 4 to 72 hours with two of the following symptoms:
1. Unilateral pain, often at the front of the head. This is a throbbing pain that gets worse when you move with a moderate to severe intensity.
2. Nausea or vomiting during an attack.
3. Extra sensitivity to light or sounds.

4. Some people also get what is called an aura before an attack (about 15 %). The aura is a warning of an attack and happens because some of the nerves fail to work in their normal way. This may take the form of: flashing lights or blind spots, ringing in the ears, numbness in parts of the body, such as hands or face, pins and needles and can sometimes result in trouble speaking.

There are two main approaches to migraine treatment. The first is to stop the attack or control the pain and nausea and the second is preventing future attacks.

In acute attacks medication is taken as early as possible, ideally when you get an aura or other early symptoms. Many medicines can help but the leading ones are called triptans and can be given as tablets, injections or nasal sprays.

Preventative therapy is usually recommended if you have more than two or three migraines per month. There are a variety of medications used for this and your doctor will discuss this with you if needed.

There are a few occasions when you should see your doctor straight away.
These include a very painful headache for the first time that came on suddenly, within minutes. It may feel like someone has kicked you in the back of your head. This may be a sign that a blood vessel in your brain has leaked and this needs urgent assessment. Dial 999 or visit the Accident and Emergency department of your local hospital.

Furthermore, if you have a severe headache with fever, sickness and possibly a rash, these symptoms could mean you have a serious illness called meningitis and you should get treatment straight away.

If you have any questions for Dr Jones please email him at: drjones@city-dweller.co.uk

For further information please visit: www.nuffieldhealth.com

Issue 46:

Do you feel tired?

Hi all, I trust you are all getting along ok. We’re back with some more questions this week.

Q: I am a 25 year old healthy girl and I am feeling tired all the time. Is this normal? Thanks, Sally.

As with abdominal pain, there can be a multitude of causes of tiredness. A quick Google search reveals 646 causes…The causes can come from an upset of any of the body’s systems. As with diagnosis of most conditions clues are often found in the history of the problem. How long have I had it and how did it start? Did I change anything around that time? Does anything make it worse or better? Is there a pattern? This along with an examination and some blood tests done by your doctor will often help find the cause.

Causes can include:
• Infections (viral/parasitic) particularly chronic ones.
• Endocrine problems (diabetes/thyroid dysfunction )

• Gastrointestinal problems (IBS/weight change )

• Blood problems (anaemia/leukaemia )

• Respiratory problems (asthma/chronic pulmonary disease)

• Heart problems (failure/rhythm disturbance )

• Medication side effects

• Any form of cancer

• Disturbed sleep or sleeping difficulty (stress/excessive alcohol )

• Mental health problems (anxiety/depression )

As with everything, a sensible diet, regular exercise and a good sleep pattern are essential to staying healthy.

Have a think about these and then go and see your doctor for further investigation.

If you have any questions for Dr Jones please email him at: drjones@city-dweller.co.uk

For further information please visit: www.nuffieldhealth.com

Issue 45:

Smelly Feet?

Hi all, I trust you are all getting along ok. We’re back to some questions this week.

Q. Dr Jones, can you tell me the causes of smelly feet? I wash mine every day but they still smell. Over the past year I have started taking steroids for polymyalgia, could this be a factor? Cheers, W

Bromodosis or ‘smelly feet’.

This is usually caused by a reaction between the sweat produced by your feet and the bacteria and fungi present on the surface of the body. There are several things that can be done to help. These fall into two main categories.

Keeping the feet clean/cutting down on bacteria and fungi.

- Wash your feet at least once a day, ideally with anti-bacterial soap to stop bacterial build up. Dry properly.

- Check for fungal infections between toes and on soles of feet. Keep nails short and see your GP if any nail discoloration or thickening occurs which may indicate an infection.

- Use anti-bacterial/ fungal spray or insoles in shoes. Chucking sweaty shoes in a dark cupboard at night is an ideal way to help the bugs multiply!

Cutting down the amount of sweat produced.

- Try and wear well ventilated shoes or ones made of leather as this helps with sweat evaporation.

- Cotton socks are better than synthetic ones. Changing socks during the day if possible.

- Alternating shoes so as not to wear the same ones every day.

