Pregnancy and medications
Although some medicines are considered safe during pregnancy, the effects of other medicines on developing fetus are unknown. Most medicines taken during pregnancy cross the placenta and reach the developing fetus, therefore it is wise to be extremely cautious when prescribing any medication during pregnancy. Women are advised that before taking any medicine when they are pregnant – including painkillers – they should check with their obstetrician, pharmacist, or healthcare provider.
Certain medicines can be most harmful to a developing baby when taken during the first three months of pregnancy – often before a woman even knows she is pregnant.
If you were taking prescription medicines before you became pregnant, please ask your obstetrician or healthcare provider about the safety of continuing these medicines as soon as you find out that you are pregnant. Do not just stop taking a medication on your own as this can also lead to problems as well.
Your qualified healthcare provider will weigh the benefit to you, and the risk to your baby, when making his or her recommendation about a particular medicine. With some medicines, the risk of not taking them might be more serious than the potential risk associated with taking them.
If you are prescribed any new medicine, please inform your healthcare provider that you are pregnant.
Teratogenic Medications
During the last decades, it has been clearly shown that drugs administered to the mothers during pregnancy might have detrimental effects on the physical development of the fetus. Thalidomide is a well-described example of how an innocent, over-the-counter, medication for morning sickness could exert such a deleterious effect on the fetus, such as miscarriages, and physical deformities. A teratogen is an agent that can disturb the development of the embryo or fetus. Teratogens halt the pregnancy or produce malformation deformities. There are a number of drugs that are capable of acting as teratogens – including many antibiotics, anti-hypertensive drugs and acne medications. Talk to your obstetrician if you think you might be pregnant and are presently using a medication that might be teratogenic.

Prenatal vitamins and supplements
Most prenatal vitamins are safe to take during pregnancy. It should be noted that the time when they should be taken might depend on the medical history of the women. A number of vitamins are not safe to use during pregnancy especially in high doses. Please talk to your medical doctor before taking any over-the-counter medications and supplements. When in doubt about any medication or supplement, ask your healthcare provider before taking or using it.
Alcohol and pregnancy
Drinking alcohol during pregnancy increases the risk of miscarriage, premature birth and your baby having a low birthweight. It can also affect your baby after he/she is born. Drinking during pregnancy can cause your baby to develop a serious condition called fetal alcohol spectrum disorder. There is no known safe amount of alcohol use during pregnancy. There is also no safe time for alcohol use during pregnancy. All types of alcohol are equally harmful, including all wines and beer. It is never too late to stop alcohol use during pregnancy. Stopping alcohol use will improve the baby’s health and well-being. If you are using alcohol during pregnancy, please let your obstetrician or healthcare provider know. He/she can provide the necessary information and care for you.
Illegal drugs and pregnancy
Using illegal or street drugs during pregnancy, including cannabis, ecstasy, cocaine, and heroin, can have a potentially serious effect on the developing fetus. Women using these drugs should discuss this with their healthcare provider.
It is best not to stop abruptly without first seeking medical advice as there may be withdrawal problems or other side effects. If you use drugs, it is important to seek help straight away so you can get the right advice and support. If illegal drugs are part of your life, getting help can really improve the outlook for you and your baby.

Use of herbs during pregnancy
The use of herbal medicine during pregnancy is a common occurrence. Different studies revealed that using herbal medicine during the first 12 weeks and the last 12 weeks of gestation is dangerous for the fetus. The common untoward effects of using herbal medicine in pregnancy are heartburn, premature labour, miscarriage, increase blood flow, abortion, and allergic reactions. Pregnant women should consult their doctors before using any herbal medicines. Not all “natural” remedies or complementary therapies are safe in pregnancy.
Some products used may not be of a high quality and may contain other substances, such as lead, which could be harmful.
What medicines can you take during pregnancy?
It can be hard to know if a particular medicine is safe for the developing fetus. Most medicines are not studied in pregnant women because researchers worry about how the medicines might affect the baby. Some medicines have been taken for so long, by so many women, that obstetricians have a good idea of how safe they are. If you are pregnant always talk to your obstetrician or midwife before you take any medicines.
Women with medical conditions
Women with pre-existing medical conditions (such as asthma, epilepsy, or diabetes) must continue treatment with the appropriate medications during pregnancy – under supervision of an experienced and qualified medical doctor.
Planning a pregnancy
If you are planning a pregnancy, talk to your obstetrician or midwife about any medicines you are taking, including over-the-counter ones. Some of them may be safe during pregnancy, but others may not be safe. Your doctor or midwife may have you stop taking a medicine or may switch you to another one. Some medicines that are not safe in the first trimester may be safe to use later in the pregnancy.
Folic acid is especially important before, and in the first few weeks of pregnancy, because it prevents some birth defects. Take at least 400 mcg of folic acid every day for at least 2 to 3 months before trying to get pregnant – and while you are pregnant. Some women need higher doses. Talk with your health professional about how much folic acid you need.
What else can you do
The use of various medications and drugs during pregnancy can pose many challenges. Most women take a drug of some kind during pregnancy – often without realising the potential for harm. All pregnant women are advised to inform their doctor or midwife of all medications and drugs they take or have recently taken, including prescription and over-the-counter medicines, nutrition supplements, complementary therapies (such as herbal medicine), social drugs (such as alcohol) and illegal drugs. This will prove extremely helpful.

Conclusion
Many individuals are aware of the dangers of using various medications and drugs during pregnancy, yet we know that many women do use them during pregnancy. It is estimated that drugs are used in over half of all pregnancies, and prevalence of use is increasing. The most used drugs include antiemetics, antacids, antihistamines, analgesics, antimicrobials, diuretics, hypnotics, tranquilizers, and social and illicit drugs. Healthcare providers must continue to educate communities about the dangers of using various medications and drugs during pregnancy.

Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented. Always talk to your doctor for professional medical advice.
Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).

What is preeclampsia?
Preeclampsia is a serious blood pressure condition that develops during pregnancy. Individuals with preeclampsia often have high blood pressure (hypertension) and high levels of protein in their urine (proteinuria). Preeclampsia typically develops after the 20th week of pregnancy. It can also affect other organs in the body and be dangerous for both the pregnant woman and her developing fetus (unborn baby).
The exact cause of preeclampsia involves several factors. Experts believe it begins in the placenta (afterbirth) — the organ that nourishes the fetus throughout pregnancy. Early in a pregnancy, new blood vessels develop and evolve to supply oxygen and nutrients to the placenta.
In women with preeclampsia, these blood vessels do not seem to develop or work properly. Problems with how well blood circulates in the placenta may lead to the irregular regulation of blood pressure in the mother.

Who gets preeclampsia?
Preeclampsia may be more common in first-time mothers. Experts are not entirely sure why some people develop preeclampsia. Some factors that may put a woman at a higher risk of developing preeclampsia are:
• History of high blood pressure, kidney disease or diabetes.
• Family history of preeclampsia.
• Autoimmune conditions like lupus and antiphospholipid syndrome.
• Obesity.
• Being 40 years old or more.
• It is more than 10 years since your last pregnancy.
• expecting multiple babies (twins or triplets).

What are some symptoms and signs of preeclampsia?
Early signs of preeclampsia include having high blood pressure (hypertension) and protein in your urine (proteinuria).
It is unlikely that the pregnant woman will notice these signs, but they should be picked up during routine prenatal/antenatal visits. In some cases, further symptoms can develop, including:
• severe headache
• vision problems, such as blurring or flashing
• vomiting
• sudden swelling of the face, hands, or feet
• Shortness of breath, caused by fluid in the lungs
• Pain in the upper abdomen (belly), usually under the ribs on the right side
Weight gain and swelling (oedema) are typical during healthy pregnancies. However, sudden weight gain or a sudden appearance of oedema in the second half of pregnancy — particularly in your face and hands — may be a sign of preeclampsia.
If you are pregnant and notice any symptoms of preeclampsia, seek medical advice immediately by calling your healthcare provider or going to the emergency room at the hospital.
Although many cases of preeclampsia are mild, the condition can lead to serious complications for both mother and baby if it is not monitored and treated.
The earlier preeclampsia is diagnosed and monitored, the better the outlook for mother and baby.
It is particularly important that all pregnant women share all of their pregnancy symptoms with their midwife/obstetrician or healthcare provider. It should be noted that some women with preeclampsia do not have any symptoms, so it is important that all pregnant women see their midwife or doctor for regular blood pressure checks and other tests.
Treating preeclampsia
If you are diagnosed with preeclampsia, you should be referred for an assessment by a specialist obstetrician.
In most cases you will be admitted to hospital. While in hospital, you will be monitored closely to determine how severe the condition is and whether a hospital stay is needed.
A number of medications will be used in the treatment of this serious disorder.

The only way to cure preeclampsia is to deliver the baby, so you will usually be monitored regularly until it is possible for your baby to be delivered. This will normally be at around 37 to 38 weeks of pregnancy, but it may be earlier in more severe cases.

Complications
Although most cases of preeclampsia do not develop serious complications and improve soon after the baby is delivered, there is a risk of serious complications that can affect both the mother and her baby.
There is a risk that the mother will develop fits called “eclampsia”. These fits can be life threatening for the mother and baby, but they are rare.
Other complications of severe preeclampsia include:
• Fetal growth restriction. Preeclampsia affects the arteries carrying blood to the placenta. This can lead to slow growth known as fetal growth restriction.
• Preterm birth. Preeclampsia may lead to an unplanned preterm birth — delivery before 37 weeks. Also, planned preterm birth is a primary treatment for preeclampsia. A baby born prematurely has increased risk of breathing and feeding difficulties, vision or hearing problems, developmental delays, and cerebral palsy. Treatments before preterm delivery may decrease some risks.
• Placental abruption. Preeclampsia increases your risk of placental abruption. With this condition, the placenta separates from the inner wall of the uterus before delivery. Severe abruption can cause heavy bleeding, which can be life-threatening for both the mother and baby.
• HELLP syndrome. HELLP stands for haemolysis (the destruction of red blood cells), elevated liver enzymes and low platelet count. This severe form of preeclampsia affects several organ systems. HELLP syndrome is life-threatening to the mother and baby, and it may cause lifelong health problems for the mother.
• Other organ damage. Preeclampsia may result in damage to the kidneys, liver, lung, heart, or eyes, and may cause a stroke or other brain injury. The amount of injury to other organs depends on how severe the preeclampsia is.
• Cardiovascular disease. Having preeclampsia may increase your risk of future heart and blood vessel (cardiovascular) disease.

Prevention

Medication
The best clinical evidence for prevention of preeclampsia is the use of low-dose aspirin. Your obstetrician may recommend taking an 81-milligram aspirin tablet daily after 12 weeks of pregnancy if you have one high-risk factor for preeclampsia or more than one moderate-risk factor.

It is important that you talk with your provider before taking any medications, vitamins, or supplements to make sure it is safe for you.
All women are advised to see their gynaecologist before having a planned pregnancy, especially if they had preeclampsia before. They should try to be as healthy as possible prior to becoming pregnant, and in conjunction with their healthcare provider try to manage any disorder that might increase their risk of developing preeclampsia.

Conclusion
Preeclampsia is a serious disorder associated with pregnancy. A woman can help protect herself by learning the symptoms of preeclampsia, and by seeing her obstetrician/doctor for regular prenatal care. Diagnosing preeclampsia early may lower the chances of long-term problems for both mother and baby.

Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented. Always talk to your doctor for professional medical advice.

Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).

What is Anorexia nervosa?
This is an eating disorder characterised by an abnormally low body weight, an intense fear of gaining weight and a distorted perception of weight.
To prevent weight gain or to continue losing weight, people with anorexia usually severely restrict the amount of food they eat. They may control calorie intake by vomiting after eating or by misusing laxatives, diet aids, diuretics, or enemas. They may also try to lose weight by exercising excessively. No matter how much weight is lost, the person continues to fear weight gain.
Anorexia is more than a food problem. It is an extremely unhealthy and sometimes life-threatening way to try to cope with emotional problems. When someone has anorexia, he/she often equates thinness with self-worth.

What causes anorexia nervosa?
The exact cause of anorexia is unknown. As with many diseases, it is probably a combination of biological, psychological and environmental factors.

Who gets anorexia nervosa?
Anorexia affects 1% to 2% of the population. Anorexia can occur in people of any age, sex, gender, race, gender, ethnicity, sexual orientation and economic status – and individuals of all body weights, shapes, and sizes. Anorexia most commonly affects adolescents and young adult women, although it also occurs in men and is increasing in numbers in children and older adults.
What are some symptoms and signs of anorexia?
The physical signs and symptoms of anorexia nervosa are related to starvation. Anorexia also includes emotional and behavioural issues involving an unrealistic perception of body weight and an extremely strong fear of gaining weight or becoming fat.

It may be difficult to notice signs and symptoms because what is considered a low body weight is different for each person, and some individuals may not appear extremely thin. Also, people with anorexia often disguise their thinness, eating habits or physical problems.

Physical symptoms
Physical signs and symptoms of anorexia may include:
• Extreme weight loss or not making expected developmental weight gains
• Thin appearance
• Abnormal blood counts
• Fatigue
• Insomnia
• Dizziness or fainting
• Bluish discolouration of the fingers
• Hair that thins, breaks, or falls out
• Soft, downy hair covering the body
• Absence of menstruation
• Constipation and abdominal pain
• Dry or yellowish skin
• Intolerance of cold
• Irregular heart rhythms
• Low blood pressure
• Dehydration
• Swelling of arms or legs
• Eroded teeth and calluses on the knuckles from induced vomiting

Some people who have anorexia binge and purge, similar to individuals who have bulimia. Individuals with anorexia generally struggle with an abnormally low body weight, while individuals with bulimia typically are normal to above normal weight.

Emotional and behavioural symptoms
Behavioural symptoms of anorexia may include attempts to lose weight by:
• Severely restricting food intake through dieting or fasting
• Exercising excessively
• Bingeing and self-induced vomiting to get rid of food, which may include the use of laxatives, enemas, diet aids or herbal products

Emotional and behavioural signs and symptoms may include:
• Preoccupation with food, which sometimes includes cooking elaborate meals for others but not eating them
• Frequently skipping meals or refusing to eat
• Denial of hunger or making excuses for not eating
• Eating only a few certain “safe” foods, usually those low in fat and calories
• Adopting rigid meal or eating rituals, such as spitting food out after chewing
• Not wanting to eat in public
• Lying about how much food has been eaten
• Fear of gaining weight that may include repeated weighing or measuring the body
• Frequent checking in the mirror for perceived flaws
• Complaining about being fat or having parts of the body that are fat
• Covering up in layers of clothing
• Flat mood (lack of emotion)
• Social withdrawal
• Irritability
• Insomnia
• Reduced interest in sex
Getting help
If you think that you have anorexia you should get help and support as soon as possible as this gives you the best chance of recovering from anorexia.

If you think you may have anorexia, even if you are not sure, see your family doctor as soon as you can.

Your doctor will carry out a detailed clinical history, ask you questions about your eating habits and how you are feeling, and will check your overall health and weight. He/she may also arrange for you to have some blood tests to make sure your weight loss is not caused by something else.

If he/she think you may have anorexia, or another eating disorder, he/she should refer you to an eating disorder specialist or team of specialists.
It can be extremely hard to admit you have a problem and to ask for help. It may make things easier if you bring a friend or loved one with you to your appointment.

Getting help for someone else
If you are concerned that a family member or friend may have anorexia, let him/her know you are worried about him/her and encourage him/her to see a doctor. You could offer to go along with him/her.

Diagnosis
If your doctor suspects that you have anorexia nervosa, he or she will typically do several tests and exams to help pinpoint a diagnosis, rule out medical causes for the weight loss, and check for any related complications.

Treatment
The biggest challenge in treating anorexia is helping the person recognise and accept that they have an illness. Many people with anorexia deny that he/she has an eating disorder. They often seek medical treatment only when their condition is serious or life-threatening. This is why it is important to diagnose and treat anorexia in its beginning stages.

Treatment for anorexia is generally done using a team approach, which includes doctors, mental health professionals and dietitians, all with experience in eating disorders. Ongoing therapy and nutrition education are incredibly important to continued recovery.

You can recover from anorexia, but it may take time – and recovery will be different for everyone.
Your treatment plan will be tailored to you and should consider any other support you might need, such as for depression or anxiety.

Dietary supplements and herbal products, designed to suppress the appetite or aid in weight loss, may be abused by people with anorexia. Weight-loss supplements or herbs can have serious side effects – and dangerously interact with other medications. If you use dietary supplements or herbs, discuss the potential risks with your doctor.

People with anorexia can recover. However, they are at increased risk of relapse during periods of high stress or during triggering situations. Ongoing therapy or periodic appointments during times of stress may help you stay healthy.

What are the complications of anorexia?
The medical complications and health risks of malnutrition and starvation, which are common in people who have anorexia, can affect nearly every organ in the body. In severe cases, vital organs such as your brain, heart and kidneys can sustain damage. This damage may be irreversible even after a person has recovered from anorexia.

Severe medical complications that can happen from untreated anorexia include irregular heartbeats, osteoporosis, kidney and liver damage, seizures, rapid breakdown of skeletal muscle, delayed puberty and physical growth, infertility, insomnia, anaemia cardiac arrest and death.

In addition to physical complications, people with anorexia also commonly have other mental health conditions, including depression, anxiety, personality disorders, obsessive-compulsive disorders, alcohol abuse and substance misuse.

If these mental health conditions are left untreated, they could lead to self-injury, suicidal thoughts, or suicide attempts.

Conclusion
Anorexia nervosa is an eating and mental health disorder. It is a serious and potentially life-threatening disorder. The good news is that recovery is possible. If you or someone you know is experiencing signs and symptoms of anorexia, it is important to seek help and care as soon as possible. It is never too late to seek treatment but getting help early improves the chance of a lasting recovery.

Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented. Always talk to your doctor for professional medical advice.

Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).

What are the distinct types of acne?
Acne can take several forms. They include:
• Blackheads: Open bumps on the skin that fill with excess oil and dead skin. They look as if dirt has deposited in the bump, but the dark spots are caused by an irregular light reflection off the clogged follicle.

• Whiteheads: Bumps that remain closed by oil and dead skin.

• Papules: Small red or pink bumps that become inflamed.

• Pustules: Pimples containing pus. They look like whiteheads surrounded by red rings. They can cause scarring if picked or scratched.

• Fungal acne (pityrosporum folliculitis): This type occurs when an excess of yeast develops in the hair follicles. They can become itchy and inflamed.

• Nodules: Solid pimples that are deep in your skin. They are large and painful.

• Cysts: Pus-filled pimples. These can cause scars.

All these forms of acne can affect your self-esteem. It is best to seek help from your healthcare provider early so they can help determine the best treatment option(s) for you.

Who is affected by acne?
Acne is quite common in teenagers and younger adults. Acne is most common in girls from the ages of 14 to 17, and in boys from the ages of 16 to 19.

Most people have acne on and off for several years before their symptoms start to improve as they get older. Acne often disappears when a person is in his/her mid-twenties. In some cases, acne can continue into adult life. About 3% of adults have acne over the age of thirty-five.

Do certain foods cause acne?
For the most part, hormonal changes in the body drive acne. There is some evidence that skim milk, whey protein and diets, high in sugar, may cause acne breakouts, although this remains controversial. Chocolate has not been linked to acne. Eating a balanced, nutritious diet, with plenty of fresh fruits and vegetables, especially those rich with vitamin C and beta carotene, helps reduce inflammation. There is also some evidence that eating fish can help.

How is acne treated?
Your doctor may suggest some non-prescription medications for your acne. Depending on the condition’s severity, your age, the type of acne you have, and how effective the over-the-counter remedies have been, you may need stronger prescription medications.

The use of certain contraceptives can sometimes help a woman’s acne go away.

Various medications and therapies have proven to be effective. They target the underlying factors that contribute to acne. You might require at least one or multiple – depending on the severity of your condition.

Do I need to see a specialist?

Your acne can be managed by your general healthcare provider. However, when acne does not improve, or is severe, you should see an experienced dermatologist.

What can you do for mild acne?
If you have mild acne, there are lots of things you can do on your own to improve it. I recommend that all affected individuals cleanse their face twice daily, use a facial scrub at least three times per week if they have oily skin, and gentle toner at least once daily. Refrain from trying any and every soap and handmade cream on the market – as some ingredients can have permanent side effects.

In addition, if you notice that certain foods like sweets or dairy cause the worsening of your acne, then you must avoid them. You should clean your phone at least once daily, and change face towels and pillowcases at least twice weekly. You should also wash make-up brushes and sponges weekly.

Try to resist the temptation to pick or squeeze the spots, as this can lead to permanent scarring.

Prevention
Preventing acne is difficult, if not impossible, during normal hormonal changes, but some things can help:

• Wash your face twice daily with warm water and a mild facial cleanser.

• Routinely use moisturiser.
• You do not have to stop using makeup – but try to use “non-comedogenic” products, and remove makeup at the end of each day.
• Keep your hands away from your face.