- If your feet are particularly sweaty you can use the roll on deodorants such as Anhydrol Forte at night for a few nights a week to help cut sweat production.

- There has been some success recently using botox to cut down the production of sweat and can be used on feet, hands and armpits.

Unfortunately, yes, taking medication that may suppress the body’s own defences such as steroids may make you more susceptible to the presence of skin bugs. Cutting the dose, when possible, and practising the above methods should help.

If you have any questions for Dr Jones please email him at: drjones@city-dweller.co.uk

For further information please visit: www.nuffieldhealth.com

Issue 44:

Travelling abroad can expose you to diseases that aren’t present in the UK such as yellow fever, malaria and rabies. These are common in some regions of the world that are now frequent holiday destinations. Many infectious diseases are transmitted through contaminated food and water and insect bites.

Using some common sense can often prevent problems. For example, using bottled water in countries with poor sanitation. Being aware that the malaria mosquitoes bite between dusk and dawn and Yellow Fever ones during the day.

The following infectious diseases can affect UK travellers:

• Hepatitis A and Typhoid - spread by contaminated food and water.

• Yellow fever, Malaria and Dengue Fever - spread by mosquito bites.

• HIV, STIs and Hepatitis B - spread through sexual intercourse, blood transfusions, contaminated needles (incl. tattoo needles) and poorly sterilised medical and dental equipment.

• Rabies - A virus that attacks the central nervous system.The virus is found in the saliva of infected animals.

• Meningitis - Meningitis is the inflammation of the lining around the brain and the spinal column caused by different types of bacteria and viruses.

There is plenty of information out there about where you are travelling to and what precautions and vaccinations you may need which will help reduce your exposure to these infections. A few good sites are;

www.fitfortravel.nhs.uk A very good NHS run site.

www.travelhealth.co.uk An independent travel site.

www.nathnac.org/travel/index.htm National Travel Health Network, including advice about Yellow Fever.

We also give vaccinations, including Yellow Fever, and malaria prescriptions at the Nuffield Health Leeds Hospital.

If you have a question for Dr Jones please email him at: drjones@city-dweller.co.uk

For further information please visit: www.nuffieldhealth.com

Issue 43:

Hi All, this month I have had a chance to sit down and read through some of your questions so far. They are pretty varied and hopefully will apply to a lot of readers.
Keep ‘em coming! - Dr Jones

Q - Dear Dr Jones - Do you have any advice on excessive snoring? My partner is aged 45 and in reasonable health. However I have to sleep in a separate bed on work nights due to this problem.
Yours hopefully

A - Snoring is caused by turbulence inside the airway during breathing in. This can occur anywhere from the nose right down to the vocal cords. The main problem appears to be reduced muscle tone during sleep but this can have many causes. These include being overweight, alcohol, smoking, sleeping position, allergies and nasal congestion. Many products are available including nasal sprays and strips, mandibular advancement devices (these push the jaw forward to help airflow) and mouth guards along with various machines if the cause is thought to be sleep apnoea. *Sleep Apnoea service is available at Nuffield Health Leeds Hospital

Q - Could you clear something up for me please. The five a day fruit and veg thing is not as straightforward as it first seems. Is a piece of fruit one item or a couple of larger items? Thanks, Lynn

A - I agree Lynn this can be confusing and it does depend on the type of fruit or veg. For example, a glass of fruit/veg juice (150mls) counts as only one portion no matter how many times a day you have it. The best place to go for info is the World Cancer Research Fund. A copy of their 5 a day PDF can be found here: http://www.wcrf-uk.org/PDFs/5adayposter.pdf

Q - Dear Dr Jones - I would be very grateful for any advice you can offer. For a while now I have been getting a swollen stomach. Please can you give me any possible reasons and how I can avoid
this. I look forward to your advice. Thank you, female, Leeds

A - A common problem but with a multitude of causes. I remember seeing one website in the past listing over 500! A careful history and examination are essential in narrowing down the possible causes. Blood tests and scans may also be needed to follow these up. The cause may be a discrete swelling within the abdomen, an enlargement of an organ or a condition giving rise to increased gas or fluid in this area. Things such as general health, weight loss or gain, bowel and urine function along with periods would need to be looked into. Medication may also be a factor. Perhaps you can think about these and if anything has changed over this time.