Acne and pregnancy

Many topical and oral acne treatments are contraindicated during pregnancy. If you are a woman in your childbearing years, it is important to discuss acne treatments with your healthcare provider and alert him/her if you become pregnant. Isotretinoin is known to cause severe birth defects, and therefore two methods of birth control are required while on this medication.

Conclusion
Acne is a quite common skin condition. Acne is a skin condition that occurs when your hair follicles become plugged with oil and dead skin cells. Acne is most common among teenagers, though it affects people of all ages as well. Effective acne treatments are now available, but acne can be persistent. Depending on its severity, acne can cause emotional distress and scar the skin. The earlier you start treatment, the lower your risk of such problems.

Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented. Always talk to your doctor for professional medical advice.

Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).

What is a stroke?
A stroke is a serious life-threatening medical condition that happens when the blood supply to part of the brain is cut off. Strokes are a medical emergency and urgent treatment is essential.
The sooner a person receives treatment for a stroke, the less damage is likely to happen.
If you suspect that you or someone else is having a stroke, phone 911 immediately and ask for an ambulance.

Symptoms of a stroke
The main symptoms of stroke can be remembered with the word FAST:

• Face – the face may have dropped on one side. The person may not be able to smile, or his/her mouth or eye may have dropped.

• Arms – the person with suspected stroke may not be able to lift both arms and keep them there because of weakness or numbness in one arm.

• Speech – his/her speech may be slurred or garbled, or the person may not be able to talk at all despite appearing to be awake; he/she may also have problems understanding what you are saying to him/her.

• Time – it is time to dial 911 immediately if you see any of these signs or symptoms.

What are some causes of a stroke?
A stroke results from damage to the brain. If the supply of blood to the brain is restricted, or stopped, brain cells begin to die. This can lead to brain injury, disability and possibly death.

There are two main types of strokes:
• ischaemic – where the blood supply is stopped because of a blood clot, accounting for 85% of all cases
• haemorrhagic – where a weakened blood vessel supplying the brain bursts

There is also a related condition called a transient ischaemic attack (TIA) where the blood supply to the brain is temporarily interrupted. This causes what is known as a mini-stroke. It can last a few minutes or persist up to 24 hours.

TIAs should be treated urgently, as they are often a warning sign you are at risk of having a full stroke in the near future.

Seek medical advice as soon as possible, even if your symptoms get better.

Certain conditions increase the risk of having a stroke, including:
• high blood pressure (hypertension)
• high cholesterol
• irregular heartbeats (atrial fibrillation)
• diabetes

Treatment
The stroke treatments that work best are available only if the stroke is recognised and diagnosed within 3 hours of the first symptoms. Stroke patients may not be eligible for these if they do not arrive at the hospital in time.

Treatment depends on the type of stroke you have, including which part of the brain was affected and what caused it.

Strokes are usually treated with medication. This includes medicines to prevent and dissolve blood clots, reduce blood pressure, and reduce cholesterol levels.
In some cases, procedures may be required to remove blood clots. Surgery may also be required to treat brain swelling and reduce the risk of further bleeding if this was the cause of your stroke.

Prevention
Anyone can have a stroke at any age, but certain things can increase your chances of having a stroke. The best way to protect yourself and your loved ones from a stroke is to understand your risk and how to control it.

While you cannot control your age or family history, you can take steps to lower your chances of having a stroke.
You can help prevent stroke by making healthy choices and controlling any health conditions you may have.
Many strokes could be prevented through healthy lifestyle changes – and working with your healthcare team to control health conditions that raise your risk for stroke.

Many common medical conditions, such as diabetes, high blood pressure (hypertension), high cholesterol, obesity, heart disease, can increase your chances of having a stroke. Work with your healthcare team to control your risk. You can significantly reduce your risk of having a stroke by:
• eating a healthy diet
• taking regular exercise
• following the recommended guidelines on alcohol intake (not drinking more than fourteen units a week)
• not smoking

Conclusion
A stroke is a common cause for individuals seeking medical attention. A stroke is a medical emergency, and prompt treatment is crucial. Prompt action can reduce brain damage and other complications. Effective treatments are now available for strokes, and there are treatments that can also help prevent disability from stroke. Treatment has the best results if started as soon as signs and symptoms develop.

If you notice any signs or symptoms of a stroke, even if they seem to come and go, or disappear completely, seek immediate medical attention. Call 911 right away. Do not wait to see if symptoms stop. Every minute counts. The longer a stroke goes untreated, the greater the potential for brain damage and disability.

Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented. Always talk to your doctor for professional medical advice.

Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).

What Is Inflammation?
Inflammation plays a significant role in our immune system, our body’s defense system, against anything that may be potentially harmful to our body, which we call pathogens.
The soldiers of our immune system (our white blood cells) are constantly patrolling our body in search of pathogens to engulf and release their signaling chemicals that tell other white blood cells to come and help fight the pathogen. This process is termed the ‘inflammatory response,’ and the four main characteristics of inflammation are redness caused by the vessels dilating, swelling from the fluid going to the affected tissues, pain from chemicals, and heat from the increased blood flow.
In short, inflammation is totally normal and an important natural process by which the immune system recognises and removes pathogens.

When Is Inflammation a terrible thing?
The trouble with inflammation, however, is that at chronic high levels it can be problematic. This is especially the case when our immune system reacts inappropriately or excessively to something.
We often associate this type of inflammation when talking about people who suffer from autoimmune diseases, such as rheumatoid arthritis or lupus. In these diseases, the immune system inappropriately targets the person’s own body, leading to disease symptoms such as fevers, malaise, joint pains, rashes, and many others.
There is much evidence confirming that chronic inflammation plays a vital role in some of the most challenging diseases of our time, including rheumatoid arthritis, cancer, heart disease, diabetes, asthma, and even Alzheimer’s.

Measuring inflammation
When inflammation is present in the body, there will be higher levels of substances known as biomarkers. An example of a biomarker is C-reactive protein (CRP). If a doctor wants to test for inflammation, he/she may assess CRP levels. 25 years ago, Harvard researchers found that men with higher CRP levels — approximately two milligrams per litre (mg/L) or greater — had three times the risk of heart attack, and twice the risk of stroke, as men with little or no chronic inflammation.

How to Lower Inflammation in the Body
If you are experiencing chronic pain and fatigue, it is quite possible that you have elevated levels of inflammation in your body. Lifestyle choices, diet, and even family history play a role in the diseases and conditions brought about by chronic inflammation. Here are some tips for lowering chronic inflammation:

1. Eat an anti-inflammatory diet
Many experts suggest that focusing on getting plenty of fruits and vegetables, water, whole grains and fatty fish, like salmon, is helpful in decreasing inflammation. On the other side, it is wise to avoid eating simple sugars, refined carbohydrates, high-glycemic foods, trans fats and hydrogenated oils because these can increase inflammation.

2. Do not abuse medications
Medications, both prescription and over the counter, may serve a purpose, but relying on them unnecessarily, or for extended periods, can lead to inflammation. Prolonged use can harm the gut microbiome and cause inflammation in the intestinal walls, known as “leaky gut, which, in turn, can release toxins and trigger chronic inflammation. Many doctors recommend only using antibiotics and over-the-counter pain relievers when prescribed or recommended by your healthcare provider.

3. Follow an exercise routine
Daily movement to maintain a normal bodyweight is important because the fat cells on the body release inflammation. It has been has shown that just 20-minute sessions of walking, or other moderate exercise, were enough to stimulate cells that regulate inflammation.

4. Sleep longer
It is a good idea to aim for the recommended seven to nine hours of sleep recommended by most authorities. In fact, doing so can help maintain inflammation levels. The circadian rhythm regulates our immune system so, to keep these coordinated, it is important to maintain a consistent sleep routine by going to bed and waking up at the same time every day.

Medications
There are a number of medications available for dealing with acute or chronic inflammation. Treatment for diseases that involve long-term inflammation will depend on the condition.
Some drugs act to repress the body’s immune reactions. These can help relieve symptoms of rheumatoid arthritis, psoriasis, and other similar autoimmune reactions. However, they can also leave a person’s body less able to fight an infection if it occurs. Your doctor will be able to discuss the use of medications if they are warranted – and the possible side effects of using these medications.

Conclusion
In recent times, there has been much talk concerning inflammation. This topic can be confusing to many as although inflammation might be bad for you in some instances, in many other cases inflammation serves many essential functions in our bodies. Inflammation can be either acute or chronic. If you are trying to reduce chronic inflammation, your doctor may recommend certain things such as reducing your intake of certain foods and eat a variety of foods known to have anti-inflammatory properties. Losing weight (if your doctor recommends it), increasing physical activity have been shown to be beneficial in decreasing chronic inflammation.

Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented. Always talk to your doctor for professional medical advice.
Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).

Chronic pain
Pain in older adults is poorly understood. Aging seems to be associated with increased pain thresholds and poor functioning of endogenous pain inhibition mechanisms. The treatments of chronic pain are frequently misunderstood and steeped in myth. While pain sometimes comes with age, there is a difference between some nuisance pain from physical wear and tear and chronic pain. Chronic pain can be a result of an illness or injury, and is also linked to back pain, cancer, arthritis, headache and nerve pain. If you have chronic pain, you should not just tough it out – seek professional help. There are many treatments available. Ignoring your pain can have serious consequences, especially if you choose to self-medicate in unhealthy ways rather than see a healthcare professional. Your doctor will be able to guide you toward the best treatment for you so you can live your healthiest, pain-free, life. Although in most cases, chronic pain cannot kill you, but it can have a profound effect on your quality of life. People who suffer from chronic pain are twice as likely to report suicidal behaviours or commit suicide. The constant struggle with chronic pain can be enough for some people to feel hopeless and, unfortunately, contemplate suicide.

If you have suicidal thoughts, it is imperative that you seek help from support groups, your doctor, family or friends.

Things to do
Aging of the human body is a natural process and certain things are inevitable and happen to everyone – things such as greying hair, diminishing hearing or eyesight, wrinkling skin. We are all familiar with these and accept that some or most of them will eventually come to all of us sooner or later. However, the onset of pain leading to chronic pain, need not be one of the things we accept as a normal part of the aging process. There are measures we can take to avoid this and continue to live a healthier, more active life. The first and probably most significant thing we can do is preventive. By adopting a healthy lifestyle at an early age, we are helping ourselves to stay fit or as fit as we can be whilst on this earth. In other words, adopt a sensible attitude towards food, drink and fitness. People who are active early in life usually stay healthier longer.

Seek help. There is no need to suffer in silence, or just put up with it making ourselves miserable and frequently irritable with our loved ones. It is better if we consult a professional sooner, rather than later, meaning when we start to endure pain that does not go away, we should make that call searching for a qualified professional who can offer the appropriate treatment before it gets any worse, rather than waiting until it is hardly bearable. If we wait until that point, not only have we caused ourselves unnecessary suffering, but it makes the healing process so much more difficult, and takes so much longer to get back to a more normal way of being. We have choices and here are other measures we can take, intellectually and emotionally.
We can seek out information on chronic pain management, thus reducing our fear. We can make sure we try to control negativity, remembering that our thoughts have an impact on our physical bodies. Adopting one or more relaxations techniques have been shown to be helpful. These might be meditation or yoga, and under the guidance of our healthcare provider we can do appropriate exercises, follow a healthy diet and adopt a good sleep regime.

Management of chronic pain in the elderly
The management of chronic pain in the elderly is a major clinical challenge. Pain can often co-occur with emotional and mental health difficulties and be associated with anxiety and depression. Medicines play only a minor part in managing persistent pain and therefore patients should be encouraged to see a team of professionals. Under the guidance of a qualified healthcare provider, individuals with chronic pain should be encouraged to adopt self-management strategies and non-pharmacological treatment options and encouraged to use them. The principal aim of chronic pain management, in the elderly, is to enable people with chronic pain to achieve as normal a life as possible by reducing physical disability and emotional distress.

Conclusion
Many elderly individuals in Anguilla suffer from chronic pain. This pain can severely disrupt daily routines for many. It is widely agreed that chronic pain in the elderly is poorly evaluated and managed in many countries, including Anguilla. There is no reason for elderly individuals in Anguilla to suffer silently with persistent pain as they get older. Healthcare professionals agree that it is everyone’s right to receive adequate pain management that improves quality of life, and conserves the ability to carry out the activities of daily living. Good pain management can also keep older persons healthier by allowing them to stay active, eat well, and enjoy a normal social life. If you are elderly and suffers from chronic pain, please seek professional help.

Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented. Always talk to your doctor for professional medical advice.

Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).

What is an ectopic pregnancy?
An ectopic pregnancy occurs when a fertilized egg implants in any location which is not the intended place — namely, in the uterus. It happens in about 1 out of every 90 pregnancies.
In the vast majority of cases — more than 90% — ectopic pregnancies occur in the fallopian tubes. The fallopian tubes carry eggs from the ovaries to the uterus but, in some cases, the fertilized egg can get stuck along the way, which can happen if the tube is inflamed or misshapen.
The fallopian tubes are not the only location where an ectopic pregnancy can occur. The uterus has upper corners — called the cornua— for which implantation here is not normal and is considered an ectopic pregnancy. If a pregnancy implants in the scar of a prior cesarean section, that is not in the uterine body, so that also is an ectopic pregnancy.

What can cause an ectopic pregnancy?
In many cases, it is not clear why a woman has an ectopic pregnancy. Sometimes it happens when there is a problem with the fallopian tubes, such as them being narrow or blocked. The following are all associated with an increased risk of ectopic pregnancy:
• pelvic inflammatory disease (PID) – inflammation of the female reproductive system, usually caused by a sexually transmitted infection (STI)
• previous ectopic pregnancy – the risk of having another ectopic pregnancy is around 10%
• previous surgery on your fallopian tubes – such as an unsuccessful female sterilisation procedure
• fertility treatment, such as IVF – taking medication to stimulate ovulation (the release of an egg) can increase the risk of ectopic pregnancy
• becoming pregnant while using an intrauterine device (IUD) or intrauterine system (IUS) for contraception – it is rare to get pregnant while using these, but if you do you are more likely to have an ectopic pregnancy
• smoking
• increasing age – the risk is highest for pregnant women aged 35 to 40.

How would you know if you are experiencing an ectopic pregnancy?
With an ectopic pregnancy, most women will experience cramping or abdominal pain — typically on just one side of the lower belly — and vaginal spotting or bleeding.
These symptoms and signs are very common and can occur with other medical disorders. This accounts for many cases of ectopic pregnancies being misdiagnosed.
The most important issue for any person early in pregnancy, with either of these symptoms, is to discuss them with a doctor to figure out if an evaluation for ectopic pregnancy is indicated or not.
If it is indicated, or if you are concerned, your health care provider may perform a pelvic exam, do an ultrasound or check your blood for a pregnancy hormone called hCG (human chorionic gonadotropin).
An ectopic pregnancy does not always cause symptoms – and may only be detected during a routine pregnancy ultrasound scan.

When to get emergency help
Call 991 for an ambulance or go to the hospital immediately if you experience a combination of:
• a sharp, sudden and intense pain in your tummy
• feeling very dizzy or fainting
• feeling sick
• looking very pale
These symptoms could mean that you have a ruptured ectopic pregnancy. This is very serious, and surgery needs to be carried out as soon as possible.

How is ectopic pregnancy treated?
Ectopic pregnancies are typically treated with medication — namely, methotrexate — or in some cases with surgery. For tubal ectopic pregnancies, treatment can be with medications that dissolve the ectopic pregnancy tissue or with surgery. Other ectopic pregnancies are more complex and may require medications, surgery or commonly, a combination of these treatments.
With surgery, it often involves removal of the pregnancy or affected fallopian tube. This is often the treatment for those patients who have experienced a rupture ectopic pregnancy.

What happens if an ectopic pregnancy is not treated?
When a pregnancy implants in the correct location of the uterus, the uterine muscle is designed to be able to stretch/grow as the pregnancy develops. Other organs, like the fallopian tube, cannot grow that way and will eventually burst.
This will also happen if the fertilized egg is implanted in the cervix, the corner of the uterus or even the ovary. If left untreated, an ectopic pregnancy can result in life-threatening haemorrhage.
Women who have a ruptured ectopic pregnancy can quickly become unstable and die. Luckily, life-threatening haemorrhages caused by ectopic pregnancies are now very rare in Anguilla.

Help and support after an ectopic pregnancy
Losing a pregnancy can be devastating, and many women feel the same sense of grief as if they had lost a family member or partner.
It is not uncommon for these feelings to last several months, although they usually improve with time. Make sure you give yourself and your partner time to grieve.
If you or your partner are struggling to come to terms with your loss, you may benefit from professional support or counselling. Speak to your gynaecologist or family doctor about this.

Conclusion
Ectopic pregnancy is a complication of pregnancy that, left untreated, can be life threatening. The diagnosis can be missed, as the signs and symptoms might be very vague, especially if pregnancy is not considered. Once diagnosed, there are several treatment options available. Unfortunately, it is not possible to save the pregnancy. It usually has to be removed using medicine or an operation.

Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field is ongoing, it is possible that new findings may supersede some data presented. Always talk to your doctor for professional medical advice.
Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).

What is hydrogen peroxide?
Hydrogen is water (H2O) with an extra oxygen molecule (H2O2). It is a chemical compound and has been used as a first aid antiseptic for injured skin since the 1920’s. In the past it was a common ‘go to’ when there is a wound, and it can usually be found in most households’ first aid kits in Anguilla and many other countries. It is time to retire peroxide from first-aid duty. Numerous studies have found that hydrogen peroxide irritates the skin. It may prevent the wound from healing, doing more harm than good.
Hydrogen peroxide can be used in many places, from your kitchen to your bathroom, but keep it away from wounds and acne.

The blood and other living cells found in a wound use the catalase enzyme to attack the hydrogen peroxide and convert it to (water) H2O and (oxygen) O2. In its low concentration, hydrogen peroxide will start a bubbling action which helps remove debris from the wound and works to kill bacteria cells by destroying their cell walls.
Although hydrogen peroxide is thought to be a good first aid antiseptic, hydrogen peroxide can damage skin cells and angiogenesis which is the process of new vessel formation. This will delay wound healing.
People on certain medications will have delayed wound healing potential – as well as people with other co-morbidities such as rheumatoid arthritis and diabetes. These individuals are starting the wound healing cascade already impeded by low healing potential, so pouring hydrogen peroxide on their wounds, even initially, can drastically affect their chance of ever healing.

For diabetic patients, especially after a skin injury, the odds of healing not only stack up against you but they do so quickly.
So the question is not whether hydrogen peroxide is beneficial. That is not up for debate. There are many good uses for it, just not on wounds. Wounds can instead be cleaned with mild soap and water immediately after an injury.

On a long-term basis, there are a myriad of wound cleansing options available which will help to remove biofilm and reduce bioburden in the wound but not affect the healthy skin cells – allowing the proliferation of fibroblast cells in the wound cells that play an important role in forming new granulation tissue and getting the wound healed.
Although the debate on the effectiveness of using hydrogen peroxide on wounds may continue, one thing that is certain is wound care has grown so much especially over the past 20 years. There are many advanced wound care modalities available.

What to use for wound care?
So what do you use on a scrape or cut? I strongly recommend a good wash with soap and plenty of clean water. After washing, pat dry with a clean towel. Then apply an antibiotic ointment and cover it with a bandage. There is no need for hydrogen peroxide or alcohol.
Seek medical care for larger wounds and gashes, excessive bleeding, or if there is debris stuck in the wound.

Hydrogen peroxide as a disinfectant
I strongly urge you to move your peroxide from the medicine cabinet to the cleaning cabinet. Hydrogen peroxide is a great alternative to bleach.
Use peroxide in a well-ventilated area and wear gloves. There is a chance of toxicity if you inhale it, and it can irritate the skin and eyes.
Hydrogen peroxide is a great germ-killer for:
• Bathtubs, sinks and showers.
• Counters.
• Cutting boards.
• Door knobs.
• Garbage cans.
• Mirrors.
• Refrigerators.
• Toilets.
• Toys.
Peroxide kills bacteria, fungi and viruses. It can come in handy if you do not have disinfecting wipes or bleach. Just be careful not to get it on your clothes or furniture, or it may bleach them.

Conclusion
While hydrogen peroxide does have known antiseptic properties, it may do more harm than good when it comes to wound care. Numerous studies have confirmed that hydrogen peroxide should not be used to clean cuts and scrapes. Many of us will say my mom (or grandma) told me to clean it out good with hydrogen peroxide. Unfortunately, this deeply held belief extends across multiple cultures and generations, and health professionals must do more to educate the population on why hydrogen peroxide should not be used for wound care. There are many other good uses for hydrogen peroxide but wound care is not one of them.

Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.

Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).