If you have a question for Dr Jones please email him at: drjones@city-dweller.co.uk

For further information please visit: www.nuffieldhealth.com

Issue 42:

SEX! There, that got your attention didn’t it! Only three letters but very powerful ones. No, I can’t tell you when you will be getting it next but I do feel sexual health is a very important subject for everyone to think about. Sex is permanently thrust in our faces these days - on TV, in the papers, everywhere really. So, I thought a quick run-down of common infections and what to look for would be useful.

These include chlamydia, gonorrhoea, herpes, genital warts, syphilis and of course HIV. They can present in a variety of ways from discomfort and discharge, blisters and ulcers, to non specific abdominal or pelvic pain. Sometimes there are few symptoms. In gonorrhoea for example up to 50% of women and 10% of men may have no symptoms at all and therefore be unaware that they can pass it on.

The speed of onset is also variable from days to months depending on the type of infection. Some infections appear and then seem to hide away for sometime such as herpes and genital warts. HIV can come on slowly, only becoming apparent when conditions associated with a compromised immune system are found in hitherto healthy individuals.

Of course taking precautions, like using condoms, is always the best option but mistakes/accidents can happen. If you are worried about any of the above or your sexual health in general there is help at hand! You can see your GP to discuss your concerns and they may well refer you on to the Local Genito-Urinary- Medicine ( GUM ) department, in our case this is based at the LGI, for further assessment.

There is as always plenty of helpful advice on the web.
• www.leedssexualhealth.com - A fantastic site covering every aspect from testing to contraception. Well worth a look.
• www.leedsth.nhs.uk/sites/sexual_health/index - NHS sexual health clinic based at the LGI.
• www.mesmac.co.uk - Sexual health information and resources for gay men in the north of England.

A big thanks to all those who have emailed in questions already. There has been a fantastic response. As these are on a wide variety of subjects I am grouping them together into topics and plan to cover a topic each issue. If there are any short questions I will try and answer them briefly at the end of each article.

Quick question - “I am a sufferer of cold sores and have tried many creams that are on the market, but none seem to work. Do you have any other suggestions?”

Quick answer - Recurrent or chronic cold sores often require treatment with oral anti-viral tablets, such as aciclovir, to keep the infection suppressed. See your GP for advice regarding this.

If you have a question for Dr Jones please email him at: drjones@city-dweller.co.uk

For further information please visit: www.nuffieldhealth.com

Issue 41:

Dr Jones is the lead GP at the Nuffield’s City GP service based at the hospital in Leeds. As such he has a healthy interest in what goes on in and around the city.

I have been asked to answer questions on topics and issues that are of interest to the people living in Leeds. That means you! Each month I will base the article around correspondence that I receive from you. This can be a specific problem or a general subject matter, whatever you want to know really. I will also try and include some relevant internet links so you can look into the subject further. As we had no set topic for the first month I took a straw poll in the office and top of the list at present is of course ‘Swine Flu’.

In the UK there have been approximately 700,000 possible cases with some 20,000 + confirmed and approximately 240 deaths. The number of new cases though has dropped for the last 2 weeks. The vaccination programme is well under way and 65 million doses have been given worldwide so far. These include those aged between six months and 65 years in the seasonal flu vaccine at-risk groups, all pregnant women and people who live with those whose immune systems are compromised, such as cancer patients or people with HIV/AIDS. Now also healthy children aged six months to 5 years are to be covered. If you are concerned about the vaccine you can discuss it with your GP or look for advice on the sites below.

If you experience any symptoms that may be flu related such as high temperature around 38oC or above, cough, sore throat, runny nose, loss of appetite, muscle or joint aches and pains and headaches. Start taking paracetamol and/ or ibuprofen straight away along with plenty of fluids as you would for any other viral bug. In the vast majority of normally fit people this will work quickly to help you recover. If you feel worse over the next 24-48 hours despite this then you can phone the flu line ( 0800 1 513 513 ) for advice as the medication tamiflu is most effective in the first 48 hours.

Sites for further information are:
www.swinefluinfo.leeds.nhs.uk
www.hpa.org.uk
www.direct.gov.uk/pandemicflu

Remember regular hand and surface washing and the use of alcohol gels is a good way to help stop the spread at work.

If you have a question for Dr Jones please
email him at: drjones@city-dweller.co.uk

For further information please visit:
www.nuffieldhealth.com