Risk factors
Almost everyone is at risk of cold sores. Most adults carry the virus that causes cold sores, even if they have never had symptoms.
You are most at risk of complications from the virus if you have a weakened immune system from conditions and treatments such as:
• HIV/AIDS
• Atopic dermatitis (eczema)
• Cancer chemotherapy
• Anti-rejection drugs for organ transplants

What are some symptoms of cold sores?
Symptoms of cold sores might vary in severity and whether it is the first attack or a recurrence.
A cold sore usually passes through several stages:
• Tingling and itching. Many people feel itching, burning or tingling around the lips for a day or so before a small, hard, painful spot appears, and blisters erupt.
• Blisters. Small fluid-filled blisters typically erupt along the border of your lips. Sometimes they appear around the nose or cheeks or inside the mouth.
• Oozing and crusting. The small blisters may merge and then burst, leaving shallow open sores that ooze and crust over.
The first time you have a cold sore, symptoms may not start for up to 20 days after you were first exposed to the virus. The sores can last several days, and the blisters can take two to three weeks to heal completely. Recurrences typically appear at the same spot each time and tend to be less severe than the first outbreak.
In a first-time outbreak, you also might experience:
• Fever
• Painful gums
• Sore throat
• Headache
• Muscle aches
• Swollen lymph nodes
Children under 5 years old may have cold sores inside their mouths and the lesions are commonly mistaken for canker sores. Canker sores involve only the mucous membrane and are not caused by the herpes simplex virus.

When to see a doctor
Cold sores generally clear up without treatment. See your doctor if:
• You have a weakened immune system
• The cold sores do not heal within two weeks
• Symptoms are severe
• You have frequent recurrences of cold sores
• You experience irritation in your eyes

Diagnosis
Your doctor can usually diagnose cold sores just by looking at them. To confirm the diagnosis, your doctor might take a sample from the blister for testing in a laboratory.

Treatment
Cold sores generally clear up without treatment in two to four weeks. Several types of prescription antiviral medications may speed the healing process. These can be used as a cream, orally or by injection in severe infections.

If you regularly get cold sores, use antiviral creams as soon as you recognise the early tingling feeling. They do not always work after blisters appear.

How long cold sores are contagious?
Cold sores are contagious from the moment you first feel tingling or other signs of a cold sore coming on to when the cold sore has completely healed.

How to reduce the risk of spreading this condition?
To help avoid spreading cold sores to other people, or to other parts of your body, you might try some of the following precautions:
• Avoid kissing and skin contact with people while blisters are present. The virus spreads most easily when the blisters leak fluid.
• Avoid sharing items. Utensils, towels, lip balm and other personal items can spread the virus when blisters are present.
• Keep your hands clean. When you have a cold sore, wash your hands carefully before touching yourself and other people, especially babies.

Kissing a baby if you have a cold sore can lead to neonatal herpes which is very dangerous to newborn babies.
If you have cold sores the following are recommended:
• do not have oral sex until your cold sore completely heals as you could give your partner genital herpes
• do not touch your cold sore (apart from applying cream). If you do, wash your hands
• do not rub cream into the cold sore – dab it on instead
• do not eat acidic or salty food if it makes your cold sore feel worse

What triggers recurrences?
Recurrence may be triggered by the following:
• Viral infection or fever
• Hormonal changes such as those related to menstruation
• Stress
• Fatigue
• Exposure to sunlight and wind
• Changes in the immune system
• Injury to the skin

Conclusion
Cold sores are very common. They are caused by a virus called herpes simplex.
Once you have the virus, it stays in your skin for the rest of your life. Sometimes it causes a cold sore.
Most people are exposed to the virus when they are young after close skin to skin contact, such as kissing with someone who has a cold sore.

It does not usually cause any symptoms until you are older. You may not know if it is in your skin unless you get a cold sore. Cold sores usually heal in two to three weeks without leaving a scar. Several antiviral medications are available to help reduce symptoms but there is no cure for cold sores at this time.

Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.

Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).

What is shoulder pain?
Shoulder pain is any pain in or around the shoulder joint. The shoulder is the most moveable joint in the human body. It is composed of a group of four muscles and their tendons. This group is called the rotator cuff, a group of muscles which connect the shoulder to the arm, and it is the rotator cuff which gives the shoulder such a wide range of movement.

Causes of shoulder pain
The most common cause of shoulder pain is when rotator cuff tendons become inflamed or trapped in your shoulder. This is called rotator cuff tendinitis, or irritation of these tendons and inflammation of the bursa, small slippery fluid filled sacs that the tendons glide over. A rotator cuff tear, when one of the tendons is torn from overuse or injury, can also cause intense shoulder pain.
Shoulder pain may also be caused by:
• Arthritis in the shoulder joint
• Bone spurs in the shoulder area
• Bursitis, which is inflammation of a fluid-filled sac (bursa) that normally protects the joint and helps it move smoothly
• Broken shoulder bone
• Dislocation of the shoulder
• Shoulder separation
• Frozen shoulder, which occurs when the muscles, tendons, and ligaments inside the shoulder become stiff, making movement difficult and painful
• Overuse or injury of nearby tendons, such as the bicep muscles of the arms
• Nerve injury that leads to abnormal shoulder movement
• Tears of the rotator cuff tendons
• Poor shoulder posture and mechanics
Shoulder pain may be due to a problem in another area of the body, such as the neck or lungs. This is called referred pain. There is usually pain at rest and no worsening of pain when moving the shoulder.

What can you do if you have shoulder pain?
In some cases you can take care of your shoulder pain at home. Try putting ice on your shoulder for 15 minutes, then leave it off for 15 minutes, three or four times a day for a few days. Make sure you wrap the ice in cloth so it does not give you frostbite. Take ibuprofen to reduce pain and swelling. Slowly return to your regular activities once you start feeling less pain.

Sudden shoulder pain can be a sign of a heart attack. Call Emergency Services if you have sudden pressure or crushing pain in your shoulder, especially if the pain starts in your chest, jaw or neck. If you fall on your shoulder and feel sudden intense pain, you should see a doctor because you may have torn rotator cuff or dislocated your shoulder. If you have had shoulder pain before, try using ice and ibuprofen after exercising. Learn proper exercises to stretch and strengthen your rotator cuff tendons and shoulder muscles. Also, physical therapy can help. Make an appointment and talk about your options.
If you have shoulder pain the following are recommended:
• do not completely stop using your shoulder – this can stop it getting better
• do not do things that make it worse
• do not make up your own strenuous exercises or use heavy gym equipment
• do not slouch when sitting – do not roll your shoulders or bring your neck forward

Medical treatment
The most common cause of shoulder pain is related to rotator cuff problem. Your doctor might make the diagnosis or refer you to a specialist. In coming to a diagnosis your doctor will check your shoulder for tenderness and lift your arm to see in which position you have pain. Blood or imaging tests, such as x-rays or MRI, may be ordered to help diagnose the problem. Treatment for rotator cuff tendinitis involves resting your shoulder and avoiding the activities that cause you pain. You can also try applying ice packs 20 minutes at a time, 3 or 4 times a day. Medicines like Non-steroidal anti-inflammatory drugs (NSAIDs) might reduce swelling and inflammation. Injection of an anti-inflammatory medicine called corticosteroid might be required.
Eventually, you should start physical therapy to learn to stretch and strengthen the muscles of your shoulder. Surgery can remove inflamed tissue and part of the bone that lies over the rotator cuff – which may help relieve the pressure on your tendons. Someone with a partial rotator cuff tear can try rest and exercise, if he/she does not normally put a lot of demand on his/her shoulder. If there is a complete tear, or if the symptoms do not improve with therapy, you may need surgery to repair the tendon. With rest or exercise, symptoms of most shoulder problems often improve or go away, though it may take months.

Conclusion
Pain in the shoulder is very common and can occur throughout adult life. Many cases of shoulder pain respond to simple treatments / self-management. If pain persists or is very severe you should seek medical attention.

Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).

What is cholesterol?
Cholesterol is a waxy, fat-like, substance that is found in all the cells in the body. Your body needs some cholesterol to make hormones, vitamin D, and substances that help you digest foods. Your body makes all the cholesterol it needs. Cholesterol is also found in foods from animal sources such as egg yolks, meat and cheese.

If you have too much cholesterol in your blood, it can combine with other substances in the blood to form plaque. Plaque sticks to the walls of your arteries. This buildup of plaque is known as atherosclerosis. It can lead to coronary artery disease where your coronary arteries become narrow or even blocked.

What causes high cholesterol?
The most common cause of high cholesterol is an unhealthy lifestyle. This can include:

• Unhealthy eating habits such as eating lots of bad fats. One type, saturated fat, is found in some meats, dairy products, chocolate, baked goods, and deep-fried and processed foods. Another type, trans fat, is in some fried and processed foods. Eating these fats can raise your LDL (bad) cholesterol.

• Lack of physical activity, with lots of sitting and little exercise. This lowers your HDL (good) cholesterol.

• Smoking, which lowers HDL cholesterol, especially in women. It also raises your LDL cholesterol.

Genetics may also cause people to have high cholesterol. For example, familial hypercholesterolemia (FH) is an inherited form of high cholesterol. Other medical conditions, and certain medicines, may also cause high cholesterol.

Cholesterol is carried through your blood, attached to proteins. This combination of proteins and cholesterol is called a lipoprotein. There are different types of cholesterol based on what the lipoprotein carries. They are:

• Low-density lipoprotein (LDL). LDL, the “bad” cholesterol, transports cholesterol particles throughout your body. LDL cholesterol builds up in the walls of your arteries making them hard and narrow.

• High-density lipoprotein (HDL). HDL, the “good” cholesterol, picks up excess cholesterol and takes it back to your liver.

What can you do if you have high cholesterol levels?
There are several things individuals can do if they are found to have high cholesterol levels. Good habits are essential for everyone, but they are essential if high cholesterol runs in the family. If you come from a family with a history of high cholesterol, it is essential to be proactive about maintaining your health. The following are recommended.

Lifestyle choices
Many individuals might not be aware that various lifestyle choices can influence their cholesterol levels. Things like diet, exercise, and stress management can all impact cholesterol. Here are some habits that can increase your cholesterol:

– Eating a diet high in saturated and trans fats. These fats are found in animal products, processed foods, and some vegetable oils. They can raise your LDL (bad) cholesterol levels and make it harder for your body to remove LDL from your bloodstream.

– Being overweight or obese. Excess weight can increase your LDL levels and reduce your HDL (good) cholesterol levels. It can also lead to other health problems like diabetes and high blood pressure, further increasing your risk for heart disease.

One way to help lower your cholesterol is by eating a healthy diet. This means choosing foods low in saturated and trans fats and high in fibre. Saturated and trans fats can raise your cholesterol level, while fibre helps to reduce it. In addition to making healthy food choices, you can also help lower your cholesterol by maintaining a healthy weight and exercising regularly. Both of these habits can help to increase your HDL (‘good’) cholesterol levels and improve your overall cardiovascular health.

Make sure you are eating a healthy diet. This means plenty of fruits, vegetables, and whole grains and limiting saturated and trans fats. Eating healthy foods will help reduce your overall cholesterol level.

Get regular exercise
When it comes to reducing cholesterol levels, exercise is one of the best habits you can adopt. When you are physically active, your body produces more HDL cholesterol, which is the ‘good’ kind that helps remove LDL cholesterol from your arteries. Regular exercise also helps increase the size of your LDL particles, which makes them less harmful. Regular exercise lowers triglyceride levels, another type of fat in your blood that can contribute to heart disease. Even if you already have high cholesterol, exercising a regular part of your routine can help bring it down to a healthier level. Just 30 minutes of moderate activity most days of the week can make a big difference. If this is not possible as little as ten minutes of moderate activity is beneficial. Walking, jogging, swimming, dancing, playing cricket, football and many other sports can allow us to have regular exercise.

Stop smoking
While it is no secret that smoking is bad for your health, many people are unaware of the specific ways in which it can damage your body. For example, smoking can increase your cholesterol levels. This is because the chemicals in cigarettes cause a build-up of plaque in your arteries which makes it difficult for blood to flow freely. In addition, smoking causes inflammation and oxidative stress which can contribute to high cholesterol levels. The good news is that it is never too late to quit smoking and improve your overall health. If you are struggling to give up smoking, many resources are available to help. If you have questions talk to your doctor.

Know your numbers
It is important that all of us know our cholesterol levels This can be done in Anguilla at several sites. A blood test to check cholesterol levels — called a lipid panel or lipid profile — typically reports:
• Total cholesterol
• LDL cholesterol
• HDL cholesterol
• Triglycerides — a type of fat in the blood
Generally, you are required to fast, consuming no food or liquids other than water, for nine to 12 hours before the test. You should follow your doctor’s instructions when going for a lipid profile.

Medications
Lifestyle changes such as exercising and eating a healthy diet are the first line of defence against high cholesterol. If you have made these important lifestyle changes and your cholesterol levels remain high, your doctor might recommend medication.

The choice of medication or a combination of medications depends on various factors, including your personal risk factors, your age, your health and possible drug side effect.

Conclusion
In summary, there are two main types of cholesterol: LDL and HDL. LDL, or low-density lipoprotein, is the ‘bad’ type of cholesterol. This can build up in the arteries, leading to blockages. HDL, or high-density lipoprotein, is the ‘good’ type of cholesterol. This is because it helps remove LDL from the arteries and transport it to the liver, where it is broken down. Although the body needs cholesterol to function properly, too much cholesterol can be harmful. High cholesterol levels are a significant risk factor for heart disease, stroke, and other health problems. If you have high cholesterol levels, lifestyle changes are strongly recommended. If levels are still elevated following these lifestyle changes, then various medications are advised. As high cholesterol levels do not cause symptoms, it is important that all of us have regular medical check-ups and have our cholesterol levels checked.

Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.

Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).

What is glaucoma?
Glaucoma is a group of eye conditions where the optic nerve, which connects the eye to the brain, becomes damaged. It is usually caused by fluid building up in the front part of the eye, which increases pressure inside the eye. Glaucoma can lead to loss of vision if it is not diagnosed and treated early.

It can affect people of all ages but is most common in adults in their 70s and 80s. Glaucoma tends to run in families. In some people, scientists have identified genes related to high eye pressure and optic nerve damage.

The definition of glaucoma in adults has changed over the years due to changes in our understanding of how glaucoma affects the eye, technology available, and the reasons why a particular definition was constructed. A current clinical definition of glaucoma is: “A characteristic pattern of glaucomatous optic neuropathy (e.g. with narrowing of the neurorentinal rim) with corresponding visual field defects.” Glaucoma is a huge topic, and this article will be concentrating on open-angle disease in adults. Open-angle glaucoma is the most common form of the disease. There are other types.

What are some symptoms of glaucoma?
Glaucoma does not usually cause any symptoms in the early stages of the disorder. It tends to develop slowly over many years and affects the edges of your vision (peripheral vision) first.

For this reason, many people do not realise they have glaucoma, and it is often only picked up during a routine eye test.
If you do notice any symptoms, they might include blurred vision, or seeing rainbow-coloured circles around bright lights.
Both eyes are usually affected, although it may be worse in one eye.
Very occasionally, glaucoma can develop suddenly and cause:
• intense eye pain
• nausea and vomiting
• a red eye
• a headache
• tenderness around the eyes
If left untreated, glaucoma will eventually cause blindness. Even with treatment, about 15 percent of people with glaucoma become blind in at least one eye within 20 years.

When to see a doctor
Promptly go to an emergency room or an eye doctor’s (ophthalmologist’s) office if you experience some of the symptoms of acute angle-closure glaucoma, such as severe headache, eye pain and blurred vision.

Diagnosis
Your doctor will review your medical history and conduct a comprehensive eye examination. He or she may perform several tests, including:
• Measuring intraocular pressure (tonometry)
• Testing for optic nerve damage with a dilated eye examination and imaging tests
• Checking for areas of vision loss (visual field test)
• Measuring corneal thickness (pachymetry)
• Inspecting the drainage angle (gonioscopy)

Treatment
The damage caused by glaucoma cannot be reversed, but treatment and regular checkups can help slow or prevent vision loss, especially if you catch the disease in its early stages.
Glaucoma is treated by lowering your eye pressure (intraocular pressure). Depending on your situation, your options may include prescription eyedrops, oral medications, laser treatment, surgery, or a combination of any of these.

Prevention
These self-care steps can help you detect glaucoma in its early stages, which is important in preventing vision loss or slowing its progress.
• Get regular dilated eye examinations. Regular comprehensive eye exams can help detect glaucoma in its early stages, before significant damage occurs. If you are over 65 years, it is recommended to have a comprehensive eye exam every one to two years. If you are at risk of glaucoma, you will need more frequent screening. Ask your doctor to recommend the right screening schedule for you.
• Know your family’s eye health history. Glaucoma tends to run in families. If you are at increased risk, you may need more frequent screening.
• Exercise safely. Regular, moderate exercise may help prevent glaucoma by reducing eye pressure. Talk with your doctor about an appropriate exercise programme.
• Take prescribed eyedrops regularly. Glaucoma eyedrops can significantly reduce the risk that high eye pressure will progress to glaucoma. To be effective, eyedrops prescribed by your doctor need to be used regularly even if you have no symptoms.
• Wear eye protection. Serious eye injuries can lead to glaucoma. Wear eye protection when using power tools or playing high-speed racket sports in enclosed courts.

Conclusion
Glaucoma is one of the leading causes of blindness worldwide. People with glaucoma have optic nerve damage from fluid buildup in the eye. Left untreated, this eye pressure can permanently affect vision. In many cases there are few symptoms – therefore it is important to have regular eye examinations. Treatments — including eyedrops, laser treatments and surgeries — can slow down vision loss and save your sight.

Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.

Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).

What is bacterial vaginosis?
Bacterial vaginosis is a type of vaginal inflammation caused by the overgrowth of bacteria naturally found in the vagina, which upset the natural balance.
Women in their reproductive years are most likely to get bacterial vaginosis, but it can affect women of any age.

What causes bacterial vaginosis?
The cause is not completely understood at this time but, certain activities, such as unprotected sex or frequent douching, increase your risk. Many clinicians feel that bacterial vaginosis results from overgrowth of one of several bacteria naturally found in your vagina. Usually, “good” bacteria (lactobacilli) outnumber “bad” bacteria (anaerobes), but if there are too many anaerobic bacteria, they upset the natural balance of microorganisms in your vagina and cause bacterial vaginosis.

What are some symptoms of bacterial vaginosis?
The most common symptom of bacterial vaginosis is unusual vaginal discharge that has a strong “fishy” smell, particularly after sex.
The woman may notice a change in colour and consistency of vaginal discharge, such as becoming greyish-white and thin and watery.
It should be noted that 50% of women with bacterial vaginosis do not have any symptoms.
Bacterial vaginosis does not usually cause any soreness or itching.

What are some risk factors for bacterial vaginosis?
Women in the reproductive period can develop bacterial vaginosis, but there are a few risk factors that increase a woman’s chances of getting bacterial vaginosis. They include the following:

• Having multiple sex partners or a new sex partner. Doctors do not fully understand the link between sexual activity and bacterial vaginosis, but the condition occurs more often in women who have multiple sex partners or a new sex partner. Bacterial vaginosis also occurs more frequently in women who have sex with women.

• Douching. The practice of rinsing out your vagina with water, or a cleansing agent (douching), upsets the natural balance of your vagina. This can lead to an overgrowth of anaerobic bacteria and cause bacterial vaginosis. Since the vagina is self-cleaning, douching is not necessary – and should be discouraged in all females.

• Natural lack of lactobacilli bacteria. If your natural vaginal environment does not produce enough of the good lactobacilli bacteria, you are more likely to develop bacterial vaginosis.

Diagnosis
If you have symptoms suggestive of bacterial vaginosis, see your doctor. Your gynaecologist will be able to make the diagnosis and rule out other disorders that can mimic bacterial vaginosis.

Treatment
Bacterial vaginosis is usually treated with antibiotic tablets or gels or creams.
It is generally not necessary to treat an infected woman’s male sexual partner, but bacterial vaginosis can spread between female sexual partners. Female partners should seek testing and may need treatment. It is especially important for pregnant women, with symptoms, to be treated to help decrease the risk of premature delivery or low birth weight.

What can you do
To help relieve symptoms, and prevent bacterial vaginosis returning, the following are recommended:
• use water and plain soap to wash your genital area
• have showers instead of baths

Women are advised to do the following:
• do not use perfumed soaps, bubble bath, shampoo or shower gel in the bath
• do not use vaginal deodorants, washes or douches
• do not put antiseptic liquids in the bath
• do not use strong detergents to wash your underwear
• do not smoke

Recurring bacterial vaginosis
It is common for bacterial vaginosis to come back, usually within three months. Your gynaecologist might recommend a longer course of treatment and identify any factors that are causing repeat infections.

Conclusion
Bacterial vaginosis is a common vaginal inflammatory disorder that happens when some normal bacteria that live in the vagina overgrow, causing a bacterial imbalance. Symptoms include an off-white or grey vaginal discharge that smells “fishy.” In some women, in a few cases bacterial vaginosis goes away without treatment – in others, antibiotics successfully treat this infection.

Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.

Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).

What is anaphylaxis?

Anaphylaxis is a severe, potentially life-threatening allergic reaction. It can occur within seconds or minutes of exposure to something you are allergic to, such as peanuts or bee stings. Anaphylaxis causes the immune system to release a flood of chemicals that can cause you to go into shock — blood pressure drops suddenly, and the airways narrow blocking breathing.

Triggers of anaphylaxis

Anaphylaxis is the result of the immune system, the body’s natural defence system, overreacting to a trigger.
This is often something you are allergic to, but not always.
Common anaphylaxis triggers include:
• foods – including nuts, milk, fish, shellfish, eggs and some fruits
• medicines – including some antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin
• insect stings – particularly wasp and bee stings
• general anaesthetic
• contrast agents – dyes used in some medical tests to help certain areas of your body show up better on scans
• latex – a type of rubber found in some rubber gloves and condoms
In some cases, there is no obvious trigger. This is known as idiopathic anaphylaxis.

What are some symptoms of anaphylaxis?

Anaphylaxis symptoms usually occur within minutes of exposure to an allergen. Sometimes, however, anaphylaxis can occur a half-hour or longer after exposure. In rare cases, anaphylaxis may be delayed for hours. Signs and symptoms include:

• Skin reactions, including hives and itching and flushed or pale skin
• Low blood pressure (hypotension)
• Constriction of the airways and a swollen tongue or throat which can cause wheezing
• A weak and rapid pulse
• Nausea, vomiting or diarrhea
• Dizziness or fainting, feeling lightheaded or faint
• breathing difficulties – such as fast, shallow breathing
• wheezing
• a fast heartbeat
• clammy skin
• confusion and anxiety
• collapsing or losing consciousness

What to do if someone has anaphylaxis

Anaphylaxis is a medical emergency and urgent treatment is needed.
If someone has symptoms of anaphylaxis:
1. Use an adrenaline auto-injector if the person has one – but make sure you know how to use it correctly first.

2. Call 911 for an ambulance immediately (even if he/ she they starts to feel better) – Mention that you think the person has anaphylaxis.

3. Remove any trigger if possible – for example, carefully remove any stinger stuck in the skin.

4. Lie the person down and raise his/her legs – unless he/she is are having breathing difficulties and need to sit up to help him/her breathe. If she is pregnant, lie her down on her left side.

5. Give another injection after 5 minutes if the symptoms do not improve and a second auto-injector is available.

If you are having an anaphylactic reaction, you can follow the above steps yourself if you feel able to.

Prevention
If you have a serious allergy, or have experienced anaphylaxis before, it is important to try to prevent future episodes. The best way to prevent anaphylaxis is to stay away from substances that cause this severe reaction.
The following can help reduce your risk:

• Identify any triggers.
• If you have food allergies, carefully read the labels of all the foods you buy and eat. Manufacturing processes can change, so it’s important to periodically recheck the labels of foods you commonly eat.
• Be sure to alert all your providers to medication reactions you’ve had.
• Wear a medical alert necklace or bracelet to indicate you have an allergy to specific drugs or other substances.
• Always carry 2 in-date adrenaline auto-injectors – Give yourself an injection whenever you think you may be experiencing anaphylaxis, even if you are not completely sure.
Coping

Having a potentially life-threatening reaction is frightening whether it happens to you, others close to you or your child. Developing an anaphylaxis emergency action plan can help put your mind at ease.

Work with your own or your child’s medically trained doctor to develop this written, step-by-step, plan of what to do in the event of a reaction. Then share the plan with teachers, babysitters and other caregivers.

If your child has a severe allergy, or has had anaphylaxis, talk to the school nurse and teachers to find out what plans they have for dealing with an emergency. Make sure school officials have a current autoinjector.
Conclusion

Anaphylaxis is when you get severe allergic reactions. Common examples include reactions to certain foods or insect stings. Going into anaphylactic shock can be life-threatening. If you notice symptoms of anaphylaxis, such as having trouble breathing, use an epinephrine injector. This anaphylaxis treatment can save your life. Make sure to call 911 and seek urgent medical care.

Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.

Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).

Treatment
Your treatment options will depend on what is causing your syncope, and the results of your evaluation and testing. The goal of treatment is to keep you from having episodes of syncope.
Treatment options include:
• Taking medications or making changes to medications you already take.
• Wearing support garments or compression stockings to improve blood circulation.
• Making changes to your diet. Your doctor may suggest that you eat small, frequent meals; eat more salt (sodium); drink more fluids; increase the amount of potassium in your diet; and avoid caffeine and alcohol.
• Being extra cautious when you stand up.
• Elevating the head of your bed while sleeping. You can do this by using extra pillows or by placing risers under the legs of the head of the bed.
• Avoiding or changing the situations or “triggers” that cause a syncope episode.
• Biofeedback training to control a fast heartbeat.
• Treatment for structural heart disease.
• Implanting a pacemaker to keep your heart rate regular (only needed for patients with certain medical conditions).
Your doctor and other members of your healthcare team will develop a treatment plan that is right for you, and talk to you about your treatment options.

Conclusion
Syncope is a clinical syndrome characterised by transient loss of consciousness and postural tone. Syncope is a common condition. With the proper diagnosis and treatment, syncope can be managed and controlled. If you experience syncope on several occasions, you should see your doctor for an evaluation.

Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field is ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).

What is heart failure?
Heart failure does not mean your heart has stopped working. It usually means the heart needs some support to help it work better. Heart failure causes an accumulation of fluid in other parts of the body, most commonly in the lungs and lower extremities (feet/legs). Heart failure can occur at any age, but is most common in older people. It is a long-term condition that tends to get gradually worse over time. In many cases the symptoms can often be controlled for many years.

What are some causes of heart failure?
Heart failure often develops after other conditions have damaged or weakened the heart. However, heart failure can also occur if the heart becomes too stiff. Conditions that can lead to heart failure include: coronary heart disease, high blood pressure, cardiomyopathy, heart rhythm problems, and congenital heart disease. Sometimes anaemia, drinking too much alcohol, an overactive thyroid or high pressure in the lungs (pulmonary hypertension) can also lead to heart failure.

What are some symptoms and signs of heart failure?
Heart failure signs and symptoms may include:
• Shortness of breath with activity or when lying down
• Fatigue and weakness
• Swelling in the legs, ankles and feet
• Rapid or irregular heartbeat
• Reduced ability to exercise
• Persistent cough or wheezing with white or pink blood-tinged mucus
• Swelling of the abdomen
• Very rapid weight gain from fluid buildup
• Nausea and lack of appetite
• Difficulty concentrating or decreased alertness
• Chest pain if heart failure is caused by a heart attack

Treatment
Treatment for heart failure usually aims to control the symptoms for as long as possible, and slow down the progression of the condition.
Common treatments include:
• lifestyle changes – including eating a healthy diet, exercising regularly and stopping smoking
• medicine – a range of medicines can help. Many people need to take 2 or 3 different types
• devices implanted in your chest. These can help control your heart rhythm
• surgery – such as a bypass operation or a heart transplant
Treatment will usually be needed for life.
A cure may be possible when heart failure has a treatable cause. For example, if your heart valves are damaged, replacing or repairing them may cure the condition.

How to prevent heart failure?
Although you cannot control some risk factors like age, family history or race, you can change your lifestyle to give yourself the best chance of preventing heart failure. Things you can do include:
• Staying at a healthy weight.
• Eating foods that are good for your heart.
• Exercising regularly.
• Reducing and managing stress.
• Stopping the use of tobacco products.
• Not drinking alcohol.
• Not using recreational drugs.
• Controlling certain conditions such as high blood pressure and diabetes
• Taking care of other medical conditions you have that can increase your risk.

What are the complications of heart failure?
Some of the complications of heart failure include:
• Irregular heartbeat.
• Sudden cardiac arrest.
• Heart valve problems.
• A collection of fluid in your lungs.
• Pulmonary hypertension.
• Kidney damage.
• Liver damage.
• Malnutrition.

Conclusion
Heart failure is a long-term condition in which the heart cannot pump blood well enough to meet the body’s needs all the time. Treatment includes exercise and medicine at first, and possible surgical procedures when heart failure gets worse. Your outlook depends on a range of factors, including how well you take care of yourself. If you have symptoms suggestive of heart failure please see your medical doctor for an evaluation.

Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.

Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).

What is sciatica?
Sciatica is where the sciatic nerve, which runs from your lower back to your feet, is irritated or compressed. Typically, sciatica affects only one side of your body. Sciatica most commonly occurs when a herniated disc, bone spur on the spine, or narrowing of the spine (spinal stenosis) compresses part of the nerve. This causes inflammation, pain, and often some numbness in the affected leg.
Although the pain associated with sciatica can be severe, most cases resolve with non-operative treatments in a few weeks. People who have severe sciatica that is associated with significant leg weakness or bowel, or bladder changes, might be candidates for surgery.

Risk factors for sciatica
Sciatica results from irritation of the root(s) of your lower lumbar and lumbosacral spine. Additional common causes of sciatica include degenerative disc disease (breakdown of discs which act as cushions between the vertebrae), spondylolisthesis (a condition in which one vertebra slips forward over another one), pregnancy and muscle spasm in the back or buttocks.
Other things that may make you more likely to have sciatica include:
• Aging (which can cause changes in the spine, like bone spurs or herniated discs)
• Diabetes
• Being overweight
• Not exercising regularly
• Wearing high heels
• Sleeping on a mattress that is too hard or too soft
• Smoking
• Your job, especially if it involves driving for long periods of time, twisting your back, or carrying heavy things

What are some symptoms associated with sciatica?
For some people, the pain from sciatica can be severe and disabling. For others, the sciatica pain might be infrequent and irritating, but has the potential to get worse. Common symptoms – of sciatica include the following:
• Lower back pain
• Pain in the rear or leg that is worse when sitting
• Hip pain
• Burning or tingling down the leg
• Weakness, numbness, or a hard time moving the leg or foot
• A constant pain on one side of the rear
• A shooting pain that makes it hard to stand up

When to see a doctor
Mild sciatica usually goes away over time. Make an appointment to see your doctor if self-care measures fail to ease your symptoms – or if your pain lasts longer than a week, is severe or becomes progressively worse. Get immediate medical care if:
• You have sudden, severe pain in your lower back or leg and numbness or muscle weakness in your leg
• The pain follows a violent injury, such as a traffic accident
• You have trouble controlling your bowels or bladder

Diagnosis
Once you have visited your doctor, he/she will carry out a detailed clinical history and physical examination. If your pain is severe, the doctor might order imaging tests to confirm the diagnosis.

Treatment
Most people with sciatica feel better after self-care activities or at-home remedies like:
• Using cold or hot packs
• Stretching
• Taking over-the-counter pain medication
You should not do the following:
• do not sit or lie down for long periods – even if moving hurts, it is not harmful and can help you get better faster
• do not use hot water bottles to ease the pain – you could scald yourself if your skin is numb
If your pain is not getting better, you should make an appointment with your doctor. Your doctor might suggest other options. He or she might also refer you for physiotherapy – including exercise advice and techniques like massage (manual therapy) and or psychological support – to help you cope with the pain.
If your pain is severe and treatments from your doctor have not helped, he or she may refer you to a specialist for:
• painkilling injections
• a procedure to seal off some of the nerves in your back so they stop sending pain signals
• surgery – an operation called decompression surgery can sometimes help relieve sciatica

How to prevent recurrence of sciatica?
It some cases it might be possible to prevent sciatica. The following are recommended:
• stay active – take regular exercise
• use a safe technique when lifting heavy objects
• make sure you have a good posture when sitting and standing
• sit correctly when using a computer
• lose weight if you are overweight
If you are a smoker, stop smoking as smoking can increase your risk of getting sciatica.

Conclusion
Sciatica pain is caused by an irritation, inflammation, pinching or compression of a nerve in the lower back. The most common cause is a herniated or slipped disc that causes pressure on the nerve root. Most people with sciatica get better on their own with time and self-care treatments. If pain persists, then a visit to your doctor is warranted where several management options will be discussed and a treatment plan going forward instituted.

Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.

Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).

What is prediabetes?
Prediabetes is a health condition in which you have higher than normal blood sugar levels. Unmanaged prediabetes can lead to Type 2 diabetes. Prediabetes does not always have symptoms so it is important to get blood sugar levels tested, especially if you are at high risk. Losing weight, exercising regularly and eating healthy can reverse prediabetes and prevent Type 2 diabetes. People with prediabetes have up to a 50% chance of developing diabetes over the next five to 10 years if they do not take the necessary steps to reverse this disorder. You would be diagnosed with prediabetes if:
• Your fasting plasma glucose test is 100 to 125 mg/dL (normal is <100; diabetes is 126 or higher).
• Your HbA1c level is between 42mmol/mol (6%) – 47mmol/mol (6.4%). A normal HbA1c is less than 5.7%, diabetes is 6.5 or higher. HbA1c levels are your average blood glucose (sugar) levels for the last two to three months.

What causes prediabetes?
The exact cause of prediabetes is unknown. Many experts believe that family history and genetics appear to play an important role. A lack of regular physical activity and being overweight with excess fat around your abdomen also seem to be important factors.
What is clear is that people with prediabetes do not process sugar (glucose) properly anymore. As a result, sugar builds up in the blood instead of doing its normal job of giving energy to the cells that make up muscles and other tissues. In prediabetes, your cells do not respond to insulin as they should. Cells become insulin resistant resulting in prediabtes.

How do you get prediabetes?
There are three main things that contribute to developing prediabetes, and the progression to diabetes:
1. What you eat: Being overweight affects the body’s ability to process sugar in the blood.
2. What you do: Long periods of inactivity (e.g. watching television all evening) reduce the ability of insulin to deal with sugar in the blood. By the same token, being physically active increases the efficiency of the insulin.
3. The genes you inherit also contribute to the development of prediabetes.
You cannot change your genes, but you can do something about your eating habits and your physical activity. It is important to realise that dealing with prediabetes or diabetes is not simply about eating less sugar.
Who are at risk of getting prediabetes?
If you have risk factors for prediabetes, talk to your healthcare provider about getting your blood sugar checked regularly. These prediabetes checks are essential because prediabetes often has no symptoms. You can have it for years and not know it.
You may also be at higher risk of prediabetes due to:
• Age (being 45 or older).
• Parent or sibling with Type 2 diabetes.
• Ethnicity. Being black or Hispanic.
• Previous gestational diabetes.
• Polycystic ovary syndrome (PCOS).
• Certain medications, such as steroids, certain antipsychotics and some HIV medications.
• Hormonal conditions, including Cushing’s syndrome and acromegaly.
• Sleep disorders, such as sleep apnea.
Some risk factors for prediabetes can be modified, meaning you can change them. These include:
• Obesity or carrying extra weight.
• Exercising less than three times a week.
• High blood pressure or high cholesterol levels.
• Metabolic syndrome, a combination of high blood pressure, high cholesterol level and large waist measurement.
• Smoking.

Symptoms
Individuals with prediabetes do not usually have any signs or symptoms.
One possible sign of prediabetes is darkened skin on certain parts of the body. Affected areas can include the neck, armpits, elbows, knees and knuckles.
Classic signs and symptoms that suggest you have moved from prediabetes to type 2 diabetes include:
• Increased thirst
• Frequent urination
• Excess hunger
• Fatigue
• Blurred vision

How is prediabetes diagnosed?
To test for prediabetes, your healthcare provider will arrange for a number of tests.

Treatment for prediabetes
The best way to treat prediabetes is through healthy lifestyle changes. Eating a nutritious diet and getting regular exercise can help prevent or delay Type 2 diabetes. Even small changes can significantly lower your risk for developing Type 2 diabetes. Your healthcare provider may prescribe metformin, a diabetes medication. It may help delay diabetes in people with prediabetes.

What are some complications of prediabetes?
Having prediabetes means you are more likely to develop Type 2 diabetes, but it also puts you at increased risk of heart disease and stroke. Prediabetes is a serious problem especially if you do not take steps to address the condition. For many people with prediabetes, diabetes can be delayed or prevented by increasing your physical activity, making changes to what you eat and by losing weight. Keeping these changes going over time improves your overall health and reduces your heart disease risk too. Out of 100 people with prediabetes who make ‘healthy lifestyle’ changes, only 13 will develop diabetes (compare this with 33 out of 100 if no action is taken).

Conclusion
Prediabetes is a common condition. It means your blood sugar levels are high but not high enough to be considered to have diabetes. You may not have any symptoms. It is important to talk to your healthcare provider about getting regular blood tests, including an HbA1c test, especially if you are high risk. The good news is that you can reverse prediabetes. Losing weight and exercising, along with other lifestyle changes, can bring your blood sugar levels back to a healthy range. Talk to your doctor today about how you can prevent or delay Type 2 diabetes.

Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).

What is knee pain?
Knee pain can occur for many reasons, most commonly because of overuse, injuries or arthritis. You can experience knee pain at any age, but older people are more likely to develop it due to degeneration of the joint – a condition known as osteoarthritis. Knee pain might also be known as referred pain, that is, it is due to problems not related to the knee itself.

Depending on what is causing your pain, you may feel better with home measures such as rest, anti-inflammatory medication, and ice. If you have a more severe injury, you may need a procedure or a surgery.

Surgeons often use minimally invasive types of surgery (arthroscopic surgery) to repair damage to the knee like torn tendons or ligaments. These types of injuries can cause knee instability and pain. In cases when the damage is severe, your healthcare provider may recommend knee replacement surgery.

What causes knee pain?
Many conditions and injuries can make your knees hurt. Some common knee pain causes can include overuse, injuries, and arthritis.

Overuse
Repetitive activities can lead to pain. Some examples are:

• Patellofemoral pain (runner’s knee): pain under or around the kneecap, often related to mechanics, shape of the kneecap, or
• Osgood-Schlatter disease: In children, swelling in the shinbone below the kneecap due to overuse.
• Tendonitis due to repetitive jumping sports such as volleyball or basketball.

Injury
Sudden trauma can damage parts of your knee joint. Common knee injuries can include:
• Anterior cruciate ligament (ACL) injury or medial collateral ligament (MCL) injury: Damage to the main stabilising ligaments of the knee.
• Bursitis: Inflammation (swelling) of the fluid-filled sacs that cushion the knee joint.
• Kneecap dislocation: Movement out of place of your kneecap (the bone that covers your knee).
• Meniscus tear: Tear in the knee’s cartilage (slippery tissue that helps bones move together smoothly).

Arthritis
Arthritis is a condition that can impact many different joints in your body. When you have arthritis in your knee, it causes the joint to swell. This can be a painful condition. Arthritis in your knee is more likely to develop over time as you age. There are several distinct types of arthritis that can affect the knees, including rheumatoid arthritis and osteoarthritis.

Risk factors
A number of factors can increase your risk of having knee problems, including:

• Excess weight. Being overweight or obese increases stress on your knee joints, even during ordinary activities such as walking or going up and downstairs. It also puts you at increased risk of osteoarthritis by accelerating the breakdown of joint cartilage.

• Lack of muscle flexibility or strength. A lack of strength and flexibility can increase the risk of knee injuries. Strong muscles help stabilise and protect your joints, and muscle flexibility can help you achieve full range of motion.

• Certain sports or occupations. Some sports put greater stress on your knees than do others. Alpine skiing with its rigid ski boots and potential for falls, basketball’s jumps, and pivots, and the repeated pounding your knees take when you run, or jog all increase your risk of knee injury. Jobs that require repetitive stress on the knees such as construction or farming also can increase your risk.

• Previous injury. Having a previous knee injury makes it more likely that you will injure your knee again.

Symptoms
The location and severity of knee pain may vary, depending on the cause of the problem. Signs and symptoms that sometimes accompany knee pain include:
• Swelling and stiffness
• Redness and warmth to the touch
• Weakness or instability
• Popping or crunching noises
• Inability to fully straighten the knee

Dealing with knee pain
Treatment for knee pain depends on what is causing it and how uncomfortable it is.

• Mild knee injuries often improve with rest, ice, and anti-inflammatory medications. Wearing a brace can stabilise the knee while it recovers.

• If arthritis is causing knee pain, your treatment may include medication and physical therapy.
• Doctors can usually repair tendon and ligament tears with minimally invasive surgery, if necessary.
• More serious knee pain may require knee replacement surgery.

No matter what caused your knee pain, physical therapy exercises can strengthen the muscles supporting your knee to help relieve discomfort.

How can I ease knee pain at home?
Your doctor or physical therapist can recommend home care to relieve knee pain. These may include:

• Applying heat or ice packs.
• Modifying activities to avoid causing pain.
• Practising gentle stretches or exercises.
• Taking over-the-counter pain relievers such as ibuprofen or acetaminophen.
• Topical treatments such as muscle creams or rubs.
• Wearing a brace to support the knee.

When should you see your doctor?
It is especially important to seek urgent medical attention if you have severe knee pain after a fall or accident, or if your knee is too painful or unstable to support your weight. You should also see your doctor if your knee is swollen, or you cannot extend it all the way. Call your doctor if you have pain that keeps bothering you longer than a few days.

Conclusion
Knee pain is a very common complaint. Knee pain can be caused by a sudden injury, an overuse injury, or by an underlying condition such as arthritis. Treatment will vary depending on the cause. Symptoms of knee injury can include pain, swelling, and stiffness. Many cases can be managed at home, but if symptoms persist you should seek medical attention. Not all knee pain is serious, but some knee injuries and medical conditions, such as osteoarthritis, can lead to increasing pain, joint damage and disability if left untreated.

Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.

Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).